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<1>
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Accession Number
2034153677
Title
Exploring the Impact of Age, Frailty, and Multimorbidity on the Effect of
ICU Interventions: A Systematic Review of Randomized Controlled Trials.
Source
Critical Care Medicine. 52(9) (pp e463-e472), 2024. Date of Publication:
01 Sep 2024.
Author
Perrella A.; Geen O.; Ahuja M.; Scott S.; Kaushik R.; Ferrante L.E.;
Brummel N.E.; Muscedere J.; Rochwerg B.
Institution
(Perrella) Department of Medicine, Division of Geriatric Medicine,
McMaster University, Hamilton, ON, Canada
(Geen) Department of Medicine, Division of Geriatric Medicine, Trillium
Health Partners, Mississauga, ON, Canada
(Ahuja, Rochwerg) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Scott) Department of Pediatrics, Western University, London, ON, Canada
(Kaushik) Department of Medicine, Yale University, New Haven, CT, United
States
(Ferrante) Section of Pulmonary, Critical Care, and Sleep Medicine,
Department of Internal Medicine, Yale School of Medicine, New Haven, CT,
United States
(Brummel) Division of Pulmonary, Critical Care, and Sleep Medicine,
Department of Internal Medicine, The Ohio State University College of
Medicine, Columbus, OH, United States
(Muscedere) Department of Critical Care Medicine, Queens University,
Kingston, ON, Canada
(Rochwerg) Department of Health Research Methods, Evidence and Impact,
McMaster University, Hamilton, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVES: To date, age, frailty, and multimorbidity have been used
primarily to inform prognosis in older adults. It remains uncertain,
however, whether these patient factors may also predict response to
critical care interventions or treatment outcomes. DATA SOURCES: We
conducted a systematic search of top general medicine and critical care
journals for randomized controlled trials (RCTs) examining critical care
interventions published between January 1, 2011, and December 31, 2021.
STUDY SELECTION: We included RCTs of critical care interventions that
examined any one of three subgroups - age, frailty, or multimorbidity. We
excluded cluster RCTs, studies that did not report interventions in an
ICU, and studies that did not report data examining subgroups of age,
frailty, or multimorbidity. DATA EXTRACTION: We collected study
characteristics (single vs. multicountry enrollment, single vs.
multicenter enrollment, funding, sample size, intervention, comparator,
primary outcome and secondary outcomes, length of follow-up), study
population (inclusion and exclusion criteria, average age in intervention
and comparator groups), and subgroup data. We used the Instrument for
assessing the Credibility of Effect Modification Analyses instrument to
evaluate the credibility of subgroup findings. DATA SYNTHESIS: Of 2037
unique citations, we included 48 RCTs comprising 50,779 total
participants. Seven (14.6%) RCTs found evidence of statistically
significant effect modification based on age, whereas none of the
multimorbidity or frailty subgroups found evidence of statistically
significant subgroup effect. Subgroup credibility ranged from very low to
moderate. CONCLUSION(S): Most critical care RCTs do not examine for
subgroup effects by frailty or multimorbidity. Although age is more
commonly considered, the cut-point is variable, and relative effect
modification is rare. Although interventional effects are likely similar
across age groups, shared decision-making based on individual patient
preferences must remain a priority. RCTs focused specifically on
critically ill older adults or those living with frailty and/or
multimorbidity are crucial to further address this research
question. Copyright © 2024 by the Society of Critical Care
Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

<2>
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Accession Number
2034153660
Title
Low Versus High Blood Pressure Targets in Critically Ill and Surgical
Patients: A Systematic Review and Meta-Analysis of Randomized Controlled
Trials.
Source
Critical Care Medicine. 52(9) (pp 1427-1438), 2024. Date of Publication:
01 Sep 2024.
Author
D'amico F.; Pruna A.; Putowski Z.; Dormio S.; Ajello S.; Scandroglio A.M.;
Lee T.C.; Zangrillo A.; Landoni G.
Institution
(D'amico, Pruna, Dormio, Ajello, Scandroglio, Zangrillo, Landoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Putowski) Department of Intensive Care and Perioperative Medicine, Center
for Intensive Care and Perioperative Medicine, Jagiellonian University
Medical College, Krakow, Poland
(Lee) Division of Infectious Diseases, Department of Medicine, McGill
University, Montreal, QC, Canada
(Zangrillo, Landoni) School of Medicine, Vita-Salute San Raffaele
University, Milan, Italy
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVES: Hypotension is associated with adverse outcomes in critically
ill and perioperative patients. However, these assumptions are supported
by observational studies. This meta-analysis of randomized controlled
trials aims to compare the impact of lower versus higher blood pressure
targets on mortality. DATA SOURCES: We searched PubMed, Cochrane, and
Scholar from inception to February 10, 2024. STUDY SELECTION: Randomized
trials comparing lower versus higher blood pressure targets in the
management of critically ill and perioperative settings. DATA EXTRACTION:
The primary outcome was all-cause mortality at the longest follow-up
available. This review was registered in the Prospective International
Register of Systematic Reviews, CRD42023452928. DATA SYNTHESIS: Of 2940
studies identified by the search string, 28 (12 in critically ill and 16
in perioperative settings) were included totaling 15,672 patients.
Patients in the low blood pressure target group had lower mortality (23
studies included: 1019/7679 [13.3%] vs. 1103/7649 [14.4%]; relative risk
0.93; 95% CI, 0.87-0.99; p = 0.03; I2 = 0%). This corresponded
to a 97.4% probability of any increase in mortality with a Bayesian
approach. These findings were mainly driven by studies performed in the
ICU setting and with treatment lasting more than 24 hours; however, the
magnitude and direction of the results were similar in the majority of
sensitivity analyses including the analysis restricted to low risk of bias
studies. We also observed a lower rate of atrial fibrillation and fewer
patients requiring transfusion in low-pressure target groups. No
differences were found in the other secondary outcomes.
 CONCLUSION(S): Based on pooled randomized trial evidence, a lower
compared with a higher blood pressure target results in a reduction of
mortality, atrial fibrillation, and transfusion requirements. Lower blood
pressure targets may be beneficial but there is ongoing uncertainty.
However, the present meta-analysis does not confirm previous findings and
recommendations. These results might inform future guidelines and promote
the study of the concept of protective hemodynamics. Copyright ©
2024 by the Society of Critical Care Medicine and Wolters Kluwer Health,
Inc. All Rights Reserved.

<3>
Accession Number
2034210003
Title
Impact of Small Aortic Annuli on the Performance of Transcatheter Aortic
Valve Replacement Bioprostheses: An Updated Meta-Analysis of Recent
Studies.
Source
American Journal of Cardiology. 229 (pp 1-12), 2024. Date of Publication:
15 Oct 2024.
Author
Di Pietro G.; Improta R.; Bruno F.; De Filippo O.; Leone P.P.; Nebiolo M.;
Giacobbe F.; Caporusso D.; Birtolo L.I.; Ielasi A.; Mohamed A.-W.; Ho
K.W.; Meguro K.; Ferrara J.; Waksman R.; Pilgrims T.; McKay R.G.; Seiffert
M.; Massimo M.; De Ferrari G.M.; D'Ascenzo F.
Institution
(Di Pietro, Improta, Birtolo, Massimo) Department of Clinical, Internal,
Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza
University of Rome, Italy
(Di Pietro, Improta, Bruno, De Filippo, Nebiolo, Giacobbe, De Ferrari,
D'Ascenzo) Division of Cardiology, Cardiovascular and Thoracic Department,
"Citta della Salute e della Scienza" Hospital, Turin, Italy
(Leone) Department of Biomedical Sciences, Humanitas University, Milan,
Italy
(Leone) Cardio Center, IRCCS Humanitas Research Hospital, Milan, Italy
(Leone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, New York, United States
(Caporusso) Gefaschirurgie, Klinikum Munchen West, Lehrkrankenhaus LMU,
Germany
(Ielasi) UO Cardiologia Ospedaliera IRCCS Ospedale Galeazzi Sant'Ambrogio,
Milano, Italy
(Mohamed) The Heart Center, Segeberger Kliniken, Bad Segeberger, Germany
(Ho) Department of Cardiology, National Heart Center, Singapore
(Meguro) Department of Cardiovascular Medicine, Kitasato University,
Sagamihara, Japan
(Ferrara) Department de Cardiologie, CHU Timone, Marseille, France
(Waksman) Section of Interventional Cardiology, Medstar Washington
Hospital Center, Washington, District of Columbia, United States
(Pilgrims) Department of Cardiology, Inselspital, University of Bern,
Bern, Switzerland
(McKay) Department of Cardiology, Hartford Healthcare Heart and Vascular
Institute, Hartford Hospital, Hartford, Connecticut, United States
(Seiffert) Department of Cardiology, University Heart and Vascular Center
Hamburg, Hamburg, Germany
Publisher
Elsevier Inc.
Abstract
A metanalysis of available randomized controlled trials and observational
studies comparing self-expanding (SE) and balloon-expandable (BE)
bioprostheses in patients with small aortic annulus and aortic stenosis
for short- and midterm hemodynamic and clinical outcomes was performed. A
total of 21 studies with a total 8,647 patients (SE: n = 4,336 patients vs
BE: n = 4,311 patients) were included. SE bioprostheses had a lower
postoperative mean gradient at 30 days (Mean Difference [MD] -5.16, 95%
confidence interval [CI] 4.7 to 5.5, p <0.001) and at 1 year (MD -6.6,
95%CI 6.1 to 7.03, p <0.001), with a larger indexed effective orifice area
(0.17, 95% CI 0.13 to 0.22, p <0.001 and 0.17, 95% CI 0.08 to 0.27, p
<0.001) at both time intervals. BE bioprostheses had a higher risk of
30-day and 1-year severe prosthesis-patient mismatch (risk ratio [RR]
1.07, 95% CI 1.04 to 1.09, p <0.001; RR 1.07, 95% CI 1.04 to 1.11, p
<0.001). The 30-day and 1 year paravalvular leaks (RR 0.99, 95% CI 0.98 to
0.99, p <0.001; RR 0.89, 95% CI 0.82 to 0.95, p <0.001) and permanent
pacemaker implantation (RR 0.97, 95% CI 0.94 to 0.99, p 0.01, I2 = 40%,)
were lower in the BE group. BE bioprostheses were associated with a lower
risk of in-hospital stroke (RR 0.99, 95% CI 0.98 to 1, p = 0.01). In
conclusion, in patients with small aortic annulus and aortic stenosis, SE
bioprostheses have superior hemodynamic performance but higher rates of
paravalvular leak, permanent pacemaker implantation, and in-hospital
stroke. BE bioprostheses were associated with a higher risk of severe
prosthesis-patient mismatch. Copyright © 2024 Elsevier Inc.

<4>
Accession Number
2031081062
Title
Effects of dexmedetomidine on early postoperative cognitive function and
postoperative inflammatory response: a systematic review and network
meta-analysis.
Source
Frontiers in Neurology. 15 (no pagination), 2024. Article Number: 1422049.
Date of Publication: 2024.
Author
Huang C.; Yang R.; Xie X.; Dai H.; Pan L.
Institution
(Huang, Xie, Dai, Pan) Department of Anesthesiology, Guangxi Medical
University Cancer Hospital, Nanning, China
(Huang, Xie, Dai, Pan) Guangxi Clinical Research Center for Anesthesiology
(GKAD22035214), Nanning, China
(Huang, Xie, Dai, Pan) Guangxi Engineering Research Center for Tissue and
Organ Injury and Repair Medicine, Nanning, China
(Huang, Xie, Dai, Pan) Guangxi Health Commission Key Laboratory of Basic
Science and Prevention of Perioperative Organ Dysfunction, Nanning, China
(Yang) Department of Anesthesiology, First Affiliated Hospital of Guangxi
Medical University, Nanning, China
Publisher
Frontiers Media SA
Abstract
Background: Dexmedetomidine (DEX) has demonstrated potential as an
effective agent for enhancing early postoperative cognitive function.
However, there is ongoing debate regarding its optimal dosage and impact
on early postoperative inflammatory response. This study aimed to assess
and prioritize the effects of varying doses of DEX on early postoperative
cognitive function and inflammatory response, in order to identify the
most effective intervention dosage. Method(s): Randomised controlled
trials (RCTs) and retrospective cohort studies (RCS) from PubMed, Embase,
and Cochrane Library up to January 28, 2024, were included. The
Mini-Mental State Examination (MMSE) was utilized to assess the impact of
varying doses of DEX on cognitive function during the early postoperative
period as the primary outcome, peripheral blood levels of IL-6 and
TNF-alpha were considered as secondary outcomes. Meta-analysis and
Bayesian Network Meta-Analysis (NMA) were conducted using R. Funnel plots
were generated using Stata 15.0. Result(s): A total of 29 studies
involving 2,807 patients and 25 different doses of DEX were included. DEX
was given at a loading dose of 0.3-1.0 mug/kg followed by a maintenance
dose of 0.1-0.5 mug/kg/h, or at a uniform intraoperative dose of 0.4-0.7
mug/kg/h. Network meta-analysis revealed most doses of DEX were
significantly more effective than normal saline (NS) in improving
postoperative MMSE scores (on days 1, 3, and 7) and lowering IL-6 and
TNF-alpha levels. Probability results showed that a 1 mug/kg loading dose
followed by a 0.6 mug/kg/h maintenance dose was the best dosing regimen
for improving MMSE scores on postoperative days 1 (97.3%), 3 (100%), and 7
(99.9%), as well as for reducing postoperative blood IL-6 levels (1.3%).
On the other hand, 0.3 mug/kg followed by 0.2 mug/kg/h was the optimal
dosing regimen for reducing postoperative blood TNF-alpha levels (6.6%).
 Conclusion(s): Compared with NS, intraoperative intravenous DEX
improved early postoperative cognitive function and postoperative
inflammatory response in patients undergoing elective surgery. In
particular, a 1 mug/kg loading dose and a 0.6 mug/kg/h maintenance dose
resulted in the best improvement in postoperative MMSE scores and blood
IL-6 levels, while a 0.3 mug/kg loading dose followed by a 0.2 mug/kg/h
maintenance dose is the optimal regimen for lowering postoperative blood
TNF-alpha levels. Systematic review registration:
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=433932,
identifier CRD42023433932. Copyright © 2024 Huang, Yang, Xie, Dai
and Pan.

<5>
Accession Number
2031077095
Title
Minimally invasive vs. conventional mitral valve surgery: a meta-analysis
of randomised controlled trials.
Source
Frontiers in Cardiovascular Medicine. 11 (no pagination), 2024. Article
Number: 1437524. Date of Publication: 2024.
Author
Amin A.; Kumar R.; Mokhtassi S.S.; Alassiri A.K.; Odaman A.; Khan M.A.R.;
Lakshmana S.; Din Z.U.; Acharya P.; Cheema H.A.; Nashwan A.J.; Khan A.A.;
Hussain A.; Bhudia S.; Vincent R.P.
Institution
(Amin, Mokhtassi, Bhudia) Department of Cardiothoracic Surgery, Harefield
Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United
Kingdom
(Kumar) Department of Cardiothoracic and Vascular Surgery, Jay Prabha
Medanta Super Specialty Hospital, Patna, India
(Alassiri) Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi
Arabia
(Odaman, Lakshmana) Department of Cardiothoracic Surgery, Royal Brompton
Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United
Kingdom
(Khan) Department of Radiology, Shaukat Khanum Memorial Cancer Hospital,
Lahore, Pakistan
(Din) Department of Surgery, Khyber Medical College, Peshawar, Pakistan
(Acharya) Lister Hospital, Stevenage, United Kingdom
(Cheema) Department of Cardiology, King Edward Medical University, Lahore,
Pakistan
(Nashwan) Hamad Medical Corporation, Doha, Qatar
(Khan) Department of Cardiothoracic Surgery, Rush University Medical
Center, Chicago, IL, United States
(Hussain) Department of Cardiac Surgery, Yale University School of
Medicine, New Haven, CT, United States
(Vincent) Department of Clinical Biochemistry, King's College Hospital NHS
Foundation Trust, London, United Kingdom
(Vincent) Faculty of Life Sciences & Medicine, King's College London,
London, United Kingdom
Publisher
Frontiers Media SA
Abstract
Objective: The evidence underlying the efficacy and safety of minimally
invasive mitral valve surgery (MIMVS) is inconclusive. We conducted a
meta-analysis to evaluate whether MIMVS improves clinical outcomes
compared with conventional sternotomy. Method(s): We searched MEDLINE
(via PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov from
inception to January 2024 for all randomised controlled trials (RCTs),
comparing MIMVS with conventional mitral valve surgery. RevMan 5.4 was
used to analyse the data with risk ratio (RR) and mean difference (MD) as
the effect measures. Result(s): Eight studies reporting data on 7
RCTs were included in our review. There was no significant difference in
all-cause mortality, the number of patients requiring blood product
transfusion, and the change from baseline in the SF-36 physical function
scores between the MIMVS and conventional sternotomy groups. MIMVS reduced
the length of hospital stay (MD -2.02 days, 95% CI: -3.66, -0.39) but did
not affect the length of ICU stay, re-operation for bleeding, and the
incidence of renal injury, wound infection, neurological events, and
postoperative moderate or severe mitral regurgitation. MIMVS was
associated with a trend toward lower postoperative pain scores (MD -1.06;
95% CI: -3.96 to 0.75). Conclusion(s): MIMVS reduced the number of
days spent in the hospital and showed a trend toward lower postoperative
pain scores, but it did not decrease the risk of all-cause mortality or
the number of patients needing blood product transfusions. Further
large-scale RCTs are required to inform definitive conclusions,
particularly with regard to quality-of-life outcomes investigating
functional recovery. Systematic Review Registration: PROSPERO
(CRD42023482122). Copyright 2024 Amin, Kumar, Mokhtassi, Alassiri,
Odaman, Khan, Lakshmana, Din, Acharya, Cheema, Nashwan, Khan, Hussain,
Bhudia and Vincent.

<6>
Accession Number
2030616094
Title
Randomized Study Comparing Radiofrequency Ablation with the PVAC Gold
System vs. Antiarrhythmic Drugs in Elderly Patients with Symptomatic
Atrial Fibrillation.
Source
Arquivos Brasileiros de Cardiologia. 121(6) (no pagination), 2024. Article
Number: e20230684. Date of Publication: 2024.
Author
Martins L.C.B.; Pisani C.F.; Dorfman F.K.; Darrieux F.C.C.; Wu T.C.;
Ferraz A.P.; Hachul D.T.; de Castro C.C.; Do Prado R.R.; Souza L.V.F.;
Sacilloto L.; Pessente G.D.A.; Grupi C.J.; Chokr M.O.; Nomura C.H.; de
Oliveira K.R.; Balbo C.P.; Melo S.L.; Veronese P.; Scanavacca M.I.
Institution
(Martins, Pisani, Dorfman, Darrieux, Wu, Ferraz, Hachul, de Castro, Do
Prado, Souza, Sacilloto, Pessente, Grupi, Chokr, Nomura, de Oliveira,
Balbo, Melo, Veronese, Scanavacca) Unidade de Arritmia, Instituto do
Coracao (InCor), Hospital das Clinicas da Faculdade de Medicina da
Universidade de Sao Paulo, SP, Sao Paulo, Brazil
Publisher
Sociedade Brasileira de Cardiologia
Abstract
Background: There are no randomized studies comparing the maintenance of
sinus rhythm after catheter ablation (CA) concerning treatment with
antiarrhythmic drugs (AA) in elderly patients with paroxysmal atrial
fibrillation (AF). Objective(s): To compare the clinical results of
pulmonary vein (PV) isolation with the second-generation PVAC Gold
catheter against AA treatment in elderly people with recurrent symptomatic
paroxysmal AF, refractory to at least one AA, and without structural heart
disease. Method(s): Sixty patients with paroxysmal AF >= 65 years old
were randomized to two forms of treatment: group 1: CA and group 2: AA
drugs. The primary outcome was the AF recurrence-free rate after at least
one year of follow-up. Secondary outcomes were: progression to persistent
forms of AF, impact on quality of life (QOLF), and complications. The
significance level adopted in the statistical analysis was 5% (p<0.05).
 Result(s): The AF recurrence-free rate was 80% (10% with amiodarone)
in the CA group, after 1.3 procedures per patient and 65% in the AA group
(60% with amiodarone), (p = 0.119) in an average follow-up of 719 days
(Q1: 566; Q3: 730). The persistent AF free rate was 83.4% in the AC group
and 67.7% in the AA group (p = 0.073) Both strategies showed an
improvement in the AFQoL score during follow-up (p < 0.001), with no
difference between the groups. Although without clinical repercussions or
impact on the intellectual assessment test, 25% of patients in the CA
group showed signs of cerebral embolization on brain MRI.
 Conclusion(s): Both strategies for maintaining sinus rhythm promoted
an improvement in the quality of life of elderly patients with symptomatic
AF, with no statistical difference in the clinical outcomes. Additional
studies using technologies with a better safety profile are needed to
evaluate the benefits of CA in elderly patients with AF. Copyright
© 2024, Sociedade Brasileira de Cardiologia. All rights reserved.

<7>
Accession Number
2031487898
Title
Pericardiotomy and atrial fibrillation after isolated coronary artery
bypass grafting: A systematic review and meta-analysis of 16 randomised
controlled trials.
Source
Cardiovascular Revascularization Medicine. 66 (pp 27-32), 2024. Date of
Publication: September 2024.
Author
San T.M.M.; Han K.P.P.; Ismail M.; Thu L.M.; Thet M.S.
Institution
(San) Department of Surgery, Pyin Oo Lwin General Hospital, University of
Medicine Mandalay, Myanmar
(Han) Department of Medicine, Mandalay General Hospital, Mandalay, Myanmar
(Ismail) Department of Neurosurgery, Khalifa Gul Nawaz Hospital, Medical
Teaching Institution, Bannu, Pakistan
(Thu) Department of Trauma & Orthopaedic, Colchester General Hospital,
Colchester, United Kingdom
(Thet) Department of Surgery and Cancer, Imperial College London, United
Kingdom
Publisher
Elsevier Inc.
Abstract
Background: Atrial fibrillation (AF) and pericardial effusion are notable
complications following coronary artery bypass grafting (CABG),
contributing to increased morbidity and healthcare costs. Posterior
pericardiotomy has been proposed to mitigate these complications. This
systematic review and meta-analysis aim to evaluate the efficacy of
posterior pericardiotomy in reducing postoperative AF and pericardial
effusion in isolated CABG patients. Material(s) and Method(s): A
comprehensive literature search, adhering to PRISMA guidelines, was
conducted across PubMed, MEDLINE via Ovid, Embase, Scopus, the Central
Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov up to
December 2023. Only randomised controlled trials (RCTs) comparing
prophylactic posterior pericardiotomy to control treatments in adult CABG
patients were included. The primary outcomes assessed were the incidences
of postoperative AF and pericardial effusion. Result(s): The
meta-analysis incorporated 16 RCTs with a total of 2414 patients. The
findings demonstrated a significant reduction in the incidence of
postoperative AF (Odds Ratio = 0.34, 95 % CI: 0.25-0.48, P < 0.00001) and
pericardial effusion (Odd Ratio = 0.24, 95 % CI: 0.15-0.38, P < 0.0001) in
the group undergoing posterior pericardiotomy. However, the analysis
revealed substantial heterogeneity and publication bias in the included
studies. Conclusion(s): The posterior pericardiotomy is effective in
reducing the incidences of AF and pericardial effusion in patients
undergoing isolated CABG. Despite the positive outcomes, the presence of
heterogeneity and publication bias warrants a cautious interpretation of
the results and underscores the need for further multicentre RCTs in this
area. Copyright © 2024 The Authors

<8>
Accession Number
2030797634
Title
Thoracic endovascular aortic repair completion following frozen elephant
trunk: how it's done and device selection.
Source
Expert Review of Medical Devices. 21(8) (pp 671-677), 2024. Date of
Publication: 2024.
Author
Capitain A.N.; Rylski B.; Berger T.; Kondov S.; Discher P.; Walter T.;
Batinkov N.; Bork M.; D'Inka M.; Czerny M.; Kreibich M.
Institution
(Capitain, Rylski, Berger, Kondov, Discher, Walter, Batinkov, Bork,
D'Inka, Czerny, Kreibich) Department of Cardiovascular Surgery, Heart
Centre Freiburg University, Freiburg, Germany
(Capitain, Rylski, Berger, Kondov, Discher, Walter, Batinkov, Bork,
D'Inka, Czerny, Kreibich) Faculty of Medicine, University of Freiburg,
Freiburg, Germany
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Since its introduction in the mid-1990s the frozen elephant
trunk (FET) technique has quickly evolved into an effective hybrid
treatment option for patients with various thoracic aortic pathologies,
acute and chronic. However, a notable incidence of and risk for distal
aortic reinterventions persists after the implementation of the FET
device. In this review, the authors analyze the indications and outcomes
of thoracic endovascular aortic repair completion following FET. Areas
covered: For this review, we looked not only at our own data but also
searched PubMed for relevant studies, comments, and current
recommendations of the European Association for Cardio-Thoracic Surgery
(EACTS) and the European Society for Vascular Surgery (ESVS).
Additionally, we outline our approach in this 2-stage-treatment plan.
Expert opinion: The treatment of acute or chronic aortic pathologies
involving the aortic arch frequently requires a 2-stage treatment
approach. Sometimes, a tertiary procedure is needed to fix the entire
aortic pathology. Thoracic endovascular aortic repair completion following
FET requires careful planning to achieve the excellent clinical outcomes
that we and numerous other aortic centers have shown. Only a dedicated
aortic clinic provides the long-term continuous follow-up required to
identify the few patients in need of a tertiary procedure. Copyright
© 2024 The Author(s). Published by Informa UK Limited, trading as
Taylor & Francis Group.

<9>
Accession Number
2031091249
Title
Risk Factors and Outcomes Associated With the Development of Persistent
Acute Kidney Injury in Non-Renal Solid Organ Transplant Recipients:
Systematic Review and Meta-Analysis.
Source
Clinical Transplantation. 38(9) (no pagination), 2024. Article Number:
e15444. Date of Publication: September 2024.
Author
Saraiva I.E.; Hamahata N.; Sakhuja A.; Chen X.; Minturn J.S.; Sanchez
P.G.; Chan E.G.; Kaczorowski D.J.; Al-Khafaji A.; Kellum J.A.; Gomez H.
Institution
(Saraiva, Hamahata, Al-Khafaji, Kellum, Gomez) Department of Critical Care
Medicine, Center for Critical Care Nephrology, University of Pittsburgh,
Pittsburgh, PA, United States
(Sakhuja) Department of Medicine and Institute for Critical Care Medicine,
Icahn School of Medicine, Mount Sinai, New York, NY, United States
(Chen) Department of Biostatistics, School of Public Health, University of
Pittsburgh, Pittsburgh, PA, United States
(Minturn, Al-Khafaji, Kellum, Gomez) Department of Critical Care Medicine,
The CRISMA Center, University of Pittsburgh, Pittsburgh, PA, United States
(Sanchez, Chan, Kaczorowski) Department of Cardiothoracic Surgery,
University of Pittsburgh, Pittsburgh, PA, United States
Publisher
John Wiley and Sons Inc
Abstract
Persistent acute kidney injury (pAKI), compared with acute kidney injury
(AKI) that resolves in <72 h, is associated with worse prognosis in
critically ill patients. Definitions and prognosis of pAKI are not well
characterized in solid organ transplant patients. Our aims were to
investigate (a) definitions and incidence of pAKI; (b) association with
clinical outcomes; and (c) risk factors for pAKI among heart, lung, and
liver transplant recipients. We systematically reviewed the literature
including PubMed, Embase, Web of Science, and Cochrane from inception to
8/1/2023 for human prospective and retrospective studies reporting on the
development of pAKI in heart, lung, or liver transplant recipients. We
assessed heterogeneity using Cochran's Q and I2. We identified
25 studies including 6330 patients. AKI (8%-71.6%) and pAKI (2.7%-55.1%)
varied widely. Definitions of pAKI included 48-72 h (six studies), 7 days
(three studies), 14 days (four studies), or more (12 studies). Risk
factors included age, body mass index (BMI), diabetes, preoperative
chronic kidney disease (CKD), intraoperative vasopressor use, and
intraoperative circulatory support. pAKI was associated with new onset of
CKD (odds ratio [OR] 1.41-11.2), graft dysfunction (OR 1.81-8.51), and
long-term mortality (OR 3.01-13.96), although significant heterogeneity
limited certainty of CKD and graft dysfunction outcome analyses. pAKI is
common and is associated with worse mortality among liver and lung
transplant recipients. Standardization of the nomenclature of AKI will be
important in future studies (PROSPERO CRD42022371952). Copyright
© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

<10>
Accession Number
2030712223
Title
EFFECT OF PERIOPERATIVE EXERCISES ON KINESIOPHOBIA AND QUALITY OF LIFE IN
PATIENTS UNDERGOING OPEN HEART SURGERY WITH FORWARD HEAD POSTURE.
Source
Journal of Population Therapeutics and Clinical Pharmacology. 31(6) (pp
2186-2194), 2024. Date of Publication: 01 Jun 2024.
Author
Omer A.; Shadmehr A.; Awan W.A.; Malik A.N.; Arif M.; Altaf S.; Zaffar K.;
Moghadam B.A.
Institution
(Omer, Shadmehr, Moghadam) School of Rehabilitation, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Awan, Malik) Islamabad College of Physiotherapy, Margalla Institute of
Health Sciences, Rawalpindi, Pakistan
(Arif) Riphah College of Rehabilitation & Allied Health Sciences, Riphah
International University, Islamabad, Pakistan
(Altaf) Department of Rehabilitation Sciences, Shifa Tameer e Millat
University, Islamabad, Pakistan
(Zaffar, Zaffar) Chandka Medical College, Larkana, Pakistan
Publisher
Codon Publications
Abstract
Open heart surgery is a major procedure that can significantly impact
quality of life (QoL). Forward head posture (FHP) is a prevalent condition
that also adversely affects QoL. Objective was to compare the effect of
perioperative exercises on kinesiophobia and quality of life in persons
undergoing open heart surgery (OHS) with forward head posture. This
prospective, parallel-group, randomized controlled trial included 32
patients undergoing open heart surgery via median sternotomy with FHP,
recruited from Rawalpindi Institute of Cardiology, Pakistan. Participants
were randomized into two groups: 1) standard cardiac rehabilitation (CR)
protocol, 2) CR protocol with therapeutic exercises for FHP. The
intervention included a combination of stretching and strengthening
exercises. Outcomes assessed were Health-related QoL (SF-36) and Tampa
scale for Kinesiophobia (TSK); assessed at 4 weeks before surgery (T1),
one day before surgery (T2), day of discharge (T3) & 4 weeks
post-discharge (T4). One-way ANOVA and Repeated measures ANOVA were used
to test hypotheses and evaluate changes from baseline to various time
points. The between-group comparison indicated significant differences in
TSK scores at all time points T1 (p = 0.029), T2 (p = 0.008), T3 (p =
0.001), and T4 (p = 0.022) while all domains of SF-36 showed no
significant differences (p>0.05) at all time points. The study concludes
that both standard CR and CR + therapeutic exercise for FHP showed equal
effects on QoL of patients while kinesiophobia was greater in the group
performing exercises for FHP. Copyright © 2024, Codon
Publications. All rights reserved.

