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<1>
Accession Number
2032176048
Title
Pericardial fluid troponin in cardiac surgery.
Source
Clinica Chimica Acta. 559 (no pagination), 2024. Article Number: 119722.
Date of Publication: 01 Jun 2024.
Author
Fatehi Hassanabad A.; El-Sherbini A.H.; Cherif I.A.; Ahmad B.; Gonzalez
A.L.F.; Pelletier M.; Fedak P.; El-Diasty M.
Institution
(Fatehi Hassanabad, Fedak) Section of Cardiac Surgery, Department of
Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of
Medicine, University of Calgary, Calgary, AB, Canada
(El-Sherbini, Cherif, El-Diasty) Faculty of Health Sciences, Queen's
University, Kingston, ON, Canada
(Ahmad) School of Medicine, Queen's University, Kingston, ON, Canada
(Gonzalez) Division of Cardiac Surgery, University Hospital, Santiago de
Compostela, Spain
(Pelletier, El-Diasty) Division of Cardiac Surgery, University Hospitals
Cleveland Medical Centre, Cleveland, OH, United States
Publisher
Elsevier B.V.
Abstract
Background and Objective: Pericardial Fluid (PF) is a rich reservoir of
biologically active factors. Due to its proximity to the heart, the
biochemical structure of PF may reflect the pathological changes in the
cardiac interstitial environment. This manuscript aimed to determine
whether the PF level of cardiac troponins changes in patients undergoing
cardiac surgery. Method(s): This scoping review followed the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines. Medline, EMBASE, Cochrane, ClinicalTrials.gov, and
Google Scholar databases were electronically searched for primary studies
using the keywords "pericardial fluid," "troponin," and "cardiac surgery."
The primary outcome of interest was changes in troponin levels within the
PF preoperatively and postoperatively. Secondary outcomes of interest
included comparisons between troponin level changes in the PF compared to
plasma. Result(s): A total of 2901 manuscripts were screened through
a title and abstract stage by two independent blinded reviewers. Of those,
2894 studies were excluded, and the remaining seven studies underwent a
full-text review. Studies were excluded if they did not provide data or
failed to meet inclusion criteria. Ultimately, six articles were included
that discussed cardiac troponin levels within the PF in patients who had
undergone cardiac surgery. Pericardial troponin concentration increased
over time after surgery, and levels were significantly higher in PF
compared to serum. All studies found that the type of operation did not
affect these overall observations. Conclusion(s): Our review of the
literature suggest that the PF level of cardiac troponins increases in
patients undergoing cardiac surgery, irrespective of the procedure type.
However, these changes' exact pattern and clinical significance remain
undefined. Copyright © 2024 The Authors

<2>
Accession Number
2032151775
Title
Mechanical prosthetic valve thrombosis: A literature review of treatment
strategies.
Source
Current Problems in Cardiology. 49(7) (no pagination), 2024. Article
Number: 102628. Date of Publication: July 2024.
Author
Ebrahimi P.; Sattartabar B.; Taheri H.; Soltani P.; Bahiraie P.;
Mousavinezhad S.M.; Gooshvar M.; Kampaktsis P.; Arsanjani R.; Sahebjam M.;
Hosseini K.; Siegel R.J.
Institution
(Ebrahimi, Sattartabar, Soltani, Sahebjam, Hosseini) Tehran Heart Center,
Cardiovascular Diseases Research Institute, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Taheri, Siegel) Cedars-Sinai Smidt Heart Institute, Los Angeles, CA,
United States
(Bahiraie) School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Mousavinezhad, Gooshvar) School of Medicine, Ahvaz Jundishapur University
of Medical Sciences, Ahvaz, Iran, Islamic Republic of
(Kampaktsis) Division of Cardiology, Columbia University Irving Medical
Center, NYC, NY, United States
(Arsanjani) Department of Cardiovascular Medicine, Mayo Clinic, Phoenix,
AZ 85054, United States
Publisher
Elsevier Inc.
Abstract
Mechanical prosthetic valve thrombosis (MPVT) is a common complication of
valvular implantations. This study compared the efficacy and safety of
different treatments for MPVT. A systematic search of electronic databases
identified studies evaluating surgical, anticoagulant, and thrombolytic
therapies. Although several studies of different types have been conducted
to evaluate the efficacy of these treatment strategies the lack of
randomized controlled trials has resulted in the inability to make a
definitive conclusion about the pros and cons of these treatments. Recent
treatments, such as slow and ultraslow infusion of thrombolytics, showed
comparable efficacy and lower complication rates than traditional methods.
Inadequate anticoagulant use is a major risk factor for MPVT, highlighting
the importance of prevention. Treatment selection should be individualized
based on patient factors and available expertise. Overall, slow and
ultraslow infusion of thrombolytics may be a promising treatment option
for MPVT. Copyright © 2024 Elsevier Inc.

<3>
Accession Number
2029808146
Title
Comparison between catheter ablation versus permanent pacemaker
implantation as an initial treatment for tachycardia-bradycardia syndrome
patients: a prospective, randomized trial.
Source
BMC Cardiovascular Disorders. 24(1) (no pagination), 2024. Article Number:
246. Date of Publication: December 2024.
Author
Cho M.S.; Lee J.H.; Nam G.-B.; Hwang K.W.; Cha M.-J.; Kim J.; Choi K.-J.
Institution
(Cho, Nam, Cha, Kim, Choi) Department of Cardiology, Heart Institute, Asan
Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro
43-gil, Songpa-gu, Seoul 05505, South Korea
(Lee) Cardiovascular Center, Seoul National University Bundang Hospital,
Seoul National University College of Medicine, Seongnam, South Korea
(Hwang) Division of Cardiology, Department of Internal Medicine, Pusan
National University Yangsan Hospital, Pusan National University of
Medicine, Yangsan, South Korea
Publisher
BioMed Central Ltd
Abstract
Background: Clinical outcomes after catheter ablation (CA) or pacemaker
(PM) implantation for the tachycardia-bradycardia syndrome (TBS) has not
been evaluated adequately. We tried to compare the efficacy and safety
outcomes of CA and PM implantation as an initial treatment option for TBS
in paroxysmal atrial fibrillation (AF) patients. Method(s):
Sixty-eight patients with paroxysmal AF and TBS (mean 63.7 years, 63.2%
male) were randomized, and received CA (n = 35) or PM (n = 33) as initial
treatments. The primary outcomes were unexpected emergency room visits or
hospitalizations attributed to cardiovascular causes. Result(s): In
the intention-to-treatment analysis, the rates of primary outcomes were
not significantly different between the two groups at the 2-year follow-up
(19.8% vs. 25.9%; hazard ratio (HR) 0.73, 95% confidence interval (CI)
0.25-2.20, P = 0.584), irrespective of whether the results were adjusted
for age (HR 1.12, 95% CI 0.34-3.64, P = 0.852). The 2-year rate of
recurrent AF was significantly lower in the CA group compared to the PM
group (33.9% vs. 56.8%, P = 0.038). Four patients (11.4%) in the CA group
finally received PMs after CA owing to recurrent syncope episodes. The
rate of major or minor procedure related complications was not
significantly different between the two groups. Conclusion(s): CA had
a similar efficacy and safety profile with that of PM and a higher sinus
rhythm maintenance rate. CA could be considered as a preferable initial
treatment option over PM implantation in patients with paroxysmal AF and
TBS. Trial registration: KCT0000155. Copyright © The Author(s)
2024.

<4>
Accession Number
2031106151
Title
Vasoplegic syndrome during heart transplantation: A systematic review and
meta-analysis.
Source
Journal of Heart and Lung Transplantation. 43(6) (pp 931-943), 2024. Date
of Publication: June 2024.
Author
Kumar N.; Fitzsimons M.G.; Iyer M.H.; Essandoh M.; Kumar J.E.; Dalia A.A.;
Osho A.; Sawyer T.R.; Bardia A.
Institution
(Kumar, Fitzsimons, Dalia, Bardia) Department of Anesthesia, Critical
Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical
School, Boston, Massachusetts, United States
(Iyer, Essandoh) Department of Anesthesiology, The Ohio State University
Wexner Medical Center, Columbus, OH, United States
(Kumar) University of Cincinnati College of Medicine, Cincinnati, Ohio,
United States
(Osho) Division of Cardiac Surgery, Department of Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston, Massachusetts, United
States
(Sawyer) Central Michigan University College of Medicine, Mt. Pleasant,
Michigan, United States
Publisher
Elsevier Inc.
Abstract
Background: Vasoplegic syndrome (VS) is a common occurrence during heart
transplantation (HT). It currently lacks a uniform definition between
transplant centers, and its pathophysiology and treatment remain
enigmatic. This systematic review summarizes the available published
clinical data regarding VS during HT. Method(s): We searched
databases for all published reports on VS during HT. Data collected
included the incidence of VS in the HT population, patient and
intraoperative characteristics, and postoperative outcomes.
 Result(s): Twenty-two publications were included in this review. The
prevalence of VS during HT was 28.72% (95% confidence interval: 27.37%,
30.10%). Factors associated with VS included male sex, higher body mass
index, hypothyroidism, pre-HT left ventricular assist device or
venoarterial extracorporeal membrane oxygenation (VA-ECMO), pre-HT calcium
channel blocker or amiodarone usage, longer cardiopulmonary bypass time,
and higher blood product transfusion requirement. Patients who developed
VS were more likely to require postoperative VA-ECMO support, renal
replacement therapy, reoperation for bleeding, longer mechanical
ventilation, and a greater 30-day and 1-year mortality.
 Conclusion(s): The results of our systematic review are an initial
step for providing clinicians with data that can help identify high-risk
patients and avenues for potential risk mitigation. Establishing
guidelines that officially define VS will aid in the precise diagnosis of
these patients during HT and guide treatment. Future studies of treatment
strategies for refractory VS are needed in this high-risk patient
population. Copyright © 2024 International Society for the Heart
and Lung Transplantation

<5>
Accession Number
2029742342
Title
Activated clotting time-guided heparinization during open AAA surgery: a
pilot study.
Source
Pilot and Feasibility Studies. 10(1) (no pagination), 2024. Article
Number: 73. Date of Publication: December 2024.
Author
Roosendaal L.C.; Hoebink M.; Wiersema A.M.; Blankensteijn J.D.; Jongkind
V.
Institution
(Roosendaal, Hoebink, Wiersema, Jongkind) Department of Vascular Surgery,
Dijklander Ziekenhuis, Maelsonstraat 3, Hoorn 1624 NP, Netherlands
(Roosendaal, Hoebink, Wiersema, Blankensteijn, Jongkind) Department of
Vascular Surgery, Amsterdam UMC, Location VUmc, De Boelelaan 1117,
Amsterdam 1081 HV, Netherlands
(Roosendaal, Hoebink, Wiersema, Jongkind) Amsterdam Cardiovascular
Sciences, Microcirculation, Amsterdam, Netherlands
(Blankensteijn) Amsterdam Cardiovascular Sciences, Atherosclerosis & amp;
Ischemic Syndromes, Amsterdam, Netherlands
Publisher
BioMed Central Ltd
Abstract
Background: Arterial thrombo-embolic complications (TEC) are still common
during and after non-cardiac arterial procedures (NCAP). While
unfractionated heparin has been used during NCAP for more than 70 years to
prevent TEC, there is no consensus regarding the optimal dosing strategy.
The aim of this pilot study was to test the effectiveness and feasibility
of an activated clotting time (ACT)-guided heparinization protocol during
open abdominal aortic aneurysm (AAA) surgery, in anticipation of a
randomized controlled trial (RCT) investigating if ACT-guided
heparinization leads to better clinical outcomes compared to a single
bolus of 5000 IU of heparin. Method(s): A prospective multicentre
pilot study was performed. All patients undergoing elective open repair
for an AAA (distal of the superior mesenteric artery) between March 2017
and January 2020 were included. Two heparin dosage protocols were
compared: ACT-guided heparinization with an initial dose of 100 IU/kg
versus a bolus of 5000 IU. The primary outcome was the effectiveness and
feasibility of an ACT-guided heparinization protocol with an initial
heparin dose of 100 IU/kg during open AAA surgery. Bleeding complications,
TEC, and mortality were investigated for safety purposes. Result(s):
A total of 50 patients were included in the current study. Eighteen
patients received a single dose of 5000 IU of heparin and 32 patients
received 100 IU/kg of heparin with additional doses based on the ACT. All
patients who received the 100 IU/kg dosing protocol reached the target ACT
of > 200 s. In the 5000 IU group, TEC occurred in three patients (17%),
versus three patients (9.4%) in the 100 IU/kg group. Bleeding
complications were found in six patients (33%) in the 5000 IU group and in
9 patients (28%) in the 100 IU/kg group. No mortality occurred in either
group. Conclusion(s): This pilot study demonstrated that ACT-guided
heparinization with an initial dose of 100 IU/kg appears to be feasible
and leads to adequate anticoagulation levels. Further randomized studies
seem feasible and warranted to determine whether ACT-guided heparinization
results in better outcomes after open AAA repair. Copyright © The
Author(s) 2024.

<6>
Accession Number
2029564350
Title
Effect of liposomal bupivacaine for preoperative erector spinae plane
block on postoperative pain following video-assisted thoracoscopic lung
surgery: a protocol for a multicenter, randomized, double-blind, clinical
trial.
Source
Frontiers in Medicine. 11 (no pagination), 2024. Article Number: 1359878.
Date of Publication: 2024.
Author
Liao D.; Peng K.; Zhang Y.; Xia Z.; Guo J.; Wei F.; Chen C.; Lv X.; Tong
J.; Li X.; Qu X.; Wang X.; Wang Y.; Ou S.; Liu H.; Shan X.; Ji F.
Institution
(Liao, Peng, Zhang, Liu, Shan, Ji) Department of Anesthesiology, The First
Affiliated Hospital of Soochow University, Suzhou, China
(Liao, Peng, Zhang, Liu, Shan, Ji) Institute of Anesthesiology, Soochow
University, Suzhou, China
(Liao) Department of Anesthesiology, Tongren People's Hospital, Tongren,
China
(Xia) Department of Anesthesiology, Renmin Hospital of Wuhan University,
Wuhan, China
(Guo) Department of Anesthesiology, The Fourth Affiliated Hospital
Zhejiang University School of Medicine, Yiwu, China
(Wei) Department of Anesthesiology, Yantaishan Hospital, Yantai, China
(Chen) Department of Anesthesiology, The First People's Hospital of
Changzhou, Changzhou, China
(Lv) Department of Anesthesiology, Shanghai Pulmonary Hospital, Shanghai,
China
(Tong) Department of Anesthesiology, The Second Affiliated Hospital of
Nanjing Medical University, Nanjing, China
(Li) Department of Anesthesiology, Lianshui County People's Hospital,
Huaian, China
(Qu) Department of Anesthesiology, Taizhou Municipal Hospital, Taizhou,
China
(Wang) Department of Anesthesiology, The Affiliated Hospital of Southwest
Medical University, Luzhou, China
(Wang) Department of Anesthesiology, Lanzhou University Second Hospital,
Lanzhou, China
(Ou) Department of Anesthesiology, The Fifth Affiliated Hospital of Sun
Yat-sen University, Zhuhai, China
(Liu) Department of Anesthesiology and Pain Medicine, University of
California Davis Health, Sacramento, CA, United States
Publisher
Frontiers Media SA
Abstract
Background: There is still a controversy about the superiority of
liposomal bupivacaine (LB) over traditional local anesthetics in
postoperative analgesia after thoracic surgery. This study aims to
determine the effect of LB versus bupivacaine hydrochloride (HCl) for
preoperative ultrasound-guided erector spinae plane block (ESPB) on
postoperative acute and chronic pain in patients undergoing video-assisted
thoracoscopic lung surgery. Method(s): This multicenter, randomized,
double-blind, controlled trial will include 272 adult patients scheduled
for elective video-assisted thoracoscopic lung surgery. Patients will be
randomly assigned, 1:1 and stratified by site, to the liposomal
bupivacaine (LB) group or the bupivacaine (BUPI) HCl group. All patients
will receive ultrasound-guided ESPB with either LB or bupivacaine HCl
before surgery and patient-controlled intravenous analgesia (PCIA) as
rescue analgesia after surgery. The numeric rating scale (NRS) score will
be assessed after surgery. The primary outcome is the area under the curve
of pain scores at rest for 0-72 h postoperatively. The secondary outcomes
include the total amount of opioid rescue analgesics through 0-72 h
postoperatively, time to the first press on the PCIA device as rescue
analgesia, the area under the curve of pain scores on activity for 0-72 h
postoperatively, NRS scores at rest and on activity at different time
points during the 0-72 h postoperative period, Quality of Recovery 15
scores at 72 h after surgery, and NRS scores on activity on postsurgical
day 14 and postsurgical 3 months. Adverse events after the surgery are
followed up to the postsurgical day 7, including postoperative nausea and
vomiting, fever, constipation, dizziness, headache, insomnia, itching,
prolonged chest tube leakage, new-onset atrial fibrillation, severe
ventricular arrhythmia, deep venous thrombosis, pulmonary embolism,
pulmonary atelectasis, cardiac arrest, ileus, urinary retention,
chylothorax, pneumothorax, and organ failure. Analyzes will be performed
first according to the intention to treat principle and second with the
per-protocol analysis. Discussion(s): We hypothesize that LB for
preoperative ultrasound-guided ESPB would be more effective than
bupivacaine HCl in reducing postoperative pain in video-assisted
thoracoscopic lung surgery. Our results will contribute to the
optimization of postoperative analgesia regimens for patients undergoing
video-assisted thoracoscopic lung surgery. Clinical trial
registration:http://www.chictr.org.cn, identifier
ChiCTR2300074852. Copyright © 2024 Liao, Peng, Zhang, Liu, Xia,
Guo, Wei, Chen, Lv, Tong, Li, Qu, Wang, Wang, Ou, Liu, Shan and Ji.

<7>
Accession Number
644197285
Title
Calcium supplementation for people with overweight or obesity.
Source
Cochrane Database of Systematic Reviews. 2024(5) (no pagination), 2024.
Article Number: CD012268. Date of Publication: 09 May 2024.
Author
Cormick G.; Ciapponi A.; Harbron J.; Perez S.M.; Vazquez P.; Rivo J.;
Metzendorf M.-I.; Althabe F.; Belizan J.M.
Institution
(Cormick, Vazquez, Rivo, Althabe, Belizan) Instituto de Efectividad
Clinica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
(Ciapponi) Argentine Cochrane Centre, Institute for Clinical Effectiveness
and Health Policy (IECS-CONICET), Buenos Aires, Argentina
(Harbron) Research Centre for Health through Physical Activity, Lifestyle
& Sport, Division of Physiological Sciences, Department of Human Biology,
Faculty of Health Sciences, University of Cape Town, Cape Town, South
Africa
(Perez) Universidad de La Matanza, San Justo, Argentina
(Metzendorf) Institute of General Practice, Medical Faculty of the
Heinrich-Heine University, Dusseldorf, Germany
Publisher
John Wiley and Sons Ltd
Abstract
Background: Obesity is a major health problem worldwide as it can lead to
high blood pressure, heart disease, stroke, diabetes, and insulin
resistance. The prevalence of overweight and obesity is increasing
worldwide across different age groups. There is evidence of an inverse
relationship between calcium intake and body weight. The clinical
relevance of a small reduction in body weight has been questioned.
However, at a population level, a small effect could mitigate the observed
global trends. Objective(s): To assess the effects of calcium
supplementation on weight loss in individuals living with overweight or
obesity. Search Method(s): We searched CENTRAL, MEDLINE, Embase,
LILACS (Latin American and Caribbean Health Science Information database),
and two clinical trials registries. The date of the last search of all
databases (except Embase) was 10 May 2023. No language restrictions were
applied. Selection Criteria: We included randomised controlled trials
evaluating the effect of calcium in participants with overweight or
obesity of any age or gender. We excluded studies in participants with
absorption problems. We included studies of any dose with a minimum
duration of two months. We included the following comparisons: calcium
supplementation versus placebo, calcium-fortified food or beverage versus
placebo, or calcium-fortified food or beverage versus
non-calcium-fortified food or beverage. We excluded studies that evaluated
the effect of calcium and vitamin D or mixed minerals compared to placebo.
 Data Collection and Analysis: We used standard methodological
procedures expected by Cochrane. Our primary outcomes were body weight,
health-related quality of life, and adverse events. Our secondary outcomes
were anthropometric measures other than body weight, all-cause mortality,
and morbidity. Main Result(s): We found 18 studies that evaluated the
effect of calcium compared to placebo or control, with a total of 1873
randomised participants (950 participants in the calcium supplementation
groups and 923 in the control groups). All included studies gave oral
calcium supplementation as the intervention. We did not find any studies
evaluating calcium-fortified foods. We excluded 38 studies, identified
four ongoing studies, and listed one study as 'awaiting classification'.
Sixteen studies compared calcium supplementation to placebo; two studies
compared different doses of calcium supplementation. Doses ranged from
very low (0.162 g of calcium/day) to high (1.5 g of calcium/day). Most
studies were performed in the USA and Iran, lasted less than six months,
and included only women. Low-certainty evidence suggests that calcium
supplementation compared to placebo or control may result in little to no
difference in body weight (mean difference (MD) -0.15 kg, 95% confidence
interval (CI) -0.55 to 0.24; P = 0.45, I2 = 46%; 17 studies,
1317 participants; low-certainty evidence). We downgraded the certainty of
the evidence by two levels for risk of bias and heterogeneity. None of the
included studies reported health-related quality of life, all-cause
mortality, or morbidity/complications as outcomes. Only five studies
assessed or reported adverse events. Low-certainty evidence suggests a low
frequency of adverse events, with no clear difference between intervention
and control groups. Moderate-certainty evidence shows that calcium
supplementation compared to placebo or control probably results in a small
reduction in body mass index (BMI) (MD -0.18 kg/m2,95% CI -0.22
to -0.13; P < 0.001, I2 = 0%; 9 studies, 731 participants) and
waist circumference (MD -0.51 cm, 95% CI -0.72 to -0.29; P < 0.001,
I2 = 0%; 6 studies, 273 participants). Low-certainty evidence
suggests that calcium supplementation compared to placebo or control may
result in a small reduction in body fat mass (MD -0.34 kg, 95% CI -0.73 to
0.05; P < 0.001, I2 = 97%; 12 studies, 812 participants).
Authors' conclusions: Calcium supplementation for eight weeks to 24 months
may result in little to no difference in body weight in people with
overweight or obesity. The current evidence is of low certainty, due to
concerns regarding risk of bias and statistical heterogeneity. We found
that the degree of heterogeneity might be partly explained by calcium
dosage, the presence or absence of a co-intervention, and whether an
intention-to-treat analysis was pursued. While our analyses suggest that
calcium supplementation may result in a small reduction in BMI, waist
circumference, and fat mass, this evidence is of low to moderate
certainty. Future studies could investigate the effect of calcium
supplementation on lean body mass to explore if there is a change in body
composition. Copyright © 2024 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<8>
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Accession Number
2031926455
Title
The effects of common-sense model interventions on cancer patients: A
systematic review.
Source
Medicine (United States). 103(17) (pp E37777), 2024. Date of Publication:
26 Apr 2024.
Author
Gu X.; Shen X.; Zhou J.-R.; Chu J.-H.; Jiang L.
Institution
(Gu, Shen, Zhou) Wuxi School of Medicine, Jiangnan University, Wuxi, China
(Chu) Department of Cardiothoracic Surgery, Affiliated Hospital of
Jiangnan University, Wuxi, China
(Jiang) Department of Radiology, Huadong Sanatorium, Wuxi, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: From the time of new diagnosis to treatment, cancer patients
experience a variety of health problems that can affect the patient's
health outcomes. Individuals with cancer are being given increasing
responsibility for the self-management of their health and illness. The
self-regulating common-sense model (CSM) is effective in patients' disease
management. This article briefly introduces the common-sense model
intervention, in which patients with cancer are affected by these
interventions, what they are about, and what effects they have.
 Method(s): The authors systematically review evidence for the
common-sense model of self-regulation for cancer using Preferred Reporting
Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Based
on a comprehensive literature search, we searched the Cochrane Library,
PsycINFO, Embase, PubMed, Medline, CINAHL, CNKI, and WanFang databases.
The included studies underwent a quality assessment using the Effective
Public Health Practice Project (EPHPP). Result(s): Eleven empirical
studies illustrated the aspects of common-sense model interventions for
cancer patients. It is concluded that common-sense model intervention has
an effect on symptoms in cancer treatment, behavior, and quality of life,
but more studies are needed to verify the use of common-sense model
intervention to explore in patients with different cancers. The systematic
review summarized a four-point paradigm about intervention content,
including assessing the current situation, setting goals, having a disease
education and psychological adjustment, and getting feedback for further
response. However, the application of intervention requires specific
analysis of patient behavior and outcomes. Conclusion(s):
Common-sense model interventions are beneficial for the self-management of
cancer patients; however, more intervention studies are needed to specify
the cognitive, emotional, and coping styles of people with a particular
cancer. Copyright © 2024 Lippincott Williams and Wilkins. All
rights reserved.

<9>
[Use Link to view the full text]
Accession Number
2032151598
Title
Low-Dose Rivaroxaban Plus Aspirin in Patients with Peripheral Artery
Disease Undergoing Lower Extremity Revascularization with and Without
Concomitant Coronary Artery Disease: Insights from VOYAGER PAD.
Source
Circulation. 149(19) (pp 1536-1539), 2024. Date of Publication: 07 May
2024.
Author
Morrison J.T.; Canonico M.E.; Anand S.S.; Patel M.R.; Debus E.S.; Nehler
M.R.; Hess C.N.; Hsia J.; Capell W.H.; Muehlhofer E.; Haskell L.P.;
Berkowitz S.D.; Bauersachs R.M.; Bonaca M.P.
Institution
(Morrison, Canonico, Nehler, Hess, Hsia, Capell, Berkowitz, Bonaca)
Colorado Prevention Center Clinical Research, Aurora, CO, United States
(Morrison, Canonico, Nehler, Hess, Hsia, Capell, Berkowitz, Bonaca)
Division of Cardiology, University of Colorado, School of Medicine,
Aurora, United States
(Capell) Division of Endocrinology, University of Colorado, School of
Medicine, Aurora, United States
(Berkowitz) Division of Hematology, University of Colorado, School of
Medicine, Aurora, United States
(Bauersachs) Department of Medicine, Department of Surgery, University of
Colorado, School of Medicine, Aurora, United States
(Anand) Population Health Research Institute, Hamilton Health Sciences,
Department of Medicine, McMaster University, Canada
(Patel) Duke Clinical Research Institute, Division of Cardiology, Duke
University, Medical Center, Durham, NC, United States
(Debus) Department of Vascular Medicine, Vascular
Surgery-Angiology-Endovascular Therapy, University of Hamburg-Eppendorf,
Germany
(Muehlhofer) Bayer AG Research and Development, Pharmaceuticals,
Wuppertal, Germany
(Haskell) Janssen Research and Development, Raritan, NJ, United States
(Bauersachs) Cardioangiologic Center, Agaplesion Bethanien Hospital,
Frankfurt am Main, Germany
(Haskell) Center for Thrombosis and Hemostasis, University of Mainz,
Germany
Publisher
Lippincott Williams and Wilkins

<10>
Accession Number
2032150651
Title
Current spectrum and outcomes of infarct-related cardiogenic shock:
insights from the CULPRIT-SHOCK registry and randomized controlled trial.
Source
European Heart Journal: Acute Cardiovascular Care. 13(4) (pp 335-346),
2024. Date of Publication: 01 Apr 2024.
Author
Zeymer U.; Heer T.; Ouarrak T.; Akin I.; Noc M.; Stepinska J.; Oldroyd K.;
Serpytis P.; Montalescot G.; Huber K.; Windecker S.; Savonitto S.; Vrints
C.; Schneider S.; Desch S.; Thiele H.
Institution
(Zeymer) Department of Cardiology, Klinikum der Stadt Ludwigshafen am
Rhein, Bremserstrase 79, Ludwigshafen 67063, Germany
(Zeymer, Ouarrak, Schneider) Stiftung Institut fur Herzinfarktforschung,
Bremserstrase 79, Ludwigshafen 67063, Germany
(Heer) Department of Cardiology, Munchen Klinik Neuperlach, Academic
Teaching Hospital, LMU University of Munich, Oskar-Maria-Graf-Ring 51,
Munich 81737, Germany
(Akin) Department of Cardiology, Universitatsmedizin Mannheim, Mannheim,
Germany
(Noc) Department of Cardiology, University Medical Center Ljubljana,
Ljubljana, Slovenia
(Stepinska) Department of Cardiology, Institute of Cardiology, Warsaw,
Poland
(Oldroyd) Department of Cardiology, Golden Jubilee National Hospital,
Glasgow, United Kingdom
(Serpytis) Department of Cardiology, Vilnius University Hospital Santaros
Klinikos, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
(Montalescot) Department of Cardiology, ACTION Study Group, Sorbonne
Universite Paris 6, Centre Hospitalier Universitaire Pitie-Salpetriere,
Paris, France
(Huber) Department of Cardiology, Wilhelminenspital, Vienna, Austria
(Huber) Department of Cardiology, Medical School, Sigmund Freud
University, Vienna, Austria
(Windecker) Department of Cardiology, University of Bern, Inselspital,
Bern, Switzerland
(Savonitto) Department of Cardiology, Manzoni Hospital, Lecco, Italy
(Vrints) Department of Cardiology, Universitair Ziekenhuis Antwerp,
Antwerp, Belgium
(Desch, Thiele) Department of Cardiology, Heart Center Leipzig, University
Hospital, Leipzig, Germany
Publisher
Oxford University Press
Abstract
Aims We analysed consecutive patients with acute myocardial
infarction complicated by cardiogenic shock (CS) who were enrolled into
the CULPRIT-SHOCK randomized controlled trial (RCT) and those with
exclusion criteria who were included into the accompanying registry. . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. Methods In total, 1075 patients with infarct-related CS were
screened for CULPRIT-SHOCK in 83 specialized centres in Europe; 369 and
results of them had exclusion criteria for the RCT and were
enrolled into the registry. Patients were followed over 1 year. The mean
age was 68 years and 260 (25%) were women. 13.5%, 30.9%, and 55.6% had
one-vessel, two-vessel, and three-vessel coronary artery disease (CAD),
respectively. Significant left main (LM) coronary artery stenosis was
present in 8.0%. 54.2% of the patients had cardiac arrest before
admission. Thrombolysis in myocardial infarction (TIMI) 3 patency of the
infarct vessel after percutaneous coronary intervention was achieved in
83.6% of all patients. Mechanical circulatory support was applied in
one-third of patients. Total mortality after 30 days and 1 year was 47.6%
and 52.9%. Mortality after 1 year was highest in patients with LM coronary
artery stenosis (63.5%), followed by three-vessel (56.6%), two-vessel
(49.8%), and one-vessel CAD (38.6%), respectively. Mechanical
complications were rare (21/1008; 2.1%) but associated with a high
mortality of 66.7% after 1 year. . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . Conclusion In
specialized centres in Europe, short- and long-term mortality of patients
with infarct-related CS treated with an invasive strategy is still high
and mainly depends on the extent of CAD. Therefore, there is still a need
for improvement of care to improve the prognosis of infarct-related CS.
Graphical Abstract Copyright © 2024 Oxford University Press. All
rights reserved.

<11>
Accession Number
2032125083
Title
Can resistance prehabilitation training bring additional benefits in
valvular cardiac surgery? protocol for a randomized controlled trial.
Source
PLoS ONE. 19(5 May) (no pagination), 2024. Article Number: e0303163. Date
of Publication: May 2024.
Author
Montero-Camara J.; Ferrer-Sargues F.J.; Rovira M.J.S.; Cabello A.S.;
Peredo D.C.; Calabuig J.A.M.; Valtuena-Gimeno N.; Sanchez-Sanchez M.L.
Institution
(Montero-Camara, Ferrer-Sargues, Rovira, Valtuena-Gimeno) Deparment of
Nursing and Physiotherapy, Universidad Cardenal Herrera-CEU, CEU
Universities, Alfara del Patriarca, Valencia, Spain
(Rovira, Cabello, Peredo, Calabuig) Hospital Universitario de la Ribera,
Alzira, Valencia, Spain
(Sanchez-Sanchez) Department of Physiotherapy Physiotherapy in Motion,
Multispeciality Research Group (PTinMOTION), University of Valencia,
Valencia, Spain
Publisher
Public Library of Science
Abstract
Introduction Cardiovascular diseases (CVD) are a group of illnesses that
include coronary heart disease, cerebrovascular disease, congenital heart
disease and deep vein thrombosis. Major surgery is often chosen as the
treatment of choice for CVD. The concept of fast-track rehabilitation
after surgery appeared in the 1970s. Participation in these exercise-based
prehabilitation programmes may decrease postoperative complications and
length of hospital stay. The primary aim of the present study is to
evaluate whether the implementation of an additional resistance training
(RT) prehabilitation protocol within cardiac exercises based
prehabilitation can reduce intensive care unit (ICU) length of stay,
postoperative complications and hospital length of stay (LOS). Methods A
protocol of a prospective, parallel, randomised clinical trial includes 96
adult patients diagnosed with valvular pathology and who have been
scheduled for surgery. The participants will be randomly assigned to two
groups of 48. Control group will be treated with ventilatory and
strengthening of respiratory muscles, and aerobic exercise. Experimental
group, in addition, will be treated with RT of peripheral muscles. Both
hospital stay and ICU stay will be assessed as main variables. Other
secondary variables such as exercise capacity, quality of life and
respiratory values will also be assessed. Quantitative variables will be
analysed with a T-Test or ANOVA, or Mann Witney if the distribution is
non-parametric. Results and conclusion This will be the first controlled
clinical study focused on adding strength exercise as an additional
treatment during prehabilitation. The results of this study will focus on
helping to improve rehabilitation and prehabilitation protocols,
considering that it is essential to maintain pulmonary training, as well
as the inclusion of peripheral exercises that help people with heart
disease to be in a better physical condition in order to increase their
participation and sense of quality of life. Copyright © 2024
Montero-Camara 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.

<12>
[Use Link to view the full text]
Accession Number
2032104765
Title
Apolipoprotein A1 Infusions and Cardiovascular Outcomes after Acute
Myocardial Infarction.
Source
New England Journal of Medicine. 390(17) (pp 1560-1571), 2024. Date of
Publication: 02 May 2024.
Author
Gibson C.M.; Duffy D.; Korjian S.; Bahit M.C.; Chi G.; Alexander J.H.;
Lincoff A.M.; Heise M.; Tricoci P.; Deckelbaum L.I.; Mears S.J.; Nicolau
J.C.; Lopes R.D.; Merkely B.; Lewis B.S.; Cornel J.H.; Trebacz J.;
Parkhomenko A.; Libby P.; Sacks F.M.; Povsic T.J.; Bonaca M.; Goodman
S.G.; Bhatt D.L.; Tendera M.; Steg P.G.; Ridker P.M.; Aylward P.;
Kastelein J.J.P.; Bode C.; Mahaffey K.W.; Nicholls S.J.; Pocock S.J.;
Mehran R.; Harrington R.A.
Institution
(Gibson, Korjian, Chi) The Division of Cardiovascular Medicine, Beth
Israel Deaconess Medical Center, Boston, United States
(Libby) The Department of Medicine, Cardiovascular Division, Boston,
United States
(Ridker) The Center for Cardiovascular Disease Prevention, Boston, United
States
(Sacks) Brigham and Women's Hospital, Harvard Medical School, Boston,
United States
(Sacks) The Harvard T.H. Chan School of Public Health, Boston, United
States
(Duffy, Heise, Tricoci, Deckelbaum, Mears) Csl Behring, King of Prussia,
PA, United States
(Bahit) Ineco Neurociencias, Rosario, Argentina
(Alexander, Lopes, Trebacz) Duke Clinical Research Institute, Duke Health,
Durham, NC, United States
(Lincoff) The Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland Clinic Lerner College of Medicine of Case Western Reserve
University, Cleveland, United States
(Nicolau) Instituto Do Coracao, Hospital das Clinicas Hcfmusp, Faculdade
de Medicina, Universidade de Sao Paulo, Brazil
(Lopes) The Brazilian Clinical Research Institute, Sao Paulo, Brazil
(Merkely) The Heart and Vascular Center of Semmelweis University,
Budapest, Hungary
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Cornel) Radboud University Medical Center, Nijmegen and Noordwest
Ziekenhuisgroep, Alkmaar, Netherlands
(Kastelein) The University of Amsterdam Academic Medical Center,
Amsterdam, Netherlands
(Trebacz) Krakowski Szpital Specjalistyczny Im. Jana Paw.a Ii, Krakow,
Poland
(Tendera) The Department of Cardiology and Structural Heart Disease,
School of Medicine in Katowice, Medical University of Silesia, Katowice,
Poland
(Aylward) The National Scientific Center, Kyiv, Ukraine
(Bonaca) The University of Colorado School of Medicine, Anschutz Medical
Campus, Aurora, United States
(Goodman) The Canadian Vigour Centre, University of Alberta, Edmonton,
Canada
(Bhatt) St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
(Mehran) Peter Munk Cardiac Centre, University Health Network, University
of Toronto, Toronto, Canada
(Harrington) Mount Sinai Fuster Heart Hospital, New York, United States
(Steg) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, Weill Cornell Medicine, New York, United
States
(Parkhomenko) Universite Paris-Cite, Inserm Unite 1148, Fact and
Assistance Publique-Hopitaux de Paris, Hopital Bichat, Paris, France
(Nicholls) South Australian Health and Medical Research Institute/SAHMRI,
Adelaide, SA, Australia
(Bode) Victorian Heart Institute, Monash University, Melbourne, VIC,
Australia
(Mahaffey) The Heart Center, Faculty of Medicine, University of Freiburg,
Freiburg, Germany
(Pocock) Stanford Center for Clinical Research, Department of Medicine,
Stanford University School of Medicine, Palo Alto, CA, United States
(Povsic) London School of Hygiene and Tropical Medicine, London, United
Kingdom
Publisher
Massachussetts Medical Society
Abstract
Background Cardiovascular events frequently recur after acute myocardial
infarction, and low cholesterol efflux - a process mediated by
apolipoprotein A1, which is the main protein in high-density lipoprotein -
has been associated with an increased risk of cardiovascular events.
CSL112 is human apolipoprotein A1 derived from plasma that increases
cholesterol efflux capacity. Whether infusions of CSL112 can reduce the
risk of recurrent cardiovascular events after acute myocardial infarction
is unclear. Methods We conducted an international, double-blind,
placebo-controlled trial involving patients with acute myocardial
infarction, multivessel coronary artery disease, and additional
cardiovascular risk factors. Patients were randomly assigned to receive
either four weekly infusions of 6 g of CSL112 or matching placebo, with
the first infusion administered within 5 days after the first medical
contact for the acute myocardial infarction. The primary end point was a
composite of myocardial infarction, stroke, or death from cardiovascular
causes from randomization through 90 days of follow-up. Results A total of
18,219 patients were included in the trial (9112 in the CSL112 group and
9107 in the placebo group). There was no significant difference between
the groups in the risk of a primary end-point event at 90 days of
follow-up (439 patients [4.8%] in the CSL112 group vs. 472 patients [5.2%]
in the placebo group; hazard ratio, 0.93; 95% confidence interval [CI],
0.81 to 1.05; P=0.24), at 180 days of follow-up (622 patients [6.9%] vs.
683 patients [7.6%]; hazard ratio, 0.91; 95% CI, 0.81 to 1.01), or at 365
days of follow-up (885 patients [9.8%] vs. 944 patients [10.5%]; hazard
ratio, 0.93; 95% CI, 0.85 to 1.02). The percentage of patients with
adverse events was similar in the two groups; a higher number of
hypersensitivity events was reported in the CSL112 group. Conclusions
Among patients with acute myocardial infarction, multivessel coronary
artery disease, and additional cardiovascular risk factors, four weekly
infusions of CSL112 did not result in a lower risk of myocardial
infarction, stroke, or death from cardiovascular causes than placebo
through 90 days. (Funded by CSL Behring; AEGIS-II ClinicalTrials.gov
number, NCT03473223.) Copyright © 2024 Massachusetts Medical
Society.

<13>
[Use Link to view the full text]
Accession Number
2032104764
Title
Transcatheter or Surgical Treatment of Aortic-Valve Stenosis.
Source
New England Journal of Medicine. 390(17) (pp 1572-1583), 2024. Date of
Publication: 02 May 2024.
Author
Blankenberg S.; Seiffert M.; Vonthein R.; Baumgartner H.; Bleiziffer S.;
Borger M.A.; Choi Y.-H.; Clemmensen P.; Cremer J.; Czerny M.; Diercks N.;
Eitel I.; Ensminger S.; Frank D.; Frey N.; Hagendorff A.; Hagl C.; Hamm
C.; Kappert U.; Karck M.; Kim W.-K.; Konig I.R.; Krane M.; Landmesser U.;
Linke A.; Maier L.S.; Massberg S.; Neumann F.-J.; Reichenspurner H.;
Rudolph T.K.; Schmid C.; Thiele H.; Twerenbold R.; Walther T.; Westermann
D.; Xhepa E.; Ziegler A.; Falk V.
Institution
(Blankenberg, Seiffert, Clemmensen, Diercks, Twerenbold, Ziegler) The
Department of Cardiology, The Center for Population Health Innovation,
University Heart and Vascular Center Hamburg, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
(Blankenberg, Seiffert, Clemmensen, Cremer, Diercks, Eitel, Frank, Konig,
Reichenspurner, Rudolph) German Center for Cardiovascular Research
(Deutsches Zentrum Fur Herz-Kreislauf-Forschung (DZHK)), Partner Site
Hamburg-Kiel- Lubeck, Hamburg, Germany
(Reichenspurner) The Department of Cardiovascular Surgery, University
Heart and Vascular Center Hamburg, Hamburg, Germany
(Seiffert) The Department of Cardiology and Angiology, Bg University
Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
(Vonthein, Konig) The Institute of Medical Biometry and Statistics,
University of Lubeck, Lubeck, Germany
(Eitel) The Departments of Cardiology, Angiology, and Intensive Care
Medicine, Lubeck, Germany
(Ensminger) Cardiovascular Surgery, University Hospital of
Schleswig-Holstein, Lubeck, Germany
(Baumgartner) The Department of Cardiology III-Adult Congenital and
Valvular Heart Disease, University Hospital Munster, Munster, Germany
(Bleiziffer) The Departments of Thoracic and Cardiovascular Surgery, Bad
Oeynhausen, University Clinic of Cardiac Surgery, Germany
(Rudolph) General and Interventional Cardiology-Angiology, Bad Oeynhausen,
University Clinic of Cardiac Surgery, Germany
(Borger) Heart and Diabetes Center Nrw, Ruhr University Bochum, Bad
Oeynhausen, University Clinic of Cardiac Surgery, Germany
(Thiele) The Department of Internal Medicine, Leipzig, Germany
(Borger) Heart Center Leipzig at Leipzig University, Leipzig, Germany
(Thiele) Leipzig Heart Science, Leipzig, Germany
(Thiele) The Department of Cardiology, University Hospital Leipzig,
Leipzig, Germany
(Hagendorff) Departments of Cardiac Surgery, The Department of Cardiology
and Angiology, University of Giessen and Marburg, Germany
(Choi) Departments of Cardiology (W.-K.K.), The Department of Cardiology
and Angiology, University of Giessen and Marburg, Germany
(Kim) Kerckhoff Clinic, Bad Nauheim, Medical Clinic I, The Department of
Cardiology and Angiology, University of Giessen and Marburg, Germany
(Kim) Campus Kerckhoff and Medical Clinic I, University of Giessen,
Giessen, Germany
(Cremer) The Departments of Cardiovascular Surgery, Germany
(Frank) Internal Medicine Iii, University Hospital of Schleswig- Holstein,
Kiel, Germany
(Czerny) Clinic for Cardiovascular Surgery, University Heart Center
Freiburg-Bad Krozingen, University Clinic Freiburg, The Faculty of
Medicine, Albert Ludwigs University Freiburg, Germany
(Neumann, Westermann) The Department of Cardiology and Angiology,
University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine,
University of Freiburg, Freiburg, Germany
(Frey) The Department of Cardiology, Angiology, and Pneumology, Heidelberg
University Hospital, Heidelberg, Germany
(Frey, Karck) Dzhk Partner Site Heidelberg-Mannheim, University Hospital
Heidelberg, Heidelberg, Germany
(Karck) The Department of Cardiac Surgery, University Hospital Heidelberg,
Heidelberg, Germany
(Hagl) The Departments of Cardiac Surgery, Ludwig Maximilians University
Munich, Dzhk Partner Site Munich Heart Alliance, Germany
(Massberg) The Departments of Cardiology (S.M.), Ludwig Maximilians
University Munich, Dzhk Partner Site Munich Heart Alliance, Germany
(Hagl, Krane, Massberg, Xhepa) University Hospital Munich, Ludwig
Maximilians University Munich, Dzhk Partner Site Munich Heart Alliance,
Germany
(Krane) The Department of Cardiovascular Surgery, Institute Insure, German
Heart Center Munich, School of Medicine and Health, Germany
(Xhepa) The Department of Cardiology, German Heart Center Munich,
Technical University of Munich, Munich, Germany
(Hamm, Kim, Walther) Dzhk Partner Site Rhine-Main, Rhine-Main, Germany
(Kappert) The Departments of Cardiac Surgery, Heart Center Dresden,
University of Technology Dresden, Dresden, Germany
(Linke) Internal Medicine and Cardiology, Heart Center Dresden, University
of Technology Dresden, Dresden, Germany
(Landmesser) The Departments of Cardiology, Angiology, and Intensive Care
Medicine, Berlin, Germany
(Falk) The Departments of Cardiothoracic and Vascular Surgery, Berlin,
Germany
(Landmesser, Falk) Deutsches Herzzentrum der Charite, Charite University
Medicine Berlin, Berlin, Germany
(Landmesser, Falk) Dzhk Partner Site Berlin, Berlin, Germany
(Maier) The Departments of Internal Medicine Ii, University Medical Center
Regensburg, Regensburg, Germany
(Schmid) Cardiothoracic Surgery, University Medical Center Regensburg,
Regensburg, Germany
(Walther) The Department of Cardiac and Vascular Surgery, University
Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main,
Germany
(Krane) The Division of Cardiac Surgery, Department of Surgery, Yale
School of Medicine, New Haven, CT, United States
(Ziegler) Cardio-CARE, Medizincampus Davos, Davos, Switzerland
(Blankenberg) The Department of Health Sciences and Technology, Eth
Zurich, Translational Cardiovascular Technology, Zurich, Switzerland
(Falk) The School of Mathematics, Statistics, and Computer Science,
University of KwaZulu-Natal, Pietermaritzburg, South Africa
Publisher
Massachussetts Medical Society
Abstract
Background Among low-risk patients with severe, symptomatic aortic
stenosis who are eligible for both transcatheter aortic-valve implantation
(TAVI) and surgical aortic-valve replacement (SAVR), data are lacking on
the appropriate treatment strategy in routine clinical practice. Methods
In this randomized noninferiority trial conducted at 38 sites in Germany,
we assigned patients with severe aortic stenosis who were at low or
intermediate surgical risk to undergo either TAVI or SAVR. Percutaneous-
and surgical-valve prostheses were selected according to operator
discretion. The primary outcome was a composite of death from any cause or
fatal or nonfatal stroke at 1 year. Results A total of 1414 patients
underwent randomization (701 to the TAVI group and 713 to the SAVR group).
The mean (+/-SD) age of the patients was 74+/-4 years; 57% were men, and
the median Society of Thoracic Surgeons risk score was 1.8% (low surgical
risk). The Kaplan-Meier estimate of the primary outcome at 1 year was 5.4%
in the TAVI group and 10.0% in the SAVR group (hazard ratio for death or
stroke, 0.53; 95% confidence interval [CI], 0.35 to 0.79; P<0.001 for
noninferiority). The incidence of death from any cause was 2.6% in the
TAVI group and 6.2% in the SAVR group (hazard ratio, 0.43; 95% CI, 0.24 to
0.73); the incidence of stroke was 2.9% and 4.7%, respectively (hazard
ratio, 0.61; 95% CI, 0.35 to 1.06). Procedural complications occurred in
1.5% and 1.0% of patients in the TAVI and SAVR groups, respectively.
Conclusions Among patients with severe aortic stenosis at low or
intermediate surgical risk, TAVI was noninferior to SAVR with respect to
death from any cause or stroke at 1 year. (Funded by the German Center for
Cardiovascular Research and the German Heart Foundation; DEDICATE-DZHK6
ClinicalTrials.gov number, NCT03112980.) Copyright © 2024
Massachusetts Medical Society.

<14>
Accession Number
2032076525
Title
Adenosine as adjunctive therapy in acute coronary syndrome: A
meta-Analysis of randomized controlled trials.
Source
European Heart Journal - Cardiovascular Pharmacotherapy. 9(2) (pp
173-182), 2023. Date of Publication: 01 Mar 2023.
Author
Laborante R.; Bianchini E.; Restivo A.; Ciliberti G.; Galli M.; Vergallo
R.; Rodolico D.; Zito A.; Princi G.; Leone A.M.; Aurigemma C.; Romagnoli
E.; Montone R.A.; Burzotta F.; Trani C.; Crea F.; D'Amario D.
Institution
(Laborante, Bianchini, Restivo, Ciliberti, Galli, Rodolico, Zito, Princi,
Burzotta, Trani, Crea) Department of Cardiovascular and Pulmonary
Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
(Galli) Department of Cardiology, Maria Cecilia Hospital, GVM Care and
Research, Cotignola (RA), Cotignola 48033, Italy
(Vergallo, Leone, Aurigemma, Romagnoli, Montone, Burzotta, Trani, Crea)
Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico
Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
(D'Amario) Department of Translational Medicine, Universita Del Piemonte
Orientale, Padiglione G, L.go Bellini, Novara, NO 28100, Italy
Publisher
Oxford University Press
Abstract
Aims Adenosine has been tested in several randomized controlled trials
(RCTs) to minimize the incidence of coronary microvascular obstruction
(CMVO). The aim of this study was to pool all the RCTs comparing
intracoronary or intravenous adenosine versus placebo in patients with
acute coronary syndrome (ACS) undergoing myocardial revascularization.
Methods and results PubMed and Scopus electronic databases were scanned
for eligible studies up to 5th June 2022. A total of 26 RCTs with 5843
patients were included. Efficacy endpoints were major adverse cardiac
events (MACE), all-cause death, non-fatal myocardial infarction, and heart
failure. Atrioventricular blocks and ventricular fibrillation/sustained
ventricular tachycardia (VF/SVT) were the safety endpoints. Myocardial
blush grade, thrombolysis in myocardial infarction (TIMI) flow grade, left
ventricular ejection fraction (LVEF), infarct size, and ST-segment
resolution were also assessed. Adenosine administration was not associated
with any clinical benefit in terms of MACE, all-cause death, non-fatal
myocardial infarction, and heart failure. However, adenosine was
associated with an increased rate of advanced atrioventricular blocks and
of VF/SVT in studies with total mean ischaemic time >3 h, compared to
placebo. Remarkably, among patients undergoing percutaneous coronary
intervention, adenosine was associated with reduced myocardial blush grade
0-1 and TIMI flow grade 0-2, compared to placebo. Furthermore, adenosine
did not show favourable effects on LVEF and infarct size. Conclusion
Adenosine infusion, as adjunctive therapy in ACS, was associated with an
increased risk of advanced atrioventricular blocks and increased rates of
adenosine-Triggered ventricular arrhythmias in patients with long
ischaemic time, without providing any clinical benefit compared to
placebo. Copyright © The Author(s) 2022.

<15>
Accession Number
2032076521
Title
Safety and efficacy of very low LDL-cholesterol intensive lowering: A
meta-Analysis and meta-regression of randomized trials.
Source
European Heart Journal - Cardiovascular Pharmacotherapy. 9(2) (pp
138-147), 2023. Date of Publication: 01 Mar 2023.
Author
Patti G.; Spinoni E.G.; Grisafi L.; Mehran R.; Mennuni M.
Institution
(Patti, Spinoni, Grisafi) Department of Translational Medicine, University
of Eastern Piedmont, Novara 28100, Italy
(Patti, Mennuni) Division of Cardiology, Maggiore della Carita Hospital,
Novara 28100, Italy
(Mehran) Cardiac Catheterization Laboratory of the Cardiovascular
Institute, Mount Sinai Hospital, New York, NY 10029, United States
Publisher
Oxford University Press
Abstract
Aims We performed a study-level meta-Analysis to provide more robust
evidence on safety of very low LDL-cholesterol (LDL-C) levels. Background
Concerns on the safety of LDL-C values achieved with potent lipid-lowering
therapies have been raised. Methods and results We searched randomized
trials reporting clinical outcomes with intensive lipid-lowering
treatments leading to very low (<40 mg/dL) LDL-C levels vs. a control
group with higher LDL-C levels. Only studies with follow-up duration >= 3
months were considered. Primary endpoint was the incidence of various
safety measures. A total of 10 randomized trials were overall included,
with 38 427 patients being in the very low LDL-C group vs. 70 668 in the
control group. Median follow-up duration was 28.8 months. The incidence of
all safety outcomes was similar in the two groups: non-cardiovascular
death: OR 1.13, 95% CI 0.87-1.45; P = 0.36; any adverse events: OR 1.00,
0.90-1.11, P = 0.94; adverse events leading to drug discontinuation: OR
1.00, 0.87-1.15, P = 0.99; cancer: OR 1.02, 0.95-1.10, P = 0.57;
haemorrhagic stroke OR 0.89, 0.66-1.20, P = 0.44; new-onset diabetes: OR
1.16, 0.91-1.47, P = 0.23; neurocognitive disorders: OR 0.97, 0.91-1.04, P
= 0.41; haepatobiliary disorders: OR 0.99, 0.83-1.18, P = 0.93; muscle
disorders: OR 0.94, 0.77-1.13, P = 0.49; cataract: OR 1.28, 0.78-2.10, P =
0.34. The rates of major adverse cardiovascular events were significantly
lower in the very low LDL-C group: OR 0.82, 0.72-0.94, P = 0.005.
Conclusion This meta-Analysis indicates that very low LDL-C levels on
intensive lipid-lowering treatments are not associated with any adverse
event and maintain a persistent reduction of cardiovascular
events. Copyright © The Author(s) 2022.

<16>
Accession Number
2032076517
Title
Focus on lipid treatment.
Source
European Heart Journal - Cardiovascular Pharmacotherapy. 9(2) (pp
119-120), 2023. Date of Publication: 01 Mar 2023.
Author
Agewall S.
Institution
(Agewall) Institute of Clinical Sciences, University of Oslo, Oslo, Norway
Publisher
Oxford University Press

<17>
Accession Number
2029799687
Title
Urinary L-FABP as an Early Biomarker for Pediatric Acute Kidney Injury
Following Cardiac Surgery with Cardiopulmonary Bypass: A Systematic Review
and Meta-Analysis.
Source
International Journal of Molecular Sciences. 25(9) (no pagination), 2024.
Article Number: 4912. Date of Publication: May 2024.
Author
Wilnes B.; Castello-Branco B.; Branco B.C.; Sanglard A.; Vaz de Castro
P.A.S.; Simoes-e-Silva A.C.
Institution
(Wilnes, Castello-Branco, Branco, Sanglard, Vaz de Castro, Simoes-e-Silva)
Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric
Nephrology, Department of Pediatrics, Faculty of Medicine, Federal
University of Minas Gerais, MG, Belo Horizonte 30130-100, Brazil
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Acute kidney injury (AKI) following surgery with cardiopulmonary bypass
(CPB-AKI) is common in pediatrics. Urinary liver-type fatty acid binding
protein (uL-FABP) increases in some kidney diseases and may indicate
CPB-AKI earlier than current methods. The aim of this systematic review
with meta-analysis was to evaluate the potential role of uL-FABP in the
early diagnosis and prediction of CPB-AKI. Databases Pubmed/MEDLINE,
Scopus, and Web of Science were searched on 12 November 2023, using the
MeSH terms "Children", "CPB", "L-FABP", and "Acute Kidney Injury".
Included papers were revised. AUC values from similar studies were pooled
by meta-analysis, performed using random- and fixed-effect models, with p
< 0.05. Of 508 studies assessed, nine were included, comprising 1658
children, of whom 561 (33.8%) developed CPB-AKI. Significantly higher
uL-FABP levels in AKI versus non-AKI patients first manifested at baseline
to 6 h post-CPB. At 6 h, uL-FABP correlated with CPB duration (r = 0.498,
p = 0.036), postoperative serum creatinine (r = 0.567, p < 0.010), and
length of hospital stay (r = 0.722, p < 0.0001). Importantly, uL-FABP at
baseline (AUC = 0.77, 95% CI: 0.64-0.89, n = 365), 2 h (AUC = 0.71, 95%
CI: 0.52-0.90, n = 509), and 6 h (AUC = 0.76, 95% CI: 0.72-0.80, n = 509)
diagnosed CPB-AKI earlier. Hence, higher uL-FABP levels associate with
worse clinical parameters and may diagnose and predict CPB-AKI
earlier. Copyright © 2024 by the authors.

