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<1>
Accession Number
2032148060
Title
The Role of 2, 4, and 5-dimensional Cardiac Flow MRI for Evaluation of
Valvulopathies: A Literature Review.
Source
Echocardiography. 41(11) (no pagination), 2024. Article Number: e70005.
Date of Publication: November 2024.
Author
Fassler S.; Falcao M.B.L.; de Marchi S.F.; Roy C.W.; Rutz T.
Institution
(Fassler, Rutz) Service of Cardiology, Lausanne University Hospital and
University of Lausanne, Lausanne, Switzerland
(Falcao, Roy) Department of Radiology, Lausanne University Hospital and
University of Lausanne, Lausanne, Switzerland
(de Marchi) Service of Cardiology, Bern University Hospital and University
of Bern, Bern, Switzerland
Publisher
John Wiley and Sons Inc
Abstract
Aim: Two-dimensional phase-contrast magnetic resonance imaging (2D flow
MRI) and its multidimensional alternatives, 4D and 5D flow MRI, measure
blood flow in the heart and great vessels. While 2D flow MRI is the
standard technique, it has limitations regarding need for precise image
plane prescribing and long scan time. In contrast, 4D and 5D flow MRI
acquire 3D volumes, enabling retrospective assessment of all vessels. This
review evaluates these three techniques for quantification of blood flow
of the aortic and pulmonary valves in congenital heart disease.
 Method(s): A systematic literature search was conducted in August
2024 using the PUBMED database, including articles comparing 2D, 4D, and
5D flow MRI. Result(s): Fifteen articles comparing 2D and 4D, one
comparing 2D and 5D and three articles comparing 4D and 5D flow MRI were
included. No study compared all three techniques. 2D, 4D and 5D flow MRI
demonstrated a good agreement for flow quantification. 4D flow MRI,
however, tends to present a better accuracy and internal consistency than
2D flow MRI for determination of peak velocities and flow in stenotic
lesions, particularly when comparing velocities to echocardiography. 4D
and 5D flow MRI are associated with shorter scan times than 2D flow MRI.
 Conclusion(s): 4D and 5D flow MRI appear to offer promising
alternatives to 2D flow MRI with the advantage of reduced scan times.
Larger and prospective studies including echocardiography are needed to
evaluate the potential of 4D and 5D to replace 2D flow MRI for flow
quantification and peak velocity determination. Copyright © 2024
The Author(s). Echocardiography published by Wiley Periodicals LLC.

<2>
Accession Number
2035616728
Title
Late Survival Benefits of Concomitant Surgical Ablation for Atrial
Fibrillation During Cardiac Surgery: A Systematic Review and
Meta-Analysis.
Source
American Journal of Cardiology. 235 (pp 16-29), 2025. Date of Publication:
15 Jan 2025.
Author
Sakurai Y.; Kuno T.; Yokoyama Y.; Fujisaki T.; Balakrishnan P.; Takagi H.;
Kaneko T.
Institution
(Sakurai, Balakrishnan) Department of Surgery, Marshall University Joan
Edwards School of Medicine, West Virginia, United States
(Kuno) Division of Cardiology, Massachusetts General Hospital, Havard
Medical School, Massachusetts, United States
(Yokoyama) Department of Cardiac Surgery, University of Michigan,
Michigan, United States
(Fujisaki) Department of Medicine, Mount Sinai Morningside and West, Icahn
School of Medicine at Mount Sinai, New York, United States
(Fujisaki) Department of Cardiovascular Medicine, Graduate School of
Medical Sciences, Kumamoto University, Kumamoto, Japan
(Fujisaki) Department of Cardiovascular Medicine, National Cerebral and
Cardiovascular Center, Osaka, Japan
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kaneko) Division of Cardiothoracic Surgery, Washington University in St
Louis, St Louis, Missouri, United States
Publisher
Elsevier Inc.
Abstract
The long-term survival benefits after surgical ablation for atrial
fibrillation (AF) during cardiac surgery were not confirmed in previous
randomized controlled trials or meta-analyses. This study aimed to
investigate the long-term efficacy of surgical ablation in patients with
AF. MEDLINE, EMBASE, and CENTRAL were searched to identify studies
comparing concomitant surgical AF ablation with no surgical ablation
during cardiac surgery. The primary outcome was long-term all-cause
mortality. Secondary outcomes were stroke, heart failure
rehospitalization, major bleeding, freedom from AF, and permanent
pacemaker implantation during follow-up. To minimize confounding, only
adjusted outcomes were used from observational studies. A total of 38
studies met the inclusion criteria. Of those, 9 randomized controlled
trials and 15 observational studies with 41,678 patients (surgical
ablation: n = 19,125; no surgical ablation: n = 22,553) were analyzed for
all-cause mortality, with a weighted median follow-up of 62.0 months.