<11>
Accession Number
2034264824
Title
Adverse outcomes with left atrial appendage occlusion device implantation
in chronic and end stage kidney disease: A systemic review and
meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2024. Date of
Publication: 2024.
Author
Gill G.S.; Shailly S.; Chakrala T.; Palicherla A.; Ponna P.K.; Alla V.M.;
Kanmanthareddy A.
Institution
(Gill) Minneapolis Heart Institute, Abbott Northwestern Hospital,
Minneapolis, MN, United States
(Shailly) Division of Nephrology, University of Michigan, Ann Arbor, MI,
United States
(Chakrala) Department of Medicine, University of Florida, Gainesville, FL,
United States
(Palicherla) Department of Medicine, Creighton University School of
Medicine, Omaha, NE, United States
(Ponna) Department of Medicine, Louisiana State University, Shreveport,
LA, United States
(Alla, Kanmanthareddy) Division of Cardiovascular Disease, Creighton
University School of Medicine, Omaha, NE, United States
Publisher
Elsevier Inc.
Abstract
Background: Chronic kidney disease (CKD) and end stage renal disease
(ESRD) are associated with increased risk of bleeding events, including
hemorrhagic stroke, and periprocedural and gastrointestinal bleeding among
patients with atrial fibrillation who are on anticoagulation. Safety of
percutaneous left atrial appendage occlusion (LAAO) among this patient
population has been uncertain with studies showing contradictory results.
 Method(s): PubMed and Google Scholar databases were queried for
studies comparing outcomes among patients with and without significant
CKD, and with and without ESRD who underwent LAAO device implantation.
Data on outcomes from the selected studies were extracted and analyzed
using random effects model. Heterogeneity was assessed using I2
test. Result(s): Data from eleven studies with 61,724 patients with
and without kidney disease were included in the final analyses. There was
an increased risk of in-hospital mortality (OR 2.76, 95 % CI [1.15-6.64];
p = 0.02) and peri-procedural bleeding (1.51 [1.33-1.71]; p < 0.01)
associated with kidney disease. There was no significant difference in
risk of stroke (1.19 [0.70-2.03]; p = 0.53), pericardial effusion (1.22
[0.77-1.92]; p = 0.40), vascular complications (1.18 [0.92-1.52]; p =
0.20), or device related thrombus (1.13 [0.53-2.40]; p = 0.75).
 Conclusion(s): This study shows an increased risk of complications
among patients with kidney disease, who undergo LAAO device implantation.
These findings suggest the need for studies with randomized control design
specifically designed to compare outcomes with LAAO versus anticoagulation
in the CKD and ESRD populations. Copyright © 2024 Elsevier Inc.

<12>
Accession Number
2034152742
Title
Intraoperative Oxygen Treatment, Oxidative Stress, and Organ Injury
Following Cardiac Surgery A Randomized Clinical Trial.
Source
JAMA Surgery. (no pagination), 2024. Date of Publication: 2024.
Author
Lopez M.G.; Shotwell M.S.; Hennessy C.; Pretorius M.; McIlroy D.R.;
Kimlinger M.J.; MacE E.H.; Absi T.; Shah A.S.; Brown N.J.; Billings F.T.;
Deegan R.; Eagle S.S.; Hernandez A.; Gelfand B.J.; Kertai M.D.; Kingeter
M.; LeFevre R.; Lombard F.W.; Mantinan M.F.; Mishra K.K.; Shaw A.D.;
Siegrist K.K.; Sileshi B.; Freundlich R.E.; Wanderer J.P.
Institution
(Lopez, Pretorius, McIlroy, Billings) Department of Anesthesiology,
Vanderbilt University Medical Center, Vanderbilt University School of
Medicine, Nashville, TN, United States
(Shotwell, Hennessy) Department of Biostatistics, Vanderbilt University
Medical Center, Vanderbilt University School of Medicine, Nashville, TN,
United States
(MacE) Department of Surgery, Vanderbilt University Medical Center,
Vanderbilt University School of Medicine, Nashville, TN, United States
(Absi, Shah) Department of Cardiac Surgery, Vanderbilt University Medical
Center, Vanderbilt University School of Medicine, Nashville, TN, United
States
(Brown, Billings) Department of Medicine, Vanderbilt University Medical
Center, Vanderbilt University School of Medicine, Nashville, TN, United
States
(Kimlinger, Deegan, Eagle, Hernandez, Gelfand, Kertai, Kingeter, LeFevre,
Lombard, Mantinan, Mishra, Shaw, Siegrist, Sileshi, Freundlich, Wanderer)
Vanderbilt University Medical Center, Vanderbilt University School of
Medicine, Nashville, TN, United States
Publisher
American Medical Association
Abstract
IMPORTANCE Liberal oxygen (hyperoxia) is commonly administered to patients
during surgery, and oxygenation is known to impact mechanisms of
perioperative organ injury. OBJECTIVE To evaluate the effect of
intraoperative hyperoxia compared to maintaining normoxia on oxidative
stress, kidney injury, and other organ dysfunctions after cardiac surgery.
DESIGN, SETTING, AND PARTICIPANTS Thiswas a participant- and
assessor-blinded, randomized clinical trial conducted from April 2016 to
October 2020 with 1 year of follow-up at a single tertiary care medical
center. Adult patients (>18 years) presenting for elective open cardiac
surgery without preoperative oxygen requirement, acute coronary syndrome,
carotid stenosis, or dialysis were included. Of 3919 patients assessed,
2501 were considered eligible and 213 provided consent. Of these, 12 were
excluded prior to randomization and 1 following randomization whose
surgery was cancelled, leaving 100 participants in each group.
INTERVENTIONS Participants were randomly assigned to hyperoxia (1.00
fraction of inspired oxygen [FiO2]) or normoxia (minimum FiO2 to maintain
oxygen saturation 95%-97%) throughout surgery. MAIN OUTCOMES AND MEASURES
Participantswere assessed for oxidative stress by measuring
F2-isoprostanes and isofurans, for acute kidney injury (AKI), and for
delirium, myocardial injury, atrial fibrillation, and additional secondary
outcomes. Participants were monitored for 1 year following surgery.
RESULTS Two hundred participants were studied (median [IQR] age, 66
[59-72] years; 140 male and 60 female; 82 [41.0%] with diabetes).
F2-isoprostanes and isofurans (primary mechanistic end point) increased on
average throughout surgery, from a median (IQR) of 73.3 (53.1-101.1) pg/mL
at baseline to a peak of 85.5 (64.0-109.8) pg/mL at admission to the
intensive care unit and were 9.2 pg/mL (95%CI, 1.0-17.4; P = .03) higher
during surgery in patients assigned to hyperoxia. Median (IQR) change in
serum creatinine (primary clinical end point) from baseline to
postoperative day 2 was 0.01mg/dL (-0.12 to 0.19) in participants assigned
hyperoxia and -0.01mg/dL (-0.16 to 0.19) in those assigned normoxia
(median difference, 0.03; 95%CI, -0.04 to 0.10; P = .45). AKI occurred in
21 participants (21%) in each group. Intraoperative oxygen treatment did
not affect additional acute organ injuries, safety events, or kidney,
neuropsychological, and functional outcomes at 1 year. CONCLUSIONS Among
adults receiving cardiac surgery, intraoperative hyperoxia increased
intraoperative oxidative stress compared to normoxia but did not affect
kidney injury or additional measurements of organ injury including
delirium,myocardial injury, and atrial fibrillation. Copyright ©
2024 American Medical Association. All rights reserved.

<13>
Accession Number
2031099052
Title
Implantation of a permanent pacemaker following orthotopic heart
transplantation: a systematic review and meta-analysis.
Source
Journal of Interventional Cardiac Electrophysiology. (no pagination),
2024. Date of Publication: 2024.
Author
Pajareya P.; Srisomwong S.; Siranart N.; Kaewkanha P.; Chumpangern Y.;
Prasitlumkum N.; Kewchareon J.; Chokesuwattanaskul R.; Tokavanich N.
Institution
(Pajareya, Siranart, Kaewkanha, Chokesuwattanaskul) Division of
Cardiovascular Medicine, Center of Excellence in Arrhythmia Research,
Cardiac Center, Faculty of Medicine, King Chulalongkorn Memorial Hospital,
Chulalongkorn University, Bangkok, Thailand
(Srisomwong) Faculty of Medicine, Vajira Hospital, Navamindradhiraj
University, Bangkok, Thailand
(Siranart, Prasitlumkum) Department of Cardiovascular Medicine, Mayo
Clinic, Rochester, United States
(Chumpangern) Faculty of Medicine, Siriraj Hospital, Mahidol University,
Bangkok, Thailand
(Kewchareon) Division of Cardiovascular Medicine, Loma Linda University
Health, Loma Linda, CA, United States
(Tokavanich) Division of Cardiovascular Medicine, Frankel Cardiovascular
Center, University of Michigan Health, Ann Arbor, MI, United States
Publisher
Springer
Abstract
Background: Orthotopic heart transplant (OHT) is among the final
armamentariums for end-stage heart disease. Many patients who have had OHT
require a post-transplant permanent pacemaker (PPM) implantation due to an
abnormal conduction system. We aimed to evaluate the risk of mortality and
acute rejection in patients with OHT who had received PPM compared to
patients without PPM and to determine predictors for PPM placement in this
population. Method(s): We comprehensively searched for studies from
MEDLINE, EMBASE, and Cochrane databases from inception to September 2023.
Inclusion criteria focused on patients who had undergone OHT and PPM
implantation post-transplant. Data from each study were combined using a
random-effects model. Results were expressed as relative risk (RR) or odd
ratios (OR) with a 95% confidence interval (CI). Result(s): A total
of 9 studies were included in this meta-analysis incorporating a total of
54,848 patients (3.3% had PPM). The pooled all-cause mortality rate among
patients with PPM post-OHT was 26% (95% CI: 19-33%, I2 = 1%).
There were no differences between post-heart transplant patients with PPM
and those without PPM in risk of all-cause mortality (RR 0.76, 95% CI:
0.43-1.34; I2 = 45%) and acute rejection (RR 1.22, 95% CI:
0.74-2.00, I2 = 59%). Bi-atrial anastomosis was associated with
an increased risk of PPM implantation post-OHT (OR 7.74, 95% CI:
3.55-16.91, I2 = 0%), while pre-OHT mechanical circulatory
support (MCS) was associated with a decreased risk of PPM implantation
post-OHT (OR 0.45, 95% CI 0.27-0.76, I2 = 0%).
 Conclusion(s): There were no significant differences in all-cause
mortality or acute rejection between post-OHT recipients who required PPM
compared to those who did not receive PPM. Further, bi-atrial anastomosis
portended the need for PPM implantation, while MCS was associated with a
decreased occurrence of PPM. Copyright © The Author(s), under
exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature 2024.

<14>
Accession Number
2034137343
Title
Temporal recovery and prognostic factors for dysphagia following
cardiovascular surgery: Retrospective analysis and development of
predictive score.
Source
Nutrition. 127 (no pagination), 2024. Article Number: 112534. Date of
Publication: November 2024.
Author
Hashida N.; Hosokawa K.; Kawamura A.; Suzuki M.; Kitayama I.; Nozawa M.;
Okajima E.; Sugamoto M.; Sugauchi A.; Sahara W.; Miyagawa S.; Inohara H.
Institution
(Hashida, Hosokawa, Suzuki, Kitayama, Nozawa, Okajima, Sugamoto, Sugauchi,
Sahara, Inohara) Swallowing Center, Osaka University Hospital, Osaka,
Suita city, Japan
(Hosokawa, Suzuki, Kitayama, Nozawa, Okajima, Inohara) Department of
Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate
School of Medicine, Osaka, Suita City, Japan
(Kawamura, Miyagawa) Department of Cardiovascular Surgery, Osaka
University Graduate School of Medicine, Osaka, Suita City, Japan
(Sugamoto, Sahara) Department of Rehabilitation, Osaka University
Hospital, Osaka, Suita city, Japan
(Sugauchi) Unit of Dentistry, Osaka University Hospital, Osaka, Suita
city, Japan
Publisher
Elsevier Inc.
Abstract
Objective: Dysphagia is a common complication associated with
cardiovascular surgery (CVS). This study sought to better understand
recovery timelines, identify risk factors, and create a prognostic model
for oral intake restoration. Method(s): This retrospective study
included 134 patients who had CVS between April 2022 and March 2024. We
assessed swallowing ability through fiberoptic endoscopic evaluation of
swallowing (FEES). We randomly divided the patients' data into a training
dataset and a test dataset in a ratio of 70/30 and Kaplan-Meier analyses
and Cox regression were used to assess predictors of total oral intake. We
also created a scoring system using the estimated regression coefficients.
 Result(s): Most patients with CVS achieved total oral intake in 7-11
days after extubation. Over 168 h of intubation, the presence of
penetration or aspiration, a poor FEES score (score > 6), and
perioperative complications were significant risk factors for delayed
total oral intake. The predicting score was calculated by adding the
scores for each individual factor, including FEES score,
penetration/aspiration, and preoperative complications. Scores ranged 0-8,
categorizing patients into 0-2, 3-5, and 6-8 groups, clearly demonstrating
that the higher the predicting score, the longer the time to total oral
intake in both the training and the test dataset. Conclusion(s): All
risk factors for unsuccessful or delayed total oral intake were intubation
for more than a week, poor swallowing ability, and the presence of
perioperative complications. The scoring system accurately predicts the
restoration of oral intake following CVS. Copyright © 2024 The
Author(s)

<15>
Accession Number
2033658321
Title
Assessment of feasibility of opioid-free anesthesia combined with
preoperative thoracic paravertebral block and postoperative intravenous
patient-controlled analgesia oxycodone with non-opioid analgesics in the
perioperative anesthetic management for video-assisted thoracic surgery.
Source
Anaesthesiology Intensive Therapy. 56(2) (pp 98-107), 2024. Date of
Publication: 2024.
Author
Copik M.M.; Sadowska D.; Smereka J.; Czyzewski D.; Misiolek H.D.; Bialka
S.
Institution
(Copik, Misiolek, Bialka) Department of Anaesthesiology and Intensive
Care, Faculty of Medical Sciences in Zabrze, Medical University of
Silesia, Katowice, Poland
(Sadowska) Clinical Department of Internal Medicine,, Dermatology and
Allergology, Faculty of Medical Sciences in Zabrze, Medical University of
Silesia, Katowice, Poland
(Smereka) Department of Emergency Medical Service, Wroclaw Medical
University, Wroclaw, Poland
(Czyzewski) Department of Chest Surgery, Faculty of Medical Sciences in
Zabrze, Medical University of Silesia, Katowice, Poland
Publisher
Termedia Publishing House Ltd.
Abstract
Background: This study, conducted between December 2015 and March 2018 at
a single university hospital, explored the feasibility and safety of
opioid-free anesthesia combined with preoperative thoracic paravertebral
block (ThPVB) for patients undergoing elective video-assisted
thoracoscopic surgery (VATS). The aim was to assess the impact of this
approach on postoperative pain levels and opioid consumption.
 Method(s): Sixty-four patients scheduled for elective VATS were
randomly assigned to either the intervention group, receiving opioid-free
anesthesia with ThPVB, or the control group, managed with standard general
anesthesia. Postoperatively, both groups received oxycodone
patient-controlled analgesia along with non-opioid analgesics. Pain
intensity was measured using the Numeric Pain Rating Scale (NRS) and
Prince Henry Hospital Pain Score (PHHPS). The total dose of postoperative
oxycodone and the occurrence of opioid-related adverse events were
recorded during the 24-hour follow-up period. Result(s): Patients in
the intervention group showed significantly lower pain levels at 20 and 24
hours post-procedure (P = 0.015, P = 0.021, respectively) compared to the
control group. Notably, oxycodone consumption at 24 hours was
significantly higher in the control group (p < 0.0001). No serious adverse
events were observed during the study period. Conclusion(s): This
study demonstrates the feasibility and safety of opioid-free anesthesia
combined with ThPVB for elective VATS. The approach significantly reduces
postoperative pain and the need for opioids, supporting its potential as
an effective and balanced perioperative anesthetic strategy. Copyright
© 2024 Termedia Publishing House Ltd.. All rights reserved.

<16>
Accession Number
2034172908
Title
PCSK9 inhibitor added to high-intensity statin therapy to prevent
cardiovascular events in patients with acute coronary syndrome after
percutaneous coronary intervention: a randomized, double- blind,
placebo-controlled, multicenter SHAWN study.
Source
American Heart Journal. 277 (pp 58-65), 2024. Date of Publication:
November 2024.
Author
Wu Z.-M.; Kan J.; Ye F.; You W.; Wu X.-Q.; Tian N.-L.; Lin S.; Ge Z.; Liu
Z.-Z.; Li X.-B.; Gao X.-F.; Chen J.; Wang Y.; Wen S.-Y.; Xie P.; Cong
H.-L.; Liu L.-J.; Zeng H.-S.; Zhou L.; Liu F.; Zheng Y.-H.; Li R.; Ji
H.-L.; Zhou S.-H.; Zhao S.-M.; Qian X.-S.; Luo J.; Wang X.; Zhang J.-J.;
Chen S.-L.
Institution
(Wu, Kan, Ye, You, Wu, Tian, Lin, Ge, Liu, Li, Gao, Zhang, Chen) Division
of Cardiology, Nanjing First Hospital, Nanjing Medical University,
Nanjing, China
(Chen) Division of Cardiology, Renmin Hospital of Wuhan University, Wuhan,
China
(Wang) Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen
University, Xiamen, China
(Wen) Division of Cardiology, Tianjin 4th Central Hospital, Tianjin, China
(Xie) Division of Cardiology, Gansu Province People's Hospital, Lanzhou,
China
(Cong) Division of Cardiology, Tianjin Chest Hospital, Tianjin, China
(Liu) Division of Cardiology, The First Affiliated Hospital of Anhui
University of Science and Technology, Huainan, China
(Zeng) Division of Cardiology, Huazhong University of Science and
Technology Tongji Medical College Tongji Hospital, Wuhan, China
(Zhou) Division of Cardiology, Changzhou Jintan First People's Hospital,
Changzhou, China
(Liu) Division of Cardiology, The Second Hospital of Hebei Medical
University, Shijiazhuang, China
(Zheng) Division of Cardiology, Liyang Hospital of Chinese Medicine,
Liyang, China
(Li) Division of Cardiology, First Affiliated Hospital of Harbin Medical
University, Harbin, China
(Ji) Division of Cardiology, The First Hospital of Jilin University,
Jilin, China
(Zhou) Division of Cardiology, The Second Xiangya Hospital of Central
South University, Changsha, China
(Zhao) Division of Cardiology, First Peoples of Hospital of Taicang,
Suzhou, China
(Qian) Division of Cardiology, Zhangjiagang First People's Hospital,
Zhangjiagang, China
(Luo) Division of Cardiology, The People's Hospital of Ganzhou, Ganzhou,
China
(Wang) Division of Cardiology, Lianyungang Hospital of Chinese Medicine,
Lianyungang, China
Publisher
Elsevier Inc.
Abstract
Background: It is currently uncertain whether the combination of a
proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor and
high-intensity statin treatment can effectively reduce cardiovascular
events in patients with acute coronary syndrome (ACS) who have undergone
percutaneous coronary intervention (PCI) for culprit lesions.
 Method(s): This study protocol describes a double-blind, randomized,
placebo-controlled, multicenter study aiming to investigate the efficacy
and safety of combining a PCSK9 inhibitor with high-intensity statin
therapy in patients with ACS following PCI. A total of 1,212 patients with
ACS and multiple lesions will be enrolled and randomly assigned to receive
either PCSK9 inhibitor plus high-intensity statin therapy or
high-intensity statin monotherapy. The randomization process will be
stratified by sites, diabetes, initial presentation and use of stable (>=4
weeks) statin treatment at presentation. PCSK 9 inhibitor or its placebo
is injected within 4 hours after PCI for the culprit lesion. The primary
endpoint is the composite of cardiovascular death, myocardial infarction,
stroke, re-hospitalization due to ACS or heart failure, or any
ischemia-driven coronary revascularization at 1-year follow-up between 2
groups. Safety endpoints mean PCSK 9 inhibitor and statin intolerance.
 Conclusion(s): The SHAWN study has been specifically designed to
evaluate the effectiveness and safety of adding a PCSK9 inhibitor to
high-intensity statin therapy in patients who have experienced ACS
following PCI. The primary objective of this study is to generate new
evidence regarding the potential benefits of combining a PCSK9 inhibitor
with high-intensity statin treatment in reducing cardiovascular events
among these patients. Copyright © 2024

<17>
Accession Number
2034169882
Title
Effect of Respiratory Muscle Training on Improving Respiratory Muscle
Strength in Younger Population: A Systematic Review.
Source
Journal of Clinical and Diagnostic Research. 18(8) (pp YE01-YE05), 2024.
Date of Publication: August 2024.
Author
Chobisa C.A.; Lalwani L.; Vardhan V.; Nathani H.
Institution
(Chobisa, Lalwani, Vardhan, Nathani) Department of Cardio-Respiratory
Physiotherapy, Datta Meghe Institute of Higher Education and Research,
Sawangi, Maharashtra, Wardha, India
Publisher
JCDR Research and Publications Pvt Ltd
Abstract
Introduction: Inspiratory Muscle Training (IMT) is an integral part of
pulmonary rehabilitation. It is a therapeutic modality that has
demonstrated considerable promise in augmenting respiratory muscle
function and overall pulmonary well-being in a range of clinical cohorts.
While IMT has been extensively scrutinised in the adult demographic, its
efficacy in paediatric populations has remained a relatively underexplored
realm. Aim(s): This systematic review seeks to undertake a meticulous
assessment of the existing literature to gauge the potential of IMT in
ameliorating respiratory function in children and adolescents.
 Material(s) and Method(s): The present systematic review includes
seven pertinent studies, comprising randomised controlled trials, cohort
investigations, and pilot studies published in English from 2018-2023 from
the Cochrane Library, PubMed, Google Scholar, and ScienceDirect. The
keywords used were paediatric, restrictive lung diseases, obstructive lung
diseases, IMT, obesity, neuromuscular disorders, thoracic surgeries, and
advanced physiotherapy. Risk of bias assessment was done using the
Cochrane risk-of-bias assessment tool. Result(s): These studies have
investigated the impact of IMT on various paediatric cohorts, from
athletic populations to those afflicted with neuromuscular disorders,
cystic fibrosis, and other respiratory pathologies. Collectively, the
findings offer compelling evidence that IMT has the potential to enhance
inspiratory muscle strength, endurance, and overall respiratory function
in paediatric populations. Conclusion(s): In light of the findings
gleaned from this systematic review, it is evident that IMT possesses the
potential to be an efficacious intervention for enhancing respiratory
function in the paediatric population and offering the prospect of
improved clinical outcomes and an enhanced quality of life for this
vulnerable cohort. Copyright © 2024 JCDR Research and
Publications Pvt Ltd. All rights reserved.

<18>
Accession Number
2034154215
Title
Intravascular ultrasound-guided drug-coated balloon angioplasty for
femoropopliteal artery disease: a clinical trial.
Source
European Heart Journal. 45(31) (pp 2839-2847), 2024. Date of Publication:
14 Aug 2024.
Author
Ko Y.-G.; Lee S.-J.; Ahn C.-M.; Lee S.-H.; Lee Y.-J.; Kim B.-K.; Hong
M.-K.; Jang Y.; Kim T.-H.; Park H.-W.; Jang J.Y.; Lee J.-H.; Park J.-H.;
Kim S.H.; Im E.; Park S.-H.; Choi D.
Institution
(Ko, Lee, Ahn, Lee, Lee, Kim, Hong, Jang, Choi) Severance Cardiovascular
Hospital, Yonsei University College of Medicine, Seodaemungu, Seoul 03722,
South Korea
(Kim) Division of Cardiology, Hanil General Hospital, Seoul, South Korea
(Kim, Park) Division of Cardiology Cardiovascular Center, Bucheon Sejong
Hospital, Bucheon, South Korea
(Jang) Division of Cardiology, National Health Insurance Service Ilsan
Hospital, Goyang, South Korea
(Lee) Division of Cardiology, Chungnam National University Sejong
Hospital, Sejong, South Korea
(Lee, Park) Division of Cardiology, Chungnam National University Hospital,
Daejeon, South Korea
(Kim) Division of Cardiology, Busan Veterans Hospital, Busan, South Korea
(Im) Division of Cardiology, Yongin Severance Hospital, Seoul, South Korea
(Park) Cardiology Department, Soonchunhyang University Cheonan Hospital,
Cheonan, South Korea
Publisher
Oxford University Press
Abstract
Background and Drug-coated balloons (DCBs) have demonstrated favourable
outcomes following endovascular therapy for femoropopliteal Aims artery
(FPA) disease. However, uncertainty remains whether the use of
intravascular ultrasound (IVUS) can improve the outcomes of DCBs. . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methods This prospective, multicentre, randomized trial, conducted at
seven centres in South Korea, compared the outcomes of IVUS-guided vs.
angiography-guided angioplasty for treating FPA disease with DCBs.
Patients were assigned to receive IVUS-guided (n = 119) or
angiography-guided (n = 118) angioplasty using DCBs. The primary endpoint
was 12-month primary patency. . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . Results Between May 2016 and August
2022, 237 patients were enrolled and 204 (86.0%) completed the trial
(median follow-up; 363 days). The IVUS guidance group showed significantly
higher primary patency [83.8% vs. 70.1%; cumulative difference 19.6% (95%
confidence interval 6.8 to 32.3); P = .01] and increased freedom from
clinically driven target lesion revascularization [92.4% vs. 83.0%;
difference 11.6% (95% confidence interval 3.1 to 20.1); P = .02],
sustained clinical improvement (89.1% vs. 76.3%, P = .01), and
haemodynamic improvement (82.4% vs. 66.9%, P = .01) at 12 months compared
with the angiography guidance group. The IVUS group utilized larger
balloon diameters and pressures for pre-dilation, more frequent
post-dilation, and higher pressures for post-dilation, resulting in a
greater post-procedural minimum lumen diameter (3.90 +/- 0.59 vs. 3.71 +/-
0.73 mm, P = .03). . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . Conclusions Intravascular ultrasound guidance
significantly improved the outcomes of DCBs for FPA disease in terms of
primary patency, freedom from clinically driven target lesion
revascularization, and sustained clinical and haemodynamic improvement at
12 months. These benefits may be attributed to IVUS-guided optimization of
the lesion before and after DCB treatment. Copyright © The
Author(s) 2024. Published by Oxford University Press on behalf of the
European Society of Cardiology. All rights reserved.

<19>
Accession Number
2031055150
Title
Predictive significance of cardio ankle vascular index for the assessment
of cardiovascular risk in hypertensive patients: A systematic review.
Source
Journal of Clinical Hypertension. (no pagination), 2024. Date of
Publication: 2024.
Author
Saravanan C.R.; Chowdhury S.R.; Inban P.; Chandrasekaran S.H.; Pattani
H.H.; Santoshi K.; Bamba H.; Singh G.; Prajjwal P.; Ranjan R.; Marsool
M.D.M.; Amir O.
Institution
(Saravanan) Internal Medicine, Madras Medical College, Chennai, India
(Chowdhury) Cardiology, Lincoln County Hospital, Lincoln, United Kingdom
(Inban) Internal Medicine, St. Mary's General Hospital and Saint Clare's
Health, New York, NY, United States
(Chandrasekaran) Internal Medicine, Vijaya Hospitals, Chennai, India
(Pattani) Internal Medicine, Gujarat University, Ahmedabad, India
(Santoshi) Internal Medicine, MNR Medical College, Sangareddy, India
(Bamba, Singh) Internal Medicine, Government Medical College and Hospital,
Chandigarh, India
(Prajjwal) Internal Medicine, Bharati Vidyapeeth Medical College Pune,
Pune, India
(Ranjan) SCGMC Nanded, Nanded, India
(Marsool) Internal Medicine, Al-Kindy College of Medicine, University of
Baghdad, Baghdad, Iraq
(Amir) Internal Medicine, Al-Manhal Academy, Khartoum, Sudan
Publisher
John Wiley and Sons Inc
Abstract
Cardio-ankle vascular index (CAVI) is an innovative indicator of
large-artery stiffness, which is evaluated by the pulse wave velocity
(PWV) measurement. Mortality and morbidity due to cardiovascular diseases
among the general public with high-risk conditions such as hypertension
are usually associated with arterial stiffness. CAVI modelizes the hazard
of future cardiovascular events with standard risk factors. Additionally,
the "European Society of Hypertension and Cardiology" included the aortic
PWV assessment in managing hypertension in their updated guidelines in
2007. We conducted this systematic review to collect, summarize, and
evaluate the evidence from relevant reported studies. A literature search
of four databases was conducted comprehensively until February 2024.
Cardiovascular events are the primary outcome of interest in this study,
cardiovascular events that have been defined as major adverse cardiac
events include "heart failure", "stroke", "myocardial infarction",
"cardiovascular deaths", "stable angina pectoris", "coronary
revascularization", and "unstable angina pectoris". We included five
studies with a 11 698 sample size in this systematic review. All five
prospective studies investigated composite cardiovascular events as an
outcome. Three of them revealed a statistically significant prediction
ability of CAVI to assess Cardiovascular disease (CVD) risk. Further
analysis is required. Current evidence is insufficient to confirm the
predictive power of CAVI in the assessment of cardiovascular risk in
hypertensive patients. CAVI is modestly associated with incidents of CVD
risk. It is necessary to conduct further studies to assess CAVI concerning
CVD predictor measures in the masses and nations other than
Asia. Copyright © 2024 The Author(s). The Journal of Clinical
Hypertension published by Wiley Periodicals LLC.