<18>
Accession Number
2028717994
Title
Stroke reduction by cerebral embolic protection devices in transcatheter
aortic valve implantation: A systematic review and Bayesian meta-analysis.
Source
Heart. (no pagination), 2023. Date of Publication: 2023.
Author
Heuts S.; Gabrio A.; Veenstra L.; Maesen B.; Kats S.; Maessen J.G.; Walton
A.S.; Nanayakkara S.; Lansky A.J.; Van 'T Hof A.W.J.; Vriesendorp P.A.
Institution
(Heuts, Maesen, Kats, Maessen) Cardiothoracic Surgery, Maastricht
University Medical Center+, Maastricht, Netherlands
(Heuts, Maesen, Maessen, Van 'T Hof, Vriesendorp) Cardiovascular Research
Institute Maastricht (CARIM), Maastricht University, Maastricht,
Netherlands
(Gabrio) Methodology and Statistics, Maastricht University, Maastricht,
Netherlands
(Gabrio) Care and Public Health Research Institute (CAPHRI), Maastricht
University, Maastricht, Netherlands
(Veenstra, Van 'T Hof, Vriesendorp) Cardiology, Maastricht University,
Medical Center+, Maastricht, Netherlands
(Veenstra, Van 'T Hof) Cardiology, Zuyderland Medical Center, Heerlen,
Netherlands
(Walton, Nanayakkara) Cardiovascular Medicine, Alfred Hospital, Victoria,
Melbourne, Australia
(Walton, Nanayakkara) Heart Failure Research Group, Baker Heart & Diabetes
Institute, Melbourne, VIC, Australia
(Nanayakkara) Faculty of Medicine Nursing and Health Sciences, Monash
University, Melbourne, VIC, Australia
(Lansky) Yale Cardiovascular Research Group, Yale Medical School, New
Haven, CT, United States
Publisher
BMJ Publishing Group
Abstract
Objectives: The use of cerebral embolic protection (CEP) during
transcatheter aortic valve implantation (TAVI) has been studied in several
randomised trials. We aimed to perform a systematic review and Bayesian
meta-analysis of randomised CEP trials, focusing on a clinically relevant
reduction in disabling stroke. Method(s): A systematic search was
applied to three electronic databases, including trials that randomised
TAVI patients to CEP versus standard treatment. The primary outcome was
the risk of disabling stroke. Outcomes were presented as relative risk
(RR), absolute risk differences (ARDs), numbers needed to treat (NNTs) and
the 95% credible intervals (CrIs). The minimal clinically important
difference was determined at 1.1% ARD, per expert consensus (NNT 91). The
principal Bayesian meta-analysis was performed under a vague prior, and
secondary analyses were performed under two informed literature-based
priors. Result(s): Seven randomised studies were included for
meta-analysis (n=3996: CEP n=2126, control n=1870). Under a vague prior,
the estimated median RR of CEP use for disabling stroke was 0.56 (95% CrI
0.28 to 1.19, derived ARD 0.56% and NNT 179, I2=0%). Although the
estimated posterior probability of any benefit was 94.4%, the probability
of a clinically relevant effect was 0-0.1% under the vague and informed
literature-based priors. Results were robust across multiple sensitivity
analyses. Conclusion(s): There is a high probability of a beneficial
CEP treatment effect, but this is unlikely to be clinically relevant.
These findings suggest that future trials should focus on identifying TAVI
patients with an increased baseline risk of stroke, and on the development
of new generation devices. PROSPERO registration number: CRD42023407006.
 Copyright © Author(s) (or their employer(s)) 2023. No commercial
re-use. See rights and permissions. Published by BMJ.

<19>
Accession Number
2029814887
Title
Extracorporeal life support after surgical repair for acute type a aortic
dissection: A systematic review and meta-analysis.
Source
Perfusion (United Kingdom). (no pagination), 2024. Date of Publication:
2024.
Author
Sa M.P.; Jacquemyn X.; Hess N.; Brown J.A.; Caldonazo T.; Kirov H.; Doenst
T.; Serna-Gallegos D.; Kaczorowski D.; Sultan I.
Institution
(Sa, Hess, Brown, Serna-Gallegos, Kaczorowski, Sultan) Department of
Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United
States
(Sa, Hess, Brown, Serna-Gallegos, Kaczorowski, Sultan) UPMC Heart and
Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh,
PA, United States
(Jacquemyn) Department of Cardiovascular Sciences, KU Leuven, Leuven,
Belgium
(Caldonazo, Kirov, Doenst) Department of Cardiothoracic Surgery, Jena
University Hospital, Jena, Germany
Publisher
SAGE Publications Ltd
Abstract
Background: The use of extracorporeal life support (ECLS) in patients
after surgical repair for acute type A aortic dissection (ATAAD) has not
been well documented. Method(s): We performed a systematic review and
meta-analysis to assess the outcomes of ECLS after surgery for ATAAD with
data published by October 2023 in compliance with the Preferred Reporting
Items for Systematic Reviews and Meta-analyses (PRISMA) and the
Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting
guidelines. The protocol was registered in PROSPERO (CRD42023479955).
 Result(s): Twelve observational studies met our eligibility criteria,
including 280 patients. Mean age was 55.0 years and women represented
25.3% of the overall population. Although the mean preoperative left
ventricle ejection fraction was 59.8%, 60.8% of patients developed left
ventricle failure and 34.0% developed biventricular failure. Coronary
involvement and malperfusion were found in 37.1% and 25.6%, respectively.
Concomitant coronary bypass surgery was performed in 38.5% of patients.
Regarding ECLS, retrograde flow (femoral) was present in 39.9% and central
cannulation was present in 35.4%. In-hospital mortality was 62.8% and
pooled estimate of successful weaning was 50.8%. Neurological
complications, bleeding and renal failure were found in 25.9%, 38.7%, and
65.5%, respectively. Conclusion(s): ECLS after surgical repair for
ATAAD remains associated with high rates of in-hospital death and
complications, but it still represents a chance of survival in critical
situations. ECLS remains a salvage attempt and surgeons should not try to
avoid ECLS at all costs after repairing an ATAAD case. Copyright
© The Author(s) 2024.

<20>
Accession Number
644233869
Title
Transcatheter Aortic Valve Replacement in Low-Surgical Risk Patients: an
updated metanalysis of extended follow-up randomized controlled trials.
Source
The American journal of cardiology. (no pagination), 2024. Date of
Publication: 08 May 2024.
Author
Pietro G.D.; Improta R.; De Filippo O.; Bruno F.; Birtolo L.I.; Tocci M.;
Fabris T.; Saade W.; Colantonio R.; Celli P.; Sardella G.; Esposito G.;
Tarantini G.; Massimo M.; D'Ascenzo F.
Institution
(Pietro, Improta) Department of Clinical, Internal, Anesthesiology and
Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome,
Italy; Department of Medical Science, Division of Cardiology, Molinette
Hospital, Turin University, Italy
(De Filippo, Bruno, D'Ascenzo) Department of Medical Science, Division of
Cardiology, Molinette Hospital, Turin University, Italy
(Birtolo, Tocci, Saade, Colantonio, Sardella, Massimo) Department of
Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I
Hospital, Sapienza University of Rome, Italy
(Fabris, Tarantini) Department of Cardiac, Thoracic and Vascular Sciences
and Public Health, University of Padova, Italy
(Celli) Department of General and Specialistic Surgery "Paride Stefanini",
"Sapienza" University of Rome, Viale del Policlinico 155, Rome 00161,
Italy
(Esposito) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University of Neaples, Italy
Abstract
The long-term safety and effectiveness of transcatheter aortic valve
replacement (TAVR) compared to surgical aortic valve replacement (SAVR) in
low surgical risk has not been evaluated in a pooled analysis. An
electronic database search was conducted for randomized controlled trials
(RCTs) with a maximal 5 years clinical and echocardiographic follow-up
including low surgical risk patients underwent TAVR or SAVR. We calculated
Odds Ratio (OD) and 95% confidence intervals (CIs) using a random-effects
model. Subgroups analysis was performed for PPI and PVLs. Three randomized
controlled trials (RCTs) were included with a total of 2611 low-surgical
risk patients (STS score < 4%). Compared to SAVR, TAVR group had similar
rates of all-cause of mortality (OR 0.94,95%CI 0.65 to 1.37, p value 0.75)
and disabling stroke (OR 0.84, 95%CI 0.52 to 1.36, p value 0.48). No
significant differences were registered in the TAVR group in terms of
major cardiovascular events (OR 0.96, 95%CI 0.67 to 1.38,value 0.83),
myocardial infarction (OR 0.69, 95% CI 0.34 to 1.40, p value 0.31),valve
thrombosis (OR 3.11, 95%CI 0.29 to 33.47, p value 0.35), endocarditis (OR
0.71,95%CI 0.35 to 1.48, p value 0.36), aortic valve reintervention (OR
0.93, 95%CI 0.52 to 1.66, p value 0.80), and rehospitalization (OR 0.80,
95%CI 0.52 to 1.02, p value 0.07) compared to SAVR. However, TAVR patients
had a higher risk of paravalvular leaks (OR 8.21, 95%CI 4.18 to 16.14, p
value < 0.00001), but lower rates of new-onset atrial fibrillation (OR
0.27,95%CI 0.17 to 0.30, p value <0.0001). The rates of permanent
pacemaker implantation were comparable from 1 year up to a maximum of 5
years (OR 1.32, 95%CI 0.88 to 1.97, p value 0.18). Lastly, TAVR had a
greater effective orifice area (0.10 cm2/m2, 95%CI 0.05 to 0.15, p value
0.0001), but similar transvalvular mean gradients (0.60, 95%CI 3.94 to
2.73, p value 0.72). In conclusion, TAVR patients had similar long-term
outcomes compared to SAVR, except for an elevated risk of PVLs in the TAVR
group and increased rates of atrial fibrillation in the SAVR
cohort. Copyright © 2024. Published by Elsevier Inc.

<21>
Accession Number
644233129
Title
Randomized comparison of TAVI valves: The Compare-TAVI trial.
Source
American heart journal. (no pagination), 2024. Date of Publication: 08
May 2024.
Author
Terkelsen C.J.; Thim T.; Freeman P.; Dahl J.S.; Norgaard B.L.; Kim W.-Y.;
Tang M.; Sorensen H.T.; Christiansen E.H.; Nissen H.
Institution
(Terkelsen) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark; Department of Clinical Medicine, Aarhus University Hospital,
Denmark.; The Danish Heart Foundation. Electronic address: chriterk@rm.dk
(Thim, Christiansen) Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark
(Freeman) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
(Dahl, Nissen) Department of Cardiology, Odense University Hospital,
Odense, Denmark
(Norgaard, Kim) Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark; Department of Clinical Medicine, Aarhus University
Hospital, Denmark
(Tang) Department of Cardiothoracic and Vascular Surgery, Aarhus
University Hospital, Aarhus, Denmark
(Sorensen) Department of Clinical Epidemiology, Aarhus University Hospital
and Aarhus University, Aarhus, Denmark
Abstract
INTRODUCTION: Based on technical advancements and clinical evidence,
transcatheter aortic valve implantation (TAVI) has been widely adopted.
New generation TAVI valve platforms are continually being developed.
Ideally, new valves should be superior or at least non-inferior regarding
efficacy and safety, when compared to best-in-practice contemporary TAVI
valves. METHODS AND ANALYSIS: The Compare-TAVI trial (ClinicalTrials.gov
NCT04443023) was launched in 2020, to perform a 1:1 randomized comparison
of new versus contemporary TAVI valves, preferably in all comers.
Consecutive cohorts will be launched with sample sizes depending on the
choice of interim analyses, expected event rates, and chosen superiority
or non-inferiority margins. Enrollment has just been finalized in cohort
B, comparing the Sapien 3/ Sapien 3 Ultra Transcatheter Heart Valve (THV)
series (Edwards Lifesciences, Irvine, California, USA) and the Myval/Myval
Octacor THV series (Meril Life Sciences Pvt. Ltd., Vapi, Gujarat, India)
balloon expandable valves. This non-inferiority study was aimed to include
1062 patients. The 1-year composite safety and efficacy endpoint comprises
death, stroke, moderate-severe aortic regurgitation, and moderate-severe
valve deterioration. Patients will be followed until withdrawal of
consent, death, or completion of 10-year follow-up, whichever comes first.
Secondary endpoints will be monitored at 30 days, 1, 3, 5, and 10 years.
SUMMARY: The Compare-TAVI organization will launch consecutive cohorts
wherein patients scheduled for TAVI are randomized to one of two valves.
The aim is to ensure that the short- and long-term performance and safety
of new valves being introduced is benchmarked against what achieved
bybest-in-practice contemporary valves. Copyright © 2024.
Published by Elsevier Inc.

<22>
Accession Number
644232982
Title
Perioperative Management and Outcomes in Patients Receiving Low-dose
Rivaroxaban and or Aspirin: A Sub-analysis of the COMPASS Trial.
Source
Journal of thrombosis and haemostasis : JTH. (no pagination), 2024. Date
of Publication: 08 May 2024.
Author
Douketis J.D.; Yi Q.; Bhatt D.L.; Muehlhofer E.; Wang M.K.; Connolly S.;
Yusuf S.; Maggioni A.P.; Eikelboom J.W.
Institution
(Douketis) Department of Medicine, McMaster University, Hamilton, ON,
Canada; Thrombosis and Atherosclerosis Research Institute, McMaster
University. Electronic address: jdouket@mcmaster.ca
(Yi) Population Health Research Institute, McMaster University
(Bhatt, Yusuf) Mt. Sinai Fuster Heart Hospital, Icahn School of Medicine
at Mt. Sinai, New York, NY, USA
(Muehlhofer) Bayer AG Research & Development, Wuppertal, Germany
(Wang, Connolly) Department of Medicine, McMaster University, Hamilton,
ON, Canada; Mt. Sinai Fuster Heart Hospital, Icahn School of Medicine at
Mt. Sinai, New York, NY, USA
(Maggioni) Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
(Eikelboom) Department of Medicine, McMaster University, Hamilton, ON,
Canada; Thrombosis and Atherosclerosis Research Institute, McMaster
University; Population Health Research Institute, McMaster University
Abstract
BACKGROUND: No study has investigated the perioperative management and
clinical outcomes in patients who are receiving rivaroxaban 2.5 mg bid and
ASA 81-100 mg daily. METHOD(S): Sub-analysis of the COMPASS trial to
assess perioperative management and clinical outcomes in patients with
stable coronary or peripheral artery disease who were randomized to
receive rivaroxaban 2.5 mg bid plus ASA 100 mg daily, rivaroxaban 5 mg
bid, or ASA 100 mg daily. Patients studied required a surgery/procedure
during the trial. The study outcomes, which included myocardial
infarction, angina, stroke, acute limb ischemia, bleeding, and death, were
assessed according to treatment allocation. RESULT(S): There were
2,632 patients studied (mean age, 68 years; 80% male) who had a
surgery/procedure, comprising percutaneous coronary interventions (~43%),
carotid or other arterial angioplasty (~15%), pacemaker or internal
cardiac defibrillator implantation (~9%), and coronary artery bypass graft
surgery (~7%). Perioperative study drug management varied, with about
one-third of patients not interrupting study drug and the remainder
interrupting it between 1 and >=10 days pre-procedure. The incidences of
adverse outcomes across treatment groups were 12.7% to 15.3% for
myocardial ischemia, 0.8% to 1.2% for stroke, 0.1% to 0.2% for venous
thromboembolism, and 3.1% to 4.2% for any bleeding. There was no
statistically significant difference in outcome rates across treatment
groups. CONCLUSION(S): In patients in the COMPASS trial who required
a surgery/procedure, there was no significant difference in perioperative
adverse outcomes whether patients were receiving rivaroxaban 2.5 mg bid
and ASA 100 mg daily, rivaroxaban 5 mg bid or ASA alone. Copyright
© 2024 International Society on Thrombosis and Haemostasis. Published
by Elsevier Inc. All rights reserved.

<23>
Accession Number
2032130254
Title
A review regarding the article 'Local versus General Anaesthesia for
Transcatheter Aortic Valve Implantation (TAVI): A systematic review,
meta-analysis, and trial sequential analysis of randomised and
propensity-score matched studies'.
Source
Current Problems in Cardiology. 49(7) (no pagination), 2024. Article
Number: 102629. Date of Publication: July 2024.
Author
Li H.; Li J.; Huang J.
Institution
(Li, Huang) Department of Anesthesiology, Sichuan Provincial People's
Hospital, School of Medicine, University of Electronic Science and
Technology of China, Sichuan, Chengdu 610072, China
(Li) Department of Anesthesiology, Chengdu Seventh People's Hospital,
Sichuan, Chengdu 610072, China
Publisher
Elsevier Inc.
Abstract
Transcatheter aortic valve implantation (TAVI) is a promising treatment
strategy for high-risk surgical patients, and trials investigating its
effectiveness in intermediate- and lower-risk patients are underway. Data
are inconsistent regarding the superiority of using local anesthesia with
conscious sedation alone versus general anesthesia (GA) as the anesthesia
management of choice for elderly frail patients. Historically, TAVI
procedure is performed under GA with transesophageal echocardiography.
This approach gives operators stable hemodynamic control of the patient
and helps decrease the risk of many of the operation's documented
complications, including paravalvular leak and valve malpositioning.
However, some studies have criticized the dependence of GA on mechanical
ventilation and an increased need for catecholamine and/or vasopressor
agents. Alternatively, to further capitalize on the minimally invasive
nature of TAVI, some authors have advocated for the use of local
anesthesia (LA) and/or conscious sedation approach, which would decrease
procedure time, length of hospital stay, and minimize the need for
postoperative inotropes. Ultimately and at present, the choice of
anesthesia is based on the personal experience and preference of the Heart
Team involved in the TAVI procedure, which will dictate the best possible
management plan for each patient. Many patients currently undergoing TAVI
are elderly and have multiple comorbidities, making their care complex.
Anesthetic care is shifting from GA to sedation and regional block, but
life-threatening complications are still relatively common and safety
during planning and conduct of these procedures by the heart team, with
the anesthesiologist at the center, is paramount. Copyright ©
2024

<24>
Accession Number
2029932692
Title
Comparative Effect of High-Frequency Nasal Cannula and Noninvasive
Ventilation on the Work of Breathing and Postoperative Pulmonary
Complication after Pediatric Congenital Cardiac Surgery: A Prospective
Randomized Controlled Trial.
Source
Annals of Cardiac Anaesthesia. 27(1) (pp 43-50), 2024. Date of
Publication: 2024.
Author
Goel A.; Kumar B.; Negi S.; Mahajan S.; Puri G.D.; Khan W.A.
Institution
(Goel, Kumar, Negi, Puri, Khan) Departments of Anesthesia and Intensive
Care, Postgraduate Institute of Medical Education and Research,
Chandigarh, India
(Mahajan) Cardiothoracic and Vascular Surgery, Postgraduate Institute of
Medical Education and Research, Chandigarh, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Various forms of commonly used noninvasive respiratory support
strategies have considerable effect on diaphragmatic contractile function
which can be evaluated using sonographic diaphragm activity parameters.
 Objective(s): To compare the magnitude of respiratory workload
decreased as assessed by thickening fraction of the diaphragm and
longitudinal diaphragmatic strain while using high-flow nasal cannula
(HFNC) and noninvasive ventilation (NIV) modes [nasal intermittent
positive pressure ventilation (NIPPV) and bilevel positive airway pressure
(BiPAP)] in pediatric patients after cardiothoracic surgery. Methodology:
This prospective randomized controlled trial was performed at a tertiary
care surgical intensive care unit in postcardiac surgery patients aged
between 1 and 48 months, who were randomly allocated into three groups: 1)
HFNC (with flows at 2 L/kg/min), 2) NIPPV via RAMS cannula in PSV mode
(pressure support 8 cmH<inf>2</inf>O, PEEP 5 cmH<inf>2</inf>O), and 3)
BiPAP in nCPAP mode (CPAP of 5 cmH<inf>2</inf>O). Measurements were
recorded at baseline after extubation (R0) and subsequently every 12
hourly (R1, R2, R3, R4, R5) at 12, 24, 36, 48, and 60 hours respectively
until therapy was discontinued. Result(s): Sixty patients were
included, with 20 patients each in the NIPPV group, HFNC group, and BiPAP
group. Longitudinal strain at crura of diaphragm was lower in the BiPAP
group as compared to HFNC group at R2-R4 [R2 (-4.27+/- -2.73 vs - 8.40+/-
-6.40, P = 0.031), R3 (-5.32+/- -2.28 vs -8.44+/- -5.6, P = 0.015), and R4
(-3.8+/- -3.42 vs -12.4+/- -7.12, P = 0.040)]. PFR was higher in HFNC than
NIPPV group at baseline and R1-R3[R0 (323 +/- 114 vs 264 +/- 80, P =
0.008), R1 (311 +/- 114 vs 233 +/- 66, P = 0.022), R2 (328 +/- 116 vs 237
+/- 4, P = 0.002), R3 (346 +/- 112 vs 238 +/- 54, P = 0.001)]. DTF and
clinical parameters of increased work of breathing remain comparable
between three groups. The rate of reintubation (within 48 hours of
extubation or at ICU discharge) was 0.06% (1 in NIPPV, 1 in BiPAP, 2 in
HFNC) and remain comparable between groups (P = 1.0). Conclusion(s):
BiPAP may provide better decrease in work of breathing compared to HFNC as
reflected by lower crural diaphragmatic strain pattern. HFNC may provide
better oxygenation compared to NIPPV group, as reflected by higher PFR
ratio. Failure rate and safety profile are similar among different methods
used. Copyright © 2024 Wolters Kluwer Medknow Publications. All
rights reserved.

<25>
Accession Number
2029932686
Title
Intrathecal Morphine for Cardiac Surgery: A Systematic Review and
Meta-Analysis of Randomized Controlled Trials.
Source
Annals of Cardiac Anaesthesia. 27(1) (pp 3-9), 2024. Date of Publication:
2024.
Author
Ciconini L.E.; Ramos W.A.; Lima Fonseca A.C.; Nooli N.P.; Gosling A.F.
Institution
(Ciconini) SUNY Downstate Health Sciences University, United States
(Ramos) Department of Internal Medicine, University UNINTA-Ceara, Brazil
(Lima Fonseca) Positivo University, Anhembi Morumbi University, Brazil
(Nooli, Gosling) Cardiac Anesthesia and Critical Care Medicine, University
of Alabama, United States
Publisher
Wolters Kluwer Medknow Publications
Abstract
Cardiac surgeries often result in significant postoperative pain, leading
to considerable use of opioids for pain management. However, excessive
opioid use can lead to undesirable side effects and chronic opioid use.
This systematic review and meta-analysis aimed to evaluate whether
preoperative intrathecal morphine could reduce postoperative opioid
consumption in patients undergoing cardiac surgery requiring sternotomy.
We conducted a systematic search of Cochrane, EMBASE, and MEDLINE
databases from inception to May 2022 for randomized controlled trials that
evaluated the use of intrathecal morphine in patients undergoing cardiac
surgery. Studies that evaluated intrathecal administration of other
opioids or combinations of medications were excluded. The primary outcome
was postoperative morphine consumption at 24 h. Secondary outcomes
included time to extubation and hospital length of stay. The final
analysis included ten randomized controlled trials, with a total of 402
patients. The results showed that postoperative morphine consumption at 24
h was significantly lower in the intervention group (standardized mean
difference -1.43 [-2.12, -0.74], 95% CI, P < 0.0001). There were no
significant differences in time to extubation and hospital length of stay.
Our meta-analysis concluded that preoperative intrathecal morphine is
associated with lower postoperative morphine consumption at 24 h following
cardiac surgeries, without prolonging the time to extubation. The use of
preoperative intrathecal morphine can be considered part of a multimodal
analgesic and opioid-sparing strategy in patients undergoing cardiac
surgery. Copyright © 2024 Wolters Kluwer Medknow Publications.
All rights reserved.

<26>
Accession Number
2028517618
Title
Cerebral Embolic Protection in Transcatheter Aortic Valve Implantation
Using the Sentinel Cerebral Protection System: A Systematic Review and
Meta-Analysis.
Source
Cardiology and Therapy. 13(2) (pp 299-314), 2024. Date of Publication:
June 2024.
Author
Harmouch W.; Karnkowska B.; Thakker R.; Rasmussen P.; Shalaby M.; Khalife
W.; Alwash H.; Motiwala A.; Kumfa P.; Gilani S.; Jneid H.; Rangasetty U.
Institution
(Harmouch, Karnkowska, Rasmussen) Department of Internal Medicine,
University of Texas Medical Branch, Galveston, TX, United States
(Thakker, Shalaby, Khalife, Alwash, Motiwala, Kumfa, Gilani, Jneid,
Rangasetty) Division of Cardiovascular Medicine, University of Texas
Medical Branch, Galveston, TX, United States
Publisher
Adis
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) plays a vital
role in patients with symptomatic aortic stenosis. Despite the mortality
benefit of TAVI, embolic stroke remains a feared complication. As a
result, transcatheter cerebral embolic protection (TCEP) devices have been
developed to reduce this risk. Given the ongoing debate of TCEP in TAVI,
we performed a systematic review and meta-analysis of all randomized
controlled trials to date to identify outcomes of periprocedural stroke
using the SentinelTM cerebral protection system (CPS). Method(s):
MEDLINE, Cochrane, and Scopus databases were utilized from inception until
12/2023. PRISMA criteria was utilized. Keywords included "cerebral embolic
protection", "sentinel cerebral protection system", "transcatheter aortic
valve implantation", and "transcatheter aortic valve replacement". Primary
outcome was periprocedural stroke. Secondary outcomes included
periprocedural disabling and non-disabling stroke, all-cause mortality,
transient ischemic attack, delirium, acute kidney injury, vascular
complications, bleeding, and pacemaker implantation. Risk ratios (RR) were
measured via Mantel-Haenszel method with fixed analysis. Heterogeneity was
assessed via chi-squared and Higgin's I2 test. Result(s):
Four trials with 3528 patients were assessed. SAPIEN 3 was the most common
bioprosthetic valve used. The average age was 79.4 years with 41.9% of the
sample size being females. The most prevalent comorbidities were
hypertension, diabetes mellitus, and coronary artery disease. There was no
difference in periprocedural stroke in patients who underwent TAVI with
the SentinelTM CPS compared to no TCEP (RR 0.75, P = 0.12). Periprocedural
disabling strokes were less likely in those who underwent TAVI with the
SentinelTM CPS compared to no TCEP (RR 0.41, P = 0.02) with a number
needed to treat (NNT) of 123. All other outcomes did not reach statistical
significance. Conclusion(s): In our analysis, there was no difference
between TAVI with the SentinelTM CPS compared to TAVI without TCEP in
regard to risk of periprocedural stroke; however, it was associated with a
decreased risk of periprocedural disabling stroke. Copyright ©
The Author(s) 2024.

<27>
Accession Number
2021671524
Title
Ultrafiltration in cardiac surgery: Results of a systematic review and
meta-analysis.
Source
Perfusion (United Kingdom). 39(4) (pp 743-751), 2024. Date of Publication:
May 2024.
Author
Hensley N.B.; Colao J.A.; Zorrilla-Vaca A.; Nanavati J.; Lawton J.S.;
Raphael J.; Mazzeffi M.A.; Wierschke C.; Kostibas M.P.; Cho B.C.; Frank
S.M.; Grant M.C.
Institution
(Hensley, Colao, Kostibas, Cho, Frank, Grant) Department of Anesthesiology
and Critical Care Medicine, Johns Hopkins University School of Medicine,
Baltimore, MD, United States
(Zorrilla-Vaca) Department of Anesthesiology, Perioperative and Pain
Medicine, Brigham and Women's Hospital, Boston, MA, United States
(Nanavati) Welch Medical Library, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
(Lawton) Department of Surgery, Division of Cardiac Surgery, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
(Raphael) Sidney Kimmel Medical College, Department of Anesthesiology,
Thomas Jefferson University Hospitals, Philadelphia, PA, United States
(Mazzeffi) Department of Anesthesiology, George Washington University
Hospital, Washington, DC, United States
(Wierschke) Department of Surgery, Perfusion Division, Johns Hopkins
Hospital, Baltimore, MD, United States
Publisher
SAGE Publications Ltd
Abstract
Background: Ultrafiltration is used with cardiopulmonary bypass to reduce
the effects of hemodilution and restore electrolyte balance. We performed
a systematic review and meta-analysis to analyze the effect of
conventional and modified ultrafiltration on intraoperative blood
transfusion. Method(s): Utilizing the Preferred Reporting Items for
Systematic Reviews and Meta-Analysis (PRISMA) statement, we systematically
searched MEDLINE, EMBASE, Web of Science, and Cochrane Library to perform
a meta-analysis of studies of randomized controlled trials (RCTs) and
observational studies evaluating conventional ultrafiltration (CUF) and
modified ultrafiltration (MUF) on the primary outcome of intraoperative
red cell transfusions. Result(s): A total of 7 RCTs (n = 928) were
included, comparing modified ultrafiltration (n = 473 patients) to
controls (n = 455 patients) and 2 observational studies (n = 47,007),
comparing conventional ultrafiltration (n = 21,748) to controls (n =
25,427). Overall, MUF was associated with transfusion of fewer
intraoperative red cell units per patient (n = 7); MD -0.73 units; 95% CI
-1.12 to -0.35 p = 0.04; p for heterogeneity = 0.0001, I2 =
55%) compared to controls. CUF was no difference in intraoperative red
cell transfusions compared to controls (n = 2); OR 3.09; 95% CI
0.26-36.59; p = 0.37; p for heterogeneity = 0.94, I2 = 0%.
Review of the included observational studies revealed an association
between larger volumes (>2.2 L in a 70 kg patient) of CUF and risk of
acute kidney injury (AKI). Conclusion(s): The results of this
systematic review and meta-analysis suggest that MUF is associated with
fewer intraoperative red cell transfusions. Based on limited studies, CUF
does not appear to be associated with a difference in intraoperative red
cell transfusion. Copyright © The Author(s) 2023.

<28>
Accession Number
2007013479
Title
The effects of monocusp valve implantation and transannular patch
angioplasty on pulmonary regurgitation and right ventricular failure after
total correction of tetralogy of fallot.
Source
Biomedical Research and Therapy. 7(5) (pp 3799-3806), 2020. Date of
Publication: 26 May 2020.
Author
Samadi M.; Khoshfetrat M.; Keykha A.; Javadi S.H.
Institution
(Samadi) Department of Paediatric Cardiology, School of Medicine, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Khoshfetrat) Department of Anaesthesiology and Critical Care,
Khatam-Al-Anbiya Hospital, Zahedan University of Medical Sciences,
Zahedan, Iran, Islamic Republic of
(Keykha) Department of Nursing, School of Nursing and Midwifery, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Javadi) Department of Paediatrics, School of Medicine, Tabriz University
of Medical Sciences, Tabriz, Iran, Islamic Republic of
Publisher
BiomedPress
Abstract
Background: Pulmonary regurgitation (PR) is often known as an acquired
condition after surgical correction of tetralogy of Fallot (TOF).
Therefore, the present study aimed to compare the use of monocusp valve
(MV) implantation and transannular patch (TAP) angioplasty on PR and right
ventricular (RV) failure following surgery to repair TOF. Method(s):
This prospective randomized clinical trial (RCT) was performed on a total
number of 60 patients undergoing reconstructive surgery on TOF. For this
purpose, TAPs without and with monocusp reconstruction were used in Group
I (n = 30 patients) and Group II (n = 30 patients), respectively. Then,
echocardiographic parameters, mortality rates, and clinical data from
pediatric intensive care unit (PICU) were evaluated during a follow-up
period for both groups. Result(s): Out of the 60 patients undergoing
surgery and evaluated, 39 individuals were male (65%) and the rest were
female (n = 21 patients, 35%). No significant difference was observed in
terms of age, body weight, body surface area (BSA), mortality rate, and
ejection fraction (EF) between the two study groups. The findings revealed
that the number of patients with severe PR was higher in the group
receiving TAP angioplasty. Furthermore, the difference between the two
groups with regards to severity of PR was significant (p = 0.012).
 Conclusion(s): It was concluded that MV reconstruction of TOF is
effective in reducing pulmonary artery (PA) and pulmonary valve (PV)
insufficiency. Copyright © 2020 Biomedpress.

<29>
Accession Number
622178514
Title
The significance of perioperative coagulation and fibrinolysis related
parameters after lung surgery for predicting venous thromboembolism: A
prospective, single center study.
Source
Journal of Thoracic Disease. 10(4) (pp 2223-2230), 2018. Date of
Publication: 01 Apr 2018.
Author
Tian B.; Song C.; Li H.; Zhang W.; Chen Q.; Chen S.; Fu Y.; Hu X.; You B.;
Li T.; Hu B.; Hou S.
Institution
(Tian, Song, Li, Zhang, Chen, Chen, Fu, Hu, You, Li, Hu, Hou) Department
of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical
University, Beijing 100020, China
Publisher
AME Publishing Company
Abstract
Background: The high incidence of venous thromboembolism (VTE) has been
perceived in post thoracic surgery patients. However, the significance of
perioperative coagulation and fibrinolysis related parameters after lung
surgery for VTE predicting is not clear. To investigate that, we conducted
a prospective single center study. Method(s): A total of 111 patients
undergoing lung surgery were enrolled in this study, included 52 primary
lung cancer patients and 59 benign lung disease patients from July 2016 to
March 2017. Preoperative and postoperative days 1, 3, and 5 coagulation
and fibrinolysis related parameters were tested, including antithrombin
(AT), fibrinogen degradation product (FDP), prothrombin time (PT),
prothrombin time activity (PA), prothrombin time ratio (PR), international
normalized ratio (INR), activated partial thromboplastin time (APTT),
plasma fibrinogen (FBG), thrombin time (TT) and D-Dimer. The Doppler
ultrasonography was performed before and after surgery for deep venous
thrombosis (DVT) confirmation. Patients with new postoperative DVT,
unexplained dyspnea, hemoptysis, chest pain, or high Caprini score (=9)
were received further computer tomography pulmonary angiography (CTPA) for
pulmonary embolism (PE). We used the area under
receiver-operating-characteristic (ROC) curve to discriminate patients
between those who developed VTE and those who did not. Single factor
analysis was utilized to define risk factors associated with VTE.
 Result(s): The overall incidence of VTE was 16.2% (18/111). The
incidence of VTE in primary lung cancer patients was 23.1% (12/52), much
higher than that in benign lung diseases 10.2% (6/59), but did not reach
statistical significance (P=0.066). Among 18 VTE patients, 83.3% was DVT,
16.7% was DVT + PE and 72.2% was muscular veins of the calf thrombosis.
D-Dimer was much higher in VTE group than that in non-VTE group
preoperatively and at postoperative days 1, 3 (0.64+/-0.24 vs.
0.33+/-0.06, P=0.007; 3.14+/-0.75 vs. 1.51+/-0.09, P=0.005, and
1.88+/-0.53 vs. 0.76+/-0.05, P=0.001, respectively). And the ROC curve
areas of preoperative and postoperative days 1, 3 of D-Dimer were 0.70,
0.71 and 0.74, respectively. And FDP was much higher in VTE group than
that in non-VTE group at postoperative day 3 (6.78+/-1.43 vs. 3.79+/-0.15,
P=0.004). But AT, PT, PA, PR, INR, APTT, FBG and TT there were no
significantly difference. Conclusion(s): The overall incidence of VTE
after lung surgery was 16.2%. The patients with preoperative high D-Dimer
should receive VTE prophylaxis. Copyright © Journal of Thoracic
Disease.

<30>
Accession Number
2028769439
Title
Serum creatinine is an unreliable marker of renal function in patients
undergoing heart transplantation.
Source
Acta Anaesthesiologica Scandinavica. 68(5) (pp 619-625), 2024. Date of
Publication: May 2024.
Author
Tholen M.; Lannemyr L.; Moller-Sorensen H.; Ricksten S.-E.
Institution
(Tholen, Lannemyr, Ricksten) Department of Anesthesiology and Intensive
Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy,
University of Gothenburg, Gothenburg, Sweden
(Moller-Sorensen) Department of Cardiothoracic Anesthesiology,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Publisher
John Wiley and Sons Inc
Abstract
Background: Renal dysfunction is a common complication after heart
transplantation (Htx). Glomerular filtration rate (GFR) can be assessed by
various estimating equations (eGFR). We evaluated the correlation,
agreement, and accuracy between eGFR and mGFR and the ability of eGFR to
track changes in mGFR early after Htx. Method(s): A single-center
prospective observational study on 55 patients undergoing Htx. Serum
creatinine and mGFR (plasma clearance of Cr51-EDTA or iohexol)
were measured preoperatively and on the fourth postoperative day. The
accuracy of eGFR to predict true mGFR was calculated as the percentage of
patients with an eGFR within 30% of mGFR (P30). The agreement between eGFR
and mGFR was assessed according to Bland and Altman. A four-quadrant plot
was made to evaluate the ability of eGFR to track changes in mGFR.
 Result(s): The accuracy of eGFR to assess mGFR was 52%. The bias was
11.2 +/- 17.4 mL/min/1.72 m2. The limits of agreement were
-23.0 to 45.4 mL/min/1.72 m2 and the error 58%. The concordance
rate between eGFR and mGFR was 72%. Conclusion(s): eGFR
underestimated mGFR and the agreement between eGFR and mGFR was low with
an unacceptably large between-group error and low accuracy. Furthermore,
the ability of eGFR to assess changes in mGFR, postoperatively, was poor.
Thus, the use of estimating equations from serum creatinine will not
adequately assess renal function early after major heart surgery. To gain
adequate information on renal function early after Htx, GFR needs to be
measured, not estimated. Copyright © 2024 The Authors. Acta
Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on
behalf of Acta Anaesthesiologica Scandinavica Foundation.

<31>
Accession Number
2028751040
Title
Glycaemic control and macrovascular and microvascular outcomes: A
systematic review and meta-analysis of trials investigating intensive
glucose-lowering strategies in people with type 2 diabetes.
Source
Diabetes, Obesity and Metabolism. 26(6) (pp 2069-2081), 2024. Date of
Publication: June 2024.
Author
Kunutsor S.K.; Balasubramanian V.G.; Zaccardi F.; Gillies C.L.; Aroda
V.R.; Seidu S.; Khunti K.
Institution
(Kunutsor, Zaccardi, Gillies, Seidu, Khunti) Leicester Real World Evidence
Unit, Diabetes Research Centre, University of Leicester, Leicester, United
Kingdom
(Kunutsor, Balasubramanian, Zaccardi, Gillies, Seidu, Khunti) Diabetes
Research Centre, University of Leicester, Leicester, United Kingdom
(Kunutsor, Zaccardi, Gillies, Seidu, Khunti) NIHR Leicester Biomedical
Research Centre, Leicester General Hospital, Leicester, United Kingdom
(Balasubramanian) College of Life Sciences, University of Leicester,
Leicester, United Kingdom
(Aroda) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
Publisher
John Wiley and Sons Inc
Abstract
Aim: We aimed to determine the macrovascular and microvascular outcomes of
intensive versus standard glucose-lowering strategies in type 2 diabetes
(T2D) and investigate the relationships between these outcomes and trial
arm glycated haemoglobin (HbA1c) reduction. Material(s) and
Method(s): In this systematic review and meta-analysis, we identified
relevant trials from MEDLINE, Embase, the Cochrane Library, and
bibliographies up to August 2023. Macrovascular and microvascular
outcomes, along with safety outcomes, were evaluated. Pooled
study-specific hazard ratios (HRs) with 95% confidence intervals (CIs)
were calculated, and meta-regression was employed to analyse the
relationships between outcomes and HbA1c reduction. Result(s): We
included 11 unique RCTs involving 51 469 patients with T2D (intensive
therapy, N = 26 691; standard therapy, N = 24 778). Intensive versus
standard therapy reduced the risk of non-fatal myocardial infarction (MI)
(HR 0.84; 95% CI 0.75-0.94) with no difference in the risk of major
adverse cardiovascular events (HR 0.97; 95% CI 0.92-1.03) and other
adverse cardiovascular outcomes. Intensive versus standard therapy reduced
the risk of retinopathy (HR 0.85; 0.78-0.93), nephropathy (HR 0.71;
0.58-0.87) and composite microvascular outcomes (HR 0.88; 0.77-1.00).
Meta-regression analyses showed modest evidence of inverse linear
relationships between HbA1c reduction and the outcomes of major adverse
cardiovascular events, non-fatal MI, stroke and retinopathy, but these
were not statistically significant. Conclusion(s): In people with
T2D, intensive glucose control was associated with a reduced risk of
non-fatal MI and several microvascular outcomes, particularly retinopathy
and nephropathy. The lack of an effect of intensive glucose-lowering on
most macrovascular outcomes calls for a more comprehensive approach to
managing cardiovascular risk factors alongside glycaemic
control. Copyright © 2024 The Authors. Diabetes, Obesity and
Metabolism published by John Wiley & Sons Ltd.

<32>
Accession Number
2021906013
Title
Optimum heparin dose in off-pump coronary artery bypass grafting: A
systematic review and meta-analysis.
Source
Perfusion (United Kingdom). 39(4) (pp 675-683), 2024. Date of Publication:
May 2024.
Author
Khalil M.A.; Kaddoura R.; Omar A.S.; Abohamar A.D.; Izham M.
Institution
(Khalil) Anesthesia Department, Faculty of Medicine, Cairo University,
Giza, Egypt
(Kaddoura) Department of Clinical pharmacy, Hamad Medical Corporation,
Doha, Qatar
(Omar) Department of Cardiothoracic Surgery/Cardiac Anesthesia & ICU,
Heart Hospital, Hamad Medical Corporation, Doha, Qatar
(Omar) Department of Critical Care Medicine, Beni-Suef University, Beni
Suef, Egypt
(Omar) Weill Cornell Medical College, Ar-Rayyan, Qatar
(Abohamar) Anesthesia Department, Faculty of Medicine, Tanta University,
Tanta, Egypt
(Izham) Faculty of Pharmacy, Qatar University, Doha, Qatar
Publisher
SAGE Publications Ltd
Abstract
Introduction: Off-pump coronary artery bypass grafting (OPCABG) was
introduced many years ago aiming to reduce the known complications of
conventional on-pump coronary surgeries. Heparin is required during the
procedures, but the available protocols have diverse dosage regimens. The
primary objective of this systematic review is to examine the effect of
different heparin doses on the outcomes of OPCABG. Evidence
Acquisition: MEDLINE and EMBASE were searched. Four reviewers identified
eligible clinical trials. Two reviewers extracted data and independently
assessed the risk of bias using Cochrane tool. The primary outcome was the
activated clotting time (ACT) at three minutes. The secondary outcomes
were proportion of patients requiring blood products and the length of
hospital stay. An aggregate data approach was used. Evidence
Synthesis: Three single-center randomized studies recruiting 256 patients
were included. The studies compared low-dose (1.5-2 mg/kg) and high-dose
(3 mg/kg) heparin boluses. The overall mean difference for ACT after three
minutes between low- and high-dose heparin is - 126.16 (95% CI: - 142.19,
- 110.14). The proportion of patients requiring blood products after
surgery [odd ratio 1.27 (95% CI: 0.69, 2.32)] or the overall length of
stay [mean difference -0.15 (95% CI: -0.84, 0.53)] did not differ between
the heparin doses. Conclusion(s): In OPCABG, high-dose compared with
low-dose heparin did not affect the utilization of more blood products or
increased the overall length of stay. Unsurprisingly, ACT values were
higher in the high-dose heparin group. Larger and adequately powered
randomized clinical trials are indicated to resolve the
uncertainty. Copyright © The Author(s) 2023.

<33>
Accession Number
2021698210
Title
Safety outcomes of anti-platelet therapy post coronary artery bypass graft
surgery: A systematic review and network meta-analysis of randomized
control trials.
Source
Perfusion (United Kingdom). 39(4) (pp 684-697), 2024. Date of Publication:
May 2024.
Author
Hasan S.U.; Pervez A.; Shah A.A.; Shah S.D.A.; Aslam M.; Arshad A.; Rajput
A.S.; Zubair M.M.
Institution
(Hasan, Pervez) Aga Khan University, Karachi, Pakistan
(Shah, Shah, Arshad, Rajput) Dow University of Health Sciences, Karachi,
Pakistan
(Aslam) National Institute of Cardiovascular Diseases, Karachi, Pakistan
(Zubair) Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
Publisher
SAGE Publications Ltd
Abstract
Background: Antiplatelet therapy is used to decrease the risk of graft
failure post coronary artery bypass graft surgery. We aimed to compare
dual antiplatelet therapy (DAPT) with monotherapy along with a comparison
of Aspirin, Ticagrelor, Aspirin+Ticagrelor (A+T) and Aspirin+Clopidogrel
(A+C) to determine the major and minor bleeding risk, risk of
postoperative myocardial infarction (MI), stroke, and all-cause mortality
(ACM). Method(s): Randomized Controlled Trials comparing the four
groups were included. Odds ratio (OR) and Absolute Risk (AR) were employed
to assess the mean and standard deviation (SD) with 95% confidence
intervals (CI). The Bayesian random-effects model was used for statistical
analysis. Risk difference and Cochran Q tests were used to calculate rank
probability (RP) and heterogeneity, respectively. Result(s): We
included 10 trials, consisting of 21 arms and 3926 patients. For the risk
of major and minor bleed, A + T and Ticagrelor showed the lowest mean
value of 0.040 (0.043) and 0.067 (0.073), respectively, and the highest RP
of being the safest group. While a direct comparison between DAPT and
monotherapy resulted in an OR of 0.57 [0.34, 0.95] for the risk of minor
bleed. A + T was found to have the highest RP and the lowest mean value in
terms of ACM, MI, and stroke. Conclusion(s): No significant
difference was found between monotherapy or dual-antiplatelet therapy for
the major bleeding risk safety outcome, however DAPT was found to have a
significantly higher rate of minor bleeding complications post-CABG. DAPT
should be considered as the antiplatelet modality of choice
post-CABG. Copyright © The Author(s) 2023.

<34>
Accession Number
2021650995
Title
Efficacy of propofol-supplemented cardioplegia on biomarkers of organ
injury in patients having cardiac surgery using cardiopulmonary bypass: A
protocol for a randomised controlled study (ProMPT2).
Source
Perfusion (United Kingdom). 39(4) (pp 722-732), 2024. Date of Publication:
May 2024.
Author
Heys R.; Angelini G.D.; Joyce K.; Smartt H.; Culliford L.; Maishman R.; de
Jesus S.E.; Emanueli C.; Suleiman M.-S.; Punjabi P.; Rogers C.A.; Gibbison
B.
Institution
(Heys, Joyce, Smartt, Culliford, Maishman, de Jesus, Rogers) Bristol
Trials Centre, Bristol Medical School, University of Bristol, Bristol,
United Kingdom
(Angelini, Suleiman) Bristol Heart Institute, University of Bristol,
Bristol, United Kingdom
(Emanueli, Punjabi) National Heart and Lung Institute, Hammersmith
Hospital, London, United Kingdom
(Gibbison) Department of Anaesthesia, University Hospitals Bristol and
Weston NHS Foundation Trust, Bristol, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Introduction: Cardiac surgery with cardiopulmonary bypass and cardioplegic
arrest is known to be responsible for ischaemia and reperfusion organ
injury. In a previous study, ProMPT, in patients undergoing coronary
artery bypass or aortic valve surgery we demonstrated improved cardiac
protection when supplementing the cardioplegia solution with propofol (6
mcg/ml). The aim of the ProMPT2 study is to determine whether higher
levels of propofol added to the cardioplegia could result in increased
cardiac protection. Methods and Analysis: The ProMPT2 study is a
multi-centre, parallel, three-group, randomised controlled trial in adults
undergoing non-emergency isolated coronary artery bypass graft surgery
with cardiopulmonary bypass. A total of 240 patients will be randomised in
a 1:1:1 ratio to receive either cardioplegia supplementation with high
dose of propofol (12 mcg/ml), low dose of propofol (6 mcg/ml) or placebo
(saline). The primary outcome is myocardial injury, assessed by serial
measurements of myocardial troponin T up to 48 hours after surgery.
Secondary outcomes include biomarkers of renal function (creatinine) and
metabolism (lactate). Ethics and Dissemination: The trial received
research ethics approval from South Central - Berkshire B Research Ethics
Committee and Medicines and Healthcare products Regulatory Agency in
September 2018. Any findings will be shared though peer-reviewed
publications and presented at international and national meetings.
Participants will be informed of results through patient organisations and
newsletters. Trial Registration: ISRCTN15255199. Registered in March
2019. Copyright © The Author(s) 2023.

<35>
[Use Link to view the full text]
Accession Number
2031689702
Title
Renin as a Prognostic Marker in Intensive Care and Perioperative Settings:
A Scoping Review.
Source
Anesthesia and Analgesia. 138(5) (pp 929-936), 2024. Date of Publication:
01 May 2024.
Author
Kotani Y.; Belletti A.; Maiucci G.; Lodovici M.; Fresilli S.; Landoni G.;
Bellomo R.; Zarbock A.
Institution
(Kotani, Belletti, Maiucci, Lodovici, Fresilli, Landoni) Department of
Anesthesia and Intensive Care, IRCCS, San Raffaele Scientific Institute,
Milan, Italy
(Kotani, Landoni) School of Medicine, Vita-Salute San Raffaele University,
Milan, Italy
(Kotani) Department of Intensive Care Medicine, Kameda Medical Center,
Kamogawa, Japan
(Bellomo) Department of Critical Care, The University of Melbourne,
Melbourne, VIC, Australia
(Bellomo) Department of Critical Care, Australian and New Zealand
Intensive Care Research Centre, Monash University, Melbourne, VIC,
Australia
(Zarbock) Department of Anesthesiology, Intensive Care Medicine and Pain
Therapy, University Hospital Muenster, Muenster, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
Serum renin increases in response to sympathetic nerve activation and
hypotension. Recent studies have reported the association of serum renin
levels with adverse clinical outcomes in acute care settings. This scoping
review aimed to systematically review the available literature on renin as
a prognostic marker in intensive care and perioperative patients. We
searched for studies published since inception until March 31, 2023, which
assessed the association between serum renin levels and clinical outcomes
or the effect of synthetic angiotensin II administration on serum renin
levels in critically ill and perioperative patients in PubMed, Embase, and
the Cochrane Library. The primary outcome was mortality at the longest
follow-up; the secondary outcomes were adverse renal outcomes (ie, acute
kidney injury, the need for renal replacement therapy, and major adverse
kidney events), hemodynamic instability, outcomes to angiotensin II
administration, and prognostic performance for mortality when compared
with lactate. Among the 2081 studies identified, we included 16 studies
with 1573 patients (7 studies on shock, 5 on nonspecific critical illness,
2 on cardiac surgery, 1 on noncardiac surgery, and 1 on coronavirus
disease 2019). A significant association between serum renin levels and
poor outcomes was identified in 14 studies, with 10 studies demonstrating
an association with mortality. One post hoc analysis found that
angiotensin II administration reduced mortality in patients with markedly
elevated renin values. Two studies showed that renin was superior to
lactate as a prognostic marker of mortality. Our scoping review showed
that elevated serum renin levels may be associated with clinically
relevant outcomes among various perioperative and intensive care
populations. Increased serum renin levels may identify patients in which
synthetic angiotensin II administration improves clinical outcomes and may
outperform serum lactate in predicting mortality. Copyright ©
2024 Lippincott Williams and Wilkins. All rights reserved.

<36>
[Use Link to view the full text]
Accession Number
2031587722
Title
Clinical guideline on reversal of direct oral anticoagulants in patients
with life threatening bleeding.
Source
European Journal of Anaesthesiology. 41(5) (pp 327-350), 2024. Date of
Publication: 01 May 2024.
Author
Grottke O.; Afshari A.; Ahmed A.; Arnaoutoglou E.; Bolliger D.;
Fenger-Eriksen C.; von Heymann C.
Institution
(Grottke) The Department of Anaesthesiology, RWTH Aachen University
Hospital, Pauwelsstrasse, Aachen, Germany
(Afshari) Department of Paediatric and Obstetric Anaesthesia, Juliane
Marie Centre, Rigshospitalet, Department of Clinical Medicine, Copenhagen
University, Denmark
(Ahmed) Department of Anaesthesia and Critical Care, Glenfield Hospital,
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
(Ahmed) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
(Arnaoutoglou) Department of Anaesthesiology, Larissa University Hospital,
Larissa, Greece
(Bolliger) Clinic for Anaesthesia, Intermediate Care, Prehospital
Emergency Medicine and Pain Therapy, University Hospital Basel,
Spitalstrasse, Basel, Switzerland
(Fenger-Eriksen) Department of Anaesthesiology, Aarhus University
Hospital, Palle Juul-Jensens Boulevard, Aarhus, Denmark
(von Heymann) Department of Anaesthesia, Intensive Care Medicine,
Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain,
Landsberger Allee, Berlin, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND Anticoagulation is essential for the treatment and prevention
of thromboembolic events.Current guidelines recommend direct oral
anticoagulants (DOACs)over vitamin K antagonists in DOAC-eligible
patients. The major complication of anticoagulation is serious or
life-threatening haemorrhage, which may necessitate prompt haemostatic
intervention. Reversal of DOACs may also be required for patients in need
of urgent invasive procedures. This guideline from the European Society of
Anaesthesiology and Intensive Care (ESAIC) aims to provide evidence-based
recommendations and suggestions on how to manage patients on DOACs
undergoing urgent or emergency procedures including the treatment of
DOAC-induced bleeding. DESIGN A systematic literature search was
performed, examining four drug comparators (dabigatran, rivaroxaban,
apixaban, edoxaban) and clinical scenarios ranging from planned to
emergency surgery with the outcomes of mortality, haematoma growth and
thromboembolic complications. The GRADE (Grading of Recommendations,
Assessment, Development and Evaluation) methodology was used to assess the
methodological quality of the included studies. Consensus on the wording
of the recommendations was achieved by a Delphi process. RESULTS So far,
no results from prospective randomised trials comparing two active
comparators (e.g. a direct reversal agent and an unspecific haemostatic
agent such as prothrombin complex concentrate: PCC) have been published
yet and the majority of publications were uncontrolled and observational
studies. Thus, the certainty of evidence was assessed to be either low or
very low (GRADE C). Thirtyfive recommendations and clinical practice
statements weredeveloped. During the Delphi process, strong consensus
(>90% agreement) was achieved in 97.1% of recommendations and consensus
(75 to 90% agreement) in 2.9%. DISCUSSION DOAC-specific coagulation
monitoring may help in patients at risk for elevated DOAC levels, where as
global coagulation tests are not recommended to exclude clinically
relevant DOAC levels. In urgent clinical situations, haemostatic treatment
using either the direct reversal or nonspecific haemostatic agents should
be started without waiting for DOAC level monitoring. DOAC levels above
50ng ml-1 may be considered clinically relevant necessitating haemostatic
treatment before urgent or emergency procedures. Before cardiac surgery
under activated factor Xa (FXa) inhibitors, the use of andexanet alfa is
not recommended because of inhibition of unfractionated heparin, which is
needed for extracorporeal circulation. In the situation of DOAC overdose
without bleeding, no haemostatic intervention is suggested, instead
measures to eliminate the DOACs should be taken. Due to the lack of
published results from comparative prospective, randomised studies, the
superiority of reversal treatment strategy vs. a nonspecific haemostatic
treatment is unclear for most urgent and emergency procedures and
bleeding. Due to the paucity of clinical data, no recommendations for the
use of recombinant activated factor VII as a nonspecific haemostatic agent
can be given. CONCLUSION In the clinical scenarios of DOAC intake before
urgent procedures and DOAC-induced bleeding, practitioners should evaluate
the risk of bleeding of the procedure and the severity of the DOAC-induced
bleeding before initiating treatment. Optimal reversal strategy remains to
be determined in future trials for most clinical settings. Copyright
© 2024 Lippincott Williams and Wilkins. All rights reserved.

<37>
Accession Number
2031226606
Title
Randomized trial of routine versus on-demand intraoperative extracorporeal
membrane oxygenation in lung transplantation: A feasibility study.
Source
Journal of Heart and Lung Transplantation. 43(6) (pp 1005-1009), 2024.
Date of Publication: June 2024.
Author
Nasir B.S.; Weatherald J.; Ramsay T.; Cypel M.; Donahoe L.; Durkin C.;
Schisler T.; Nagendran J.; Liberman M.; Landry C.; Overbeek C.; Moore A.;
Ferraro P.
Institution
(Nasir, Liberman, Ferraro) Division of Thoracic Surgery, Centre
Hospitalier de l'Universite de Montreal (CHUM), Montreal, QC, Canada
(Weatherald) Division of Pulmonary Medicine, Department of Medicine,
University of Alberta and Mazankowski Heart Institute, Edmonton, AB,
Canada
(Ramsay) Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Cypel, Donahoe) Division of Thoracic Surgery, University Health
Networks/Toronto General Hospital (UHN-TGH), Toronto, ON, Canada
(Durkin, Schisler) Department of Anesthesiology, Pharmacology &
Therapeutics, University of British Columbia-Vancouver General Hospital
(UBC-VGH), Vancouver, BC, Canada
(Nagendran) Division of Cardiac Surgery, University of Alberta and
Mazankowski Heart Institute, Edmonton, AB, Canada
(Landry) Centre de Recherche du Centre Hospitalier de l'Universite de
Montreal (CRCHUM), Montreal, QC, Canada
(Overbeek, Moore) Department of Anesthesiology, Centre Hospitalier de
l'Universite de Montreal (CHUM), Montreal, QC, Canada
Publisher
Elsevier Inc.
Abstract
In most centers, extracorporeal membrane oxygenation (ECMO) is the
preferred means to provide cardiopulmonary support during lung
transplantation. However, there is controversy about whether
intraoperative venoarterial (VA) ECMO should be used routinely or
selectively. A randomized controlled trial is the best way to address this
controversy. In this publication, we describe a feasibility study to
assess the practicality of a protocol comparing routine versus selective
VA-ECMO during lung transplantation. This prospective, single-center,
randomized controlled trial screened all patients undergoing lung
transplantation. Exclusion criteria include retransplantation, multiorgan
transplantation, and cases where ECMO is mandatory. We determined that the
trial would be feasible if we could recruit 19 participants over 6 months
with less than 10% protocol violations. Based on the completed feasibility
study, we conclude that the protocol is feasible and safe, giving us the
impetus to pursue a multicenter trial with little risk of failure due to
low recruitment. Copyright © 2024 The Authors

<38>
Accession Number
2032211115
Title
Off-Label Use of Balloon-Expandable Transcatheter Valves to Treat Pure
Aortic Regurgitation.
Source
American Journal of Cardiology. 222 (pp 20-22), 2024. Date of Publication:
01 Jul 2024.
Author
Orzalkiewicz M.; Foroni M.; Chietera F.; Bendandi F.; Mazzapicchi A.;
Bruno A.G.; Ghetti G.; Taglieri N.; Marrozzini C.; Galie N.; Palmerini T.;
Saia F.
Institution
(Orzalkiewicz, Foroni, Chietera, Bendandi, Mazzapicchi, Bruno, Ghetti,
Taglieri, Marrozzini, Galie, Palmerini, Saia) Cardiology Unit, IRCCS
University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
(Galie, Palmerini, Saia) Department of Medical and Surgical Sciences
(DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
Publisher
Elsevier Inc.
Abstract
Transcatheter aortic valve implantation (TAVI) in native pure aortic
regurgitation (AR) with off-label use of balloon-expandable valves (BEV)
has been reported. However, there are scant data regarding optimal
oversizing and its safety, and our study assessed BEV oversizing and
outcomes of TAVI. Thirteen consecutive tricuspid aortic valve patients who
underwent transfemoral TAVIs for pure AR with Sapien BEV at our center
between 2019 and 2023 (69.2% males, mean age 80.8 years, Society of
Thoracic Surgeons 4.0%) were divided into small annulus (SA) group (<=618
mm2) where >=20% oversizing is achievable based on published
data on BEV overexpansion, and larger annulus (LA) group (>618
mm2). Overexpansion and actual oversizing were measured on
postprocedural computed tomography scan. Technical success was 92.3% with
1 valve embolization in the LA group. The postprocedural computed
tomography showed a mean 28.3% oversizing, significantly higher in SA
(31.2%) than in LA group (19.4%), p = 0.0092. Oversizing >=20% was
achieved in 100% SA versus 33.3% LA patients (p = 0.046). In conclusion,
TAVI in pure AR with oversized Sapien BEV showed good procedural and
short-term outcomes when >=20% oversizing was predictably
achievable. Copyright © 2024 Elsevier Inc.