Surgical ablation was associated with decreased risks of long-term
mortality (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.71 to
0.84), stroke (HR 0.60, 95% CI 0.48 to 0.76), heart failure
rehospitalization (HR 0.92, 95% CI 0.87 to 0.96), and more freedom from AF
during follow-up (relative risk 1.93, 95% CI 1.50 to 2.49), whereas
surgical ablation was associated with a higher risk of permanent pacemaker
implantation during follow-up (HR 1.35, 95% CI 1.03 to 1.77). There was no
significant difference in major bleeding during follow-up between the 2
groups. In patients with AF who underwent cardiac surgery, surgical
ablation was associated with decreased risks of long-term mortality,
stroke, and heart failure rehospitalization compared with patients with
untreated AF. Given that the survival benefits were predominantly observed
in observational studies, further randomized trials are necessary to
confirm these findings. Copyright © 2024 Elsevier Inc.

<3>
Accession Number
2035615952
Title
Comparison of Outcome After Percutaneous Coronary Intervention for De Novo
and In-Stent Restenosis Indications.
Source
American Journal of Cardiology. 235 (pp 1-8), 2025. Date of Publication:
15 Jan 2025.
Author
Jakobsen L.; Christiansen E.H.; Freeman P.; Kahlert J.; Veien K.; Maeng
M.; Ellert J.; Kristensen S.D.; Christensen M.K.; Terkelsen C.J.; Thim T.;
Lassen J.F.; Hougaard M.; Eftekhari A.; Jensen R.V.; Stottrup N.B.;
Rasmussen J.G.; Junker A.; Jensen L.O.
Institution
(Jakobsen, Christiansen, Maeng, Kristensen, Terkelsen, Thim, Jensen,
Stottrup) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Freeman, Christensen, Eftekhari, Rasmussen) Department of Cardiology,
Aalborg University Hospital, Aalborg, Denmark
(Kahlert) Department of Clinical Epidemiology, Aarhus University Hospital,
Aarhus, Denmark
(Veien, Ellert, Lassen, Hougaard, Junker, Jensen) Department of
Cardiology, Odense University Hospital, Odense, Denmark
Publisher
Elsevier Inc.
Abstract
In-stent restenosis (ISR) still occurs after percutaneous coronary
intervention (PCI). Few studies have compared the outcomes of PCI for de
novo stenosis with those of PCI for ISR, and the results are conflicting.
The present study aimed to conduct this comparison. Using patient-level
data from the randomized all-comer SORT OUT studies III to X, we included
all patients with previous PCI and either an ISR or a de novo lesion as
the study target lesion. Outcomes of interest were major adverse cardiac
events (MACE) and target lesion revascularization (TLR) after 5 years. Of
the 2,928 patients with a previous PCI included in the SORT OUT studies,
491 (17%) were treated for ISR and 2,437 (83%) for a de novo stenosis.
Baseline characteristics did not differ significantly. At 5 years, MACE
occurred in 148 patients (32%) in the ISR group and 654 patients (28%) in
the de novo stenosis group (crude and adjusted hazard ratio 1.16 [95%
confidence interval (CI) 0.97 to 1.38] and 1.16 [95% CI 0.97 to 1.38]).
The risk of TLR was higher in the ISR group compared with the de novo
stenosis group (crude and adjusted hazard ratio 1.64 [95% CI 1.24 to 2.17]
and 1.71 [95% CI 1.27 to 2.30]). In conclusion, the risk of MACE was
similar between PCI for ISR and PCI for de novo lesions after 5 years.
However, the risk of TLR was higher in the ISR group compared with the de
novo stenosis group. Copyright © 2024 The Author(s)

<4>
Accession Number
2035616951
Title
Prevalence and Impact of Recurrent Rejection on Pediatric Heart Transplant
Recipients: A PHTS Multi-Institutional Analysis.
Source
Journal of the American College of Cardiology. 84(22) (pp 2170-2182),
2024. Date of Publication: 26 Nov 2024.
Author
Amdani S.; Kirklin J.K.; Cantor R.; Koehl D.; Lal A.; Chau P.; Curren V.;
Edelson J.B.; Parent J.J.; Victor H.; Burnette A.; Lamour J.M.