<20>
Accession Number
2031032043
Title
Percutaneous coronary revascularization versus medical therapy in chronic
coronary syndromes: An updated meta-analysis of randomized controlled
trials.
Source
European Journal of Clinical Investigation. (no pagination), 2024. Date
of Publication: 2024.
Author
Panuccio G.; Carabetta N.; Torella D.; DeRosa S.
Institution
(Panuccio, Torella) Department of Experimental and Clinical Medicine,
Magna Graecia University, Catanzaro, Italy
(Panuccio) Department of Cardiology, Angiology and Intensive Care
Medicine, Deutsches Herzzentrum der Charite, Berlin, Berlin, Germany
(Carabetta, De Rosa) Department of Medical and Surgical Sciences, Magna
Graecia University, Catanzaro, Italy
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Coronary artery disease (CAD) is a main cause of morbidity
and mortality. The effectiveness of coronary revascularization in chronic
coronary syndromes (CCS) is still debated. Our recent study showed the
superiority of coronary revascularization over optimal medical therapy
(OMT) in reducing cardiovascular (CV) mortality and myocardial infarction
(MI). The recent publication of the ORBITA-2 trial suggested superiority
of percutaneous coronary revascularization (PCI) in reducing angina and
improving quality of life. Therefore, we aimed to provide an updated
meta-analysis evaluating the impact of PCI on both clinical outcomes and
angina in CCS. Method(s): Relevant studies were screened in
PubMed/Medline until 08/01/2024. Randomized controlled trials (RCTs)
comparing PCI to OMT in CCS were selected. The primary outcome was CV
death. Secondary outcomes were MI, all-cause mortality, stroke, major
bleeding and angina severity. Result(s): Nineteen RCTs involving 8616
patients were included. Median follow-up duration was 3.3 years.
Revascularization significantly reduced CV death (4.2% vs. 5.5%; OR =.77;
95% CI.62-.96, p =.02). Subgroup analyses favoured revascularization in
patients without chronic total occlusions (CTOs) (p =.052) and those aged
<65 years (p =.02). Finally, a follow-up duration beyond 3 years showed
increased benefit of coronary revascularization (p =.04). Secondary
outcomes analyses showed no significant differences, except for a lower
angina severity in the revascularization group according to the Seattle
Angina Questionnaire (SAQ) (p =.04) and to the Canadian Cardiovascular
Society (CCS) classification (p =.005). Conclusion(s): PCI compared
to OMT significantly reduces CV mortality and angina severity, improving
quality of life in CCS patients. This benefit was larger without CTOs, in
patients aged <65 years and with follow-up duration beyond 3
years. Copyright © 2024 The Author(s). European Journal of
Clinical Investigation published by John Wiley & Sons Ltd on behalf of
Stichting European Society for Clinical Investigation Journal Foundation.

<21>
Accession Number
644524082
Title
Randomized feasibility trial for evaluating the impact of primary nursing
on delirium duration during intensive care unit stay.
Source
Intensive & critical care nursing. 84 (pp 103748), 2024. Date of
Publication: 01 Oct 2024.
Author
Kruger L.; Zittermann A.; Mannebach T.; Wefer F.; Becker T.; Lohmeier S.;
Luttermann A.; von Dossow V.; Rojas S.V.; Gummert J.; Langer G.
Institution
(Kruger) Project and Knowledge Management/Care Development Intensive Care,
Care Directorate, Heart and Diabetes Center NRW, Ruhr University Bochum,
Georgstrasse 11, 32345 Bad Oeynhausen, Germany
(Zittermann, Becker, Rojas, Gummert) Clinic for Thoracic and
Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University
Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
(Mannebach, Lohmeier, Luttermann) Surgical Intensive Care Unit, Heart and
Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad
Oeynhausen, Germany
(Wefer) Care Development, Care Directorate, Heart and Diabetes Center NRW,
Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany;
Institute of Nursing Science, Medical Faculty and University Hospital
Cologne, University of Cologne, Gleueler Strasse 176-178, 50935 Cologne,
Germany
(von Dossow) Institute of Anesthesiology and Pain Therapy, Heart and
Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad
Oeynhausen, Germany
(Langer) Institute of Health and Nursing Sciences, German Center for
Evidence-based Nursing, Martin Luther University Halle-Wittenberg,
Magdeburger Strasse 8, 06112 Halle (Saale), Germany
Abstract
OBJECTIVE: We tested the feasibility of a randomized controlled trial for
comparing primary nursing with standard care. RESEARCH METHODOLOGY:
Elective cardiac surgical patients were eligible for inclusion. Patients
with an intensive care unit stay of >= 3 days were followed up until
intensive care unit discharge. Recruitment period was one year. SETTING:
Two intensive care units at a university hospital specialized in
cardiovascular and diabetic diseases. MAIN OUTCOME MEASURES: Primary
outcomes were recruitment and delivery rate. Primary clinical outcome was
duration of delirium, as assessed by the Confusion Assessment Method for
Intensive Care Units. Secondary outcomes included the incidence of
delirium, anxiety (10-point Numeric Rating Scale), and the satisfaction of
patient relatives (validated questionnaire). RESULT(S): Of 369
patients screened, 269 could be allocated to primary nursing (n = 134) or
standard care (n = 135), of whom 46 patients and 48 patients,
respectively, underwent an intensive care unit stay >= 3 days. Thus,
recruitment and delivery rates were 73 and 26 %, respectively. During
primary nursing and standard care, 18 and 24 patients developed a
delirium, with a median duration of 32 (IQR: 14-96) and 24 (IQR: 8-44)
hours (P = 0.10). The risk difference of delirium for primary nursing
versus standard care was 11 % and the relative risk was 0.65 (95 % CI:
0.28-1.46; P = 0.29). The extent of anxiety was similar between groups (P
= 0.13). Satisfaction could be assessed in 73.5 % of relatives, without
substantial differences between groups. CONCLUSION(S): Data
demonstrate that a trial for comparing primary nursing with standard care
is generally feasible. However, the incidence of delirium may be a better
primary outcome parameter than delirium duration, both in terms of
long-term patient outcome and robustness of data quality. IMPLICATIONS FOR
CLINICAL PRACTICE: A randomized clinical trial regarding nursing
organization during intensive care unit stay requires detailed planning of
patient recruitment, data evaluation, and power calculation. Copyright
© 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

<22>
Accession Number
645076718
Title
Can heartbeat recovery be improved with terminal non-cardioplegic warm
blood perfusion prior to aortic unclamping in single-clamp technique
coronary artery bypass surgery? A randomized controlled trial.
Source
Journal of cardiothoracic surgery. 19(1) (pp 486), 2024. Date of
Publication: 22 Aug 2024.
Author
Satdhabudha O.; Songvasin M.; Homvises B.; Noppawinyoowong N.; Chanawangsa
P.; Kaewbunjong J.
Institution
(Satdhabudha, Songvasin, Homvises, Noppawinyoowong, Chanawangsa,
Kaewbunjong) Division of Cardiothoracic Surgery, Department of Surgery,
Faculty of Medicine, Thammasat University, 95 Phahonyothin Road, Khlong
Luang, Pathum Thani 12120, Thailand
Abstract
BACKGROUND: The objective of this study is to investigate whether the use
of antegrade perfusion with terminal non-cardioplegic warm blood (TNWB)
before aortic unclamping in single-clamp technique coronary artery bypass
has a positive impact on intraoperative heartbeat recovery.
 METHOD(S): Between December 2022 and May 2023, 40 consecutive
patients undergoing coronary artery bypass using single-clamp technique
were randomized into one of two groups: the TNWB group received an
antegrade perfusion with TNWB before removing the aortic cross-clamp
(n=20), while the control group did not receive (n=20). The time intervals
between coronary perfusion and the onset of the first heartbeats and sinus
rhythms, occurrences of spontaneous sinus rhythm, intraoperative
defibrillation requirements, as well as postoperative CK-MB and troponin T
levels were recorded and subjected to analysis. RESULT(S): In the
TNWB group, the median onset of the first heartbeats after the initiation
of coronary perfusion was 34 s (4-100), while in the control group, it was
90 s (15-340) (p<0.001). The median onset of the sinus rhythms was 100 s
(28-290) in the TNWB group and was 132 s (45-350) in the control group
(p=0.023). The occurrence of intraoperative arrhythmias was 15% in the
TNWB group compared to 50% in the control group (p=0.018), and the
incidence for internal defibrillation was 5% in the TNWB group and was 30%
in the control group (p=0.037). The TNWB group showed the median CK-MB
levels at 6 h postoperative was 14.10 ng/mL (9.78-19.26), compared to
18.31 ng/mL (13.98-23.80) in the control group (p=0.045).
 CONCLUSION(S): During single clamp coronary artery bypass,
administration TNWB into the aortic root before aortic unclamping has the
potential to enhance heartbeat recovery, as evidenced by the shortened
time to the initial heartbeat and the establishment of sinus beats
following coronary perfusion. TRIAL REGISTRATION: Trial registration
number (Study ID): TCTR20231002003. Copyright © 2024. The
Author(s).

<23>
Accession Number
2034227256
Title
Protective effects of fructose-1,6-bisphosphate postconditioning on
myocardial ischaemia-reperfusion injury in patients undergoing valve
replacement: a randomized, double-blind, placebo-controlled clinical
trial.
Source
European Journal of Cardio-thoracic Surgery. 66(2) (no pagination), 2024.
Article Number: ezae306. Date of Publication: 01 Aug 2024.
Author
Xu H.; Wang M.; Zhao T.; Yu X.; Wang F.
Institution
(Xu, Wang, Wang) Affiliated Hospital, North Sichuan Medical College,
Nanchong, China
(Zhao) Department of Anesthesiology, North Sichuan Medical College,
Nanchong, China
(Yu) Second Affiliated Hospital of North Sichuan Medical College,
Nanchong, China
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Pharmacological postconditioning can protect against
myocardial ischaemia-reperfusion injury during cardiac surgery with
extracorporeal circulation. The aim of this study was to observe the
protective effects of fructose-1,6-bisphosphate (FDP) postconditioning on
myocardial ischaemia-reperfusion injury in patients undergoing cardiac
valve replacement with extracorporeal circulation. METHOD(S):
Patients undergoing elective mitral valve replacement and/or aortic valve
replacement were divided into normal saline postconditioning group (NS
group) and FDP postconditioning group (FDP group). The primary outcome was
the plasma concentration of creatine kinase-MB (CK-MB). The secondary
outcomes were the plasma concentrations of lactate dehydrogenase, CK,
high-sensitivity C-reactive protein, alpha-hydroxybutyrate dehydrogenase
and cardiac troponin I, the spontaneous cardiac rhythm recovery profile,
the extracorporeal circulation time and duration of surgery, intensive
care unit and postoperative hospitalization. RESULT(S): Forty
patients were randomly assigned to receive intervention and included in
the analysis. The serum concentrations of CK-MB, lactate dehydrogenase,
CK, cardiac troponin I, alpha-hydroxybutyrate dehydrogenase and
high-sensitivity C-reactive protein at T<inf>1~4</inf> were lower in the
FDP group than in the NS group (P<0.001). Compared with the NS group, the
dosage of dopamine administered 1-90 min after cardiac resuscitation, the
spontaneous cardiac rhythm recovery time and the incidence of ventricular
fibrillation were lower in the FDP group (P<0.001, P<0.001 and P1/4 0.040,
respectively). The values of ST- changes were increased more significantly
in the NS group than in the FDP group (median [standard deviation] 1.3
[0.3] mm vs 0.7 [0.2] mm; P<0.001). Compared with the NS group, the time
of recovery of ST-segment deviations was shorter in the FDP group (50.3
[12.3] min vs 34.6 [6.9] min; P<0.001). CONCLUSION(S): The FDP
postconditioning could improve both myocardial ischaemia-reperfusion
injury and the spontaneous cardiac rhythm recovery during cardiac valve
surgery with extracorporeal circulation. Copyright © The
Author(s) 2024. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<24>
[Use Link to view the full text]
Accession Number
2034214666
Title
A Randomized Trial of Intravenous Amino Acids for Kidney Protection.
Source
New England Journal of Medicine. 391(8) (pp 687-698), 2024. Date of
Publication: 22 Aug 2024.
Author
Landoni G.; Monaco F.; Ti L.K.; Baiardo Redaelli M.; Bradic N.; Comis M.;
Kotani Y.; Brambillasca C.; Garofalo E.; Scandroglio A.M.; Viscido C.;
Paternoster G.; Franco A.; Porta S.; Ferrod F.; Calabro M.G.; Pisano A.;
Vendramin I.; Barucco G.; Federici F.; Severi L.; Belletti A.; Cortegiani
A.; Bruni A.; Galbiati C.; Covino A.; Baryshnikova E.; Giardina G.;
Venditto M.; Kroeller D.; Nakhnoukh C.; Mantovani L.; Silvetti S.; Licheri
M.; Guarracino F.; Lobreglio R.; Di Prima A.L.; Fresilli S.; Labanca R.;
Mucchetti M.; Lembo R.; Losiggio R.; Bove T.; Ranucci M.; Fominskiy E.;
Longhini F.; Zangrillo A.; Bellomo R.
Institution
(Landoni, Monaco, Baiardo Redaelli, Scandroglio, Franco, Calabro, Barucco,
Belletti, Galbiati, Giardina, Nakhnoukh, Licheri, Di Prima, Fresilli,
Labanca, Mucchetti, Lembo, Losiggio, Fominskiy, Zangrillo) The Department
of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute,
Milan, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University, Milan, Italy
(Brambillasca) Dipartimento di Chirurgia Cardiovascolare, Unita Operativa
di Anestesia e Terapia Intensiva, IRCCS Centro Cadiologico Monzino, Milan,
Italy
(Comis, Viscido, Porta, Ferrod) S.C. Anestesia e Rianimazione
Cardiovascolare, A.O. Ordine Mauriziano Umberto I di Torino, Turin, Italy
(Garofalo, Bruni, Longhini) The Department of Medical and Surgical
Sciences, University Hospital 'R. Dulbecco', Magna Graecia University,
Catanzaro, Italy
(Paternoster, Covino) Cardiovascular Anesthesia and ICU San Carlo
Hospital, Potenza, Italy
(Pisano, Venditto) Cardiac Anesthesia and ICU, AORN 'Dei Colli', Monaldi
Hospital, Naples, Italy
(Vendramin, Bove) The Department of Medicine, University of Udine, Rome,
Italy
(Vendramin) The Division of Cardiac Surgery, Azienda Sanitaria
Universitaria Friuli Centrale, Rome, Italy
(Bove) The Department of Anesthesia and Intensive Care Medicine, ASUFC
University, Hospital of Central Friuli, Rome, Italy
(Federici) Udine, UOC Anestesia e Rianimazione, Azienda Ospedaliero
Universitaria Sant'Andrea, Rome, Italy
(Severi) UO Complessa Anestesia e Rianimazione, Dipartimento
Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Rome,
Italy
(Cortegiani) The Department of Precision Medicine in Medical, Surgical and
Critical Care, University of Palermo, Palermo, Italy
(Baryshnikova, Ranucci) The Department of Cardiovascular Anesthesia and
Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Italy
(Kroeller) IRCCS Humanitas Research Hospital, Anestesia e Terapia
Intensiva Cardiochirurgica, Rozzano, Italy
(Mantovani) The Department of Anesthesia, ICU Maria Cecilia Hospital GVM
Care and Research, Cotignola, Italy
(Silvetti) The Department of Cardiac Anesthesia and Intensive Care,
Ospedale Policlinico San Martino IRCCS, IRCCS Cardiovascular Network,
Genoa, Italy
(Guarracino) The Department of Cardiothoracic and Vascular Anaesthesia and
Intensive Care, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
(Lobreglio) The Department of Anesthesia, Intensive Care and Emergency,
'Citta della Salute e della Scienza' University Hospital, Turin, Italy
(Ti) The Department of Anaesthesia, National University Hospital,
Singapore
(Bradic) The Clinic of Anesthesiology, Resuscitation, and Intensive
Medicine, University Hospital Dubrava, Zagreb, Croatia
(Kotani) The Department of Intensive Care Medicine, Kameda Medical Center,
Kamogawa, Japan
(Bellomo) The Department of Critical Care, University of Melbourne, The
Australian and New Zealand Intensive Care Research Centre, Monash
University, Melbourne, VIC, Australia
(Bellomo) The Department of Intensive Care, Austin Hospital, Melbourne,
VIC, Australia
(Bradic) University North, Department of Nursing, Varazdin, Croatia
(Cortegiani) The Department of Anesthesia Analgesia Intensive Care and
Emergency, University Hospital Policlinico Paolo Giaccone, Palermo, Italy
Publisher
Massachussetts Medical Society
Abstract
Background Acute kidney injury (AKI) is a serious and common complication
of cardiac surgery, for which reduced kidney perfusion is a key
contributing factor. Intravenous amino acids increase kidney perfusion and
recruit renal functional reserve. However, the efficacy of amino acids in
reducing the occurrence of AKI after cardiac surgery is uncertain. Methods
In a multinational, double-blind trial, we randomly assigned adult
patients who were scheduled to undergo cardiac surgery with
cardiopulmonary bypass to receive an intravenous infusion of either a
balanced mixture of amino acids, at a dose of 2 g per kilogram of ideal
body weight per day, or placebo (Ringer's solution) for up to 3 days. The
primary outcome was the occurrence of AKI, defined according to the Kidney
Disease: Improving Global Outcomes creatinine criteria. Secondary outcomes
included the severity of AKI, the use and duration of kidney-replacement
therapy, and all-cause 30-day mortality. Results We recruited 3511
patients at 22 centers in three countries and assigned 1759 patients to
the amino acid group and 1752 to the placebo group. AKI occurred in 474
patients (26.9%) in the amino acid group and in 555 (31.7%) in the placebo
group (relative risk, 0.85; 95% confidence interval [CI], 0.77 to 0.94;
P=0.002). Stage 3 AKI occurred in 29 patients (1.6%) and 52 patients
(3.0%), respectively (relative risk, 0.56; 95% CI, 0.35 to 0.87).
Kidney-replacement therapy was used in 24 patients (1.4%) in the amino
acid group and in 33 patients (1.9%) in the placebo group. There were no
substantial differences between the two groups in other secondary outcomes
or in adverse events. Conclusions Among adult patients undergoing cardiac
surgery, infusion of amino acids reduced the occurrence of AKI.
 Copyright © 2024 Massachusetts Medical Society.

<25>
[Use Link to view the full text]
Accession Number
2034199027
Title
Outcomes of Heart Transplantation from Donation after Circulatory Death:
An Up-to-date Systematic Meta-analysis.
Source
Transplantation. 108(9) (pp e264-e275), 2024. Date of Publication: 01 Sep
2024.
Author
Zong J.; Ye W.; Yu J.; Zhang X.; Cui J.; Chen Z.; Li Y.; Wang S.; Ran S.;
Niu Y.; Luo Z.; Li X.; Zhao J.; Hao Y.; Xia J.; Wu J.
Institution
(Zong, Ye, Yu, Zhang, Cui, Chen, Li, Wang, Ran, Niu, Luo, Li, Zhao, Hao,
Xia, Wu) Department of Cardiovascular Surgery, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Hubei,
Wuhan, China
(Zong, Ye, Chen, Xia, Wu) Center for Translational Medicine, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Hubei, Wuhan, China
(Yu, Zhang, Cui, Li, Wang, Ran, Niu, Luo, Li, Zhao, Hao, Xia, Wu) Hubei
Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Hubei,
Wuhan, China
(Xia, Wu) Key Laboratory of Organ Transplantation, Ministry of Education,
Chinese Academy of Medical Sciences, Hubei, Wuhan, China
(Xia, Wu) NHC Key Laboratory of Organ Transplantation, Chinese Academy of
Medical Sciences, Hubei, Wuhan, China
(Xia, Wu) Key Laboratory of Organ Transplantation, Chinese Academy of
Medical Sciences, Hubei, Wuhan, China
(Xia, Wu) Institute of Translational Medicine, Tongji Medical College,
Huazhong University of Science and Technology, Hubei, Wuhan, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background. Donation after circulatory death (DCD) heart transplantation
(HTx) significantly expands the donor pool and reduces waitlist mortality.
However, high-level evidence-based data on its safety and effectiveness
are lacking. This meta-analysis aimed to compare the outcomes between DCD
and donation after brain death (DBD) HTxs. Methods. Databases, including
MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled
Trials, were systematically searched for randomized controlled trials and
observational studies reporting the outcomes of DCD and DBD HTxs published
from 2014 onward. The data were pooled using random-effects models. Risk
ratios (RRs) with 95% confidence intervals (CIs) were used as the summary
measures for categorical outcomes and mean differences were used for
continuous outcomes. Results. Twelve eligible studies were included in the
meta-analysis. DCD HTx was associated with lower 1-y mortality rate (DCD
8.13% versus DBD 10.24%; RR=0.75; 95% CI, 0.59-0.96; P=0.02) and 5-y
mortality rate (DCD 14.61% versus DBD 20.57%; RR=0.72; 95% CI, 0.54-0.97;
P=0.03) compared with DBD HTx. Conclusions. Using the current DCD
criteria, HTx emerges as a promising alternative to DBD transplantation.
The safety and feasibility of DCD hearts deserve further exploration and
investigation. Copyright © 2024 Wolters Kluwer Health, Inc. All
rights reserved.

<26>
Accession Number
2034137896
Title
The Use of Immunomodulators, Biologic Therapies, and Small Molecules in
Patients with Inflammatory Bowel Disease and Solid Organ Transplant.
Source
Journal of Clinical Gastroenterology. (no pagination), 2024. Date of
Publication: 2024.
Author
Ghusn W.; Mourad F.H.; Francis F.F.; Pasha S.; Farraye F.A.; Hashash J.G.
Institution
(Ghusn) Division of Gastroenterology and Hepatology, Mayo Clinic, MN,
United States
(Ghusn) Department of Internal Medicine, Boston Medical Center, MA, United
States
(Mourad) Division of Gastroenterology and Hepatology, Department of
Internal Medicine, American University of Beirut, Beirut, Lebanon
(Francis) Division of Gastroenterology, Hepatology, and Nutrition,
University of Pittsburgh Medical Center, PA, United States
(Pasha) Division of Gastroenterology and Hepatology, Mayo Clinic, AZ,
United States
(Farraye, Hashash) Division of Gastroenterology and Hepatology, Mayo
Clinic, FL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Patients with inflammatory bowel diseases (IBDs) may require solid organ
transplants (SOTs) for multiple reasons, making its prevalence slightly
higher than the general population. Although immunosuppression used in SOT
may help control IBD-related inflammation, many patients still require
additional immunosuppressive medications. We aim to assess the
effectiveness and safety of the combination of SOT-related
immunosuppression and IBD medications in patients with liver, kidney, or
heart transplantation. We conducted a clinical review using PubMed,
Scopus, MEDLINE, Embase, and Google Scholar databases for our search. We
included data from systematic reviews, meta-analyses, case series, and
case reports to assess the safety, effectiveness, and side effect profile
of immunomodulators, biologic therapies, and small molecules in patients
with SOT. Our review encompassed 25 liver, 6 kidney, and 1 heart
transplant studies involving patients with IBD. Common liver transplant
immunosuppressants included tacrolimus, mycophenolate mofetil,
cyclosporine, and steroids. Anti-TNF agents, widely used in all SOT types,
showed no significant safety issues, though infections and malignancies
were noted. Patients with liver transplant on tacrolimus responded well to
anti-integrins and ustekinumab without major complications. For kidney
transplants, cyclosporine and tacrolimus were prevalent, and their
combination with anti-TNF or ustekinumab was generally safe, with rare
reports of malignancy or infection. Hence, the use of anti-TNF,
anti-integrin agents, and ustekinumab appears to be safe in patients with
SOT, regardless of their transplant related immunosuppression. More
studies are needed in patients with kidney and heart transplants and in
patients treated with small molecules for their IBD. Copyright ©
2024 Lippincott Williams and Wilkins. All rights reserved.

<27>
Accession Number
2031086962
Title
An Updated Comprehensive Review of Existing Transcatheter Aortic Valve
Replacement Access.
Source
Journal of Cardiovascular Translational Research. (no pagination), 2024.
Date of Publication: 2024.
Author
Sheng W.; Dai H.; Zheng R.; Aihemaiti A.; Liu X.
Institution
(Sheng, Dai, Zheng, Aihemaiti, Liu) Department of Cardiology, the Second
Affiliated Hospital Zhejiang University School of Medicine, Hangzhou
310009, China
(Sheng, Dai, Zheng, Aihemaiti, Liu) Internal Medicine, Zhejiang University
School of Medicine, Hangzhou 310058, China
(Liu) Binjiang Institute of Zhejiang University, Zhejiang, Hangzhou
310052, China
Publisher
Springer
Abstract
For the past 20 years, transcatheter aortic valve replacement (TAVR) has
been the treatment of choice for symptomatic aortic stenosis. The
transfemoral (TF) access is considered the gold standard approach for
TAVR. However, TF-TAVR cannot be performed in some patients; thus,
alternative accesses are required. Our review paper generalises the TAVR
accesses currently available, including the transapical, transaortic,
trans-subclavian/axillary, transcarotid, transcaval, and suprasternal
approaches. Their advantages and disadvantages have been analysed. Since
there is no standard recommendation for an alternative approach, access
selection depends on the expertise of the local cardiac team, patient
characteristics, and access properties. Each TAVR centre is recommended to
master a minimum of one non-TF access alternative. Of note, more evidence
is required to delve into the clinical outcomes of each approach, at both
early and long-term (Figure 1). Graphical Abstract: (Figure
presented.). Copyright © The Author(s), under exclusive licence
to Springer Science+Business Media, LLC, part of Springer Nature 2024.

<28>
Accession Number
645081846
Title
Long-Term Results Following Transcatheter Versus Surgical Aortic Valve
Replacement in Low-Risk Patients with Severe Aortic Stenosis: A Systematic
Review and Meta-Analysis of Randomized Trials.
Source
The American journal of cardiology. (no pagination), 2024. Date of
Publication: 20 Aug 2024.
Author
Caminiti R.; Ielasi A.; Vetta G.; Parlavecchio A.; Rocca D.G.D.; Glauber
M.; Tespili M.; Vizzari G.; Micari A.
Institution
(Caminiti, Ielasi, Tespili) U.O. Cardiologia Ospedaliera, IRCCS Ospedale
Galeazzi Sant'Ambrogio, Milan, Italy
(Vetta, Rocca) Heart Rhythm Management Centre, Postgraduate Program in
Cardiac Electrophysiology and Pacing, UniversitairZiekenhuis Brussel-Vrije
Universiteit Brussel, European Reference Networks Guard-Heart, Brussels,
Belgium
(Parlavecchio, Vizzari, Micari) Cardiology Unit, Department of Clinical
and Experimental Medicine, University of Messina, Messina, Italy
(Glauber) Mini-Invasive Cardiac Surgery Unit, IRCCS Ospedale Galeazzi
Sant'Ambrogio, Milan, Italy
Abstract
Transcatheter aortic valve replacement (TAVR) is a safe and effective
treatment option for patients with severe aortic stenosis at intermediate
or high surgical risk. Results after TAVR in low-risk patients are very
encouraging at mid-term follow-up while limited long-term (>= 3-year) data
are available in this subset of patients. This meta-analysis aims to
compare the long-term follow-up after TAVR versus surgical aortic valve
replacement (SAVR) in low-risk patients. We searched databases up to July
7th 2024, for randomized clinical trials (RCTs) comparing TAVR versus SAVR
in low-risk patients (defined as STS-PROM Score less than 4%). (PROSPERO
ID: CRD42023480495). Primary outcome analysed was all-cause death at
minimum 3-year follow-up. Secondary outcomes were: cardiovascular death,
disabling stroke, myocardial infarction (MI), aortic valve reintervention,
endocarditis, new-onset atrial fibrillation, permanent pacemaker
implantation (PPI) and bioprosthetic valve failure (BVF). A total of 3
RCTs with 2,644 patients (TAVR, n=1,371 patients; SAVR, n=1,273 patients)
were included. Follow-up time was 6 +/- 2.9 years. TAVR resulted
non-inferior to SAVR for all-cause death [RR: 0.99 (95% CI: 0.84-1.17;
p=0.89; I2=28%)], cardiovascular death [RR: 0.94 (95% CI: 0.76-1.15;
p=0.54; I2=0%)], MI [RR: 1.06 (95% CI: 0.71-1.57; p=0.79; I2=61%)], aortic
valve reintervention, endocarditis and BVF. New-onset atrial fibrillation
was higher in the SAVR group, while PPI in the TAVR group. In conclusion
our meta-analysis showed that TAVR is associated with similar long-term
outcomes compared to SAVR in selected, low-risk patients. Copyright
© 2024. Published by Elsevier Inc.

<29>
Accession Number
645081266
Title
Percutaneous coronary intervention with drug-eluting stents versus
coronary bypass surgery for coronary artery disease: a Bayesian
perspective.
Source
The Journal of thoracic and cardiovascular surgery. (no pagination),
2024. Date of Publication: 20 Aug 2024.
Author
Kawczynski M.J.; Gabrio A.; Maessen J.G.; van 't Hof A.W.J.; Brophy J.M.;
Gollmann-Tepekoylu C.; Sardari Nia P.; Vriesendorp P.A.; Heuts S.
Institution
(Kawczynski, Maessen, Sardari Nia, Heuts) Department of Cardiothoracic
Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, the
Netherlands; Cardiovascular Research Institute Maastricht (CARIM),
Maastricht University, Maastricht, the Netherlands
(Gabrio) Department of Methodology and Statistics, University Maastricht,
Maastricht, Netherlands
(van 't Hof) Cardiovascular Research Institute Maastricht (CARIM),
Maastricht University, Maastricht, the Netherlands; Department of
Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, the
Netherlands; Department of Cardiology, Zuyderland Medisch Centrum,
Heerlen, the Netherlands
(Brophy) McGill University Health Centre, Centre for Health Outcome
Research (CORE), Montreal, QC, Canada
(Gollmann-Tepekoylu) Department of Cardiac Surgery, Medical University of
Innsbruck, Innsbruck, Austria
(Vriesendorp) Cardiovascular Research Institute Maastricht (CARIM),
Maastricht University, Maastricht, the Netherlands; Department of
Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, the
Netherlands
Abstract
OBJECTIVES: Coronary revascularization is frequently performed for
coronary artery disease (CAD). This study aims to assess the totality of
randomized evidence comparing percutaneous coronary intervention with
drug-eluting stents (DES-PCI) to coronary artery bypass grafting (CABG)
for CAD. METHOD(S): A systematic search was applied to three
electronic databases, including randomized trials comparing DES-PCI to
CABG for CAD with 5-year follow-up. A Bayesian hierarchical meta-analytic
model was applied. The primary outcome was all-cause mortality at five
years; secondary outcomes were stroke, myocardial infarction, and repeat
revascularization. Endpoints were reported in median relative risks (RR)
and absolute risk differences (ARD), with 95% credible intervals (CrI).
Kaplan-Meier curves were used to reconstruct individual patient data.
 RESULT(S): Six studies comprising 8269 patients (DES-PCI n=4134, CABG
n=4135) were included. All-cause mortality at 5 years was increased with
DES-PCI (median RR 1.23 (95%CrI 1.01-1.45), with a median ARD of +2.3%
(95%CrI 0.1-4.5%). For stroke, MI, and repeat revascularization, the
median RRs were 0.79 (95%CrI 0.54-1.25), 1.84 (95%CrI 1.23-2.75), and 1.80
(95%CrI 1.51-2.16) for DES-PCI, respectively. In a sample of 1000 patients
undergoing DES-PCI instead of CABG for CAD, a median of 23 additional
deaths, 46 myocardial infarctions and 85 repeat revascularizations
occurred at five years, while 10 strokes were prevented.
 CONCLUSION(S): The current data suggests a clinically relevant
benefit of CABG over DES-PCI at five years, in terms of mortality,
myocardial infarction, and repeat revascularization, despite an increased
risk of stroke. These findings may guide the heart-team and the shared
decision-making process. Copyright © 2024. Published by Elsevier
Inc.