<39>
Accession Number
2032196197
Title
A review regarding the article 'Comparative efficacy and safety of mitral
valve repair versus mitral valve replacement in Rheumatic heart disease: A
high-value care systematic review and meta-analysis'.
Source
Current Problems in Cardiology. 49(7) (no pagination), 2024. Article
Number: 102622. Date of Publication: July 2024.
Author
Luo M.; Yuan D.
Institution
(Luo) Department of Cardiology, West China Hospital of Sichuan University,
West China School of Nursing, Sichuan University, Sichuan, Chengdu 610041,
China
(Yuan) Department of Cardiovascular Surgery, Chengdu Shang Jin Nan Fu
Hospital, West China Hospital of Sichuan University, Sichuan Province,
Chengdu 610041, China
Publisher
Elsevier Inc.
Abstract
Rheumatic heart disease remains a major cause of cardiovascular death
worldwide. Limited real-world nationwide data are available to compare the
long-term outcomes between mitral valve repair and replacement in
rheumatic heart disease. For patients with RHD, MVP is the superior choice
of surgical intervention owing to better long-term survival, reduced
incidence of early mortality and thromboembolic events. However, it
entails higher chances of re-operation at follow-up at four, eight and
twelve years. Although feasible, surgeons may opt for MVR in patients with
a worse prognosis. Whereas degenerative mitral repair for severe MR has
been proven superior to replacement, the optimal operative strategy for
mitral RHD remains unclear. In developing countries, mitral RHD commonly
develops in young patients, predominantly consists of MR rather than MS,
and occurs more frequently than in the United States. In addition, the
predominant MR etiology (rather than MS), relatively early intervention in
the RHD timeline, and variation in Carpentier MR types among developing
world populations further make these rheumatic MVs more amenable to repair
than replacement. Patients should be carefully selected for mitral valve
repair because of its higher reoperation rate, particularly those with
previous percutaneous transvenous mitral commissurotomy. Careful
assessment of anterior leaflet mobility/calcification to determine mitral
repair or replacement was associated with improved outcomes. This
decision-making strategy may alter the threshold for rheumatic mitral
replacement in the current valve-in-valve era. Copyright © 2024

<40>
Accession Number
2032150687
Title
Patient-physician sex concordance and outcomes in cardiovascular disease:
a systematic review.
Source
European Heart Journal. 45(17) (pp 1505-1511), 2024. Date of Publication:
01 May 2024.
Author
Harik L.; Yamamoto K.; Kimura T.; Rong L.Q.; Vogel B.; Mehran R.;
Bairey-Merz C.N.; Gaudino M.
Institution
(Harik, Gaudino) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, 525 E 68th St, New York, NY 10065, United States
(Yamamoto, Kimura) Department of Cardiology, Hirakata Kohsai Hospital,
Osaka, Japan
(Rong) Department of Anesthesiology, Weill Cornell Medicine, New York, NY,
United States
(Vogel, Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Bairey-Merz) Barbara Streisand Women's Heart Center, Smidt Heart
Institute, Cedars-Sinai, Los Angeles, CA, United States
Publisher
Oxford University Press
Abstract
The sex disparity in outcomes of patients with cardiovascular disease is
well-described and has persisted across recent decades. While there have
been several proposed mechanisms to explain this disparity, there are
limited data on female patient-physician sex concordance and its
association with outcomes. The authors review the existing literature on
the relationship between patient-physician sex concordance and clinical
outcomes in patients with cardiovascular disease, the evidence of a
benefit in clinical outcomes with female patient-physician sex
concordance, and the possible drivers of such a benefit and highlight
directions for future study. Copyright © 2024 Oxford University
Press. All rights reserved.

<41>
Accession Number
2032150658
Title
Efficacy and safety of mechanical circulatory support in acute myocardial
infarction complicated by cardiogenic shock: DanGer trial in perspective.
Source
European Heart Journal: Acute Cardiovascular Care. 13(4) (pp 365-367),
2024. Date of Publication: 01 Apr 2024.
Author
Tavazzi G.; Morrow D.A.
Institution
(Tavazzi) Department of Clinical-Surgical, Diagnostic and Pediatric
Sciences, University of Pavia, Via Alessandro Brambilla, 74, PV, Pavia
27100, Italy
(Tavazzi) Intensive Care, Fondazione Policlinico San Matteo Hospital
IRCCS, Viale Camillo Golgi, 19, PV, Pavia 27100, Italy
(Morrow) Levine Cardiac Intensive Care Unit, Cardiovascular Division,
Department of Medicine, Brigham and Women's Hospital, Harvard Medical
School, 60 Fenwood Road, Suite 7022, Boston, MA 02115, United States
Publisher
Oxford University Press

<42>
Accession Number
2029813404
Title
Short-Term Outcomes Analysis Comparing Open, Laparoscopic,
Laparoscopic-Assisted, and Robotic Distal Gastrectomy for Locally Advanced
Gastric Cancer: A Randomized Trials Network Analysis.
Source
Cancers. 16(9) (no pagination), 2024. Article Number: 1620. Date of
Publication: May 2024.
Author
Manara M.; Aiolfi A.; Sozzi A.; Cali M.; Grasso F.; Rausa E.; Bonitta G.;
Bonavina L.; Bona D.
Institution
(Manara, Aiolfi, Sozzi, Cali, Grasso, Rausa, Bonitta, Bona) I.R.C.C.S.
Ospedale Galeazzi-Sant'Ambrogio, Division of General Surgery, Department
of Biomedical Science for Health, University of Milan, Via C. Belgioioso,
Milan 173, 20157, Italy
(Bonavina) Department of Biomedical Sciences for Health, Division of
General and Foregut Surgery, IRCCS Policlinico San Donato, University of
Milan, Milan 20097, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background. Minimally invasive surgery for the treatment of locally
advanced gastric cancer (AGC) is debated. The aim of this study was to
execute a comprehensive assessment of principal surgical treatments for
resectable distal gastric cancer. Methods. Systematic review and
randomized controlled trials (RCTs) network meta-analysis. Open (Op-DG),
laparoscopic-assisted (LapAs-DG), totally laparoscopic (Lap-DG), and
robotic distal gastrectomy (Rob-DG) were compared. Pooled effect-size
measures were the risk ratio (RR), the weighted mean difference (WMD), and
the 95% credible intervals (CrIs). Results. Ten RCTs (3823 patients) were
included. Overall, 1012 (26.5%) underwent Lap-DG, 902 (23.6%) LapAs-DG,
1768 (46.2%) Op-DG, and 141 (3.7%) Rob-DG. Anastomotic leak, severe
complications (Clavien-Dindo > 3), and in-hospital mortality were
comparable. No differences were observed for reoperation rate, pulmonary
complications, postoperative bleeding requiring transfusion, surgical-site
infection, cardiovascular complications, number of harvested lymph nodes,
and tumor-free resection margins. Compared to Op-DG, Lap-DG and LapAs-DG
showed a significantly reduced intraoperative blood loss with a trend
toward shorter time to first flatus and reduced length of stay.
Conclusions. LapAs-DG, Lap-DG, and Rob-DG performed in referral centers by
dedicated surgeons have comparable short-term outcomes to Op-DG for
locally AGC. Copyright © 2024 by the authors.

<43>
Accession Number
2029784489
Title
Transplant Trial Watch.
Source
Transplant International. 37 (no pagination), 2024. Article Number: 13111.
Date of Publication: 2024.
Author
Knight S.R.; O'Callaghan J.M.
Institution
(Knight) Oxford Transplant Centre, Churchill Hospital, Oxford, United
Kingdom
(Knight, O'Callaghan) Centre for Evidence in Transplantation, Nuffield
Department of Surgical Sciences, University of Oxford, Oxford, United
Kingdom
(O'Callaghan) University Hospitals Coventry and Warwickshire, Coventry,
United Kingdom
Publisher
Frontiers Media SA

<44>
Accession Number
2029742674
Title
Induction therapy in heart transplantation: A systematic review and
network meta-analysis for developing evidence-based recommendations.
Source
Clinical Transplantation. 38(5) (no pagination), 2024. Article Number:
e15326. Date of Publication: May 2024.
Author
Kugathasan L.; Rayner D.G.; Wang S.M.; Rodenas-Alesina E.; Orchanian-Cheff
A.; Stehlik J.; Gustafsson F.; Greig D.; McDonald M.; Bertolotti A.M.;
Demas-Clarke P.; Kozuszko S.; Guyatt G.; Foroutan F.; Alba A.C.
Institution
(Kugathasan, Rodenas-Alesina, McDonald, Kozuszko, Foroutan, Alba) Ted
Rogers Centre for Heart Research, University Health Network, Toronto, ON,
Canada
(Rayner, Guyatt, Foroutan) Department of Health Research Methods,
Evidence, and Impact, McMaster, Hamilton, ON, Canada
(Wang) Faculty of Medicine, University of Toronto, Toronto, ON, Canada
(Orchanian-Cheff, Demas-Clarke) Toronto General Hospital, University
Health Network, Toronto, Canada
(Stehlik) Department of Medicine, Division of Cardiovascular Medicine,
University of Utah School of Medicine, Salt Lake City, UT, United States
(Gustafsson) Rigshospitalet - Copenhagen University Hospital, Copenhagen,
Denmark
(Greig) Pontificia Universidad Catolica de Chile, Santiago, Chile
(Bertolotti) Cardiothoracic Surgery Department, Favaloro Foundation
University hospital, Buenos Aires, Argentina
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Induction therapy (IT) utility in heart transplantation (HT)
remains contested. Commissioned by a clinical-practice guidelines panel to
evaluate the effectiveness and safety of IT in adult HT patients, we
conducted this systematic review and network meta-analysis (NMA).
 Method(s): We searched for studies from January 2000 to October 2022,
reporting on the use of any IT agent in adult HT patients. Based on
patient-important outcomes, we performed frequentist NMAs separately for
RCTs and observational studies with adjusted analyses, and assessed the
certainty of evidence using the GRADE framework. Result(s): From 5156
publications identified, we included 7 RCTs and 12 observational studies,
and report on two contemporarily-used IT agents-basiliximab and rATG. The
RCTs provide only very low certainty evidence and was uninformative of the
effect of the two agents versus no IT or one another. With low certainty
in the evidence from observational studies, basiliximab may increase
30-day (OR 1.13; 95% CI 1.06-1.20) and 1-year (OR 1.11; 95% CI 1.02-1.22)
mortality compared to no IT. With low certainty from observational
studies, rATG may decrease 5-year cardiac allograft vasculopathy (OR.82;
95% CI.74-.90) compared to no IT, as well as 30-day (OR.85; 95%
CI.80-.92), 1-year (OR.87; 95% CI.79-.96), and overall (HR.84; 95%
CI.76-.93) mortality compared to basiliximab. Conclusion(s): With low
and very low certainty in the synthetized evidence, these NMAs suggest
possible superiority of rATG compared to basiliximab, but do not provide
compelling evidence for the routine use of these agents in HT
recipients. Copyright © 2024 The Authors. Clinical
Transplantation published by John Wiley & Sons Ltd.

<45>
Accession Number
2029723386
Title
Economic and healthcare resource utilization assessments of PET imaging in
Coronary Artery Disease diagnosis: a systematic review and discussion of
opportunities for future economic evaluations.
Source
Journal of Medical Economics. 27(1) (pp 715-729), 2024. Date of
Publication: 2024.
Author
Ferko N.; Priest S.; Almuallem L.; Walczyk Mooradally A.; Wang D.; Oliva
Ramirez A.; Szabo E.; Cabra A.
Institution
(Ferko, Priest, Almuallem, Walczyk Mooradally, Wang, Oliva Ramirez)
EVERSANA, Burlington, Canada
(Szabo, Cabra) GE HealthCare Inc, Marlborough, MA, United States
Publisher
Taylor and Francis Ltd.
Abstract
Aims: This systematic literature review (SLR) consolidated economic and
healthcare resource utilization (HCRU) evidence for positron emission
tomography (PET) and single-photon emission computed tomography (SPECT)
myocardial perfusion imaging (MPI) to inform future economic evaluations.
 Material(s) and Method(s): An electronic search was conducted in
MEDLINE, Embase, and Cochrane databases from 2012-2022. Economic and HCRU
studies in adults who underwent PET- or SPECT-MPI for coronary artery
disease (CAD) diagnosis were eligible. A qualitative methodological
assessment of existing economic evaluations, HCRU, and downstream cardiac
outcomes was completed. Exploratory meta-analyses of clinical outcomes
were performed. Result(s): The search yielded 13,439 results, with 71
records included. Economic evaluations and comparative clinical trials
were limited in number and outcome types (HCRU, downstream cardiac
outcomes, and diagnostic performance) assessed. No studies included all
outcome types and only one economic evaluation linked diagnostic
performance to HCRU. The meta-analyses of comparative studies demonstrated
significantly higher rates of early- and late-invasive coronary
angiography and revascularization for PET- compared to SPECT-MPI; however,
the rate of repeat testing was lower with PET-MPI. The rate of acute
myocardial infarction was lower, albeit non-significant with PET- vs.
SPECT-MPI. Limitations and conclusions: This SLR identified economic and
HCRU evaluations following PET- and SPECT-MPI for CAD diagnosis and
determined that existing studies do not capture all pertinent outcome
parameters or link diagnostic performance to downstream HCRU and cardiac
outcomes, thus, resulting in simplified assessments of CAD burden. A
limitation of this work relates to heterogeneity in study designs, patient
populations, and follow-up times of existing studies. Resultingly, it was
challenging to pool data in meta-analyses. Overall, this work provides a
foundation for the development of comprehensive economic models for PET-
and SPECT-MPI in CAD diagnosis, which should link diagnostic outcomes to
HCRU and downstream cardiac events to capture the full CAD
scope. Copyright © 2024 GE HealthCare, INC. Published by Informa
UK Limited, trading as Taylor & Francis Group.

<46>
Accession Number
2032076280
Title
ESC/EACTS vs. ACC/AHA guidelines for the management of severe aortic
stenosis.
Source
European Heart Journal. 44(10) (pp 796-812), 2023. Date of Publication: 07
Mar 2023.
Author
Lee G.; Chikwe J.; Milojevic M.; Wijeysundera H.C.; Biondi-Zoccai G.;
Flather M.; Gaudino M.F.L.; Fremes S.E.; Tam D.Y.
Institution
(Lee) Temerty Faculty of Medicine, 1 King's College Circle, Toronto, ON
M5S1A8, Canada
(Chikwe) Department of Cardiac Surgery, Smidt Heart Institute,
Cedars-Sinai Medical Center, 127 San Vicente Blvd a3600, Los Angeles, CA
90048, United States
(Milojevic) Department of Cardiac Surgery and Cardiovascular Research,
Dedinje Cardiovascular Institute, Heroja Milana Tepica 1, Belgrade, Serbia
(Milojevic) Department of Cardiothoracic Surgery, Erasmus University
Medical Centre, Doctor Molewaterplein 40, Rotterdam 3015 GD, Netherlands
(Wijeysundera) Schulich Heart Program, Sunnybrook Health Sciences Centre,
University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
(Biondi-Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Piazzale Aldo Moro, 5, RM,
Roma 00185, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Via Orazio, 2, NA, Napoli
80122, Italy
(Flather) Norwich Medical School, University of East Anglia, Norwich
Research Park, Norwich NR4 7TJ, United Kingdom
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
1300 York Ave, New York, NY, United States
(Fremes) Division of Cardiac Surgery, Schulich Heart Centre, Department of
Surgery, Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, ON, Canada
(Tam) Division of Cardiac Surgery, University of Toronto, 200 Elizabeth
St, Toronto, ON M5G 2C4, Canada
Publisher
Oxford University Press
Abstract
Aortic stenosis (AS) is a serious and complex condition, for which optimal
management continues to evolve rapidly. An understanding of current
clinical practice guidelines is critical to effective patient care and
shared decision-making. This state of the art review of the 2021 European
Society of Cardiology/European Association for Cardio-Thoracic Surgery
Guidelines and 2020 American College of Cardiology/American Heart
Association Guidelines compares their recommendations for AS based on the
evidence to date. The European and American guidelines were generally
congruent with the exception of three key distinctions. First, the
European guidelines recommend intervening at a left ventricular ejection
fraction of 55%, compared with 60% over serial imaging by the American
guidelines for asymptomatic patients. Second, the European guidelines
recommend a threshold of >=65 years for surgical bioprosthesis, whereas
the American guidelines employ multiple age categories, providing latitude
for patient factors and preferences. Third, the guidelines endorse
different age cut-offs for transcatheter vs. surgical aortic valve
replacement, despite limited evidence. This review also discusses trends
indicating a decreasing proportion of mechanical valve replacements.
Finally, the review identifies gaps in the literature for areas including
transcatheter aortic valve implantation in asymptomatic patients, the
appropriateness of Ross procedures, concomitant coronary revascularization
with aortic valve replacement, and bicuspid AS. To summarize, this state
of the art review compares the latest European and American guidelines on
the management of AS to highlight three areas of divergence: timing of
intervention, valve selection, and surgical vs. transcatheter aortic valve
replacement criteria. Copyright © The Author(s) 2023. Published
by Oxford University Press on behalf of the European Society of
Cardiology.

<47>
Accession Number
2031045878
Title
Mitral Regurgitation "Proportionality" in Functional Mitral Regurgitation
and Outcomes After Mitral Valve Transcatheter Edge-to-Edge Repair: A
Systematic Review and Meta-Analysis.
Source
Structural Heart. 8(3) (no pagination), 2024. Article Number: 100284. Date
of Publication: May 2024.
Author
Moonen A.; Cao J.; Celermajer D.S.; Ng M.K.C.
Institution
(Moonen, Cao, Celermajer, Ng) Faculty of Medicine, University of Sydney,
Sydney, NSW, Australia
(Cao) Department of Cardiology, St Vincent's Hospital, Sydney, NSW,
Australia
(Celermajer, Ng) Department of Cardiology, Royal Prince Alfred Hospital,
Sydney, NSW, Australia
(Celermajer, Ng) Heart Research Institute, Sydney, NSW, Australia
Publisher
Cardiovascular Research Foundation
Abstract
Background: Certain patients with functional mitral regurgitation survive
longer with fewer heart failure hospitalizations after undergoing
transcatheter edge-to-edge repair (TEER); however, clinical markers
identifying who will benefit have not been established. The
'proportionality' of mitral regurgitation (MR) severity compared to left
ventricular size has been hypothesized to predict clinical outcome.
 Method(s): We sought to combine existing studies to compare outcomes
between 'proportionate' MR and 'disproportionate' MR in patients
undergoing TEER. PubMed and Medline were searched from January 2018 until
May 2023. Data was extracted and synthesized by 2 independent authors
using random effects models with risk ratios (RRs) for binary outcomes.
The primary outcome was a combined endpoint of all-cause mortality or
heart failure hospitalization (ACM/HFH). Other outcomes of interest
included ACM and residual >2+ MR after TEER. Result(s): Six trials
with a total of 1594 patients (mean age 71 years, 66% male) were included,
which assessed MR proportionality using either a ratio of estimated
regurgitant orifice area to left ventricular end-diastolic volume
(EROA:LVEDV) or regurgitant fraction. Seven hundred and five (mean age 70
years, 75% male) were classified as proportionate MR, and 889 (mean age 72
years, 60% male) had disproportionate MR. There was no significant
association between MR proportionality (by EROA:LVEDV) and ACM (RR 0.79,
95% confidence interval [CI] 0.44-1.42). Proportionality did not
significantly associate with ACM/HFH, though there were divergent effect
signals when proportionality was measured by EROA:LVEDV (RR 0.80, 95% CI
0.45-1.44) or regurgitant fraction (RR 1.48, 95% CI 0.53-4.11).
Disproportionate MR showed a greater association with residual MR > 2+
post-TEER that did not meet statistical significance (RR 1.86, 95% CI
0.77-4.49). Conclusion(s): In patients undergoing TEER for functional
mitral regurgitation, MR proportionality was not significantly associated
with ACM/HFH, all-cause mortality, or residual MR. Copyright ©
2024

<48>
Accession Number
2027811419
Title
Induction chemoimmunotherapy with surgery versus concurrent chemoradiation
followed by immunotherapy for stage III-N2 non-small cell lung cancer.
Source
Journal of Thoracic and Cardiovascular Surgery. 167(6) (pp 1895-1905.e2),
2024. Date of Publication: June 2024.
Author
Kumar A.; Srinivasan D.; Potter A.L.; Mathey-Andrews C.; Lanuti M.; Martin
L.W.; Jeffrey Yang C.-F.
Institution
(Kumar) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Srinivasan, Potter, Mathey-Andrews, Lanuti, Jeffrey Yang) Division of
Thoracic Surgery, Department of Surgery, Massachusetts General Hospital,
Boston, Mass, United States
(Martin) Division of Thoracic and Cardiovascular Surgery, Department of
Surgery, University of Virginia, Charlottesville, VA, United States
Publisher
Elsevier Inc.
Abstract
Objective: Despite the growing relevance of immunotherapy for non-small
cell lung cancer (NSCLC), there is limited consensus on the optimal
treatment strategy for locally advanced NSCLC. This study evaluated the
overall survival of patients with stage III-N2 NSCLC undergoing induction
chemoimmunotherapy with surgery (CT/IO+Surgery) and definitive concurrent
chemoradiation followed by immunotherapy (cCRT+IO). Method(s):
Patients with cT1-3, N2, M0 NSCLC in the National Cancer Database (2013 to
2019) were included and stratified by treatment regimen: CT/IO+Surgery or
cCRT+IO. Overall survival was evaluated using Kaplan-Meier analysis, Cox
proportional hazards modeling, and propensity score matching on 10
prognostic variables. Result(s): Of the 3382 patients who met the
study eligibility criteria, 3289 (97.3%) received cCRT+IO and 93 (2.8%)
received CT/IO+Surgery. The 3-year overall survival of the entire cohort
was 58.2% (95% CI, 56.2% to 60.1%). Multivariable-adjusted Cox
proportional hazards modeling demonstrated better survival after
CT/IO+Surgery than after cCRT+IO (hazard ratio [HR], 0.52; 95% confidence
interval [CI], 0.32 to 0.84; P = .007). In a 3:1 variable ratio propensity
score-matched analysis of 223 patients who received cCRT+IO and 76
patients who received CT/IO+Surgery, 3-year overall survival was 63.2%
(95% CI, 55.9% to 70.2%) after cCRT+IO and 77.2% (95% CI, 64.6% to 85.7%)
after CT/IO+Surgery (P = .029). Conclusion(s): In this national
analysis, multimodal treatment including immunotherapy was associated with
a 3-year overall survival rate of 58.2% for all patients with stage III-N2
NSCLC and 77.2% for patients who underwent chemoimmunotherapy followed by
surgery. These results should be considered hypothesis-generating and
demonstrate the importance of developing a randomized trial to evaluate
the role of surgery versus chemoradiation for locally advanced NSCLC in
the modern immunotherapy era. Copyright © 2023 The American
Association for Thoracic Surgery

<49>
Accession Number
2023893715
Title
Randomized feasibility trial of prophylactic radiofrequency ablation to
prevent atrial fibrillation after cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 167(6) (pp 2129-2135.e1),
2024. Date of Publication: June 2024.
Author
Willekes C.L.; Fanning J.S.; Heiser J.C.; Wai Sang S.L.; Timek T.A.;
Parker J.; Ragagni M.K.
Institution
(Willekes, Fanning, Heiser, Wai Sang, Timek) Department of Cardiothoracic
Surgery, Corewell Health Hospital, Grand Rapids, Mich, United States
(Willekes, Fanning, Heiser, Wai Sang, Timek) College of Human Medicine,
Michigan State University, Grand Rapids, Mich, United States
(Parker) Office of Research and Education, Corewell Health Hospital, Grand
Rapids, Mich, United States
(Ragagni) Department of Cardiovascular Research, Corewell Health Hospital,
Grand Rapids, Mich, United States
Publisher
Elsevier Inc.
Abstract
Objective: To evaluate the feasibility of prophylactic radiofrequency
isolation of the pulmonary veins, with left atrial appendage amputation,
to reduce the incidence of postoperative atrial fibrillation after cardiac
surgery in patients aged 70 years and older. Method(s): The Federal
Food and Drug Administration granted an investigational device exemption
to utilize a bipolar radiofrequency clamp for prophylactic pulmonary vein
isolation in a limited feasibility trial. Sixty-two patients without prior
dysrhythmias were prospectively randomized to undergo either their index
cardiac surgical procedure or bilateral pulmonary vein isolation and left
atrial appendage amputation during their cardiac operation. The primary
outcome was occurrence of in-hospital postoperative atrial fibrillation.
Subjects were on 24-hour telemetry until discharge. Dysrhythmias, any
episode of atrial fibrillation >30 seconds, were confirmed by
electrophysiologists blinded to the study. Result(s): Sixty patients,
mean age 75 years and mean Congestive heart failure, Hypertension, Age
(>65 = 1, >75 = 2 points), Diabetes, previous Stroke/Transient ischemic
attack (2 points), Vascular disease, Gender (female) score of 4, were
analyzed. Thirty-one patients randomized to control and 29 to the
treatment group. The majority of patients in each group underwent isolated
coronary artery bypass grafting. No perioperative complications related to
the treatment procedure, need for permanent pacemaker, or mortality
occurred. The in-hospital incidence of postoperative atrial fibrillation
was 55% (17 out of 31) in the control group and 7% (2 out of 29) in the
treatment group (P < .001) The control group had a significantly higher
requirement for antiarrhythmic medications at discharge: 45% (14 out of
31) versus 7% (2 out of 29) in the treatment group (P < .001).
 Conclusion(s): Prophylactic radiofrequency isolation of the pulmonary
veins with left atrial appendage amputation during the primary cardiac
surgical operation reduced the incidence of postoperative atrial
fibrillation in patients aged 70 years and older with no history of atrial
arrhythmias. Copyright © 2023 The American Association for
Thoracic Surgery

<50>
Accession Number
2022285485
Title
Pacemaker implantation associated with tricuspid repair in the setting of
mitral valve surgery: Insights from a Cardiothoracic Surgical Trials
Network randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 167(6) (pp 2104-2116.e5),
2024. Date of Publication: June 2024.
Author
Ailawadi G.; Voisine P.; Raymond S.; Gelijns A.C.; Moskowitz A.J.; Falk
V.; Overbey J.R.; Chu M.W.A.; Mack M.J.; Bowdish M.E.; Krane M.; Yerokun
B.; Conradi L.; Bolling S.F.; Miller M.A.; Taddei-Peters W.C.; Fenton
K.N.; Jeffries N.O.; Kramer R.S.; Geirsson A.; Moquete E.G.; O'Sullivan
K.; Hupf J.; Hung J.; Beyersdorf F.; Bagiella E.; Gammie J.S.; O'Gara
P.T.; Iribarne A.; Borger M.A.; Gillinov M.
Institution
(Ailawadi, Bolling) Department of Cardiac Surgery, University of Michigan
Health System, Ann Arbor, Mich, United States
(Voisine) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec (IUCPQ), Quebec, Canada
(Raymond, Gelijns, Moskowitz, Overbey, Moquete, O'Sullivan, Hupf,
Bagiella) Department of Population Health Science and Policy, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
(Falk) Department of Cardiothoracic and Vascular Surgery, Deutsche
Herzzentrum Berlin, Department of Cardiovascular Surgery, Charite
Universitatsmedizin Berlin, German Centre for Cardiovascular Research,
DZHK, Partner Site Berlin, Berlin, Germany
(Chu) Division of Cardiac Surgery, London Health Sciences Centre, Western
University, London, ON, Canada
(Mack) Cardiac and Thoracic Surgery, Baylor Scott & White Health, Plano,
Tex, United States
(Bowdish) Department of Surgery and Population and Public Health Sciences,
Keck School of Medicine of USC, University of Southern California, Los
Angeles, Calif, United States
(Krane, Geirsson) Division of Cardiac Surgery, Department of Surgery, Yale
School of Medicine, New Haven, Conn, United States
(Yerokun) Division of Cardiovascular and Thoracic Surgery, Department of
Surgery, Duke University, Durham, NC, United States
(Conradi) University Heart and Vascular Center Hamburg, Hamburg, Germany
(Miller, Taddei-Peters, Fenton) Division of Cardiovascular Sciences,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md, United States
(Jeffries) National Heart, Lung, and Blood Institute, National Institutes
of Health, Bethesda, Md, United States
(Kramer) Thoracic Surgery (Cardiothoracic Vascular Surgery), Internal
Medicine, Maine Medical Center, Portland, Maine, United States
(Hung) Division of Cardiology, Massachusetts General Hospital, Boston,
Mass, United States
(Beyersdorf) Department of Cardiovascular Surgery, University Heart Center
Freiburg, Freiburg, Germany
(Gammie) Cardiac Surgery, Johns Hopkins Heart and Vascular Institute,
Baltimore, Md, United States
(O'Gara) Cardiovascular Medicine, Brigham and Women's Hospital, Boston,
Mass, United States
(Iribarne) Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center,
NH, Lebanon
(Borger) Leipzig Heart Center, University of Leipzig, Leipzig, Germany
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, Ohio, United States
Publisher
Elsevier Inc.
Abstract
Objectives: In a recent trial, tricuspid annuloplasty (TA) during mitral
valve surgery (MVS) for degenerative mitral regurgitation and moderate or
less tricuspid regurgitation (TR) reduced the composite rate of death,
reoperation for TR, or TR progression at 2 years. However, this benefit
was counterbalanced by an increase in implantation of permanent pacemakers
(PPMs). In this study, we analyzed the timing, indications, and risk
factors for these implantations. Method(s): We randomized 401
patients (MVS alone = 203; MVS + TA = 198). Potential risk factors for
PPMs were assessed using multivariable time-to-event models with death and
PPM implantation for heart failure indications as competing risks.
 Result(s): A PPM was implanted in 36 patients (9.6; 95% CI, 6.8-13.0)
within 2 years of randomization, with 30/187 (16.0%) in the MVS + TA and
6/188 (3.2%) in the MVS groups (rate ratio, 5.08; 95% CI, 2.16-11.94; P <
.001). Most (29/36; 80.6%) implantations occurred within 30 days
postoperatively. Independent risk factors for PPM implantation within 2
years were TA (hazard ratio [HR], 5.94; 95% CI, 2.27-15.53; P < .001),
increasing age (5 years, HR, 1.23; 95% CI, 1.01-1.52; P = .04), and left
ventricular ejection fraction (LVEF; HR, 0.96; 95% CI, 0.92-0.99; P =
.02). In the subset of TA recipients (n = 197), age (5 years, HR, 1.05;
95% CI, 1.00-1.10; P = .04) and LVEF (HR, 0.95; 95% CI, 0.91-0.99; P =
.01) were associated with PPM within 2 years. Conclusion(s):
Concomitant TA, age, and baseline LVEF were risk factors for PPM
implantation in patients who underwent MVS for degenerative mitral
regurgitation. Although TA was effective in preventing progression of TR,
innovation is needed to identify ways to decrease PPM implantation
rates. Copyright © 2022 The American Association for Thoracic
Surgery

<51>
Accession Number
643679655
Title
Outcomes by sex in the International Study of Comparative Health
Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
20(9) (pp 551-560), 2024. Date of Publication: 10 May 2024.
Author
Gaudino M.; Alexander J.H.; Sandner S.; Harik L.; Kim J.; Stone G.W.;
Rahouma M.; O'Gara P.; Bhatt D.L.; Redfors B.
Institution
(Gaudino, Harik, Rahouma) Department of Cardiothoracic Surgery, Weill
Cornell Medicine, New York, NY, USA
(Alexander) Division of Cardiology, Duke Clinical Research Institute, Duke
University, Durham, NC, United States
(Sandner) Department of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
(Kim) Division of Biostatistics, Department of Population Health Sciences,
Weill Cornell Medicine, New York, NY, USA
(Stone) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, USA
(O'Gara) Department of Medicine, Brigham and Women's Hospital, Boston, MA,
United States
(Bhatt) Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New
York, NY, USA
(Redfors) Department of Cardiology, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden
Abstract
BACKGROUND: In the International Study of Comparative Health Effectiveness
With Medical and Invasive Approaches (ISCHEMIA) trial, among participants
with stable coronary artery disease, the risk of cardiac events was
similar between an invasive (INV) strategy of angiography and coronary
revascularisation and a conservative (CON) strategy of initial medical
therapy alone. Outcomes according to participant sex were not reported.
AIMS: We aimed to analyse the outcomes of ISCHEMIA by participant sex.
 METHOD(S): We evaluated 1) the association between participant sex
and the likelihood of undergoing revascularisation for participants
randomised to the INV arm; 2) the risk of the ISCHEMIA primary composite
outcome (cardiovascular death, any myocardial infarction [MI] or
rehospitalisation for unstable angina, heart failure or resuscitated
cardiac arrest) by participant sex; and 3) the contribution of the
individual primary outcome components to the composite outcome by
participant sex. RESULT(S): Of 5,179 randomised participants, 1,168
(22.6%) were women. Female sex was independently associated with a lower
likelihood of revascularisation when assigned to the INV arm (adjusted
odds ratio 0.75, 95% confidence interval [CI]: 0.57-0.99; p=0.04). The INV
versus CON effect on the primary composite outcome was similar between
sexes (women: hazard ratio [HR] 0.96, 95% CI: 0.70-1.33; men: HR 0.90, 95%
CI: 0.76-1.07; pinteraction=0.71). The contribution of the individual
components to the composite outcome was similar between sexes except for
procedural MI, which was significantly lower in women (9/151 [5.9%]) than
men (67/519 [12.9%]; p=0.01). CONCLUSION(S): In ISCHEMIA, women
assigned to the INV arm were less likely to undergo revascularisation than
men. The effect of an INV versus CON strategy was consistent by sex, but
women had a significantly lower contribution of procedural MI to the
primary outcome.

<52>
Accession Number
644228582
Title
Quantitative flow ratio versus fractional flow reserve for Heart Team
decision-making in multivessel disease: the randomised, multicentre
DECISION QFR trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
20(9) (pp 561-570), 2024. Date of Publication: 10 May 2024.
Author
Asano T.; Tanigaki T.; Hoshino M.; Yasunaga M.; Nonaka H.; Emori H.;
Katagiri Y.; Miyazaki Y.; Sotomi Y.; Kogame N.; Kuramitsu S.; Saito A.;
Miyata K.; Takaoka Y.; Kanie T.; Yamasaki M.; Yoshino K.; Wakabayashi N.;
Ouchi K.; Kodama H.; Shiina Y.; Tamaki R.; Nishihata Y.; Masuda K.; Suzuki
T.; Reiber J.H.C.; Okamura T.; Higuchi Y.; Kakuta T.; Misumi H.; Abe K.;
Komiyama N.; Tanabe K.; Matsuo H.; Qfr Investigators O.B.O.T.D.
Institution
(Asano, Saito, Miyata, Takaoka, Kanie, Kodama, Shiina, Nishihata, Masuda,
Suzuki, Komiyama) Department of Cardiovascular Medicine, St. Luke's
International Hospital, St. Luke's International University, Tokyo, Japan
(Tanigaki, Matsuo) Department of Cardiovascular Medicine, Gifu Heart
Center, Gifu, Japan
(Hoshino, Kakuta) Division of Cardiovascular Medicine, Tsuchiura Kyodo
General Hospital, Japan
(Yasunaga, Higuchi) Cardiovascular Division, Osaka Police Hospital, Osaka,
Japan
(Nonaka, Tanabe) Division of Cardiology, Mitsui Memorial Hospital, Tokyo,
Japan
(Emori) Department of Cardiovascular Medicine, Wakayama Medical
University, Wakayama, Japan
(Katagiri) Department of Cardiovascular Medicine, Sapporo Higashi
Tokushukai Hospital, Sapporo, Japan
(Miyazaki, Okamura) Division of Cardiology, Department of Medicine and
Clinical Science, Yamaguchi University Graduate School of Medicine, Ube,
Japan
(Sotomi) Department of Cardiovascular Medicine, Osaka University Graduate
School of Medicine, Osaka, Japan
(Kogame) Division of Cardiovascular Medicine, Toho University Ohashi
Medical Center, Tokyo, Japan
(Kuramitsu) Sapporo Cardiovascular Clinic, Sapporo Heart Center, Sapporo,
Japan
(Yamasaki, Yoshino, Tamaki, Misumi, Abe) Department of Cardiovascular
Surgery, St. Luke's International Hospital, St. Luke's International
University, Tokyo, Japan
(Wakabayashi, Ouchi) Department of Radiology, St. Luke's International
Hospital, St. Luke's International University, Tokyo, Japan
(Reiber) Department of Radiology, Leiden University Medical Center,
Leiden, Netherlands
Abstract
BACKGROUND: Vessel-level physiological data derived from pressure wire
measurements are one of the important determinant factors in the optimal
revascularisation strategy for patients with multivessel disease (MVD).
However, these may result in complications and a prolonged procedure time.
AIMS: The feasibility of using the quantitative flow ratio (QFR), an
angiography-derived fractional flow reserve (FFR), in Heart Team
discussions to determine the optimal revascularisation strategy for
patients with MVD was investigated. METHOD(S): Two Heart Teams were
randomly assigned either QFR- or FFR-based data of the included patients.
They then discussed the optimal revascularisation mode (percutaneous
coronary intervention [PCI] or coronary artery bypass grafting [CABG]) for
each patient and made treatment recommendations. The primary endpoint of
the trial was the level of agreement between the treatment recommendations
of both teams as assessed using Cohen's kappa. RESULT(S): The trial
included 248 patients with MVD from 10 study sites. Cohen's kappa in the
recommended revascularisation modes between the QFR and FFR approaches was
0.73 [95% confidence interval {CI} : 0.62-0.83]. As for the
revascularisation planning, agreements in the target vessels for PCI and
CABG were substantial for both revascularisation modes (Cohen's kappa=0.72
[95% CI: 0.66-0.78] and 0.72 [95% CI: 0.66-0.78], respectively). The team
assigned to the QFR approach provided consistent recommended
revascularisation modes even after being made aware of the FFR data
(Cohen's kappa=0.95 [95% CI:0.90-1.00]). CONCLUSION(S): QFR provided
feasible physiological data in Heart Team discussions to determine the
optimal revascularisation strategy for MVD. The QFR and FFR approaches
agreed substantially in terms of treatment recommendations.

<53>
Accession Number
2032196061
Title
A COMPARISON BETWEEN 2 DIFFERENT PROPORTIONS OF KETAMINE-PROPOFOL AND
PROPOFOL-FENTANYL FOR PROCEDURAL SEDATION AND ANALGESIA FOR MINOR
GYNAECOLOGICAL PROCEDURES: A PROSPECTIVE RANDOMIZED CONTROL TRIAL.
Source
International Journal of Academic Medicine and Pharmacy. 6(2) (pp
756-760), 2024. Date of Publication: 2024.
Author
Somanathan R.M.; Arul J.; Shahul Hameed K.
Institution
(Somanathan, Arul, Shahul Hameed) Government Stanley Medical College,
Chennai, India
Publisher
Society for Healthcare and Research Development
Abstract
Background: Procedural Sedation and Analgesia (PSA) involves a reduction
in patient's degree of awareness while maintaining airway control and
haemodynamics at the same time. This study aims to compare
Ketamine-Propofol and Propofol-Fentanyl for Procedural Sedation in minor
gynaecological procedures. Aim and objectives: To study the duration and
level of sedation, hemodynamic and respiratory profiles, quality of
analgesia of Ketamine-Propofol and Propofol-Fentanyl for Procedural
Sedation in minor gynaecological procedures. Material(s) and
Method(s): Three groups of thirty patients were selected and allotted into
three groups. Group 1- Received ketamine-propofol intravenously (IV) in
ratio of 1:1. Group 2 - Received ketamine-propofol in ratio of 1:2. Group
3 - Received fentanyl-propofol mixture. All the three study drugs were
given till a Ramsay Sedation Score of 5-6 was achieved. Result(s):
Three groups were demographically similar. Duration of surgery was
similar. Heart rate, respiratory rate, systolic and diastolic blood
pressure were similar between the groups. Ramsay sedation score,
EVANS/PRST Score and Wong Bakers pain score were significant at 15 min, at
end of procedure and 15 min after procedure. Conclusion(s): We
conclude that propofol: fentanyl group had better postoperative pain
relief and faster recovery time. Copyright © 2024 Society for
Healthcare and Research Development. All rights reserved.

<54>
Accession Number
2032130936
Title
Combined epicardial and endocardial approach for redo radiofrequency
catheter ablation in patients with persistent atrial fibrillation: a
randomized clinical trial.
Source
Europace. 24(9) (pp 1412-1419), 2022. Date of Publication: 01 Sep 2022.
Author
Lee K.N.; Kim D.Y.; Boo K.Y.; Kim Y.G.; Roh S.Y.; Shim J.; Choi J.I.; Kim
Y.H.
Institution
(Lee) Department of Cardiology, Ajou University, School of Medicine, World
cup-ro 164, Yeongtong-gu, Gyeonggi-do, Suwon-si 16499, South Korea
(Kim) Division of Cardiology, Department of Internal Medicine, Hallym
University Dongtan Sacred Heart Hospital, Keunjaebong-gil 7, Gyeonggi-do,
Hwaseong-si 18450, South Korea
(Boo) Division of Cardiology, Department of Internal Medicine, Jeju
National University Hospital, Aran 13-gil 15, Jeju-do, Jeju-si 63241,
South Korea
(Kim, Shim, Choi, Kim) Division of Cardiology, Department of Internal
Medicine, Korea University Anam Hospital, Goryeodae-ro 73, Seongbuk-gu,
Seoul 02841, South Korea
(Roh) Division of Cardiology, Department of Internal Medicine, Korea
University Guro Hospital, Gurodong-ro 148, Guro-gu, Seoul 08308, South
Korea
Publisher
Oxford University Press
Abstract
Aims: An epicardial approach is an effective means to detect and eliminate
residual potentials in non-transmural lesions created during prior
endocardial ablation. We sought to determine the impact of a combined
epicardial and endocardial approach compared with a conventional
endocardial approach, on recurrence-free survival after redo ablation.
 Methods and Results: Participants with recurred persistent atrial
fibrillation after prior endocardial ablation were randomized (1:1) to
undergo treatment with the combined approach (epicardial followed by
endocardial ablation) for the treatment group or conventional approach
(endocardial ablation only) for the control group. The primary outcome was
the time to recurrence of atrial fibrillation or atrial tachycardia
following a 90-day blanking period within 12 months after the procedure.
The secondary safety outcome was the occurrence of procedure-related
complications within 24 h after the procedure. Of 100 randomized
participants {median age, 59.0 [(interquartile range (IQR): 53.8-64.3]
years, including 16% women, with one prior ablation (IQR: 1-1)}, 93 (93%)
completed the trial. Events relevant to the primary outcome occurred in 16
patients in the treatment group and in 21 patients in the control group
{Kaplan-Meier estimator percentages, 32 vs. 42%; hazard ratio, 0.71 [95%
confidence interval (CI): 0.37-1.37]}. The periprocedural complication
rate was lower in the treatment group [2 vs. 16%; odds ratio, 0.11 (95%
CI: 0.00-0.87)] with similar achievement of the procedural endpoint in the
two groups. Conclusion(s): In the redo procedure for persistent
atrial fibrillation, the combined approach had no significant difference
of recurrence-free survival and a lower procedural complication rate
compared with the conventional approach. Copyright © 2022 The
Author(s). Published by Oxford University Press on behalf of the European
Society of Cardiology. All rights reserved.

<55>
Accession Number
2032248075
Title
Influence of intravenous fentanyl or dexmedetomidine infusions, combined
with lidocaine and ketamine, on cardiovascular response, sevoflurane
requirement and postoperative pain in dogs anesthetized for unilateral
mastectomy.
Source
Veterinary Anaesthesia and Analgesia. (no pagination), 2024. Date of
Publication: 2024.
Author
Cardozo H.G.; Monteiro E.R.; Correia B.S.; Victor B Ferronatto J.;
Almeida-Filho F.T.; Alievi M.M.; Valle S.F.
Institution
(Cardozo, Monteiro, Correia, Victor B Ferronatto, Almeida-Filho, Alievi,
Valle) Faculty of Veterinary Medicine, Federal University of Rio Grande do
Sul, RS, Porto Alegre, Brazil
Publisher
Association of Veterinary Anaesthetists and American College of Veterinary
Anesthesia and Analgesia
Abstract
Objective: To compare the effects of constant rate infusions (CRI) of
fentanyl or dexmedetomidine, combined with lidocaine and ketamine, on
cardiovascular response during surgery, sevoflurane requirement and
postoperative pain in dogs undergoing mastectomy. Study design:
Prospective, randomized, blinded, clinical trial. Animals: A total of 29
female dogs with mammary tumors. Method(s): Premedication consisted
of intramuscular acepromazine and morphine. General anesthesia was induced
with intravenous propofol and maintained with sevoflurane. Dogs were
randomized to be administered intravenous DLK [dexmedetomidine 1 mug
kg-1 loading dose (LD) and 1 mug kg-1
hour-1; lidocaine 2 mg kg-1 LD and 3 mg
kg-1 hour-1; ketamine 1 mg kg-1 LD and
0.6 mg kg-1 hour-1; n = 14] or FLK (fentanyl 5 mug
kg-1 LD and 9 mug kg-1 hour-1; same doses
of lidocaine and ketamine; n = 15) during anesthesia. Cardiorespiratory
variables and end-tidal sevoflurane (FE'Sevo) were recorded during
surgery. The number of dogs administered ephedrine to treat arterial
hypotension [mean arterial pressure (MAP) < 60 mmHg] was recorded.
Meloxicam was administered to both groups. Postoperative pain and rescue
analgesia requirement were assessed for 24 hours using the short form of
the Glasgow Composite Measure Pain Scale. Data were compared using a mixed
effects model or a Mann-Whitney test. Result(s): More dogs required
ephedrine in FLK than in DLK (67% versus 7%). Heart rate was not
significantly different between groups, whereas lower values of MAP (p <=
0.01) and FE'Sevo (p = 0.018) were observed in FLK than in DLK. Rescue
analgesia was administered to 2/15 dogs in FLK and 0/14 dogs in DLK.
Conclusions and clinical relevance: Based on the cardiovascular response
during surgery, intraoperative infusions of FLK and DLK provided adequate
antinociception. Infusion of DLK provided greater stability of blood
pressure. Both protocols resulted in minimal need for additional analgesia
within 24 hours postoperatively. Copyright © 2024 Association of
Veterinary Anaesthetists and American College of Veterinary Anesthesia and
Analgesia

<56>
Accession Number
2032157092
Title
n-3 fatty acids and the risk of atrial fibrillation, review.
Source
Diagnosis. (no pagination), 2024. Date of Publication: 2024.
Author
Herrmann W.; Herrmann M.
Institution
(Herrmann) Medical School, Saarland University, Homburg/Saar 66424,
Germany
(Herrmann) Clinical Institute of Medical and Clinical Laboratory
Diagnostics, Medical University Graz, Graz, Austria
Publisher
Walter de Gruyter GmbH
Abstract
Atrial fibrillation (AF) is the most frequent type of cardiac arrhythmia
that affects over six million individuals in Europe. The incidence and
prevalence of AF rises with age, and often occurs after cardiac surgery.
Other risk factors correlated with AF comprise high blood pressure,
diabetes mellitus, left atrial enlargement, ischemic heart disease, and
congestive heart failure. Considering the high prevalence of AF in aging
societies, strategies to prevent serious complications, such as stroke or
heart failure, are important because they are correlated with high
morbidity and mortality. The supplementation of sea-derived n-3
polyunsaturated fatty acids (PUFA) is widely discussed in this context,
but the results of experimental and observational studies are in contrast
to randomized placebo-controlled intervention trials (RCTs). Specifically,
larger placebo-controlled n-3 PUFA supplementation studies with long
follow-up showed a dose-dependent rise in incident AF. Daily n-3 PUFA
doses of >=1 g/d are correlated with a 50 % increase in AF risk, whereas a
daily intake of <1 g/d causes AF in only 12 %. Individuals with a high
cardiovascular risk (CVD) risk and high plasma-triglycerides seem
particularly prone to develop AF upon n-3 PUFA supplementation. Therefore,
we should exercise caution with n-3 PUFA supplementation especially in
patients with higher age, CVD, hypertriglyceridemia or diabetes. In
summary, existing data argue against the additive intake of n-3 PUFA for
preventative purposes because of an incremental AF risk and lacking CVD
benefits. However, more clinical studies are required to disentangle the
discrepancy between n-3 PUFA RCTs and observational studies showing a
lower CVD risk in individuals who regularly consume n-3 PUFA-rich
fish. Copyright © 2024 Walter de Gruyter GmbH. All rights
reserved.

<57>
Accession Number
2029824963
Title
A systematic review of the prevalence of chronic postsurgical pain in
children.
Source
Paediatric Anaesthesia. (no pagination), 2024. Date of Publication: 2024.
Author
Sim N.Y.W.; Chalkiadis G.A.; Davidson A.J.; Palmer G.M.
Institution
(Sim) Department of Anaesthesia and Perioperative Medicine, Monash Health,
Clayton, VIC, Australia
(Chalkiadis, Davidson, Palmer) Department of Anaesthesia and Pain
Management, Royal Children's Hospital, Parkville, VIC, Australia
(Chalkiadis, Davidson, Palmer) Murdoch Children's Research Institute,
Parkville, VIC, Australia
(Chalkiadis, Davidson, Palmer) Department of Paediatrics, University of
Melbourne, Parkville, VIC, Australia
(Davidson) Department of Critical Care, University of Melbourne,
Parkville, VIC, Australia
Publisher
John Wiley and Sons Inc
Abstract
Two prior reviews highlight the scarcity and conflicting nature of
available data on chronic postsurgical pain in children, reporting a wide
prevalence range of 3.2% to 64% (at >=3 months). This updated systematic
review aimed to consolidate information on the prevalence of pediatric
chronic postsurgical pain. A thorough literature search of full
English-text publications from April 2014 to August 2021 was conducted
using Ovid MEDLINE, PubMed, and Cochrane Database of Systematic Reviews,
with search terms: postoperative pain, child, preschool, pediatrics,
adolescent, chronic pain. Seventeen relevant studies were identified. Most
assessed chronicity once greater than 3 months duration postoperatively
(82%), were predominantly prospective (71%) and conducted in inpatient
settings (88%). The surgeries examined included orthopedic (scoliosis and
limb), urological, laparotomy, inguinal, and cardiothoracic procedures,
involving numbers ranging from 36 to 750, totaling 3137 participants/2792
completers. The studies had wide variations in median age at surgery (6
days to 16 years), the percentage of female participants (unspecified or
12.5% to 90%), and follow-up duration (2.5 months to 9 years). Various
pain, functional, psychosocial, and health-related quality of life
outcomes were documented. Chronic postsurgical pain prevalence varied
widely from 2% to 100%. Despite increased data, challenges persist due to
heterogeneity in definitions, patient demographics, mixed versus single
surgical populations, diverse perioperative analgesic interventions,
follow-up durations and reported outcomes. Interpretation is further
complicated by limited information on impact, long-term analgesia and
healthcare utilization, and relatively small sample sizes, hindering the
assessment of reported associations. In some cases, preoperative pain and
deformity may not have been addressed by surgery and persisting pain
postoperatively may then be inappropriately termed chronic postsurgical
pain. Larger-scale, procedure-specific data to better assess current
prevalence, impact, and whether modifiable factors link to negative
long-term outcomes, would be more useful and allow targeted perioperative
interventions for at-risk pediatric surgical patients. Copyright
© 2024 The Authors. Pediatric Anesthesia published by John Wiley &
Sons Ltd.

<58>
Accession Number
2029789649
Title
A randomized trial of the inflammatory cytokines levels and the blood
transfusion rate between miniaturized tubing group and conventional tubing
group in congenital heart disease open heart surgeries.
Source
Perfusion (United Kingdom). (no pagination), 2024. Date of Publication:
2024.
Author
Wang P.; Meng B.; Li G.; Zhou X.; Zhang S.; Zhang Q.
Institution
(Wang, Meng, Li, Zhou, Zhang, Zhang) Department of Cardiothoracic Surgery,
Shenzhen Children's Hospital, Shenzhen, China
Publisher
SAGE Publications Ltd
Abstract
Introduction: We aimed to compare the inflammatory cytokines levels of the
miniaturized and conventional extracorporeal circuit system. The
miniaturized extracorporeal circuit system may be fewer possible
inflammation-induced or blood transfusion-related complications.
 Method(s): We performed a prospective randomized controlled trial
(RCT) of 101 patients undergoing congenital heart surgery with CPB
(cardiopulmonary bypass, weight <=15 kg, age <=2 years). Patients were
divided into two different CPB groups randomly by random data form. Blood
samples at five different time points and the ultrafiltration fluid before
and after CPB were collected in all patients. IL-6, IL-8, and TNF alpha
were respectively tested with Abcam ELISA kit. Result(s): The IL-6
level of blood serum in two groups had no statistical differences between
the two groups at all time points. The IL-8 level of blood serum in two
groups had no statistical differences right after anesthesia and 5 min
after CPB. However, IL-8 level was significantly higher in conventional
extracorporeal circuit group than that in miniaturized extracorporeal
circuit group at 6 h, 12 h and 24 h after CPB. Blood serum TNF alpha in
conventional extracorporeal circuit group was significantly higher at 6 h
after CPB than that in miniaturized extracorporeal circuit group. No
statistical differences in TNF alpha were found between two groups right
after anesthesia and at 5 min after CPB, 12 h and 24 h after CPB. In
ultrafiltration fluid, no statistical differences were found in IL-6, IL-8
nor TNF alpha between two groups in all time. No statistical differences
were found in ICU (intensive care unit) stay and mechanical ventilation
time between the two groups. The blood transfusion rate was significantly
lower in miniaturized extracorporeal circuit group. Conclusion(s):
Implementing the miniaturized extracorporeal circuit system could decrease
the inflammatory cytokines at a certain level. The blood transfusion rate
is significantly lower in miniaturized extracorporeal circuit group This
indicates the miniaturized extracorporeal circuit system might be a safer
CPB strategy with fewer possible inflammation-induced or blood
transfusion-related complications. Copyright © The Author(s)
2024.