Institution
(Amdani, Victor) Division of Cardiology and Cardiovascular Medicine,
Children's Institute Department of Heart Vascular and Thoracic, Cleveland,
OH, United States
(Kirklin, Cantor, Koehl) Kirklin Solutions, Inc, Birmingham, AL, United
States
(Lal) Department of Pediatrics, Primary Children's Hospital, Salt Lake
City, UT, United States
(Chau) Division of Pediatric Cardiology, Department of Pediatrics,
University of California-San Diego, San Diego, CA, United States
(Curren) Division of Pediatric Cardiology, The Johns Hopkins University
School of Medicine, Baltimore, MD, United States
(Edelson) Division of Cardiology, The Children's Hospital of Philadelphia,
Philadelphia, PA, United States
(Parent) Division of Cardiology, Department of Pediatrics, Indiana
University School of Medicine, Indianapolis, IN, United States
(Burnette) Division of Cardiology, Department of Pediatrics, Medical
University of South Carolina Children's Hospital, Charleston, SC, United
States
(Lamour) Division of Pediatric Cardiology, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Studies evaluating the prevalence and impact of recurrent
rejection (RR) in pediatric heart transplant (HT) are sparse.
 Objective(s): The purpose of this study was to describe prevalence
and impact of RR on cardiac allograft vasculopathy (CAV) and graft loss
after pediatric HT. Method(s): Data on HT from January 1, 2000, to
June 30, 2020, in the Pediatric Heart Transplant Society database were
included. Freedom from RR (>=2 rejection episodes) was compared by era
(early: 2000-2009; current: 2010-2020). Outcomes for children experiencing
RR were compared with those experiencing 0 or 1 rejection episodes and by
type of RR (antibody-mediated rejection [AMR], acute cellular rejection
[ACR], mixed [ACR/AMR]). Result(s): Of 6,342 HT recipients, 1,035
(17%) experienced RR. In the current era, pediatric HT recipients were
less likely to experience RR (P < 0.001). Freedom from CAV was similar for
those experiencing RR to those experiencing 0 or 1 episode (96.6% vs 95.3%
vs 96.6%); and similar regardless of the type of RR (AMR, ACR, or mixed)
(65.5% vs 82.9% vs 100%) (P > 0.05). Freedom from graft loss was
significantly lower for those experiencing RR to those experiencing 0 or 1
episode (56.3% vs 72.3% vs 82.3%) and lower for those experiencing
recurrent mixed rejection or recurrent AMR compared with those
experiencing recurrent ACR (65.3% vs 50% vs 81.8%). Black children
experiencing RR subsequently had lower freedom from CAV and graft loss
than White children (P < 0.05 for all). Conclusion(s): Although
prevalence of RR has decreased, children experiencing RR are at greatly
increased risk for losing their graft, particularly those who have
recurrent mixed or antibody-mediated rejection. Copyright © 2024
American College of Cardiology Foundation

<5>
Accession Number
2035513029
Title
Mechanical or neurohumoral left ventricle ballooning: Challenging to
differentiate between and to manage. Authors' reply.
Source
Kardiologia Polska. 82(10) (pp 1029-1030), 2024. Date of Publication:
2024.
Author
Olpinska B.; Wyderka R.; Truszkiewicz K.; Loboz-Rudnicka M.; Brzezinska
B.; Jaroch J.
Institution
(Olpinska, Wyderka, Loboz-Rudnicka, Brzezinska, Jaroch) Department of
Cardiology, Marciniak Lower Silesian Specialist Hospital, Emergency
Medicine Center, Wroclaw, Poland
(Wyderka, Jaroch) Faculty of Medicine, Wroclaw University of Science and
Technology, Wroclaw, Poland
(Truszkiewicz) Department of Radiology and Imaging Diagnostics, Emergency
Medicine Center, Marciniak Lower Silesian Specialist Hospital, Wroclaw,
Poland
Publisher
Via Medica

<6>
[Use Link to view the full text]
Accession Number
2034369110
Title
Extracorporeal Membrane Oxygenation-Supported Patient Outcome Undergoing
Transcatheter Aortic Valve Replacement.
Source
ASAIO Journal. 70(11) (pp 920-928), 2024. Date of Publication: 01 Nov
2024.
Author
Banga A.; Bansal V.; Pattnaik H.; Amal T.; Agarwal A.; Guru P.K.