<30>
Accession Number
645079042
Title
Comparison Between Histidine-Tryptophan-Ketoglutarate Cardioplegia and
Cold Blood Cardioplegia for Myocardial Protection in Tetralogy of Fallot
Patients Undergoing Surgical Repair: A Randomized Clinical Trial.
Source
Journal of cardiothoracic and vascular anesthesia. (no pagination), 2024.
Date of Publication: 23 Jul 2024.
Author
Abdel Twab S.M.; Kamal F.; Fouad A.
Institution
(Abdel Twab) Department of Anaesthesiology, Intensive Care, Pain
Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Kamal, Fouad) Department of Anaesthesiology, Intensive Care, Pain
Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Abstract
OBJECTIVES: This study was conducted to compare the efficacy of
histidine-tryptophan-ketoglutarate (HTK) cardioplegia and cold blood
cardioplegia (CBC), especially for postoperative right ventricular (RV)
function after tetralogy of Fallot repair. DESIGN: Randomized,
double-blinded, parallel-group, controlled clinical trial. SETTING: Ain
Shams University Hospitals. PARTICIPANTS: A total of 100 children (1 to 5
years old) scheduled for tetralogy of Fallot repair. INTERVENTIONS:
Patients were allocated (double-blinded 1:1 allocation ratio) to either
the HTK group that received HTK cardioplegia (30 mL/kg via antegrade
route) or the CBC group that received cold blood cardioplegia with
blood-to-Ringer solution (4:1) in a volume of 20 mL/kg. MEASUREMENTS AND
MAIN RESULTS: The HTK group showed a statistically significant reduction
of the vasoactive inotropic score on admission to the pediatric intensive
care unit (13.0 +/- 4.1) in comparison to the CBC group (15.5 +/- 5.4),
with a p value of 0.011. However, after 24 hours, the vasoactive-inotropic
score was comparable. Lactate level during the first 24 hours was 6.2 +/-
0.7 mmol/L in the HTK group and 6.9 +/- 0.4 mmol/L in the CBC group (p <
0.0001). Serial troponin measurements were lower in the HTK group (1.49
+/- 0.45) compared to the CBC group (1.69 +/- 0.18) at the first 72 hours
postoperatively (p = 0.005). Postoperative echocardiographic assessment of
RV function by means of tricuspid annular plane systolic excursion and
myocardial performance index were better in the HTK group than in the CBC
grpup (p < 0.05). CONCLUSION(S): HTK cardioplegia may offer better
cardiac protection to pediatric patients undergoing tetralogy of Fallot
repair than our institutional standard CBC with better recovery for the
hypertrophic RV. Copyright © 2024 Elsevier Inc. All rights
reserved.

<31>
Accession Number
644981481
Title
Left Atrial Appendage Closure Compared With Oral Anticoagulants for
Patients With Atrial Fibrillation: A Systematic Review and Network
Meta-Analysis.
Source
Journal of the American Heart Association. 13(16) (pp e034815), 2024. Date
of Publication: 20 Aug 2024.
Author
Oliva A.; Ioppolo A.M.; Chiarito M.; Cremonesi A.; Azzano A.; Micciche E.;
Mangiameli A.; Ariano F.; Ferrante G.; Reimers B.; Garot P.; Amabile N.;
Mehran R.; Condorelli G.; Stefanini G.; Cao D.
Institution
(Oliva, Ioppolo, Cremonesi, Azzano, Micciche, Mangiameli, Ariano, Cao)
Cardiovascular Department Humanitas Gavazzeni Hospital Bergamo Italy,
Italy
(Oliva, Chiarito, Cremonesi, Ferrante, Reimers, Condorelli, Stefanini,
Cao) Department of Biomedical Sciences Humanitas University Pieve Emanuele
MI Italy, Italy
(Oliva, Chiarito, Ferrante, Reimers, Condorelli, Stefanini) Cardio Center
Humanitas Clinical and Research Hospital IRCCS Rozzano Italy, Italy
(Garot, Amabile, Cao) Institut Cardiovasculaire Paris Sud (ICPS), France
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute Icahn School
of Medicine at Mount Sinai New York NY USA
Abstract
BACKGROUND: Percutaneous left atrial appendage closure (LAAC) has been
suggested as an alternative to long-term oral anticoagulation for
nonvalvular atrial fibrillation, but comparative data remain scarce. We
aimed to assess ischemic and bleeding outcomes of LAAC compared with
vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) for the
prevention of cardioembolic events in patients with atrial fibrillation.
METHODS AND RESULTS: Embase and MEDLINE were searched for randomized
trials comparing LAAC, VKAs, and DOACs. The primary efficacy end point was
any stroke or systemic embolism. Treatment effects were calculated from a
network meta-analysis and ranked according to the surface under the
cumulative ranking curve. Seven trials and 73199 patients were included.
The risk of the primary end point was not statistically different between
LAAC versus VKAs (odds ratio [OR], 0.92 [95% CI, 0.62-1.50]) and LAAC
versus DOACs (OR, 1.11 [95% CI, 0.71-1.73]). LAAC and DOACs resulted in
similar risk of major or minor (OR, 0.93 [95% CI, 0.61-1.42]) and major
bleeding (OR, 0.92 [95% CI, 0.58-1.46]); however, after exclusion of
procedural bleeding, bleeding risk was significantly lower in those
undergoing LAAC. Both LAAC and DOACs reduced the risk of all-cause death
compared with VKAs (LAAC versus VKAs: OR, 0.70 [95% CI, 0.53-0.91]; DOACs
versus VKAs: OR, 0.90 [95% CI, 0.85-0.95], respectively). DOACs ranked as
the best treatment for stroke or systemic embolism prevention (66.9%) and
LAAC for reducing major bleeding (63.9%) and death (96.4%).
 CONCLUSION(S): As a nonpharmacological alternative to oral
anticoagulation for atrial fibrillation, LAAC showed similar efficacy and
safety compared with VKAs or DOACs. Prospective confirmation from larger
studies is warranted.

<32>
Accession Number
2031074431
Title
Impact of Dexmedetomidine Dosing and Timing on Acute Kidney Injury and
Renal Outcomes After Cardiac Surgery: A Meta-Analytic Approach.
Source
Annals of Pharmacotherapy. (no pagination), 2024. Date of Publication:
2024.
Author
Li H.; Wang L.; Shi C.; Zhou B.; Yao L.
Institution
(Li, Wang, Shi, Zhou, Yao) Department of Anesthesiology, Peking University
International Hospital, Beijing, China
Publisher
SAGE Publications Inc.
Abstract
Background: Acute kidney injury (AKI) is a common and serious complication
following cardiac surgery. Dexmedetomidine, a highly selective
alpha2-adrenergic agonist, has shown potential renoprotective effects, but
previous studies have yielded conflicting results. Objective(s): This
meta-analysis aimed to evaluate the efficacy and safety of dexmedetomidine
in preventing AKI and reducing postoperative serum creatinine levels in
adult patients undergoing cardiac surgery. Method(s): We
comprehensively searched 5 databases for randomized controlled trials
comparing dexmedetomidine with control groups in adult cardiac surgery
patients. The main outcomes were the incidence of AKI and change in
postoperative serum creatinine levels. Meta-analyses were conducted using
RevMan 5.4 models, and subgroup analyses were performed based on
dexmedetomidine dosing and timing of administration. Continuous outcomes
were combined and analyzed using either mean difference (M.D.), while
dichotomous outcomes were analyzed using risk ratio (RR) with 95%
confidence intervals (CI). Result(s): Our study included a total of
14 trials involving 2744 patients. Dexmedetomidine administration
significantly reduced the incidence of AKI compared to control groups (RR
= 0.54, 95% CI: 0.41-0.70, P < 0.00001). Postoperative serum creatinine
levels were also lower with dexmedetomidine (MD = -0.14 mg/dL, 95% CI:
-0.28 to -0.001, P =0.04). Subgroup analyses revealed that higher initial
doses (>0.5 mug/kg) and administration during intraoperative and
postoperative periods were associated with more pronounced renoprotective
effects. Dexmedetomidine did not significantly affect mortality but
reduced the duration of the length of hospital stay and mechanical
ventilation. Conclusions and Relevance: This meta-analysis
demonstrates that dexmedetomidine administration, particularly at higher
doses and during both intraoperative and postoperative periods, reduces
the risk of AKI in adults undergoing cardiac surgery. These findings
support the use of dexmedetomidine as a preventive strategy to enhance
renal outcomes in this population. Copyright © The Author(s)
2024.

<33>
Accession Number
2031028164
Title
Characteristics and Outcomes of Fetal Cardiac Rhabdomyoma With or Without
mTOR Inhibitors, a Systematic Review and Meta-Analysis.
Source
Prenatal Diagnosis. (no pagination), 2024. Date of Publication: 2024.
Author
Mustafa H.J.; Javinani A.; Morning M.L.; D'Antonio F.; Pagani G.; Puranik
P.M.; Khalil A.; Shamshirsaz A.A.
Institution
(Mustafa) The Fetal Center at Riley Children's and Indiana University
Health, Division of Maternal-Fetal Medicine, Indiana University School of
Medicine, Indianapolis, IN, United States
(Javinani, Shamshirsaz) Maternal Fetal Care Center, Division of Fetal
Medicine and Surgery, Boston Children's Hospital, Harvard Medical School,
Boston, MA, United States
(Morning) Department of Obstetric and Gynecology, Indiana University
School of Medicine, Indianapolis, IN, United States
(D'Antonio) Center for Fetal Care and High-Risk Pregnancy, Department of
Obstetrics and Gynecology, University Hospital of Chieti, Chieti, Italy
(Pagani) Maternal Fetal Medicine Unit, Department of Obstetrics and
Gynecology, ASST-Papa Giovanni XXIII, Bergamo, Italy
(Puranik) Pediatric Cardiology, Riley Hospital for Children and Indiana
University School of Medicine, Indianapolis, IN, United States
(Khalil) Fetal Medicine Unit, St George's Hospital, St George's University
of London, London, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Objectives: To investigate the characteristics and outcomes of fetal
cardiac rhabdomyoma with or without prenatal use of mammalian target of
rapamycin inhibitor (mTORi). Search Strategy: We systematically searched
PubMed, Scopus, and Web of Science until June 2023. Selection
Criteria: Studies reporting on pregnancies with fetal cardiac rhabdomyoma
were included. Data Collection and Analysis: A meta-analysis of
proportions was conducted only on studies that included three or more
cases. Result(s): A systematic review included 61 studies reporting
on 400 fetuses with cardiac rhabdomyoma, of which 52 studies (389 fetuses)
had expectant management and 9 studies (11 fetuses) were managed with
mTORi. The meta-analysis included 26 studies reporting on 354 fetuses.
Prenatally, 14% (95% CI 4-36) had pericardial effusion, 13% (95% CI 6-27)
had arrhythmia, 16% (95% CI 7-31) had outflow tract obstruction, and 10%
(95% CI 4-21) had hydrops. Fetal demise occurred in 12% (95% CI 5-30).
Before delivery, tumor size reduction was noted in 13%, and after birth in
58%. Following birth, 8% (95% CI 3-14) had neonatal death and 9% (95%
4-17) required cardiac surgery. 60% (95% CI 41-79) of cases were diagnosed
with tuberous sclerosis. Seizures were reported only in cases with a
tuberous sclerosis diagnosis (41/71 infants). For the 9 studies reporting
all together on 11 fetuses with tuberous sclerosis receiving prenatal
mTORi, they showed improvement in the size of cardiac rhabdomyoma as well
as outflow obstruction and none had fetal demise or neonatal death, and
none required postnatal cardiac surgery. Conclusion(s): We report on
the natural history of prenatal cardiac rhabdomyoma, including
characteristics, progression, and survival. We report 11 fetuses with
tuberous sclerosis and cardiac rhabdomyoma receiving prenatal mTORi,
showing promising results. Copyright © 2024 The Author(s).
Prenatal Diagnosis published by John Wiley & Sons Ltd.

<34>
Accession Number
2030624587
Title
Comparing the Hemodynamic Effects of Midazolam, Etomidate, and Propofol
following Anesthesia Induction in Coronary Artery Bypass Graft Surgery: A
Double-Blind Randomized Clinical Trial.
Source
Journal of Tehran University Heart Center. 19(2) (pp 89-95), 2024. Date of
Publication: 2024.
Author
Afghaniyan P.; Farhadian M.; Tarbiat M.; Bakhshaei M.H.; Salimbahrami S.A.
Institution
(Afghaniyan) Faculty of Medicine, Hamadan University of Medical Sciences,
Hamadan, Iran, Islamic Republic of
(Farhadian) Research Center for Health Sciences, Department of
Biostatistics, School of Public Health, Hamadan University of Medical
Sciences, Hamadan, Iran, Islamic Republic of
(Tarbiat, Bakhshaei, Salimbahrami) Department of Anesthesiology, School of
Medicine, Hamadan University of Medical Sciences, Hamadan, Iran, Islamic
Republic of
Publisher
Tehran Heart Center
Abstract
Background: Hemodynamic disorders during anesthesia lead to complications.
To reduce hemodynamic complications, this study was conducted to compare
midazolam, etomidate, and propofol following anesthesia induction in
patients undergoing coronary artery bypass grafting surgery (CABG).
 Method(s): A double-blind, randomized clinical trial was conducted
involving 90 patients with coronary artery disease. These patients were
randomly assigned to 1 of 3 groups receiving propofol, etomidate, or
midazolam. Hemodynamic variables, including systolic blood pressure (SBP),
diastolic blood pressure (DBP), mean arterial blood pressure (MABP), and
heart rate (HR), were measured at baseline, before intubation, and 1 and 5
minutes after intubation. Result(s): Ninety patients with coronary
artery disease (mean age: 60.83 y) were included in the study. Women and
men comprised 74.4% and 25.6% of the study population. HR, SBP, DBP, and
MABP exhibited significant decreases in all 3 groups after intubation. The
etomidate group demonstrated the least change in SBP (P<0.001) and MABP
(P<0.001), followed by the midazolam group. Concerning HR, the least
change was observed in the midazolam group, followed by the propofol group
(P=0.688). After intubation, blood pressure increased almost equally in
the etomidate and midazolam groups compared with the levels during
intubation. In contrast, the propofol group exhibited a downward trend in
blood pressure during intubation, a significant difference across all 3
groups (P<0.001). Conclusion(s): This study, conducted on candidates
for CABG, demonstrated that anesthesia induction with etomidate and
midazolam resulted in less variation in hemodynamic variables compared
with propofol. Copyright © 2024 Tehran University of Medical
Sciences.

<35>
Accession Number
2034175336
Title
Exploring the Acceptable Delay for Elective Treatment of Patients With an
Abdominal Aortic Aneurysm: A Reflection During a Pandemic and an
Exploratory Analysis.
Source
Journal of Surgical Research. 302 (pp 555-560), 2024. Date of Publication:
October 2024.
Author
Leveille N.; Laurendeau A.; Drudi L.M.; Elkouri S.
Institution
(Leveille, Drudi, Elkouri) Faculte de medecine de l'Universite de
Montreal, Montreal, QC, Canada
(Laurendeau) Faculte de medecine de l'Universite Laval, Quebec, QC, Canada
(Drudi, Elkouri) Centre de recherche du Centre Hospitalier de l'Universite
de Montreal (CRCHUM), Montreal, QC, Canada
Publisher
Academic Press Inc.
Abstract
Introduction: This study sought to determine the rupture risk of
asymptomatic abdominal aortic aneurysms (AAAs) undergoing interventions as
a function of time to establish a maximal acceptable surgical delay.
 Method(s): A literature review was performed from inception to August
30, 2021, to assess the risk of rupture of aneurysms over time. The
analysis was limited to men with asymptomatic AAAs. The data on AAA
rupture risk according to diameter and follow-up time were extracted. The
acceptable mortality risk for AAA patients as a function of surgical delay
was further evaluated. This acceptable mortality risk was based on the
acceptable risk of cardiovascular death associated with the accepted
delays of coronary revascularization in coronary artery disease
populations. Data on estimated surgical delays and risks were extracted
using a free web-based software (WebPlotDigitizer) and plotted using
Microsoft Excel. Result(s): Our study identified minimal evidence as
it pertains to AAA rupture risk as a function of surgical delay. The data
on rupture risk of AAAs according to diameter and time were extracted from
a single review and a single meta-analysis (Figure 1). The acceptable
delays of semiurgent and nonurgent invasive treatment for coronary artery
disease found in literature are 6 and 12 wks respectively. These
acceptable delays are associated with an estimated acceptable
cardiovascular mortality risk threshold of 0.47% at 6 and 12 wks. Using
this threshold of estimated maximum acceptable risk and the data on the
natural history of AAAs found in our review, we found that the acceptable
surgical delays for AAAs would be estimated at 13-27 ds for AAAs >= 7 cm,
20-42 ds for 6-6.9 cm, and 32-49 ds for 5.5-5.9 cm (Figure 1).
 Conclusion(s): This study identified estimated surgical delays for
patients with AAAs based on the acceptable maximum risk. These estimations
may be used cautiously to triage patients with asymptomatic AAAs,
particularly in the setting of triaging patients during local and global
crises. Copyright © 2024

<36>
Accession Number
2034172904
Title
Assessment of LGBTQ+ Diversity, Equity, and Inclusion in Subspecialty
Surgery Literature: A Scoping Review.
Source
World Neurosurgery. 190 (pp 297-307), 2024. Date of Publication: October
2024.
Author
Foresi B.; Galbraith L.; Uzoukwu C.; Ezeudu C.; Najafali D.; Pannullo S.
Institution
(Foresi, Galbraith, Uzoukwu) Northeast Ohio Medical University, College of
Medicine, Rootstown, OH, United States
(Ezeudu) Texas A&M, College of Medicine, College Station, TX, United
States
(Najafali) Carle Illinois College of Medicine, University of Illinois
Urbana-Champaign, Urbana, IL, United States
(Pannullo) New York Presbyterian/Weill Cornell, Department of
Neurosurgery, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objective: To identify LGBTQ+ diversity, equity, and inclusion (DEI)
publications and contextualize the current frequency of the literature
across subspecialty surgical fields. Method(s): A PRISMA systematic
review using PubMed, MEDLINE, and Web of Science was conducted in April
2024. The main inclusion criterion was intrafield DEI content for defined
subspecialties; exclusion criteria were foreign language, poor
methodology, and duplicates. The primary endpoint was the number of
publications across subspecialties. Secondary endpoints included
publication dates, study design, and sample size. Result(s): Of the
702 articles identified, 27 were included in the analysis. Neurologic
surgery had 2 studies; plastic surgery, 11 studies; orthopedic surgery, 7
studies; otolaryngology, 5 studies; and thoracic surgery, 2 studies. There
was a statistically significant different frequency of publications across
subspecialties (P = 0.031). Post hoc residual analysis indicated that
neurosurgery and thoracic surgery had statistically fewer publications,
while plastic surgery had statistically more publications (P = 0.04,
0.002, 0.21, 0.42, and 0.04 for neurologic surgery, plastic surgery,
orthopedic surgery, otolaryngology, and thoracic surgery, respectively).
Secondary outcomes found a majority of publications between 2022 and 2024.
Study methodologies involved cross-sectional studies, editorials, and
retrospective reviews (14, 11, and 3 respectively) and had a median sample
size of 248.5. Conclusion(s): This systematic review provides
objective data to contextualize DEI literature across surgical
subspecialties. Overall, this review highlights the lack of LGBTQ+ DEI
literature in neurosurgery and advocates for correcting this gap for the
benefit of both surgeons and patients. Understanding the current numbers
and evaluating progress in other surgical fields might provide
solutions. Copyright © 2024 Elsevier Inc.

<37>
Accession Number
2034164902
Title
Short- and Midterm Outcomes of Off- and On-Pump Coronary Artery Bypass in
Patients with a Mean Age of 65 or More: Systematic Review and
Meta-Analysis.
Source
Journal of Cardiac Surgery. 2024 (no pagination), 2024. Article Number:
3616580. Date of Publication: 2024.
Author
Trotman J.E.; Eboka T.F.; Smart N.A.; King N.
Institution
(Trotman, Eboka, King) School of Biomedical Science, Faculty of Health,
University of Plymouth, Plymouth, United Kingdom
(Smart) School of Science and Technology, Faculty of Science, Agriculture,
Business and Law, University of New England, Armidale, Australia
Publisher
Wiley-Hindawi
Abstract
Background. Advancing age is a nonmodifiable risk factor for the
development of coronary artery disease. Furthermore, patients >65 years
old are considered at high risk for coronary artery bypass grafting
(CABG). The aim of this study was to investigate whether there were any
differences in clinical outcomes for patients with a mean age >=65
undergoing CABG on or off pump. Methods. Systematic searches were
conducted in EMBASE, PubMed, Web of Science, and Cochrane Central Registry
of Controlled Trials (CENTRAL). The key search terms used were
"cardiopulmonary bypass"OR "On pump"AND "off pump"OR "beating heart"AND
"coronary artery bypass grafting"OR "CABG"AND "age."This was followed by a
meta-analysis assessing the primary outcomes mortality, myocardial
infarction, renal failure, and stroke in the short - (30 days) and midterm
(12-44 months) and repeat revascularisation at midterm follow up.
Secondary outcomes investigated included postoperative atrial
fibrillation, number of units of blood transfused, ventilation time,
length of intensive care unit stay, and length of hospital stay. Results.
14 studies involving 10,260 participants, 5,141 of whom had on-pump CABG
and 5,119 of whom had off-pump CABG were identified. There was a
significantly greater need for repeat revascularisation in the off-pump
group (risk ratio 1.47, 95% confidence interval 1.07 to 2.01, I2 = 0%,
p=0.02) at midterm follow up. The off-pump group also had a shorter
hospital stay. All other comparisons were insignificant. Conclusion. A
number of different factors contribute to whether the increased need for
repeat revascularisation for off-pump patients is truly clinically
significant. This requires further investigation in meta-analysis based on
longer-term trials in patients with a mean age >=65. Otherwise, the
similarity in clinical outcomes for patients in this age group suggests
the choice to carry out CABG on or off pump should continue to be at the
surgeon's discretion. Copyright © 2024 Jake E. Trotman et al.

<38>
Accession Number
2034135241
Title
A Systematic Review and Meta-Analysis of 35,409 Patients Undergoing PCI
versus CABG for Unprotected Left Main Coronary Artery Diseases.
Source
Reviews in Cardiovascular Medicine. 25(8) (no pagination), 2024. Article
Number: 282. Date of Publication: August 2024.
Author
Liu H.; Li D.; Gao C.; Dai H.; Kang L.; Zhang M.; Yun C.; Guo W.
Institution
(Liu, Li, Gao, Dai, Zhang, Guo) Department of Cardiology, The Second
Affiliated Hospital, Air Force Medical University, Shaanxi, Xi'an 710038,
China
(Kang) Department of Gastroenterology, The Second Affiliated Hospital, Air
Force Medical University, Shaanxi, Xi'an 710038, China
(Yun) Department of Anesthesiology, The Second Affiliated Hospital, Air
Force Medical University, Shaanxi, Xi'an 710038, China
Publisher
IMR Press Limited
Abstract
Background: Patients with unprotected left main (UPLM) disease who
underwent percutaneous coronary intervention (PCI) were found to have
inconsistent results compared to those treated with coronary artery bypass
grafting (CABG). Method(s): We identified and enrolled randomized
controlled trials (RCTs) and observational studies (OSs) comparing PCI
versus CABG for UPLM disease. A meta-analysis was performed using Stata
17.0. The primary endpoints were major adverse cardiovascular and
cerebrovascular events (MACCEs). Additionally, all-cause death, cardiac
death, myocardial infarction (MI), stroke, target vessel revascularization
(TVR), and stent thrombosis (ST) were included as secondary endpoints. The
odds ratios and 95% confidence intervals (CIs) were calculated.
Sensitivity analyses were implemented if I2 > 50% or p < 0.01.
Publication bias analysis was conducted if more than 10 studies were
included. Result(s): A total of 5 RCTs and 18 OSs involving 35,409
patients were included. The CABG strategy had a significantly lower
incidence of MACCEs, primarily due to TVR. A significantly lower stroke
rate was observed with the PCI strategy, as well as a significantly lower
all-cause death, cardiac death, MI, and ST rate compared with the CABG
strategy. Conclusion(s): MACCE rates were significantly lower in
patients who underwent CABG, primarily due to TVR, but stroke rates were
higher. RCTs with different study types need further investigation to
confirm the most effective strategy. Copyright © 2024 The
Author(s).

<39>
[Use Link to view the full text]
Accession Number
2034096864
Title
Fecal Microbiota, Live-jslm for the Prevention of Recurrent Clostridioides
difficile Infection Subgroup Analysis of PUNCH CD2 and PUNCH CD3.
Source
Journal of Clinical Gastroenterology. 58(8) (pp 818-824), 2023. Date of
Publication: 30 Nov 2023.
Author
Feuerstadt P.; Crawford C.V.; Tan X.; Pokhilko V.; Bancke L.; Ng S.;
Guthmueller B.; Bidell M.R.; Tillotson G.; Johnson S.; Skinner A.M.
Institution
(Feuerstadt) The Yale School of Medicine, Division of Digestive Diseases,
New Haven, CT, United States
(Feuerstadt) PACT Gastroenterology Center, Hamden, CT, United States
(Crawford) Weill Cornell Medicine, New York, NY, United States
(Tan, Pokhilko, Ng, Bidell) Ferring Pharmaceuticals, Parsippany, NJ,
United States
(Bancke, Guthmueller) Ferring Pharmaceuticals, Roseville, MN, United
States
(Tillotson) GST Micro LLC, North, VA, United States
(Johnson, Skinner) Edward Hines Jr. Veterans Affairs Hospital, Department
of Research and Medicine, Hines, IL, United States
(Johnson, Skinner) Loyola University Medical Center, Department of
Medicine, Fahey Center, Maywood, IL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Goals: To assess fecal microbiota, live-jslm (REBYOTA, abbreviated as RBL,
formerly RBX2660) efficacy and safety in participants grouped by recurrent
Clostridioides difficile infection (rCDI) risk factors and
treatment-related variables. Background(s): RBL is the first
microbiota-based live biotherapeutic approved by the US Food and Drug
Administration for the prevention of rCDI in adults after antibiotic
treatment for rCDI. Study: Treatment success rates across subgroups for
PUNCH CD3 (NCT03244644) were estimated using a Bayesian hierarchical
model, borrowing data from PUNCH CD2 (NCT02299570). Treatment-emergent
adverse events were summarized for the double-blind treatment period
within 8 weeks. Result(s): Treatment differences between RBL and
placebo at 8 weeks were similar to the total population for most
subgroups. Treatment effect sizes were similar between CDI tests, higher
for oral vancomycin courses > 14 days versus <= 14 days and higher for
antibiotic washout periods of 3 days versus <= 2 days. The largest
reductions in the rate of rCDI with RBL versus placebo were observed for
participants with a 3-day CDI antibiotic washout period and participants
with >= 4 previous CDI episodes. Most RBL-treated participants experienced
TEAEs that were mild or moderate in severity and related to preexisting
conditions. Conclusion(s): This analysis provides further evidence of
RBL efficacy and safety across subgroups, including those at high risk for
rCDI. Copyright © 2023 The Author(s).

<40>
Accession Number
2034137753
Title
Coronary Procedures via Distal Transradial Access in Older as Compared
With Non-Older Patients: Insights From the DISTRACTION Registry.
Source
Journal of Invasive Cardiology. 35(9) (no pagination), 2023. Date of
Publication: September 2023.
Author
Oliveira M.D.; Navarro E.C.; Branca N.R.; Garcia M.E.; Scarpa M.C.;
Caixeta A.
Institution
(Oliveira, Caixeta) The Discipline of Cardiology, Interventional
Cardiology Unit, Hospital Universitario I, Escola Paulista de Medicina,
Universidade Federal de Sao Paulo, SP, Sao Paulo, Brazil
(Oliveira, Navarro) Department of Interventional Cardiology, Hospital
Regional do Vale do Paraiba, SP, Taubate, Brazil
(Branca, Garcia, Scarpa) Hospital Municipal Universitario de Taubate, SP,
Taubate, Brazil
(Caixeta) Hospital Israelita Albert Einstein, SP, Sao Paulo, Brazil
Publisher
Cliggott Publishing Co.
Abstract
BACKGROUND. Older patients are at a higher risk of access site
complications and bleeding. Systematic reviews and meta-analysis have
highlighted the benefits of distal over proximal transradial access
(mainly, lower rates of radial artery occlusion and faster hemostasis). We
aimed to evaluate the feasibility and safety of distal transradial access
(dTRA) for routine coronary procedures in older patients compared with
non-older patients. METHODS. Retrospective analysis of a large and
real-world sample of 5524 consecutive all-comers patients who underwent
coronary procedures via dTRA were included in the DISTRACTION registry.
RESULTS. In the older patients (>=65 years) group (n = 2594, 47%), there
were higher rates of hypertension (83% vs 71.1%; P<.0001), diabetes (45.1%
vs 34.7%; P<.0001), previous stroke (2.9% vs 2%; P=.0425), chronic heart
failure (9.2% vs 7.1%; P=.0040), severe aortic valvar disease (4.2% vs
2.9%; P=.0070), chronic kidney disease stages 3 and 4 (8.1% vs 3.1%;
P<.0001), previous percutaneous coronary intervention (27.2% vs 24.5%;
P=.0253), previous coronary artery bypass grafting (5.1% vs 2.2%;
P<.0001), cardiogenic shock at presentation (1.3% vs 0.4%; P=.0003),
rotational atherectomy (0.7% vs 0.2%; P=.0050), and left main percutaneous
coronary intervention (2.7% vs 1.5%; P=.0033). No significant differences
were observed in the rates of access site crossovers. No major adverse
cerebrovascular and cardiac events directly related to dTRA, no hand/thumb
dysfunction or ischemia after any procedure, and no access site-related
hematomas (early discharge after transradial stenting of coronary arteries
>=2) were recorded. CONCLUSIONS. Despite more comorbidities, more complex
coronary disease, and more challenging presentation, the adoption of dTRA
as the default approach for routine coronary procedures in older patients,
by proficient operators, appears to be safe and feasible. Copyright
© 2023 HMP Global. All Rights Reserved.