<59>
Accession Number
644228656
Title
Ten-Year Outcome of Recanalization or Medical Therapy for Concomitant
Chronic Total Occlusion After Myocardial Infarction.
Source
Journal of the American Heart Association. (pp e033556), 2024. Date of
Publication: 10 May 2024.
Author
van Veelen A.; Coerkamp C.F.; Somsen Y.B.O.; Ramunddal T.; Ioanes D.;
Laanmets P.; van der Schaaf R.J.; Eriksen E.; Bax M.; Suttorp M.J.;
Strauss B.H.; Barbato E.; Marques K.M.; Meuwissen M.; Bertrand O.; van der
Ent M.; Knaapen P.; Tijssen J.G.P.; Claessen B.E.P.M.; Hoebers L.P.C.;
Elias J.; Henriques J.P.S.
Institution
(van Veelen, Coerkamp, Tijssen, Claessen, Hoebers, Elias, Henriques)
Department of Cardiology, Heart Center, Location AMC Amsterdam
Cardiovascular Sciences Amsterdam the Netherlands, Netherlands
(Somsen, Marques, Knaapen) Department of Cardiology, Heart Center,
Location VUMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands,
Netherlands
(Ramunddal, Ioanes) Department of Cardiology Sahlgrenska University
Hospital Gothenburg Sweden, Sweden
(Laanmets) Department of Cardiology North-Estonia Medical Center Tallinn
Estonia, Estonia
(van der Schaaf) Department of Cardiology OLVG Hospital Amsterdam the
Netherlands, Netherlands
(Eriksen) Department of Cardiology Haukeland University Hospital Bergen
Norway, Norway
(Bax) Department of Cardiology Haga Teaching Hospital The Hague the
Netherlands, Netherlands
(Suttorp) Department of Cardiology St. Antonius Hospital Nieuwegein the
Netherlands, Netherlands
(Strauss) Department of Cardiology Sunnybrook Health Sciences Centre
Toronto Canada, Canada
(Barbato) Department of Clinical and Molecular Medicine Sapienza
University of Rome Rome Italy, Italy
(Meuwissen) Department of Cardiology Amphia Hospital Breda the
Netherlands, Netherlands
(Bertrand) Department of Cardiology Quebec Heart-Lung Institute Quebec
Canada, Canada
(van der Ent) Department of Cardiology Maasstad Hospital Rotterdam the
Netherlands, Netherlands
(Hoebers) Department of Cardiology Maastricht UMC+ Maastricht the
Netherlands, Netherlands
Abstract
BACKGROUND: The EXPLORE (Evaluating Xience and Left Ventricular Function
in PCI on Occlusions After STEMI) trial was the first and only randomized
trial investigating chronic total occlusion (CTO) percutaneous coronary
intervention (PCI) early after primary PCI for ST-segment-elevation
myocardial infarction, compared with medical therapy for the CTO. We
performed a 10-year follow-up of EXPLORE to investigate long-term safety
and clinical impact of CTO PCI after ST-segment-elevation myocardial
infarction, compared with no-CTO PCI. METHODS AND RESULTS: In EXPLORE, 302
patients post-ST-segment-elevation myocardial infarction with concurrent
CTO were randomized to CTO PCI within =1week or no-CTO PCI. We performed
an extended clinical follow-up for the primary end point of major adverse
cardiac events, consisting of cardiovascular death, coronary artery bypass
grafting, or myocardial infarction. Secondary end points included
all-cause death, angina, and dyspnea. Median follow-up was 10years
(interquartile range, 8-11years). The primary end point occurred in 25% of
patients with CTO PCI and in 24% of patients with no-CTO PCI (hazard ratio
[HR], 1.11 [95% CI, 0.70-1.76]). Cardiovascular mortality was higher in
the CTO PCI group (HR, 2.09 [95% CI, 1.10-2.50]), but all-cause death was
similar (HR, 1.53 [95% CI, 0.93-2.50]). Dyspnea relief was more frequent
after CTO PCI (83% versus 65%, P=0.005), with no significant difference in
angina. CONCLUSION(S): This 10-year follow-up of patients
post-ST-segment-elevation myocardial infarction randomized to CTO PCI or
no-CTO PCI demonstrated no clinical benefit of CTO PCI in major adverse
cardiac events or overall mortality. However, CTO PCI was associated with
a higher cardiovascular mortality compared with no-CTO PCI. Our long-term
data support a careful weighing of effective symptom relief against an
elevated cardiovascular mortality risk in CTO PCI decisions. REGISTRATION:
URL: https://www.trialregister.nl; Unique identifier: NTR1108.

<60>
Accession Number
644226701
Title
Landiolol for perioperative atrial tachyarrhythmias in cardiac and
thoracic surgery patients: a systematic review and meta-analysis.
Source
British journal of anaesthesia. (no pagination), 2024. Date of
Publication: 08 May 2024.
Author
Kowalik K.; Silverman M.; Oraii A.; Conen D.; Belley-Cote E.P.; Healey
J.S.; Um K.J.; Inami T.; Wanner P.M.; Wang M.K.; Pandey A.; Udayashankar
A.; Whitlock R.P.; Devereaux P.J.; McIntyre W.F.
Institution
(Kowalik, Silverman, Pandey, Udayashankar) Michael G. DeGroote School of
Medicine, Hamilton, ON, Canada
(Oraii, Conen, Belley-Cote, Healey, Wanner, Wang, Whitlock, Devereaux,
McIntyre) Population Health Research Institute, Hamilton, ON, Canada
(Um) McMaster University, Hamilton, ON, Canada
(Inami) Nippon Medical School, Tokyo, Japan

<61>
Accession Number
644226633
Title
Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo Surgical
Aortic Valve Replacement In Patients With Aortic Stenosis: A Systematic
Review and Meta-analysis.
Source
The American journal of cardiology. (no pagination), 2024. Date of
Publication: 07 May 2024.
Author
Nasir M.M.; Ikram A.; Usman M.; Sarwar J.; Ahmed J.; Hamza M.; Farhan
S.A.; Siddiqi R.; Qadar L.T.; Shah S.R.; Khalid M.R.; Memon R.S.; Hameed
I.
Institution
(Nasir, Ikram, Usman, Sarwar, Ahmed) Department of Internal Medicine, Dow
University of Health Sciences, Karachi, Pakistan
(Hamza) Department of Internal Medicine, Guthrie Medical Group, Cortland,
NY, United States
(Farhan) Department of Surgery, Ohio State University, Columbus, OH,
United States
(Siddiqi) Department of Internal Medicine, University of Toledo, OH,
United States
(Qadar) Department of Internal Medicine, St Vincent's Medical Center,
Bridgeport, CT, United States
(Shah) Division of Cardiovascular Medicine, University of Louisville,
Louisville, KY, United States
(Khalid) Department of Internal Medicine, Texas Health Presbyterian
Hospital, Denton, TX, United States
(Memon) Department of Internal Medicine, Jacobi Medical Center-NYCHHC/
Albert Einstein College of Medicine, Bronx, NY, United States
(Hameed) Division of Cardiac Surgery, Yale University School of Medicine,
New Haven, CT, United States
Abstract
Aortic stenosis is a common and significant valve condition requiring
bioprosthetic heart valves (BHV) with transcatheter aortic valve
replacement (TAVR) being strongly recommended for high-risk patients or
patients over 75. This meta-analysis aimed to pool existing data on
post-procedural clinical as well as echocardiographic outcomes comparing
ViV-TAVR to redo-SAVR to assess the short-term and medium-term outcomes
for both treatment modalities. A systematic literature search on Cochrane
Central, Scopus, and Medline (PubMed interface) electronic databases from
inception to August 2023. We used odds ratios (OR) for dichotomous
outcomes and mean differences (MD) for continuous outcomes. Twenty-four
studies (25,216 patients) were pooled with a mean follow-up of 16.4
months. The analysis revealed that ViV-TAVR group showed a significant
reduction in 30-day mortality (OR: 0.50 (95% CI: 0.43, 0.58), P <
0.00001), new-onset atrial fibrillation (OR: 0.34 (95% CI: 0.17, 0.67)
P=0.002), major bleeding event (OR: 0.28 (95% CI: 0.17, 0.45), P <
0.00001) and lower rate of device success (OR: 0.25 (95% CI: 0.12, 0.53),
P=0.0003). There were no significant differences between either group when
assessing 1-year mortality, stroke, M.I, post-operative LVEF, and
effective orifice area. ViV-TAVR cohort showed a significantly increased
incidence of paravalvular leaks, aortic regurgitation, and increased mean
aortic valve gradient. ViV-TAVR is a viable short-term option for elderly
patients with high comorbidities and operative risks, reducing
perioperative complications and improving 30-day mortality with no
significant cardiovascular adverse events. However, both treatment
modalities present similar results on short to medium-term complications
assessment. Copyright © 2024. Published by Elsevier Inc.

<62>
Accession Number
644224784
Title
Improved Early Outcomes With Off-Pump Coronary Artery Bypass Grafting in
Patients With Left Ventricular Dysfunction: A Systematic Review and
Meta-Analysis.
Source
Cardiology in review. (no pagination), 2024. Date of Publication: 09 May
2024.
Author
Abdul Qadeer M.; Khalid M.; Abdul Muqeet Farid A.; Fatima T.; Mariam
Khalid F.; Ali S.I.; Mujtaba G.; Elahi N.; Kamal Siddiqi A.; Said S.M.
Institution
(Abdul Qadeer, Ali) From the Department of Medicine, Jinnah Sindh Medical
University, Karachi, Pakistan
(Khalid) Department of Medicine, Karachi Medical and Dental College,
Karachi, Pakistan
(Abdul Muqeet Farid, Kamal Siddiqi) Department of Medicine, Ziauddin
Medical University, Karachi, Pakistan
(Fatima, Mujtaba, Elahi) Department of Internal Medicine, Dow University
of Health Sciences, Karachi, Pakistan
(Mariam Khalid) Department of Emergency Medicine, Jinnah Medical and
Dental College, Karachi, Pakistan
(Said) Division of Pediatric and Adult Congenital Cardiac Surgery, Maria
Fareri Children's Hospital, Valhalla, NY, United States
(Said) Department of Surgery, Westchester Medical Center, Valhalla, NY,
United States
(Said) Department of Cardiothoracic Surgery, Faculty of Medicine,
Alexandria University, Alexandria, Egypt
Abstract
The ongoing debate surrounding coronary artery bypass grafting (CABG) with
or without cardiopulmonary bypass persists, particularly in individuals
with left ventricular dysfunction. The objective of this study was to
evaluate the safety and efficacy of these 2 strategies through a
comprehensive meta-analysis of existing studies. A systematic search of
PubMed, EMBASE, Web of Science, and the Cochrane Central Registry was
conducted from inception to July 2023. The primary focus was on studies
comparing on-pump versus off-pump CABG as the primary treatment for
multivessel coronary artery disease in patients with left ventricular
dysfunction (ejection fraction <=40%), with mortality as the primary
outcome. The meta-analysis included 26 studies with a total of 35,863
patients. The results revealed a significant reduction in mortality risk
[risk ratio (RR), 0.75; 95% confidence interval (CI), 0.60-0.93; P =
0.009] and other perioperative morbidities associated with off-pump CABG.
These included stroke (RR, 0.67; 95% CI, 0.54-0.82; P = 0.0002),
myocardial infarction (RR, 0.74; 95% CI, 0.56-0.97; P = 0.03), pulmonary
complications (RR, 0.71; 95% CI, 0.55-0.92; P = 0.010), postoperative
transfusion (RR, 0.70; 95% CI, 0.55-0.88; P = 0.002), neurological
dysfunction (RR, 0.80; 95% CI, 0.64-1.00; P = 0.05), infection (RR, 0.74;
95% CI, 0.56-0.97; P = 0.03), renal failure (RR, 0.79; 95% CI, 0.67-0.95;
P = 0.010), and reoperation for bleeding (RR, 0.66; 95% CI, 0.52-0.84; P =
0.0006). However, no significant difference was observed between the 2
groups regarding postoperative atrial fibrillation (RR, 0.97; 95% CI,
0.84-1.12; P = 0.69). In conclusion, off-pump CABG demonstrates a lower
perioperative mortality risk and improved overall early outcomes compared
with on-pump techniques in individuals with reduced left ventricular
function. Copyright © 2024 Wolters Kluwer Health, Inc. All rights
reserved.

<63>
Accession Number
2031845569
Title
Ventricular Pseudoaneurysm and Free Wall Rupture After Acute Myocardial
Infarction: JACC Focus Seminar 4/5.
Source
Journal of the American College of Cardiology. 83(19) (pp 1902-1916),
2024. Date of Publication: 14 May 2024.
Author
Lorusso R.; Cubeddu R.J.; Matteucci M.; Ronco D.; Moreno P.R.
Institution
(Lorusso, Matteucci, Ronco) Cardio-Thoracic Surgery Department, Maastricht
University Medical Centre (MUMC), Maastricht, Netherlands
(Lorusso, Matteucci, Ronco) Cardiovascular Research Institute Maastricht
(CARIM), Maastricht, Netherlands
(Cubeddu) NCH Rooney Heart Institute, Section for Structural Heart
Disease, NCH Healthcare System, Naples, FL, United States
(Cubeddu, Moreno) Igor Palacios Fellow Fouldation, Boston, MA, United
States
(Matteucci) Cardiac Surgery Unit, ASSTSette Laghi, Varese, Italy
(Ronco) Cardiac Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda,
Milan, Italy
(Moreno) Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Postinfarction ventricular free-wall rupture is a rare mechanical
complication, accounting for <0.01% to 0.02% of cases. As an
often-catastrophic event, death typically ensues within minutes due to
sudden massive hemopericardium resulting in cardiac tamponade. Early
recognition is pivotal, and may allow for pericardial drainage and open
surgical repair as the only emergent life-saving procedure. In cases of
contained rupture with pseudo-aneurysm (PSA) formation, hospitalization
with subsequent early surgical intervention is warranted. Not uncommonly,
PSA may go unrecognized in asymptomatic patients and diagnosed late during
subsequent cardiac imaging. In these patients, the unsettling risk of
complete rupture demands early surgical repair. Novel developments, in the
field of transcatheter-based therapies and multimodality imaging, have
enabled percutaneous PSA repair as a feasible alternate strategy for
patients at high or prohibitive surgical risk. Contemporary advancements
in the diagnosis and treatment of postmyocardial infarction ventricular
free-wall rupture and PSA are provided in this review. Copyright
© 2024 American College of Cardiology Foundation

<64>
Accession Number
2029753503
Title
Effects of non-invasive respiratory support in post-operative patients: a
systematic review and network meta-analysis.
Source
Critical Care. 28(1) (no pagination), 2024. Article Number: 152. Date of
Publication: December 2024.
Author
Pettenuzzo T.; Boscolo A.; Pistollato E.; Pretto C.; Giacon T.A.; Frasson
S.; Carbotti F.M.; Medici F.; Pettenon G.; Carofiglio G.; Nardelli M.;
Cucci N.; Tuccio C.L.; Gagliardi V.; Schiavolin C.; Simoni C.; Congedi S.;
Monteleone F.; Zarantonello F.; Sella N.; De Cassai A.; Navalesi P.
Institution
(Pettenuzzo, Boscolo, Zarantonello, Sella, De Cassai, Navalesi) Institute
of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via
Gallucci, Padua 35121, Italy
(Boscolo, Pistollato, Pretto, Giacon, Frasson, Carbotti, Medici, Pettenon,
Carofiglio, Nardelli, Cucci, Tuccio, Gagliardi, Schiavolin, Simoni,
Congedi, Monteleone, Navalesi) Department of Medicine, University of
Padua, 2 Via Giustiniani, Padua 35128, Italy
(Boscolo) Department of Cardiac, Thoracic, Vascular Sciences, and Public
Health, University of Padua, 2 Via Giustiniani, Padua 35128, Italy
Publisher
BioMed Central Ltd
Abstract
Background: Re-intubation secondary to post-extubation respiratory failure
in post-operative patients is associated with increased patient morbidity
and mortality. Non-invasive respiratory support (NRS) alternative to
conventional oxygen therapy (COT), i.e., high-flow nasal oxygen,
continuous positive airway pressure, and non-invasive ventilation (NIV),
has been proposed to prevent or treat post-extubation respiratory failure.
Aim of the present study is assessing the effects of NRS application,
compared to COT, on the re-intubation rate (primary outcome), and time to
re-intubation, incidence of nosocomial pneumonia, patient discomfort,
intensive care unit (ICU) and hospital length of stay, and mortality
(secondary outcomes) in adult patients extubated after surgery.
 Method(s): A systematic review and network meta-analysis of
randomized and non-randomized controlled trials. A search from Medline,
Embase, Scopus, Cochrane Central Register of Controlled Trials, and Web of
Science from inception until February 2, 2024 was performed.
 Result(s): Thirty-three studies (11,292 patients) were included.
Among all NRS modalities, only NIV reduced the re-intubation rate,
compared to COT (odds ratio 0.49, 95% confidence interval 0.28; 0.87, p =
0.015, I2 = 60.5%, low certainty of evidence). In particular,
this effect was observed in patients receiving NIV for treatment, while
not for prevention, of post-extubation respiratory failure, and in
patients at high, while not low, risk of post-extubation respiratory
failure. NIV reduced the rate of nosocomial pneumonia, ICU length of stay,
and ICU, hospital, and long-term mortality, while not worsening patient
discomfort. Conclusion(s): In post-operative patients receiving NRS
after extubation, NIV reduced the rate of re-intubation, compared to COT,
when used for treatment of post-extubation respiratory failure and in
patients at high risk of post-extubation respiratory
failure. Copyright © The Author(s) 2024.

<65>
Accession Number
2028596617
Title
Reporting of social determinants of health in randomized controlled trials
conducted in the pediatric intensive care unit.
Source
Frontiers in Pediatrics. 12 (no pagination), 2024. Article Number:
1329648. Date of Publication: 08 Mar 2024.
Author
Huang E.; Albrecht L.; O'Hearn K.; Nicolas N.; Armstrong J.; Weinberg M.;
Menon K.
Institution
(Huang) Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
(Albrecht, O'Hearn, Nicolas, Armstrong, Menon) Children's Hospital of
Eastern Ontario Research Institute, Ottawa, ON, Canada
(Weinberg) Faculty of Science, University of Ottawa, Ottawa, ON, Canada
(Menon) Department of Pediatrics, Children's Hospital of Eastern Ontario,
University of Ottawa, Ottawa, ON, Canada
Publisher
Frontiers Media SA
Abstract
Introduction: The influence of social determinants of health (SDOH) on
access to care and outcomes for critically ill children remains an
understudied area with a paucity of high-quality data. Recent publications
have highlighted the importance of incorporating SDOH considerations into
research but the frequency with which this occurs in pediatric intensive
care unit (PICU) research is unclear. Our objective was to determine the
frequency and categories of SDOH variables reported and how these
variables were defined in published PICU randomized controlled trials
(RCTs). Method(s): We searched Medline, Embase, Lilacs, and Central
from inception to Dec 2022. Inclusion criteria were randomized controlled
trials of any intervention on children or their families in a PICU. Data
related to study demographics and nine WHO SDOH categories were extracted,
and descriptive statistics and qualitative data generated. Result(s):
586 unique RCTs were included. Studies had a median sample size of 60
patients (IQR 40-106) with 73.0% of studies including <=100 patients and
41.1% including <=50 patients. A total of 181 (181/586, 30.9%) studies
reported >=1 SDOH variable of which 163 (163/586, 27.8%) reported them by
randomization group. The most frequently reported categories were food
insecurity (100/586, 17.1%) and social inclusion and non-discrimination
(73/586, 12.5%). Twenty-five of 57 studies (43.9%) investigating feeding
or nutrition and 11 of 82 (13.4%) assessing mechanical ventilation
reported baseline nutritional assessments. Forty-one studies investigated
interventions in children with asthma or bronchiolitis of which six
reported on smoking in the home (6/41, 14.6%). Discussion(s):
Reporting of relevant SDOH variables occurs infrequently in PICU RCTs. In
addition, when available, categorizations and definitions of SDOH vary
considerably between studies. Standardization of SDOH variable collection
along with consistent minimal reporting requirements for PICU RCT
publications is needed. Copyright 2024 Huang, Albrecht, O'Hearn,
Nicolas, Armstrong, Weinberg and Menon.

<66>
Accession Number
2021279375
Title
Neurodevelopmental and functional outcome in hypoplastic left heart
syndrome after Hybrid procedure as stage I.
Source
Frontiers in Pediatrics. 10 (no pagination), 2023. Article Number:
1099283. Date of Publication: 18 Jan 2023.
Author
Knirsch W.; De Silvestro A.; von Rhein M.
Institution
(Knirsch, De Silvestro) Pediatric Cardiology, Pediatric Heart Center,
Department of Surgery, University Children's Hospital Zurich, Switzerland
(Knirsch, De Silvestro, von Rhein) Children's Research Center, University
Children's Hospital Zurich, Switzerland
(Knirsch, De Silvestro, von Rhein) University of Zurich (UZH), Switzerland
(von Rhein) Child Development Center, University Children's Hospital
Zurich, Switzerland
Publisher
Frontiers Media SA
Abstract
Background: Patients with hypoplastic left heart syndrome (HLHS)
undergoing staged palliation until Fontan procedure are at risk for
impaired neurodevelopmental (ND) outcome. The Hybrid procedure with
bilateral pulmonary artery banding, ductal stenting, and balloon
atrioseptostomy may offer a less invasive stage I procedure compared to
the Norwood stage I procedure avoiding early neonatal cardiopulmonary
bypass (CPB) surgery. Despite altered fetal cerebral hemodynamics, the
type of stage I procedure may be a covariate influencing ND outcome and
functional outcome may also be altered due to postponing neonatal CPB
surgery. Within this review, we analyzed ND outcome as well as functional
outcome after Hybrid procedure as stage I procedure. Method(s): The
review analyzed original publications (OPs) published before March 15,
2022, identified by Cochrane, EMBASE, OVID, Scopus, and Web of science. An
OP was included if short-to-long-term neurodevelopment outcome, brain
development, somatic, and cardiac outcome in patients for HLHS and
variants treated by Hybrid procedure were analyzed. In addition to
database searches, we reviewed all references of the analyzed OP to obtain
a comprehensive list of available studies. The author, year of
publication, demographic characteristics of study population, study design
(prospective or retrospective), study assessment, and main findings were
summarized. Result(s): Twenty-one OPs were included with data of
patients with ND outcome and functional cardiac outcome. Overall, there is
an impaired mid-term ND outcome in patients with Hybrid procedure as stage
I for HLHS. Only slight differences between stage I procedures (Hybrid vs.
Norwood) in two comparing studies have been determined affecting right
ventricular remodeling, short- and mid-term ND outcome, reduced brain
growth until two years of age, sufficient quality of life, and altered
hemodynamics influencing brain volumes and cerebral perfusion pattern.
 Conclusion(s): Despite some minor differences regarding the mid-term
follow-up in patients with HLHS comparing Hybrid vs. Norwood procedure,
its impact on ND outcome seems rather low. This may be explained by the
large number of covariates as well as the small study populations and the
different selection criteria for patients undergoing Hybrid or Norwood
procedure as stage I. Copyright 2023 Knirsch, De Silvestro and von
Rhein.

<67>
Accession Number
2021254972
Title
Intercostal nerve cryoanalgesia in the treatment of pain in patients
operated on by the modified Nuss method with the BackOnFeet application-a
new strategy to improve outcomes.
Source
Frontiers in Pediatrics. 10 (no pagination), 2023. Article Number:
1069805. Date of Publication: 18 Jan 2023.
Author
Zacha S.; Andrzejewska A.; Jastrzebska-Ligocka B.; Szwed A.; Modrzejewska
E.; Zacha W.; Skonieczna-Zydecka K.; Miegon J.; Jarosz K.; Biernawska J.
Institution
(Zacha, Szwed, Modrzejewska) Department of Pediatric Orthopedics and
Oncology of the Musculoskeletal System, Pomeranian Medical University,
Szczecin, Poland
(Andrzejewska, Jastrzebska-Ligocka, Miegon, Biernawska) Department of
Anesthesiology and Intensive Care, Pomeranian Medical University,
Szczecin, Poland
(Zacha) Department of Orthopedics, Traumatology and Oncology of the
Musculoskeletal System, Pomeranian Medical University, Szczecin, Poland
(Skonieczna-Zydecka) Department of Biochemical Science, Pomeranian Medical
University, Szczecin, Poland
(Jarosz) Department of Clinical Nursing, Pomeranian Medical University,
Szczecin, Poland
Publisher
Frontiers Media SA
Abstract
Introduction: The surgical Nuss correction of the funnel chest deformity
is a painful procedure without an established consensus of pain relief
methods. High doses and long duration of opioids requirements impedes the
ERAS protocol introduction. The aim of this study was to evaluate the
effectiveness of intraoperative intercostal nerve cryolysis in terms of
pain management in relation to the routinely used multimodal analgesia in
Poland. We also assessed the impact of using the proprietary "BackOnFeet"
application on the quality of life of patients after surgery in relation
to the ERAS protocol. Method(s): The prospective, single-centre,
non-randomised, before-after pilot study was conducted. Inclusion criteria
were: funnel-shaped chest deformity, age range 11-18 years, first chest
wall operation, agreement for the cryolysis and regional analgesia, no
history of chronic painkillers use. The results of the "control group"
(multimodal analgesia with regional analgesia commonly performed in
Poland) were assessed. The interdisciplinary perioperative protocol with
the "BackOnFeet" application and intraoperative intercostal nerve
cryoanalgesia were introduced to the "intervention group". Result(s):
Eighteen children were treated with standard protocol typical for Polish
management and matched to eighteen patients who received cryoanalgesia and
the "BackOnFeet" application access "intervention group". We noticed lower
NRS points in first 24 h (p = 0.0048), shortening of time of opioid use (p
= 0.0002), hospitalisation time (p = 0,01), improved quality of
postoperative rehabilitation (p < 0.0001) and quality of life (p < 0.0001)
among the "intervention group". Conclusion(s): Intraoperative
intercostal nerves cryolysis performed during the minimally invasive Nuss
correction of funnel deformation in combination with bilateral is more
effective in terms of acute pain management in relation to the routinely
used multimodal analgesia in Poland, allowing for the shortening of time
of opioid use, hospitalisation time, improved quality of postoperative
rehabilitation and enabled ERAS protocol introduction. The use of the
proprietary "BackOnFeet" application has a positive effect on the quality
of life of patients after surgery. Copyright 2023 Zacha, Andrzejewska,
Jastrzebska-Ligocka, Szwed, Modrzejewska, Zacha, Skonieczna-Zydecka,
Miegon, Jarosz and Biernawska.

<68>
Accession Number
2021223645
Title
Risk factors of postoperative low cardiac output syndrome in children with
congenital heart disease: A systematic review and meta-analysis.
Source
Frontiers in Pediatrics. 10 (no pagination), 2023. Article Number: 954427.
Date of Publication: 18 Jan 2023.
Author
Wang P.; Fu C.; Bai G.; Cuan L.; Tang X.; Jin C.; Jin H.; Zhu J.; Xie C.
Institution
(Wang, Cuan, Tang, Zhu) Department of Pediatric Surgery, The Children's
Hospital, Zhejiang University School of Medicine, National Clinical
Research Center for Child Health, Hangzhou, China
(Fu) Department of Nursing, The Children's Hospital, Zhejiang University
School of Medicine, National Clinical Research Center for Child Health,
Hangzhou, China
(Bai, Jin) The Children's Hospital, Zhejiang University School of
Medicine, National Clinical Research Center for Child Health, Hangzhou,
China
(Jin) Cardiac Intensive Care Unit, The Children's Hospital, Zhejiang
University School of Medicine, National Clinical Research Center for Child
Health, Hangzhou, China
(Xie) Department of Cardiovascular Medicine, The Children's Hospital,
Zhejiang University School of Medicine, National Clinical Research Center
for Child Health, Hangzhou, China
Publisher
Frontiers Media SA
Abstract
Background: Low cardiac output syndrome (LCOS) is the most common
complication after cardiac surgery, which is associated with the extension
of postoperative hospital stay and postoperative death in children with
congenital heart disease (CHD). Although there are some studies on the
risk factors of LCOS in children with CHD, an unified conclusion is lack
at present. Purpose(s): To synthesize the risk factors of LCOS after
CHD in children, and to provide evidence-based insights into the early
identification and early intervention of LCOS. Method(s): The
databases of the China National Knowledge Infrastructure (CNKI), Wanfang
Database, China Science and Technology Journal Database (VIP), PubMed,
Cochrane Library, Embase and Web of Science were searched for relevant
articles that were published between the establishing time of each
database and January 2022. Based on retrospective records or cohort
studies, the influencing factors of postoperative low cardiac output in
children with congenital heart disease were included in Meta analysis.This
study followed the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines. The risk of bias was evaluated
according to the Newcastle-Ottawa Scale (NOS). RevMan 5.4 software was
used to conduct the meta-analysis. Result(s): A total of 1,886
records were screened, of which 18 were included in the final review. In
total, 37 risk factors were identified in the systematic review. Meta-
analysis showed that age, type of CHD, cardiac reoperation, biventricular
shunt before operation, CPB duration, ACC duration, postoperative residual
shunt, cTn-1 level 2 h after CPB > 14 ng/ml and postoperative 24 h
MR-ProADM level > 1.5 nmol/l were independent risk factors of LCOS.
Additionally, the level of blood oxygen saturation before the operation
was found to have no statistically significant relationship with LOCS.
 Conclusion(s): The risk factors of postoperative LCOS in children
with CHD are related to disease condition, intraoperative time and
postoperative related indexes, so early prevention should be aimed at
high-risk children. Systematic Review Registration:
https://www.crd.york.ac.uk/prospero/, identifier:
CRD42022323043. Copyright 2023 Wang, Chuan, Tang and Zhu.

<69>
Accession Number
2024055398
Title
Coronary surgery provides better survival than drug-eluting stent: A
pooled meta-analysis of Kaplan-Meier-derived individual patient data.
Source
Journal of Thoracic and Cardiovascular Surgery. 167(6) (pp 2138-2146.e3),
2024. Date of Publication: June 2024.
Author
Urso S.; Sadaba R.; Gonzalez-Martin J.M.; Dayan V.; Nogales E.; Tena M.A.;
Abad C.; Portela F.
Institution
(Urso, Tena, Abad, Portela) Cardiac Surgery Department, Hospital
Universitario Dr Negrin, Las Palmas de Gran Canaria, Spain
(Sadaba) Cardiac Surgery Department, Hospital Universitario de Navarra,
Pamplona, Spain
(Gonzalez-Martin) Research Unit, Hospital Universitario Dr Negrin, Las
Palmas de Gran Canaria, Spain
(Dayan) Cardiac Surgery Department, Centro Cardiovascular Universitario,
Universidad de la Republica, Montevideo, Uruguay
(Nogales) Cardiology Department, Complejo Hospitalario Universitario
Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
Publisher
Elsevier Inc.
Abstract
Objectives: We explored the current evidence on coronary disease treatment
comparing the survival of 2 therapeutic strategies: coronary artery bypass
grafting (CABG) and percutaneous coronary intervention (PCI) with
drug-eluting stent (DES). Method(s): PubMed, Embase, and Google
Scholar were searched for randomized clinical trials comparing CABG versus
PCI with DES. The end point was overall mortality. Two statistical
approaches were used: the generic inverse variance method, which was used
to pool the incident rate ratios, and the pooled meta-analysis of
Kaplan-Meier-derived individual patient data. Result(s): Eight
randomized clinical trials comparing 4975 patients undergoing CABG and
4992 patients undergoing PCI were included in our meta-analysis. Generic
inverse variance method showed a statistically significant survival
benefit of the CABG group (incident rate ratio, 1.21; 95% confidence
interval, 1.09-1.35; P < .01). The Kaplan-Meier estimates of survival at
1, 5, and 10 years of the CABG group were 97.1%, 90.3%, and 80.3%,
respectively. The Kaplan-Meier estimates of survival at 1, 5, and 10 years
of the PCI group were 97.0%, 87.7%, and 76.4%, respectively. The log-rank
analysis confirmed a statistically significant benefit in term of overall
mortality of the CABG group (hazard ratio, 1.24; 95% confidence interval,
1.11-1.38; P = .0001). Conclusion(s): The present meta-analysis
suggests that CABG provides a consistent survival benefit over PCI with
DES. Copyright © 2023 The American Association for Thoracic
Surgery

<70>
Accession Number
2031325058
Title
Heel skin microclimate control: Secondary analysis of a self-controlled
randomized clinical trial.
Source
Journal of Tissue Viability. 33(2) (pp 305-311), 2024. Date of
Publication: May 2024.
Author
Eberhardt T.D.; Lima S.B.D.; Pozzebon B.R.; Santos K.P.D.; Silveira
L.B.D.; Soares R.S.D.A.; Alves P.J.
Institution
(Eberhardt) University of Passo Fundo, RS, Brazil
(Lima, Santos, Silveira) University Federal of Santa Maria, RS, Brazil
(Pozzebon) Hospital Santa Cruz, RS, Santa Cruz do Sul, Brazil
(Soares) Polytechnic College of University Federal of Santa Maria, RS,
Brazil
(Alves) Portuguese Catholic University, Porto, Portugal
Publisher
Tissue Viability Society
Abstract
Objective: this study was undertaken to evaluate the efficacy of
multilayer polyurethane foam with silicone (MPF) compared to transparent
polyurethane film (TPF) dressings in the control of heel skin microclimate
(temperature and moisture) of hospitalized patients undergoing elective
surgeries. Method(s): the study took of a secondary analysis of a
randomized self-controlled trial, involving patients undergoing elective
surgical procedure of cardiac and gastrointestinal specialties in a
university hospital in southern Brazil, from March 2019 to February 2020.
Patients served as their own control, with their heels randomly allocated
to either TPF (control) or MPF (intervention). Skin temperature was
measured using a digital infrared thermometer; and moisture determined
through capacitance, at the beginning and end of surgery. The study was
registered in the Brazilian Registry of Clinical Trials: RBR-5GKNG5.
 Result(s): significant difference in the microclimate variables were
observed when the groups (intervention and control) and the timepoint of
measurement (beginning and end of surgery) were compared. When assessing
temperature, an increase (+3.3 degreeC) was observed with TPF and a
decrease (-7.4 degreeC) was recorded with MPF. Regarding skin moisture, an
increase in moisture (+14.6 AU) was recorded with TPF and a slight
decrease (-0.3 AU) with MPF. Conclusion(s): The findings of this
study suggest that MPF is more effective than TPF in controlling skin
microclimate (temperature and moisture) in heels skin of hospitalized
patients undergoing elective surgeries. However, this control should be
better investigated in other studies. Copyright © 2024 Tissue
Viability Society / Society of Tissue Viability

<71>
Accession Number
643760557
Title
Impact of subclinical hypothyroidism on outcomes after coronary artery
bypass grafting: a systematic review and meta-analysis.
Source
The Journal of cardiovascular surgery. 65(2) (pp 155-160), 2024. Date of
Publication: 01 Apr 2024.
Author
Larik M.O.; Shahid A.R.; Shiraz M.I.; Urooj M.
Institution
(Larik) Department of Medicine, Dow International Medical College,
Karachi, Pakistan
(Shahid, Shiraz, Urooj) Department of Medicine, Dow International Medical
College, Karachi, Pakistan
Abstract
INTRODUCTION: Coronary artery bypass grafting (CABG) is a surgical
procedure that restores blood flow to heart muscle by bypassing the
blocked or narrowed coronary arteries. On the other hand, subclinical
hypothyroidism (SCH) is characterized by an elevated serum concentration
of thyroid stimulating hormone with normal levels of serum free thyroxine.
With limited research into the impact of SCH on postoperative CABG
outcomes, this systematic review and meta-analysis was performed. EVIDENCE
ACQUISITION: An electronic search of PubMed, Cochrane Library, and Scopus
was performed from inception to April 2023. After the inclusion of five
studies, a total of 2,786 patients were pooled in this quantitative
synthesis. EVIDENCE SYNTHESIS: It was observed that SCH significantly
increased cardiovascular mortality (OR: 2.80; 95% CI: 1.37, 5.72;
P=0.005), and all-cause mortality (OR: 2.62; 95% CI: 1.80, 3.80;
P<0.00001). However, no significant differences were observed for
secondary outcomes, including major adverse cardiac events, incidence of
postoperative stroke, and incidence of postoperative myocardial
infarction. CONCLUSION(S): To the best of our knowledge, this is the
first meta-analysis conducted that evaluates the impact of SCH on outcomes
after CABG. The preoperative assessment of thyroid function may be
considered prior to cardiovascular procedures, particularly within CABG.
However, future comprehensive studies, with individual participant-level
data, are necessary in order to arrive at a valid conclusion and
recommendation.

<72>
Accession Number
627182683
Title
Usefulness of skeletal muscle area detected by computed tomography to
predict mortality in patients undergoing transcatheter aortic valve
replacement: a meta-analysis study.
Source
International Journal of Cardiovascular Imaging. 35(6) (pp 1141-1147),
2019. Date of Publication: June 2019.
Author
Soud M.; Alahdab F.; Ho G.; Kuku K.O.; Cejudo-Tejeda M.; Hideo-Kajita A.;
Goncalves P.A.; Teles R.C.; Waksman R.; Garcia-Garcia H.M.
Institution
(Soud, Ho, Kuku, Cejudo-Tejeda, Hideo-Kajita, Waksman, Garcia-Garcia)
Section of Interventional Cardiology, MedStar Washington Hospital Center,
110 Irving St NW, Washington, DC 20010, United States
(Alahdab) Mayo Clinic Evidence-based Practice Center, Mayo Clinic,
Rochester, MN, United States
(Goncalves) Hospital da Luz, Luz-Saude, Av. Lusiada 100, Lisbon 1500-650,
Portugal
(Goncalves, Teles) Hospital de Santa Cruz - Centro Hospitalar de Lisboa
Ocidental, Lisbon, Carnaxide, Portugal
(Goncalves) Chronic Diseases Research Center - Nova Medical School,
Lisbon, Portugal
Publisher
Springer Science and Business Media B.V.
Abstract
Measures of sarcopenia, such as low muscle mass measured from the readily
available preoperative computed tomography (CT) images, have been recently
suggested as a predictor of outcomes in patients undergoing transcatheter
aortic valve replacement (TAVR). However, results of these studies are
variable and, therefore, we performed a systematic review of current
literature to evaluate sarcopenia as a predictor of outcome post TAVR. The
search was carried out in electronic databases between 2008 and 2018. We
identified studies that reported CT-derived skeletal muscle area (SMA) and
survival outcomes post TAVR. Studies were evaluated for the incidence of
early (<= 30 days) and late all-cause mortality (>30 days) post TAVR.
Eight studies with 1881 patients were included (mean age of 81.8 years +/-
12, 55.9% men). Mean body mass index was (28.2 kg/m2 +/- 1.1),
mean Society of Thoracic Surgeons risk score (7.0 +/- 0.6), and mean
albumin level was (3.8 g/ dL +/- 0.1). Higher SMA was associated with
lower long-term mortality [odds ratio (OR) 0.49, 95% confidence interval
(CI) 0.28-0.83, p = 0.049], compared with low SMA. Also, higher SMA was
associated with lower early mortality but was not statistically
significant (OR 0.72; 95% CI 0.44-1.18; p = 0.285). CT-derived SMA
provides value in predicting post-TAVR long-term outcomes for patients
undergoing TAVR. This is a simple risk assessment tool that may help in
making treatment decisions and help identifying and targeting high-risk
patients with interventions to improve muscle mass prior to and following
the procedures. Copyright © Springer Nature B.V. 2019.

<73>
Accession Number
2029813315
Title
Comparison between Imaging and Physiology in Guiding Coronary
Revascularization: A Meta-Analysis.
Source
Journal of Clinical Medicine. 13(9) (no pagination), 2024. Article Number:
2504. Date of Publication: May 2024.
Author
Improta R.; Di Pietro G.; Giansanti M.; Bruno F.; De Filippo O.; Tocci M.;
Colantonio R.; Sardella G.; D'Ascenzo F.; Mancone M.
Institution
(Improta, Di Pietro, Giansanti, Tocci, Colantonio, Sardella, Mancone)
Department of Clinical, Internal, Anesthesiology and Cardiovascular
Sciences, Umberto I Hospital, Sapienza University of Rome, Viale del
Policlinico 155 (Emodinamica A, Ottavo Padiglione, II Piano), Rome 00161,
Italy
(Bruno, De Filippo, D'Ascenzo) Department of Medical Science, Division of
Cardiology, Molinette Hospital, Turin University, Turin 10124, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Percutaneous coronary intervention (PCI) is a widely used
revascularization strategy for coronary artery disease. The choice between
imaging-guided and physiology-guided PCI has been a subject of debate.
This meta-analysis aims to systematically compare outcomes between imaging
and physiology-guided PCI and management of intermediate coronary lesions
(ICLs). Method(s): A comprehensive literature search was conducted
across major databases for studies published up to December 2023 following
PRISMA guidelines. Seven eligible studies comparing imaging-guided and
physiology-guided PCI were selected for the final analysis. Relevant
outcome measures included major adverse cardiovascular events (MACE),
target vessel revascularization (TVR), target vessel failure (TVF), and
target lesion revascularization (TLR). Subgroup analysis was performed for
ICLs. Result(s): A total of 5701 patients were included in the
meta-analysis. After a mean follow-up of 2.1 years, imaging-guided PCI was
associated with lower rates of TVR compared to physiology-guided PCI (OR
0.70, 95% CI 0.52-0.95, p = 0.02); concerning MACE, TVF, and TLR, no
differences were found. When the analysis was restricted to studies
considering ICLs management, there were no differences between the two
techniques. Meta regression analysis did not show any impact of acute
coronary syndromes (ACS) presentation on MACE and TVR. Conclusion(s):
The findings suggest that imaging-guided PCI may reduce the need for
future revascularization of the target vessel compared to the
functional-guided approach, and this result was not influenced by ACS
presentation. These results may have important implications for clinical
practice, guiding interventional cardiologists in selecting the most
appropriate guidance strategy. Copyright © 2024 by the authors.

<74>
Accession Number
2031984282
Title
Feasibility study of rehabilitation for cardiac patients aided by an
artificial intelligence web-based programme: a randomised controlled trial
(RECAP trial)-a study protocol.
Source
BMJ Open. 14(4) (no pagination), 2024. Article Number: e079404. Date of
Publication: 30 Apr 2024.
Author
Witharana P.; Chang L.; Maier R.; Ogundimu E.; Wilkinson C.; Athanasiou
T.; Akowuah E.
Institution
(Witharana, Chang, Maier, Wilkinson, Akowuah) Academic Cardiovascular
Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United
Kingdom
(Witharana, Athanasiou) Department of Surgery and Cancer, Imperial College
London, London, United Kingdom
(Ogundimu) Mathematical Sciences, University of Durham, Durham, United
Kingdom
(Wilkinson) Hull York Medical School, University of York, York, United
Kingdom
Publisher
BMJ Publishing Group
Abstract
Introduction Cardiac rehabilitation (CR) delivered by rehabilitation
specialists in a healthcare setting is effective in improving functional
capacity and reducing readmission rates after cardiac surgery. It is also
associated with a reduction in cardiac mortality and recurrent myocardial
infarction. This trial assesses the feasibility of a home-based CR
programme delivered using a mobile application (app). Methods The
Rehabilitation through Exercise prescription for Cardiac patients using an
Artificial intelligence web-based Programme (RECAP) randomised controlled
feasibility trial is a single-centre prospective study, in which patients
will be allocated on a 1:1 ratio to a home-based CR programme delivered
using a mobile app with accelerometers or standard hospital-based
rehabilitation classes. The home-based CR programme will employ artificial
intelligence to prescribe exercise goals to the participants on a weekly
basis. The trial will recruit 70 patients in total. The primary objectives
are to evaluate participant recruitment and dropout rates, assess the
feasibility of randomisation, determine acceptability to participants and
staff, assess the rates of potential outcome measures and determine
hospital resource allocation to inform the design of a larger randomised
controlled trial for clinical efficacy and health economic evaluation.
Secondary objectives include evaluation of health-related quality of life
and 6 minute walk distance. Ethics and dissemination RECAP trial received
a favourable outcome from the Berkshire research ethics committee in
September 2022 (IRAS 315483). Trial results will be made available through
publication in peer-reviewed journals and presented at relevant scientific
meetings. Copyright © Author(s) (or their employer(s)) 2024.

<75>
Accession Number
2032083727
Title
Unmasking the NLRP3 inflammasome in dendritic cells as a potential
therapeutic target for autoimmunity, cancer, and infectious conditions.
Source
Life Sciences. 348 (no pagination), 2024. Article Number: 122686. Date of
Publication: 01 Jul 2024.
Author
Alipour S.; Mardi A.; Shajari N.; Kazemi T.; Sadeghi M.R.; Ahmadian Heris
J.; Masoumi J.; Baradaran B.
Institution
(Alipour, Mardi, Shajari, Ahmadian Heris, Masoumi, Baradaran) Immunology
Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,
Islamic Republic of
(Alipour, Mardi, Kazemi, Baradaran) Department of Immunology, Faculty of
Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
(Alipour, Mardi) Student Research Committee, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Sadeghi) Department of Molecular Medicine, Faculty of Advanced Medical
Sciences, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
Publisher
Elsevier Inc.
Abstract
Proper and functional immune response requires a complex interaction
between innate and adaptive immune cells, which dendritic cells (DCs) are
the primary actors in this coordination as professional antigen-presenting
cells. DCs are armed with numerous pattern recognition receptors (PRRs)
such as nucleotide-binding and oligomerization domain-like receptors
(NLRs) like NLRP3, which influence the development of their activation
state upon sensation of ligands. NLRP3 is a crucial component of the
immune system for protection against tumors and infectious agents, because
its activation leads to the assembly of inflammasomes that cause the
formation of active caspase-1 and stimulate the maturation and release of
proinflammatory cytokines. But, when NLRP3 becomes overactivated, it plays
a pathogenic role in the progression of several autoimmune disorders. So,
NLRP3 activation is strictly regulated by diverse signaling pathways that
are mentioned in detail in this review. Furthermore, the role of NLRP3 in
all of the diverse immune cells' subsets is briefly mentioned in this
study because NLRP3 plays a pivotal role in modulating other immune cells
which are accompanied by DCs' responses and subsequently influence
differentiation of T cells to diverse T helper subsets and even impact on
cytotoxic CD8+ T cells' responses. This review sheds light on
the functional and therapeutic role of NLRP3 in DCs and its contribution
to the occurrence and progression of autoimmune disorders, prevention of
diverse tumors' development, and recognition and annihilation of various
infectious agents. Furthermore, we highlight NLRP3 targeting potential for
improving DC-based immunotherapeutic approaches, to be used for the
benefit of patients suffering from these disorders. Copyright ©
2024 Elsevier Inc.

<76>
Accession Number
2031489437
Title
Ticagrelor alone versus ticagrelor plus aspirin from month 1 to month 12
after percutaneous coronary intervention in patients with acute coronary
syndromes (ULTIMATE-DAPT): a randomised, placebo-controlled, double-blind
clinical trial.
Source
The Lancet. 403(10439) (pp 1866-1878), 2024. Date of Publication: 11 May
2024.
Author
Ge Z.; Kan J.; Gao X.; Raza A.; Zhang J.-J.; Mohydin B.S.; Gao F.; Wang
Y.; Zeng H.; Li F.; Mengal N.; Cong H.; Wang M.; Chen L.; Wei Y.; Chen F.;
Stone G.W.; Chen S.-L.; Li X.; Anjum M.; Ye F.; Jalal A.; Xie P.; Tao L.;
Chen X.; Khan H.S.; Javed A.; Shao Y.; Guo X.; Saghir T.; Nie S.; Qu H.;
Qian X.; Yang S.; Chen J.; Gao D.; Liu L.; Liu F.; Xu T.; Liu Y.; Gill
B.U.A.; Yang Q.; Guo N.; Wen S.; Hong L.; Sheiban I.; Mintz G.S.
Institution
(Ge, Kan, Gao, Zhang, Chen) Nanjing First Hospital, Nanjing Medical
University, Nanjing, China
(Raza) Airdale General Hospital, West Yorkshire, United Kingdom
(Mohydin) Punjab Institute of Cardiology, Lahore, Pakistan
(Gao) Gansu Provincial People's Hospital, Lanzhou, China
(Shao) Qingdao Municipal Hospital, Qingdao, China
(Wang) Xiamen Heart Center, Xiamen University, Xiamen, China
(Zeng) Tongji Hospital, Tongji Medical College, Huazhong University of
Science and Technology, Wuhan, China
(Li) Affiliated Oriental Huainan General Hospital, Anhui University of
Science and Technology, Huainan, China
(Khan) Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
(Mengal) National Institute of Cardiovascular Diseases of Pakistan,
Karaqi, Pakistan
(Cong) Tianjin Chest Hospital, Tianjin University, Tianjin, China
(Wang) Puto People's Hospital, Tongji University, Shanghai, China
(Chen) Fujian Medical University Union Hospital, Fuzhou, China
(Wei) Center for Public Health and Epidemic Preparedness & Response,
Peking University, Beijing, China
(Chen) School of Public Health, Center of Global Health, Nanjing Medical
University, Nanjing, China
(Stone) The Zena and Michael A Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier B.V.
Abstract
Background: Following percutaneous coronary intervention with stent
placement to treat acute coronary syndromes, international clinical
guidelines generally recommend dual antiplatelet therapy with aspirin plus
a P2Y<inf>12</inf> receptor inhibitor for 12 months to prevent myocardial
infarction and stent thrombosis. However, data on single antiplatelet
therapy with a potent P2Y<inf>12</inf> inhibitor earlier than 12 months
after percutaneous coronary intervention for patients with an acute
coronary syndrome are scarce. The aim of this trial was to assess whether
the use of ticagrelor alone, compared with ticagrelor plus aspirin, could
reduce the incidence of clinically relevant bleeding events without an
accompanying increase in major adverse cardiovascular or cerebrovascular
events (MACCE). Method(s): In this randomised, placebo-controlled,
double-blind clinical trial, patients aged 18 years or older with an acute
coronary syndrome who completed the IVUS-ACS study and who had no major
ischaemic or bleeding events after 1-month treatment with dual
antiplatelet therapy were randomly assigned to receive oral ticagrelor (90
mg twice daily) plus oral aspirin (100 mg once daily) or oral ticagrelor
(90 mg twice daily) plus a matching oral placebo, beginning 1 month and
ending at 12 months after percutaneous coronary intervention (11 months in
total). Recruitment took place at 58 centres in China, Italy, Pakistan,
and the UK. Patients were required to remain event-free for 1 month on
dual antiplatelet therapy following percutaneous coronary intervention
with contemporary drug-eluting stents. Randomisation was done using a
web-based system, stratified by acute coronary syndrome type, diabetes,
IVUS-ACS randomisation, and site, using dynamic minimisation. The primary
superiority endpoint was clinically relevant bleeding (Bleeding Academic
Research Consortium [known as BARC] types 2, 3, or 5). The primary
non-inferiority endpoint was MACCE (defined as the composite of cardiac
death, myocardial infarction, ischaemic stroke, definite stent thrombosis,
or clinically driven target vessel revascularisation), with an expected
event rate of 6.2% in the ticagrelor plus aspirin group and an absolute
non-inferiority margin of 2.5 percentage points between 1 month and 12
months after percutaneous coronary intervention. The two co-primary
endpoints were tested sequentially; the primary superiority endpoint had
to be met for hypothesis testing of the MACCE outcome to proceed. All
principal analyses were assessed in the intention-to-treat population.
This trial is registered with ClinicalTrials.gov, NCT03971500, and is
completed. Finding(s): Between Sept 21, 2019, and Oct 27, 2022, 3400
(97.0%) of the 3505 participants in the IVUS-ACS study were randomly
assigned (1700 patients to ticagrelor plus aspirin and 1700 patients to
ticagrelor plus placebo). 12-month follow-up was completed by 3399
(>99.9%) patients. Between month 1 and month 12 after percutaneous
coronary intervention, clinically relevant bleeding occurred in 35
patients (2.1%) in the ticagrelor plus placebo group and in 78 patients
(4.6%) in the ticagrelor plus aspirin group (hazard ratio [HR] 0.45 [95%
CI 0.30 to 0.66]; p<0.0001). MACCE occurred in 61 patients (3.6%) in the
ticagrelor plus placebo group and in 63 patients (3.7%) in the ticagrelor
plus aspirin group (absolute difference -0.1% [95% CI -1.4% to 1.2%]; HR
0.98 [95% CI 0.69 to 1.39]; p<inf>non-inferiority</inf><0.0001,
p<inf>superiority</inf>=0.89). Interpretation(s): In patients with an
acute coronary syndrome who had percutaneous coronary intervention with
contemporary drug-eluting stents and remained event-free for 1 month on
dual antiplatelet therapy, treatment with ticagrelor alone between month 1
and month 12 after the intervention resulted in a lower rate of clinically
relevant bleeding and a similar rate of MACCE compared with ticagrelor
plus aspirin. Along with the results from previous studies, these findings
show that most patients in this population can benefit from superior
clinical outcomes with aspirin discontinuation and maintenance on
ticagrelor monotherapy after 1 month of dual antiplatelet therapy.
 Funding(s): The Chinese Society of Cardiology, the National Natural
Scientific Foundation of China, and the Jiangsu Provincial & Nanjing
Municipal Clinical Trial Project. Translation: For the Mandarin
translation of the abstract see Supplementary Materials
section. Copyright © 2024 Elsevier Ltd

<77>
Accession Number
2022989968
Title
Head-to-head comparison between left atrial appendage occlusion and
non-vitamin K oral anticoagulants in non-valvular atrial fibrillation
patients: A systematic review and meta-analysis study.
Source
Trends in Cardiovascular Medicine. 34(4) (pp 225-233), 2024. Date of
Publication: May 2024.
Author
Waranugraha Y.; Lin L.-Y.; Tsai C.-T.
Institution
(Waranugraha) Department of Cardiology and Vascular Medicine, Faculty of
Medicine, Universitas Brawijaya, Universitas Brawijaya Brawijaya
University Hospital, Malang, Indonesia
(Lin, Tsai) Division of Cardiology, Department of Internal Medicine,
National Taiwan University College of Medicine and Hospital, Taipei,
Taiwan (Republic of China)
Publisher
Elsevier Inc.
Abstract
Left atrial appendage occlusion (LAAO) was found to be non-inferior to
warfarin. In non-valvular atrial fibrillation (AF), there is still a
scarcity of data comparing LAAO versus non-vitamin K oral anticoagulants
(NOACs). Our purpose was to compare the clinical benefits between LAAO and
NOACs in non-valvular AF patients. The patient, intervention, comparison,
and outcome principles were used to develop the research question in this
systematic review and meta-analysis. Literature searches were conducted in
online scientific databases such as ProQuest, PubMed, and ScienceDirect.
All important information was extracted. The random-effect model was
applied to estimate all pooled effects. The Mantel-Haenszel statistical
method was used to determine the pooled risk ratio (RR) and 95% confidence
interval (CI). A total of 4411 participants from 5 studies were involved.
LAAO significantly decreased the cardiovascular mortality risk compared to
NOACs (RR = 0.56; 95% CI = 0.42 to 0.75; p <0.01). Major bleeding risk in
the LAAO group was significantly lower than in the NOACs group (RR = 0.66;
RR = 0.53 to 0.82; p <0.01). A significantly lower risk of major bleeding
or non-major bleeding in the patients receiving LAAO than NOACs was also
observed in this meta-analysis (RR = 0.66; 95% CI = 0.54 to 0.81; p
<0.01). LAAO was superior to the NOACs in reducing cardiovascular
mortality, major bleeding, and major or non-major bleeding risks in
non-valvular AF patients. In high-risk thromboembolism and bleeding
patients, LAAO can be considered first as a long-term treatment
strategy. Copyright © 2023

<78>
Accession Number
2031846949
Title
Do platelets protect the heart against ischemia/reperfusion injury or
exacerbate cardiac ischemia/reperfusion injury? The role of PDGF, VEGF,
and PAF.
Source
Life Sciences. 347 (no pagination), 2024. Article Number: 122617. Date of
Publication: 15 Jun 2024.
Author
Voronkov N.S.; Maslov L.N.; Vyshlov E.V.; Mukhomedzyanov A.V.; Ryabov
V.V.; Derkachev I.A.; Kan A.; Gusakova S.V.; Gombozhapova A.E.; Panteleev
O.O.
Institution
(Voronkov, Maslov, Vyshlov, Mukhomedzyanov, Ryabov, Derkachev, Kan,
Gombozhapova, Panteleev) Department of Emergency Cardiology and Laboratory
of Experimental Cardiology, Cardiology Research Institute, Tomsk National
Research Medical Center, Russian Academy of Sciences, Tomsk 634012,
Russian Federation
(Gusakova) Department of Biophysics and Functional Diagnostics, Siberian
State Medical University, Tomsk 634050, Russian Federation
Publisher
Elsevier Inc.
Abstract
Background: Acute myocardial infarction (AMI) is one of the main causes of
death. It is quite obvious that there is an urgent need to develop new
approaches for treatment of AMI. Objective(s): This review analyzes
data on the role of platelets in the regulation of cardiac tolerance to
ischemia/reperfusion (I/R). Method(s): It was performed a search of
topical articles using PubMed databases. Finding(s): Platelets
activated by a cholesterol-enriched diet, thrombin, and myocardial
ischemia exacerbate I/R injury of the heart. The P2Y<inf>12</inf> receptor
antagonists, remote ischemic postconditioning and conditioning alter the
properties of platelets. Platelets acquire the ability to increase cardiac
tolerance to I/R. Platelet-derived growth factors (PDGFs) increase
tolerance of cardiomyocytes and endothelial cells to I/R. PDGF receptors
(PDGFRs) were found in cardiomyocytes and endothelial cells. PDGFs
decrease infarct size and partially abrogate adverse postinfarction
remodeling. Protein kinase C, phosphoinositide 3-kinase, and Akt involved
in the cytoprotective effect of PDGFs. Vascular endothelial growth factor
increased cardiac tolerance to I/R and alleviated adverse postinfarction
remodeling. The platelet-activating factor (PAF) receptor inhibitors
increase cardiac tolerance to I/R in vivo. PAF enhances cardiac tolerance
to I/R in vitro. It is possible that PAF receptor inhibitors could protect
the heart by blocking PAF receptor localized outside the heart. PAF
protects the heart through activation of PAF receptor localized in
cardiomyocytes or endothelial cells. Reactive oxygen species and kinases
are involved in the cardioprotective effect of PAF. Conclusion(s):
Platelets play an important role in the regulation of cardiac tolerance to
I/R. Copyright © 2024

<79>
Accession Number
2031843488
Title
A randomised multicentre study of angiography- versus physiology-guided
percutaneous coronary intervention in patients with coronary artery
disease undergoing TAVI: design and rationale of the FAITAVI trial.
Source
EuroIntervention. 20(8) (pp E504-E510), 2024. Date of Publication: 15 Apr
2024.
Author
Ribichini F.; Pesarini G.; Fabris T.; Lunardi M.; Barbierato M.; D'Amico
G.; Zanchettin C.; Gregori D.; Piva T.; Nicolini E.; Gandolfo C.; Fineschi
M.; Petronio A.S.; Berti S.; Caprioglio F.; Saia F.; Sclafani R.; Esposito
G.; D'Ascenzo F.; Tarantini G.
Institution
(Ribichini, Pesarini, Lunardi) Department of Medicine, Division of
Cardiology, University of Verona, Verona, Italy
(Fabris, Zanchettin, Gregori, Tarantini) Department of Cardiac, Thoracic
and Vascular Science, University of Padova, Padova, Italy
(Barbierato, D'Amico, Zanchettin) Division of Cardiology, Ospedale
dell'Angelo di Mestre, Chirignago, Zelarino, Italy
(Piva, Nicolini) Division of Cardiology, Azienda Ospedaliero Universitaria
delle Marche, Ancona, Italy
(Gandolfo) Division of Cardiology, ISMETT di Palermo, Palermo, Italy
(Fineschi) Division of Cardiology, Azienda Ospedaliera Universitaria
Senese, Siena, Italy
(Petronio) Division of Cardiology, Azienda Ospedaliero Universitaria
Pisana, Pisa, Italy
(Berti) Division of Cardiology, Ospedale del Cuore, Fondazione Monasterio,
Massa, Italy
(Caprioglio) Division of Cardiology, Ospedale San Bortolo di Vicenza,
Vicenza, Italy
(Saia) Division of Cardiology, Policlinico S. Orsola-Malpighi, Bologna,
Italy
(Sclafani) Division of Cardiology, Azienda Ospedaliera di Perugia,
Ospedale S. Maria della Misericordia, Perugia, Italy
(Esposito) Division of Cardiology, Policlinico Universitario Federico II
di Napoli, Napoli, Italy
(D'Ascenzo) Division of Cardiology, Department of Medical Sciences, Citta
della Salute e della Scienza, Hospital University of Turin, Torino, Italy
Publisher
Europa Group
Abstract
The treatment of coronary artery disease (CAD) in patients with severe
aortic valve stenosis (AVS) eligible for transcatheter aortic valve
implantation (TAVI) is not supported by clinical evidence, and the role of
physiology over anatomy as well as the timing of coronary intervention are
not defined. FAITAVI (ClinicalTrials.gov: NCT03360591) is a nationwide
prospective, open-label, multicentre, randomised controlled study
comparing the angiography-guided versus the physiology-guided coronary
revascularisation strategy in patients with combined significant CAD and
severe AVS undergoing TAVI. Significant CAD will be defined as coronary
stenosis >=50%, as assessed by visual estimation in vessels >=2.5 mm.
Physiology will be tested by fractional flow reserve (FFR) and
instantaneous wave-free ratio (iFR). The study will be conducted at 15
sites in Italy. In the angiography arm, percutaneous coronary intervention
(PCI) will be performed either before TAVI, during the TAVI procedure -
before or after the valve implantation - or within 1 month+/-5 days of the
valve implantation, left to the operator's decision. In the physiology
arm, FFR and iFR will be performed before TAVI, and PCI will be indicated
for FFR <=0.80, otherwise the intervention will be deferred. In case of
borderline values (0.81-0.85), FFR and iFR will be repeated after TAVI,
with PCI performed when needed. With a sample size of 320 patients, the
study is powered to evaluate the primary endpoint (a composite of death,
myocardial infarction, stroke, major bleeding, or ischaemia-driven target
vessel revascularisation). TAVI indication, strategy and medical treatment
will be the same in both groups. After discharge, patients will be
contacted at 1, 6, 12 and 24 months after the procedure to assess their
general clinical status, and at 12 months for the occurrence of events
included in the primary and secondary endpoints. FAITAVI is the first
randomised clinical trial to investigate "optimal" percutaneous coronary
intervention associated with TAVI in patients with severe AVS and
CAD. Copyright © Europa Digital & Publishing 2024. All rights
reserved.