Institution
(Banga) Department of Medicine, Mount Auburn Hospital, Cambridge, MA,
United States
(Bansal) Department of Critical Care Medicine, Mayo Clinic, Rochester, MN,
United States
(Pattnaik) Department of Medicine, Lady Hardinge Medical College,
University of Delhi, India
(Amal) Department of Internal Medicine, William Beaumont University
Hospital, Royal Oak, MI, United States
(Agarwal) Department of Critical Care Medicine, Mayo Clinic Florida,
Jacksonville, FL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
The efficacy and safety of extracorporeal membrane oxygenation (ECMO)
support during transcatheter aortic valve replacement (TAVR) remains
unknown. We conducted a meta-analysis to compare benefit and risk of ECMO
in TAVR patients. Bibliographic databases were searched from inception to
January 1, 2024. Included studies involved patients >=18 years old
undergoing TAVR and using ECMO emergently or prophylactically. Mortality
and procedure success were primary outcomes. Peri- or postoperative
complications were the secondary outcomes. We identified 11 observational
studies, including 2,275 participants (415 ECMO and 1,860 non-ECMO). The
unadjusted mortality risk in ECMO-supported patient was higher than
non-ECMO patients (odds ratio [OR] 1.73). The mortality unadjusted risk
remained high (OR 3.89) and statistically significant for prophylactic
ECMO. Prophylactic ECMO had lower mortality risk compared with emergent
ECMO (OR 0.17). Extracorporeal membrane oxygenation-supported patients had
lower procedural success rate (OR 0.10). Extracorporeal membrane
oxygenation patients undergoing TAVR had significantly increased risk of
bleeding (OR 3.32), renal failure (OR 2.38), postoperative myocardial
infarction (OR 1.89), and stroke (OR 2.32) compared with non-ECMO
patients. Clinical results are not improved by ECMO support in patients
with high-risk TAVR. Prophylactic ECMO outperforms emergent. Overall, ECMO
support increases mortality and postoperative complications. Transcatheter
aortic valve replacement outcomes may improve with prophylactic ECMO in
high-risk situations. Copyright © ASAIO 2024.

<7>
Accession Number
2032153188
Title
Five-year outcomes of patients with diabetes mellitus treated with a
sirolimus-eluting or a biolimus-eluting stents with biodegradable polymer.
From the SORT OUT VII trial.
Source
Diabetes and Vascular Disease Research. 21(5) (no pagination), 2024. Date
of Publication: September-October 2024.
Author
Troan J.; Christiansen E.H.; Hansen K.N.; Eftekhari A.; Jakobsen L.; Maeng
M.; Freeman P.; Jensen R.V.; Christensen M.K.; Noori M.; Ellert-Gregersen
J.; Stottrup N.B.; Kahlert J.; Veien K.T.; Jensen L.O.
Institution
(Troan, Hansen, Noori, Ellert-Gregersen, Veien, Jensen) Department of
Cardiology, Odense University Hospital, Odense, Denmark
(Christiansen, Jakobsen, Maeng, Jensen, Stottrup) Department of
Cardiology, Aarhus University Hospital, Aarhus, Denmark
(Eftekhari, Freeman, Christensen) Department of Cardiology, Aalborg
University Hospital, Aalborg, Denmark
(Kahlert) Department of Clinical Epidemiology, Aarhus University, Aarhus,
Denmark
Publisher
SAGE Publications Ltd
Abstract
Background: Diabetes mellitus is associated with higher risk of target
lesion failure (TLF) after percutaneous coronary intervention. We studied
the 5-year outcome in patients with diabetes mellitus treated with
biodegradable polymer stents. Method(s): The SORT OUT VII was a
randomised trial comparing the ultrathin sirolimus-eluting Orsiro stent
(O-SES) and the biolimus-eluting Nobori stent (N-BES) in an all-comer
setting. Patients (n = 2525) were randomised to receive O-SES (n = 1261,
diabetes: n = 236) or N-BES (n = 1264, diabetes: n = 235). Endpoints were
TLF (a composite of cardiac death, target-lesion myocardial infarction
(MI), target lesion revascularization (TLR)), definite stent thrombosis
and a patient related outcome (all-cause mortality, MI and
revascularization) within 5 years. Result(s): Patients with diabetes
mellitus had higher TLF (20.6% vs 11.0%, (Rate ratio (RR) 1.85 95%
confidence interval (CI): (1.42-2.40) and patient related outcome (42.0%
vs 31.0%, RR 1.43 95% CI: (1.19-1.71)) compared to patients without
diabetes. Among patients with diabetes mellitus, TLF after 5 years did not
differ between O-SES and N-BES (21.2% vs 20.0%), RR 1.05 95% CI:
(0.70-1.58), p = 0.81). Cardiac death, MI, TLR, and definite stent
thrombosis did not differ between the groups. Conclusion(s): In
patients with diabetes mellitus, 5-year outcomes were similar among
patients treated with biodegradable polymer O-SES or N-BES. Clinical trial
registration: URL: https://www.clinicaltrials.gov. Unique identifier:
NCT01879358. Copyright © The Author(s) 2024.