<41>
Accession Number
645064298
Title
Effect of narrative photography to improve physical therapy students'
learning outcomes when studying heart transplantation: A randomized
controlled trial.
Source
Nursing & health sciences. 26(3) (pp e13155), 2024. Date of Publication:
01 Sep 2024.
Author
Marques-Sule E.; Sempere-Rubio N.; Gomez-Ibanez R.; Leyva-Moral J.M.;
Mestres-Soler O.; Munoz-Gomez E.
Institution
(Marques-Sule) Multispeciality Research Group (PTinMOTION), Department of
Physiotherapy, University of Valencia, Valencia, Spain
(Sempere-Rubio, Munoz-Gomez) Department of Physiotherapy, University of
Valencia, Valencia, Spain
(Gomez-Ibanez, Leyva-Moral) Nursing Department, Faculty of Medicine.
Autonomous University of Barcelona, Bellaterra, Spain
(Gomez-Ibanez, Leyva-Moral) Nursing Research Group on Vulnerability and
Health (GRIVIS), Nursing Department, Faculty of Medicine, Autonomous
University of Barcelona, Bellaterra, Spain
(Mestres-Soler) Multidisciplinary Nursing Research Group, VHIR Vall
d'Hebron Institute of Research, Barcelona, Spain
(Mestres-Soler) Vall d'Hebron University Hospital, Barcelona, Spain
Abstract
Physical therapy students must learn about heart transplantation. They
need to know how to care for these patients' emotions and needs. The study
aimed to compare the effectiveness of a narrative photography (NP) program
and a traditional learning (TL) program in physical therapy students'
knowledge, satisfaction, empathy, and moral sensitivity. A two-armed
assessor-blinded randomized controlled trial was carried out. One hundred
and seventeen physical therapy students participated in the study. They
were divided into two groups: (i) NP group (n=56) and (ii) TL group
(n=61). At the end of the program, NP group's knowledge increased when
compared with the TL group (p=0.02). 90.57% of the sample was very
satisfied/satisfied with the NP method, and 88.68% felt that NP helped
them to understand the importance of considering subjective realities. In
conclusion, NP improved knowledge and satisfaction compared with the TL
group. These results suggest that NP may be a useful method to improve the
academic outcomes of physical therapy students in the heart
transplantation field; thus, NP may be considered a teaching-learning
methodology of choice in physical therapy students. Copyright ©
2024 The Author(s). Nursing & Health Sciences published by John Wiley &
Sons Australia, Ltd.

<42>
Accession Number
2034255014
Title
SARS-CoV-2 infection-induced immune thrombocytopenia in a patient with
orthotopic heart transplantation: A case report and literature review.
Source
Journal of Cardiology Cases. (no pagination), 2024. Date of Publication:
2024.
Author
Ono R.; Iwahana T.; Aoki K.; Kato H.; Tsutsui Y.; Takaishi K.; Takeda Y.;
Sakaida E.; Kobayashi Y.
Institution
(Ono, Iwahana, Aoki, Kato, Kobayashi) Department of Cardiovascular
Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
(Tsutsui, Takaishi, Takeda, Sakaida) Department of Hematology, Chiba
University Graduate School of Medicine, Chiba, Japan
Publisher
Elsevier Ltd
Abstract
Immune thrombocytopenia (ITP) is an acquired autoimmune disorder
characterized by low platelet counts with increased risk of bleeding. In
particular, ITP induced by severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) infection has been increasingly reported. Since
immunosuppressive regimens in organ transplantation are often the primary
cause of increased risk of infection, ITP following solid organ
transplantation has occasionally been observed. However, SARS-CoV-2
infection-induced ITP in a heart transplant patient has not been reported.
We report the first case of ITP after SARS-CoV-2 infection in an
orthotopic heart transplant patient who did not respond well to first-line
ITP treatment. We also review the previously reported cases of SARS-CoV-2
infection-induced ITP on immunosuppressive therapy. Learning objective:
Post-transplant immune thrombocytopenia (ITP) may have different
mechanisms than ordinal ITP; post-transplant ITP may be associated with
donor condition such as history of ITP, autoantibodies, and use of
immunosuppressants. Our literature review showed that severe acute
respiratory syndrome coronavirus 2 infection-induced ITP patients with
autoimmune diseases, with malignant hematologic disorders, or after organ
transplantation may be refractory to prednisolone and intravenous
immunoglobulin and require second-line ITP treatments. Copyright
© 2024

<43>
Accession Number
2034202402
Title
Dexamethasone for Cardiac Surgery: A Practice Preference-Randomized
Consent Comparative Effectiveness Trial.
Source
Anesthesiology. (no pagination), 2024. Article Number:
10.1097/ALN.0000000000005127. Date of Publication: 2024.
Author
Dieleman J.M.; Forbes A.; Martin C.A.; Smith J.A.; McGiffin D.; Myles
P.S.; Wallace S.; Ueoka M.; Dutton M.; Robertshaw S.; Clarris M.; Neylan
A.; Smith J.; Hulley A.; Warwarek S.; Painter T.; Heyman K.; Falland
R.-L.; Pieterse J.; Fiddes R.; Marriott A.; Dieleman J.; Cope J.;
Clark-Mackay E.; Munting K.E.; Verheijen L.P.J.; van Dijk D.; Wietsma
N.E.; Monteiro de Olivieira N.P.; Oey L.W.L.
Institution
(Myles, Wallace) Department of Anaesthesiology and Perioperative Medicine,
Alfred Hospital, Monash University, Melbourne, Australia
(Dieleman) Department of Anaesthesia, Westmead Hospital, Western Sydney
University, Penrith, Australia
(Munting, Verheijen) Department of Anaesthesia, University Medical Center,
Utrecht, Netherlands
(Forbes, Martin) Biostatistics Unit, School of Public Health and
Preventive Medicine, Monash University, Melbourne, Australia
(Smith) Department of Cardiothoracic Surgery, Department of Surgery,
School of Clinical Sciences at Monash Health, Monash University, Clayton,
Australia
(McGiffin) Department of Cardiothoracic Surgery, Alfred Hospital,
Melbourne, Australia
(Myles, Wallace, Ueoka, Dutton, Robertshaw, Clarris, Neylan, Smith,
Hulley, Warwarek, Painter, Heyman, Falland, Pieterse, Fiddes, Marriott,
Dieleman, Cope, Clark-Mackay) Australia
(Munting, Verheijen, van Dijk, Wietsma, Monteiro de Olivieira, Oey)
Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
Background: High-dose corticosteroids have been used to attenuate the
inflammatory response to cardiac surgery and cardiopulmonary bypass, but
patient outcome benefits remain unclear. The primary aim was to determine
whether using dexamethasone was superior to not using dexamethasone to
increase the number of home days in the first 30 days after cardiac
surgery. Our secondary aim was to evaluate efficiency, value, and impact
of the novel trial design. Method(s): This pragmatic, international
trial incorporating a prerandomized consent design favoring local practice
enrolled patients undergoing cardiac surgery across seven hospitals in
Australia and The Netherlands. Patients were randomly assigned to
dexamethasone 1 mg/kg or not (control). The primary outcome was the number
of days alive and at home up to 30 days after surgery ("home days").
Secondary outcomes included prolonged mechanical ventilation (more than 48
h), sepsis, renal failure, myocardial infarction, stroke, and death.
 Result(s): Of 2,093 patients assessed for eligibility, 1,951 were
randomized (median age, 63 yr; 80% male). The median number of home days
was 23.0 (interquartile range, 20.1 to 24.1) in the dexamethasone group
and 23.1 (interquartile range, 20.1 to 24.6) in the no dexamethasone group
(median difference, 0.1; 95% CI, -0.3 to 0.5; P = 0.66). The rates of
prolonged mechanical ventilation (risk ratio, 0.72; 95% CI, 0.48 to 1.08),
sepsis (risk ratio, 1.02; 95% CI, 0.57 to 1.82), renal failure (risk
ratio, 0.94; 95% CI, 0.80 to 1.12), myocardial infarction (risk ratio,
1.20; 95% CI, 0.30 to 4.82), stroke (risk ratio, 1.06; 95% CI, 0.54 to
2.08), and death (risk ratio, 0.72; 95% CI, 0.22 to 2.35) were comparable
between groups (all P > 0.10). Dexamethasone reduced intensive care unit
stay (median, 29 h; interquartile range, 22 to 50 h vs. median, 43 h;
interquartile range, 24 to 72 h; P = 0.004). Our novel trial design was
highly efficient (89.3% enrollment). Conclusion(s): Among patients
undergoing cardiac surgery, high-dose dexamethasone decreased intensive
care unit stay but did not increase the number of home days after
surgery. Copyright © 2024 American Society of Anesthesiologists.
All Rights Reserved.

<44>
Accession Number
2031023779
Title
Effect of early administration of tetracosactide on mortality and host
response in critically ill patients requiring rescue surgery: a
sensitivity analysis of the STOPSHOCK phase 3 randomized controlled trial.
Source
Military Medical Research. 11(1) (no pagination), 2024. Article Number:
56. Date of Publication: December 2024.
Author
Noera G.; Bertolini A.; Calza L.; Gori M.; Pitino A.; D'Arrigo G.; Egan
C.G.; Tripepi G.
Institution
(Noera) Health Ricerca e Sviluppo, Global Contractor for STOPSHOCK
National Plan of Military Research Ministry of Defence, Rome 00187, Italy
(Bertolini) Department of Medicine and Division of Clinical Pharmacology,
School of Medicine, UNIMORE, Policlinico, Modena 41124, Italy
(Calza) IRET Foundation, Ozzano Dell' Emilia, Bologna 40064, Italy
(Gori, Pitino) Institute of Clinical Physiology (IFC-CNR), Section of
Rome, Rome 00185, Italy
(D'Arrigo, Tripepi) National Research Council-Institute of Clinical
Physiology, Reggio Calabria 89124, Italy
(Egan) CE Medical Writing SRLS, Pisa 56021, Italy
Publisher
BioMed Central Ltd
Abstract
Background: Undifferentiated shock is recognized as a criticality state
that is transitional in immune-mediated topology for casual risk of lethal
microcirculatory dysfunction. This was a sensitivity analysis of a drug
(tetracosactide; TCS10) targeting melanocortin receptors (MCRs) in a phase
3 randomized controlled trial to improve cardiovascular surgical rescue
outcome by reversing mortality and hemostatic disorders. Method(s):
Sensitivity analysis was based on a randomized, two-arm, multicenter,
double-blind, controlled trial. The Naive Bayes classifier was performed
by density-based sensitivity index for principal strata as proportional
hazard model of 30-day surgical risk mortality according to European
System for Cardiac Operative Risk Evaluation inputs-outputs in 100
consecutive cases (from August to September 2013 from Emilia Romagna
region, Italy). Patients included an agent-based TCS10 group (10 mg,
single intravenous bolus before surgery; n = 56) and control group (n =
44) and the association with cytokines, lactate, and bleeding-blood
transfusion episodes with the prior-risk log-odds for mortality rate in
time-to-event was analyzed. Result(s): Thirty-day mortality was
significantly improved in the TCS10 group vs. control group (0 vs. 8
deaths, P < 0.0001). Baseline levels of interleukin (IL)-6, IL-10, and
lactate were associated with bleeding episodes, independent of TCS10
treatment [odds ratio (OR) = 1.90, 95% confidence interval (CI) 1.39-2.79;
OR = 1.53, 95%CI 1.17-2.12; and OR = 2.92, 95%CI 1.40-6.66, respectively],
while baseline level of Fms-like tyrosine kinase 3 ligand (Flt3L) was
associated with lower bleeding rates in TCS10-treated patients (OR = 0.31,
95%CI 0.11-0.90, P = 0.03). For every 8 TCS10-treated patients, 1 bleeding
case was avoided. Blood transfusion episodes were significantly reduced in
the TCS10 group compared to the control group (OR = 0.32, 95%CI 0.14-0.73,
P = 0.01). For every 4 TCS10-treated patients, 1 transfusion case was
avoided. Conclusion(s): Sensitivity index underlines the quality
target product profile of TCS10 in the runway of emergency casualty care.
To introduce the technology readiness level in real-life critically ill
patients, further large-scale studies are required. Trial registration:
European Union Drug Regulating Authorities Clinical Trials Database
(EudraCT Number: 2007-006445-41). Copyright © The Author(s) 2024.

<45>
Accession Number
2030624617
Title
Cardioprotective Efficacy of Sevoflurane in Patients With Rheumatic Heart
Disease Undergoing Heart Valve Surgery Under Cardiopulmonary Bypass.
Source
Journal of the Saudi Heart Association. 36(2) (pp 120-127), 2024. Date of
Publication: 2024.
Author
Lam V.T.; Kinh N.Q.; Ly N.M.
Institution
(Lam) Department of Anesthesiology and Pain Management, Vinmec Times City
International Hospital, Vietnam
(Kinh) Anesthesia Surgical Intensive Care Center, Viet Duc University
Hospital, Vietnam
(Ly) Department of Anesthesia and Resuscitation, 108 Military Central
Hospital, Vietnam
Publisher
Saudi Heart Association
Abstract
Objectives: In this study, we investigated whether cardioprotective
properties of sevoflurane were expressed in patients with rheumatic heart
disease undergoing heart valve surgery under cardiopulmonary bypass (CPB).
 Method(s): Fifty patients with rheumatic heart disease undergoing
heart valve surgery under CPB were randomly assigned to receive total
anesthesia with sevoflurane or propofol during surgery. Except for this,
anesthetic and surgical management was the same in all patients. The
primary outcomes were postoperative high-sensitive cardiac troponin T
(hs-cTnT) and creatine kinase-myocardial band (CK-MB) release. The
secondary outcomes were hemodynamic events and short-term clinical
outcomes (within 30 days after surgery). Result(s): The plasma
concentrations of hs-cTnT at 24-hour and CK-MB from 6-hour to 48-hour in
the sevoflurane group were lower than those in the control group (the
propofol group). After aortic unclamping, heartbeat recovery was faster
and the rate of sinus rhythm was higher in the sevoflurane group than in
the control group. Moreover, a lower proportion of pacemaker use and the
need for intraoperative and postoperative inotropes were also found in the
sevoflurane group. Nevertheless, there were no differences between the two
groups regarding short-term clinical outcomes (durations of mechanical
ventilation, intensive care unit stay, hospital stay, morbidity, and
mortality rates). Conclusion(s): Sevoflurane administered during the
entire anesthetic procedure had a myocardial protective effect with less
evidence of myocardial damage in the first 48-hour postoperatively but
short-term clinical outcomes were not significantly different when
compared with the control group in patients with rheumatic heart disease
undergoing heart valve surgery under CPB. Copyright © 2024 Saudi
Heart Association.

<46>
Accession Number
2030598446
Title
Opioid Free Ptyregopalatine Ganglion Block Based Multimodal Anesthesia
Versus Conventional Opioid Based Multimodal Anesthesia for Tonsillectomy
Operations: A Randomized Controlled Trial.
Source
Anesthesiology and Pain Medicine. 14(3) (no pagination), 2024. Article
Number: e146617. Date of Publication: Jun 2024.
Author
Mahrose R.; Shorbagy M.S.; Kasem A.A.
Institution
(Mahrose, Shorbagy, Kasem) Intensive Care & Pain Management, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
Publisher
Brieflands
Abstract
Background: Otolaryngology often involves adenotonsillectomies, surgical
procedures aimed at addressing obstructive sleep-disordered breathing and
underlying apnea in children. Objective(s): Pediatric
anesthesiologists and otolaryngologists encounter challenges in managing
pain post-adenotonsillectomy, especially due to the use of opioid
medications in children who have an elevated baseline risk of airway
obstruction and associated morbidity and mortality. Method(s): This
prospective, randomized, double-blinded study was conducted at Eldemerdash
Hospital, Ain Shams University, Egypt, from September 2022 to August 2023.
A total of 90 patients aged 5-13 years who underwent elective
tonsillectomy surgery were randomly assigned to two groups, with 45
patients in each group. The first group, referred to as group A, received
intravenous 1.0 mug/kg fentanyl, dexamethasone 150 mug/kg, and paracetamol
15 mg/kg. The second group, referred to as group B, received dexamethasone
150 mug/kg and paracetamol 15 mg/kg, with an opioid-free pterygopalatine
ganglion block for multimodal anesthesia. The primary outcome measure of
this study was the postoperative Wong-Baker scale at 1st, 3rd, and 24th
hours. Result(s): This study included 90 individuals with similar
demographic profiles and comparable initial characteristics and surgical
techniques in both groups (P > 0.05). Intraoperative heart rate, mean
blood pressure, additional analgesia, postoperative Wong-Baker scale,
postoperative rescue analgesia, and laryngospasm did not show significant
differences between the two groups (P > 0.05). However, there were
statistically significant differences between the groups in terms of
nausea, vomiting, hypoxia, and post-anesthesia care unit stay, with group
B experiencing fewer of these issues (P < 0.05). Conclusion(s): Both
conventional opioid-based multimodal anesthesia and opioid-free
pterygopalatine ganglion block-based multimodal anesthesia are effective
methods for providing analgesia during and after tonsillectomy surgery.
The pterygopalatine ganglion block, the latter option, has been found to
result in fewer postoperative complications such as nausea, vomiting, and
hypoxia. Additionally, patients who receive this type of anesthesia
typically require less time in the post-anesthesia care
unit. Copyright © 2024, Mahrose et al.

<47>
Accession Number
2030581485
Title
Identification of Presurgical Risk Factors for the Development of Chronic
Postsurgical Pain in Adults: A Comprehensive Umbrella Review.
Source
Journal of Pain Research. 17 (pp 2511-2530), 2024. Date of Publication:
2024.
Author
Sydora B.C.; Whelan L.J.; Abelseth B.; Brar G.; Idris S.; Zhao R.; Leonard
A.J.; Rosenbloom B.N.; Clarke H.; Katz J.; Beesoon S.; Rasic N.
Institution
(Sydora, Whelan, Beesoon) Department of Surgery Strategic Clinical
Network, Alberta Health Services, Edmonton, AB, Canada
(Whelan, Abelseth, Rasic) Cumming School of Medicine, University of
Calgary, Calgary, AB, Canada
(Brar, Idris) Health Systems Knowledge and Evaluation, Alberta Health
Services, Edmonton, AB, Canada
(Zhao, Leonard) Knowledge Resource Service, Alberta Health Services,
Edmonton, AB, Canada
(Rosenbloom) Toronto Academic Pain Medicine Institute, Toronto, ON, Canada
(Clarke, Katz) Department of Anesthesia and Pain Management, Toronto
General Hospital, UHN, Toronto, ON, Canada
(Katz) Department of Psychology, York University, Toronto, ON, Canada
(Rasic) Department of Anesthesiology, Perioperative & Pain Medicine,
University of Calgary, Calgary, AB, Canada
Publisher
Dove Medical Press Ltd
Abstract
Purpose: Risk factors for the development of chronic postsurgical pain
(CPSP) have been reported in primary studies and an increasing number of
reviews. The objective of this umbrella review was to compile and
understand the published presurgical risk factors associated with the
development of CPSP for various surgery types. Method(s): Six
databases were searched from January 2000 to June 2023 to identify
meta-analyses, scoping studies, and systematic reviews investigating
presurgical CPSP predictors in adult patients. Articles were screened by
title/abstract and subsequently by full text by two independent reviewers.
The selected papers were appraised for their scientific quality and
validity. Data were extracted and descriptively analyzed. Result(s):
Of the 2344 retrieved articles, 36 reviews were selected for in-depth
scrutiny. The number of primary studies in these reviews ranged from 4 to
317. The surgery types assessed were arthroplasty (n = 13), spine surgery
(n = 8), breast surgery (n = 4), shoulder surgery (n = 2), thoracic
surgery (n = 2), and carpal tunnel syndrome (n = 1). One review included a
range of orthopedic surgeries; six reviews included a variety of
surgeries. A total of 39 presurgical risk factors were identified, some of
which shared the same defining tool. Risk factors were themed into six
broad categories: psychological, pain-related, health-related,
social/lifestyle-related, demo-graphic, and genetic. The strength of
evidence for risk factors was inconsistent across different reviews and,
in some cases, conflicting. A consistently high level of evidence was
found for preoperative pain, depression, anxiety, and pain
catastrophizing. Conclusion(s): This umbrella review identified a
large number of presurgical risk factors which have been suggested to be
associated with the development of CPSP after various surgeries. The
identification of presurgical risk factors is crucial for the development
of screening tools to predict CPSP. Our findings will aid in designing
screening tools to better identify patients at risk of developing CPSP and
inform strategies for prevention and treatment. Copyright © 2024
Sydora et al.

<48>
Accession Number
2029036971
Title
Prognostic value of liver stiffness in patients hospitalized for acute
decompensated heart failure: a meta-analysis.
Source
Journal of Ultrasound. 27(3) (pp 551-557), 2024. Date of Publication:
September 2024.
Author
Macerola N.; Riccardi L.; Di Stasio E.; Montalto M.; Gasbarrini A.;
Pompili M.; Garcovich M.
Institution
(Macerola) Division of Internal Medicine, San Carlo di Nancy Hospital, GVM
Care and Research, Rome, Italy
(Riccardi, Garcovich) Diagnostic and Interventional Ultrasound Unit, CEMAD
Centro Malattie dell'Apparato Digerente, Medicina Interna e
Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS,
Rome, Italy
(Di Stasio) UOC Chimica, Biochimica e Biologia Molecolare, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
(Di Stasio) Dipartimento di Scienze biotecnologiche di base, cliniche
intensivologiche e perioperatorie, Universita Cattolica del Sacro Cuore,
Rome 00168, Italy
(Montalto, Gasbarrini, Pompili) Dipartimento di Medicina e Chirurgia
Traslazionale, Universita Cattolica del Sacro Cuore, Rome 00168, Italy
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Heart failure (HF) is a major health problem affecting millions
of people worldwide. In the latest years, many efforts have been made to
identify predictors of poor prognosis in these patients. The aim of this
systematic review and meta-analysis was to enlighten the correlation
between liver stiffness (LS), assessed by Shear Wave Elastography
techniques, and HF, particularly focusing on the prognostic value of LS on
cardiovascular outcomes. Method(s): We searched the PUBMED databases
(up to May 1st, 2023) for studies that enlightened the correlation between
LS and cardiovascular outcomes in patients hospitalized for acute
decompensated heart failure (ADHF). We performed a meta-analysis to
estimate the efficacy of LS in predicting the prognosis of patients with
ADHF. Result(s): We analyzed data from 7 studies, comprising 677
patients, that assessed the prognostic value of LS in predicting
cardiovascular outcomes in patients hospitalized for ADHF. The pooled
analysis showed that increased liver stiffness was associated with higher
risk of adverse cardiac events (hazard ratio 1.07 [1.03, 1.12], 95% CI).
 Conclusion(s): Increased LS is associated with poor prognosis in
patients hospitalized for HF and might help effectively identify those
patients at high risk for worse outcomes. Copyright © The
Author(s) 2024.

<49>
Accession Number
2030670692
Title
Comparing the Cardiac Outcomes of Mild and Moderate Hypothermic
Cardiopulmonary Bypass in Children Undergoing Congenital Heart Surgery.
Source
Iranian Heart Journal. 25(3) (pp 6-15), 2024. Date of Publication: July
2024.
Author
Gholampour-Dehaki M.; Kachoueian N.; Golverdi A.Y.; Toloueitabar Y.;
Jafarian M.; Ferasatkish R.; Sheikhi B.; Gorjipour F.
Institution
(Gholampour-Dehaki, Golverdi, Toloueitabar, Jafarian, Ferasatkish,
Sheikhi, Gorjipour) Rajaie Cardiovascular Medical and Research Center,
Iran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Kachoueian) Department of Cardiac Surgery, Imam Hossein Educational
Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Gorjipour) Physiology Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Iranian Heart Association
Abstract
Objectives: This single-blind, parallel-design randomized clinical trial
aimed to assess the impact of mild and moderate hypothermia on brain
oxygenation changes in pediatric patients with noncyanotic cardiac
disorders undergoing cardiac surgery. Method(s): In this trial, 68
pediatric patients undergoing noncyanotic cardiac surgery at Rajaie
Cardiovascular, Medical, and Research Center were included. Participants
were randomly allocated to mild hypothermia (32 C) and moderate
hypothermia (28 C) groups. Outcomes were measured and compared between the
groups at baseline, during, and after cardiopulmonary bypass.
 Result(s): The mean bypass and cross-clamp times were 147.72+/-68.30
minutes and 92.03+/-54.91 minutes, respectively. There were no significant
differences between the groups in terms of bypass time, ICU length of
stay, and ventilation time. The frequency of neurological complications
was also similar between the groups (P>0.05). Conclusion(s): The
results of this trial demonstrated no significant differences in
perioperative and postoperative outcomes, including ICU length of stay,
mechanical ventilation time, and neurological outcomes, between the groups
managed with mild or moderate hypothermia during cardiopulmonary bypass in
noncyanotic pediatric patients undergoing surgery for the correction of
congenital heart anomalies. Copyright © 2024, Iranian Heart
Association. All rights reserved.

<50>
Accession Number
2034172670
Title
Effectiveness of the Green Heart Smartphone Application as a
Self-Management Intervention for Hypertension and Dyslipidemia: A
Randomized Clinical Trial.
Source
Archives of Iranian Medicine. 27(6) (pp 313-322), 2024. Date of
Publication: June 2024.
Author
Ghavami M.; Abdshah A.; Sadeghian S.; Ahmadi A.; Jolani M.S.; Akbarzadeh
D.; Asgari F.H.A.
Institution
(Ghavami, Sadeghian) Cardiovascular Research Institute, Tehran Heart
Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Abdshah) Department of Public Health Sciences, Miller School of Medicine,
University of Miami, Miami, FL, United States
(Abdshah, Jolani) School of Medicine, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Ahmadi) Knowledge Utilization Research Center, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Akbarzadeh) Student Research Committee, School of Medicine, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Asgari) Department of Information Technology, Virtual School, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Academy of Medical Sciences of I.R. Iran
Abstract
Background: Cardiovascular disease (CVD) is a major global health concern,
the leading cause of death and disability. Thus, preventive interventions
targeting modifiable risk factors are essential. Mobile-health
technologies have emerged as promising tools for improving prevention by
modifying risk factors. We created the "Green Heart" mobile app to help
coronary artery disease (CAD) patients control their risk factors. The app
has three modules: smoking cessation, dyslipidemia (DLP) control, and
blood pressure (BP) management. This study evaluated the app's performance
in monitoring hypertension (HTN) and DLP among known CAD cases.
 Method(s): A randomized controlled trial enrolled 1590 CAD subjects,
including 1114 hypertensive patients and 1488 subjects with DLP, and
assigned them randomly to paper-based education or application-based
groups. Result(s): Regarding HTN, after 6 months, we finally analyzed
545 and 546 hypertensive patients, assigned to the conventional and app
groups, respectively. Patients in the app group were more likely to have
their BP managed successfully (88.6% vs. 78.5%; P<0.001). The app group
showed higher odds of successful BP management (odds ratio [OR]: 2.13; 95%
CI: 1.51 - 3.03). Regarding DLP, we analyzed 728 patients in the
conventional and 714 patients in the app group. A higher percentage of
patients in the app group (24.8%) had low-density lipoprotein cholesterol
(LDL-C) levels less than 70 mg/dL (16.1%; P<0.001). The app group showed
higher odds of reducing LDL-C (OR: 1.72; 95% CI: 1.32-2.26).
 Conclusion(s): We found that using the Green Heart app in the
self-monitoring setting significantly improved BP and DLP management
across the study population. Copyright © 2024 Academy of Medical
Sciences of I.R. Iran. All rights reserved.

<51>
Accession Number
2034169303
Title
Empowering treatment decisions: ChatGPT in severe coronary artery disease.
Source
Current Problems in Cardiology. 49(11) (no pagination), 2024. Article
Number: 102789. Date of Publication: November 2024.
Author
Savithri Nandeesha D.S.
Institution
(Savithri Nandeesha) Internal Medicine, Karnataka Institute of Medical
Sciences, Hubli, India
Publisher
Elsevier Inc.