<80>
Accession Number
2029154173
Title
Postoperative pulmonary complications in adult surgical patients in low-to
middle-income countries: a systematic review and meta-analysis.
Source
Southern African Journal of Anaesthesia and Analgesia. 30(2) (pp 51-61),
2024. Date of Publication: 24 Apr 2024.
Author
Earle E.; Turton E.W.; Rodseth R.N.
Institution
(Earle, Turton) Department of Anaesthesiology, School of Clinical
Sciences, Faculty of Health Sciences, University of the Free State, South
Africa
(Rodseth) Department of Anaesthesia, Greys Hospital, University of
KwaZulu-Natal, South Africa
(Rodseth) Consistency of Care Division, Netcare Ltd, South Africa
Publisher
Medpharm Publications
Abstract
Background: After surgery, patients are at risk of developing
postoperative pulmonary complications (PPCs). Our current understanding of
PPCs is based on data from high-income countries (HICs). Method(s): A
systematic review and meta-analysis was conducted to evaluate the
incidence of PPCs in adult postsurgical patients from low-to middle-income
countries (LMICs). The protocol was registered on the PROSPERO database
(CRD42020212932). The search strategy was performed in 2021 on several
electronic databases. Studies were assessed for risk of bias with the
modified Newcastle-Ottawa Scale. Forest plots of the event rate for the
incidence of PPCs and factors associated with PPCs were created.
 Result(s): The search strategy identified 1 052 records. Fifteen
studies were included in the final review (total of 4 873 participants).
Five studies were of high methodological quality. The overall pooled event
rate for the incidence of PPCs was 22.4% (95% confidence interval (CI),
15.76-30.78%). In-hospital mortality in patients who developed PPCs was
33.1%. PPCs were identified as a risk factor for in-hospital mortality
(odds ratio (OR) 18.2, CI 11.01-30.09). Insufficient outcome data were
available to determine the association of PPCs between elective versus
emergency surgery, and cardiothoracic versus non-cardiothoracic surgery.
Advanced age was associated with the development of PPCs (MD 4.7, 95% CI
0.63-8.7). Male sex was associated with the development of PPCs (OR 1.5,
95% CI 1.17-2.02). PPCs were associated with increased length of hospital
stay (mean difference (MD) 6.5, 95% CI 4.04-8.96). Conclusion(s): The
incidence of PPCs was 22.4% following surgery in adult patients in LMICs
and was influenced by differences in the definitions of PPCs used. PPCs
were identified as a risk factor for in-hospital mortality. Data on the
type of surgery and patient characteristics were poorly reported. Further
research on PPCs in LMICs is needed to provide granular data for future
use. Copyright © 2024 The Author(s).

<81>
Accession Number
2029136295
Title
Impact of Prosthesis-Patient Mismatch After Surgical Aortic Valve
Replacement: Systematic Review and Meta-Analysis of Reconstructed
Time-to-Event Data of 122 989 Patients With 592 952 Patient-Years.
Source
Journal of the American Heart Association. 13(7) (no pagination), 2024.
Article Number: e033176. Date of Publication: 2024.
Author
Sa M.P.; Jacquemyn X.; Van den Eynde J.; Chu D.; Serna-Gallegos D.; Ebels
T.; Clavel M.-A.; Pibarot P.; Sultan I.
Institution
(Sa, Chu, Serna-Gallegos, Sultan) Department of Cardiothoracic Surgery,
University of Pittsburgh, PA, United States
(Sa, Chu, Serna-Gallegos, Sultan) University of Pittsburgh Medical Center,
UPMC Heart and Vascular Institute, Pittsburgh, PA, United States
(Jacquemyn, Van den Eynde) Department of Cardiovascular Sciences, KU
Leuven, Leuven, Belgium
(Ebels) Department of Cardiothoracic Surgery, University Medical Center
Groningen, University of Groningen, Netherlands
(Clavel, Pibarot) Centre de Recherche de l'Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
(Clavel, Pibarot) Department of Medicine, Faculty of Medicine, Universite
Laval, Quebec City, QC, Canada
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: It remains controversial whether prosthesis-patient mismatch
(PPM) impacts long-term outcomes after surgical aortic valve replacement.
We aimed to evaluate the association of PPM with mortality,
rehospitalizations, and aortic valve reinterventions. METHODS AND RESULTS:
We performed a systematic review with meta-analysis of reconstructed
time-to-event data of studies published by March 2023 (according to the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses).
Sixty-five studies met our eligibility criteria and included 122 989
patients (any PPM: 68 332 patients, 55.6%). At 25 years of follow-up, the
survival rates were 11.8% and 20.6% in patients with and without any PPM,
respectively (hazard ratio [HR], 1.16 [95% CI, 1.13-1.18], P<0.001). At 20
years of follow-up, the survival rates were 19.5%, 12.1%, and 8.8% in
patients with no, moderate, and severe PPM, respectively (moderate versus
no PPM: HR, 1.09 [95% CI, 1.06-1.11], P<0.001; severe versus no PPM: HR,
1.29 [95% CI, 1.24-1.35], P<0.001). PPM was associated with higher risk of
cardiac death, heart failure-related hospitalizations, and aortic valve
reinterventions over time (P<0.001). Statistically significant
associations between PPM and worse survival were observed regardless of
valve type (bioprosthetic versus mechanical valves), contemporary PPM
definitions unadjusted and adjusted for body mass index, and PPM
quantification method (in vitro, in vivo, Doppler echocardiography). Our
meta-regression analysis revealed that populations with more women tend to
have higher HRs for all-cause death associated with PPM.
 CONCLUSION(S): The results of the present study suggest that any
degree of PPM is associated with poorer long-term outcomes following
surgical aortic valve replacement and provide support for implementation
of preventive strategies to avoid PPM after surgical aortic valve
replacement. Copyright © 2024 The Authors.

<82>
Accession Number
2029136282
Title
Highlights From the Society for Cardiovascular Angiography & Interventions
(SCAI) Scientific Sessions 2023.
Source
Journal of the American Heart Association. 13(7) (no pagination), 2024.
Article Number: e031067. Date of Publication: 02 Apr 2024.
Author
Cader F.A.; Arshad N.; Tremmel J.A.
Institution
(Cader, Arshad) Kettering General Hospital, Kettering, United Kingdom
(Tremmel) Stanford University Medical Center, Stanford, CA, United States
Publisher
American Heart Association Inc.
Abstract
The Society for Cardiovascular Angiography & Interventions (SCAI)
Scientific Sessions 2023, held in Phoenix, AZ, was attended by more than
1800 registered participants, 7% of whom were international attendees. The
meeting comprised a total of 250 sessions, including 9 live cases and
didactic sessions in coronary, structural, peripheral, and congenital
heart disease interventional tracks. The conference also featured unique
SCAI sessions tracks including Cath Lab Boot Camp, Fellows' Summit, and 13
global case exchange sessions in collaboration with international
societies, providing for standing room-only case-based interventional
discussions and learning. This report summarizes SCAI sessions
programming, including highlights from the named lectures, featured
science, and dedicated programming for early career investigators and
women in cardiology. Copyright © 2024 The Authors.

<83>
Accession Number
2031577320
Title
Quality of Life 5 Years Following Transfemoral TAVR or SAVR in
Intermediate Risk Patients.
Source
JACC: Cardiovascular Interventions. 17(8) (pp 979-988), 2024. Date of
Publication: 22 Apr 2024.
Author
Kleiman N.S.; Van Mieghem N.M.; Reardon M.J.; Gada H.; Mumtaz M.; Olsen
P.S.; Heiser J.; Merhi W.; Chetcuti S.; Deeb G.M.; Chawla A.; Kiaii B.;
Teefy P.; Chu M.W.A.; Yakubov S.J.; Windecker S.; Althouse A.D.; Baron
S.J.
Institution
(Kleiman) Department of Interventional Cardiology, Houston Methodist
DeBakey Heart and Vascular Center, Houston, TX, United States
(Van Mieghem) Thoraxcenter, Erasmus University, Rotterdam, Netherlands
(Reardon) Department of Cardiothoracic Surgery, Houston Methodist DeBakey
Heart and Vascular Center, Houston, TX, United States
(Gada) Department of Interventional Cardiology, University of Pittsburgh
Medical Center Pinnacle, Wormleysburg, PA, United States
(Mumtaz) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center Pinnacle Health, Harrisburg, PA, United States
(Olsen) Department of Cardiothoracic Surgery, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Heiser) Department of Interventional Cardiology, Corewell Health, Grand
Rapids, MI, United States
(Merhi) Department of Cardiothoracic Surgery, Corewell Health, Grand
Rapids, MI, United States
(Chetcuti) Interventional Cardiology, University of Michigan, Ann Arbor,
MI, United States
(Deeb) Cardiac Surgery, University of Michigan, Ann Arbor, MI, United
States
(Chawla) Department of Cardiology, Iowa Heart Center, Des Moines, IA,
United States
(Kiaii) Division of Cardiac Surgery, University of California-Davis
Health, Sacramento, CA, United States
(Teefy, Chu) Divisions of Cardiology and Cardiac Surgery, London Health
Sciences Centre, Western University, London, ON, Canada
(Yakubov) Interventional Cardiology, OhioHealth Riverside Methodist
Hospital, Columbus, OH, United States
(Windecker) Department of Cardiology, Inselspital Bern University
Hospital, University of Bern, Bern, Switzerland
(Althouse) Medtronic, Minneapolis, MN, United States
(Baron) Massachusetts General Hospital, Boston, MA, United States
(Baron) Baim Institute for Clinical Research, Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
Background: Symptomatic patients with severe aortic stenosis (AS) at high
risk for surgical aortic valve replacement (SAVR) sustain comparable
improvements in health status over 5 years after transcatheter aortic
valve replacement (TAVR) or SAVR. Whether a similar long-term benefit is
observed among intermediate-risk AS patients is unknown.
 Objective(s): The purpose of this study was to assess health status
outcomes through 5 years in intermediate risk patients treated with a
self-expanding TAVR prosthesis or SAVR using data from the SURTAVI
(Surgical Replacement and Transcatheter Aortic Valve Implantation) trial.
 Method(s): Intermediate-risk patients randomized to transfemoral TAVR
or SAVR in the SURTAVI trial had disease-specific health status assessed
at baseline, 30 days, and annually to 5 years using the Kansas City
Cardiomyopathy Questionnaire (KCCQ). Health status was compared between
groups using fixed effects repeated measures modelling. Result(s): Of
the 1,584 patients (TAVR, n = 805; SAVR, n = 779) included in the
analysis, health status improved more rapidly after TAVR compared with
SAVR. However, by 1 year, both groups experienced large health status
benefits (mean change in KCCQ-Overall Summary Score (KCCQ-OS) from
baseline: TAVR: 20.5 +/- 22.4; SAVR: 20.5 +/- 22.2). This benefit was
sustained, albeit modestly attenuated, at 5 years (mean change in KCCQ-OS
from baseline: TAVR: 15.4 +/- 25.1; SAVR: 14.3 +/- 24.2). There were no
significant differences in health status between the cohorts at 1 year or
beyond. Similar findings were observed in the KCCQ subscales, although a
substantial attenuation of benefit was noted in the physical limitation
subscale over time in both groups. Conclusion(s): In
intermediate-risk AS patients, both transfemoral TAVR and SAVR resulted in
comparable and durable health status benefits to 5 years. Further research
is necessary to elucidate the mechanisms for the small decline in health
status noted at 5 years compared with 1 year in both groups. (Safety and
Efficacy Study of the Medtronic CoreValve System in the Treatment of
Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need
Aortic Valve Replacement [SURTAVI]; NCT01586910) Copyright © 2024
American College of Cardiology Foundation

<84>
Accession Number
2031483807
Title
Effects of sevoflurane on left ventricular function by speckle-tracking
echocardiography in coronary bypass patients: A randomized trial.
Source
Journal of Biomedical Research. 38(1) (pp 76-86), 2024. Date of
Publication: 2024.
Author
Gong C.; Zhou X.; Fang Y.; Zhang Y.; Zhu L.; Ding Z.
Institution
(Gong, Zhou, Fang, Zhu, Ding) Department of Anesthesiology and
Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical
University, Jiangsu, Nanjing 210029, China
(Zhang) Department of Cardiology, the First Affiliated Hospital of Nanjing
Medical University, Jiangsu, Nanjing 210029, China
Publisher
Nanjing Medical University and Chungbuk National University Press
Abstract
The present study aimed to dynamically observe the segmental and global
myocardial movements of the left ventricle during coronary artery bypass
grafting by transesophageal speckle-tracking echocardiography, and to
assess the effect of sevoflurane on cardiac function. Sixty-four patients
scheduled for the off-pump coronary artery bypass grafting were randomly
divided into a sevoflurane-based anesthesia (AS) group and a
propofol-based total intravenous anesthesia (AA) group. The AS group
demonstrated a higher absolute value of left ventricular global
longitudinal strain than that of the AA group at both T<inf>1</inf> (after
harvesting all grafts and before coronary anastomosis) and T<inf>2</inf>
(30 min after completing all coronary anastomoses) (P < 0.05). Moreover,
strain improvement in the segment with the highest preoperative strain was
significantly reduced in the AS group, compared with the AA group at both
T<inf>1</inf> and T<inf>2</inf> (P < 0.01). The flow of the left internal
mammary artery-left anterior descending artery graft was superior, and the
postoperative concentration of troponin T decreased rapidly in the AS
group, compared with the AA group (P < 0.05). Compared with total
intravenous anesthesia, sevoflurane resulted in a significantly higher
global longitudinal strain, stroke volume, and cardiac output. Sevoflurane
also led to an amelioration in the condition of the arterial graft.
Furthermore, sevoflurane significantly reduced strain improvement in the
segmental myocardium with a high preoperative strain value. The findings
need to be replicated in larger studies. Copyright © 2024 by
Journal of Biomedical Research.

<85>
Accession Number
2031226539
Title
Prospective Randomized Pilot Trial on the Effects of Mild Hypercapnia on
Cerebral Oxygen Saturation in Patients Undergoing Off-Pump Coronary Artery
Bypass Grafting.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 38(6) (pp 1322-1327),
2024. Date of Publication: June 2024.
Author
Bhandari C.; Gandhi H.; Panwar A.; Haranal M.; Pandya H.
Institution
(Bhandari, Gandhi, Panwar) Department of Cardiac Anesthesia, U. N. Mehta
Institute of Cardiology and Research Center (affiliated with B. J. Medical
College), New Civil Hospital Campus, Ahmedabad, Asarwa, India
(Haranal) Department CVTS, U. N. Mehta Institute of Cardiology and
Research Center (affiliated with B. J. Medical College), New Civil
Hospital Campus, Ahmedabad, Asarwa, India
(Pandya) Department of Research, U. N. Mehta Institute of Cardiology and
Research Center (affiliated with B. J. Medical College), New Civil
Hospital Campus, Ahmedabad, Asarwa, India
Publisher
W.B. Saunders
Abstract
Objective and Design: A single-center prospective randomized controlled
study was conducted to assess the effect of targeted mild hypercapnia
(TMH) on cerebral oxygen saturation (rSO<inf>2</inf>) in patients
undergoing off-pump coronary artery bypass grafting (CABG). Setting and
Participants: A prospective randomized controlled study involving 100
patients undergoing off-pump CABG at U. N. Mehta Hospital, Ahmedabad,
Gujarat, India. Intervention(s): Patients were randomized to either
the TMH (PaCO<inf>2</inf> 45-55 mmHg) or the targeted normocapnia (TN;
PaCO<inf>2</inf> 35-45 mmHg) group, containing 50 patients in each group.
Measurements: Monitoring of rSO<inf>2</inf>, heart rate, mean arterial
pressure (MAP), PaCO<inf>2</inf>, and peripheral oxygen saturation was
done at baseline, after induction, after left internal mammary artery
harvesting, at each grafting (distal and proximal), after protamine, and
after shifting to the intensive care unit. The standardized
minimental-state examination (SMMSE) was performed preoperatively and at
8, 12, and 24 hours postextubation. Data were analyzed using an
independent sample t test. Result(s): The TMH group had higher MAP
during grafting (p < 0.001) and higher rSO<inf>2</inf> on both sides
during distal and proximal grafting (p < 0.001) and after protamine (p <
0.05), as compared to the TN group. Compared to preoperative values, SMMSE
scores in the TN group were significantly lower at 12 and 24 hours
postextubation (p < 0.001). Conclusion(s): TMH during grafting
increased the cerebral blood flow and rSO<inf>2</inf> when hemodynamic
instability was very common. It has a protective role on the brain and
helps maintain cognition postoperatively. Copyright © 2024
Elsevier Inc.

<86>
Accession Number
2032019952
Title
Comparison of arterial hypotension incidence during general anesthesia
induction - target-controlled infusion vs. bolus injection of propofol: a
randomized clinical trial.
Source
Brazilian Journal of Anesthesiology (English Edition). 74(4) (no
pagination), 2024. Article Number: 844503. Date of Publication: 01 Jul
2024.
Author
Vale A.G.G.; Goveia C.S.; Guimaraes G.M.N.; Terra L.R.; Ladeira L.C.A.;
Essado G.A.
Institution
(Vale, Terra, Essado) Hospital Universitario de Brasilia, DF, Brasilia,
Brazil
(Goveia, Guimaraes, Ladeira) Universidade de Brasilia, Departamento de
Anestesiologia, DF, Brasilia, Brazil
Publisher
Elsevier Editora Ltda
Abstract
Background: The incidence of arterial hypotension during induction of
general anesthesia is influenced by the method of propofol administration,
but there is a dearth of randomized clinical trials comparing bolus
injection and target-controlled infusion in relation to arterial
hypotension. This study seeks to compare the incidence of arterial
hypotension between these two methods of propofol administration.
 Method(s): This prospective, randomized, single-center, non-blinded
study included 60 patients (aged 35 to 55 years), classified as ASA
physical status I or II, who were undergoing non-cardiac surgeries. They
were randomly allocated using a computer to two groups based on the method
of propofol administration during the induction of general anesthesia: the
Target Group, receiving target-controlled infusion at 4
mug.mL-1, and the Bolus Group, receiving a bolus infusion of 2
mg.kg-1. Both groups also received midazolam 2 mg, fentanyl 3
mug.kg-1, and rocuronium 0.6 mg.kg-1. Over the first
10 minutes of anesthesia induction, Mean Arterial Pressure (MAP), Heart
Rate (HR), level of Consciousness (qCON), and Suppression Rate (SR) were
recorded every 2 minutes. Result(s): Twenty-seven patients remained
in the TCI group, while 28 were in the Bolus group. Repeated measure
analysis using mixed-effects models could not reject the null hypothesis
for the effect of group-time interactions in MAP (p = 0.85), HR (p =
0.49), SR (p = 0.44), or qCON (p = 0.72). The difference in means for qCON
(60.2 for TCI, 50.5 for bolus, p < 0.001), MAP (90.3 for TCI, 86.2 for
bolus, p < 0.006), HR (76.2 for TCI, 76.9 for bolus, p = 0.93), and SR
(0.01 for TCI, 5.5 for bolus, p < 0.001), irrespective of time (whole
period means), revealed some significant differences. Conclusion(s):
Patients who received propofol bolus injection exhibited a lower mean
arterial pressure, a greater variation in the level of consciousness, and
a higher suppression rate compared to those who received it as a
target-controlled infusion. However, the interaction effect between groups
and time remains inconclusive. Copyright © 2024 Sociedade
Brasileira de Anestesiologia

<87>
Accession Number
2032005269
Title
Impact of loss-of-function in angiopoietin-like 4 on the human phenome.
Source
Atherosclerosis. 393 (no pagination), 2024. Article Number: 117558. Date
of Publication: June 2024.
Author
Gagnon E.; Bourgault J.; Gobeil E.; Theriault S.; Arsenault B.J.
Institution
(Gagnon, Bourgault, Gobeil, Theriault, Arsenault) Centre de Recherche de
L'Institut Universitaire de Cardiologie et de Pneumologie de Quebec,
Quebec, QC, Canada
(Theriault) Department of Molecular Biology, Medical Biochemistry and
Pathology, Faculty of Medicine, Universite Laval, Quebec, QC, Canada
(Arsenault) Department of Medicine, Faculty of Medicine, Universite Laval,
Quebec, QC, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Background: Carriers of the E40K loss-of-function variant in
Angiopoietin-like 4 (ANGPTL4), have lower plasma triglyceride levels as
well as lower rates of coronary artery disease (CAD) and type 2 diabetes
(T2D). These genetic data suggest ANGPTL4 inhibition as a potential
therapeutic target for cardiometabolic diseases. However, it is unknown
whether the association between E40K and human diseases is due to linkage
disequilibrium confounding. The broader impact of genetic ANGPTL4
inhibition is also unknown, raising uncertainties about the safety and
validity of this target. Method(s): To assess the impact of ANGPLT4
inhibition, we evaluated whether E40K and other loss-of-function variants
in ANGPTL4 influenced a wide range of health markers and diseases using 29
publicly available genome-wide association meta-analyses of
cardiometabolic traits and diseases, as well as 1589 diseases assessed in
electronic health records within FinnGen (n = 309,154). To determine
whether these relationships were likely causal, and not driven by other
correlated variants, we used the Bayesian fine mapping algorithm
CoPheScan. Result(s): The CoPheScan posterior probability of E40K
being the causal variant for triglyceride levels was 99.99 %, validating
the E40K to proxy lifelong lower activity of ANGPTL4. The E40K variant was
associated with lower risk of CAD (odds ratio [OR] = 0.84, 95 % CI = 0.81
to 0.87, p=3.6e-21) and T2D (OR = 0.91, 95 % CI = 0.87 to 0.95, p=2.8e-05)
in GWAS meta-analyses, with results replicated in FinnGen. These
significant results were also replicated using other rare loss-of-function
variants identified through whole exome sequencing in 488,278 participants
of the UK Biobank. Using a Mendelian randomization study design, the E40K
variant effect on cardiometabolic diseases was concordant with lipoprotein
lipase enhancement (r = 0.82), but not hepatic lipase enhancement (r =
-0.10), suggesting that ANGPTL4 effects on cardiometabolic diseases are
potentially mainly mediated through lipoprotein lipase. After correction
for multiple testing, the E40K variant did not significantly increase the
risk of any of the 1589 diseases tested in FinnGen. Conclusion(s):
ANGPTL4 inhibition may represent a potentially safe and effective target
for cardiometabolic diseases prevention or treatment. Copyright ©
2024 The Authors

<88>
Accession Number
2032164827
Title
Stroke risk after transcatheter aortic valve replacement in patients with
carotid stenosis: A systematic review and meta-analysis.
Source
International Journal of Cardiology. 408 (no pagination), 2024. Article
Number: 132085. Date of Publication: 01 Aug 2024.
Author
Garagoli F.; Chiabrando J.G.; Seropian I.M.; Lombardi M.; Agatiello C.R.;
Fernandez Recalde M.L.; Vergallo R.; Porto I.; Bluro I.M.
Institution
(Garagoli, Fernandez Recalde, Bluro) Department of Cardiology, Hospital
Italiano de Buenos Aires, Buenos Aires, Argentina
(Chiabrando) Department of Interventional Cardiology, Sanatorio Anchorena,
Buenos Aires, Argentina
(Seropian, Agatiello) Department of Interventional Cardiology, Hospital
Italiano de Buenos Aires, Buenos Aires, Argentina
(Lombardi, Vergallo, Porto) Department of Internal Medicine and Medical
Specialties (DIMI), Universita di Genova, Largo R. Benzi, 10, Genova
16132, Italy
(Vergallo, Porto) Cardiothoracic and Vascular Department (DICATOV), IRCCS
Ospedale Policlinico San Martino, Viale Benedetto XV, 6, Genova 16132,
Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: Stroke is a feared complication of transcatheter aortic valve
replacement (TAVR). Patients undergoing TAVR typically have multiple
comorbidities, such as carotid artery stenosis (CAS). We conducted the
present meta-analysis to determine the risk of stroke and mortality
following TAVR in patients with CAS. Method(s): We searched
PubMed/Medline, Scopus, ScienceDirect, and Cochrane Clinical Trials
databases for clinical studies that compared CAS >=50% and CAS >=70%
versus non-CAS TAVR population. The endpoints included the 30-day
incidence of stroke or transient ischemic attack (TIA) and 30-day
all-cause of mortality. Result(s): We identified seven studies that
included 12,418 patients in the CAS group and 102,316 in the control
group. CAS >=50% was not associated with an increased risk of 30-day
stroke or TIA after TAVR [risk ratio (RR): 1.38; 95% confidence interval
(95% CI): 0.95-2.02; p = 0.09]. However, patients with CAS >=70% had an
increased risk of stroke or TIA (RR: 1.43; 95% CI: 1.02-2.01; p = 0.04).
No difference in 30-day all-cause mortality was observed between CAS >=50%
or CAS >=70% and control groups (RR: 1.09; 95% CI: 0.79-1.52; p = 0.59 and
RR: 1.11; 95% CI: 0.85-1.45; p = 0.43, respectively). Conclusion(s):
CAS >=70% was associated with an increased risk of stroke or TIA following
TAVR compared with patients without CAS. Copyright © 2024
Elsevier B.V.

<89>
Accession Number
2032143725
Title
The effect of individualized nutrition training of children with
congenital heart disease (CHD) on their growth and development a
randomized controlled trial.
Source
Current Problems in Cardiology. 49(7) (no pagination), 2024. Article
Number: 102567. Date of Publication: July 2024.
Author
Yuruk E.; Cetinkaya S.
Institution
(Yuruk, Cetinkaya) Department of Nursing, Child Health and Diseases
Nursing, Cukurova University, Faculty of Health Sciences, Adana, Turkey
Publisher
Elsevier Inc.
Abstract
Objective: This study investigated the effectiveness of individualized
nutrition training for mothers of children who underwent congenital heart
disease (CHD) surgery on their children's growth and development.
 Method(s): The researchers conducted a randomized controlled trial at
Cukurova University Medical Faculty Balcali Hospital in Adana, Turkey,
between January 20th, 2021, and June 30th, 2021. They recruited 42
children with CHD and their families. Researchers used a personal
information form, growth parameter measurements, and the Ankara
Developmental Screening Inventory to assess the children. Participants
were randomly divided into three groups. Control group, received standard
care. Experimental group 1 (orally fed), received family-centered care and
individualized nutrition training focused on age-appropriate food content,
preparation methods, and meeting children's caloric needs. Experimental
group 2 (orally and nutritionally fed), received the same interventions as
group 1. The training programs for the experimental groups included
information on strengthening breast milk and additional nutritional
nutrition support. The training programs for the experimental groups
likely addressed feeding challenges specific to children with CHD.
 Result(s): The study found a statistically significant difference in
weight gain between the first and third follow-ups within the training
group (children who received individualized nutrition education). This
suggests that the training may have positively impacted weight gain.
Additionally, the children in the training groups who were breastfed for
longer than 12 months had better growth parameters and developmental
scores compared to those with shorter breastfeeding durations.
 Conclusion(s): This study suggests that individualized nutrition
training for mothers of children with CHD surgery may support their
children's growth and development, particularly when combined with
prolonged breastfeeding. Copyright © 2024

<90>
Accession Number
2032090209
Title
Intensive blood pressure control on arterial stiffness among older
patients with hypertension.
Source
Chinese Medical Journal. 137(9) (pp 1078-1087), 2024. Date of Publication:
05 May 2024.
Author
Zhang S.; Zhong Y.; Wu S.; Wu H.; Cai J.; Zhang W.
Institution
(Zhang, Zhang) National Clinical Research Center of Cardiovascular
Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases,
Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing
100037, China
(Zhang) Department of Cardiology, State Key Laboratory of Complex Severe
and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy
of Medical Sciences, Peking Union Medical College, Beijing 100730, China
(Zhong, Wu, Cai, Zhang) State Key Laboratory of Cardiovascular Disease,
Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union
Medical College, Chinese Academy of Medical Sciences, Beijing 100037,
China
(Wu) Department of Cardiology, Kailuan General Hospital, Hebei, Tangshan
063000, China
(Zhang) Central China Subcenter of National Center for Cardiovascular
Diseases, Henan Cardiovascular Disease Center, Fuwai Central-China
Cardiovascular Hospital, Central China Fuwai Hospital, Zhengzhou
University, Henan, Zhengzhou 450046, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Arterial stiffening increases with age and blood pressure and
is associated with cardiovascular disease (CVD), but the relationship
between blood pressure lowering and arterial stiffening is still
uncertain, especially in older people. This study aimed to evaluate the
effect of intensive blood pressure treatment on the progression of
arterial stiffness and risk of CVD in older patients with hypertension.
 Method(s): The Strategy of Blood Pressure Intervention in the Elderly
Hypertensive Patients (STEP) trial was a multicenter, randomized,
controlled trial performed at 42 clinical centers throughout China, and
8511 patients aged 60-80 years with essential hypertension were enrolled
and randomly assigned to systolic blood pressure (SBP) target of 110 mmHg
to <130 mmHg (intensive treatment) or 130 mmHg to <150 mmHg (standard
treatment). Patients underwent repeated examinations of the brachial-ankle
pulse wave velocity (baPWV) and ankle-brachial index (ABI) at baseline,
and the arterial stiffness was evaluated at the 3-year follow-up. A total
of 5339 patients who had twice repeated measurements were included in this
study. Changes in arterial stiffness between the intensive and standard
treatment groups were analyzed using a multivariate linear regression
model. The Cox proportional hazard regression model was used to evaluate
the effect of intensive treatment on primary CVD outcomes. Result(s):
The changes in baPWV were 61.5 cm/s (95% confidence interval [CI]:
49.8-73.2 cm/s) in the intensive treatment group and 98.4 cm/s (95% CI:
86.7-110.1 cm/s) in the standard treatment group (P <0.001). Intensive
treatment significantly delayed the progression of arterial stiffness,
with an annual change of 23.1 cm.s-1.year-1vs. 36.7
cm.s-1.year-1of baPWV in the intensive and standard
treatment groups, respectively. During a median follow-up period of 3.36
years, primary CVD outcomes occurred in 77 (2.9%) patients in the
intensive treatment group compared with 93 (3.5%) in the standard
treatment group. Intensive treatment resulted in a significantly lower CVD
risk in patients aged 70-80 years or with SBP <140 mmHg.
 Conclusion(s): Intensive blood pressure control with an SBP target of
110 mmHg to <130 mmHg could delay the progression of arterial stiffness
and reduce the risk of CVD in older patients with hypertension. Clinical
trial registration: http://www.clinicaltrials.gov; No.
NCT03015311. Copyright © 2024 Lippincott Williams and Wilkins.
All rights reserved.

<91>
Accession Number
2029718942
Title
Neuroinvasion of emerging and re-emerging arboviruses: A scoping review.
Source
SAGE Open Medicine. 12 (no pagination), 2024. Date of Publication:
January-December 2024.
Author
Srichawla B.S.; Manan M.R.; Kipkorir V.; Dhali A.; Diebel S.; Sawant T.;
Zia S.; Carrion-Alvarez D.; Suteja R.C.; Nurani K.; Gaman M.-A.
Institution
(Srichawla) Department of Neurology, University of Massachusetts Chan
Medical School, Worcester, MA, United States
(Manan) Services Institute of Medical Sciences, Punjab, Lahore, Pakistan
(Kipkorir, Nurani) Department of Human Anatomy and Physiology, University
of Nairobi, Nairobi, Kenya
(Dhali) Department of Internal Medicine, Nottingham University Hospitals
NHS Trust, Nottingham, United Kingdom
(Diebel) Department of Family Medicine, Northern Ontario School of
Medicine University, Sudbury, ON, Canada
(Sawant) Department of Neurology, Spartan Health Sciences University,
Spartan Drive St, Saint Lucia
(Zia) Department of Infectious Diseases, University of Massachusetts Chan
Medical School, Worcester, MA, United States
(Carrion-Alvarez) Departmento de Medicina Interna, ISSSTE Regional de
Monterrey, Monterrey, Mexico
(Suteja) Faculty of Medicine, Udayana University, Kampus Bukit, Jl, Raya
Kampus Unud Jimbaran, Kec, Kuta Sel, Kabupaten Badung, Bukit Jimbaran,
Bali, Indonesia
(Gaman) Faculty of Medicine, "Carol Davila" University of Medicine and
Pharmacy, Bucuresti, Romania
(Gaman) BucharestRomania
(Gaman) Department of Hematology, Center of Hematology and Bone Marrow
Transplantation, Fundeni Clinical Institute, Bucuresti, Romania
Publisher
SAGE Publications Ltd
Abstract
Background: Arboviruses are RNA viruses and some have the potential to
cause neuroinvasive disease and are a growing threat to global health.
 Objective(s): Our objective is to identify and map all aspects of
arbovirus neuroinvasive disease, clarify key concepts, and identify gaps
within our knowledge with appropriate future directions related to the
improvement of global health. Method(s): Sources of Evidence: A
scoping review of the literature was conducted using PubMed, Scopus,
ScienceDirect, and Hinari. Eligibility Criteria: Original data including
epidemiology, risk factors, neurological manifestations,
neuro-diagnostics, management, and preventive measures related to
neuroinvasive arbovirus infections was obtained. Sources of evidence not
reporting on original data, non-English, and not in peer-reviewed journals
were removed. Charting Methods: An initial pilot sample of 30 abstracts
were reviewed by all authors and a Cohen's kappa of kappa = 0.81
(near-perfect agreement) was obtained. Records were manually reviewed by
two authors using the Rayyan QCRI software. Result(s): A total of 171
records were included. A wide array of neurological manifestations can
occur most frequently, including parkinsonism,
encephalitis/encephalopathy, meningitis, flaccid myelitis, and
Guillain-Barre syndrome. Magnetic resonance imaging of the brain often
reveals subcortical lesions, sometimes with diffusion restriction
consistent with acute ischemia. Vertical transmission of arbovirus is most
often secondary to the Zika virus. Neurological manifestations of
congenital Zika syndrome, include microcephaly, failure to thrive,
intellectual disability, and seizures. Cerebrospinal fluid analysis often
shows lymphocytic pleocytosis, elevated albumin, and protein consistent
with blood-brain barrier dysfunction. Conclusion(s): Arbovirus
infection with neurological manifestations leads to increased morbidity
and mortality. Risk factors for disease include living and traveling in an
arbovirus endemic zone, age, pregnancy, and immunosuppressed status. The
management of neuroinvasive arbovirus disease is largely supportive and
focuses on specific neurological complications. There is a need for
therapeutics and currently, management is based on disease prevention and
limiting zoonosis. Copyright © The Author(s) 2024.

<92>
Accession Number
2032076265
Title
Transiently achieved very low low-density lipoprotein cholesterol levels
by statin and alirocumab after acute coronary syndrome are associated with
cardiovascular risk reduction: the ODYSSEY OUTCOMES trial.
Source
European Heart Journal. 44(16) (pp 1408-1417), 2023. Date of Publication:
21 Apr 2023.
Author
Schwartz G.G.; Szarek M.; Bhatt D.L.; Bittner V.A.; Bujas-Bobanovic M.;
Diaz R.; Fazio S.; Fras Z.; Goodman S.G.; Harrington R.A.; Jukema J.W.;
Manvelian G.; Pordy R.; Ray K.K.; Scemama M.; White H.D.; Steg Ph.G.
Institution
(Schwartz) Division of Cardiology, University of Colorado School of
Medicine, Box B-130, Aurora, CO 80045, United States
(Szarek) CPC Clinical Research, Aurora, CO, United States
(Szarek) State University of New York, Downstate Health Sciences
University, Brooklyn, NY, United States
(Bhatt) Mount Sinai Heart, Icahn School of Medicine, Mount Sinai Health
System, New York, NY, United States
(Bittner) Division of Cardiovascular Disease, University of Alabama at
Birmingham, Birmingham, AL, United States
(Bujas-Bobanovic, Scemama) Sanofi, Paris, France
(Diaz) Estudios Cardiologicos Latinoamerica, Instituto Cardiovascular de
Rosario, Rosario, Argentina
(Fazio, Manvelian, Pordy) Regeneron Pharmaceuticals Inc., Tarrytown, NY,
United States
(Fras) Preventive Cardiology Unit, Department of Vascular Medicine,
Division of Medicine, University Medical Centre Ljubljana, Ljubljana,
Slovenia
(Fras) Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton, AB,
Canada
(Goodman) St. Michael's Hospital, University of Toronto, Toronto, ON,
Canada
(Harrington) Stanford Center for Clinical Research, Department of
Medicine, Stanford University, Stanford, CA, United States
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Jukema) Netherlands Heart Institute, Utrecht, Netherlands
(Ray) Department of Primary Care and Public Health, Imperial Centre for
Cardiovascular Disease Prevention, Imperial College London, London, United
Kingdom
(White) Green Lane Cardiovascular Services, Auckland City Hospital,
Auckland University, Auckland, New Zealand
(Steg) Assistance Publique-Hopitaux de Paris, Hopital Bichat, FACT (French
Alliance for Cardiovascular Trials), Universite Paris-Cite,
INSERM-UMR1148, Paris F-75018, France
(Steg) Institut Universitaire de France, Paris, France
Publisher
Oxford University Press
Abstract
Aims Long-term, placebo-controlled cholesterol-lowering trials have
demonstrated legacy effects (clinical benefits that persist or emerge
after trial end). It is unknown whether legacy effects follow a short
period of very low low-density lipoprotein cholesterol (LDL-C) levels
achieved with statin plus proprotein convertase subtilisin/kexin type 9
(PCSK9) inhibitor. Methods In 18 924 patients with recent acute coronary
syndrome, the ODYSSEY OUTCOMES trial compared the PCSK9 inhibitor alir-
and results ocumab with placebo, each added to high-intensity or
maximum-tolerated statin therapy. Patients with two consecutive LDL-C
levels <0.39 mmol/L (15 mg/dL) on alirocumab had blinded placebo
substitution for the remainder of the trial with continued statin
treatment. In post hoc analyses, major adverse cardiovascular events
(MACE) in these patients were compared to MACE in propensity score-matched
patients from the placebo group with similar baseline characteristics and
study medication adherence. In the alirocumab group, 730 patients had
blinded placebo substitution at a median of 8.3 months from randomization,
after a median of 6.0 months with LDL-C <0.39 mmol/L. They were matched to
1460 placebo patients. Both groups had lower Copyright © The
Author(s) 2023. Published by Oxford University Press on behalf of the
European Society of Cardiology.

<93>
Accession Number
2032076246
Title
Transcatheter versus surgical aortic valve replacement in lower-risk and
higher-risk patients: a meta-analysis of randomized trials.
Source
European Heart Journal. 44(10) (pp 836-852), 2023. Date of Publication: 07
Mar 2023.
Author
Ahmad Y.; Howard J.P.; Arnold A.D.; Madhavan M.V.; Cook C.M.; Alu M.; Mack
M.J.; Reardon M.J.; Thourani V.H.; Kapadia S.; Horsted Thyregod H.G.;
Sondergaard L.; Jorgensen T.H.; Toff W.D.; Van Mieghem N.M.; Makkar R.R.;
Forrest J.K.; Leon M.B.
Institution
(Ahmad, Forrest) Yale School of Medicine, Yale University, 135 College
Street, Suite 101, New Haven, CT 06510, United States
(Howard, Arnold) National Heart and Lung Institute, Imperial College
London, Du Cane Road, London W120HS, United Kingdom
(Madhavan, Leon) Division of Cardiology, Department of Medicine, Columbia
University Medical Center, New York-Presbyterian Hospital, W. 168th St.,
New York, NY 10032, United States
(Madhavan, Alu, Leon) Clinical Trials Center, The Cardiovascular Research
Foundation, 1700 Broadway, New York, NY 10019, United States
(Cook) Essex Cardiothoracic Center, Nether Mayne, Basildon SS16 5NL,
United Kingdom
(Mack) Department of Cardiovascular Disease, Baylor Scott and White
Health, 4700 Alliance Blvd, Plano, TX 75093, United States
(Reardon) Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin
St Suite 1901, Houston, TX 77030, United States
(Thourani) Department of Cardiovascular Surgery, Marcus Valve Center,
Piedmont Heart and Vascular Institute, 95 Collier Rd NW Suite 5015,
Atlanta, GA 30309, United States
(Kapadia) Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United
States
(Horsted Thyregod, Sondergaard, Jorgensen) The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Section, 2151, Blegdamsvej
9, Copenhagen O 2100, Denmark
(Toff) Department of Cardiovascular Sciences, University of Leicester and
NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University
Rd, Leicester LE1 7RH, United Kingdom
(Van Mieghem) Department of Interventional Cardiology, Thoraxcenter,
Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam 3015
GD, Netherlands
(Makkar) Cedars-Sinai Medical Center, Smidt Heart Institute, S San Vicente
Blvd, Los Angeles, CA 90048, United States
Publisher
Oxford University Press
Abstract
Aims Additional randomized clinical trial (RCT) data comparing
transcatheter aortic valve implantation (TAVI) with surgical aortic valve
replacement (SAVR) is available, including longer term follow-up. A
meta-analysis comparing TAVI to SAVR was performed. A pragmatic risk
classification was applied, partitioning lower-risk and higher-risk
patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . Methods The main endpoints were death, strokes, and the
composite of death or disabling stroke, occurring at 1 year (early) or
after and results 1 year (later). A random-effects meta-analysis was
performed. Eight RCTs with 8698 patients were included. In lower-risk
patients, at 1 year, the risk of death was lower after TAVI compared with
SAVR [relative risk (RR) 0.67; 95% confidence interval (CI) 0.47 to 0.96,
P = 0.031], as was death or disabling stroke (RR 0.68; 95% CI 0.50 to
0.92, P = 0.014). There were no differences in strokes. After 1 year, in
lower-risk patients, there were no significant differences in all main
outcomes. In higher-risk patients, there were no significant differences
in main outcomes. New-onset atrial fibrillation, major bleeding, and acute
kidney injury occurred less after TAVI; new pacemakers, vascular
complications, and paravalvular leak occurred more after TAVI. . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Conclusion In lower-risk patients, there was an early mortality reduction
with TAVI, but no differences after later follow-up. There was also an
early reduction in the composite of death or disabling stroke, with no
difference at later follow-up. There were no significant differences for
higher-risk patients. Informed therapy decisions may be more dependent on
the temporality of events or secondary endpoints than the long-term
occurrence of main clinical outcomes. Copyright © The Author(s)
2023. Published by Oxford University Press on behalf of the European
Society of Cardiology.

<94>
Accession Number
2031579577
Title
Biomaterials for direct cardiac repair-A rapid scoping review 2012-2022.
Source
Acta Biomaterialia. 180 (pp 61-81), 2024. Date of Publication: May 2024.
Author
Sedlakova V.; Mourcos S.; Pupkaite J.; Lunn Y.; Visintini S.; Guzman-Soto
I.; Ruel M.; Suuronen E.; Alarcon E.I.
Institution
(Sedlakova) Department of Histology and Embryology, Faculty of Medicine,
Masaryk University, Kamenice 753/5, Brno 625 00, Czechia
(Mourcos, Pupkaite, Lunn, Guzman-Soto, Ruel, Suuronen, Alarcon) BEaTS
Research, Division of Cardiac Surgery, University of Ottawa Heart
Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
(Mourcos, Lunn, Ruel, Suuronen, Alarcon) Division of Cardiac Surgery,
University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y
4W7, Canada
(Mourcos) Department of Biomedical Science, Faculty of Science, University
of Ottawa, 150 Louis-Pasteur Private, Ottawa, ON K1N 9A7, Canada
(Lunn, Alarcon) Department of Biochemistry, Microbiology, and Immunology,
Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H
8M5, Canada
(Visintini) Berkman Library, University of Ottawa Heart Institute, 40
Ruskin Street, Ottawa, ON K1Y 4W7, Canada
(Suuronen) Department of Cellular and Molecular Medicine, Faculty of
Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
Publisher
Acta Materialia Inc
Abstract
A plethora of biomaterials for heart repair are being tested worldwide for
potential clinical application. These therapeutics aim to enhance the
quality of life of patients with heart disease using various methods to
improve cardiac function. Despite the myriad of therapeutics tested, only
a minority of these studied biomaterials have entered clinical trials.
This rapid scoping review aims to analyze literature available from 2012
to 2022 with a focus on clinical trials using biomaterials for direct
cardiac repair, i.e., where the intended function of the biomaterial is to
enhance the repair of the endocardium, myocardium, epicardium or
pericardium. This review included neither biomaterials related to stents
and valve repair nor biomaterials serving as vehicles for the delivery of
drugs. Surprisingly, the literature search revealed that only 8 different
biomaterials mentioned in 23 different studies out of 7038 documents
(journal articles, conference abstracts or clinical trial entries) have
been tested in clinical trials since 2012. All of these, intended to treat
various forms of ischaemic heart disease (heart failure, myocardial
infarction), were of natural origin and most used direct injections as
their delivery method. This review thus reveals notable gaps between
groups of biomaterials tested pre-clinically and clinically. Statement of
significance: Rapid scoping review of clinical application of biomaterials
for cardiac repair. 7038 documents screened; 23 studies mention 8
different biomaterials only. Biomaterials for repair of endocardium,
myocardium, epicardium or pericardium. Only 8 different biomaterials
entered clinical trials in the past 10 years. All of the clinically
translated biomaterials were of natural origin. Copyright © 2024
The Author(s)

<95>
Accession Number
2032137668
Title
PO-03-054 INTRACARDIAC VS TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR LEFT ATRIAL
APPENDAGE CLOSURE WITH WATCHMAN OR WATCHMAN FLX.
Source
Heart Rhythm. Conference: Heart Rhythm 2024. Boston United States. 21(5
Supplement) (pp S386), 2024. Date of Publication: May 2024.
Author
Ambesh P.; Maan A.; Pant K.; Vashistha K.; Newman S.; Mirza J.; Zhang C.;
Malyshev Y.; Jia K.; Koruth J.S.; Whang W.; Lampert J.; Miller M.A.;
Dukkipati S.R.; Reddy V.Y.
Publisher
Elsevier B.V.
Abstract
Background: Although the landmark clinical trials of left atrial appendage
closure (LAAC) were conducted using trans-esophageal echocardiography
(TEE), the use of intracardiac echocardiography (ICE) to guide LAAC is
gaining increasing prominence Objective: To compare acute procedural and
follow-up imaging outcomes according to the use of intraprocedural imaging
with TEE or ICE in patients undergoing LAAC. Method(s): We performed
a retrospective review to compare acute procedure complications. The
presence of peri-device leak (PDL) was assessed with follow-up TEE imaging
performed at ~4 months and at ~1 year follow-up post-LAAC. For this
analysis, patients were stratified according to the type of procedural
imaging used (TEE vs ICE). Result(s): A total of 609 patients
underwent LAAC with either the Watchman, Watchman Flx, or Amulet (minority
of cases) devices at our center between 2016 and 2023. In 415 (68.1%)
patients, TEE was used for intraprocedural imaging, and in 194 (31.9%) ICE
was used. There was no statistically significant difference in the degree
of acute device compression (19.7+/-6.2 % with ICE vs 18.8+/-5.2 % with
TEE; p=0.30). The acute procedural complication rate did not differ
between the two imaging modalities (2% with ICE vs 1.9% with TEE; p =
0.83). On follow-up TEE imaging at ~1 year, the PDL size was greater with
the use of ICE (1.1+/-3.3 vs 0.7+/-1.5 mm; p=0.04) in comparison with TEE.
 Conclusion(s): In our experience with LAAC, there was no difference
in the rate of acute procedural outcomes such as (device compression and
pericardial effusion) according to the choice of intraprocedural imaging
(TEE vs ICE). Further (randomized) studies should carefully assess whether
ICE-guided implantation results in more and larger PDLs than with TEE
guidance. [Formula presented] Copyright © 2024

<96>
Accession Number
2032137008
Title
PO-03-069 EFFECT OF COLCHICINE ON THE OUTCOMES OF CATHETER ABLATION FOR
ATRIAL FIBRILLATION.
Source
Heart Rhythm. Conference: Heart Rhythm 2024. Boston United States. 21(5
Supplement) (pp S393), 2024. Date of Publication: May 2024.
Author
Al-Sadawi M.; Tokavanich N.; Devgun J.K.; Aslam F.; Kim P.M.; Latchamsetty
R.; Jongnarangsin K.; Ghannam M.; Oral H.
Publisher
Elsevier B.V.
Abstract
Background: Colchicine is recommended following cardiac surgery to reduce
the risk of atrial fibrillation (AF); however, the data on its effect on
the outcomes of catheter ablation (CA) of AF have remained controversial.
 Objective(s): We aimed to determine the effect of colchicine on CA
for AF on short and long term follow up. Method(s): We performed a
systemic review and meta-analysis of patients who underwent CA for AF. The
database including MEDLINE, EMBASE, and Cochrane database were
comprehensively search from inception to November 2023. Data of each study
was combined with random effects model. The results were reported in Risk
ratio (RR) with 95% confidence intervals. Result(s): A total of 10
studies and 3,848 patients (mean age 64 and 31% are females) were included
in the analysis. Colchicine use was between 14 days to 3 months. It was
not associated with reduction of AF in the blanking period (1-3 months
following ablation): RR 0.87; 95%CI 064-1.18, but was associated with
reduction of AF recurrence in long-term follow up (>12 moths): RR 0.74;
95% CI 0.61-90. Colchicine use was associated with reduction of post CA
pericarditis: RR 0.39; 95% CI 0.28-0.54. Discontinuation rates of
colchicine due to side effects was 3-10% in the included studies.
 Conclusion(s): Colchicine use was associated with lower long-term AF
recurrence after AF ablation and lower incidence of pericarditis. [Formula
presented] Copyright © 2024

<97>
Accession Number
2032134101
Title
PO-03-052 SINGLE CENTER EXPERIENCE COMPARING USE OF TRANSESOPHAGEAL VS.
INTRACARDIAC ECHOCARDIOGRAPHY FOR LEFT ATRIAL APPENDAGE CLOSURE.
Source
Heart Rhythm. Conference: Heart Rhythm 2024. Boston United States. 21(5
Supplement) (pp S385), 2024. Date of Publication: May 2024.
Author
Hoskins M.; Mazer S.; Nair S.G.; Adjei-Poku Y.A.; Remo B.; Henriquez W.;
Bestawros M.T.
Publisher
Elsevier B.V.
Abstract
Background: Left atrial appendage closure (LAAC) is an alternative to oral
anticoagulants for stroke prevention in patients with atrial fibrillation.
The traditional approach is to use transesophageal echocardiography (TEE)
to guide the implant procedure. Intracardiac echocardiography (ICE) is
emerging as a potential substitute for TEE for LAAC procedures.
 Objective(s): To describe our single-center experience directly
comparing the use of TEE vs. ICE during LAAC with the Watchman FLXTM
device. Method(s): We analyzed 236 consecutive patients undergoing
implantation of a Watchman FLXTM device (Boston Scientific, Marlborough,
MA) at the Heart Hospital of New Mexico. All procedures were performed by
one of three operators, each of whom had performed >200 WatchmanTM
implants. Result(s): The mean age was 77 (+/-8) years and 42% were
female. 96 procedures were performed with TEE guidance while 140
procedures used ICE. The mean CHADS<inf>2-</inf>VAS<inf>2</inf>C and
HAS-BLED scores were 4.1 (+/-1.2) and 2.4 (+/-0.9) respectively.
Procedural success for the TEE and ICE groups were similarly high (96.9%
vs. 99.3%, respectively) and procedure times were similar (38.0 +/- 17.8
minutes vs. 36.5 +/- 16.4 minutes, p=0.23). In a comparison of first vs.
last ten ICE-guided procedure times, there was an improvement demonstrated
among all three operators (mean decrease of 5.0 minutes). Fluoroscopy
times were higher in the TEE group compared to the ICE group (8.2 +/- 6.8
minutes vs. 5.9 +/- 3.4 minutes, p=0.004). There were no acute peri-device
leaks in either group. Of the patients with six-week follow up imaging
data, 24/91 (26.4%) had peri-device leaks in the TEE group vs. 19/131
(14.5%) in the ICE group (p=0.012 between groups). The mean size of the
peri-device leaks was slightly larger in the ICE group (3.4 +/- 0.7 mm vs.
2.9 +/- 0.8 mm, p=0.02). Complications included one groin hematoma in the
TEE group and one pericardial effusion requiring percutaneous draining in
the ICE group. Conclusion(s): ICE-guided Watchman implantation is
associated with high procedural success and safety compared to TEE guided
procedures. While overall procedure time is similar between TEE and ICE,
we demonstrated rapid learning curve using ICE based on a decrease in
procedure time among all operators. The need for fluoroscopy was less with
ICE and there was a decrease in the rate of leaks on 45-day imaging.
Further direct comparisons between these two imaging modalities should be
pursued. Copyright © 2024

<98>
Accession Number
2032147337
Title
Efficacy and Safety of Botulinum Toxin Type A for the Prevention of
Postoperative Atrial Fibrillation.
Source
JACC: Clinical Electrophysiology. (no pagination), 2024. Date of
Publication: 2024.
Author
Piccini J.P.; Ahlsson A.; Dorian P.; Gillinov A.M.; Kowey P.R.; Mack M.J.;
Milano C.A.; Noiseux N.; Perrault L.P.; Ryan W.; Steinberg J.S.; Voisine
P.; Waldron N.H.; Gleason K.J.; Titanji W.; Leaback R.D.; O'Sullivan A.;
Ferguson W.G.; Benussi S.; Akhter S.A.; Andreas M.; Castella M.;
Dalrymple-Hay M.; El-Eshmawi A.; Groh M.; Hanke T.; Jeanmart H.; Katz M.;
McCullough J.N.; Melby S.; Miller J.; Romano M.A.; Podgoreanu M.V.; Sharma
V.; Shults C.; Teman N.; Whitson B.A.; Wickbom A.; Vallabhajosyula P.; Yau
T.
Institution
(Piccini) Department of Electrophysiology, Duke Clinical Research
Institute/Duke University Medical Center, Durham, NC, United States
(Ahlsson) Cardiovascular Division, Karolinska Institute, Stockholm, Sweden
(Dorian) Division of Cardiology, St Michael's Hospital, Toronto, ON,
Canada
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Kowey) Division of Cardiovascular Research, Lankenau Heart Institute,
Wynnewood, PA, United States
(Mack, Ryan) Department of Thoracic Surgery, Baylor Scott and White
Health, Dallas, TX, United States
(Milano) Division of Cardiothoracic Surgery, Duke Clinical Research
Institute/Duke University Medical Center, Durham, NC, United States
(Noiseux) Division of Cardiac Surgery, Centre Hospitalier de l'Universite
de Montreal, Centre de Recherche du Centre Hospitalier de l'Universite de
Montreal, QC, Canada
(Perrault) Department of Surgery, Montreal Heart Institute, Universite de
Montreal, Montreal, Quebec City, QC, Canada
(Steinberg) Clinical Cardiovascular Research Center, University of
Rochester School of Medicine and Dentistry, Rochester, NY, United States
(Voisine) Division of Cardiac Surgery, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, QC, Canada
(Waldron) Department of Anesthesiology and Critical Care, Mayo Clinic,
Jacksonville, FL, United States
(Gleason, Titanji, Leaback, O'Sullivan, Ferguson) AbbVie Inc, North
Chicago, IL, United States
(Benussi) Department of Cardiothoracic Surgery, University of Brescia,
Brescia, Italy
(Akhter) East Carolina University Brody School of Medicine, Greenville,
NC, United States
(Andreas) Medical University of Vienna, Vienna, Austria
(Benussi) University of Brescia, Brescia, Italy
(Castella) Hospital Clinic de Barcelona, Barcelona, Spain
(Dalrymple-Hay) University Hospital Plymouth NHS Trust, Plymouth, United
Kingdom
(El-Eshmawi) Icahn School of Medicine at Mount Sinai - The Mount Sinai
Medical Center, New York, NY, United States
(Groh) Mission Hospital, Asheville, NC, United States
(Hanke) Asklepios Klinik Harburg-Hamburg, Hamburg, Germany
(Jeanmart) CIUSS du NIM site Hopital du Sacre-Coeur de Montreal, Montreal,
Canada
(Katz) Medical University of South Carolina, Charleston, SC, United States
(McCullough) Dartmouth Hitchcock Medical Center, Lebanon, NH, United
States
(Melby) Washington University School of Medicine, St. Louis, MO, United
States
(Miller) Emory St Joseph's Hospital, Atlanta, GA, United States
(Noiseux) Centre Hospitalier de l'Universite de Montreal, Centre de
Recherche du CHUM, QC, Canada
(Romano) University of Michigan Health System, Ann Arbor, MI, United
States
(Perrault) Montreal Heart Institute/ Universite de Montreal, Montreal,
Canada
(Piccini) Duke Clinical Research Institute/Duke University Medical Center,
Durham, NC, United States
(Podgoreanu) Duke University Medical Center, Durham, NC, United States
(Ryan) Baylor Scott & White Health, Dallas, TX, United States
(Sharma) University of Utah Health, Salt Lake City, UT, United States
(Shults) Medstar Heart and Vascular Institute, Washington, DC, United
States
(Teman) University of Virginia, Charlottesville, VA, United States
(Voisine) IUCPQ, QC, Canada
(Whitson) Ohio State University - Davis Heart and Lung Institute,
Columbus, OH, United States
(Wickbom) Orebro University Hospital Sweden, Orebro, Sweden
(Vallabhajosyula) Yale New Haven Hospital, New Haven, CT, United States
(Yau) Toronto General Hospital, Toronto, Canada
Publisher
Elsevier Inc.
Abstract
Background: Postoperative atrial fibrillation (POAF) is associated with
increased morbidity and mortality. Epicardial injection of botulinum toxin
may suppress POAF. Objective(s): This study sought to assess the
safety and efficacy of AGN-151607 for the prevention of POAF after cardiac
surgery. Method(s): This phase 2, randomized, placebo-controlled
trial assessed the safety and efficacy of AGN-151607, 125 U and 250 U vs
placebo (1:1:1), for the prevention of POAF after cardiac surgery.
Randomization was stratified by age (<65, >=65 years) and type of surgery
(nonvalvular/valve surgery). The primary endpoint was the occurrence of
continuous AF >=30 seconds. Result(s): Among 312 modified
intention-to-treat participants (placebo, n = 102; 125 U, n = 104; and 250
U, n = 106), the mean age was 66.9 +/- 6.8 years; 17% were female; and 64%
had coronary artery bypass graft (CABG) only, 12% had CABG + valve, and
24% had valve surgery. The primary endpoint occurred in 46.1% of the
placebo group, 36.5% of the 125-U group (relative risk [RR] vs placebo:
0.80; 95% CI: 0.58-1.10; P = 0.16), and 47.2% of the 250-U group (RR vs
placebo: 1.04; 95% CI: 0.79-1.37; P = 0.78). The primary endpoint was
reduced in the 125-U group in those >=65 years (RR: 0.64; 95% CI:
0.43-0.94; P = 0.02) with a greater reduction in CABG-only participants
>=65 years (RR: 0.49; 95% CI: 0.27-0.87; P = 0.01). Rehospitalization and
rates of adverse events were similar across the 3 groups.
 Conclusion(s): There were no significant differences in the rate of
POAF with either dose compared with placebo; however, there was a lower
rate of POAF in participants >=65 years undergoing CABG only and receiving
125 U of AGN-151607. These hypothesis-generating findings require
investigation in a larger, adequately powered randomized clinical trial.
(Botulinum Toxin Type A [AGN-151607] for the Prevention of Post-operative
Atrial Fibrillation in Adult Participants Undergoing Open-chest Cardiac
Surgery [NOVA]; NCT03779841); A Phase 2, Multi-Center, Randomized,
Double-Blind, Placebo-Controlled, Dose Ranging Study to Evaluate the
Efficacy and Safety of Botulinum Toxin Type A [AGN 151607] Injections into
the Epicardial Fat Pads to Prevent Post-Operative Atrial Fibrillation in
Patients Undergoing Open-Chest Cardiac Surgery;
2017-004399-68) Copyright © 2024 American College of Cardiology
Foundation

<99>
Accession Number
2032112925
Title
Left atrial appendage occlusion for recurrent stroke while on oral
anticoagulation: A case series.
Source
European Heart Journal - Case Reports. 8(5) (no pagination), 2024. Article
Number: ytae157. Date of Publication: 01 May 2024.
Author
Costa G.; Grine M.; Simoes M.; Oliveira-Santos M.; Paiva L.; Costa M.;
Goncalves L.
Institution
(Costa, Grine, Simoes, Oliveira-Santos, Paiva, Costa, Goncalves) Servico
de Cardiologia, Centro Hospitalar e Universitario de Coimbra, Praceta
Professor Mota Pinto, Coimbra 3004-561, Portugal
(Costa, Oliveira-Santos, Goncalves) Faculdade de Medicina da Universidade
de Coimbra, Azinhaga de Santa Comba, Celas, Coimbra 3000-548, Portugal
(Goncalves) Coimbra Institute for Clinical and Biomedical Research (ICBR),
Coimbra, Portugal
Publisher
Oxford University Press
Abstract
Background: Clinical practice guidelines recommend oral anticoagulation
(OAC) for stroke prevention in selected patients with atrial fibrillation
(AF). However, some patients still experience thrombo-embolic events
despite adequate anticoagulation. The optimal management of these cases
remains uncertain, leading to practice pattern variability. We present a
series of three cases illustrating the use of left atrial appendage
occlusion (LAAO) as an adjunctive stroke prevention strategy in AF
patients with recurrent thrombo-embolic events despite adequate
anticoagulation. Case summary: Case one describes an 89-year-old female on
apixaban who presented with a thrombus and underwent successful mechanical
thrombectomy. Left atrial appendage occlusion was performed, and no
subsequent thrombo-embolic events were reported. Case 2 involves a
72-year-old female on full-dose apixaban who experienced recurrent strokes
despite adequate anticoagulation. Thrombectomy was performed twice, and
complications arose during LAAO. The patient was discharged on warfarin +
clopidogrel and remained event-free at the six-month follow-up. Case 3
features an 88-year-old female on rivaroxaban who experienced recurrent
cerebral ischaemic events and gastrointestinal bleeding. Left atrial
appendage occlusion using an Amplatzer AmuletTM device was successful, and
the patient remained event-free at the one-year follow-up.
 Discussion(s): This case series emphasizes the complexity of stroke
prevention in AF patients and underscores the need for an individualized
approach. Incorporating LAAO alongside OAC can provide additional stroke
protection for patients with inadequate response to anticoagulation.
Further randomized controlled trials are needed to evaluate the efficacy
and safety of this approach. In light of the limited evidence available,
these cases contribute to the growing body of knowledge on the potential
role of LAAO in secondary stroke prevention in AF patients with recurrent
thrombo-embolic events despite appropriate anticoagulation. Copyright
© 2024 The Author(s). Published by Oxford University Press on behalf
of the European Society of Cardiology.