<8>
Accession Number
2031375445
Title
Impella 5.5: A Systematic Review of the Current Literature.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 19(4) (pp 380-389), 2024. Date of Publication: July/August 2024.
Author
Valdes C.A.; Bilgili A.; Reddy A.; Sharaf O.; Jimenez-Contreras F.;
Stinson G.; Ahmed M.; Vilaro J.; Parker A.M.; Al-Ani M.A.Z.; Demos D.;
Aranda J.; Bleiweis M.; Beaver T.M.; Jeng E.I.
Institution
(Valdes, Bilgili, Reddy, Sharaf, Stinson) College of Medicine, University
of Florida, Gainesville, FL, United States
(Jimenez-Contreras, Bleiweis, Beaver, Jeng) Division of Cardiovascular
Surgery, College of Medicine, University of Florida, Gainesville, FL,
United States
(Ahmed, Vilaro, Parker, Al-Ani, Demos, Aranda) Division of Cardiovascular
Medicine, Department of Medicine, University of Florida Health,
Gainesville, FL, United States
Publisher
SAGE Publications Ltd
Abstract
Objective: Impella 5.5 (Abiomed, Danvers, MA, USA) is a temporary
mechanical circulatory support device used for patients in cardiogenic
shock. This review provides a comprehensive overview of the device's
clinical effectiveness, safety profile, patient outcomes, and relevant
procedural considerations. Method(s): We conducted a systematic
review according to the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses guidelines using the PubMed/MEDLINE database. The search
query included articles available from October 6, 2022, through January
13, 2023. Our initial search identified 75 studies. All records were
screened by 2 independent reviewers using the Covidence software for
adherence to our inclusion criteria, and 8 retrospective cohort studies
were identified as appropriate for inclusion. Result(s): Across the
included studies, the sample size ranged from 4 to 275, with predominantly
male cohorts. Indications for Impella support varied, and the duration of
support ranged from 9.8 to 70 days. Overall, Impella support appeared to
be associated with favorable survival rates and manageable complications
in various patient populations. Complications associated with Impella use
included bleeding, stroke, and device malfunctions. Two studies compared
prolonged and Food and Drug Administration-approved Impella support,
showing similar outcomes and adverse events. Conclusion(s): Impella
5.5 continues to be an attractive option for bridging patients to
definitive therapy. Survival during and after Impella 5.5 was favorable
for patients regardless of initial indication. However, device use was
associated with several important complications, which calls for judicious
use and a precontemplated exit strategy. Limitations of this literature
review include biases inherent to the retrospective studies included, such
as selection and publication bias. Copyright © The Author(s)
2024.

<9>
Accession Number
2031369465
Title
Minimally Invasive Coronary Artery Bypass Grafting for Multivessel
Coronary Artery Disease: A Systematic Review.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 19(4) (pp 351-359), 2024. Date of Publication: July/August 2024.
Author
Sef D.; Thet M.S.; Hashim S.A.; Kikuchi K.