<52>
Accession Number
2034167697
Title
The use of pledget-reinforced sutures during surgical aortic valve
replacement: A systematic review and meta-analysis.
Source
IJC Heart and Vasculature. 54 (no pagination), 2024. Article Number:
101494. Date of Publication: October 2024.
Author
Taco Boltje J.W.; Carvalho Mota M.T.; Vriesendorp M.D.; Vonk A.B.A.;
Groenwold R.H.H.; Klautz R.J.M.; Velders B.J.J.
Institution
(Taco Boltje, Carvalho Mota, Vriesendorp, Vonk, Klautz) Department of
Cardiothoracic Surgery, Amsterdam University Medical Center Location AMC,
Amsterdam, Netherlands
(Taco Boltje, Vriesendorp, Vonk, Klautz, Velders) Department of
Cardiothoracic Surgery, Leiden University Medical Center, Leiden,
Netherlands
(Groenwold, Velders) Department of Clinical Epidemiology, Leiden
University Medical Center, Leiden, Netherlands
(Groenwold) Department of Biomedical Data Science, Leiden University
Medical Center, Leiden, Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Objective: Literature presents conflicting results on the pros and cons of
pledget-reinforced sutures during surgical aortic valve replacement
(SAVR). We aimed to investigate the effect of pledget-reinforced sutures
versus sutures without pledgets during SAVR on different outcomes in a
systematic review and meta-analysis. Method(s): A literature search
was performed in five different medical literature databases. Studies must
include patients undergoing SAVR and must compare any pledget-reinforced
with any suturing technique without pledgets. The primary outcome was
paravalvular leakage (PVL), and secondary outcomes comprised
thromboembolism, endocarditis, mortality, mean pressure gradient (MPG) and
effective orifice area (EOA). Results were pooled using a random-effects
model as risk ratios (RRs) or mean differences (MDs) for which the no
pledgets group served as reference. Result(s): Nine observational
studies met the inclusion criteria. The risk of bias was critical in seven
studies, and high and moderate in two other. The pooled RR for moderate or
greater PVL was 0.59 (95 % confidence interval [CI] 0.13, 2.73). The
pooled RR for mortality at 30-days was 1.02 (95 % CI 0.48, 2.18) and
during follow-up was 1.15 (95 % CI 0.67, 2.00). For MPG and EOA at 1-year
follow-up, the pooled MDs were 0.60 mmHg (95 % CI -4.92, 6.11) and -0.03
cm2 (95 % CI -0.18, 0.12), respectively. Conclusion(s):
Literature on the use of pledget-reinforced sutures during SAVR is at high
risk of bias. Pooled results are inconclusive regarding superiority of
either pledget-reinforced sutures or sutures without pledgets. Hence,
there is no evidence to support or oppose the use of pledget-reinforced
sutures. Copyright © 2024

<53>
Accession Number
2034108947
Title
Aspirin-free strategy for percutaneous coronary intervention in acute
coronary syndrome based on the subtypes of acute coronary syndrome and
high bleeding risk: the STOPDAPT-3 trial.
Source
European Heart Journal - Cardiovascular Pharmacotherapy. 10(5) (pp
374-390), 2024. Date of Publication: 01 Aug 2024.
Author
Obayashi Y.; Natsuaki M.; Watanabe H.; Morimoto T.; Yamamoto K.; Nishikawa
R.; Nishikura T.; Kirigaya H.; Nishida K.; Kimura T.; Ando K.; Suwa S.;
Isawa T.; Takenaka H.; Ishikawa T.; Wakabayashi K.; Onishi Y.; Hibi K.;
Kawai K.; Ono K.; Yoshida R.; Suzuki H.; Nakazawa G.; Kusuyama T.;
Morishima I.; Tokuyama H.; Sakamoto H.; Fujita T.; Nanasato M.; Okayama
H.; Tamura T.; Kawahatsu K.; Hayashi F.; Akao M.; Serikawa T.; Kadota K.;
Hata Y.; Akashi Y.J.; Matsuoka S.; Tanaka H.; Yamada M.; Wakatsuki T.;
Nozaki Y.; Kobayashi Y.; Kato R.; Ikari Y.; Kurita T.; Kaitani K.;
Sugimoto A.; Ogata N.; Yokomatsu T.; Uehara H.; Doijiri T.; Kozuma K.;
Nishida Y.; Yamaguchi J.; Morino Y.; Tanigawa T.; Nakano Y.; Makiguchi N.;
Noda T.; Shiode N.; Abe K.; Abe S.; Tabuchi I.; Ishihara S.; Kinoshita M.;
Higuchi M.; Takaya T.; Miura S.-I.; Tsubakimoto Y.; Tsujita K.; Kumagai
K.; Tanabe K.; Inoko M.; Nakagami T.; Tomita H.; Nakano M.; Yumoto K.;
Wakeyama T.; Kaneko T.; Doi M.
Institution
(Obayashi, Nishikawa, Ono) Department of Cardiovascular Medicine, Graduate
School of Medicine, Kyoto University, Kyoto 606-8507, Japan
(Natsuaki) Department of Cardiovascular Medicine, Saga University, Saga
849-8501, Japan
(Watanabe, Takenaka, Kimura) Division of Cardiology, Hirakata Kohsai
Hospital, Hirakata 573-0153, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo Medical University,
Nishinomiya 663-8501, Japan
(Yamamoto, Ando) Department of Cardiology, Kokura Memorial Hospital,
Kitakyusyu 802-8555, Japan
(Suwa) Department of Cardiology, Juntendo University Shizuoka Hospital,
Izunokuni 410-2295, Japan
(Isawa) Department of Cardiology, Sendai Kousei Hospital, Sendai 980-0873,
Japan
(Ishikawa) Department of Cardiology, Dokkyo Medical University Saitama
Medical Center, Koshigaya 343-8555, Japan
(Tokuyama) Department of Cardiology, Kawaguchi Cardiovascular and
Respiratory Hospital, Kawaguchi 333-0842, Japan
(Sakamoto) Department of Cardiology, Shizuoka General Hospital, Shizuoka
420-8527, Japan
(Fujita) Division of Cardiology, Japanese Red Cross Wakayama Medical
Center, Wakayama 640-8558, Japan
(Nanasato) Department of Cardiology, Sakakibara Heart Institute, Fuchu
183-0003, Japan
(Okayama) Department of Cardiology, Ehime Prefectural Central Hospital,
Matsuyama 790-0024, Japan
(Nishikura) Department of Cardiology, Showa University Koto Toyosu
Hospital, Tokyo 135-8577, Japan
(Kirigaya) Division of Cardiology, Yokohama City University Medical
Center, Yokohama 232-0024, Japan
(Nishida) Division of Cardiology, Chikamori Hospital, Kochi 780-8522,
Japan
Publisher
Oxford University Press
Abstract
Background and aims: High bleeding risk (HBR) and acute coronary syndrome
(ACS) subtypes are critical in determining bleeding and cardiovascular
event risk after percutaneous coronary intervention (PCI). Methods
and Results: In 4476 ACS patients enrolled in the STOPDAPT-3, where the
no-aspirin and dual antiplatelet therapy (DAPT) strategies after PCI were
randomly compared, the pre-specified subgroup analyses were conducted
based on HBR/non-HBR and ST-segment elevation myocardial infarction
(STEMI)/non-ST-segment elevation ACS (NSTE-ACS). The co-primary bleeding
endpoint was Bleeding Academic Research Consortium (BARC) type 3 or 5, and
the co-primary cardiovascular endpoint was a composite of cardiovascular
death, myocardial infarction, definite stent thrombosis, or ischaemic
stroke at 1 month. Irrespective of the subgroups, the effect of no-aspirin
compared with DAPT was not significant for the bleeding endpoint (HBR [N =
1803]: 7.27 and 7.91%, hazard ratio (HR) 0.91, 95% confidence interval
(CI) 0.65-1.28; non-HBR [N = 2673]: 3.40 and 3.65%, HR 0.93, 95% CI
0.62-1.39; Pinteraction = 0.94; STEMI [N = 2553]: 6.58 and 6.56%, HR 1.00,
95% CI 0.74-1.35; NSTE-ACS [N = 1923]: 2.94 and 3.64%, HR 0.80, 95% CI
0.49-1.32; Pinteraction = 0.45), and for the cardiovascular endpoint (HBR:
7.87 and 5.75%, HR 1.39, 95% CI 0.97-1.99; non-HBR: 2.56 and 2.67%, HR
0.96, 95% CI 0.60-1.53; Pinteraction = 0.22; STEMI: 6.07 and 5.46%, HR
1.11, 95% CI 0.81-1.54; NSTE-ACS: 3.03 and 1.71%, HR 1.78, 95% CI
0.97-3.27; Pinteraction = 0.18). Conclusion(s): In patients with ACS
undergoing PCI, the no-aspirin strategy compared with the DAPT strategy
failed to reduce major bleeding events irrespective of HBR and ACS
subtypes. The numerical excess risk of the no-aspirin strategy relative to
the DAPT strategy for cardiovascular events was observed in patients with
HBR and in patients with NSTE-ACS. Copyright © 2024 The
Author(s). Published by Oxford University Press on behalf of the European
Society of Cardiology.

<54>
Accession Number
2034096742
Title
Evaluation of glucose-lowering medications in older people: a
comprehensive systematic review and network meta-analysis of randomized
controlled trials.
Source
Age and Ageing. 53(8) (no pagination), 2024. Article Number: afae175. Date
of Publication: August 2024.
Author
Pan S.-Y.; Su E.-L.; Huang C.-J.; Chuang S.-Y.; Chiang C.-E.; Chen C.-H.;
Cheng H.-M.
Institution
(Pan, Su, Cheng) Department of Medical Education, Taipei Veterans General
Hospital, Taipei, Taiwan (Republic of China)
(Huang, Cheng) Division of Evidence-based Medicine, Taipei Veterans
General Hospital, Taipei, Taiwan (Republic of China)
(Chuang) Institute of Population Health Science, National Health Research
Institute, Miaoli, Taiwan (Republic of China)
(Chiang, Chen, Cheng) School of Medicine, National Yang Ming Chiao Tung
University School of Medicine, Taipei, Taiwan (Republic of China)
(Chiang) General Clinical Research Centre, Taipei Veterans General
Hospital, Taipei, Taiwan (Republic of China)
(Chen, Cheng) Institute of Public Health and Community Medicine Research
Centre, National Yang Ming Chiao Tung University School of Medicine,
Taipei, Taiwan (Republic of China)
Publisher
Oxford University Press
Abstract
Background: Type 2 diabetes mellitus (T2DM) is increasingly being
diagnosed in older adults. Our objective is to assess the advantages and
potential drawbacks of different glucose-lowering medications in this
specific population. Method(s): A network meta-analysis was conducted
to identify randomized controlled trials that examined patient-centered
outcomes in adults aged >=65 years with T2DM. We searched PubMed, Cochrane
CENTRAL, and Embase up to September 23, 2023. Quality of eligible studies
were assessed using the Cochrane RoB 2.0 tool. Result(s): A total of
22 trials that involved 41 654 participants were included, incorporating
sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1
receptor agonists (GLP-1RAs), dipeptidyl peptidase-4 (DPP-4) inhibitors,
metformin, sulfonylureas (SU) and acarbose. Our findings reveal that
GLP-1RAs reduce the risk of major adverse cardiovascular events (risk
ratio [RR], 0.83; 95% confidence interval [CI], 0.71 to 0.97) and body
weight (mean difference [MD], -3.87 kg; 95% CI, -5.54 to -2.21). SGLT2
inhibitors prevent hospitalization for heart failure (RR, 0.66; 95% CI,
0.57 to 0.77), renal composite outcome (RR, 0.69; 95% CI, 0.53 to 0.89),
and reduce body weights (MD, -1.85 kg; 95% CI, -2.42 to -1.27). SU
treatment increases the risk of any hypoglycaemia (RR, 4.19; 95% CI, 3.52
to 4.99) and severe hypoglycaemia (RR, 7.06; 95% CI, 3.03 to 16.43).
GLP-1RAs, SGLT2 inhibitors, metformin, SU and DPP-4 inhibitors are
effective in reducing glycaemic parameters. Notably, the number of
treatments needed decreases in most cases as age increases.
 Conclusion(s): Novel glucose-lowering medications with benefits that
outweigh risks should be prioritized for older patients with
diabetes. Copyright © The Author(s) 2024.

<55>
Accession Number
2033208430
Title
Comparison of Propofol-Based Total Intravenous Anesthesia versus Volatile
Anesthesia with Sevoflurane for Postoperative Delirium in Adult Coronary
Artery Bypass Grafting Surgery: A Prospective Randomized Single-Blinded
Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 38(9) (pp 1932-1940),
2024. Date of Publication: September 2024.
Author
Varsha A.V.; Unnikrishnan K.P.; Saravana Babu M.S.; Raman S.P.; Koshy T.
Institution
(Varsha, Unnikrishnan, Saravana Babu, Raman, Koshy) Cardiothoracic and
Vascular Anaesthesiology Division, Sree Chitra Tirunal Institute for
Medical Sciences and Technology, Thiruvananthapuram, India
Publisher
W.B. Saunders
Abstract
Objectives: To compare the incidence of delirium and early (at 1 week)
postoperative cognitive dysfunction (POCD) between propofol-based total
intravenous anesthesia (TIVA) and volatile anesthesia with sevoflurane in
adult patients undergoing elective coronary artery bypass graft surgery
(CABG) with cardiopulmonary bypass (CPB). Design(s): This was a
prospective randomized single-blinded study. Setting(s): The study
was conducted at a single institution, the Sree Chitra Tirunal Institute
for Medical Sciences and Technology, a tertiary care institution and
university-level teaching hospital. Participant(s): Seventy-two
patients undergoing elective CABG under CPB participated in this study.
 Intervention(s): This study was conducted on 72 adult patients (>18
years) undergoing elective CABG under CPB who were randomized to receive
propofol or sevoflurane. Anesthetic depth was monitored to maintain the
bispectral index between 40 and 60. Delirium was assessed using the
Confusion Assessment Method for the Intensive Care Unit. Early POCD was
diagnosed when there was a reduction of >2 points in the Montreal
Cognitive Assessment score compared to baseline. Cerebral oximetry changes
using near-infrared spectroscopy (NIRS), atheroma grades, and
intraoperative variables were compared between the 2 groups. Measurements
& Main Results: Seventy-two patients were randomized to receive propofol
(n = 36) or sevoflurane (n = 36). The mean patient age was 59.4 +/- 8.6
years. The baseline and intraoperative variables, including atheroma
grades, NIRS values, hemoglobin, glycemic control, and oxygenation, were
comparable in the 2 groups. Fifteen patients (21.7%) patients developed
delirium, and 31 patients (44.9%) had early POCD. The incidence of
delirium was higher with sevoflurane (n = 12; 34.2%) compared to propofol
(n = 3; 8.8%) (odds ratio [OR], 1.72; 95% confidence interval [CI],
1.13-2.62; p = 0.027)*. POCD was higher with sevoflurane (n = 20; 57.1%)
compared to propofol (n = 11; 32.3%) (OR, 1.63; 95% CI, 1.01-2.62; p =
0.038)*. In patients aged >65 years, delirium was higher with sevoflurane
(7/11; 63.6%) compared to propofol (1/7; 14.2%) (p = 0.03)*.
 Conclusion(s): Propofol-based TIVA was associated with a lower
incidence of delirium and POCD compared to sevoflurane in this cohort of
patients undergoing CABG under CPB. Large-scale, multicenter randomized
trials with longer follow-up are needed to substantiate the clinical
relevance of this observation. Copyright © 2024

<56>
Accession Number
2033175162
Title
Continuous Glucose Monitoring and the Effect of Liraglutide in Cardiac
Surgery Patients: A Substudy of the Randomized Controlled GLOBE Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 38(9) (pp 1965-1971),
2024. Date of Publication: September 2024.
Author
Oosterom-Eijmael M.J.P.; Hermanides J.; van Raalte D.H.; Kouw I.W.K.;
DeVries J.H.; Hulst A.H.
Institution
(Oosterom-Eijmael, Hermanides, Hulst) Department of Anesthesiology,
Amsterdam University Medical Center, Amsterdam, Netherlands
(Oosterom-Eijmael, van Raalte, DeVries) Department of Endocrinology,
Amsterdam University Medical Center, Amsterdam, Netherlands
(Oosterom-Eijmael, van Raalte, Hulst) Amsterdam Cardiovascular Sciences
Research Institute, Amsterdam, Netherlands
(Hermanides) Amsterdam Public Health Research Institute, Amsterdam,
Netherlands
(Kouw) Department of Intensive Care Medicine, Intensive Care Research,
Gelderse Vallei Hospital, Ede, Netherlands
(Kouw) Wageningen University & Research, Division of Human Nutrition and
Health, Wageningen, Netherlands
(DeVries, Hulst) Amsterdam Gastroenterology Endocrinology Metabolism,
Amsterdam, Netherlands
Publisher
W.B. Saunders
Abstract
Objectives: The objectives of the current research were to evaluate the
accuracy and reliability of continuous glucose monitoring (CGM) in
patients undergoing cardiac surgery and assess the impact of preoperative
liraglutide administration on perioperative glucose control as captured by
CGM. Design(s): This was a prospective, single-center, prespecified
analysis of the GLOBE trial, a randomized controlled trial comparing
preoperative liraglutide treatment to placebo in patients undergoing
cardiac surgery. Setting(s): The work took place at a single-center
academic hospital in the Netherlands. Participant(s): Twenty-five
patients undergoing cardiac surgery were recruited from the hospital's
cardiac surgery department. Intervention(s): Participants received
the Dexcom G5 CGM system from the day before surgery until discharge from
the intensive care unit after surgery. Additionally, participants were
randomized to receive either preoperative liraglutide or placebo.
 Measurements and Main Results: Arterial blood gas (ABG) glucose
measurements were collected as a reference and matched to CGM readings to
assess accuracy and reliability. In 240 paired CGM-ABG glucose
measurements, the mean absolute relative difference was 14.4 +/- 12.5%.
Temporary sensor interruption occurred mainly intraoperatively (92% of
patients). The median duration of intraoperative sensor interruption was
65 (48-95) minutes. Liraglutide increased glycemic time in range 72%
versus 47% in the control group (absolute difference 25%, 95% confidence
interval -41.4 to -8.9, p = .004). Conclusion(s): Despite
intraoperative sensor interruption, CGM seems an accurate method for
semi-invasive, real-time assessment of blood glucose levels. CGM can
provide a detailed observation of the pre- and postoperative glycemic
trajectory, demonstrating increased time in range following perioperative
liraglutide treatment compared with placebo. Copyright © 2024 The
Author(s)

<57>
Accession Number
2033099780
Title
Effects of Balanced Versus Saline-based Solutions on Acute Kidney Injury
in Off-pump Coronary Artery Bypass Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 38(9) (pp 1923-1931),
2024. Date of Publication: September 2024.
Author
Nam J.-S.; Kim W.-J.; Seo W.-W.; Lee S.-W.; Joung K.-W.; Chin J.-H.; Choi
D.-K.; Choi I.-C.
Institution
(Nam, Kim, Seo, Lee, Joung, Chin, Choi, Choi) Department of Anesthesiology
and Pain Medicine, Asan Medical Center, University of Ulsan College of
Medicine, Seoul, South Korea
Publisher
W.B. Saunders
Abstract
Objectives: To determine whether balanced solutions can reduce the
incidence of acute kidney injury after off-pump coronary artery bypass
surgery compared with saline. Design(s): Randomized controlled trial.
 Setting(s): Single tertiary care center. Participant(s):
Patients who underwent off-pump coronary artery bypass surgery between
June 2014 and July 2020. Intervention(s): Balanced solution-based
chloride-restrictive intravenous fluid strategy. Measurements and
Main Results: The primary outcome was acute kidney injury within 7
postoperative days, as defined by the 2012 Kidney Disease: Improving
Global Outcomes Clinical Practice Guideline. The incidence of acute kidney
injury was 4.4% (8/180) in the balanced group and 7.3% (13/178) in the
saline group. The difference was not statistically significant (risk
difference, -2.86%; 95% confidence interval [CI], -7.72% to 2.01%; risk
ratio, 0.61, 95% CI, 0.26 to 1.43; p = 0.35). Compared with the balanced
group, the saline group had higher levels of intraoperative serum chloride
and lower base excess, which resulted in a lower pH. Conclusion(s):
In patients undergoing off-pump bypass surgery with a normal estimated
glomerular filtration rate, the intraoperative balanced solution-based
chloride-restrictive intravenous fluid administration strategy did not
decrease the rate of postoperative acute kidney injury compared with the
saline-based chloride-liberal intravenous fluid administration
strategy. Copyright © 2024 Elsevier Inc.

<58>
Accession Number
2033009462
Title
Effectiveness of Adaptive Support Ventilation in Facilitating Weaning from
Mechanical Ventilation in Postoperative Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 38(9) (pp 1978-1986),
2024. Date of Publication: September 2024.
Author
Tsai Y.-C.; Jhou H.-J.; Huang C.-W.; Lee C.-H.; Chen P.-H.; Hsu S.-D.
Institution
(Tsai, Hsu) Division of Traumatology, Department of Surgery, Tri-Service
General Hospital, National Defense Medical Center, Taipei, Taiwan
(Republic of China)
(Tsai) Division of Plastic Surgery, Department of Surgery, Tri-Service
General Hospital, National Defense Medical Center, Taipei, Taiwan
(Republic of China)
(Jhou) Department of Neurology, Changhua Christian Hospital, Changhua,
Taiwan (Republic of China)
(Huang) Division of Plastic Surgery, Department of Surgery, Cathay General
Hospital, Taipei, Taiwan (Republic of China)
(Lee, Chen) Division of Hematology and Oncology, Department of Internal
Medicine, Tri-Service General Hospital, National Defense Medical Center,
Taipei, Taiwan (Republic of China)
Publisher
W.B. Saunders
Abstract
Objective: This meta-analysis aims to evaluate the effectiveness of
adaptive support ventilation (ASV) in facilitating postoperative weaning
from mechanical ventilation in cardiac surgery patients. Design(s): A
systematic review and meta-analysis to assess ASV in weaning postoperative
cardiac surgery patients. Outcomes included early extubation, reintubation
rates, time to extubation, and lengths of intensive care units and
hospital stays. Setting(s): We searched electronic databases from
inception to March 2023 and included randomized controlled trials that
compared ASV with conventional ventilation methods in this population.
 Participant(s): Postoperative cardiac surgery patients.
 Measurements and Main Results: A random effects model was used for
meta-analysis, and trial sequential analysis (TSA) was conducted to assess
result robustness. The meta-analysis included 11 randomized controlled
trials with a total of 1027 randomized patients. ASV was associated with a
shorter time to extubation compared to conventional ventilation (random
effects, mean difference -68.30 hours; 95% confidence interval, -115.50 to
-21.09) with TSA providing a conclusive finding. While ASV indicated
improved early extubation rates, no significant differences were found in
reintubation rates or lengths of intensive care unit and hospital stays,
with these TSA results being inclusive. Conclusion(s): ASV appears to
facilitate a shorter time to extubation in postoperative cardiac surgery
patients compared to conventional ventilation, suggesting benefits in
accelerating the weaning process and reducing mechanical ventilation
duration. Copyright © 2024 Elsevier Inc.

<59>
Accession Number
2034135052
Title
Mitral Valve Transcatheter Edge-to-Edge Repair With PASCAL Vs MitraClip: A
Systematic Review and Meta-analysis.
Source
Journal of Invasive Cardiology. 35(11) (no pagination), 2023. Date of
Publication: November 2023.
Author
Oliveri F.; Amri I.A.; Cabezas J.M.; Bingen B.; Van Der Kley F.; Arslan
F.; Scherptong R.; Mazzarotto P.; Bollati M.; Pepe A.; Tua L.; Bongiorno
A.; Fasolino A.; Gentile F.R.; Colombo D.; Ghio S.; Ferlini M.; Munafo A.
Institution
(Oliveri, Pepe, Tua, Bongiorno, Fasolino, Gentile, Colombo, Munafo)
Department of Molecular Medicine, Division of Cardiology, University of
Pavia, Pavia, Italy
(Oliveri, Amri, Cabezas, Bingen, Van Der Kley, Arslan, Scherptong)
Department of Cardiology, Leiden University Medical Center, Leiden,
Netherlands
(Mazzarotto, Bollati) Cardiology Unit, Ospedale Maggiore, Lodi, Italy
(Tua) Interventional Cardiology, Policlinico San Donato, Milan, Italy
(Ghio, Ferlini) Division of Cardiology, Fondazione IRCCS Policlinico San
Matteo, Pavia, Italy
Publisher
Cliggott Publishing Co.
Abstract
Background. Transcatheter edge-to-edge repair (TEER) using the MitraClip
(Abbott Vascular) system has emerged as a standard treatment for patients
with symptomatic severe secondary or inoperable primary mitral
regurgitation (MR). The relatively recent approval of the PASCAL
Transcatheter Valve Repair System (Edwards Lifesciences) has expanded the
options of TEER devices. However, evidence comparing PASCAL with MitraClip
systems is still limited. Methods. We conducted a systematic literature
research and meta-analysis in PubMed, Medline, and EMBASE databases for
studies comparing PASCAL and MitraClip systems. Results. Four
observational studies and 1 randomized controlled trial, involving 1315
patients total, were eligible for inclusion. All patients exhibited
symptomatic (NYHA II-IV) MR grades 3+ or 4+. Baseline characteristics were
comparable across all included studies. The clinical outcomes were
assessed according to the Mitral Valve Academic Research Consortium
consensus. The procedural success rates for the 2 devices were comparable
in terms of achieving post-procedural MR grades of less than or equal to
2+ and less than or equal to 1+. Furthermore, most patients improved their
clinical status, with no significant differences between patients treated
with PASCAL and those treated with MitraClip. In terms of safety, both
procedures exhibited low overall mortality rates and occurrence of major
adverse events (MAE), without significant difference between the 2
devices. These findings remained consistent in both short- and long-term
follow-up assessments. Conclusions. Our study revealed similar
effectiveness and safety profiles between the PASCAL and MitraClip devices
in patients experiencing significant symptomatic MR. Copyright ©
2023 Cliggott Publishing Co.. All rights reserved.

<60>
Accession Number
2034154221
Title
Coronary artery disease management in older adults: revascularization and
exercise training.
Source
European Heart Journal. 45(31) (pp 2811-2823), 2024. Date of Publication:
14 Aug 2024.
Author
Pavasini R.; Biscaglia S.; Kunadian V.; Hakeem A.; Campo G.
Institution
(Pavasini, Biscaglia, Campo) Cardiology Unit, Azienda Ospedaliero
Universitaria di Ferrara, Via Aldo Moro 8, Ferrara 44124, Italy
(Kunadian) Translational and Clinical Research Institute, Newcastle
University, Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne
Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
(Hakeem) National Institute of Cardiovascular Diseases (NICVD), Karachi,
Pakistan
Publisher
Oxford University Press
Abstract
The mean age of patients with coronary artery disease (CAD) is steadily
increasing. In older patients, there is a tendency to underutilize
invasive approach, coronary revascularization, up-to-date pharmacological
therapies, and secondary prevention strategies, including cardiac
rehabilitation. Older adults with CAD commonly exhibit atypical symptoms,
multi-vessel disease involvement, complex coronary anatomy, and a higher
presence of risk factors and comorbidities. Although both invasive
procedures and medical treatments are characterized by a higher risk of
complications, avoidance may result in a suboptimal outcome. Often,
overlooked factors, such as coronary microvascular disease, malnutrition,
and poor physical performance, play a key role in determining prognosis,
yet they are not routinely assessed or addressed in older patients.
Historically, clinicians have relied on sub-analyses or observational
findings to make clinical decisions, as older adults were frequently
excluded or under-represented in clinical studies. Recently, dedicated
evidence through randomized clinical trials has become available for older
CAD patients. Nevertheless, the management of older CAD patients still
raises several important questions. This review aims to comprehensively
summarize and critically evaluate this emerging evidence, focusing on
invasive management and coronary revascularization. Furthermore, it seeks
to contextualize these interventions within the framework of improved risk
stratification tools for older CAD patients, through user-friendly scales
along with emphasizing the importance of promoting physical activity and
exercise training to enhance the outcomes of invasive and medical
treatments. This comprehensive approach may represent the key to improving
prognosis in the complex and growing patient population of older CAD
patients. Copyright © The Author(s) 2024. Published by Oxford
University Press on behalf of the European Society of Cardiology. All
rights reserved.

<61>
[Use Link to view the full text]
Accession Number
645052123
Title
Efficacy of Hypothermic Compression Bandages in Cardiac Device Surgical
Wounds: A Randomized Controlled Trial.
Source
Advances in skin & wound care. 37(9) (pp 1-7), 2024. Date of Publication:
01 Sep 2024.
Author
Cano Valls A.; Niebla M.; Diago C.; Domingo R.; Tolosana J.M.; Perez S.
Institution
(Cano Valls) In the Arrhythmia and Electrophysiology Unit, Institut Clinic
Cardiovascular, Hospital Clinic de Barcelona, Barcelona, Spain, Alba Cano,
MSc, RN, is Advance Practice Nurse and PhD Student; Mireia Niebla, MSc,
RN, is Advance Practice Nurse; Clara Diago, MSc, RN, is Nurse
Practitioner; Rebeca Domingo, MSc, RN, is Advance Practice Nurse; Jose
Maria Tolosana, PhD, MD, is Cardiologist; and Silvia Perez, MSc, RN, is
Acute Cardiac Care Unit Nursing Coordinator
Abstract
BACKGROUND: Pocket hematoma is the most prevalent complication with
cardiac implantable electronic devices (CIEDs), especially in patients who
are undergoing oral anticoagulation and/or antiplatelet therapy.
 OBJECTIVE(S): To evaluate the efficacy of hypothermic compression
bandaging versus conventional compression bandaging for the prevention of
surgical wound hematoma of CIEDs in patients who are undergoing chronic
anticoagulant drug use and/or antiplatelet therapy. METHOD(S): This
was a single-center randomized prospective study. The intervention group
received a hypothermic compression bandage, and the control group received
a conventional compression bandage. The primary endpoint was the
appearance of hematoma 10 days after the intervention. RESULT(S): A
total of 310 patients participated in the study. The mean age of the
participants was 73.77 +/- 10.68 years, and 74.8% were men. In the
intervention group, 5.88% (n = 18) of patients developed ecchymosis, and
1.3% (n = 4) developed mild hematoma. In the control group, 5.88% (n = 18)
of patients developed ecchymosis, and 2.9% (n = 9) developed mild
hematoma. No patient in either group had a severe hematoma. No significant
differences were observed between the two types of dressing in any of the
three degrees of hematoma. CONCLUSION(S): This study demonstrated
that compression bandaging with or without hypothermic therapy effectively
prevents pocket hematoma of CIEDs in patients at high risk of
bleeding. Copyright © 2024 Wolters Kluwer Health, Inc. All rights
reserved.

<62>
[Use Link to view the full text]
Accession Number
2034153867
Title
Ultrasound-Guided Transfemoral Access for Coronary Procedures: A Pooled
Learning Curve Analysis From the FAUST and UNIVERSAL Trials.
Source
Circulation: Cardiovascular Interventions. 17(8) (pp e013817), 2024. Date
of Publication: 01 Aug 2024.
Author
D'entremont M.-A.; Seto A.H.; Alrashidi S.; Alansari O.; Brochu B.;
Lemaire-Paquette S.; Heenan L.; Skuriat E.; Tyrwhitt J.; Raco M.; Tsang
M.B.; Valettas N.; Velianou J.; Sheth T.; Sibbald M.; Mehta S.R.;
Pinilla-Echeverri N.; Schwalm J.-D.; Natarajan M.K.; Abu-Fadel M.; Kelly
A.; Akl E.; Tawadros S.; Faidi W.; Bauer J.; Moxham R.; Nkurunziza J.;
Dutra G.; Winter J.; Couture E.L.; Jolly S.S.
Institution
(D'entremont, Heenan, Skuriat, Tyrwhitt, Sheth, Mehta, Schwalm, Natarajan,
Jolly) Population Health Research Institute, Hamilton, ON, Canada
(D'entremont, Alrashidi, Alansari, Raco, Tsang, Valettas, Velianou, Sheth,
Sibbald, Mehta, Pinilla-Echeverri, Schwalm, Natarajan, Kelly, Tawadros,
Faidi, Bauer, Moxham, Nkurunziza, Dutra, Jolly) Hamilton Health Sciences,
ON, Canada
(D'entremont, Alrashidi, Alansari, Raco, Tsang, Valettas, Velianou, Sheth,
Sibbald, Mehta, Pinilla-Echeverri, Schwalm, Natarajan, Kelly, Bauer,
Nkurunziza, Jolly) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Seto) Long Beach VA Medical Center, CA, United States
(Brochu) CK Hui Heart Center, Edmonton, AB, Canada
(D'entremont, Lemaire-Paquette, Couture) Centre Hospitalier Universitaire
de Sherbrooke, QC, Canada
(Abu-Fadel) Oklahoma Heart Hospital, United States
(Akl) McGill University, Faculty of Medicine and Health Sciences,
Montreal, QC, Canada
(Winter) Clinica Alemana de Santiago, Universidad de Desarrollo, Chile
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: The learning curve for new operators performing
ultrasound-guided transfemoral access (TFA) remains uncertain.
 METHOD(S): We performed a pooled analysis of the FAUST (Femoral
Arterial Access With Ultrasound Trial) and UNIVERSAL (Routine Ultrasound
Guidance for Vascular Access for Cardiac Procedures) trials, both
multicenter randomized controlled trials of 1:1 ultrasound-guided versus
non-ultrasound-guided TFA for coronary procedures. Outcomes included the
composite of major bleeding or vascular complications and successful
common femoral artery cannulation. Participants were stratified by the
operators' accrued case volume. We used adjusted repeated-measurement
logistic regression, with random intercepts for operator clustering, for
comparison against the non-ultrasound-guided TFA group and to model the
learning curve. RESULT(S): The FAUST and UNIVERSAL trials randomized
a total of 1624 patients, of which 810 were randomized to
non-ultrasound-guided TFA and 814 to ultrasound-guided TFA (cases 1-10,
391; 11-20, 183; and >20, 240). Participants who had operators who
performed >20 ultrasound-guided TFAs had a decreased risk for the primary
end point (5/240 [2.1%] versus 64/810 [7.9%]; adjusted odds ratio, 0.26
[95% CI, 0.09-0.61]) compared with non-ultrasound-guided TFA. Operators
who performed >20 ultrasound-guided procedures had increased odds of
successfully cannulating the common femoral artery (224/246 [91.1%] versus
327/382 [85.6%]; adjusted odds ratio, 1.76 [95% CI, 1.08-2.89]) compared
with non-ultrasound-guided TFA. The learning curve plots demonstrated
growing competence with increasing accrued cases. CONCLUSION(S): New
operators should perform at least 20 ultrasound-guided TFA to decrease
access site complications and increase proper cannulation compared with
non-ultrasound-guided TFA. Additional accrued cases may lead to increased
proficiency. Training programs should consider these findings in the
transradial era. Copyright © 2024 American Heart Association,
Inc.