<100>
[Use Link to view the full text]
Accession Number
2032090076
Title
Adjunctive Cilostazol in Patients with High Residual Platelet Reactivity
after Drug-Eluting Stent Implantation: A Randomized, Open-Label,
Single-Center, Prospective Study (ADJUST-HPR).
Source
American Journal of Therapeutics. 31(3) (pp E229-E236), 2024. Date of
Publication: 25 May 2024.
Author
Long Zhe G.; Hau Yu L.; Lee D.-H.; Kim M.H.; Serebruany V.
Institution
(Long Zhe, Hau Yu, Kim) Department of Cardiology, Dong-A University
Hospital, Busan, South Korea
(Long Zhe) Department of Cardiology, Affiliated Qiqihar Hospital, Southern
Medical University, China
(Hau Yu) Department of Cardiology, Guilin Medical University, China
(Lee) Department of Intensive Care Medicine, Dong-A University Hospital,
Busan, South Korea
(Serebruany) Division of Neurology, Department of Medicine, Johns Hopkins
University, Baltimore, MD, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background:Cilostazol as an adjunct to dual antiplatelet therapy (DAPT)
postcoronary stenting may further reduce vascular occlusion risks. The aim
of this study was to assess the impact of cilostazol on high residual
platelet reactivity (HRPR) in patients undergoing drug-eluting coronary
stent implantation. Method(s):In a randomized, open-label,
single-center, prospective study, the degree of platelet inhibition by
cilostazol 100 mg twice daily was assessed on top of conventional DAPT
compared with standard clopidogrel and low-dose aspirin combination in
poststent patients with HRPR. HRPR was defined as P2Y12 units (PRU) > 240
as measured by the VerifyNow P2Y12 assay. In addition, the platelet
activity was assessed by light transmittance aggregometry (LTA) and
Multiplate electrode analyzer (MEA). Result(s):The total of 148
patients were screened, and HRPR was observed in 64 (43.2%). Those were
randomized for DAPT versus triple therapy (TAPT). After 30 days, TAPT
group exhibited significantly lower rate of HRPR when assessed by all 3
devices (VerifyNow: 40.0 vs. 66.7% P = 0.04, LTA: 6.7 vs. 30.0% P = 0.02,
MEA: 10.0 vs. 30.0% P = 0.05 L all vs. DAPT). Also, higher absolute mean
difference in TAPT versus DAPT group after 30 days (VerifyNow: 71.3 +/-
38.2 vs. 24.6 +/- 40.2 P < 0.001, LTA: 23.9 +/- 15.1 vs. 9.4 +/- 11.8 P <
0.001, MEA: 9.3 +/- 12.9 vs. 2.4 +/- 17.3 P = 0.08) was observed.
 Conclusion(s):Cilostazol in addition to standard DAPT reduces the
incidence of HRPR and diminishes further platelet activity in poststent
patients. Whether this favorable laboratory finding will affect clinical
outcomes requires an adequately powered randomized trial. Copyright
© 2024 Lippincott Williams and Wilkins. All rights reserved.

<101>
Accession Number
2032076154
Title
Non-continuous mobile electrocardiogram monitoring for post-transcatheter
aortic valve replacement delayed conduction disorders put to the test.
Source
Europace. 25(3) (pp 1116-1125), 2023. Date of Publication: 01 Mar 2023.
Author
De Lucia R.; Giannini C.; Parollo M.; Barletta V.; Costa G.; Santoro M.G.;
Primerano C.; Angelillis M.; De Carlo M.; Zucchelli G.; Bongiorni M.G.;
Petronio A.S.
Institution
(De Lucia, Parollo, Barletta, Santoro, Zucchelli, Bongiorni) Second
Division of Cardiology, CardioThoracic and Vascular Department, Azienda
Ospedaliero-Universitaria Pisana, Pisa, Italy
(Giannini, Costa, Primerano, Angelillis, De Carlo, Petronio) Cardiac
Catheterization Division, CardioThoracic and Vascular Department, Azienda
Ospedaliero-Universitaria Pisana, Pisa, Italy
Publisher
Oxford University Press
Abstract
Aims Permanent pacemaker implantation (PPM-I) remains nowadays
the most important drawback of transcatheter aortic valve replacement
(TAVR) procedure and the optimal strategy of delayed conduction
disturbances (CDs) in these patients is unclear. The study aimed to
validate an ambulatory electrocardiogram (ECG) monitoring through a 30 s
spot ambulatory digital mobile ECG (AeECG), by using KardiaMobile-6L
device in a 30-day period after TAVR procedure. . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . Methods Between
March 2021 and February 2022, we consecutively enrolled all patients
undergoing TAVR procedure, except pace- and results maker (PM)
carriers. At discharge, all patients were provided of a KardiaMobile-6L
device and a spot digital ECG (eECG) recording 1 month schedule. Clinical
and follow-up data were collected, and eECG schedule compliance and
recording quality were explored. Among 151 patients without pre-existing
PM, 23 were excluded for pre-discharge PPM-I, 18 failed the
KardiaMobile-6L training phase, and 10 refused the device. Delayed CDs
with a Class I/IIa indication for PPM-I occurred in eight patients (median
6 days). Delayed PPM-I vs. non-delayed PPM-I patients were more likely to
have longer PR and QRS intervals at discharge. PR interval at discharge
was the only independent predictor for delayed PPM-I at multivariate
analysis. The overall eECG schedule compliance was 96.5%. None clinical
adverse events CDs related were documented using this new AeECG monitoring
modality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . Conclusion A strategy of 30 s spot AeECG is safe and
efficacious in delayed CDs monitoring after TAVR procedure with a very
high eECG schedule level of compliance. Graphical Abstract Patients
enrollment by device training phase, eECG 1 month schedule program and
late PPM-I Post-Transcatheter Aortic Valve Replacement A Device training
phase Digital check list Account Willingness to participate to
registration the study for one month Ability to use a
smartphone Pseudo anonymized account and send and receive
registration, guided by study emails authors, who explained how Relatives
involved and felt to use the device and the empowered dedicated
App Have a smartphone compatible with the mobile ECG device Ability to
independently store and send by email a good quality eECG for 3
consecutive times B eECG 1 month schedule C Patients submitted to PPM-I !
1 2 3 4 5 6 7 10 8 9 10 11 12 13 14 5 <inf>3</inf> 3 15 16 17
18 19 20 21 <inf>1</inf> 1 22 23 24 25 26 27 28 0 0 1 2 3 4 5 6
7 8 9 10 11 12 13 14 = eECG sending remainder Days post TAVR procedure (A)
Flow chart programme for patient access to the device training phase and
its rules. (B) eECG 1 month schedule. (C) Histogram illustrating the
number of cases and associated time to development of delayed CDs
requiring PPM-I. CD, conduction disturbance; eECG, digital
electrocardiogram; PPM-I, permanent pacemaker implantation.
Numbers Copyright © 2023 Oxford University Press. All rights
reserved.

<102>
Accession Number
2032076128
Title
Safety and efficacy of colchicine for the prevention of post-operative
atrial fibrillation in patients undergoing cardiac surgery: a
meta-analysis of randomized controlled trials.
Source
Europace. 25(7) (no pagination), 2023. Article Number: euad169. Date of
Publication: 01 Jul 2023.
Author
Agarwal S.; Beard C.W.; Khosla J.; Clifton S.; Anwaar M.F.; Ghani A.;
Farhat K.; Pyrpyris N.; Momani J.; Munir M.B.; DeSimone C.V.; Deshmukh A.;
Stavrakis S.; Jackman W.M.; Po S.; Asad Z.U.A.
Institution
(Agarwal, Beard, Khosla, Anwaar, Ghani, Farhat, Stavrakis, Jackman, Po,
Asad) Department of Medicine, University of Oklahoma Health Sciences
Center, 800 Stanton L Young Blvd, Oklahoma City, OK 73104, United States
(Clifton) Robert M Bird Health Sciences Library, University of Oklahoma
Health Sciences Center, Oklahoma City, OK, United States
(Pyrpyris) First Department of Cardiology, School of Medicine, National
and Kapodistrian University of Athens, Hippokration Hospital, Athens,
Greece
(Momani) Department of Internal Medicine, Alfaisal University, Riyadh,
Saudi Arabia
(Munir) Division of Cardiovascular Medicine, University of California
Davis, Sacramento, CA, United States
(DeSimone, Deshmukh) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
Publisher
Oxford University Press
Abstract
Background and Colchicine is an anti-inflammatory drug that may
prevent post-operative atrial fibrillation (POAF). The effect of this drug
has Aims been inconsistently shown in previous clinical trials. We aimed
to compare the efficacy and safety of colchicine vs. placebo to prevent
POAF in patients undergoing cardiac surgery. Methods A systematic search
of EMBASE, MEDLINE, SCOPUS, ClinicalTrials.gov, and the Cochrane Library
for randomized con- and results trolled trials (RCTs) was conducted from
inception till April 2023. The primary outcome was the incidence of POAF
after any cardiac surgery. The secondary outcome was the rate of drug
discontinuation due to adverse events and adverse gastrointestinal events.
Risk ratios (RR) were reported using the Mantel Haenszel method. A total
of eight RCTs comprising 1885 patients were included. There was a
statistically significant lower risk of developing POAF with colchicine
vs. placebo (RR: 0.70; 95% CI: 0.59-0.82; P < 0.01, I2 = 0%),
and this effect persisted across different subgroups. There was a
significantly higher risk of adverse gastrointestinal events (RR: 2.20;
95% CI: 1.38-3.51; P < 0.01, I2 = 55%) with no difference in
the risk of drug discontinuation in patients receiving colchicine vs.
placebo (RR: 1.33; 95% CI: 0.93-1.89; P = 0.11, I2 = 0%).
Conclusion This meta-analysis of eight RCTs shows that colchicine is
effective at preventing POAF, with a significantly higher risk of adverse
gastrointestinal events but no difference in the rate of drug
discontinuation. Future studies are required to define the optimal
duration and dose of colchicine for the prevention of POAF. Copyright
© 2023 Oxford University Press. All rights reserved.

<103>
Accession Number
2032061294
Title
Gabapentin as a novel adjunct for postoperative irritability after
superior cavopulmonary connection operation in children.
Source
Cardiology in the Young. (no pagination), 2024. Date of Publication:
2024.
Author
Thibault C.; Ramsey E.Z.; Collier H.; Shu D.; Faerber J.; Schwartz E.;
Chen J.; Goldberg D.J.; Yehya N.; Gardner M.M.
Institution
(Thibault, Yehya, Gardner) Department of Anesthesiology and Critical Care,
Children's Hospital of Philadelphia, Philadelphia, PA, United States
(Thibault) Department of Pediatrics, Universite de Montreal, Montreal, QC,
Canada
(Thibault) Division of Critical Care Medicine, Department of Pediatrics,
Chu Sainte-Justine, Montreal, QC, Canada
(Ramsey, Collier) Department of Pharmacy Services, The Children's Hospital
of Philadelphia, Philadelphia, PA, United States
(Shu) Department of Biostatistics, Epidemiology and Informatics,
University of Pennsylvania, Philadelphia, PA, United States
(Shu) The Clinical Futures, Research Institute, The Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Faerber) Department of Biomedical and Health Informatics, Data Science
and Biostatistics Unit, The Children's Hospital of Philadelphia,
Philadelphia, PA, United States
(Schwartz, Goldberg) Division of Cardiology, The Children's Hospital of
Philadelphia, Perelman School of Medicine, The University of Pennsylvania,
Philadelphia, PA, United States
(Chen) Division of Cardiothoracic Surgery, The Children's Hospital of
Philadelphia, Perelman School of Medicine, The University of Pennsylvania,
Philadelphia, PA, United States
Publisher
Cambridge University Press
Abstract
Objectives: Describing our institution's off-label use of gabapentin to
treat irritability after superior cavopulmonary connection surgery and its
impact on subsequent opiate and benzodiazepine requirements.
 Method(s): This is a single-center retrospective cohort study
including infants who underwent superior cavopulmonary connection
operation between 2011 and 2019. Result(s): Gabapentin was
administered in 74 subjects (74/323, 22.9%) during the observation period,
with a median (IQR) starting dose of 5.7 (3.3, 15.0) mg/kg/day and a
maximum dose of 10.7 (5.5, 23.4) mg/kg/day. Infants who underwent surgery
in 2015-19 were more likely to receive gabapentin compared with those who
underwent surgery in 2011-14 (p < 0.0001). Infants prescribed gabapentin
were younger at surgery (137 versus 146 days, p = 0.007) and had longer
chest tube durations (1.8 versus 0.9 days, p < 0.001), as well as longer
postoperative intensive care (5.8 versus 3.1 days, p < 0.0001) and
hospital (11.5 versus 7.0 days, p < 0.0001) lengths of stays. The year of
surgery was the only predisposing factor associated with gabapentin
administration in multivariate analysis. In adjusted linear regression,
infants prescribed gabapentin on postoperative day 0-4 (n = 64) had
reduced benzodiazepine exposure in the following 3 days (-0.29 mg/kg, 95%
CI -0.52 - -0.06, p = 0.01) compared with those not prescribed gabapentin,
while no difference was seen in opioid exposure (p = 0.59).
 Conclusion(s): Gabapentin was used with increasing frequency during
the study period. There was a modest reduction in benzodiazepine
requirements associated with gabapentin administration and no reduction in
opioid requirements. A randomised controlled trial could better assess
gabapentin's benefits postoperatively in children with congenital heart
disease. Copyright © The Author(s), 2024. Published by Cambridge
University Press.

<104>
Accession Number
644196676
Title
Incidence of Intraoperative Cardiothoracic Intervention During Open
Surgery Following Acute Posterior Sternoclavicular Joint Injury: A Case
Series and Review of the Literature.
Source
Journal of pediatric orthopedics. (no pagination), 2024. Date of
Publication: 07 May 2024.
Author
Galina J.M.; Miller S.D.; Whelan T.J.; Pavlesen S.; Ferrick M.R.
Institution
(Galina, Whelan, Pavlesen, Ferrick) Department of Orthopaedic Surgery,
University at Buffalo Jacobs School of Medicine and Biomedical Sciences,
Buffalo, NY, United States
(Miller) Eastern Virginia Medical School, Norfolk, VA, United States
Abstract
BACKGROUND: Acute posterior sternoclavicular joint injuries are rare but
potentially lethal injuries-signs of mediastinal compression range from
nonspecific to neurovascular compromise. Currently, orthopaedic experts
recommend a cardiothoracic surgeon be placed on standby during open
surgery for potential intraoperative complications. However, few studies
have reported on how often cardiothoracic intervention is required.
 METHOD(S): First, we identified patients in our institution by CPT
codes 23530, 23525, and 23532 from January 1, 2002 to May 1, 2023.
Demographic variables and intraoperative cardiothoracic intervention rates
were collected. Second, we systematically reviewed the literature to
identify articles on acute posterior sternoclavicular injury using PubMed,
Embase, and CINAHL databases (through August 20, 2023). Exclusion criteria
included conservative treatment, successful closed reduction, chronic
injury (>6 wk) cadaver studies, reviews, and nonavailable text.
 RESULT(S): Thirteen local patients underwent open surgery for an
acute posterior sternoclavicular joint injury, 11 males and 2 females with
an average age of 18.2 years old (range: 15 to 32.4). The most common
mechanism of injury was sports (n=9; 69.2%). Four (30.8%) patients had
physical or radiographic evidence of mediastinal compression. No patients
required intraoperative cardiothoracic intervention in our institution.
The literature search yielded 132 articles and 512 open surgeries for
acute posterior sternoclavicular joint injuries. Four patients required
intraoperative cardiothoracic intervention, all of whom presented with
polytrauma and/or clinical or radiographic signs of neurovascular
compromise, giving a combined overall rate of 0.76%. CONCLUSION(S):
Expert opinion commonly recommends cardiothoracic backup during open
surgery for acute posterior sternoclavicular joint injuries. On the basis
of our local data and systematic literature review, we found an overall
cardiothoracic intervention rate of 0.76%. In the presence of polytrauma
and/or findings of neurovascular compromise, we suggest having
cardiothoracic surgery on close standby during the procedure. However, a
patient with an isolated acute posterior sternoclavicular joint injury and
no clinical or radiographic findings of neurovascular compromise does not
appear to require a cardiothoracic surgeon on standby. Ultimately, the
decision to involve cardiothoracic backup during open surgery for an acute
posterior sternoclavicular injury should be made on a case-by-case basis
after a thorough physical and radiographic evaluation of the patient.
LEVEL OF EVIDENCE: Level III. Copyright © 2024 Wolters Kluwer
Health, Inc. All rights reserved.

<105>
Accession Number
644194834
Title
Rationale and design of a Single-center Randomized Trial to Compare the
Graft Patency between the Radial Artery and the No-touch Saphenous Vein in
Coronary Artery Bypass Grafting Surgery (GRAFT-CAB Study).
Source
American heart journal. (no pagination), 2024. Date of Publication: 04
May 2024.
Author
Zhang F.; Tian M.; Zhang H.; Zhou X.; Liu R.; Jin Z.; Zhang C.; Wang X.
Institution
(Zhang, Tian, Wang, Zhang, Zhou, Liu, Liu, Jin, Zhang, Wang) Department of
Surgery, National Center for Cardiovascular Disease, China & Fuwai
Hospital, Chinese Academy of Medical Sciences & Peking Union Medical
College, Chinas, Beijing, China
Abstract
BACKGROUND: Previous studies suggested only the radial artery and the
No-touch (NT) technique were effective in reducing graft occlusion after
coronary artery bypass grafting (CABG) surgery. However, there is no
randomized trial comparing these two graft conduits. The optimum second
conduit for CABG remains undetermined. MATERIALS AND METHODS: This study
is a prospective, single-center randomized clinical trial, aiming to
compare the graft patency between the radial artery and the NT vein graft.
All patients undergoing isolated CABG with left internal mammary artery
(LIMA) plus at least two additional grafts will be considered eligible.
774 cases (516 in the radial artery group and 258 in the NT vein group)
will be enrolled in over 1 to 2 years. Participants will be randomized and
allocated to two bypass strategies: the LIMA plus one radial artery and
one conventional vein graft, or the LIMA plus two NT vein grafts. The
primary outcome is graft occlusion at 1 year after CABG evaluated by CT
angiography. The secondary outcomes include graft occlusion at 3 and 5
years and major adverse cardiac or cerebrovascular events at 1, 3 and 5
years follow-ups. DISCUSSION: This study will define whether or not the NT
vein has a lower graft occlusion rate than the radial artery in short and
mid-term follow-ups, and provide new evidence for the second conduit
choice in CABG surgery. TRIAL REGISTRATION: ClinicalTrials.gov
NCT06014047. Registered on October 15th, 2023. Copyright © 2024.
Published by Elsevier Inc.

<106>
Accession Number
644183205
Title
Angiographic Characteristics and Clinical Outcomes in Patients With
Chronic Kidney Disease Undergoing Impella-Supported High-Risk Percutaneous
Coronary Intervention: Insights From the cVAD PROTECT III Study.
Source
Circulation. Cardiovascular interventions. (pp e013503), 2024. Date of
Publication: 06 May 2024.
Author
Bharadwaj A.S.; Abu-Much A.; Maini A.S.; Zhou Z.; Li Y.; Batchelor W.B.;
Grines C.L.; Baron S.J.; Redfors B.; Lansky A.J.; Basir M.B.; O'Neill W.W.
Institution
(Bharadwaj) Division of Cardiology, Loma Linda University Medical Center
(Abu-Much, Maini, Zhou, Li, Redfors) Clinical Trials Center,
Cardiovascular Research Foundation, A.S.M., NY, United States
(Batchelor) Inova Center of Outcomes Research, Inova Heart and Vascular
Institute, Falls Church
(Grines) Department of Cardiology, Northside Hospital Cardiovascular
Institute, Atlanta, United States
(Baron) Massachusetts General Hospital
(Baron) Baim Institute for Clinical Research, Boston, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, United States
(Lansky) Yale University School of Medicine, CT (A.J.L.), New Haven,
United States
(Lansky) Barts Heart Centre, Queen Mary University of London, United
Kingdom (A.J.L.), United Kingdom
(Basir, O'Neill) Division of Cardiology, Center for Structural Heart
Disease, Henry Ford Health System, Detroit, United States
Abstract
BACKGROUND: Prior studies have found that patients with chronic kidney
disease (CKD) have worse outcomes following percutaneous coronary
intervention (PCI). There are no data about patients with advanced CKD
undergoing Impella-supported high-risk PCI. We, therefore, aimed to
evaluate angiographic characteristics and clinical outcomes in patients
with CKD who received Impella-supported high-risk PCI as part of the
catheter-based ventricular assist device PROTECT III study (A Prospective,
Multi-Center, Randomized Controlled Trial of the IMPELLA RECOVER LP 2.5
System Versus Intra Aortic Balloon Pump [IABP] in Patients Undergoing Non
Emergent High Risk PCI). METHOD(S): Patients enrolled in the PROTECT
III study were analyzed according to their baseline estimated glomerular
filtration rate (eGFR). The primary outcome was 90-day major adverse
cardiovascular and cerebrovascular events (the composite of all-cause
death, myocardial infarction, stroke/transient ischemic attack, and repeat
revascularization). RESULT(S): Of 1237 enrolled patients, 1052
patients with complete eGFR baseline assessment were evaluated: 586 with
eGFR >=60 mL/min per 1.73 m2, 190 with eGFR >=45 to <60, 105 with eGFR
>=30 to <45, and 171 with eGFR <30 or on dialysis. Patients with lower
eGFR (all groups with eGFR <60) were more frequently females and had a
higher prevalence of hypertension, diabetes, anemia, and peripheral artery
disease. The baseline Synergy Between PCI With Taxus and Cardiac Surgery
score was similar between groups (28.2+/-12.6 for all groups). Patients
with lower eGFR were more likely to have severe coronary calcifications
and higher usage of atherectomy. There were no differences in individual
PCI-related coronary complications between groups, but the rates of
overall PCI complications were less frequent among patients with lower
eGFR. Major adverse cardiovascular and cerebrovascular events at 90 days
and 1-year mortality were significantly higher among patients with eGFR
<30 mL/min per 1.73 m2 or on dialysis. CONCLUSION(S): Patients with
advanced CKD undergoing Impella-assisted high-risk PCI tend to have higher
baseline comorbidities, severe coronary calcification, and higher
atherectomy usage, yet CKD was not associated with a higher rate of
immediate PCI-related complications. However, 90-day major adverse
cardiovascular and cerebrovascular events and 1-year mortality were
significantly higher among patients with eGFR<30 mL/min per 1.73 m2 or on
dialysis. Future studies of strategies to improve intermediate and
long-term outcomes of these high-risk patients are warranted.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier:
NCT04136392.

<107>
Accession Number
2032080205
Title
Negative selection bias for women inclusion in a clinical trial.
Source
International Journal of Cardiology. 408 (no pagination), 2024. Article
Number: 132138. Date of Publication: 01 Aug 2024.
Author
Landi A.; Heg D.; Frigoli E.; Routledge H.; Malik F.-T.-N.; Pourbaix S.;
Alasnag M.; Smits P.C.; Valgimigli M.
Institution
(Landi, Frigoli, Valgimigli) Cardiocentro Ticino Institute, Ente
Ospedaliero Cantonale (EOC), Lugano CH-6900, Switzerland
(Landi, Valgimigli) Faculty of Biomedical Sciences, University of Italian
Switzerland, Lugano, Switzerland
(Heg) Department of Clinical Research, University of Bern, Switzerland
(Routledge) Worcestershire Royal Hospital, Worcester, United Kingdom
(Malik) National Heart Foundation Hospital & Research Institute, Dhaka,
Bangladesh
(Pourbaix) Department of Cardiology, CHR Citadelle Liege, Liege, Belgium
(Alasnag) Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi
Arabia
(Smits) Department of Cardiology, Maasstad Hospital, Rotterdam,
Netherlands
(Valgimigli) University of Bern, Bern, Switzerland
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Despite the growing awareness towards the importance of
adequate representation of women in clinical trials among patients treated
with percutaneous coronary intervention (PCI), available evidence
continues to demonstrate a skewed distribution of study populations in
favour of men. Methods and Results: In this pre-specified analysis
from the MASTER DAPT screening log and trial, we aimed to investigate the
existence of a negative selection bias for women inclusion in a randomized
clinical trial. A total of 2847 consecutive patients who underwent
coronary revascularization across 65 participating sites, during a median
of 14 days, were entered in the screening log, including 1749 (61.4%)
non-high bleeding risk (HBR) and 1098 (38.6%) HBR patients, of whom 109
(9.9%) consented for trial participation. Female patients were less
represented in consented versus non-consented HBR patients (22% versus
30%, absolute standardized difference: 0.18) and among non-consented
eligible versus consented eligible patients (absolute standardized
difference 0.14). The observed sex gap was primarily due investigators'
choice not to offer study participation to females because deemed at very
high risk of bleeding and/or ischemic complications, and only marginally
to a slightly higher propensity of females compared to males to refuse
study participation. Conclusion(s): Female HBR patients undergoing
PCI are less prevalent, but also less likely to participate in the trial
than male patients, mainly due to investigators' preference. Copyright
© 2024 Elsevier B.V.

<108>
Accession Number
2023778534
Title
Systematic Review and Meta-Analysis of Transradial Access for Carotid
Artery Stenting.
Source
Angiology. 75(6) (pp 517-526), 2024. Date of Publication: July 2024.
Author
Du M.; Hu Y.; Zhu D.; Cao W.; Li P.; Qi D.; Wu C.; He J.; Ye S.; Li S.;
Fang Y.
Institution
(Du, Hu, Zhu, Cao, Li, Qi, Wu, He, Ye, Li, Fang) Department of
Neurovascular Disease, Shanghai Fourth People's Hospital, School of
Medicine, Tongji University, Shanghai, China
Publisher
SAGE Publications Inc.
Abstract
There is an increasing number of studies on the transradial approach (TRA)
for carotid artery stenting. We aimed to summarize the published data on
TRA vs the transfemoral approach (TFA). We searched Science Direct,
Embase, PubMed, and Web of Science databases for the relevant literature.
Primary outcomes included surgical success and cardiovascular and
cerebrovascular complication rates; secondary outcomes included the rates
of vascular access-related and other complications. We also compared the
crossover rate, success rate, and complications between TRA and TFA
carotid stenting. This is the first such meta-analysis regarding TRA and
TFA. Twenty studies on TRA carotid stenting were included (n = 1300).
Among 19 studies, the success rate of TRA carotid stenting was.951 (95%
confidence interval [CI]:.926-.975); death rate was.022 (.011-.032);
stroke rate was.005 (.001-.008); radial artery occlusion rate was.008
(.003-.013); and forearm hematoma rate was.003 (-.000 to.006). Among 4
studies comparing TRA and TFA, the success rate was lower (odds ratio:.02;
95% CI:.00-.23) and crossover rate was higher (odds ratio: 40.16; 95% CI:
4.41-365.73) with TRA. Thus, transradial neuro-interventional surgery has
a lower success rate than TFA. Copyright © The Author(s) 2023.

<109>
Accession Number
2029090707
Title
Effect of S-Ketamine on Postoperative Nausea and Vomiting in Patients
Undergoing Video-Assisted Thoracic Surgery: A Randomized Controlled Trial.
Source
Drug Design, Development and Therapy. 18 (pp 1189-1198), 2024. Date of
Publication: 2024.
Author
Qi Y.; Zhou M.; Zheng W.; Dong Y.; Li W.; Xu H.; Zhang M.; Yang D.; Wang
L.; Zhou H.
Institution
(Qi, Zhou, Zheng, Dong, Wang, Xu, Zhang, Yang, Wang, Zhou) The Xuzhou
Clinical College of Xuzhou Medical University, Jiangsu, Xuzhou, China
(Qi, Zhou, Zheng, Dong, Li, Wang, Xu, Wang, Zhou) Department of
Anesthesiology, Xuzhou Central Hospital, Jiangsu, Xuzhou, China
(Qi, Zhou, Wang, Zhou) Jiangsu Province Key Laboratory of Anesthesiology
Xuzhou Medical University, Jiangsu, Xuzhou, China
(Li) College of Anesthesiology, Xuzhou Medical University, Jiangsu,
Xuzhou, China
(Zhang, Yang) Department of Cardiothoracic Surgery, Xuzhou Central
Hospital, Jiangsu, Xuzhou, China
Publisher
Dove Medical Press Ltd
Abstract
Purpose: Postoperative nausea and vomiting (PONV) frequently occur in
patients after surgery. In this study, the authors investigated whether
perioperative S-ketamine infusion could decrease the incidence of PONV in
patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy.
 Patients and Methods: This prospective, randomized, double-blinded,
controlled study was conducted a total of 420 patients from September 2021
to May 2023 at Xuzhou Central Hospital in China, who underwent elective
VATS lobectomy under general anesthesia with tracheal intubation. The
patients were randomly assigned to either the S-ketamine group or the
control group. The S-ketamine group received a bolus injection of 0.5
mg/kg S-ketamine and an intraoperative continuous infusion of S-ketamine
at a rate of 0.25 mg/ kg/h. The control group received an equivalent
volume of saline. All patients were equipped with patient-controlled
intravenous analgesia (PCIA), with a continuous infusion rate of 0.03
mg/kg/h S-ketamine in the S-ketamine group or 0.03 mug/kg/h sufentanil in
the control group. The primary outcome was the incidence of PONV.
Secondary outcomes included perioperative opioid consumption,
hemodynamics, postoperative pain, and adverse events. Result(s): The
incidence of PONV in the S-ketamine group (9.7%) was significantly lower
than in the control group (30.5%). Analysis of perioperative opioid usage
revealed that remifentanil usage was 40.0% lower in the S-ketamine group
compared to the control group (1414.8 mug vs 2358.2 mug), while sufentanil
consumption was 75.2% lower (33.1 mug vs 133.6 mug). The S-ketamine group
demonstrated better maintenance of hemodynamic stability. Additionally,
the visual analogue scale (VAS) scores on postoperative day 1 (POD-1) and
postoperative day 3 (POD-3) were significantly lower in the S-ketamine
group. Finally, no statistically significant difference in other
postoperative adverse reactions was observed between the two groups.
 Conclusion(s): The results of this trial indicate that perioperative
S-ketamine infusion can effectively reduce the incidence of PONV in
patients undergoing VATS lobectomy. Copyright © 2024 Qi et al.

<110>
Accession Number
2029017922
Title
CORONARY ARTERY ANATOMY AND ITS IMPACT ON ISCHEMIC HEART DISEASE: A
DETAILED REVIEW.
Source
Journal of Population Therapeutics and Clinical Pharmacology. 31(4) (pp
924-932), 2024. Date of Publication: 01 Apr 2024.
Author
Surwase R.G.; Balsurkar S.; Ugale M.S.
Institution
(Surwase, Balsurkar, Ugale) Department of Anatomy, Maharashtra Institute
of Medical Science and Research Medical College, Maharashtra, LATUR, India
Publisher
Codon Publications
Abstract
Coronary artery anatomy and pathoanatomy has plays a critical impact in
the pathogenesis and management of ischemic heart disease (IHD),
influencing diagnostic accuracy, treatment efficacy, and preventive
strategies. This review article provides a detailed examination of normal
coronary artery anatomy, common and rare anatomical variations, and their
clinical implications in IHD. Advances in imaging techniques, including
MDCT, MRI, OCT, and IVUS, have significantly improved the visualization of
coronary anatomy, facilitating precise diagnoses and tailored
interventions. However, the diagnostic and therapeutic challenges posed by
coronary artery variations underscore the need for personalized approaches
in patient care. Comparative analyses of imaging modalities reveal
strengths and limitations, highlighting the importance of selecting the
appropriate technique based on individual patient characteristics. Despite
of the technological advances, research gaps remain, particularly in
understanding the long-term implications of anatomical variations and
optimizing imaging strategies for diverse patient populations. Future
directions should focus on longitudinal studies and the integration of
artificial intelligence to enhance the personalized management of
IHD. Copyright © 2024, Codon Publications. All rights reserved.

<111>
Accession Number
2028867948
Title
Association between stopping renin-angiotensin system inhibitors
immediately before hemodialysis initiation and subsequent cardiovascular
events.
Source
Hypertension Research. 47(5) (pp 1372-1379), 2024. Date of Publication:
May 2024.
Author
Nakamura Y.; Inaguma D.; Imaizumi T.; Kurasawa S.; Hishida M.; Okazaki M.;
Fujishima Y.; Nishibori N.; Suzuki K.; Takeda Y.; Maruyama S.
Institution
(Nakamura, Imaizumi, Kurasawa, Okazaki, Fujishima, Nishibori, Suzuki,
Takeda, Maruyama) Department of Nephrology, Nagoya University Graduate
School of Medicine, 65 Tsurumai-cho, Showa-ku, Aichi, Nagoya 466-8550,
Japan
(Inaguma) Department of Internal Medicine, Fujita Health University
Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Aichi, Nagoya 454-8509,
Japan
(Imaizumi) Department of Advanced Medicine, Nagoya University Hospital, 65
Tsurumai-cho, Showa-ku, Aichi, Nagoya 466-8550, Japan
(Hishida) Department of Nephrology, Kaikoukai Josai Hospital, Nagoya,
Japan, 4-1, Kitahata-cho, Nakamura-ku, Aichi, Nagoya 453-0815, Japan
(Okazaki) Department of Clinical Research Education, Nagoya University
Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Aichi, Nagoya
466-8550, Japan
Publisher
Springer Nature
Abstract
It is controversial whether renin-angiotensin system inhibitors (RASIs)
should be stopped in patients with advanced chronic kidney disease (CKD).
Recently, it was reported that stopping RASIs in advanced CKD was
associated with increased mortality and cardiovascular (CV) events;
however, it remains unclear whether stopping RASIs before dialysis
initiation affects clinical outcomes after dialysis, which this study
aimed to evaluate. In this multicenter prospective cohort study in Japan,
we included 717 patients (mean age, 67 years; 68% male) who had a
nephrology care duration >=90 days, initiated hemodialysis, and used RASIs
3 months before hemodialysis initiation. The multivariable adjusted Cox
models were used to compare mortality and CV event risk between 650 (91%)
patients who continued RASIs until hemodialysis initiation and 67 (9.3%)
patients who stopped RASIs. During a median follow-up period of 3.5 years,
170 (24%) patients died and 228 (32%) experienced CV events. Compared with
continuing RASIs, stopping RASIs was unassociated with mortality (adjusted
hazard ratio [aHR]: 0.82; 95% confidence interval [CI]: 0.50-1.34) but was
associated with higher CV events (aHR: 1.59; 95% CI: 1.06-2.38). Subgroup
analyses showed that the risk of stopping RASIs for CV events was
particularly high in patients aged <75 years, with a significant
interaction between stopping RASIs and age. This study revealed that
patients who stopped RASIs immediately before dialysis initiation were
associated with subsequent higher CV events. Active screening for CV
disease may be especially beneficial for these patients. (Figure
presented.) Copyright © The Author(s) 2024.

<112>
Accession Number
2027931805
Title
The effect of health coaching on blood pressure control and disease
self-management among patients in rural area in China: a randomized
controlled trial.
Source
Hypertension Research. 47(5) (pp 1184-1195), 2024. Date of Publication:
May 2024.
Author
Qiao L.; Li J.; Nam S.; Duan Y.; Cheng L.; Zhong Z.; Ding S.; Zhang Q.;
Zheng F.
Institution
(Qiao, Duan, Zhong, Ding, Zhang, Zheng) Nursing Department, The Third
Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu
District, Changsha 410013, China
(Qiao) College of Nursing, Anhui University of Chinese Medicine, Hefei
230012, China
(Li, Zheng) Department of Cardiovascular Medicine, The Third Xiangya
Hospital, Central South University, No.138 Tongzipo Road, Yuelu District,
Changsha 410013, China
(Nam) School of Nursing, Yale University, 400 West Campus, Orange, CT
06477, United States
(Duan) Department of Emergency and Critical Care Medicine, The Third
Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu
District, Changsha 410013, China
(Cheng) Xiangya School of Nursing, Central South University, Changsha
410013, China
Publisher
Springer Nature
Abstract
The self-management education for patients with hypertension has not been
widely provided in rural areas of China. Our study aimed to examine the
effect of health coaching intervention on controlling BP and improving
self-management skills among rural resident of <=6 month-history of
hypertension. A total of 102 participants were enrolled in the RCT. The
control group received usual health guidance and follow-up management; the
experimental group received health coaching and follow up management. The
primary outcomes were the difference in changes of BP and mean
self-management scores. The secondary outcomes included waist
circumference, body mass index (BMI), and medication literacy.
Participants in the experimental group showed a significantly greater
improvement with respect to systolic BP and diastolic BP respectively
(133.85 +/- 4.74 mmHg vs 127.96 +/- 5.42 mmHg;80.94 +/- 5.52 mmHg vs 77.37
+/- 4.44 mmHg, P < 0.05) and BMI (24.66 +/- 2.19 kg/m2 vs 23.44
+/- 2.05 kg/m2, P < 0.05) compared with the control group. A
significant difference was also observed between the experimental and
control groups in terms of self-management and medication literacy at both
3 and 6 months (P < 0.05). However, there was no significant difference in
changes of waist circumferences between the two groups (22.6% vs 38.8%).
In conclusion, for patients with diagnosed with hypertension within the
last 6 months, health coaching maybe is an effective approach to control
blood pressure and improve medication literacy and self-management skills.
(Figure presented.). Copyright © The Author(s), under exclusive
licence to The Japanese Society of Hypertension 2024.

<113>
Accession Number
2032006156
Title
Probiotics may alleviate intestinal damage induced by cardiopulmonary
bypass in children.
Source
European Journal of Cardio-thoracic Surgery. 65(4) (no pagination), 2024.
Article Number: ezae152. Date of Publication: 01 Apr 2024.
Author
Toritsuka D.; Aoki M.; Higashida A.; Fukahara K.; Nishida N.; Hirono K.;
Hane M.; Sugimoto T.; Asahara T.; Yoshimura N.
Institution
(Toritsuka, Aoki, Fukahara, Yoshimura) Department of Cardiovascular
Surgery, Graduate School of Medicine, University of Toyama, Toyama, Japan
(Higashida) Department of Cardiovascular Surgery, Kobe Children's
Hospital, Kobe, Japan
(Nishida, Hirono) Department of Pediatrics, Graduate School of Medicine,
University of Toyama, Toyama, Japan
(Hane, Sugimoto, Asahara) Yakult Central Institute, Yakult Honsha Co.,
Ltd, Tokyo, Japan
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Intestinal ischaemia-reperfusion injury induced by
cardiopulmonary bypass causes intestinal epithelial barrier dysfunction,
leading to dysbiosis and bacterial translocation. We conducted a
randomized prospective study with 2 objectives: (i) to investigate
epithelial barrier dysfunction and bacterial translocation induced by
cardiopulmonary bypass and changes in the gut microbiota and (ii) to
verify whether probiotics can improve these conditions. METHOD(S):
Between 2019 and 2020, patients 0-15 years old scheduled to undergo
cardiac surgery using cardiopulmonary bypass were enrolled and randomly
allocated to 2 groups: the intervention group received probiotics and the
control group did not receive probiotics. We analysed the microbiota in
faeces and blood, organic acid concentrations in faeces, plasma intestinal
fatty acid-binding protein and immunological responses. RESULT(S):
Eighty-two patients were enrolled in this study. The characteristics of
the patients were similar in both groups. The total number of obligate
anaerobes was higher in the intervention group than in the control group
after postoperative day 7. We identified 4 clusters within the
perioperative gut microbiota, and cluster changes showed a corrective
effect of probiotics on dysbiosis after postoperative day 7. Organic acid
concentrations in faeces, incidence of bacterial translocation, intestinal
fatty acid-binding protein levels and immunological responses, except for
interleukin -17A, were not markedly different between the 2 groups.
 CONCLUSION(S): Administration of probiotics was able to correct
dysbiosis but did not sufficiently alleviate the intestinal damage induced
by cardiopulmonary bypass. More effective methods should be examined to
prevent disturbances induced by cardiac surgery using cardiopulmonary
bypass. Clinical trial registration number:
https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037
174 UMIN000035556. Copyright © 2024 European Association for
Cardio-Thoracic Surgery. All rights reserved.

<114>
Accession Number
2031552062
Title
Blood bupivacaine concentrations after pecto-serratus and serratus
anterior plane injections of plain and liposomal bupivacaine in
robotically-assisted mitral valve surgery: Sub-study of a randomized
trial.
Source
Journal of Clinical Anesthesia. 95 (no pagination), 2024. Article Number:
111470. Date of Publication: August 2024.
Author
Alfirevic A.; Almonacid-Cardenas F.; Yalcin E.K.; Shah K.; Kelava M.;
Sessler D.I.; Turan A.
Institution
(Alfirevic, Kelava) Division of Cardiothoracic Anesthesiology, Department
of Anesthesiology, Cleveland Clinic, Cleveland, OH, United States
(Almonacid-Cardenas, Shah, Sessler, Turan) Outcomes Research Consortium,
Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, United
States
(Yalcin, Turan) Division of Multi-specialty Anesthesiology, Department of
Anesthesiology, Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Study objective: To investigate the timing of peak blood concentrations
and potential toxicity when using a combination of plain and liposomal
bupivacaine for thoracic fascial plane blocks. Design(s):
Pharmacokinetic analysis. Setting(s): Operating room.
 Patient(s): Eighteen adult patients undergoing robotically-assisted
mitral valve surgery. Intervention(s): Ultrasound-guided
pecto-serratus and serratus anterior plane blocks using a mixture of 0.5%
bupivacaine HCl up to 2.5 mg/kg and liposomal bupivacaine up to 266 mg.
Measurements: Arterial plasma bupivacaine concentration. Main
Result(s): Samples from 13 participants were analyzed. There was
substantial inter-patient variability in plasma concentrations. A
geometric mean maximum bupivacaine concentration was 1492 ng/ml (range 660
to 4650 ng/ml) at median time of 30 min after injection. In 4/13 (31%)
patients, plasma bupivacaine concentrations exceeded our predefined 2000
ng/ml toxic threshold. A second much smaller peak was observed about 32 h
after the injection. No obvious signs of local anesthetic toxicity were
observed. Conclusion(s): Combined injection of plain and liposomal
bupivacaine for pecto-serratus/serratus anterior plane blocks produced a
biphasic pattern, with the highest arterial plasma concentrations observed
within 30 min. Maximum concentrations exceeded the potential toxic
threshold in nearly a third of patients, but without clinical evidence of
toxicity. Clinicians should not assume that routine combinations of plain
and liposomal bupivacaine for thoracic fascial plane blocks are inherently
safe. Copyright © 2024 Elsevier Inc.

<115>
Accession Number
2029717468
Title
The influence of preoperative or intraoperative methadone on postcardiac
surgery pain and opioid administration: a systematic review and
meta-analysis.
Source
Cardiothoracic Surgeon. 32(1) (no pagination), 2024. Article Number: 8.
Date of Publication: December 2024.
Author
Goldblatt J.; Crawford L.; Ross J.; Edelman J.; Pavey W.
Institution
(Goldblatt, Crawford, Ross) Department of Cardiothoracic Surgery, Princess
Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD 4102,
Australia
(Edelman) Department of Cardiothoracic Surgery, Fiona Stanley Hospital,
Perth, Australia
(Pavey) Department of Cardiac Anaesthesia, Fiona Stanley Hospital, Perth,
Australia
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Opioid analgesia remains a cornerstone of the management of
perioperative pain in cardiac surgical patients. Emerging evidence
suggests that intermediate and long-term postoperative opioid dependence
is underappreciated and associated with adverse patient outcomes.
Methadone has emerged in the cardiothoracic and non-cardiothoracic
anesthesia literature as an option that may provide lasting analgesic
benefit and may be associated with a reduction in overall perioperative
opioid requirements. Main body: This study was a systematic literature
review and meta-analysis that aimed to provide evidence supporting the use
of perioperative or intraoperative methadone in adult cardiac surgical
patients, particularly with respect to objective measures of postoperative
pain and opioid requirements prior to and at discharge from the hospital.
Electronic searches of three research databases were performed: PubMed
(1972 to October 2023), Ovid MEDLINE (1946 to October 2023), and EMBASE
(1978 to October 2023). This search yielded a total of 190 articles, 7 of
which met the relevant inclusion and exclusion criteria. This included
five randomized controlled trials and two large retrospective cohort
studies. Conclusion(s): Preoperative or intraoperative methadone led
to reduced pain scores at 24 h postoperatively and reduced opioid
requirements at discharge. Methadone may be effective at reducing
perioperative pain scores and opioid requirements postoperatively,
including at discharge. The literature on this subject has important
limitations, and further research in larger randomized controlled trials
is needed. Copyright © Crown 2024.

<116>
Accession Number
2029703489
Title
Spontaneous coronary artery dissection in patients with prior
psychophysical stress: a systematic review of case reports and case
series.
Source
BMC Cardiovascular Disorders. 24(1) (no pagination), 2024. Article Number:
235. Date of Publication: December 2024.
Author
Hosseini K.; Fallahtafti P.; Roudbari P.; Soleimani H.; Jahromi N.A.;
Jameie M.; Jenab Y.; Moradi A.; Ajam A.; Heydari N.; Kuno T.; Narula N.;
Kampaktsis P.N.
Institution
(Hosseini, Soleimani, Jameie, Jenab) Cardiac Primary Prevention Research
Center, Cardiovascular Disease Research Institute, Tehran University of
Medical Sciences, Tehran 1419733141, Iran, Islamic Republic of
(Hosseini, Fallahtafti, Soleimani, Jahromi, Jameie, Jenab) Tehran Heart
Center, Cardiovascular Disease Research Institute, Tehran University of
Medical Sciences, Tehran 1419733141, Iran, Islamic Republic of
(Fallahtafti, Roudbari, Moradi) School of Medicine, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Soleimani) Non-Communicable Disease Research Center, Endocrinology and
Metabolism Population Sciences Institute, Tehran University of Medical
Sciences, Tehran 1411713139, Iran, Islamic Republic of
(Ajam) Department of Medicine and Vascular Medicine Institute, University
of Pittsburgh School of Medicine and UPMC, Pittsburgh, United States
(Heydari) Faculty of Medicine, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Kuno) Department of Medicine, Montefiore Medical Center, New York, NY
10461, United States
(Narula) Weill Cornell Medicine, New York Presbyterian, New York City,
United States
(Kampaktsis) Division of Cardiology, Columbia University Irving Medical
Center, New York, NY 10032, United States
Publisher
BioMed Central Ltd
Abstract
Background: Spontaneous coronary artery dissection (SCAD) is an
underdiagnosed cause of acute coronary syndrome, particularly in younger
women. Due to limited information about SCAD, case reports and case series
can provide valuable insights into its features and management. This study
aimed to comprehensively evaluate the features of SCAD patients who
experienced psychophysical stress before the SCAD event. Method(s):
We conducted an electronic search of PubMed, Scopus, and Web of Science
from inception until January 7, 2023. We included case reports or series
that described patients with SCAD who had experienced psychophysical
stress before SCAD. Patients with pregnancy-associated SCAD were excluded
from our analysis. Result(s): In total, we included 93 case reports
or series describing 105 patients with SCAD. The average patient age was
44.29 +/- 13.05 years and a total of 44 (41.9%) of patients were male.
Among the included SCAD patients the most prevalent comorbidities were
fibromuscular dysplasia (FMD) and hypertension with the prevalence of 36.4
and 21.9%, respectively. Preceding physical stress was more frequently
reported in men than in women; 38 out of 44 (86.4%) men reported physical
stress, while 36 out of 61 (59.1%) females reported physical stress (p
value = 0.009). On the other hand, the opposite was true for emotional
stress (men: 6 (13.6%)), women: 29 (47.6%), p value < 0.001). Coronary
angiography was the main diagnostic tool. The most frequently involved
artery was the left anterior descending (LAD) (62.9%). In our study,
recurrence of SCAD due to either the progression of a previous lesion or
new SCAD in another coronary location occurred more frequently in those
treated conservatively, however the observed difference was not
statistically significant (p value = 0.138). Conclusion(s): While
physical stress seems to precede SCAD in most cases, emotional stress is
implicated in females more than males. Copyright © The Author(s)
2024.

<117>
Accession Number
2029291230
Title
Telesimulation Training for Endoscopic Mitral Valve Surgery: An Air-Pilot
Training Concept for Distance Training.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 19(2) (pp 169-174), 2024. Date of Publication: March/April 2024.
Author
Cheheili Sobbi S.; Imran Hamid U.; Arjomandi Rad A.; Fillet M.; Maesen J.;
Sardari Nia P.
Institution
(Cheheili Sobbi, Imran Hamid, Arjomandi Rad, Maesen, Sardari Nia)
Department of Cardiothoracic Surgery, Heart and Vascular Centre,
Maastricht University Medical Centre, Netherlands
(Fillet, Maesen) Maastricht University, Netherlands
Publisher
SAGE Publications Ltd
Abstract
Objective: The aim of this study was to validate and assess the
feasibility and impact of telesimulation training on surgical skills using
a portable mitral valve telesimulator. Method(s): A telesimulation
course composed of 3 online modules was designed based on backwards
chaining, preassessment and postassessment, performance feedback, hands-on
training on a telesimulator, and the theoretical content. A fully
3-dimensional-printed and transportable telesimulator was developed and
sent out to the participants with instruments that were needed. Feedback
about the platform was obtained from participants to validate its value as
a training tool. Theoretical and technical assessments were carried out
before and after the course. Technical assessments were based on the
accuracy and time taken to place sutures at the anterior and posterior
mitral annulus. Result(s): In total, 11 practicing cardiac surgeons
from Oceania, Asia, Europe, and North America completed the course.
Theoretical preassessment and postassessment showed that participants
scored significantly higher on postassessment (mean 87.5% vs 68.1%, P <
0.004). The participant evaluation scores of the simulator as a tool for
endoscopic mitral valve surgery was 4 to 5 out of 5. There was a
significant improvement in the speed (median 14.5 vs 39.5 s, P < 0.005)
and the accuracy to place sutures in the mitral valve annulus following
course completion (P < 0.001). Conclusion(s): Here we validated the
educational value of a novel telesimulation platform and validated the
feasibility to teach participants at a distance the knowledge and skills
for endoscopic mitral valve surgery. Future studies will be required to
validate the improvement in skills during surgery. Copyright ©
The Author(s) 2024.