Institution
(Sef) Department of Cardiac Surgery, University Hospitals of Leicester,
United Kingdom
(Thet) Department of Surgery and Cancer, Faculty of Medicine, Imperial
College London & Imperial College Healthcare NHS Trust, United Kingdom
(Hashim) Department of Cardiothoracic Surgery, University of Malaya
Medical Centre, Kuala Lumpur, Malaysia
(Kikuchi) Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa
Medical Center, Japan
Publisher
SAGE Publications Ltd
Abstract
Objective: We conducted a systematic review of all available evidence on
the feasibility and safety of minimally invasive coronary artery bypass
grafting (MICS CABG) in patients with multivessel coronary artery disease
(CAD). Method(s): A systematic literature search in PubMed, MEDLINE
via Ovid, Embase, Scopus, and Web of Science was performed to identify all
relevant studies evaluating outcomes of MICS CABG among patients with
multivessel CAD and including at least 15 patients with no restriction on
the publication date. Result(s): A total of 881 studies were
identified, of which 26 studies met the eligibility criteria. The studies
included a total of 7,556 patients. The average patient age was 63.3 years
(range 49.5 to 69.0 years), male patients were an average of 77.8% (54.0%
to 89.8%), and body mass index was 29.8 kg/m2 (24.5 to 30.1
kg/m2). Early mortality and stroke were on average 0.6% (range
0% to 2.0%) and 0.4% (range 0% to 1.3%), respectively. The average number
of grafts was 2.8 (range 2.1 to 3.7). The average length of hospital stay
was 5.6 days (range 3.1 to 9.3 days). Conclusion(s): MICS CABG
appears to be a safe method in well-selected patients with multivessel
CAD. This approach is concentrated at dedicated centers, and there is no
widespread application, although it has potential to be widely applicable
as an alternative for surgical revascularization. However, large
randomized controlled studies with longer follow-up are still required to
compare the outcomes with conventional CABG and other revascularization
strategies. Copyright © The Author(s) 2024.

<10>
Accession Number
2032143787
Title
In reply: Comment on: "Superficial parasternal intercostal plane blocks in
cardiac surgery: a systematic review and meta-analysis".
Source
Canadian Journal of Anesthesia. (no pagination), 2024. Date of
Publication: 2024.
Author
Cameron M.J.; Long J.; Kardash K.; Yang S.S.
Institution
(Cameron, Long, Kardash, Yang) Faculty of Medicine, McGill University,
Montreal, QC, Canada
(Cameron, Kardash, Yang) Department of Anesthesia, Jewish General
Hospital, Montreal, QC, Canada
(Cameron, Yang) Lady Davis Research Institute, Montreal, QC, Canada
Publisher
Springer

<11>
Accession Number
2032143785
Title
Comment on: "Superficial parasternal intercostal plane blocks in cardiac
surgery: a systematic review and meta-analysis".
Source
Canadian Journal of Anesthesia. (no pagination), 2024. Date of
Publication: 2024.
Author
Sethuraman R.M.; Narayanan S.; UdayaKumar G.S.
Institution
(Sethuraman, Narayanan, UdayaKumar) Department of Anesthesiology, Sree
Balaji Medical College & amp; Hospital, Tamil Nadu, Chennai, India
Publisher
Springer

<12>
Accession Number
2034982457
Title
Hemodynamic management of acute kidney injury.
Source
Current Opinion in Critical Care. (no pagination), 2024. Article Number:
10.1097/MCC.0000000000001213. Date of Publication: 2024.
Author
De Backer D.; Rimachi R.; Duranteau J.
Institution
(De Backer, Rimachi) Department of Intensive Care, CHIREC Hospitals,
Universite Libre de Bruxelles, Belgium, Belgium
(Duranteau) Department of Anesthesiology, Intensive Care & Perioperative
Medicine, Assistance Publique Hopitaux de Paris, Paris Saclay University,
Paris, France
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of review To discuss the role of hemodynamic management in
critically ill patients with acute kidney injury. Recent findings Acute
kidney injury (AKI) may be associated with persistent alterations in renal
perfusion, even when cardiac output and blood pressure are preserved. The
effects of interventions aiming at increasing renal perfusion are best
evaluated by renal Doppler or contrast enhance ultrasound. However,
limited data have been acquired with these techniques and the essential of
the literature is based on surrogates of renal function such as incidence
of use of renal replacement therapy. Fluids may increase renal perfusion
but their effects are quite unpredictable and can be dissociated from
their impact on cardiac output and arterial pressure. Inotropes can also
be used in selected conditions. At the de-escalation phase, fluid
withdrawal should be considered. Safe fluid withdrawal may be achieved
when applied in selected patients with preserved tissue perfusion
presenting signs of fluid intolerance. When applied, stopping rules should
be set. Dobutamine, milrinone and levosimendan increase renal perfusion in
AKI associated with cardiac failure or after cardiac surgery. However, the
impact of these agents in sepsis is not well defined. Regarding
vasopressors, norepinephrine is the first-line vasopressor agent, but
vasopressin derivative may limit the requirement of renal replacement
therapy. Angiotensin has promising effects in a limited size post-Hoc
analysis of a RCT, but these data need to be confirmed. While correction
of severe hypotension is associated with improved renal perfusion and
function, the optimal mean arterial pressure (MAP) target level remains
undefined, Systematic increase in MAP results in variable changes in renal
perfusion. It sounds reasonable to individualize MAP target, paying
attention to central venous and intraabdominal pressures, as well as to
the response to an increase in MAP. Summary Recent studies have refined
the impact of the various hemodynamic interventions on renal perfusion and
function in critically ill patients with AKI. Though several of these
interventions improve renal perfusion, their impact on renal function is
more variable. Copyright © 2024 Wolters Kluwer Health, Inc. All
rights reserved.