<63>
Accession Number
2034156060
Title
Clinically Significant Incidental Findings on CT Imaging During TAVI
Work-up: A Systematic Review and Meta-Analysis.
Source
Journal of Invasive Cardiology. 34(3) (pp E218-E225), 2022. Date of
Publication: March 2022.
Author
Ko K.; Zwetsloot P.-P.; Voskuil M.; Stella P.; Leiner T.; Kraaijeveld A.
Institution
(Ko, Zwetsloot, Voskuil, Stella, Kraaijeveld) Department of Cardiology,
University Medical Centre Utrecht, Utrecht, Netherlands
(Leiner) Department of Radiology, University Medical Centre Utrecht,
Utrecht, Netherlands
Publisher
Cliggott Publishing Co.
Abstract
Background. The transcatheter aortic valve implantation (TAVI) population
is mostly elderly and frail. Clinically significant incidental findings
(SIFs) are commonly encountered in the work-up of TAVI patients. This is a
systematic review of current literature on the occurrence of SIFs on
computed tomography (CT) imaging preceding TAVI and their association with
mortality, delayed planning, and procedure cancellation. Methods. A
systematic search on Medline, Embase, and Cochrane resulted in 19
retrospective studies (published from 2010-2020) reporting SIFs in the
work-up for TAVI. A total of 6358 individuals from 19 studies were
analyzed, with mean age of 80 years and sex equally divided. A
random-effects meta-analysis was performed, with weighting based on study
size. Results. Pooled prevalence of patients with SIF was 22.2% (95%
confidence interval [CI], 17.8-26.6) and most findings (48.3%) were found
in the lungs. Pooled prevalence of new malignancies was 3.4% (95% CI,
2.5-4.4). Higher mortality in patients with SIF was only found in studies
with a follow-up period >4 years (hazard ratio, 1.5-1.7). TAVI was more
frequently cancelled in patients with SIF vs those with no SIF (ranges,
10.1%-47.1% vs 5.2%-37.0%, respectively). SIF did not delay time to TAVI
(ranges, 6-91 days in SIF patients vs 4-81 days in non-SIF patients).
Conclusion. SIFs are common in patients screened for TAVI. SIF is
associated with a higher risk of TAVI cancellation and with increased
mortality risk over the long term, which should be taken into
consideration in decision making. These findings may help inform patients
and aid patient selection. Copyright © 2022 Cliggott Publishing
Co.. All rights reserved.

<64>
Accession Number
2034156059
Title
Transcatheter Aortic Valve Replacement in Nonagenarians: A Systematic
Review and Meta-Analysis.
Source
Journal of Invasive Cardiology. 34(3) (pp E226-E236), 2022. Date of
Publication: March 2022.
Author
Demir O.M.; Curio J.; Pagnesi M.; Rahman H.; Mitomo S.; Colombo A.; Chau
M.; Prendergast B.; Latib A.
Institution
(Demir, Rahman, Prendergast) Department of Cardiology, St Thomas'
Hospital, London, United Kingdom
(Curio) Charite University Medical Care, Department of Cardiology, Campus
Benjamin Franklin, Berlin, Germany
(Pagnesi) Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Mitomo) Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
(Colombo) Invasive Cardiology Unit, Humanitas Clinical and Research Center
IRCCS, Rozzano, Milan, Italy
(Chau) Department of Cardiac Surgery, Montefiore Medical Center, New York,
NY, United States
(Latib) Department of Cardiology, Montefiore Medical Center, New York, NY,
United States
(Latib) Division of Cardiology, Department of Medicine, University of Cape
Town, Cape Town, South Africa
Publisher
Cliggott Publishing Co.
Abstract
Background. Nonagenarians represent only a small proportion of patients
included in large transcatheter aortic valve replacement (TAVR) trials,
but will become a relevant future population in need of treatment due to
demographic change. Thus, this study sought to evaluate outcomes of TAVR
for the treatment of severe aortic stenosis (AS) in nonagenarian patients.
Methods. We screened Medline/Pubmed for studies that stated specific
outcomes for nonagenarians undergoing TAVR. A weighted meta-analysis was
conducted, calculating pooled estimate rates using a binary random-effects
model for dichotomous variables, and comparing non-dichotomous outcomes
with a continuous random-effects model. Results. Data from 23 studies
including 16,094 nonagenarians were merged; 53.4% were women. Despite
reasonable rates of comorbidities, Society of Thoracic Surgeons mortality
risk score was 10.2 +/- 5.4. Pooled estimate rate of procedural success
was 94.1% (95% confidence interval [CI], 91.7-96.6), with major vascular
complications occurring in 6.3% (95% CI, 2.7-9.8) and at least moderate
postprocedural paravalvular leak in 7.5% (95% CI, 4.4-10.6). The rate of
periprocedural stroke or transient ischemic attack was 2.6% (95% CI,
2.0-3.2). At 30 days, the pooled estimate of mortality was 6.1% (95% CI,
4.7-7.4) and a permanent pacemaker was implanted in 12.6% (95% CI,
7.6-17.6). After 1 year, the mortality rate was 20.5% (95% CI, 15.9-25.1).
Conclusion. TAVR in nonagenarians is an effective and safe procedure, with
encouraging outcomes given the general life expectancy of these patients.
Currently, only selected nonagenarians are undergoing TAVR, but their
number will grow as life expectancy continues to increase in the developed
world. Specific research to identify ideal candidates and techniques in
this cohort is needed. Copyright © 2022 Cliggott Publishing Co..
All rights reserved.

<65>
Accession Number
2034152129
Title
Transcatheter Aortic Valve Implantation With or Without Predilation: A
Meta-Analysis.
Source
Journal of Invasive Cardiology. 34(2) (pp E104-E113), 2022. Date of
Publication: February 2022.
Author
Conrotto F.; D'Ascenzo F.; Franchin L.; Bruno F.; Mamas M.A.; Toutouzas
K.; Cuisset T.; Leclercq F.; Dumonteil N.; Latib A.; Nombela-Franco L.;
Schaefer A.; Anderson R.D.; Marruncheddu L.; Gallone G.; De Filippo O.; La
Torre M.; Rinaldi M.; Omede P.; Salizzoni S.; De Ferrari G.M.
Institution
(Conrotto, D'Ascenzo, Franchin, Bruno, Gallone, De Filippo, La Torre,
Omede, Salizzoni, De Ferrari) The Division of Cardiology, Cardiovascular
and Thoracic Department, Citta della Salute e della Scienza Hospital,
University of Turin, Italy
(Mamas) Keele Cardiovascular Research Group, University of Keele,
Stoke-on-Trent, United Kingdom
(Toutouzas) University of Athens, Greece
(Cuisset) Assistance Publique Hopitaux de Marseille, France
(Leclercq) CHU de Montpellier, France
(Dumonteil) Hopitaux de Toulouse, France
(Latib) Montefiore Medical Center, Bronx, NY, United States
(Nombela-Franco) Cardiovascular Institute, Hospital Clinico San Carlos,
IdISSC, Madrid, Spain
(Schaefer) University Heart and Vascular Center Hamburg, Department of
Cardiovascular Surgery, Germany
(Anderson) Department of Medicine, Division of Cardiovascular Medicine,
University of Florida, Gainesville, FL, United States
(Marruncheddu) Anesthesiological and Cardiovascular Science, Sapienza
University of Rome, Rome, Italy
(Rinaldi) Division of Cardiac Surgery, Cardiovascular and Thoracic
Department, Citta della Salute e della Scienza Hospital, University of
Turin, Italy
Publisher
Cliggott Publishing Co.
Abstract
Aims. To evaluate the impact of systematic predilation with balloon aortic
valvuloplasty (BAV) on transcatheter aortic valve implantation (TAVI).
Methods and Results. We performed a systematic meta-analysis investigating
patients undergoing TAVI with systematic BAV vs no BAV in RCT or in
adjusted studies. Device success was the primary endpoint, while all-cause
mortality, 30-day moderate/severe aortic regurgitation (AR), stroke,
permanent pacemaker implantation (PPI) and acute kidney injury (AKI) were
the secondary endpoints. Subanalysis according to design of the study (RCT
and adjusted analysis) and to the type of valve (balloon-expandable [BE]
vs self-expanding [SE]) were conducted. We obtained data from 15 studies,
comprising 16,408 patients: 10,364 undergoing BAV prior to TAVI and 6,044
in which direct TAVI has been performed. At 30-day follow-up, BAV did not
improve the rate of device success in the overall population (OR, 1.09;
95% CI, 0.90-1.31), both in SE (OR, 0.93; 95% CI, 0.60-1.45) and in BE
(OR, 1.16; 95% CI, 0.88-1.52) valves. Between BAV and direct TAVI, no
differences in secondary outcomes were observed neither in overall
population nor according to valve type between BAV and direct TAVI
strategies. All endpoints results were consistent between RCTs and
adjusted studies except for postdilation rate that did not differ in
observational studies (OR, 0.70; 95% CI, 0.47-1.04), while it was lower in
BAV when only RCTs were included in the analysis (OR, 0.48; 95% CI,
0.24-0.97). Conclusions. Direct TAVI is feasible and safe compared to
predilation approach with similar device success rates and clinical
outcomes. Direct TAVI could represent a first-choice approach in
contemporary TAVI procedures. Copyright © 2022 Cliggott
Publishing Co.. All rights reserved.

<66>
Accession Number
2034134815
Title
A systematic review and meta-Analysis of clinical outcomes of patients
undergoing chronic total occlusion percutaneous coronary intervention.
Source
Journal of Invasive Cardiology. 34(11) (pp E763-E775), 2022. Date of
Publication: November 2022.
Author
Simsek B.; Kostantinis S.; Karacsonyi J.; Alaswad K.; Megaly M.;
Karmpaliotis D.; Masoumi A.; Jaber W.A.; Nicholson W.; Rinfret S.;
Mashayekhi K.; Werner G.S.; McEntegart M.; Lee S.-W.; Khatri J.J.; Harding
S.A.; Avran A.; Jaffer F.A.; Doshi D.; Kao H.-L.; Sianos G.; Yamane M.;
Milkas A.; Azzalini L.; Garbo R.; Tammam K.; Rafeh N.A.; Nikolakopoulos
I.; Vemmou E.; Rangan B.V.; Nicholas Burke M.; Garcia S.; Croce K.J.; Wu
E.B.; Tsuchikane E.; Di Mario C.; Galassi A.R.; Gagnor A.; Knaapen P.;
Jang Y.; Kim B.-K.; Poommipanit P.B.; Brilakis E.S.
Institution
(Simsek, Kostantinis, Karacsonyi, Rangan, Nicholas Burke, Garcia,
Brilakis) The Minneapolis Heart Institute, Minneapolis Heart Institute
Foundation, Minneapolis, MN, United States
(Alaswad, Megaly) Henry Ford Hospital, Detroit, MI, United States
(Karmpaliotis, Masoumi) Gagnon Cardiovascular Institute, Morristown
Medical Center, New Jersey, United States
(Jaber, Nicholson, Rinfret) Emory University, United States
(Mashayekhi) Division of Cardiology and Angiology II, University Heart
Center Freiburg, Bad Krozingen, Germany
(Werner) Medizinische Klinik i Cardiology and Intensive Care, Klinikum
Darmstadt GmbH, Darmstadt, Germany
(McEntegart) Department of Cardiology, Golden Jubilee National Hospital,
Glasgow, United Kingdom
(Lee) Division of Cardiology, Department of Internal Medicine, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, South
Korea
(Khatri) Cleveland Clinic Foundation, Cleveland, OH, United States
(Harding) Department of Cardiology, Wellington Hospital, Wellington, New
Zealand
(Avran) Pasteur Institute, Nancy, France
(Jaffer, Doshi) Massachusetts General Hospital, Harvard Medical School,
Boston, MA, United States
(Kao) Cardiology Division, Department of Internal Medicine and
Cardiovascular Center, National Taiwan University Hospital, Taiwan
(Republic of China)
(Sianos) First Department of Cardiology, American Hellenic Educational and
Progressive Association University Hospital, School of Medicine, Faculty
of Health Sciences, Aristotle University of Thessaloniki, Greece
(Yamane) Department of Cardiology, Sayama Hospital, Saitama, Japan
(Milkas) Acute Cardiac Care Unit Athens Naval and Veterans Hospital,
Greece
(Azzalini) Division of Cardiology, VCU Health Pauley Heart Center,
Virginia Commonwealth University, Richmond, VA, United States
(Garbo) Maria Pia Hospital, GVM Care and Research MD, Torino, Italy
(Tammam) International Medical Center, Jeddah, Saudi Arabia
(Rafeh) North Oaks Health System, LA, United States
(Nikolakopoulos, Vemmou) Department of Internal Medicine, Yale New Haven
Hospital, Yale University School of Medicine, New Haven, CT, United States
(Croce) Brigham and Women s Hospital, Harvard Medical School, Boston, MA,
United States
(Wu) Prince of Wales Hospital, Hong Kong, Hong Kong
(Tsuchikane) Department of Cardiology, Toyohashi Heart Center, Japan
(Di Mario) Division of Structural Interventional Cardiology, Careggi
University Hospital, Florence, Italy
(Galassi) University of Palermo, Italy
(Gagnor) Department of Invasive Cardiology, Maria Vittoria Hospital,
Turin, Italy
(Knaapen) Department of Cardiology, VU University Medical Center,
Amsterdam, Netherlands
(Jang) Department of Cardiology, CHA Bundang Medical Center, CHA
University School of Medicine, Seongnam, South Korea
(Kim) The Division of Cardiology, Department of Internal Medicine,
Severance Cardiovascular Hospital, Yonsei University College of Medicine,
Seoul, South Korea
(Poommipanit) The Section of Cardiology, University Hospitals, Case
Western Reserve University, Cleveland, OH, United States
Publisher
Cliggott Publishing Co.
Abstract
Objectives. Chronic total occlusion (CTO) percutaneous coronary
intervention (PCI) can improve patient symptoms, but it remains
controversial whether it impacts subsequent clinical outcomes. Methods. In
this systematic review and meta-Analysis, we queried PubMed,
ScienceDirect, Cochrane Library, Web of Science, and Embase databases
(last search: September 15, 2021). We investigated the impact of CTO-PCI
on clinical events including all-cause mortality, cardiovascular death,
myocardial infarction (MI), major adverse cardiovascular event (MACE),
stroke, subsequent coronary artery bypass surgery, target-vessel
revascularization, and heart failure hospitalizations. Pooled analysis was
performed using a random-effects model. Results. A total of 58
publications with 54,540 patients were included in this analysis, of which
33 were observational studies of successful vs failed CTO-PCI, 19 were
observational studies of CTO-PCI vs no CTO-PCI, and 6 were randomized
controlled trials (RCTs). In observational studies, but not RCTs, CTO-PCI
was associated with better clinical outcomes. Odds ratios (ORs) and 95%
confidence intervals (CIs) for all-cause mortality, MACE, and MI were 0.52
(95% CI, 0.42-0.64), 0.46 (95% CI, 0.37-0.58), 0.66 (95% CI, 0.50-0.86),
respectively for successful vs failed CTO-PCI studies; 0.38 (95% CI,
0.31-0.45), 0.57 (95% CI, 0.42-0.78), 0.65 (95% CI, 0.42-0.99),
respectively, for observational studies of CTO-PCI vs no CTO-PCI; 0.72
(95% CI, 0.39-1.32), 0.69 (95% CI, 0.38-1.25), and 1.04 (95% CI,
0.46-2.37), respectively for RCTs. Conclusions. CTO-PCI is associated with
better subsequent clinical outcomes in observational studies but not in
RCTs. Appropriately powered RCTs are needed to conclusively determine the
impact of CTO-PCI on clinical outcomes. Copyright © 2022 HMP
Global.

<67>
Accession Number
2034152637
Title
Routine Protamine Administration for Bleeding in Transcatheter Aortic
Valve Implantation The ACE-PROTAVI Randomized Clinical Trial.
Source
JAMA Cardiology. (no pagination), 2024. Date of Publication: 2024.
Author
Vriesendorp P.A.; Nanayakkara S.; Heuts S.; Ball J.; Chandrasekar J.; Dick
R.; Haji K.; Htun N.M.; McGaw D.; Noaman S.; Palmer S.; Cairo S.; Shulman
M.; Lin E.; Hastings S.; Waldron B.; Proimos G.; Soon K.H.; Yudi M.B.;
Zimmet A.; Stub D.; Walton A.S.
Institution
(Vriesendorp, Nanayakkara, Haji, Htun, Noaman, Palmer, Shulman, Lin,
Hastings, Zimmet, Stub, Walton) Heart Centre, The Alfred Hospital,
Melbourne, VIC, Australia
(Vriesendorp) Heart+Vascular Center, Department of Cardiology, Maastricht
University Medical Center, Maastricht, Netherlands
(Vriesendorp, Heuts) Cardiovascular Research Institute Maastricht,
Maastricht University, Maastricht, Netherlands
(Nanayakkara) Heart Failure Research Group, Baker Heart and Diabetes
Institute, Melbourne, VIC, Australia
(Nanayakkara, Ball, Stub, Walton) School of Public Health and Preventive
Medicine, Monash University, Melbourne, VIC, Australia
(Heuts) Department of Cardiothoracic Surgery, Maastricht University
Medical Center, Maastricht, Netherlands
(Chandrasekar, Dick, Haji, Noaman, Proimos, Soon, Yudi, Walton) Department
of Cardiology, Epworth Health Care, Melbourne, VIC, Australia
(Chandrasekar) Department of Cardiology, Eastern Health, Melbourne, VIC,
Australia
(Chandrasekar) Eastern Health Clinical School, Monash University,
Melbourne, VIC, Australia
(McGaw, Stub) Department of Cardiology, Cabrini Health, Melbourne, VIC,
Australia
(Palmer, Cairo, Soon) Department of Medicine, The University of Melbourne,
Melbourne, VIC, Australia
(Cairo, Shulman, Lin, Hastings, Waldron) Cabrini Anaesthetics Department,
Cabrini Health, Melbourne, VIC, Australia
(Yudi) Department of Cardiology, Austin Health, Melbourne, VIC, Australia
Publisher
American Medical Association
Abstract
IMPORTANCE Vascular complications after transfemoral transcatheter aortic
valve implantation (TAVI) remain an important cause of procedure-related
morbidity. Routine reversal of anticoagulation with protamine at the
conclusion of transfemoral TAVI could reduce complications, but data
remain scarce. OBJECTIVE To evaluate the efficacy and safety of routine
protamine administration after transfemoral TAVI. DESIGN, SETTING, AND
PARTICIPANTS The ACE-PROTAVI trialwas an investigator-initiated,
double-blind, placebo-controlled randomized clinical trial performed at 3
Australian hospitals between December 2021 and June 2023 with a 1-year
follow-up period. All patients accepted for transfemoral TAVI by a
multidisciplinary heart team were eligible for enrollment. INTERVENTIONS
Eligible patients were randomized 1:1 between routine protamine
administration and placebo. MAIN OUTCOMES AND MEASURES The coprimary
outcomeswere the rate of hemostasis success and time to hemostasis (TTH),
presented as categorical variables and compared with a chi2
test or as continuous variables as mean (SD) or median (IQR), depending on
distribution. The major secondary outcome was a composite of all-cause
death, major and minor bleeding complications, and major and minor
vascular complications after 30 days, reported in odds ratios (ORs) with
95%CIs and P values. RESULTS The study population consisted of 410
patients: 199 patients in the protamine group and 211 in the placebo
group. The median (IQR) patient age in the protamine group was 82 (77-85)
years, and 68 of 199 patients receiving protamine (34.2%) were female. The
median (IQR) patient age in the placebo group was 80 (75-85) years, and 89
of 211 patients receiving the placebo (42.2%) were female. Patients
receiving up-front protamine administration had a higher rate of
hemostasis success (188 of 192 patients [97.9%]) than patients in the
placebo group (186 of 203 patients [91.6%]; absolute risk difference,
6.3%; 95%CI, 2.0%-10.6%; P = .006); in addition, patients receiving
up-front protamine had a shorter median (IQR) TTH (181 [120-420] seconds
vs 279 [122-600] seconds; P = .002). Routine protamine administration
resulted in a reduced risk of the composite outcome in the protamine group
(10 of 192 [5.2%]) vs the placebo group (26 of 203 [12.8%]; OR, 0.37;
95%CI, 0.1-0.8; P = .01). This difference was predominantly driven by the
difference in the prevalence of minor vascular complications. There were
no adverse events associated with protamine use. CONCLUSIONS AND RELEVANCE
In the ACE-PROTAVI randomized clinical trial, routine administration of
protamine increased the rate of hemostasis success and decreased TTH. The
beneficial effect of protamine was reflected in a reduction in minor
vascular complications, procedural time, and postprocedural hospital stay
duration in patients receiving routine protamine compared with patients
receiving placebo. Copyright © 2024 American Medical
Association. All rights reserved.

<68>
Accession Number
645049923
Title
Going the Distance: Long Term Follow-Up of the Randomized, Prospective
Scandinavian Heart Transplant Everolimus De Novo Study with Early
Calcineurin Inhibitors Avoidance (SCHEDULE) Trial.
Source
The Journal of heart and lung transplantation : the official publication
of the International Society for Heart Transplantation. (no pagination),
2024. Date of Publication: 17 Aug 2024.
Author
Gamero M.T.; Brailovsky Y.; Eisen H.J.
Institution
(Gamero, Brailovsky, Eisen) Thomas Jefferson University, Philadelphia, PA
19103, United States

<69>
Accession Number
2034162568
Title
Valve-in-valve transcatheter mitral valve replacement versus redo-surgical
mitral valve replacement for degenerated bioprosthetic mitral valves: A
systematic review and meta-analysis.
Source
International Journal of Cardiology. 415 (no pagination), 2024. Article
Number: 132448. Date of Publication: 15 Nov 2024.
Author
Nasir M.M.; Amir S.; Shahid A.; Rehman W.U.; Haris M.; Ikram A.; Mubariz
M.; Ahmed J.; Khan U.; Iqbal A.G.; Saeed H.; Noori M.A.M.
Institution
(Nasir, Amir, Shahid, Haris, Ikram, Ahmed) Department of Internal
Medicine, Dow University of Health Sciences, Karachi, Pakistan
(Rehman) Department of Internal Medicine, United Health Services Hospital,
Johnson City, NY, United States
(Mubariz) Department of Internal Medicine, Akhtar Saeed Medical and Dental
College, Lahore, Pakistan
(Khan) Division of Cardiovascular Medicine, University of Maryland, School
of Medicine, Baltimore, MD, United States
(Iqbal) Department of Internal Medicine, UNC Nash General Hospital, NC,
United States
(Saeed) RWJBarnabas Health/Trinitas Regional Medical Center, NJ, United
States
(Noori) Department of Cardiovascular Medicine, St Joseph's University
Medical Center, Paterson, NJ, United States
Publisher
Elsevier Ireland Ltd
Abstract
Bioprosthetic mitral valve degeneration is traditionally treated with
Redo-SMVR, but the latest ViV-TMVR procedure offers a less invasive and
lower risk alternative. A systematic literature search was conducted on
Cochrane Central, Scopus, and Medline (PubMed interface) electronic
databases from inception till 15th April 2024. We used risk ratios (RR)
for dichotomous outcomes and mean differences (MD) for continuous
outcomes. We included a total of eleven studies with 11,931 patients in
the final quantitative and qualitative analysis. When comparing ViV-TMVR
with Redo-SMVR, no significant difference was found for 30-day mortality
(P = 0.13) and 1-year mortality (P = 0.91), whereas patients in the
ViV-TMVR showed significantly reduced incidence of stroke (P < 0.00001),
In-hospital mortality (P), bleeding complications (P = 0.003), AKI (P =
0.0006), arrhythmias (P = 0.01), LVOT obstruction (P = 0.04), and PPI (P <
0.00001). Furthermore, no significant difference was observed between
either group when comparing vascular complications (P = 0.97), 2-year
mortality (P = 0.60) and 3-year mortality. ViV-TMVR was associated with a
significant risk of paravalvular leakage (P = 0.008). Although, ViV-TMVR
reduces the risk of complications associated with Redo-SMVR, larger
studies are imperative to reach conclusive results. Copyright ©
2024 Elsevier B.V.

<70>
Accession Number
2034056265
Title
Hypothermic oxygenated perfusion of the donor heart in heart
transplantation: the short-term outcome from a randomised, controlled,
open-label, multicentre clinical trial.
Source
The Lancet. 404(10453) (pp 670-682), 2024. Date of Publication: 17 Aug
2024.
Author
Rega F.; Lebreton G.; Para M.; Michel S.; Schramm R.; Begot E.;
Vandendriessche K.; Kamla C.; Gerosa G.; Berman M.; Boeken U.; Clark S.;
Ranasinghe A.; Ius F.; Forteza A.; Pivodic A.; Hennig F.; Guenther S.;
Zuckermann A.; Knosalla C.; Dellgren G.; Wallinder A.; Van Cleemput J.;
Degezelle K.; Wert L.; Yeter R.; Lichtenber A.; Aubin H.; Gorler A.; Freyt
S.; McDiamud A.; Jungschleger J.; Mukadam M.; Turner P.; Mullen R.;
Hernandez F.; Ospina V.; Jonsson K.; Ternstrom L.; Al Kalbany H.; Djavidi
N.; Fabozzo A.; Pradegan N.; Aliabadi-Zuckermann A.; Osorio E.
Institution
(Rega, Vandendriessche, Degezelle) Department of Cardiac Surgery,
University Hospitals Leuven, Leuven, Belgium
(Lebreton, Begot, Al Kalbany, Djavidi) Cardiac Surgery Department,
Pitie-Salpetriere Hospital, APHP, Sorbonne University, Paris, France
(Para) Department of Cardiovascular Surgery and Transplantation, Bichat
Hospital, Universite Paris Cite, Paris, France
(Michel, Kamla) Clinic of Cardiac Surgery, Ludwig-Maximilians-University
of Munich, Munich, Germany
(Michel, Kamla) Munich Heart Alliance, German Center for Cardiovascular
Research, Munich, Germany
(Schramm, Guenther) Clinic for Thoracic and Cardiovascular Surgery, Heart
and Diabetes Center North Rhine Westfalia, Ruhr-University Bochum, Bad
Oeynhausen, Germany
(Gerosa, Fabozzo, Pradegan) Department of Cardiac, Thoracic, Vascular
Sciences and Public Health, University of Padua, Padua, Italy
(Berman) Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation
Trust, Cambridge, United Kingdom
(Boeken, Lichtenber, Aubin) Department of Cardiac Surgery, Medical
Faculty, Heinrich Heine University, Duesseldorf, Germany
(Clark) Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne,
United Kingdom
(Ranasinghe) Cardiac Surgery, Queen Elizabeth Hospital, University
Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
(Ius) Department of Cardiothoracic, Transplant and Vascular Surgery,
Hannover Medical School, Hannover, Germany
(Forteza, Ospina) Department of Cardiac Surgery, Puerta de Hierro
Majadahonda University Hospital, Madrid, Spain
(Pivodic) APNC Sweden, Molndal, Sweden
(Hennig, Knosalla) Department of Cardiothoracic and Vascular Surgery,
Deutsches Herzzentrum der Charite, Berlin, Germany
(Hennig, Knosalla) Charite-Universitatsmedizin Berlin, corporate member of
Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Berlin,
Germany
(Hennig, Knosalla) German Center for Cardiovascular Research, Berlin,
Germany
(Zuckermann, Aliabadi-Zuckermann, Osorio) Department of Cardiac Surgery,
Medical University of Vienna, Vienna, Austria
(Dellgren, Jonsson, Ternstrom) Department of Cardiothoracic Surgery,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Wallinder) XVIVO Perfusion, Gothenburg, Sweden
(Van Cleemput) Department of Cardiology, University Hospitals Leuven,
Leuven, Belgium
(Wert, Yeter) Department of Cardiothoracic and Vascular Surgery, Deutsches
Herzzentrum der Charite (DHZC), Berlin, Germany
(Gorler, Freyt) Department of Cardiothoracic, Transplant and Vascular
Surgery, Hannover Medical School, Hannover, Germany
(McDiamud, Jungschleger) Cardiothoracic Centre, Freeman Hospital,
Newcastle upon Tyne, United Kingdom
(Mukadam, Turner) Department of Cardiac, Thoracic, Vascular Sciences and
Public Health, Queen Elizabeth Hospital, University Hospitals Birmingham
NHS Trust, Birmingham, United Kingdom
(Mullen) Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation
Trust, Cambridge, United Kingdom
(Hernandez) Department of Cardiology, Puerta de Hierro Majadahonda
University Hospital, Madrid, Spain
Publisher
Elsevier B.V.
Abstract
Background: Static cold storage (SCS) remains the gold standard for
preserving donor hearts before transplantation but is associated with
ischaemia, anaerobic metabolism, and organ injuries, leading to patient
morbidity and mortality. We aimed to evaluate whether continuous,
hypothermic oxygenated machine perfusion (HOPE) of the donor heart is safe
and superior compared with SCS. Method(s): We performed a
multinational, multicentre, randomised, controlled, open-label clinical
trial with a superiority design at 15 transplant centres across eight
European countries. Adult candidates for heart transplantation were
eligible and randomly assigned in a 1:1 ratio. Donor inclusion criteria
were age 18-70 years with no previous sternotomy and donation after brain
death. In the treatment group, the preservation protocol involved the use
of a portable machine perfusion system ensuring HOPE of the resting donor
heart. The donor hearts in the control group underwent ischaemic SCS
according to standard practices. The primary outcome was time to first
event of a composite of either cardiac-related death, moderate or severe
primary graft dysfunction (PGD) of the left ventricle, PGD of the right
ventricle, acute cellular rejection at least grade 2R, or graft failure
(with use of mechanical circulatory support or re-transplantation) within
30 days after transplantation. We included all patients who were randomly
assigned, fulfilled inclusion and exclusion criteria, and received a
transplant in the primary analysis and all patients who were randomly
assigned and received a transplant in the safety analyses. This trial was
registered with ClicalTrials.gov (NCT03991923) and is ongoing.
 Finding(s): A total of 229 patients were enrolled between Nov 25,
2020, and May 19, 2023. The primary analysis population included 204
patients who received a transplant. There were no patients who received a
transplant lost to follow-up. All 100 donor hearts preserved with HOPE
were transplantable after perfusion. The primary endpoint was registered
in 19 (19%) of 101 patients in the HOPE group and 31 (30%) of 103 patients
in the SCS group, corresponding to a risk reduction of 44% (hazard ratio
0.56; 95% CI 0.32-0.99; log-rank test p=0.059). PGD was the primary
outcome event in 11 (11%) patients in the HOPE group and 29 (28%) in the
SCS group (risk ratio 0.39; 95% CI 0.20-0.73). In the HOPE group, 63 (65%)
patients had a reported serious adverse event (158 events) versus 87 (70%;
222 events) in the SCS group. Major adverse cardiac transplant events were
reported in 18 (18%) and 33 (32%) patients in the HOPE and SCS group (risk
ratio 0.56; 95% CI 0.34-0.92). Interpretation(s): Although there was
not a significant difference in the primary endpoint, the 44% risk
reduction associated with HOPE was suggested to be a clinically meaningful
benefit. Post-transplant complications, measured as major adverse cardiac
transplant events, were reduced. Analysis of secondary outcomes suggested
that HOPE was beneficial in reducing primary graft dysfunction. HOPE in
donor heart preservation addresses the existing challenges associated with
graft preservation and the increasing complexity of donors and heart
transplantation recipients. Future investigation will help to further
elucidate the benefit of HOPE. Funding(s): XVIVO
Perfusion. Copyright © 2024 Elsevier Ltd

<71>
Accession Number
2031990299
Title
A systematic review of existing appropriate use criteria in cardiovascular
disease from the last 15 years.
Source
Seminars in Vascular Surgery. 37(2) (pp 101-110), 2024. Date of
Publication: June 2024.
Author
Le Q.; Mills A.; Denton A.; Weaver M.L.
Institution
(Le) University of Virginia School of Medicine, Charlottesville, VA,
United States
(Mills) Department of Surgery, University of Virginia, Charlottesville,
VA, United States
(Denton) Claude Moore Health Sciences Library, University of Virginia,
Charlottesville, VA, United States
(Weaver) Division of Vascular and Endovascular Surgery, University of
Virginia Health System, 1215 Lee Street, PO Box 800679, Charlottesville,
VA 22908-0679, United States
Publisher
W.B. Saunders
Abstract
Appropriate use criteria (AUC) aim to impact the provision of high-value
care. This scoping review identified AUC regarding the procedural and
operative treatment of cardiovascular disease and described the evolution
of AUC in this space over time, including changes in the focus, strategy,
and language of AUC. The summative presentation of these AUC identifies
elements of AUC that may lead to successes in, and barriers to,
implementation across disease processes, specialties, and societies. AUC
topics include coronary artery disease, peripheral artery disease,
valvular disease, venous disease, renal artery stenosis, and mesenteric
ischemia, among others. Copyright © 2024 Elsevier Inc.