<118>
Accession Number
2031980652
Title
Paravertebral block combined with serratus anterior plane block after
video-assisted thoracic surgery: a prospective randomized controlled
trial.
Source
European Journal of Cardio-thoracic Surgery. 64(1) (no pagination), 2023.
Article Number: ezad170. Date of Publication: 01 Jul 2023.
Author
Dusseaux M.-M.; Greg V.; Baste J.-M.; Besnier E.; Boujibar F.; Koscianski
G.; Yahia M.M.B.; Compere V.; Clavier T.; Vannier M.; Selim J.
Institution
(Dusseaux, Greg, Besnier, Koscianski, Yahia, Compere, Clavier, Selim)
Department of Anaesthesiology and Critical Care, CHU Rouen, Rouen F-76000,
France
(Baste, Besnier, Boujibar, Clavier, Selim) Univ Rouen Normandy, INSERM
EnVI, UMR 1096, Rouen F-76000, France
(Baste, Boujibar) Department of Thoracic Surgery, CHU Rouen, Rouen
F-76000, France
(Vannier) Department of Biostatistics, Rouen University Hospital, Rouen
F-76000, France
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Adequate pain management after thoracoscopic surgery is a
major issue in the prevention of respiratory complications. The
combination of the paravertebral block (PVB) with the serratus anterior
plane block (SAPB) may decrease postoperative pain. The objective of this
study was to evaluate the impact of the combination of PVB and SAPB on the
consumption of morphine and pain after video- or robot-assisted thoracic
surgery. METHOD(S): The main objective of this randomized controlled
trial was to compare the cumulative postoperative morphine consumption at
24 h between a group having PVB (PVB group) and a group having PVB and
SAPB (PV-SAPB group). Postoperative pain at 6 and 24 h and
morphine-related complications were also assessed. RESULT(S): A total
of 112 patients were included with 56 in each group. There was no
difference in median cumulative morphine consumption at 24 h between the 2
groups (P = 0.1640). At 6 h, the median postoperative pain was higher in
the PVB group compared to the PV-SAPB group (3 [0; 4] vs 2 [0; 3], P =
0.0231). There were no differences between the 2 groups for pain at 24 h
and morphine-related complications. CONCLUSION(S): We did not find
any difference in morphine consumption between the 2 groups. Our results
suggest that the combination of PVB and SAPB for video-assisted thoracic
surgery or robot-assisted thoracic surgery is safe effective and reliable
and could be an alternative to PVB alone in certain
indications. Copyright © The Author(s) 2023.

<119>
Accession Number
643992789
Title
PAIN MANAGEMENT IN MINIMALLY INVASIVE CARDIAC SURGERY: A SYSTEMATIC REVIEW
AND METAANALYSIS OF THE ERECTOR SPINAE PLANE BLOCK VERSUS CONTROL.
Source
Regional Anesthesia and Pain Medicine. Conference: 40th Annual ESRA
Congress. Paris France. 48(Supplement 1) (pp A80), 2023. Date of
Publication: September 2023.
Author
Terres M.T.; Assis M.L.; Cardoso R.G.; Amaral S.
Institution
(Terres) Universidade do Sul de Santa Catarina, Palhoca, Brazil
(Assis) Hospital das Clinicas de Porto Alegre, Porto Alegre, Brazil
(Cardoso) Hospital da Senhora da Oliveira - Guimaraes, Guimaraes, Portugal
(Amaral) Hospital Regional Deputado Afonso Guizzo, Ararangua, Brazil
Publisher
BMJ Publishing Group
Abstract
Background and Aims Minimally invasive cardiac surgery (MICS) has emerged
as a promising approach for cardiac procedures, improving patient
outcomes. However, postoperative pain management remains a significant
challenge in this field. Various regional anesthesia techniques have been
investigated with the erector spinae plane block (ESPB) being one of the
relatively recent advancements. Our aim is to compare the efficacy of this
block with a control group in patients undergoing MICS. Methods PubMed,
EMBASE, and Cochrane were searched for studies comparing the ESPB to
control (non-block group). The outcomes included opioid consumption,
postoperative duration of mechanical ventilation, and intensive care unit
(ICU) and hospital lengths of stay. RevMan 5.4 analyzed data. Results The
present study systematically analyzed a total of six studies encompassing
a sample size of 717 patients, with 43.2% of them undergoing the erector
spinae plane block (ESPB). Our findings revealed that the implementation
of ESPB yielded a statistically significant reduction in the duration of
mechanical ventilation when compared to the control group (figure 1).
Conversely, no significant differences were observed between the ESPB and
control groups in relation to opioid consumption (figure 2). Furthermore,
there were no significant disparities detected between the groups
concerning the lengths of stay in the intensive care unit (ICU) and
hospital (figure 3). Conclusions Based on our findings, it can be inferred
that the implementation of the ESPB may effectively decrease the duration
of mechanical ventilation. However, in order to draw more comprehensive
conclusions, further investigations involving a larger number of patients
are warranted .

<120>
Accession Number
643992723
Title
PAIN MANAGEMENT IN THORACIC SURGERIES: A SYSTEMATIC REVIEW AND
META-ANALYSIS COMPARING ERECTOR SPINAE AND SERRATUS ANTERIOR PLANE BLOCKS.
Source
Regional Anesthesia and Pain Medicine. Conference: 40th Annual ESRA
Congress. Paris France. 48(Supplement 1) (pp A47), 2023. Date of
Publication: September 2023.
Author
Amaral S.; Medeiros H.; Dias C.S.; Lombardi R.
Institution
(Amaral) Hospital Regional Deputado Afonso Guizzo, Ararangua, Brazil
(Medeiros) Hospital Universitario Onofre Lopes, Natal, Brazil
(Dias) Centro Hospitalar e Universitario Lisboa Central, Lisbon, Portugal
(Lombardi) University of Nebraska Medical Center, Omaha, United States
Publisher
BMJ Publishing Group
Abstract
Background and Aims The Erector Spinae Plane Block (ESPB) and the Serratus
Anterior Plane Block (SAPB) are potential options for surgeries in the
thorax. This study aims to compare the efficacy and safety between them.
Methods PubMed, EMBASE, and Cochrane were searched for RCTs comparing the
ESPB to the SAPB. The outcomes included opioid consumption
intraoperatively and in the first 24 h, pain scores, postoperative nausea
and vomiting (PONV), and block-related complications incidences. RevMan
5.4 analyzed data and sensitivity analysis was conducted by systematically
removing each study. (PROSPERO - CRD42023415421) Results The study
analyzed six RCTs with 405 patients, 50% underwent ESPB. Intraoperative
opioid consumption was significantly lower in the ESPB group (figure 1).
No significant differences were found in pain scores at rest or movement
at 2h (MD4 -0.28; 95% CI -1.01 to 0.44; p=0.44 and MD - 0.14; 95% CI -0.54
to 0.27; p=0.51) and 12h (MD -0.15; 95% CI -0.53 to 0.22; p=0.43 and MD
-0.55; 95% CI -1.24 to 0.14; p=0.12). However, at 24h, there were
significantly lower pain scores for the ESPB group when in movement
(figure 3) and overall block-related complications, there were no
significant differences. Sensitivity analysis did not change the overall
conclusion in any of the outcomes evaluated. Conclusions Our findings
suggest that ESPB may be more effective than SAPB for thoracic surgeries,
although the safety profile is similar.

<121>
Accession Number
643992687
Title
ADDING PECS II BLOCK TO MULTIMODAL ANALGESIA HALVES 24-HOUR POSTOPERATIVE
OPIOID REQUIREMENTS AFTER MINIMALLY INVASIVE CARDIAC SURGERY WITH
CARDIOPULMONARY BYPASS - A TRIPLE-BLINDED, RANDOMIZED, CONTROLLED TRIAL.
Source
Regional Anesthesia and Pain Medicine. Conference: 40th Annual ESRA
Congress. Paris France. 48(Supplement 1) (pp A102), 2023. Date of
Publication: September 2023.
Author
Stundner O.; Seisl A.; Gasteiger L.; Horner E.; Nagele F.; Bonaros N.;
Mair P.; Fiala A.
Institution
(Stundner, Seisl, Gasteiger, Horner, Mair, Fiala) Medical University
Innsbruck, Innsbruck, Austria
(Nagele, Bonaros) Cardiac Surgery, Medical University Innsbruck,
Innsbruck, Austria
Publisher
BMJ Publishing Group
Abstract
Background and Aims Minimally-invasive, on-bypass cardiac surgery (MIC)
through a unilateral mini-thoracotomy is increasingly popular but
associated with high levels of postoperative pain, opioid consumption and
opioid-associated side effects. This study aimed to elucidate whether
adding a PECS block II to conventional multimodal analgesia improves
opioid consumption, pain and quality of recovery. Methods After approval
by the ethics committee, patients scheduled for MIC were randomized
between ultrasoundguided, preoperative unilateral PECS block with
ropivacaine 0.5% vs. placebo (saline). Patients, practitioners and data
collectors were blinded to the intervention drug; a standardized
multimodal analgesic protocol was applied to all patients. Numerical
rating scores (NRS), analgesic consumption and the Overall Benefit of
Analgesia Score (OBAS) were collected at different time points up to 24
hours postoperatively, and compared between groups. Results 57 patients
were included (ropivacaine n=28, vs. placebo n=29). Block performance
(after central venous access) took 5+/-2.5 minutes. Patients in the
ropivacaine group had significantly lower morphine milligram equivalents
(MME) during the first 24 hours after extubation (median (interquartile
range): 4.2 (2.1-7.6) vs 8.3 (4.2-15.7) mg, p=0.016). NRS at extubation
was lower in the ropivacaine group (0.0 (0.0- 2.0) vs 1.5 (0.3-3.0),
p=0.041). Non-opioid analgesic consumption was similar. The OBAS was, by
trend, improved in the ropivacaine group (4.0 (3.0-6.0) vs. 7.0 (3.0-9.0),
p=0.082). (table 1) Conclusions The addition of PECS II block to
conventional, opioid-based multimodal analgesia protocols is a simple, yet
effective measure to optimize opioid consumption, pain relief and side
effect profile in patients undergoing MIC. (Figure Presented).

<122>
Accession Number
643992682
Title
40th Annual ESRA Congress.
Source
Regional Anesthesia and Pain Medicine. Conference: 40th Annual ESRA
Congress. Paris France. 48(Supplement 1) (no pagination), 2023. Date of
Publication: September 2023.
Author
Anonymous
Publisher
BMJ Publishing Group
Abstract
The proceedings contain 678 papers. The topics discussed include: time to
surgical treatment for hip fracture care; comparative study between
ultrasound guided serratus anterior and erector spinae block for
perioperative analgesia in children undergoing upper thoracic surgeries;
frequency of epidural catheter-incision congruency and effectiveness of
postoperative analgesia for adult patients after major abdominal surgery:
an observational study in LMIC; new approach for suprascapular nerve
block: up to easier; PECS 2 block for open biceps tenodesis: no analgesic
benefit vs. surgical field infiltration; implementation of the frailty
evaluation in the preoperative assessment in the major orthopedic
surgery-an efficient tool for perioperative care and discharge planning;
interventions to reduce postsurgical pain, and opioid use, in patients
with pre-existing chronic pain or high-dose opioid use: a systematic
review; factors associated with hypotension or bradycardia episodes during
arthroscopic shoulder surgery under general anesthesia combined with
interscalene block in the beach chair position; and randomized comparison
between pericapsular nerve group block with lateral femoral cutaneous
nerve block and quadratus lumborum block for postoperative analgesia in
hip surgery.

<123>
Accession Number
643992674
Title
ERECTOR SPINAE PLANE BLOCK VS. PECTOINTERCOSTAL FASCIAL PLANE BLOCK VS.
CONTROL FOR STERNOTOMY: A PROSPECTIVE RANDOMIZED TRIAL.
Source
Regional Anesthesia and Pain Medicine. Conference: 40th Annual ESRA
Congress. Paris France. 48(Supplement 1) (pp A135-A136), 2023. Date of
Publication: September 2023.
Author
Koshchak E.; Qian D.; Fang S.; Ouyang Y.; Egorova N.; Shariat A.;
Bhatt-Verma H.
Institution
(Koshchak, Qian, Fang, Ouyang, Egorova, Shariat, Bhatt-Verma) Mount Sinai
Hospital, New York, United States
Publisher
BMJ Publishing Group
Abstract
Background and Aims Many patients that undergo cardiac surgery via median
sternotomy experience uncontrolled postoperative pain leading to prolonged
intubation, impaired recovery, and the development of chronic pain. The
erector spinae plane (ESP) block and the pecto-intercostal fascial (PIF)
plane block have been used as multimodal analgesia for sternotomy pain.
The purpose of this study was to compare the analgesic efficacy of ESP
blocks and PIF blocks versus no block in patients under general anesthesia
undergoing sternotomy for cardiac surgery. Methods This randomized
prospective control trial was conducted at an academic care center and
included 90 participants. The primary endpoint was opioid consumption
during post operative days (POD) 0, 1,2,3, 4, and 5. Secondary endpoints
included Visual Analog Scale pain scores, time to extubation, ICU length
of stay (LOS), total postoperative LOS, and nausea/vomiting after
extubation. Results Among the patients included, 30 received bilateral ESP
block, 30 received bilateral PIF block, and 30 received no block. No
significant differences in post-operative opioid consumption as measured
in MME on POD 0, 1,2,3, 4, or 5 were seen between groups. When analyzing
VAS scores at POD 0,1,2, and 3 between groups, there was a statistically
significant difference between the ESP block group compared to the control
group. Conclusions These results indicate that the administration of ESP
or PIF block for sternotomy does not modulate opioid use throughout the
average ICU LOS duration for these patients, as compared to the control
however may contribute to improved patient experience as indicated by
lower pain scores. (Figure Presented).

<124>
Accession Number
643992528
Title
COMPARATIVE STUDY BETWEEN ULTRASOUND GUIDED SERRATUS ANTERIOR AND ERECTOR
SPINAE BLOCK FOR PERIOPERATIVE ANALGESIA IN CHILDREN UNDERGOING UPPER
THORACIC SURGERIES.
Source
Regional Anesthesia and Pain Medicine. Conference: 40th Annual ESRA
Congress. Paris France. 48(Supplement 1) (pp A40), 2023. Date of
Publication: September 2023.
Author
Rath A.
Institution
(Rath) Institute of Medical Sciences, BHU, Varanasi, India
Publisher
BMJ Publishing Group
Abstract
Background and Aims Perioperative thoracotomy pain management with reduced
opioid consumption is beneficial for early recovery. Both erector spinae
and serratus anterior plane block have been used in thoracic surgeries. We
aimed to compare the USG erector spinae and serratus anterior plane blocks
on cumulative opioid consumption and recovery. Methods After ethical
committee clearance, a prospective, randomised study was conducted in
patients aged 5 to 14 years undergoing open thoracotomy under general
anaesthesia. Seventy patients were allocated randomly into two equal
groups of 35 each: Group 1 received Serratus anterior plane block while
Group 2 received Erector spinae block respectively. Each group received
0.5 ml/kg of 0.25% bupivacaine with 2 micrograms/ml of fentanyl. The
primary outcome of our study was to compare the cumulative opioid
consumption between the two groups. The study's secondary outcome was to
determine the time of chest physiotherapy initiation, postoperative
hospital stay, postoperative pain scores and complications between the two
groups. Results Mean opioid requirement during intraoperative,
postoperative period and cumulative was more in Group 1 than in Group 2
with p values of 0.0002, 0.0032 and 0.0024 respectively. The mean time to
start chest physiotherapy & mean postoperative hospital stay were higher
in Group1 than in Group2 (p-value 0.002 & 0.046 respectively). Conclusions
Ultrasound-guided Erector Spinae block is superior to Serratus anterior
plane block in children undergoing thoracic surgery with decreased
perioperative opioid analgesia, early chest physiotherapy initiation, and
lesser hospital stay.

<125>
Accession Number
643992329
Title
SERRATUS PLANE BLOCK FOR POSTOPERATIVE PAIN MANAGEMENT AFTER MINIMALLY
INVASIVE HEART VALVE SURGERY: CASE SERIES.
Source
Regional Anesthesia and Pain Medicine. Conference: 40th Annual ESRA
Congress. Paris France. 48(Supplement 1) (pp A307), 2023. Date of
Publication: September 2023.
Author
Guvenli Y.; Cinar Y.; Karaman Y.; Alaygut E.; Kunt A.; Abud B.
Institution
(Guvenli, Cinar, Karaman, Alaygut) Anesthesiology and Reanimation, Tepecik
Training and Research Hospital, Izmir, Turkey
(Kunt, Abud) Cardiovascular Surgery, Tepecik Training and Research
Hospital, Izmir, Turkey
Publisher
BMJ Publishing Group
Abstract
Background and Aims The widespread use of ultrasonography in regional
anesthesia in recent years; resulted in identification of new blocks such
as serratus plane block (SPB). SPB is a regional analgesic technique that
blocks T2-T9 which has an excellent role in postoperative pain management
for cardiothoracic surgeries. We performed SPB for postoperative analgesia
in 5 patients undergoing minimally invasive heart valve surgery (MIHVS).
Methods After obtaining informed consents, SPB block was performed after
induction of general anesthesia and before the surgical incision, using
1,5mg/kg 0.25% bupivacaine. Pain was measured using a visual analogue
score (VAS) (0, no pain; 10, worst pain imaginable) in recovery and at
6th, 12th, 18th, and 24th hours. VAS was less than 3 for the 24th hour and
patients had no need for additional analgesics for a post-block period of
12 hours. Results SPB provides prolonged postoperative analgesia in
patients undergoing MIHVS. Further randomized controlled trials are needed
to enhance the efficacy of the SPB. Conclusions Thoracic pain is thought
to be transmitted via nerves originating from T2 to T9. Blockade of
unilateral intercostal nerves can provide sufficient analgesia after
MIHVS. Combination of opioids, non-steroidal antiinflammatory agents and
regional methods; with different mechanisms of action in postoperative
pain management is considered to be more effective for post operative
analgesia and minimizes side effects as well as reduces incidence of
chronic pain.

<126>
Accession Number
643992277
Title
PAIN MANAGEMENT IN OFF-PUMP CORONARY ARTERY BYPASS: A SYSTEMATIC REVIEW
AND META-ANALYSIS OF THE BILATERAL ERECTOR SPINAE PLANE BLOCK VERSUS
CONTROL.
Source
Regional Anesthesia and Pain Medicine. Conference: 40th Annual ESRA
Congress. Paris France. 48(Supplement 1) (pp A175-A176), 2023. Date of
Publication: September 2023.
Author
Terres M.T.; Assis M.L.; Cardoso R.G.; Amaral S.
Institution
(Terres) Anesthesiology, Universidade do Sul de Santa Catarina, Palhoca,
Brazil
(Assis) Anesthesiology, Hospital das Clinicas de Porto Alegre, Porto
Alegre, Brazil
(Cardoso) Anesthesiology, Hospital da Senhora da Oliveira - Guimaraes,
Guimaraes, Portugal
(Amaral) Anesthesiology, Hospital Regional Deputado Afonso Guizzo,
Ararangua, Brazil
Publisher
BMJ Publishing Group
Abstract
Background and Aims Off-pump coronary artery bypass (OPCAB) surgery is a
widely performed surgical procedure for coronary artery disease. Adequate
postoperative pain management is crucial for patient overall recovery. The
erector spinae plane block (ESPB) has gained recognition as a promising
regional anesthesia technique. Our aim is to compare standard pain
management with the ESPB in patients undergoing OPCAB. Methods Pubmed,
EMBASE, and Cochrane were searched for randomized controlled trials (RCTs)
comparing bilateral ESPB to control. We assessed pain scores, opioid
consumption, and duration of mechanical ventilation, intensive care unit
(ICU) and hospital stay. Data was analyzed with RevMan 5.4. Results We
analyzed 4 RCTs with 267 patients, of whom 50.56% underwent the ESPB. The
pain scores at 6 and 12 hours after extubation were significantly
decreased in the ESPB group (figure 1) but not at 24 hours (MD -1.37; 95%
CI -2.95 to 0.20; p < 0.09; I2 = 93%, 3 RCTs, 238 patients). Opioid
consumption also favoured the ESPB group (MD -14.30; 95% CI -21.39 to
-7.22; p < 0.0001; I2 = 98%, 3 RCTs, 238 patients). Time to extubation was
significantly shorter for the ESPB intervention (figure 2), as well as the
ICU and hospital lengths of stay (figure 3). Conclusions ESPB may reduce
opioid consumption, extubation time, ICU and hospital stay after OPCAB. It
effectively reduces pain at 6 and 12 hours post- extubation, but not at 24
hours, probably due to its duration. Larger studies are needed for
comprehensive conclusions.

<127>
Accession Number
644051969
Title
SYSTEMATIC REVIEW OF TREATMENT OF INFECTIOUS INTRACRANIAL ANEURYSMS (IIAS)
AND THE CURRENT ROLE OF ENDOVASCULAR METHODS.
Source
Journal of NeuroInterventional Surgery. Conference: 15th Annual Meeting of
the Society of NeuroInterventional Surgery, SNIS 2018. San Francisco, CA
United States. 10(Supplement 2) (pp A13), 2018. Date of Publication: July
2018.
Author
Ragulojan R.; Grupke S.; Fraser J.
Institution
(Ragulojan, Grupke) College of Medicine, University of Kentucky,
Lexington, KY, United States
(Fraser) Deparment of Neurosurgery, University of Kentucky, Lexington, KY,
United States
Publisher
BMJ Publishing Group
Abstract
Introduction With the current prominent usage of endovascular methods in
managing intracranial aneurysms, understanding the value and role of these
techniques to specifically address Infectious Intracranial Aneurysms
(IIAs) is important. IIAs are often a complication of intravenous (IV)
drug use. While these aneurysms carry high risk of rupture, there is some
lack of consensus for optimal management. Furthermore, with the growing
opioid epidemic, these lesions are likely to become more commonplace. To
better understand current practice patterns and the role endovascular
techniques occupy, we performed a systematic review. Methods Pubmed search
terms included: 'Infectious Intracranial Aneurysm', 'mycotic cerebral
aneurysm', 'cerebral mycotic aneurysm, and 'intracranial infectious
aneurysm'. We included retrospective and prospective publications 1/1980
to 5/2017. Manual search of references was also performed. We evaluated
total publication number, patient and aneurysm number, ruptured status,
mention of infective endocarditis, pathogen reported, treatment
categories, failure, death, and rupture rates of conservative management
and cardiac surgery timing. Single case reports were included. Results 131
publications with a total of 499 patients and 665 aneurysms were included.
Of the 499 patients, 83 were single case reports, and 20.5% of the total
had multiple aneurysms. 35.8% of all aneurysms were ruptured.
Chronologically, publication of IIAs has increased. Of those aneurysms
where treatment options were reported 31.8% were managed endovascularly.
Methods varied from parent artery occlusion using glue agents to coiling
with or without stent assistance. Furthermore, usage of endovascular
therapies has grown, while conservative (30.0% overall) and surgical
management (31.1%) have declined in the literature. Of those managed
endovascularly, only 5 unsuccessful attempts and 3 additional patient
deaths were reported. By comparison, 56.2% of aneurysms for which
conservative therapy was initiated eventually either underwent
intervention, or death of the patient occurred. Of 51 patients who
underwent cardiac valve surgery after aneurysm management, and for whom
corresponding aneurysm treatment modality could be determined, 30 (51.7%)
had undergone endovascular management. Discussion Increasing trend of
endovascular management of IIAs is evident. Strong consideration of
endovascular methods as a predominant form of management for IIAs is
warranted as the literature demonstrates both small rates of unsuccessful
attempts/patient deaths. The literature also reflects the additional
benefit of sooner subsequent cardiac surgery when aneurysms are treated
via endovascular methods.

<128>
Accession Number
644052456
Title
High-Frequency Spinal Cord Stimulation in Surgery-Naive Patients - A
Prospective Single-Center Study.
Source
Stereotactic and Functional Neurosurgery. Conference: 22nd Congress of the
European Society for Stereotactic and Functional Neurosurgery. Madrid
Spain. 94(Supplement 1) (pp 106-107), 2016. Date of Publication: September
2016.
Author
Ahmadi S.; Vesper J.; Schu S.; Slotty P.
Institution
(Ahmadi, Vesper, Slotty) Department of Stereotactic and Functional
Neurosurgery, Heinrich-Heine-University, Dusseldorf, Germany
(Schu) Department of Neurosurgery, Sana Kliniken Duisburg, Duisburg,
Germany
Publisher
S. Karger AG
Abstract
Introduction: A multitude of evidence supporting the beneficial effects of
spinal cord stimulation (SCS) in patients suffering from chronic pain
syndromes following spinal surgery has been published in the last decade.
Evidence is scarce however for the use of high frequency SCS (HFSCS) in
the treatment of surgery naive patients suffering from lower back pain
(LBP). Method(s): From June 2014 to April 2015 we prospectively
enrolled patients suffering from LBP alone or in conjunction with leg pain
in a trial of HFSCS. None of the patients had undergone surgical
procedures of the thoracic, lumbar or sacral spine. Patients suffered
medically intractable LBP and were deemed ineligible for spine surgery due
to mismatches in imaging findings and clinical symptoms, or were medically
unfit to undergo extensive surgical procedures. All patients underwent
trial stimulation for at least one week. IPG implantation was conducted
only following successful trials. Pain levels were assessed daily during
initial stay, 4 weeks later and then every 3 months. Different
pre-programmed modes of HFSCS were changed if pain persisted or increased
during trial or post-implant follow-up. Result(s): A total of 8
patients (4 male, 4 female) underwent HFSCS trials. Mean age was 60 x 4.8
years. Mean VAS baseline intensity for back pain was 8.9 x 0.23 and 8.1 x
0.6 for leg pain. All patients achieved meaningful reductions in pain
intensities and underwent IPG implantation at a mean interval of 13 x 1.3
days. Mean follow-up was 306 x 48 days in February 2016. Mean back pain
VAS reduction from baseline at last follow-up was -4.13 x 0.85, and -6.2 x
1.03 for leg pain. Two patients showed skin irritations and localized pain
at the IPG site. Both patients underwent surgery to replant the IPG. No
infections were seen in any of the 8 patients enrolled.
 Conclusion(s): In this prospective cohort of surgery naive patients
we were able to show good efficacy of HFSCS for both back and leg pain.
Reductions were long-lasting with a mean follow-up of nearly 10 months in
our cohort, and a mean VAS reduction at last follow-up of 4.13 and 6.2 for
back and leg pain, respectively.

<129>
Accession Number
643787285
Title
VIRTUAL REALITY FOR IMPROVED VASECTOMY EXPERIENCE: INSIGHTS FROM A
SINGLE-CENTER CLINICAL TRIAL.
Source
Journal of Sexual Medicine. Conference: 24th Annual Fall Scientific
Meeting of SMSNA. San Diego, CA United States. 21(Supplement 1) (pp i164),
2024. Date of Publication: February 2024.
Author
Codrington J.; Qureshi F.; Rahman F.; Saltzman R.; Deebel N.; Cartaya S.;
Leong P.; White J.; Muthigi A.; Ramasamy R.
Institution
(Codrington, Qureshi, Rahman, Saltzman, White, Muthigi, Ramasamy) Desai
Sethi Urology Institute, University of Miami, United States
(Deebel) Wake Forest Baptist Medical Center, United States
(Cartaya) University of South Florida, Morsani College of Medicine, United
States
(Leong) School of Clinical Sciences, Monash Health and Monash University
Clayton, Australia
Publisher
Oxford University Press
Abstract
Introduction: Vasectomy is a widely performed procedure for male
sterilization, with an estimated 33 million procedures conducted annually
worldwide. Although vasectomy is generally safe and associated with
minimal complications, concerns over procedural pain and anxiety can deter
patients from pursuing the procedure. To address these concerns,
innovations such as no-needle and no-scalpel techniques have been adopted
to minimize pain during vasectomy. However, anticipated pain and anxiety
remain significant barriers for patients. Therefore, optimizing patient
comfort during procedures performed under local anesthesia is crucial for
improving outcomes and satisfaction. Virtual reality (VR) devices have
emerged as a promising non-pharmacological intervention for pain
modulation in various medical fields. VR technology has demonstrated pain
reduction and anxiety alleviation in pediatric burn therapy, physical
therapy, dental procedures, and more. The adult urologic community has
also embraced VR, with positive results observed in surveillance
cystoscopy and office-based prostate biopsy procedures. However, limited
research exists on the use of VR headsets during vasectomy, with only one
previous non-randomized trial reporting high patient satisfaction but no
improvement in pain or anxiety. In this ongoing single-center, randomized,
open-label clinical trial, we present interim data evaluating the
effectiveness of the SmileyScope VR device in reducing anxiety and pain
during in-office vasectomy performed with local anesthesia.
 Objective(s): The primary objective of this study is to evaluate the
efficacy of virtual reality (VR) devices in alleviating peri-procedure
anxiety and pain during in-office vasectomy performed with local
anesthesia. The secondary goal of this study is to compare the
effectiveness of interactive VR, enabling patient control of the
experience, with static VR, which does not provide patient control.
 Method(s): The study enrolled patients who were scheduled for
in-office vasectomy with a single urologist. The patients were randomly
assigned to one of three groups: the control group receiving standard
in-office vasectomy without a VR headset, the static VR intervention
group, or the interactive VR intervention group. The primary outcome
measures included patient-reported pain and anxiety levels before and
after the procedure, along with heart ratemeasurements recorded using a
wearable device. Result(s): Interim analysis of this ongoing study
includes data from a total of 58 men. 20 men were in the control group, 19
in the static VR arm, and 19 in the interactive VR arm. There was no
observed difference in subjective pain scores or heart rate variability
during the procedure. However, patients who wore a VR headset reported a
significantly lower level of pre-procedure anxiety (P = 0.0700).
 Conclusion(s): Anticipation of periprocedural pain and anxiety are
barriers to vasectomy utilization. Initial results from our ongoing
randomized clinical trial indicate that the utilization of virtual reality
is feasible, safe, and effective in reducing preprocedure anxiety in
patients undergoing vasectomy. .

<130>
Accession Number
643677601
Title
XC001 gene therapy for the treatment of refractory angina: 6-month
efficacy and safety from the phase 1/2 first-in-human study (EXACT Trial).
Source
Human Gene Therapy Methods. Conference: 30th Annual Congress of the
European Society of Gene and Cell Therapy, ESGCT 2023. Brussels Belgium.
35(3-4) (pp A44), 2024. Date of Publication: February 2024.
Author
Stewart D.J.; Dittrich H.C.; Reinhardt R.R.; Rosengart T.K.; Crystal R.G.;
Povsic T.J.
Institution
(Stewart) University of Ottawa, Ottawa a, Canada
(Dittrich, Reinhardt) XyloCor Therapeutics, Wayne, PA, United States
(Rosengart) Baylor College of Medicine, Houston, TX, United States
(Crystal) Weill Cornell Medical College, New York, NY, United States
(Povsic) Duke University Medical Center, Durham, NC, United States
Publisher
Mary Ann Liebert Inc.
Abstract
Refractory angina (RA) is a debilitating chronic condition of advanced
coronary artery disease in which patients have exhausted all available
medical or surgical therapies and interventions. RA is characterized by
high symptom burden and healthcare resource utilization, poor quality of
life, and high rates of hospitalization. XC001 is a replication-deficient,
recombinant adenovirus (Ad) 5 containing a human-derived cDNA/genomic
hybrid and alternative splicing provides mRNA encoding for multiple
isoforms of vascular endothelial growth factor (VEGF) which initiates
angiogenesis to bypass coronary artery blockages. XC001 is administered
under direct visualization by surgeons via a mini-thoracotomy to ischemic
areas of the left ventricle identified by stress imaging studies and
angiography which allows for the administration of lower vector genomes
maximizing levels in the heart while minimizing systemic levels. Rodent
biodistribution data demonstrated that direct epicardial administration
resulted in localization of the vector to the left ventricular wall as
compared to other highly perfused organs (liver, lung, spleen). XC001 was
much more effective in the ischemic mouse hind-limb model at inducing
angiogenesis and hind-limb blood flow than comparable vectors expressing
only individual VEGF isoforms. XC001's increased ratio of expressed
heparin-binding isoforms are designed to have a stronger local angiogenic
effect due to their ability to bind to the extracellular matrix more
tightly. Reported here are 6-month results from the phase 1/2
first-in-human, open-label, single-arm, sequential dose escalation study
(EXACT) with the highest tolerated phase 1/2 dose of 1011 viral particles
(n = 29) demonstrating preliminary safety and signals of efficacy. The
majority of subjects showed clinically meaningful improvements from
baseline to 6 months post XC001 in the key endpoint of total exercise
duration (TED) on a standardized exercise treadmill test read by a blinded
core lab (mean (SD) increase of 1.4 (2.3) minutes, p = 0.003). Mean (SD)
change in angina episodes at 6 months showed a reduction of 6.7 (8.1)
episodes (p < 0.001) over a 2-week period prior to each visit while at the
same time nitroglycerin use decreased (-3.8 (6.9), p = 0.008). Canadian
Cardiovascular Society (CCS) Class, a measure of angina symptoms, improved
in 81% of subjects. There was a 14% reduction (p = 0.02) in total
myocardial perfusion deficit on Positron Emission Tomography (PET)
observed at 6 months. An assessment of treatment success across 5 key
endpoints (TED increase of >1 minute, angina episode reduction of >30%,
nitroglycerin reduction of >30%, >1 class improvement in CCS, and >10%
reduction in TPD) showed 93%, 67% and 40% of subjects meeting >=2, >=3 and
>=4 endpoint criteria, respectively. No serious adverse events (SAEs) were
considered related to XC001 and SAEs related to the administration
procedure (38%) were expected and occurred within 2 weeks of dosing. In
summary, multiple EXACT study efficacy endpoints demonstrated that
intramyocardial administration of XC001 was associated with improvements
in angina symptoms and exercise capacity in RA subjects while cardiac
imaging measured by PET provided supportive evidence of a biologic effect.

<131>
Accession Number
643661453
Title
VIRTUAL REALITY FOR IMPROVED VASECTOMY EXPERIENCE: INSIGHTS FROM A
SINGLE-CENTER CLINICAL TRIAL.
Source
Journal of Sexual Medicine. Conference: 24th Sexual Medicine Society of
North America Annual Fall Scientific Meeting, SMSNA 2023. San Diego, CA
United States. 21(Supplement 1) (pp i164), 2024. Date of Publication:
February 2024.
Author
Codrington J.; Qureshi F.; Rahman F.; Saltzman R.; Deebel N.; Cartaya S.;
Leong P.; White J.; Muthigi A.; Ramasamy R.
Institution
(Codrington, Qureshi, Rahman, Saltzman, White, Muthigi, Ramasamy) Desai
Sethi Urology Institute, University of Miami, United States
(Deebel) Wake Forest Baptist Medical Center, United States
(Cartaya) University of South Florida, Morsani College of Medicine, United
States
(Leong) School of Clinical Sciences, Monash Health and Monash University
Clayton, Australia
Publisher
Oxford University Press
Abstract
Introduction: Vasectomy is a widely performed procedure for male
sterilization, with an estimated 33 million procedures conducted annually
worldwide. Although vasectomy is generally safe and associated with
minimal complications, concerns over procedural pain and anxiety can deter
patients from pursuing the procedure. To address these concerns,
innovations such as no-needle and no-scalpel techniques have been adopted
to minimize pain during vasectomy. However, anticipated pain and anxiety
remain significant barriers for patients. Therefore, optimizing patient
comfort during procedures performed under local anesthesia is crucial for
improving outcomes and satisfaction. Virtual reality (VR) devices have
emerged as a promising non-pharmacological intervention for pain
modulation in various medical fields. VR technology has demonstrated pain
reduction and anxiety alleviation in pediatric burn therapy, physical
therapy, dental procedures, and more. The adult urologic community has
also embraced VR, with positive results observed in surveillance
cystoscopy and office-based prostate biopsy procedures. However, limited
research exists on the use of VR headsets during vasectomy, with only one
previous non-randomized trial reporting high patient satisfaction but no
improvement in pain or anxiety. In this ongoing single-center, randomized,
open-label clinical trial, we present interim data evaluating the
effectiveness of the SmileyScope VR device in reducing anxiety and pain
during in-office vasectomy performed with local anesthesia.
 Objective(s): The primary objective of this study is to evaluate the
efficacy of virtual reality (VR) devices in alleviating peri-procedure
anxiety and pain during in-office vasectomy performed with local
anesthesia. The secondary goal of this study is to compare the
effectiveness of interactive VR, enabling patient control of the
experience, with static VR, which does not provide patient control.
 Method(s): The study enrolled patients who were scheduled for
in-office vasectomy with a single urologist. The patients were randomly
assigned to one of three groups: the control group receiving standard
in-office vasectomy without a VR headset, the static VR intervention
group, or the interactive VR intervention group. The primary outcome
measures included patient-reported pain and anxiety levels before and
after the procedure, along with heart ratemeasurements recorded using a
wearable device. Result(s): Interim analysis of this ongoing study
includes data from a total of 58 men. 20 men were in the control group, 19
in the static VR arm, and 19 in the interactive VR arm. There was no
observed difference in subjective pain scores or heart rate variability
during the procedure. However, patients who wore a VR headset reported a
significantly lower level of pre-procedure anxiety (P = 0.0700).
 Conclusion(s): Anticipation of periprocedural pain and anxiety are
barriers to vasectomy utilization. Initial results from our ongoing
randomized clinical trial indicate that the utilization of virtual reality
is feasible, safe, and effective in reducing preprocedure anxiety in
patients undergoing vasectomy.

<132>
Accession Number
643992114
Title
SERRATUS ANTERIOR PLANE BLOCK FOR MINIMAL INVASIVE CARDIAC SURGERY: A
SUBGROUP ANALYSIS OF A SINGLE CENTER RANDOMIZED- CONTROLLED TRIAL.
Source
Regional Anesthesia and Pain Medicine. Conference: 40th Annual ESRA
Congress. Paris France. 48(Supplement 1) (pp A142), 2023. Date of
Publication: September 2023.
Author
Vaes B.; Lapage K.; Francois J.; Maes J.-W.; Allaert S.; Poelaert J.; Van
Hoecke L.
Institution
(Vaes, Lapage, Maes, Allaert, Poelaert) Anesthesiologist, AZ Maria
Middelares, Ghent, Belgium
(Francois) Cardiac surgeon, AZ Maria Middelares, Ghent, Belgium
(Van Hoecke) UZ Gent, Ghent, Belgium
Publisher
BMJ Publishing Group
Abstract
Background and Aims Regional anesthesia for minimal invasive cardiac
surgery (MICS) gained interest as part of Enhanced Recovery After Cardiac
Surgery (ERACS) protocols. At our institution, mitral valve surgery
through port access (MVS-PA), aortic valve replacement via right anterior
thoracotomy (AVRRAT) and minimally invasive direct coronary artery bypass
(MIDCAB) surgery are regularly performed MICS procedures. This study aims
to investigate whether the addition of a single- shot SAPB to the standard
institutional practice reduces NRS in MICS patients. Methods After
obtaining consent, 80 MICS patients were randomized to receive either an
additional SAPB after surgery (levobupivacaine 0.25%, dosed at 1.25 mL/kg)
or IV piritramide as per protocol alone. The primary outcome is Numeric
Rating Scale (NRS), 6 hours after extubation. Secondary outcome measure is
total piritramide consumption in the ICU. A subgroup analysis per MICS
procedure is performed. Results In the SAPB group (n = 42), MIDCAB
patients had a significant NRS reduction of nearly 2 points (difference:
1.71; 95% CI: 0.412 - 2.945; p = 0.023). In the SAPB group, postoperative
opioid consumption was reduced by 2.3 mg; however, the 95% CI spans 0
(-3.948 - 7.344; p = 0.048). Abstract EP188 Figure 1 NRS at 6h Abstract
EP188 Figure 2 Total piritramide dose Abstract EP188 Table 1 Demographics
Conclusions In patients undergoing a MIDCAB procedure, our study
demonstrates adequate pain relief when a superficial SAPB is performed.
Reported pain scores at 6h and piritramide consumption were lower during
ICU stay. Future research needs to investigate the added value of the SAPB
in the recovery of MICS patients.

<133>
Accession Number
643854974
Title
ERECTOR SPINAE PLANE BLOCK FOR ROBOT-ASSISTED MINIMALLY INVASIVE DIRECT
CORONARY ARTERY BYPASS SURGERY: A DOUBLE-BLIND, PROSPECTIVE RANDOMIZED
PLACEBO-CONTROLLED TRIAL.
Source
Regional Anesthesia and Pain Medicine. Conference: 39th Annual Congress
European Society of Regional Anaesthesia and Pain Therapy. Thessaloniki
Greece. 47(Supplement 1) (pp A239-A240), 2022. Date of Publication: June
2022.
Author
Hoogma D.F.; Van Den Eynde R.; Oosterlinck W.; Al tmimi L.; Tournoy J.;
Verbrugghe P.; Fieuws S.; Coppens S.; Rex S.
Institution
(Hoogma, Van Den Eynde, Al tmimi, Coppens, Rex) University Hospitals
Leuven, Department of Anesthesiology, Leuven, Belgium
(Hoogma, Oosterlinck, Al tmimi, Verbrugghe, Coppens, Rex) University of
Leuven, Biomedical Sciences Group, Department of Cardiovascular Sciences,
Leuven, Belgium
(Oosterlinck, Verbrugghe) University Hospitals of Leuven, Department of
Cardiac Surgery, Leuven, Belgium
(Tournoy) Geriatric Medicine, University Hospitals Leuven, Department of
Public Health and Primary Care, Leuven, Belgium
(Fieuws) University of Leuven, Biomedical Sciences Group, Leuven
Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven,
Belgium
Publisher
BMJ Publishing Group
Abstract
Background and Aims Thoracotomy for robot-assisted minimally invasive
direct coronary artery bypass (RAMIDCAB) surgery may cause severe early
postoperative pain.1The Erector Spinae Plane (ESP) block may be an
effective and safe option for postoperative analgesia in RAMIDCAB
surgery.2As randomized trials in this field are lacking,3we investigated
ifin RAMIDCAB surgery, intermittent ESP block adjuvant to the standard
multimodal analgesic regimen, compared to solely the latter, is effective
in reducing postoperative pain. Methods This single center, double-blind,
prospective, randomized, placebo-controlled trial was approved by the
Ethics Committee of the University Hospitals Leuven, Belgium (DH 11-2018
Version 008 26-10-2020 - EudraCT 2019-000596- 16). The trial was supported
by an ESRA Research Grant 2019. Between May 15th2019 and July 4th2021, 64
patients undergoing RAMIDCAB surgery were randomized to postoperatively
receive an ESP catheter with either intermittent ropivacaine 0.5%
(ropi-group) or normal saline 0.9% (placebogroup). Primary endpoint was
postoperative 24h morphine consumption. Multiple secondary endpoints were
evaluated up to 30-days postoperatively. Results The median (IQR) 24h
morphine consumption was not different between the ropi- and
placebo-group: 67mg (35;84) vs 71mg (52;90), p=0.25. Mean numerical rating
scale values for pain showed no significant difference between the groups
(Figure 1). The number of morphine-boluses requested each hour by the
patient and other secondary outcomes were comparable, figure 2 and table
1, respectively. Conclusions In the current study, adding an ESP-block to
a standard multimodal analgesia regimen did not result in reduced morphine
consumption after RAMIDCAB surgery. (Figure Presented).

<134>
Accession Number
643854857
Title
LEVO-BUPIVACAINE PLASMA CONCENTRATION FOLLOWING THORACIC ERECTOR SPINAE
PLANE BLOCK AND THE EFFECT OF ADDED EPINEPHRINE.
Source
Regional Anesthesia and Pain Medicine. Conference: 39th Annual Congress
European Society of Regional Anaesthesia and Pain Therapy. Thessaloniki
Greece. 47(Supplement 1) (pp A141-A142), 2022. Date of Publication: June
2022.
Author
De La Cuadra-Fontaine J.C.; Araneda Vilches A.; Balde Sepulveda D.; De La
Fuente Sanhueza R.; Arze Irarrazaval S.; Contreras Ibacache V.; Cortinez
Fernandez L.I.
Institution
(De La Cuadra-Fontaine, Araneda Vilches, Balde Sepulveda, De La Fuente
Sanhueza, Arze Irarrazaval, Contreras Ibacache, Cortinez Fernandez)
Division de Anestesiologia, Escuela de Medicina, Pontificia Universidad
Catolica de Chile, Santiago, Chile
Publisher
BMJ Publishing Group
Abstract
Background and Aims Erector Spinae Plane block (ESPB) has at least 3
reports of probable local anesthetic systemic toxicity1- 3, and few local
anesthetic absorption reports since first published4-5. Our primary goal
is to measure arterial levo-bupivacaine plasma levels following thoracic
ESPB, and the effect of epinephrine addition. Methods This is a randomized
controlled study on ASA I-II patients, undergoing video-assisted thoracic
surgery. The study was approved by our Institutional Research Ethic
Committee. Upon written consent, patients were randomized to receive a T5
ESPB with 0.25% levo-bupivacaine 20 mL (LB) or 0.25% levo-bupivacaine plus
100mcg epinephrine, 20 mL (LBE). ESPB was done by an experienced regional
anesthetist. Patients were awake, standard monitoring, iv-line, and
arterial line. After ESPB, arterial blood samples were drawn at 5, 10, 20,
30, 45, 60 y 90 minutes. Samples were transferred in EDTA test tubes,
plasma was separated and kept at 5degreeCelsius until analyzed with HPLC
technique. All patients received a standard protocolized general
anesthesia after 15 minutes of block completion. Results 38 patients (19
LB, 19 LE-B) 18-74 years old, were studied. Overall levels and descriptive
statistics are presented in figure 1 and 2. Peak arterial plasma
concentrations were (median;25-75 percentile) 0.64; 0.50-1,11 mcg/mL in LB
group and 0.42; 0.29-0.53 mcg/mL in LB-E group. Mann- Whitney analysis
p=0.0046. There was no difference in time to peak concentration
(median;25-75 percentile): 10 min;5-20 in LB, and 10 min;5-20 in LB-E. AUC
calculations were different: LB 46.63 mcg/mL*min (CI95 28.08-65.17) and
LB-E 27.91 mcg/mL*min (CI95 15.56-40.26). Conclusions Adding epinephrine
diminishes levo-bupivacaine arterial plasma levels after thoracic ESPB..

<135>
Accession Number
643854712
Title
EFFECT OF BILATERAL SUBPECTO-INTERFASCIAL PLANE BLOCK ON PERIOPERATIVE
FENTANYL CONSUMPTION UNDERGOING CORONARY ARTERY BYPASS GRAFTING: A
PROSPECTIVE RANDOMISED CONTROLLED TRIAL.
Source
Regional Anesthesia and Pain Medicine. Conference: 39th Annual Congress
European Society of Regional Anaesthesia and Pain Therapy. Thessaloniki
Greece. 47(Supplement 1) (pp A83), 2022. Date of Publication: June 2022.
Author
Choudhury A.; Singh R.; Gupta N.; Chauhan S.; Chaturvedi P.K.
Institution
(Choudhury, Singh, Gupta, Chauhan, Chaturvedi) All India Institute of
Medical Sciences, New Delhi, New Delhi, India
Publisher
BMJ Publishing Group
Abstract
Background and Aims Pain following sternotomy has always remained a major
concern for patients undergoing open heart cardiac surgery during the
entire perioperative period. The incidence of rest pain due to midline
sternotomy is as high as 49% following coronary artery bypass grafting
(CABG). We planned to utilize subpecto-interfascial plane (SIP) block to
determine its efficacy and quality of analgesia as compared to
conventional intravenous analgesia. Methods After institutional ethics
committee approval, we recruited 60 (NYHA I and II) patients and
randomized them into group1 as SIP block and Group2 as nurse controlled
analgesia (NCA). Patients with serious comorbidities were excluded from
the study before randomisation. Group1 patients received the allocated USG
guided block after induction of GA. A mixture of inj ropivacaine (0.375%)
and dexmedetomidine (1.1 mcg/ml) was used for six injections of 6 ml each
at 2nd,4th, and 6th intercostal space in bilateral parasternal region. All
patients were monitored and their vitals recorded. Total rescue analgesia
in PACU/ICU, peak inspiratory flow rate, time to extubation, time to first
oral intake and total length of ICU stay were also recorded. Results The
total fentanyl consumptions after 24 hrs were compared between the groups
using one-way ANOVA and post-hoc analysis. Group 1 used significantly less
fentanyl compared to the control group (715.66+/-127.45 mcg vs
1411.96+/-144.66 mcg; P < 0.001) (Plotted graph attached). Conclusions The
SIP block was found to be superior in terms of pain control following
midline sternotomy during CABG. Total fentanyl consumption was
significantly reduced when compared with conventional therapy. (Figure
Presented).

<136>
Accession Number
643854658
Title
PERIPHERAL NERVE BLOCKS DECREASE THE INCIDENCE OF INTRA-OPERATIVE
HYPOTENSION EPISODS AND TREATMENT IN TRAUMATIC ANKLE AND LEG SURGERY: A
PROPENSITY SCORE-MATCHED COMPARISON WITH GENERAL ANESTHESIA.
Source
Regional Anesthesia and Pain Medicine. Conference: 39th Annual Congress
European Society of Regional Anaesthesia and Pain Therapy. Thessaloniki
Greece. 47(Supplement 1) (pp A130), 2022. Date of Publication: June 2022.
Author
Biziou Y.; Tsekouras N.; Choquet O.; Bringuier S.; Capdevila X.
Institution
(Biziou, Tsekouras, Choquet, Bringuier, Capdevila) University Hospital
Lapeyronie, Montpellier, France
Publisher
BMJ Publishing Group
Abstract
Background and Aims Intra-operative hypotension (IOH) is associated with a
significant increase in post-operative morbidity and mortality in
non-cardiac surgery. There's no consensus concerning the best anesthesia
technique for traumatic leg and ankle surgery. We hypothesize that
peripheral nerve blocks (PNB) decrease the risk of intra-operative
hypotension episods and treatment compared to GA. Methods Using a
propensity score-matched analysis, we compared a GA group and a PNB group
in terms of vasopressors consumption (primary end point), incidence of IOH
under a MAP at 65mmHg, IOH under a MAP at 50mmHg (secondary end points)
and post-operative complications within 30 days after surgery. Results
After informed consent and clinical trials.gov registration, 259 patients
were assessed for eligibility and 250 were allocated in the both groups (
105 GA and 145 BNP) for analysis. After propensity score matching, 33
patients in each group were compared. There's no difference in demographic
characteristics, comorbidities, preoperative medications or type of
surgery. The use of vasopressors was significantly higher in the GA group
(15/33 (46%)) than in PNB group (1/33 (3%)); p=0,0002 (Table 1) .The
incidence of IOH episods under 65mmHg and 50mmHg of MAP was significantly
higher in the GA group compared to PNB group: respectively, 94% vs 18% for
65mmHg and 27% vs 3% for 50mmHg, p <0,0001 and p<0,0114. No difference
were reported for post-operative complications in both groups Conclusions
The use of PNB decrease the use of vasopressors and provide a safer
hemodynamic stability compared to GA in patients scheduled for traumatic
ankle and leg surgery..

<137>
Accession Number
643854641
Title
ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK IN CORONARY ARTERY BYPASS
SURGERY: THE ROLE OF LOCAL ANESTHETIC VOLUME - A PROSPECTIVE, RANDOMIZED
STUDY.
Source
Regional Anesthesia and Pain Medicine. Conference: 39th Annual Congress
European Society of Regional Anaesthesia and Pain Therapy. Thessaloniki
Greece. 47(Supplement 1) (pp A155), 2022. Date of Publication: June 2022.
Author
Demir Z.A.; Aydin M.E.; Balci E.; Ozay H.Y.; Ozgok A.; Ahiskalioglu A.
Institution
(Demir, Balci, Ozay, Ozgok) University of Health Sciences, Ankara City
Hospital, Department of Anaesthesiology, Ankara, Turkey
(Aydin, Ahiskalioglu) Ataturk University, School of Medicine, Department
of Anaesthesiology, Erzurum, Turkey
Publisher
BMJ Publishing Group
Abstract
Background and Aims Although the effectiveness of erector spinae plane
block (ESPB) in cardiac surgery has been shown [1], but the optimal volume
of ESPB in CABG surgery remains unclear. We hypothesized that using larger
volumes of local anesthetic in the ESPB would result in greater dermatomal
blockade. The aim of this study is to determine the analgesic efficacy of
ESP block with two different volumes in CABG patients. Methods This
prospective,randomized study was conducted in adult patients undergoing
CABG surgery with cardiopulmonary bypass. Group-20 received 20 ml of 0.25%
bupivacaine perside in ESPB and Group-30, 30 ml of 0.25% bupivacaine
perside. Following extubation, tramadol 100mg as rescue analgesia was
given to patients of NRS>4. Postoperative sternotomy and chest tube pain
was evaluated using the NRS at rest and during coughing after extubation.
Results 70 patients were analyzed. There were significant differences
between the groups regarding rescue analgesic was higher in the group 20
ml (25/35vs2/35,p<0.001) and the time of the first rescue analgesic
requirement. The mean time +/-std were 11.26+/-9.57 hours and 24.03+/-4.12
hours in the group 20 ml and the group 30 ml,(p<0.001). The median- (IQR)
NRS scores, both at sternotomy and chest tubes, were significantly lower
in the group 30 ml at the different time points after the surgery
(p<0.05). Conclusions The ESP block performed with a volume of 30 ml, less
pain was observed in the sternum and chest tube region, less rescue
analgesic requirement, and late first rescue analgesic requirement time.
30 ml can be effective in chest tube and sternum pain in cardiac surgery.

<138>
Accession Number
643854518
Title
UPDATE ON PECS BLOCK.
Source
Regional Anesthesia and Pain Medicine. Conference: 39th Annual Congress
European Society of Regional Anaesthesia and Pain Therapy. Thessaloniki
Greece. 47(Supplement 1) (pp A62), 2022. Date of Publication: June 2022.
Author
Parras T.
Institution
(Parras) Hospital Quironsalud Malaga, Spain
Publisher
BMJ Publishing Group
Abstract
The Pecs II targets the interfacial plane between the pectoralis major
muscle and the pectoralis minor muscle as does the Pecs I but also targets
the interfacial plane between the pectoralis minor muscle and the serratus
anterior muscle, aiming to block intercostal nerves 3 to 6,
intercostobrachial and the long thoracic nerves, all of which are
necessary for axillary node dissection.1 A recent meta-analysis included
14 different randomized trials looking at Pecs II block versus
paravertebral blocks. They found that Pectoralis-II reduces pain intensity
and morphine consumption during the first 24 h postoperatively when
compared with systemic analgesia alone; and it also offers analgesic
benefits non inferior to those of paravertebral block after breast cancer
surgery.2 Serratus Anterior Plane Block and Pecs II fascial plane blocks
are equally efficacious in post-thoracotomy pain management compared with
intercostal nerve block, but they have the additional benefit of being
longer lasting and are as easily performed as the traditional intercostal
nerve block.3 In open heart surgery, parasternal block provided longer
block duration with lower postoperative pain and sedation scores than the
PECS II block, with lower cumulative morphine consumption.4 Dexamethasone
8 mg when added to ropivacaine 0.2% for PECS II block in unilateral
radical mastectomy was not found to reduce total opioid consumption over
72 postoperative hours or to prolong duration of analgesia as compared to
pure ropivacaine 0.2%.5 Neshith Govil et al demonstrated that instillation
of lignocaine to block the pectoral nerves allows better postoperative
analgesia compared to other patients without regional anaesthesia and
decreases the secretion of angiogenesis markers, which contributes to
tumor generalization.6.