<13>
[Use Link to view the full text]
Accession Number
629139107
Title
Effectiveness and harms of pharmacological interventions for the treatment
of delirium in adults in intensive care units after cardiac surgery: A
systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 17(10) (pp
2020-2074), 2019. Date of Publication: 22 Aug 2019.
Author
Leigh V.; Stern C.; Elliott R.; Tufanaru C.
Institution
(Leigh, Stern, Tufanaru) Joanna Briggs Institute, Faculty of Health and
Medical Sciences, The University of Adelaide, Adelaide, Australia
(Leigh) Adelaide Nursing School, Faculty of Health and Medical Sciences,
The University of Adelaide, Adelaide, Australia
(Elliott) The Malcolm Fisher Intensive Care Unit, Royal North Shore
Hospital, Sydney, Australia
(Elliott) Nursing and Midwifery Directorate, Northern Sydney Local Health
District, St Leonards, Australia
(Elliott) Faculty of Health, University of Technology Sydney, Ultimo,
Australia
(Tufanaru) Australian Institute of Health Innovation, Macquarie
University, Sydney, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Objective:The objective of this review was to synthesize the best
available evidence on the effectiveness and harms of pharmacological
interventions for the treatment of delirium in adult patients in the
intensive care unit (ICU) after cardiac surgery.Introduction:Patients who
undergo cardiac surgery are at high risk of delirium (incidence: 50-90%).
Delirium has deleterious effects, increasing the risk of death and
adversely affecting recovery. Clinical interventional trials have been
conducted to prevent and treat postoperative delirium pharmacologically
including antipsychotics and sedatives. These trials have provided some
evidence about efficacy and influenced clinical decision making. However,
much reporting is incomplete and provides biased assessments of efficacy;
benefits are emphasized while harms are inadequately reported.Inclusion
criteria:Participants were >= 16 years, any sex or ethnicity, who were
treated postoperatively in a cardiothoracic ICU following cardiac surgery
and were identified as having delirium. Any pharmacological intervention
for the treatment of delirium was included, regardless of drug
classification, dosage, intensity or frequency of administration. Outcomes
of interest of this review were: mortality, duration and severity of
delirium, use of physical restraints, quality of life, family members'
satisfaction with delirium management, duration/severity of the aggressive
episode, associated falls, severity of accidental self-harm,
pharmacological harms, harms related to over-sedation, ICU length of stay,
hospital length of stay (post ICU), total hospital length of stay, need
for additional intervention medication and need for rescue medication.
Randomized controlled trials were considered first and in their absence,
non-randomized controlled trials and quasi-experimental would have been
considered, followed by analytical observational studies. Method(s):A
search was conducted in PubMed, Embase, CINAHL, Web of Science, Cochrane
Central Register of Controlled Trials, Scopus, Epistemonikos, Australian
New Zealand Clinical Trials Registry, ClinicalTrials.gov, Clinical Trials
in New Zealand, and ProQuest Dissertations and Theses to locate both
published and unpublished studies. There was no date limit for the search.
A hand search for primary studies published between January 1, 2012 and
November 17, 2018 in relevant journals was also conducted. Only studies
published in English were considered for inclusion. Two reviewers
independently assessed the methodological quality using standardized
critical appraisal instruments from JBI and McMaster University.
Quantitative data were extracted using the standardized JBI data
extraction tool. A meta-analysis was not performed, as there was too much
clinical and methodological heterogeneity in the included studies. Results
have been presented in a narrative form. Standard GRADE (Grading of
Recommendations, Assessment, Development, and Evaluation) evidence
assessment of outcomes has been reported. Result(s):Three RCTs
investigating morphine versus haloperidol (n = 53), ondansetron versus
haloperidol (n = 72), and dexmedetomidine versus midazolam (n = 80) were
included. Due to heterogeneity and incomplete reporting, a meta-analysis
was not feasible. Overall, the methodological quality of these studies was
found to be low. Additionally, this review found reporting of harms to be
inadequate and superficial for all three studies and did not meet the
required standards for harms reporting, as defined by the CONSORT
statement extension for harms. Conclusion(s):It was not possible to
draw any valid conclusions regarding the effectiveness of morphine vs
haloperidol, ondansetron vs haloperidol or dexmedetomidine vs midazolam in
treating delirium after cardiac surgery. This is due to the low number of
studies, the poor methodological quality in conducting and reporting and
the heterogeneity between the studies. Copyright © 2019 Joanna
Briggs Institute.