<72>
[Use Link to view the full text]
Accession Number
2034079803
Title
Effectiveness and safety of enhanced postoperative care units for
non-cardiac, non-neurological surgery: a systematic review protocol.
Source
JBI Evidence Synthesis. 22(8) (pp 1626-1635), 2024. Date of Publication:
14 Mar 2024.
Author
Tran L.; Stern C.; Harford P.; Ludbrook G.; Whitehorn A.
Institution
(Tran, Stern, Harford, Whitehorn) JBI, Faculty of Health and Medical
Sciences, School of Public Health, The University of Adelaide, SA,
Australia
(Tran, Ludbrook) Department of Anaesthesia, Royal Adelaide Hospital,
Central Adelaide Local Health Network, Adelaide, SA, Australia
(Tran, Harford, Ludbrook) Royal Adelaide Hospital, Central Adelaide Local
Health Network, Adelaide, SA, Australia
(Ludbrook) Discipline of Acute Care Medicine, The University of Adelaide,
Adelaide, SA, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The proposed systematic review will evaluate the evidence on
the effectiveness and safety of enhanced post-operative care (EPC) units
on patient and health service outcomes in adult patients following
non-cardiac, non-neurological surgery. Introduction: The increase in
surgical procedures globally has placed a significant economic and
societal burden on health care systems. Recognizing this challenge, EPC
units have emerged as a model of care, bridging the gap between
traditional, ward-level care and intensive care. EPC offers benefits such
as higher staff-to-patient ratios, close patient monitoring (eg, invasive
monitoring), and access to critical interventions (eg, vasopressor
support). However, there is a lack of well-established guidelines and
empirical evidence regarding the safety and effectiveness of EPC units for
adult patients following surgery. Inclusion criteria: This review will
include studies involving adult patients (>=18 years) undergoing any
elective or emergency non-cardiac, non-neurological surgery, who have been
admitted to an EPC unit. Experimental, quasi-experimental, and
observational study designs will be eligible. Method(s): This review
will follow the JBI methodology for systematic reviews of effectiveness.
The search strategy will identify published and unpublished studies from
the Cochrane Library, MEDLINE (Ovid), Embase (Ovid), and Scopus, as well
as gray literature sources, from 2010 to the present. Two independent
reviewers will screen studies, extract data, and critically appraise
selected studies using standardized JBI assessment tools. Where feasible,
a statistical meta-analysis will be performed to combine study findings.
The certainty of evidence will be assessed using the Grading of
Recommendations, Assessment, Development and Evaluation (GRADE)
methodology. Copyright © 2024 JBI.

<73>
Accession Number
2032455620
Title
Dapagliflozin and Timing of Prior Heart Failure Hospitalization: A
Patient-Level Meta-Analysis of DAPA-HF and DELIVER.
Source
JACC: Heart Failure. 12(9) (pp 1586-1599), 2024. Date of Publication:
September 2024.
Author
Butt J.H.; Jhund P.S.; Docherty K.F.; Claggett B.L.; Vaduganathan M.;
Bachus E.; Hernandez A.F.; Lam C.S.P.; Inzucchi S.E.; Martinez F.A.; de
Boer R.A.; Kosiborod M.N.; Desai A.S.; Kober L.; Ponikowski P.; Sabatine
M.S.; Solomon S.D.; McMurray J.J.V.
Institution
(Butt, Jhund, Docherty, McMurray) British Heart Foundation Cardiovascular
Research Centre, University of Glasgow, Glasgow, United Kingdom
(Butt, Kober) Department of Cardiology, Copenhagen University Hospital
Rigshospitalet, Copenhagen, Denmark
(Claggett, Vaduganathan, Desai, Solomon) Cardiovascular Division, Brigham
and Women's Hospital, Harvard Medical School, Boston, MA, United States
(Bachus) Late-Stage Development, Cardiovascular, Renal, and Metabolism,
BioPharmaceuticals R and D, AstraZeneca, Gothenburg, Sweden
(Hernandez) Duke University Medical Center, Durham, NC, United States
(Lam) National Heart Centre Singapore, Singapore
(Inzucchi) Duke-National University of Singapore, Singapore
(Inzucchi) Yale School of Medicine, New Haven, CT, United States
(Martinez) University of Cordoba, Cordoba, Argentina
(de Boer) Erasmus Medical Center, Rotterdam, Netherlands
(Kosiborod) Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City, MO, United States
(Ponikowski) Department of Heart Disease, Wroclaw Medical University,
Wroclaw, Poland
(Sabatine) TIMI Study Group, Division of Cardiovascular Medicine, Brigham
and Women's Hospital, Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
Background: Patients recently hospitalized for heart failure (HF) are at a
higher risk of adverse clinical outcomes, but they may experience a
greater absolute and relative benefit from effective therapies than
individuals who are considered more "stable." Objectives: The authors
examined the effects of dapagliflozin according to the timing of prior HF
hospitalization in a patient-level pooled analysis of DAPA-HF
(Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) and
DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients with
Preserved Ejection Fraction Heart Failure). Method(s): A total of
11,007 patients were randomized in DAPA-HF and DELIVER. The primary
outcome was the composite of worsening HF or cardiovascular death.
 Result(s): In total, 12.4% were hospitalized for HF within 3 months
of randomization, 14.2% between 3 and 12 months, and 16.8% more than 1
year before randomization, whereas 56.5% had not been hospitalized. The
risk of the primary endpoint was inversely associated with time from prior
HF hospitalization, and patients with a recent HF hospitalization had the
highest risk. Compared with placebo, dapagliflozin reduced the risk of the
primary outcome across HF hospitalization category (0-3 months, HR: 0.66
[95% CI: 0.55-0.81]; 3-12 months, HR: 0.73 [95% CI: 0.59-0.90]; >1 year,
HR: 0.91 [95% CI: 0.74-1.12]; and no prior hospitalization, HR: 0.83 [95%
CI: 0.73-0.94]; P<inf>interaction</inf> = 0.09). The number of patients
needed to treat with dapagliflozin to prevent 1 event over the median
follow-up of 22 months was 13, 20, 23, and 28, respectively. The
beneficial effect was consistent across the range of LVEF regardless of HF
hospitalization category. Conclusion(s): The relative benefits of
dapagliflozin were consistent across the range of LVEF regardless of the
timing of the most recent HF hospitalization with a greater absolute
benefit in patients with recent hospitalization. Copyright © 2024
The Authors

<74>
Accession Number
2030953093
Title
Narrative Review: Surgical and Hybrid Management of Atrial Fibrillation.
Source
Cardiology and Therapy. 13(3) (pp 493-528), 2024. Date of Publication:
September 2024.
Author
Trohman R.G.
Institution
(Trohman) Section of Electrophysiology, Division of Cardiology, Department
of Internal Medicine, Rush University Medical Center, 1653 W. Congress,
Chicago, IL 60612, United States
Publisher
Adis
Abstract
Although significant strides have been made in non-pharmacologic
management of atrial fibrillation (AF), these treatments remain a work in
progress. While catheter ablation is often effective for management of
paroxysmal AF, it is less successful in patients with persistent or
longstanding persistent AF. This review was undertaken to clarify the
risks, benefits, and alternatives to catheter ablation for
non-pharmacologic AF management. In order to clarify the roles of surgical
and hybrid ablation, this narrative review was undertaken by searching
MEDLINE to identify peer-reviewed clinical trials, randomized controlled
trials, meta-analyses, review articles, and other clinically relevant
studies. The search was limited to English-language reports published
between 1960 and 2023. Atrial fibrillation was searched using the terms
surgical ablation, catheter ablation, hybrid ablation, stroke prevention,
left atrial occlusion, and atrial excision. Google and Google Scholar, as
well as bibliographies of identified articles, were also reviewed for
additional references. The Cox-maze surgical approach is still the most
efficacious non-pharmacological treatment for AF. Hybrid ablation,
combining cardiac surgical and catheter ablation techniques, has become an
attractive option for persistent or longstanding persistent
AF. Copyright © The Author(s) 2024.

<75>
Accession Number
2030608483
Title
The Effect of Lidocaine-Prilocaine Cream Combined with or Without
Remimazolam on VAS and APAIS Anxiety Score in Patient Undergoing Spinal
Anesthesia.
Source
Drug Design, Development and Therapy. 18 (pp 3429-3441), 2024. Date of
Publication: 2024.
Author
Liang S.; Li S.; Zhong Z.; Luo Q.; Nie C.; Hu D.; Li Y.
Institution
(Liang, Li, Zhong, Luo, Nie, Hu, Li) Department of Anesthesiology, The
First Affiliated Hospital of Jinan University, Guangzhou 510630, China
Publisher
Dove Medical Press Ltd
Abstract
Purpose: This study aimed to investigate patients' expectative pain of
spinal anesthesia puncture and anxiety pre-anesthesia, and to examine the
effect of lidocaine-prilocaine cream and remimazolam prior to spinal
anesthesia puncture on pain relief and anxiety release. Method(s):
Patients undergoing spinal anesthesia were divided into control,
lidocaine-prilocaine cream, and lidocaine-prilocaine cream with
remimazolam groups. A questionnaire consisting of The Amsterdam
Preoperative Anxiety and Information Scale (APAIS) and patient's concerns
and Visual Analog Scale (VAS) was used to evaluate patient's anxiety and
pain. The primary outcomes were differences in VAS and anxiety scores.
Patient's spinal anesthesia-related concerns, advent events and
hemodynamic index were also recorded. Result(s): The expected spinal
anesthesia puncture pain was 5.34+/-0.27 and anxiety scores before spinal
anesthesia was 10.88 +/- 0.64. A statistically significant positive
correlation of 31.3% was detected between VAS and APAIS scores (r = 0.313;
P=0.003). The VAS score at the time of puncture decreased by 29.7%
(3.78+/-0.40, P=0.001) in lidocaine-prilocaine cream group and 29.2%
(3.75+/-0.39, P=0.001) in lidocaine-prilocaine cream with remimazolam
group compared with the expected VAS score. Lidocaine-prilocaine cream
combined with or without remimazolam reduced the percentage of moderate
pain (21.4% and 31.3% vs 50.0%, P=0.0001) and increased mild pain (60.7%
vs 59.4% vs 22.7%, P=0.03). Anxiety score in lidocaine-prilocaine cream
group was reduced by 2.84 (8.04 +/-0.76 vs 10.88 +/- 0.46, P=0.05) when
compared with pre-anesthesia. Concerns about postoperative pain (P=0.03)
and fear of the needle or intervention (P=0.000) both decreased
post-anesthesia among groups. Conclusion(s): Approximately half of
the patients scheduled for spinal anesthesia experienced a moderate level
of preoperative anxiety. The patient's pain expectation from the spinal
anesthesia puncture was moderate, which was higher than the actual pain.
Lidocaine-prilocaine cream with or without remimazolam sedative before
spinal anesthesia puncture reduced the patient's pain and anxiety scores
after surgery. Copyright © 2024 Liang et al.

<76>
Accession Number
2034119937
Title
Exploring the acceptability of and adherence to prehabilitation and
rehabilitation in patients undergoing major abdominal surgery: A
systematic review and meta-analysis.
Source
Clinical Nutrition ESPEN. 63 (pp 709-726), 2024. Date of Publication:
October 2024.
Author
Alsuwaylihi A.; Skorepa P.; Prado C.M.; Gomez D.; Lobo D.N.; O'Connor D.
Institution
(Alsuwaylihi, Skorepa, Gomez, Lobo) Nottingham Digestive Diseases Centre,
Division of Translational Medical Sciences, School of Medicine, University
of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
(Alsuwaylihi, Skorepa, Gomez, Lobo) National Institute for Health Research
Nottingham Biomedical Research Centre, Nottingham University Hospitals and
University of Nottingham, Queen's Medical Centre, Nottingham, United
Kingdom
(Alsuwaylihi) Department of Clinical Nutrition, King Saud Medical City,
Ministry of Health, Riyadh, Saudi Arabia
(Skorepa) University of Defence, Military Faculty of Medicine, Department
of Military Internal Medicine and Military Hygiene, Hradec Kralove,
Czechia
(Skorepa) 3rd Department of Internal Medicine-Metabolic Care and
Gerontology, University Hospital and Faculty of Medicine in Hradec
Kralove, Charles University in Prague, Hradec Kralove, Czechia
(Prado) Department of Agricultural, Food & Nutritional Science, University
of Alberta, Edmonton, Canada
(Lobo) MRC Versus Arthritis Centre for Musculoskeletal Ageing Research,
School of Life Sciences, University of Nottingham, Queen's Medical Centre,
Nottingham, United Kingdom
(Lobo) Divison of Surgery, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA, United States
(O'Connor) School of Health Sciences, University of Nottingham, Queen's
Medical Centre, Nottingham, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background and aims: Prehabilitation combines exercise, nutritional, and
psychological interventions administered before surgery to improve patient
outcomes. This comprehensive review and meta-analysis examined the
feasibility, adherence, and effectiveness of prehabilitation in frail,
high-risk individuals undergoing major abdominal surgery. Method(s):
We searched the Cochrane Central Register of Controlled Trials, Web of
Science, MEDLINE, Embase, and Cumulative Index to Nursing & Allied Health
Literature (CINAHL) databases to identify relevant studies evaluating
prehabilitation programs published between 2010 and 2023, either as
observational studies or randomized clinical trials (RCTs).
 Result(s): The 23 articles (13 RCTs and 10 observational studies)
included 1849 older male and female patients aged 68.7 +/- 7.2 years.
Nineteen of the included studies reported on adherence to prehabilitation
programmes, which was generally good (>75%) over different models,
settings, and durations. Factors such as patients' desire for expedited
surgery, self-assessment of fitness, personal and professional
obligations, health issues, holidays, and advancement of surgery dates
negatively affected adherence to prehabilitation programmes. When compared
with rehabilitation or standard pre- and post-surgical care,
prehabilitation was associated with a 25%, albeit not statistically
significant reduction in postoperative complications, according to data
from 14 studies reporting on postoperative complications (OR 0.75, 95% CI
0.48 to 1.17, P = 0.43; I2 = 65%). Prehabilitation has been
found to improve the 6-min walk test significantly by 29.4 m (MD +29.4 m,
95% CI 5.6 to 53.3, P = 0.02; I2 = 39%), compared with
rehabilitation or standard pre- and post-surgical care.
 Conclusion(s): Prehabilitation was acceptable to patients, with good
adherence, and improved physical function. Copyright © 2024 The
Author(s)

<77>
Accession Number
2031011308
Title
Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants
Compared with Vitamin K Antagonists in Patients with Atrial Fibrillation
and Type 2 Valvular Heart Disease: A Systematic Review and Meta-Analysis.
Source
Cardiovascular Drugs and Therapy. (no pagination), 2024. Date of
Publication: 2024.
Author
Liang X.; Liu S.; Ji L.; Ma F.; Song G.; Li F.; Liu G.
Institution
(Liang, Liu, Ji, Ma, Song, Li, Liu) Department of Cardiology, The First
Hospital of Hebei Medical University, Hebei, Shijiazhuang, China
(Liu) Hebei Key Laboratory of Cardiac Injury Repair Mechanism Study,
Hebei, Shijiazhuang, China
(Liu) Hebei Key Laboratory of Heart and Metabolism, Hebei, Shijiazhuang,
China
(Liu) Hebei Engineering Research Center of Intelligent Medical Clinical
Application, Hebei, Shijiazhuang, China
(Liu) Hebei International Joint Research Center for Structural Heart
Disease, Hebei, Shijiazhuang, China
Publisher
Springer
Abstract
Purpose: This meta-analysis aimed to evaluate the efficacy and safety of
non-vitamin K antagonist oral anticoagulants (NOACs) compared with vitamin
K antagonists (VKAs) in patients with atrial fibrillation (AF) and type 2
valvular heart disease (VHD). Method(s): We searched the PubMed,
LILACS, and MEDLINE databases to retrieve, randomized controlled trials
(RCTs) comparing NOACs and VKAs in patients with AF and type 2 VHD,
excluding mitral stenosis (moderate to severe, of rheumatic origin) or
mechanical heart valves. The efficacy outcomes assessed were stroke and
systemic embolism (SE), while safety outcomes included major bleeding and
intracranial hemorrhage (ICH). Result(s): Seven RCTs, including
16,070 patients with AF and type 2 VHD, were included. NOACs reduced the
risk of stroke/SE (relative risk [RR], 0.75; 95% confidence interval [CI],
0.64-0.89; P = 0.0005), with no significant difference in major bleeding
(RR, 0.88; 95% CI, 0.64-1.21; P = 0.43). The risk of ICH was reduced with
NOACs (RR, 0.46; 95% CI, 0.27-0.77; P = 0.003). For patients with AF and
bioprosthetic heart valve (five trials, 2805 patients), stroke/SE risks
(RR, 0.65, 95% CI, 0.44-0.96) with NOACs were superior to VKAs. Major
bleeding risks without ENVISAGE TAVI AF trial (RR, 0.53; 95% CI,
0.30-0.94; P = 0.03) with NOACs were superior to VKAs. The risks of ICH
(RR, 0.61; 95% CI 0.34-1.09; P = 0.09) with NOACs were comparable to VKAs.
 Conclusion(s): NOACs demonstrate efficacy and safety in patients with
AF and type 2 VHD and reduce the risk of stroke/SE and ICH when compared
with those with VKAs. Copyright © The Author(s) 2024.

<78>
Accession Number
2034134660
Title
Two-Year Clinical Outcomes of the REVELATION Study: Sustained Safety and
Feasibility of Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting
Stent in Acute Myocardial Infarction.
Source
Journal of Invasive Cardiology. 34(1) (pp E39-E42), 2022. Date of
Publication: January 2022.
Author
Niehe S.R.; Vos N.S.; Van Der Schaaf R.J.; Amoroso G.; Herrman J.-P.R.;
Patterson M.S.; Slagboom T.; Vink M.A.
Institution
(Niehe, Vos, Van Der Schaaf, Amoroso, Herrman, Patterson, Slagboom, Vink)
Department of Cardiology, OLVG Hospital, Amsterdam, Netherlands
Publisher
Cliggott Publishing Co.
Abstract
Objectives. The randomized REVELATION (REVascularization With
PaclitaxEL-Coated Balloon Angioplasty Versus Drug-Eluting Stenting in
Acute Myocardial InfarcTION) trial showed that in the setting of
ST-segment elevation myocardial infarction (STEMI), a drug-coated balloon
(DCB) strategy was non-inferior to a drug-eluting stent (DES) strategy in
terms of fractional flow reserve assessed at 9 months. The aim of the
present study is to evaluate the long-term clinical outcome of this
treatment strategy. Methods. Between October 2014 and November 2017, a
total of 120 patients with a non-severely calcified culprit lesion in a
native coronary artery and a residual stenosis of <50% after predilation
were randomized to treatment with DCB or DES. Primary clinical endpoint
was the occurrence of major adverse cardiac events, defined as death,
recurrent myocardial infarction, or target-lesion revascularization, the
occurrence of definite ST, and non-coronary artery bypass grafting (CABG)
major bleeding. Results. Complete clinical follow-up at 2 years was
available for 109 patients (91%). A major adverse cardiac event occurred
in 3 patients (5.4%) in the DCB group and 1 patient (1.9%) in the DES
group (hazard ratio, 2.86; 95% confidence interval, 0.30-27.53; P=.34).
Between 9 months and 2 years, only 1 additional event occurred
(target-lesion revascularization in a patient randomized to DCB).
Conclusion. In this randomized study of DCB vs DES in selected patients
presenting with STEMI, 2-year clinical outcome was excellent and
comparable between the DCB and DES groups. Copyright © 2022
Cliggott Publishing Co.. All rights reserved.

<79>
Accession Number
645041956
Title
Intracardiac vs Transesophageal Echocardiography for Left Atrial Appendage
Occlusion: An Updated Systematic Review and Meta-Analysis.
Source
Heart rhythm. (no pagination), 2024. Date of Publication: 16 Aug 2024.
Author
Serpa F.; Rivera A.; Fernandes J.M.; Braga M.A.P.; Araujo B.; Felix I.F.;
Ferro E.; Zimetbaum P.J.; d'Avila A.; Kramer D.B.
Institution
(Serpa) Richard A. and Susan F. Smith Center for Outcomes Research, Beth
Israel Deaconess Medical Center and Harvard Medical School, Boston, MA,
United States; Division of Internal Medicine, University of Texas
Southwestern Medical Center, Dallas, TX, United States
(Rivera, Araujo) Department of Medicine, Nove de Julho University, Sao
Bernardo do Campo, Brazil
(Fernandes) Department of Medicine, Albert Einstein University, Sao Paulo,
Brazil
(Braga) Department of Medicine, Federal University of Rio de Janeiro, Rio
de Janeiro, Brazil
(Felix) Department of Internal Medicine, Mayo Clinic, Rochester, MN,
United States
(Ferro, Zimetbaum, Kramer) Richard A. and Susan F. Smith Center for
Outcomes Research, Beth Israel Deaconess Medical Center and Harvard
Medical School, Boston, MA, United States; Division of Cardiology, Beth
Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,
United States
(d'Avila) Division of Cardiology, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
Abstract
BACKGROUND: Multiple studies continue to evaluate the use of intracardiac
echocardiography (ICE) and transesophageal echocardiography (TEE) for
guiding left atrial appendage occlusion (LAAO). OBJECTIVE(S): To
conduct an updated meta-analysis comparing the effectiveness and safety
outcomes of both imaging modalities. METHOD(S): PubMed, Cochrane, and
Embase were searched for studies comparing ICE vs TEE to guide LAAO. Odds
ratios (OR) with 95% confidence intervals (CI) were pooled using a
random-effects model. The primary effectiveness endpoint was procedural
success. The primary safety endpoint included the overall complications
rate. Additional safety outcomes were assessed as secondary endpoints.
Subgroup analysis of primary endpoints was conducted according to device
type (Amulet, LAmbre, Watchman, Watchman FLX) and study region (American,
Asia, Europe). We used R version 4.3.1 for all statistical analyses.
 RESULT(S): Our meta-analysis included 19 observational studies
encompassing 42,474 patients, of whom 4,415 (10.4%) underwent ICE-guided
LAAO. Compared with TEE, ICE was associated with a marginally higher
procedural success (OR 1.33; 95% CI: 1.01-1.76; p=0.04; I2=0%). There was
no significant difference in the overall complications rate (OR 1.02; 95%
CI: 0.77-1.36; p=0.89; I2=5%). However, ICE showed higher rates of
pericardial effusion (OR 2.11; 95% CI: 1.47-3.03; p<0.001; I2=0%) and
residual iatrogenic atrial septal defect (iASD) (OR 1.52; 95% CI:
1.15-2.03; p<0.004; I2=0%). Subgroup analysis revealed variations in
procedural success within the ICE group across study regions (p=0.02).
 CONCLUSION(S): In this updated meta-analysis, the increasing adoption
of ICE-guided LAAO demonstrated higher procedural success rates compared
to TEE, although with limited statistical significance. Overall
complication rates were similar; however, ICE showed higher rates of
pericardial effusion and residual iASD. Copyright © 2024.
Published by Elsevier Inc.

<80>
Accession Number
645041672
Title
ESCMID/EUCIC clinical guidelines on preoperative decolonization and
targeted prophylaxis in patients colonized by multidrug-resistant
Gram-positive bacteria before surgery.
Source
Clinical microbiology and infection : the official publication of the
European Society of Clinical Microbiology and Infectious Diseases. (no
pagination), 2024. Date of Publication: 16 Aug 2024.
Author
Righi E.; Mutters N.T.; Guirao X.; Dolores Del Toro M.; Eckmann C.;
Friedrich A.W.; Giannella M.; Presterl E.; Christaki E.; Cross E.L.A.;
Visentin A.; Sganga G.; Tsioutis C.; Tacconelli E.; Kluytmans J.
Institution
(Righi, Visentin, Tacconelli) Division of Infectious Diseases, Department
of Diagnostics and Public Health, University of Verona, Verona, Italy
(Mutters) University Hospital Bonn, Institute for Hygiene and Public
Health, Bonn, Germany
(Guirao) Surgical Endocrine Unit, Department of General Surgery, Surgical
Site Prevention Unit, Sabadell, Spain
(Dolores Del Toro) Division of Infectious Diseases and Microbiology,
University Hospital Virgen Macarena, Seville, Spain; Department of
Medicine, University of Sevilla. Centro de Investigacion Biomedica en Red
en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III,
Madrid
(Eckmann) Academic Hospital of Goettingen University, Germany
(Friedrich) University Hospital Munster, Munster, Germany
(Giannella) Infectious Diseases Unit, IRCCS Azienda Ospedaliero
Universitaria di Bologna, Bologna, Italy; Department of Medical and
Surgical Sciences, University of Bologna, Bologna, Italy
(Presterl) Department of Infection Control and Hospital Epidemiology,
Medical University of Vienna, Vienna, Austria
(Christaki) Department of Internal Medicine, Faculty of Medicine, School
of Health Sciences, University of Ioannina, Ioannina, Greece
(Cross) Department of Global Health and Infection, Brighton and Sussex
Medical School, Brighton, United Kingdom
(Sganga) Emergency Surgery and Trauma, Fondazione Policlinico
Universitario A. Gemelli IRCCS, Universita Cattolica del Sacro Cuore,
Rome, Italy
(Tsioutis) School of Medicine, European University Cyprus, Nicosia, Cyprus
(Kluytmans) Department of Medical Microbiology, University Medical Center
Utrecht, Utrecht University, Netherlands
Abstract
SCOPE: The aim of these guidelines is to provide recommendations on
decolonization and perioperative antibiotic prophylaxis (PAP) in
multidrug-resistant Gram-positive bacteria (MDR-GPB) adult carriers before
inpatient surgery. METHOD(S): These European Society of Clinical
Microbiology and Infectious Diseases (ESCMID)/European Committee on
Infection Control (EUCIC) guidelines were developed following the
systematic review of published studies targeting methicillin-resistant
Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE),
methicillin-resistant coagulase-negative staphylococci (MR-CoNS) and
pan-drug-resistant (PDR)-GPB. Critical outcomes were the occurrence of
surgical site infections (SSIs) caused by the colonizing MDR-GPB and
SSIs-attributable mortality. Important outcomes included the occurrence of
SSIs caused by any pathogen, hospital-acquired infections, all-cause
mortality, and adverse events associated with the interventions, including
resistance development to the agents used and incidence of Clostridioides
difficile infections. The last search of all databases was performed on
November 1st, 2023. The level of evidence and strength of each
recommendation were defined according to the GRADE approach. Consensus of
a multidisciplinary expert panel was reached for the final list of
recommendations. Antimicrobial stewardship considerations were included.
RECOMMENDATIONS: The guideline panel reviewed the impact of
decolonization, targeted PAP, and combined interventions (e.g.,
decolonization and targeted PAP) on the risk of SSIs and other outcomes in
MDR-GPB carriers, according to the type of bacteria and type of surgery.
We recommend screening for S. aureus (SA) before high-risk operations,
such as cardiothoracic and orthopedic surgery. Decolonization with
intranasal mupirocin with or without chlorhexidine bathing is recommended
in patients colonized with SA before cardiothoracic and orthopedic surgery
and suggested in other surgeries. Addition of vancomycin to standard
prophylaxis is suggested for MRSA carriers in cardiothoracic surgery,
orthopedic surgery, and neurosurgery. Combined interventions (e.g.,
decolonization and targeted prophylaxis) are suggested in MRSA carriers
undergoing cardiothoracic and orthopedic surgery. No recommendation could
be made regarding screening, decolonization, and targeted prophylaxis for
VRE due to the lack of data. No evidence was retrieved for MR-CoNS and
PDR-GPB. Careful consideration of the laboratory workload and involvement
of antimicrobial stewardship as well as infection control teams are
warranted before implementing screening procedures or performing changes
in PAP policy. Future research should focus on novel decolonizing
techniques, on the monitoring of resistance to decolonizing agents and PAP
regimens, and on standardized combined interventions in high-quality
studies. Copyright © 2024. Published by Elsevier Ltd.

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