<139>
Accession Number
643638871
Title
Reducing Reintubation Risk in High-Risk Cardiac Surgery Patients with High
Flow Nasal Cannula.
Source
Journal of Clinical and Translational Science. Conference: Association for
Clinical and Translational Science, ACTS 2019. Washington, DC United
States. 3(Supplement 1) (pp 29), 2019. Date of Publication: March 2019.
Author
Freundlich R.E.
Institution
(Freundlich) Vanderbilt University Medical Center, United States
Publisher
Cambridge University Press
Abstract
OBJECTIVES/SPECIFIC AIMS: More than half a million adult patients
nationally undergo cardiac surgery each year. Reintubation following
cardiac surgery is common and associated with higher short- and long-term
mortality, increased cost, and longer lengths of stay. The reintubation
incidence is estimated at 5-10%. Patients undergoing cardiac surgery are
increasing in age and comorbidity burden, and receive increasingly complex
cardiac surgical procedures, complicating decision making around when to
extubate postoperative patients. Compounding this complexity are financial
pressures to maintain high throughput and maximize ICU bed availability.
Providers are often compelled to extubate high-risk patients earlier,
despite the potential for an increased risk of reintubation. Understanding
the risk factors for reintubation after cardiac surgery and identifying
effective interventions to reduce these reintubations is of critical
importance to optimize patient outcomes. High-flow nasal cannula (HFNC)
provides up to 60 liters per minute of 100% oxygen, dead space washout,
and humidification to improve secretion clearance, and has shown some
benefits in improving hypoxia and reducing reintubation in select
populations. However, its benefit in high-risk patients undergoing cardiac
surgical procedures is not known and therefore clinicians may still be
reluctant to extubate these patients early and introduce HFNC, despite the
known risks of prolonged intubation. To address this important issue, we
aim to develop and validate a model to predict postoperative reintubation
after cardiac surgery using data readily available from the electronic
health record (EHR) and use this data to complete a pilot randomized
controlled trial (RCT) of postextubation HFNC to prevent reintubation in
cardiac surgery patients identified as at high risk for reintubation.
METHODS/STUDY POPULATION: Based on retrospective data demonstrating a 4.7%
reintubation incidence within 48 hours in our CVICU, we estimate that
there will be 340 reintubations available for analysis of the risk factors
for reintubation to develop our predictive model from November 2, 2017
(our EHR go-live). We require 15 events per predictive variable to avoid
overfitting the model, giving us at least 22 variables for analysis and
inclusion in the model. Model validation and calibration will be performed
using a bootstrapped validation cohort. Next, we will prospectively study
120 patients with a greater than 10% predicted risk of reintubation
(double the baseline risk of the overall population) and randomly assign
them to either HFNC or usual care, to test the hypothesis that HFNC
decreases the rate of reintubation in high-risk patients.
RESULTS/ANTICIPATED RESULTS: In addition to developing a predictive model,
refining it, and validating its ability to predict the primary outcome of
reintubation within 48 hours, I will further assess whether HFNC reduces
total duration of mechanical ventilation, hospital length of stay, and ICU
length of stay in this high-risk population. I will use these data to
establish the feasibility of EHR-integrated predictive modeling and
randomization, as well as to guide a future multicenter clinical trial
that will pragmatically leverage the EHR for patient selection,
enrollment, randomization, and data collection. DISCUSSION/ SIGNIFICANCE
OF IMPACT: Assuming HFNC decreases reintubation rates by 50%, at a 1:1
ratio of cases to controls, we will require 435 patients in each group
(970 total), to have an 80% power and alpha of 0.05 to detect a
difference. As this will require a multicenter study, we will instead
focus on using data from this pilot study to: 1) refine our sample size
estimates. 2) demonstrate the feasibility of our novel EHR-integrated
pragmatic trial design. 3) identify and screen collaborators at other
institutions, including obtaining important regulatory and legal approval.
4) establish a data safety monitoring board for the trial. 5) refine the
data collection infrastructure, leveraging commercially available
resources in one of the largest enterprise EHR systems (Epic) and
associated resource-sharing products, such as Epic's App Orchard.

<140>
Accession Number
643673670
Title
Thrombotic complications in single ventricle reconstructions for single
ventricle physiology congenital heart disease.
Source
Journal of Clinical and Translational Science. Conference: Association for
Clinical and Translational Science, ACTS 2018. Washington, DC United
States. 2(Supplement 1) (pp 88-89), 2018. Date of Publication: June 2018.
Author
White M.H.; Patel K.; Kochilas L.; Sidonio R.F.
Institution
(White) Emory University, United States
(Patel) Leader Thrombosis Clinical and Research Programs, Aflac Cancer and
Blood Disorders Center, Children's Healthcare of Atlanta, Emory
University, United States
(Kochilas) Sibley Heart Center Cardiology, Emory University, United States
(Sidonio) Aflac Cancer and Blood Disorders Center, Children's Healthcare
of Atlanta, Emory University, United States
Publisher
Cambridge University Press
Abstract
OBJECTIVES/SPECIFIC AIMS: Infants with single ventricle congenital heart
disease (CHD) who undergo staged surgical reconstruction are among the
pediatric patients at highest risk for thrombotic complications. Despite
improvements in survival due to medical and surgical advancements,
thrombotic complications are common and lead to increased morbidity and
mortality, especially during the first two stages of surgical
reconstruction. The burden of disease caused by thrombosis is not fully
known, and the risk factors associated with thrombosis are not clear. Due
to this knowledge gap, prevention of thrombosis with medication, a
strategy called thromboprophylaxis, has not been standardized, leading to
inadequate prevention of thrombosis. In order to understand the burden of
thrombosis and then provide targeted thrombopro-phylaxis for thrombosis
prevention, better characterization of thrombotic complications and the
associated factors is needed. Hypothesis: I hypothesize that in infants
with single ventricle CHD, the incidence of thrombosis will be more
frequent after stage I Versus stage II reconstruction, despite the type of
shunt used. Specific demographic, clinical, and surgical variables will be
associated with an increased risk for thrombotic complications, and a
model to predict which subset of infants is at increased risk will be
developed. Specific Aim 1: Characterize the incidence of thrombotic
complications at different time points from stage I through stage II of
the single ventricle reconstruction (SVR) pathway and determine the
demographic, clinical, and surgical factors associated with thrombosis in
infants with single ventricle CHD. (1) Determine the incidence of
thrombosis in infants with single ventricle CHD. (2) Compare the rate of
thrombotic complications between the 2 most commonly used approaches for
stage I reconstruction for the group of patients with hypoplastic left
heart type of anatomy [modified Blalock-Taussig shunt (MBTS) vs. right
ventricle to pulmonary artery shunt (RVPAS)]. (3) Determine the factors
(demographic, clinical, and surgical) associated with thrombosis in
infants with single ventricle CHD. Specific Aim 2: Determine which subset
of infants with single ventricle CHD is at increased risk of developing
thrombotic complications across the first 2 stages of surgical
reconstruction. (1) Test the identified demographic, clinical, and
surgical variables including, but not limited to, gestational age, sex,
CHD diagnosis, baseline oxygen saturation, stage of reconstruction, shunt
type, and other clinical data available in a univariable and multivariable
analysis and study their potential interactions to construct a novel risk
predictive model specific for single ventricle CHD. METHODS/STUDY
POPULATION: To address the specific aims, I will utilize data from the SVR
clinical trial public use data set. This data set includes a prospective
cohort of infants, 0-14 months of age, enrolled from any of the 15
participating clinical centers from the years 2005 to 2009. Inclusion
criteria for enrollment were diagnosis of hypoplastic left heart syndrome
or related single, morphologic right systemic ventricle anomaly, planned
Norwood procedure, and informed consent of parent or legal guardian. No
additional subjects outside of this data set will be included. Exclusion
criteria were a diagnosis of single, morphologic left ventricle anomaly,
preoperative identification of anatomy rendering the MBTS or RVPAS
technically impossible, and any other major abnormality or acquired
extra-cardiac disorder that could independently affect the likelihood of
the subject meeting the primary endpoint. The complication of stroke will
be excluded from the analyses of factors associated with thrombosis. The
complication of thrombosis as defined in this dataset is a composite of
events that include arterial or venous thrombosis, thromboembolism, and
pulmonary embolism. The data was collected in such a way that it will not
be possible to separate these sub-types of thrombosis. Additional
thrombotic events of interest are superior vena cava occlusion and
inferior vena cava occlusion. Specific Aim 1: Patient data will be
extracted from the SVR clinical trial public use dataset to characterize
the incidence of thrombotic complications at different time points from
stage I through stage II of the SVR pathway and determine the demographic,
clinical, and surgical factors associated with thrombosis in infants with
single ventricle CHD. In addition, I will compare the rates of thrombotic
complications between the 2 most commonly used approaches for stage I
palliation for the group of patients with hypoplastic left heart type of
anatomy (MBTS vs. RVPAS) and will test the hypothesis that the risk of
thrombotic complications is associated with the stage of palliative
surgery (stage I vs. stage II). Specific Aim 2: We will test identified
demographic, clinical, surgical, and newly identified variables in a
univariable and multivariable analysis and study their potential
interactions to construct a novel risk predictive model specific for
single ventricle CHD. RESULTS/ANTICIPATED RESULTS: To determine
feasibility for adequate numbers to be able to address the research aims,
a preliminary analysis dataset was performed using a dataset from the
Pediatric Heart Network. The PHN is a collaborative group of hospitals
that participates in clinical research studies in children with CHD. For
the SVR clinical trial, the PHN conducted a randomized clinical trial at
15 centers in North America between 2005 and 2009, prospectively enrolling
infants with HLHS or single right ventricle anomalies who were to undergo
the Stage I Norwood procedure. A total of 920 newborns were screened; 664
were medically eligible and 549 patients were randomized. The primary aim
of the trial was to compare survival of infants randomized to receive
either the Norwood procedure with the MBTS or the RVPAS. These patients
were followed at specific time points, including from baseline
(pre-Norwood), at the time of the Norwood procedure, between stage I and
II, following stage II reconstruction, and at 14 months of age. At these
time points, data were collected that includes demographic, radiologic,
clinical, and surgical outcomes. Included in the clinical outcomes are
complications, such a thrombosis. There was no screening process to assess
for asymptomatic thromboses, suggesting that most, if not all, discovered
thromboses were due to clinically relevant effects. A newer iteration of
this study (SVRIII) expands the monitoring of this cohort until the Fontan
stage at 2-6 years of age, but these data have not yet been released in
the public use data set. A descriptive analysis of the frequency of
thrombotic complications was assessed at each time point, as well as in
aggregate. Data were extracted from the specific time periods of interest,
identified as Pre-Norwood, during Norwood Hospitalization, in-between
visits, and during Stage II Hospitalization. There were 549 infants who
were randomized with available data to analyze. During the Norwood
hospitalization, 37 infants had a thrombotic complication. Between Stage I
and Stage II outpatient visits, 8 infants had a thrombotic complication.
During Stage II hospitalization, 16 infants had a thrombus. Overall, 61
individual patients (11%) had a thrombotic complication.
DISCUSSION/SIGNIFICANCE OF IMPACT: This study utilizing data from the
Pediatric Heart will be the largest cohort ever utilized for
characterizing thrombotic complications and determining the factors
associated with thrombosis across the first and second stages of surgical
reconstruction. More than 500 (n =549) subject's data will be analyzed
through the first two stages of reconstruction, while the largest analysis
before this proposed analysis only included a total of 195 children.
Notably, these prior studies did not include a comparison between the 2
shunt types in stage I reconstruction, leaving a gap in knowledge
regarding the incidence of thrombosis comparing these groups. The analysis
will be the first to address this gap and update the current literature.
Preliminary data show that the overall incidence of thrombosis across the
first 2 stages of surgical reconstruction was 11%, which is lower than the
previously reported overall rates of 40%-50%. Despite the continued lack
of evidence-based guidelines for thromboprophylaxis methods, the decreased
overall rate is most likely due to more widespread practice of
anticoagulation in general. Determining the factors associated with
thrombosis across the first and second stages of surgical reconstruction
will help identify those at risk. An innovative aspect of this analysis
will be the use of disease-specific factors to develop a model to predict
thrombosis. Unique factors include cardiac variables like ejection
fraction, baseline oxygen saturation, shunt type (MBTS vs. RVPAS), and
other echocardiographic parameters. While the use of thromboprophylaxis
has been associated with decreased risk of thrombosis, there is no general
consensus to guide thromboprophylaxis in this population, which can be
burdensome and costly. Determining which subset of infants with single
ventricle CHD are at increased risk of developing thrombotic complications
will allow for the development of a prediction model to predict those at
highest risk of developing a thrombotic complication. Developing a
predictive model will be a novel way to identify patients at risk for
thrombosis and will set the stage for targeted prevention of thrombosis.

<141>
Accession Number
643673500
Title
Targeting pulsatile load to increase exercise capacity and quality of life
after TAVR for severe aortic stenosis.
Source
Journal of Clinical and Translational Science. Conference: Association for
Clinical and Translational Science, ACTS 2018. Washington, DC United
States. 2(Supplement 1) (pp 48), 2018. Date of Publication: June 2018.
Author
Kumar A.; Chirinos J.
Publisher
Cambridge University Press
Abstract
OBJECTIVES/SPECIFIC AIMS: The objective of the study is to test the effect
of oral inorganic nitrate on the primary outcomes of exercise capacity and
quality of life in patients who have undergone TAVR for severe aortic
stenosis. We will also test the effect of the study drug on various
physiology endpoints, including systemic vasodilator response to exercise,
LV diastolic function and myocardial strain, late systolic LV load and
pulsatile arterial wave reflections. METHODS/STUDY POPULATION: This is a
randomized double-blind crossover clinical trial, in which 24 subjects who
underwent TAVR for severe AS 3 or more months before enrollment will
receive the following 2 interventions, in randomized order: (1) Potassium
nitrate (KNO<inf>3</inf>), at a dose of 12-18 mmol/day by mouth for ~4
weeks, or (2) Potassium chloride (KCl), at a dose of 12-18 mmol/day by
mouth for ~ 4 weeks. A 1-week washout period will be introduced between
the 2 interventions. RESULTS/ANTICIPATED RESULTS: We hypothesize that
sustained oral administration of potassium nitrate will lead to
improvement of exercise capacity and quality of life in this population.
DISCUSSION/SIGNIFICANCE OF IMPACT: His study will have a significant
impact on assessment and management of patients after TAVR. We will gain a
better understanding of physiologic abnormalities leading to exercise
intolerance after TAVR. In addition, there are currently no proven
therapies that improve exercise capacity in this population.

<142>
[Use Link to view the full text]
Accession Number
643295904
Title
DROXIDOPA OR ATOMOXETINE FOR REFRACTORY HYPOTENSION IN CARDIOTHORACIC
SURGERY ICU PATIENTS.
Source
Critical Care Medicine. Conference: 2024 Critical Care Congress. Phoenix,
AZ United States. 52(1 Supplement 1) (pp S46), 2024. Date of Publication:
January 2024.
Author
Lessing J.; Kram S.; Levy J.; Grecu L.; Katz J.
Institution
(Lessing, Grecu) Duke University Hospital, United States
(Kram, Katz) Duke University Hospital, Durham, United States
(Levy) Duke University Hospital, Durham, NC, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Hypotension is common in intensive care unit (ICU) patients,
and oral vasopressors may facilitate discharge from the ICU for those
requiring intravenous (IV) vasoactive agents. Midodrine is frequently used
off-label for ICU patients with refractory hypotension. Droxidopa and
atomoxetine are oral vasopressors with limited evidence for use in this
population. This study aims to evaluate the effects of droxidopa or
atomoxetine on hypotension refractory to midodrine in critically ill
cardiothoracic surgery patients. METHOD(S): A single-center,
retrospective cohort study of patients admitted to the Cardiothoracic ICU
(CTICU) from Jan 2017 to Aug 2022 who had hypotension refractory to
midodrine therapy was performed. Patients were included if they received
droxidopa or atomoxetine for at least four consecutive doses and remained
on concurrent midodrine therapy. Patients were excluded if they received
either study medication before admission, had clinical deterioration after
study medication initiation requiring additional vasoactive agents or
escalation of IV vasoactive agent dosage for at least 12 hours, had a
diagnosis of hepatorenal syndrome, were prisoners, or were pregnant. The
primary endpoint was the time to discontinuation of IV vasoactive agents
after initiation of study medication. Secondary endpoints included CTICU
and hospital length of stay, readmission to the CTICU while on study
medication, adverse drug events, and mortality. RESULT(S): A total of
45 patients met the inclusion criteria, of whom 18 received atomoxetine,
17 received droxidopa, and 10 received both study medications. There was
no difference in median time to discontinuation of IV vasoactive agents
between the groups (12.9 days vs 16.8 days vs 15.4 days, respectively;
p=0.709). There was also no difference in ICU or hospital length of stay
between groups. A higher percentage of patients who survived to hospital
discharge received both study medications or droxidopa alone compared with
those who received atomoxetine alone (90% vs 76.5% vs 44.4%, respectively;
p=0.028). CONCLUSION(S): There was no difference in median time to
discontinuation of IV vasoactive agents or length of stay between
atomoxetine, droxidopa, or both medications for the management of
refractory hypotension in critically ill cardiothoracic surgery patients.

<143>
[Use Link to view the full text]
Accession Number
643295854
Title
TWENTY YEARS OF 4-FACTOR PROTHROMBIN COMPLEX CONCENTRATE: REVIEW AND
ADVANCES OF OCTAPLEX/BALFAXAR.
Source
Critical Care Medicine. Conference: 2024 Critical Care Congress. Phoenix,
AZ United States. 52(1 Supplement 1) (pp S69), 2024. Date of Publication:
January 2024.
Author
Gareis M.; Sarode R.; Mehta-Shah T.; Goldstein J.
Institution
(Gareis) Octapharma Pharmazeutika Produktionsges.mb.H, Austria
(Sarode) UT Southwestern Medical Center, United States
(Mehta-Shah) Octapharma USA,Inc, Paramus, NJ, United States
(Goldstein) Massachusetts General Hospital, Harvard Medical School, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Octaplex/Balfaxar (Octapharma AG, Switzerland) is an
intravenously administered four-factor freezedried human prothrombin
complex concentrate (4F-PCC) available since 2003 and approved in 87
countries, including the USA. 4F-PCC is used for the treatment and
perioperative prophylaxis of bleeding in congenital or acquired vitamin
K-dependent coagulation factor deficiency, and is being investigated for
direct oral anticoagulant (DOAC)-associated bleeds and coagulation factor
deficiency during cardiac surgery. We review the efficacy and safety of
Octapharma's 4F-PCC and recent advances in clinical research.
 METHOD(S): We reviewed all studies of Octaplex/Balfaxar, including
literature searches of 'octaplex' using PubMed, Google Scholar and
Clinicaltrials.gov to capture studies reporting clinical safety and
efficacy. RESULT(S): The Octapharma clinical trial program for
Octaplex/Balfaxar included 7 studies: 5 completed (n=444) and 2 ongoing in
DOAC reversal and cardiac surgery. Five published studies of urgent
reversal of vitamin K antagonists (VKA) for bleeding or perioperative
prophylaxis are reported. In a head-to-head Phase III randomized
double-blind study (n=208), Octaplex/Balfaxar was non-inferior to control
4F-PCC (Kcentra, CSL Behring) in achieving hemostatic efficacy with
similar INR correction and safety profiles. Additionally, other studies of
4F-PCC in patients treated for urgent reversal of VKA, showed effective
hemostasis and rapid correction of INR. Proportions of TEEs were low and
not significantly different between groups. In a study of 20 patients,
excellent hemostatic efficacy was achieved for 85% after a single infusion
and in another study (n=56), the timely correction of INR to target levels
was achieved for 91% of patients. A randomized, phase II investigator-led
study (FARES) evaluated Octaplex and FFP in patients undergoing cardiac
surgery with cardiopulmonary bypass. The Octaplex group (n=54) required
significantly reduced additional hemostatic therapy compared with the FFP
group (n=47) and used fewer allogeneic blood products. CONCLUSION(S):
Multiple clinical studies have shown that Octaplex/Balfaxar is an
effective hemostatic agent for various indications including VKA reversal,
with a favorable safety profile. Ongoing studies are expanding the role of
4F-PCC.

<144>
[Use Link to view the full text]
Accession Number
643295783
Title
INTO THE STORM: ECMO TO STOP VT STORM.
Source
Critical Care Medicine. Conference: 2024 Critical Care Congress. Phoenix,
AZ United States. 52(1 Supplement 1) (pp S91), 2024. Date of Publication:
January 2024.
Author
Schultz E.; Khan A.; Plisco M.; Bunaye Z.; Cleveland J.; Longenecker R.
Institution
(Schultz) Mercy Hospital, United States
(Khan) Saint LouisMOUnited States
(Plisco, Bunaye, Cleveland, Longenecker) Mercy St. Louis, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Extracorporeal life support (ECLS) is an effective bridging
therapy in patients with refractory ventricular tachycardia (VT). Managing
refractory VT can be challenging. Inotropic support may exacerbate
tachyarrhythmias or accelerate heart rate; antiarrhythmic drugs often come
with negative inotropic effects, and electrical reconversions may risk
worsening circulatory failure or even cardiac arrest. VA ECMO can provide
vital organ perfusion and facilitate effective bridging to therapeutic
interventions. DESCRIPTION: 49 y/o male recently diagnosed with Ischemic
Cardiomyopathy post-acute coronary syndrome complicated by left
ventricular thrombus. He was discharged with a life-vest and started on
apixaban. He was subsequently admitted to our hospital and being treated
for Bi-ventricular heart failure. The hospital course was complicated by
ventricular tachycardia requiring transfer to the ICU. While on
amiodarone, the patient developed refractory VT and worsening cardiogenic
shock despite intubation, sedation, paralysis, lidocaine boluses and drip,
and eight failed cardioversions. With each VT, the arterial waveform would
become non pulsatile. The ECMO team was consulted venoarterial ECMO
(VA-ECMO) implanted at bedside. There was no further VT post ECMO
implantation. The patient was transferred to the destination center and
ECMO conversion to RA to Pulmonary artery for RV support and percutaneous
transvalvular microaxial flow pump for LV support. After a
multidisciplinary discussion, a HeartMate 3 LVAD was implanted with mitral
and tricuspid valve repair. He is now being evaluated for a heart
transplant. DISCUSSION: Ventricular storm is defined by 3 or more
sustained episodes of ventricular tachycardia, ventricular fibrillation
requiring cardioversion within 24 hours. As VT progresses, it may lead to
worsening circulatory failure and persistent VT storm despite
antiarrhythmic therapy, sedation/ paralysis, and electrical therapy. There
are no randomized clinical trials that examine the use of VA-ECMO in VT
storm. Clinical decisions are made by experienced clinicians in
institutions with established ECMO programs. VA-ECMO provides a means to
stop VT storm when everything else has failed and there are no other
options to prevent death.

<145>
[Use Link to view the full text]
Accession Number
643295091
Title
THE EFFICACY OF ANTIFIBRINOLYTICS IN ADOLESCENTS UNDERGOING SCOLIOSIS
SURGERY.
Source
Critical Care Medicine. Conference: 2024 Critical Care Congress. Phoenix,
AZ United States. 52(1 Supplement 1) (pp S374), 2024. Date of Publication:
January 2024.
Author
Hickey K.S.; Smith M.; Karam O.; Faraoni D.; Demetres M.; Duron V.; Wu
Y.S.; Nellis M.
Institution
(Hickey) Mount Sinai Hospital, United States
(Smith) Weil Cornell Hospital, United States
(Karam) Yale School of Medicine, New Haven, CT, United States
(Faraoni) Texas Children's Hospital, United States
(Demetres) Weil Cornell, United States
(Duron) Morgan Stanley Children's Hospital, United States
(Wu) Morgan Stanely Children's Hospital, United States
(Nellis) New York-Presbyterian Hospital, Weill Cornell Medical College,
New York, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Spinal fusion is commonly accompanied by substantial
intra-operative blood loss. Antifibrinolytic therapies have been studied
in pediatric cardiac surgery and have been shown to reduce blood loss and
decrease the need for transfusions. We sought to determine if
intraoperative administration of antifibrinolytics, including tranexamic
acid (TXA), aminocaproic acid (EACA), or aprotinin decreases estimated
blood loss during scoliosis surgery. METHOD(S): We conducted a
systematic review and metaanalysis of three databases from inception to
April 2023. Adult-only studies (mean age >21 years), non-human studies,
and case series were excluded. This study followed the Preferred Reporting
Items for Systematic Reviews and Metaanalyses (PRISMA) reporting
guideline. The estimated blood loss in the operating room was evaluated.
 RESULT(S): A total of 38 studies including 4,459 patients were
analyzed. Thirty-two studies were included. TXA compared to control
resulted in a mean decrease in estimated blood loss of 424 mL (95% CI
274-575 mL) p< 0.001, EACA compared to control resulted in a mean decrease
in estimated blood loss of 469 mL (95% CI 99-841 mL) p< 0.013, and
aprotinin compared to control resulted in a mean decrease in estimated
blood loss of 469 mL (95% CI 276-661 mL) p< 0.001. Four studies compared
high dose TXA to low dose and resulted in a mean decrease in estimated
blood loss of 43 mL for those receiving high dose TXA, but this did not
achieve statistical significance. Six studies compared TXA to EACA and
resulted in a mean decrease in estimated blood loss of 390 mL (95% CI
58-724 mL), p=0.02 for those receiving TXA. CONCLUSION(S): TXA, EACA
and aprotinin are potentially useful for decreasing intraoperative blood
loss during pediatric scoliosis surgery. TXA may be more efficacious than
EACA for reducing blood loss. High dose TXA may be more efficacious than
low dose, but more studies are needed to achieve significance.

<146>
[Use Link to view the full text]
Accession Number
643294989
Title
THE EFFICACY OF ANTIFIBRINOLYTICS IN CHILDREN UNDERGOING CRANIOFACIAL
SURGERY.
Source
Critical Care Medicine. Conference: 2024 Critical Care Congress. Phoenix,
AZ United States. 52(1 Supplement 1) (pp S369), 2024. Date of Publication:
January 2024.
Author
Smith M.; Hickey K.S.; Karam O.; Faraoni D.; Demetres M.; Duron V.; Wu
Y.S.; Nellis M.
Institution
(Smith) Weil Cornell Hospital, United States
(Hickey) Mount Sinai Hospital, United States
(Karam) Yale School of Medicine, New Haven, CT, United States
(Faraoni) Texas Children's Hospital, United States
(Demetres) Weil Cornell, United States
(Duron) Morgan Stanley Children's Hospital, United States
(Wu) Morgan Stanely Children's Hospital, United States
(Nellis) New York- Presbyterian Hospital, Weill Cornell Medical College,
New York, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Surgery, including repair of craniofacial defects, is one of
the most common causes of clinically relevant bleeding in the pediatric
population. Antifibrinolytic therapies have been studied in pediatric
cardiac surgery and have been shown to reduce blood loss and decrease the
need for transfusions. A recent systematic review suggests that
antifibrinolytics, such as tranexamic acid (TXA) and aminocaproic acid
(EACA) also reduce blood loss in noncardiac pediatric surgery. The
objective of this study is to determine if intraoperative administration
of antifibrinolytics, including TXA, EACA, or aprotinin, decreases blood
loss and/ or the need for transfusion in pediatric patients undergoing
craniofacial surgery. METHOD(S): We conducted a systematic review and
metaanalysis of three databases from inception to April 2023. Adultonly
studies (mean age >21 years), non-human studies, and case series were
excluded. This study followed the Preferred Reporting Items for Systematic
Reviews and Meta-analyses (PRISMA) reporting guideline. The estimated
blood loss in the operating room and post-operative transfusion of blood
components were evaluated. RESULT(S): A total of 38 studies including
7,063 patients were analyzed. Administration of TXA compared to control
resulted in a mean decrease in intraoperative red blood cell (RBC)
transfusion of 7.5 mL/kg (CI 95% 5.1-9.9 ml/kg), p< 0.001, a mean decrease
in intraoperative plasma transfusion of 6.2 mL/ kg (CI 95% 2.4-9.9 mL/kg),
p< 0.001 and a mean decrease in estimated blood loss of 14.6 mL/kg (95% CI
6.8-22.4 mL/ kg), p< 0.001. Studies looking at the blood loss in patients
receiving EACA and aprotinin were limited and did not achieve statistical
significance. Administration of aprotinin compared to control resulted in
a mean decrease in RBC transfusion of 20.0mL/kg (CI 95% 9.8-30.2mL/kg), p<
0.001. Administration of EACA compared to control was limited to two
studies and did not achieve statistical significance. CONCLUSION(S):
TXA demonstrates potential for decreasing intraoperative blood loss and
blood product requirements in pediatric patients undergoing craniofacial
surgery. Further studies are needed to evaluate the effects of other
antifibrinolytics and to determine the best dosing regimen of TXA that
maximizes hemostasis with the lowest risk of side effects.

<147>
Accession Number
643509818
Title
INFECTIVE ENDOCARDITIS INVOLVING MITRACLIP© DEVICES: A SYSTEMATIC
LITERATURE REVIEW.
Source
European Journal of Case Reports in Internal Medicine. Conference: 21st
European Congress of Internal Medicine, ECIM joint with the 12th
International Congress of Internal Medicine. Athens Greece. 10(Supplement
1) (pp 277), 2023. Date of Publication: 2023.
Author
Bertolino L.; Ramadan M.S.; Zampino R.; Mangoni E.D.
Institution
(Bertolino, Ramadan) University of Campania L. Vanvitelli, Department of
Advanced Medical and Surgical Sciences, Naples, Italy
(Zampino, Mangoni) Internal Medicine, University of Campania 'Luigi
Vanvitelli' and AORN Ospedali dei Colli-Monaldi Hospital, Department of
Precision Medicine, Naples, Italy
Publisher
SMC Media Srl
Abstract
Background and Aims: Progress of interventional cardiology has boosted the
development of newer cardiac devices. These devices are perceived to be
less prone to infections compared to traditional surgical prostheses, but
little data are currently available. We reviewed current literature
regarding the clinical characteristics, management, and outcomes of
patients with MitraClip related infective endocarditis (IE).
 Method(s): We conducted a systematic review of PubMed, Google
Scholar, Embase and Scopus between January 2003 and March 2022. Two
authors (LB and MSR) independently reviewed identified studies, and those
not complying with the study inclusion criteria were excluded. Data
regarding clinical presentation, echocardiography, management, and outcome
were collected. Result(s): 25 cases of MitraClip-related IE were
retrieved. The median age of patients was 76 [61-83] years with a median
Euroscore of 41%. Fever was present in 60% of patients followed by signs
and symptoms of heart failure (53.8%). IE occurred early in 19 (73%) cases
with a median time between MitraClip implantation and IE symptom onset of
5 [2 - 19] months. Staphylococcus aureus was the major causative
microorganism (42%). Surgical mitral valve replacement was needed in 52%
of patients. A conservative medical approach was considered in the
remainder. The overall in hospital mortality rate was 44% (surgical group:
38.4%; medical group: 54.5%; p=0.682) Conclusion(s): Our results
suggest that MitraClip related IE affects elderly, comorbid patients, is
mostly due to Staphylococcus aureus, and despite the therapeutic approach
chosen has often a poor prognosis. Clinicians must be aware of the frail
baseline clinical conditions of affected patients.

<148>
Accession Number
643509298
Title
WARFARIN VERSUS NOVEL ANTICOAGULANTS IN PATIENTS WITH ARTIFICIAL HEART
VALVES META-ANALYSIS.
Source
European Journal of Case Reports in Internal Medicine. Conference: 21st
European Congress of Internal Medicine, ECIM joint with the 12th
International Congress of Internal Medicine. Athens Greece. 10(Supplement
1) (pp 60), 2023. Date of Publication: 2023.
Author
Sharma U.
Institution
(Sharma) Mayo Clinic Arizona, Hospital Internal Medicine, Phoenix, United
States
Publisher
SMC Media Srl
Abstract
Background and Aims: The effectiveness of NOACs in patients with
artificial (bioprosthetic and mechanical) heart valves is not known.
 Method(s): PubMed, CINHAL, and Clinicaltrials.gov were searched
through May 2022 using keywords for studies comparing clinical outcomes of
adults (>18 years) with artificial heart valves that received warfarin vs.
NOACs. Result(s): Eight studies (4-RCT, 4- retrospective cohort, n =
183167, 38% female) met the criteria for study inclusion. Mechanical and
bioprosthetic valves were represented in 14.7% and 85.3% of patients
respectively. There was no statistically significant difference between
NOACs and warfarin for all bleeding, allcause mortality, TIA, systemic
embolism, and all-stroke outcomes. Overall warfarin led to 22% more major
bleeding (OR = 1.22, 95% CI = [1.05, 1.41], p = 0.01) and more ischemic
stroke (OR = 1.72, 95% CI = [1.1, 2.68], p = 0.02) compared to NOACs.
Amongst patients with bioprosthetic heart valves, warfarin led to 33% more
major bleeding compared to NOACs (OR = 1.33, 95% CI = [1.06, 1.66]). NOACs
led to 65% more major bleeding compared to warfarin among those with
mechanical heart valves (OR = 0.35, 95% CI = [0.18, 0.67]).
 Conclusion(s): NOACs reduced the risk of ischemic stroke and major
bleeding in patients with bioprosthetic heart valves, but not in patients
with mechanical heart valves compared to warfarin. Compared with warfarin,
NOACs reduced the risk of ischemic stroke and major bleeding in patients
with artificial heart valves. There were no statistically significant
differences between the two for the outcomes of all bleeding, all-cause
mortality, systemic embolism, TIA, and all-strokes.

<149>
Accession Number
643251378
Title
376. Long Term Outcomes of a Pilot Single-Blinded, Randomized Controlled
Trial Comparing BNT162b2 vs JNJ-78436735 Vaccine as the Third Dose after
Two Doses of BNT162b2 Vaccine in Solid Organ Transplant Recipients.
Source
Open Forum Infectious Diseases. Conference: Infectious Diseases Week,
IDWeek 2023. Boston, MA United States. 10(Supplement 2) (pp S234), 2023.
Date of Publication: December 2023.
Author
Natori Y.; Martin E.F.; Mattiazzi A.; Sota K.A.; Viotti J.B.; Anjan S.;
Guerra G.
Institution
(Natori) University of Miami, Miami Transplant Institute, Jackson Health
System, Miami, FL, United States
(Martin) University of Miami Miller, School of Medicine, Miami Transplant
Institute, Miami, FL, United States
(Mattiazzi) University of Miami, Miami, FL, United States
(Sota) Miami Transplant Institute, Pembroke Pines, FL, United States
(Viotti) University of Miami, Jackson Memorial Hospital, Miami, FL, United
States
(Anjan) University of Miami Miller, School of Medicine and Miami
Transplant Institute, Jackson Health System, Miami, FL, United States
(Guerra) Miami Transplant Institute, Jackson Health System, Miami, FL,
United States
Publisher
Oxford University Press
Abstract
Background. Due to immunosuppressive medication, the immunogenicity after
COVID-19 vaccination is suboptimal and durability in Solid Organ
Transplant (SOT) recipients is still questionable. Thus, booster dose has
been studied to improve not only the short but also long-term
immunogenicity. However, mix and match method for this purpose was not
well studied. Methods. This was a post hoc analysis of a patient-blinded,
single center, randomized controlled trial comparing BNT162b2 vs
JNJ-78436735 vaccine as the third dose after two doses of BNT162b2
vaccine. We included adult SOT recipients with functional graft who had
received two doses of BNT162b2 vaccine and were randomly assigned to
receive either vaccine. The outcome included SARS-CoV-2 IgG positivity at
six months after the third dose and geometric mean titer. Results. 4 SOT
recipients, including 39 kidney, 3 liver, 1 lung, and 1 heart transplants,
were analyzed per protocol. Only 1 recipient did not develop IgG after 6
months. Median IgG levels at 6 months were 5893 and 65584 for BNT162b2 vs
JNJ-78436735, respectively(p< 0.01). For geometric mean titer from prior
to third dose and 6 months after was 4.1 and 62.0 for BNT162b2 vs
JNJ-78436735, respectively( p< 0.01). Conclusion. After 6 months post
third dose, BNT162b2 showed significant higher immunogenicity in SOT
recipients. BNT162b2 provided a higher IgG titer, and durability. To
continue BNT162b2 vaccine boosters should be beneficial in SOT recipients
but further study should be required.

<150>
Accession Number
643251139
Title
External Validation of the 2023 Duke - International Society for
Cardiovascular Infectious Diseases (ISCVID) Diagnostic Criteria for
Infective Endocarditis (IE).
Source
Open Forum Infectious Diseases. Conference: Infectious Diseases Week,
IDWeek 2023. Boston, MA United States. 10(Supplement 2) (pp S16-S17),
2023. Date of Publication: December 2023.
Author
Van Der Vaart T.W.; Bossuyt P.M.M.; Baddour L.M.; Bayer A.S.; Durack D.T.;
Mangoni E.D.; Holland T.L.; Karchmer A.W.; Miro J.M.; Moreillon P.;
Rasmussen M.; Selton-Suty C.; Fowler V.G.; Van Der Meer J.T.M.
Institution
(Van Der Vaart) Academic Medical Center Amsterdam, Amsterdam,
Noord-Holland, Netherlands
(Bossuyt, Van Der Meer) Amsterdam University Medical Center, Amsterdam,
Noord-Holland, Netherlands
(Baddour) Mayo Clinic, College of Medicine, Rochester, MN, United States
(Bayer) Lundquist Institute-Harbor UCLA Medical Center, Torrance, CA,
United States
(Durack) Duke University, Durham, NC, United States
(Mangoni) University of Campania 'Luigi Vanvitelli' - Monaldi Hospital,
Napoli, Campania, Italy
(Holland, Fowler) Duke University Medical Center, Durham, NC, United
States
(Karchmer) Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA, United States
(Miro) Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona,
Catalonia, Spain
(Moreillon) UNIL - Universite de Lausanne, Lausanne, Vaud, Switzerland
(Rasmussen) Lund University, Nancy, Lorraine, France
(Selton-Suty) University Hospital of Nancy, Nancy, Lorraine, France
Publisher
Oxford University Press
Abstract
Background. The 2023 Duke-ISCVID criteria for IE were recently introduced
to improve classification of IE for research and clinical purposes (Table
1). We compared the diagnostic accuracy of the new criteria with the 2000
modified Duke criteria, the 2015 European Society of Cardiology (ESC)
criteria and a clinically adjudicated reference standard by a panel of
international experts on IE. Methods. The study population consisted of
consecutively enrolled patients suspected to have IE and discussed by the
IE team of the Amsterdam University Medical Center (AMC) between October
2016 and March 2021. A panel of international experts on IE assigned a
final diagnosis, which served as the reference standard. We compared the
definite classification of the 2023 Duke-ISCVID criteria against this
reference standard. We also evaluated accuracy of the new criteria,
excluding data obtained from cardiac surgery and pathology ("Clinical
Criteria"). Lastly, we quantified the added value of the proposed changes
to the criteria, and compared the 2023 Duke-ISCVID to previous criteria
using the McNemar test. We performed sensitivity analyses in patients who
underwent cardiac surgery and patients who underwent TEE. Results. 595
patients with suspected IE were included, of whom 399 (67%) were
adjudicated as having IE. 111 patients (19%) had prosthetic valve IE, 48
(8%) had cardiac implantable electronic device IE. The 2023 Duke-ISCVID
criteria were more sensitive than the modified Duke or ESC criteria (84.2
vs 74.9 vs 80%,respectively, p < 0.001 for ISCVID vs ESC criteria) without
significant loss of specificity (Table 2). After excluding cardiac
surgery/pathology results, the 2023 Duke-ISCVID Clinical Criteria also had
significantly better sensitivity than the modified Duke and ESC criteria,
again without losing specificity. The changes in the 'major
microbiological' and 'imaging' criteria had the most impact (Figure 1).
Findings were robust in sensitivity analyses (Table 3). When classifying
'definite' and 'possible' IE as a positive test, the 2023 Duke-ISCVID
criteria had 99% sensitivity compared to the reference standard, but
specificity decreased to 21%. Sensitivity and specificity are against the
reference standard (adjudication panel). The Clinical Criteria
classification is the Duke-ISCVID classification when results from surgery
or post-mortem studies are not used to determine classification. In the
Definite + Possible analysis, patients with possible IE according to the
Duke-ISCVID criteria were also considered as having IE. All comparisons
are against the reference standard (adjudication panel). Conclusion. In
this cohort, the 2023 Duke-ISCVID criteria represent a significant advance
in the diagnostic classification of patients suspected of IE.Added value
of new Duke-ISCVID criteria compared to modified Duke criteria Each point
(red square for sensitivity, blue circle for specificity) provides the
diagnostic accuracy measure for the 2000 modified Duke Criteria with
addition of a specific change from the Duke-ISCVID criteria. The
horizontal bars represent the 95% confidence interval for the point
estimate. The top points represent the modified Duke criteria without
addition, the bottom points are the complete Duke-ISCVID criteria. (Figure
Presented).

<151>
Accession Number
643248873
Title
Cross Validation of Surgical Procedure Data in National Healthcare Safety
Network vs Hospital Discharge Data.
Source
Open Forum Infectious Diseases. Conference: Infectious Diseases Week,
IDWeek 2023. Boston, MA United States. 10(Supplement 2) (pp S1074), 2023.
Date of Publication: December 2023.
Author
Sato Y.; Parriott A.M.; Kazerouni N.N.; Epson E.
Institution
(Sato, Parriott, Epson) California Department of Public Health, Dublin,
CA, United States
(Kazerouni) CA Dept of Public Health, Sacramento, CA, United States
Publisher
Oxford University Press
Abstract
Background. California acute care hospitals (ACH) are required to report
data on 28 types of inpatient surgical procedures via the National
Healthcare Safety Network (NHSN). ACH also report discharge data,
including procedure data, to the California Department of Healthcare
Access and Information (HCAI). We compared the number of adult (age >=18)
procedures reported in NHSN versus HCAI in 2019 for cardiac surgery
(CARD), coronary bypass with chest and donor incisions (CBGB), hip
prosthesis (HPRO), kidney transplant (KTP), and rectal surgery (REC).
Methods. For both systems, we aggregated procedure counts to the facility
level and matched individual facilities. HCAI ICD-10 codes were mapped to
NHSN procedure codes. Because NHSN counts multiple procedures that map to
the same procedure code done via the same incision as one procedure and
HCAI does not specify how many procedures were done per incision, CARD,
CBGB, and REC were counted only once per procedure code per patient per
day. HPRO and KTP were counted up to twice per patient per day if ICD-10
codes for both right and left side surgeries were present. ANOVA was used
to compare the means of log standardized infection ratio (SIR) by NHSN to
HCAI procedure count ratio as categories of less than 0.9, between 0.9 and
1.1, and more than 1.1. Results. Three hundred eleven facilities reported
82,847 procedures to NHSN and 300 facilities reported 91,961 procedures to
HCAI. Median and interquartile interval for the facility-specific ratio of
NHSN to HCAI procedures among facilities that reported procedures in both
systems are displayed in Table 1. ANOVA failed to detect any difference in
mean of log SIR by different NHSN to HCAI procedure count ratio at alpha
of 0.05. Conclusion. For all procedure types, there were more procedures
documented in HCAI than NHSN, but the ratios of NHSN procedures to HCAI
procedures varied widely by procedure type. However, difference in ratio
was not associated with SIR. Ability to compare procedure counts was
limited by inability to ascertain operating room deaths (which are not
counted in NHSN) and if procedures were done using the same incision in
HCAI. Further analysis is recommended since SSI denominator quality is
crucial to the accuracy of SIR, which informs many analyses and
interventions.

<152>
Accession Number
643246147
Title
Anticoagulation management in patients tested for heparin-induced
thrombocytopenia in the cardiothoracic intensive care unit diverges from
expert guidelines.
Source
American Journal of Clinical Pathology. Conference: 58th Annual Meeting of
the Academy of Clinical Laboratory Physicians and Scientists, ACLPS 2023.
Charlottesville, VA United States. 160(Supplement 1) (pp S139), 2023. Date
of Publication: November 2023.
Author
Spies N.; Jackups R.; Zaydman M.
Institution
(Spies, Jackups, Zaydman) Department of Pathology and Immunology,
Washington University in St. Louis, MO, United States
Publisher
Oxford University Press
Abstract
Heparin-induced thrombocytopenia (HIT) is a rare, life-threatening
complication in patients receiving heparin products. Clinical scoring
tools, such as the '4T' score, aim to help identify patients at risk for
HIT and are recommended by expert guidelines. For example, the American
Society of Hematology (ASH) recommends that patients with an intermediate
or high-risk 4T score are presumptively treated for HIT by withdrawing
heparin and starting an alternative anticoagulant. At our institution,
laboratory HIT testing involves an in-house latex immunoassay (LIA) that,
if positive, reflexes to a send-out serotonin release assay (SRA) at the
Blood Center of Wisconsin. This confirmation may take several days to
result, underscoring the importance of presumptive treatment. Anecdotally,
we have observed that clinicians have expressed reservations about the use
of the 4T score in the cardiothoracic intensive care unit (CTICU). These
reservations may lead to increased HIT testing in patients with low 4T
scores and delays in the initiation of alternative anticoagulants. We set
out to objectively determine if clinical practice in the CTICU is aligned
with ASH guidelines. To do so, we used anticoagulant usage as a proxy for
medical decisions made at the time of order for HIT laboratory testing.
Data was extracted from the electronic medical records of all patients who
were admitted to the CTICU between 5/2018 and 7/2022 and administered a
heparin product (n = 1,602). Patients that were not tested for HIT (n =
1,449) were excluded. The remaining patients' (n = 153) medication record
timings were normalized such that the time of their first LIA was set to
zero to allow for relative comparisons. 25 (16%) of the LIAs were
positive, of which 5 (20%) were confirmed by SRA. Of the 153 patients, 136
(89%) received heparin within 24 hours prior to LIA order, while 6 (4%)
were already on alternative anticoagulation (bivalirudin). Of the patients
on heparin prior to LIA, 18 (13%) were switched to bivalirudin upon LIA
order, 66 (49%) had heparin discontinued without an alternative, and 52
(39%) were continued on heparin. Our results suggest that the prevalence
of HIT in this cohort is 3.3% by SRA, much lower than the expected pretest
probability estimated for intermediate- and high-risk 4T scores in
published meta-analyses. In addition, the observed anticoagulation
practices varied widely and diverged from ASH guidelines, where only 17%
of patients were on alternative anticoagulation when the testing was
ordered. Future work will investigate these patterns across LIA positivity
and 4T scores while attempting to address the clinical outcomes of these
treatment decisions.

<153>
Accession Number
643510684
Title
PITUITARY APOPLEXY PRESENTING AS ISOLATED THIRD CRANIAL NERVE PALSY
FOLLOWING TRANSCUTANEOUS AORTIC VALVE REPLACEMENT: A CASE REPORT.
Source
European Journal of Case Reports in Internal Medicine. Conference: 19th
European Congress in Internal Medicine Internal Medicine, ECIM 2021.
Virtual. 8(Supplement 1) (pp 150), 2021. Date of Publication: 2021.
Author
Pilianidis G.; Tontikidou C.; Gogos G.; Kosmidou N.
Institution
(Pilianidis, Tontikidou, Gogos, Kosmidou) G. Papanikolaou General
Hospital, Internal Medicine, Thessaloniki, Greece
Publisher
SMC Media Srl
Abstract
Background and Aims: We report a case of a patient with third nerve palsy
due to pituitary apoplexy. Pituitary apoplexy is a rare clinical syndrome
caused by an acute ischemic infarction or hemorrhage frequently involving
a pituitary adenoma. It is very uncommon for a pituitary apoplexy to
present as a third nerve palsy. One of the commonest precipitating factors
is a cardiac and orthopedic surgical procedure. Case Presentation: A
78-year-old male presented with a twoday history of headache, weakness,
drooping of the right upper eyelid and diplopia. He had undergone
transcatheter aortic valve implantation two weeks ago and he was
prescribed dual antiplatelet therapy. On neurological examination he had
right upper lid ptosis, right diplopia, dilated right pupil and
inferolateral deviation of the right eye. The remaining cranial nerves
were intact, and there was no evidence of sensory or motor weakness. His
CT Brain was normal. Investigation of his hyponatremia revealed central
hypothyroidism and hypocortisolemia with ACTH below normal indicating
hypopituitarism. FSH, LH, GH and prolactin were also below the normal
value confirming panhypopituitarism. The MRI of the sellar region revealed
a sellar mass compatible with a pituitary macroadenoma. The mass enhanced
peripherally in the T1-sequence indicating hemorrhage. Result(s): The
patient was treated successfully with thyroxine and hydrocortisone
replacement. Conclusion(s): Pituitary apoplexy should be included in
the differential diagnosis of an acute third nerve palsy. Patients
undergoing TAVI are usually old and frail. Treating them with dual
antiplatelet therapy should be carefully evaluated with randomized
controlled trials in the future.

<154>
Accession Number
2032075942
Title
Sex Hormone-Binding Globulin and Risk of Coronary Heart Disease in Men and
Women.
Source
Clinical Chemistry. 69(4) (pp 374-385), 2023. Date of Publication: 01 Apr
2023.
Author
Li J.; Zheng L.; Chan K.H.K.; Zou X.; Zhang J.; Liu J.; Zhong Q.; Madsen
T.E.; Wu W.-C.; Manson J.E.; Yu X.; Liu S.
Institution
(Li, Zheng, Zou, Zhong, Yu, Liu) Global Health Research Center, Guangdong
Provincial People's Hospital, Guangdong Academy of Medical Sciences,
Guangzhou, China
(Li) The Second School of Clinical Medicine, Southern Medical University,
Guangzhou 510280, China
(Li) School of Medicine, South China University of Technology, Guangzhou
510006, China
(Li, Chan, Madsen, Wu, Liu) Department of Epidemiology, Center for Global
Cardiometabolic Health, School of Public Health, Brown University,
Providence, RI, United States
(Chan, Liu) Departments of Biomedical Sciences and Electrical Engineering,
City University of HongKong, Hong Kong, Hong Kong
(Zhang) Guangdong Mental Health Center, Guangdong Provincial People's
Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
(Madsen) Department of Emergency Medicine, The Warren Alpert Medical
School, Brown University, Providence, RI, United States
(Wu) Department of Medicine, Division of Cardiology, Providence VA Medical
Center, Warren Alpert Medical School of Brown University, Providence, RI,
United States
(Manson) Department of Medicine, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Manson) Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Yu) Department of Nephrology, Guangdong-Hong Kong Joint Laboratory on
Immunological and Genetic Kidney Diseases, Guangdong Provincial People's
Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
(Liu) Departments of Medicine and Surgery, The Warren Alpert Medical
School, Brown University, Providence, RI, United States
Publisher
Oxford University Press
Abstract
BACKGROUND: The role of sex hormone-binding globulin (SHBG) levels in
clinical risk stratification and intervention for coronary heart disease
(CHD) remains uncertain. We aimed to examine whether circulating levels of
SHBG are predictive of CHD risk in men and women. METHOD(S): We
investigated the association between SHBG and the risk of incident CHD in
128 322 men and 135 103 women free of CHD at baseline in the prospective
United Kingdom Biobank (UKB) cohort. The unconfounded associations were
estimated using Mendelian randomization (MR) analysis. We further
conducted a meta-analysis to integrate currently available prospective
evidence. CHD events included nonfatal and fatal myocardial infarction and
coronary revascularization. RESULT(S): In the UKB, during a median of
11.7 followup years, 10 405 men and 4512 women developed CHD. Serum levels
of SHBG were monotonically associated with a decreased risk of CHD in both
men (adjusted hazard ratio [HR] per log nmol/L increase in SHBG: 0.88
[0.83-0.94]) and women (HR: 0.89 [0.83-0.96]). MR-based analyses suggested
causality and a dose-response relationship of SHBG with CHD risk. A
cumulative meta-analysis including 216 417 men and 138 282 women from 11
studies showed that higher levels of SHBG were prospectively associated
with decreased CHD risk in men comparing the highest with the lowest
quartile: pooled relative risk (RR) 0.81 (0.74-0.89) and women (pooled RR:
0.86 [0.78-0.94]). CONCLUSION(S): Higher circulating SHBG levels were
directly and independently predictive of lower CHD risk in both men and
women. The utility of SHBG for CHD risk stratification and prediction
warrants further study. Copyright © American Association for
Clinical Chemistry 2023. All rights reserved.

<155>
Accession Number
2032076589
Title
A randomized trial of non-fasting vs. fasting for cardiac implantable
electronic device procedures (Fast-CIED Study).
Source
Europace. 24(10) (pp 1617-1626), 2022. Date of Publication: 01 Oct 2022.
Author
Bode K.; Gerhards M.; Doering M.; Lucas J.; Tijssen J.; Dagres N.; Hilbert
S.; Richter S.; Nedios S.; Lurz J.; Moscoso-Luduena C.; Arya A.; Shamloo
A.S.; Hindricks G.
Institution
(Bode, Gerhards, Doering, Lucas, Dagres, Hilbert, Richter, Nedios, Lurz,
Moscoso-Luduena, Arya, Shamloo, Hindricks) Department of
Electrophysiology, Heart Center Leipzig, University of Leipzig, Naumburger
Str. 76, Weisenfels 04443, Germany
(Bode) Department of Cardiology, Asklepios Clinic Weisenfels, Weisenfels,
Germany
(Tijssen, Shamloo) Leipzig Heart Institute, Leipzig, Germany
Publisher
Oxford University Press
Abstract
Aims Data on safety and efficacy of a non-fasting strategy in minimal
invasive cardiac procedures are lacking. We assessed a non-fasting
strategy compared with a fasting strategy regarding patient's well-being
and safety in elective cardiac implantable electronic device (CIED)
procedures. Methods and results In this randomized, single-blinded
clinical trial, 201 patients (non-fasting = 100, fasting = 101) with a
mean age of 72.0 + 11.6 years (66.7% male) were assigned to a non-fasting
strategy (solids/fluids allowed up to 1 h) or a fasting strategy (at least
6 h no solids and 2 h no fluids) before the procedure and analysed on an
intention-to-treat basis. The co-primary outcomes were patients'
well-being scores (based on numeric rating scale, 0-10) and incidence of
intra-procedural food-related adverse events, including vomiting,
perioperative pulmonary aspiration, and emergency intubation. Renal,
haematological, and metabolic blood parameters and 30-day follow-up data
were gathered. The summed pre-procedural patients' well-being score was
significantly lower in the non-fasting group [non-fasting: 13.1 + 9.6 vs.
fasting: 16.5 + 11.4, 95% confidence interval (CI) of mean difference (MD)
-6.35 to -0.46, P = 0.029], which was mainly driven by significantly lower
scores for hunger and tiredness in the non-fasting group (non-fasting vs.
fasting; hunger: 0.9 + 1.9 vs. 3.1 + 3.2, 95% CI of MD -2.86 to -1.42, P,
0.001; tiredness: 1.6 + 2.3 vs. 2.6 + 2.7, 95% CI of MD -1.68 to -0.29, P
= 0.023). No intra-procedural food-related adverse events were observed.
Relevant blood parameters and 30-day follow-up did not show significant
differences. . . . . . . . . . . . . . . . Conclusion These results showed
that a non-fasting strategy is beneficial to a fasting one regarding
patient's well-being and comparable in terms of safety for CIED procedures
(NCT04389697). Copyright © The Author(s) 2022. Published by
Oxford University Press on behalf of the European Society of Cardiology.
All rights reserved.

<156>
Accession Number
2032147130
Title
Transcatheter versus surgical aortic valve replacement for severe aortic
valve stenosis: Meta-analysis with trial sequential analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2024.
Date of Publication: 2024.
Author
Jacquemyn X.; Sa M.P.; Rega F.; Verbrugghe P.; Meuris B.; Serna-Gallegos
D.; Brown J.A.; Clavel M.-A.; Pibarot P.; Sultan I.
Institution
(Jacquemyn, Rega, Verbrugghe, Meuris) Department of Cardiovascular
Sciences, KU Leuven, Leuven, Belgium
(Sa, Serna-Gallegos, Brown, Sultan) Department of Cardiothoracic Surgery,
University of Pittsburgh, Pittsburgh, PA, United States
(Sa, Serna-Gallegos, Brown, Sultan) UPMC Heart and Vascular Institute,
University of Pittsburgh Medical Center, Pittsburgh, PA, United States
(Rega, Verbrugghe, Meuris) Department of Cardiac Surgery, University
Hospitals Leuven, Leuven, Belgium
(Clavel, Pibarot) Centre de Recherche de l'Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec City, Quebec, Canada
(Clavel, Pibarot) Department of Medicine, Faculty of Medicine, Universite
Laval, Quebec City, Quebec, Canada
Publisher
Elsevier Inc.
Abstract
Objectives: Randomized controlled trials comparing transcatheter aortic
valve implantation with surgical aortic valve replacement demonstrate
conflicting evidence, particularly in low-risk patients. We aim to
reevaluate the evidence using trial sequential analysis, balancing type I
and II errors, and compare with conventional meta-analysis.
 Method(s): Databases were searched for randomized controlled trials,
which were divided into higher-risk and lower-risk randomized controlled
trials according to a pragmatic risk classification. Primary outcomes were
death and a composite end point of death or disabling stroke assessed at 1
year and maximum follow-up. Conventional meta-analysis and trial
sequential analysis were performed, and the required information size was
calculated considering a type I error of 5% and a power of 90%.
 Result(s): Eight randomized controlled trials (n = 5274 higher-risk
and 3661 lower-risk patients) were included. Higher-risk trials showed no
significant reduction in death at 1 year with transcatheter aortic valve
implantation (relative risk, 0.93, 95% CI, 0.81-1.08, P =.345). Lower-risk
trials suggested lower death risk on conventional meta-analysis (relative
risk, 0.67, 95% CI, 0.47-0.96, P =.031), but trial sequential analysis
indicated potential spurious evidence (P =.116), necessitating more data
for conclusive benefit (required information size = 5944 [59.8%]). For
death or disabling stroke at 1 year, higher-risk trials lacked evidence
(relative risk, 0.90, 95% CI, 0.79-1.02, P =.108). In lower-risk trials,
transcatheter aortic valve implantation indicated lower risk in
conventional meta-analysis (relative risk, 0.68, 95% CI, 0.50-0.93, P
=.014), but trial sequential analysis suggested potential spurious
evidence (P =.053), necessitating more data for conclusive benefit
(required information size = 5122 [69.4%]). Follow-up results provided
inconclusive evidence for both primary outcomes across risk categories.
 Conclusion(s): Conventional meta-analysis methods may have
prematurely declared an early reduction of negative outcomes after
transcatheter aortic valve implantation when compared with surgical aortic
valve replacement. Copyright © 2024 The American Association for
Thoracic Surgery

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