<14>
Accession Number
2035525063
Title
Heart failure with preserved ejection fraction management: a systematic
review of clinical practice guidelines and recommendations.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 10(7) (pp
571-589), 2024. Date of Publication: 01 Nov 2024.
Author
Mahmood A.; Dhall E.; Primus C.P.; Gallagher A.; Zakeri R.; Mohammed S.F.;
Chahal A.A.; Ricci F.; Aung N.; Khanji M.Y.
Institution
(Mahmood, Chahal, Aung, Khanji) William Harvey Research Institute, NIHR
Barts Biomedical Research Centre, Queen Mary University of London,
Charterhouse Square, London EC1M 6BQ, United Kingdom
(Mahmood, Dhall, Gallagher, Khanji) Newham University Hospital, Barts
Health NHS Trust, Glen Road, London E13 8SL, United Kingdom
(Primus, Gallagher, Chahal, Aung, Khanji) Barts Heart Centre, St
Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London
EC1A 7BE, United Kingdom
(Zakeri) School of Cardiovascular Medicine & Sciences, James Black Centre,
King's College London, 125 Coldharbour Lane, London SE5 9NU, United
Kingdom
(Mohammed) Department of Cardiology, Creighton University School of
Medicine, Omaha, NE 68124, United States
(Chahal) Department of Cardiovascular Medicine, Mayo Clinic, 200 First
Str, SW, Rochester, MN 55905, United States
(Chahal) Center for Inherited Cardiovascular Diseases, Department of
Cardiology, WellSpan Health, 30 Monument Rd, York, PA 17403, United States
(Ricci) Department of Neuroscience, Imaging and Clinical Sciences, "G.
d'Annunzio" University of Chieti-Pescara, Via dei Vestini 33, Chieti
66100, Italy
(Ricci) University Cardiology Division, SS Annunziata Polyclinic
University Hospital, Via dei Vestini 5, Chieti 66100, Italy
(Ricci) Department of Clinical Sciences, Lund University, Jan Waldenstroms
Gata 35, Malmo 21428, Sweden
Publisher
Oxford University Press
Abstract
Multiple guidelines exist for the diagnosis and management of heart
failure with preserved ejection fraction (HFpEF). We systematically
reviewed current guidelines and recommendations, developed by national and
international medical organizations, on the management of HFpEF in adults
to aid clinical decision-making. We searched MEDLINE and EMBASE on 28
February 2024 for publications over the last 10 years as well as websites
of organizations relevant to guideline development. Of the 10 guidelines
and recommendations retrieved, 7 showed considerable rigour of development
and were subsequently retained for analysis. There was consensus on the
definition of HFpEF and the diagnostic role of serum natriuretic peptides
and resting transthoracic echocardiography. Discrepancies were identified
in the thresholds of serum natriuretic peptides and transthoracic
echocardiography parameters used to diagnose HFpEF. There was agreement on
the general pharmacological and supportive management of acute and chronic
HFpEF. However, differences exist in strategies to identify and address
specific phenotypes. Contemporary guidelines for HFpEF management agree on
measures to avoid its development and the consideration of cardiac
transplantation in advanced diseases. There were discrepancies in
recommended frequency of surveillance for patients with HFpEF and sparse
recommendations on screening for HFpEF in the general population, use of
diagnostic scoring systems, and the role of newly emerging
therapies. Copyright © The Author(s) 2024. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<15>
[Use Link to view the full text]
Accession Number
2035500459
Title
Effects of cognitive training on cognitive function in patients after
cardiac surgery A systematic review and meta-analysis of randomized
controlled trials.
Source
Medicine (United States). 103(44) (no pagination), 2024. Article Number:
e40324. Date of Publication: 01 Nov 2024.
Author
Zhang R.; Zhu C.; Chen S.; Tian F.; Huang P.; Chen Y.
Institution
(Zhang, Tian, Huang, Chen) Xiamen Cardiovascular Hospital, Xiamen
University, Xiamen, China
(Zhang, Zhu, Chen, Tian, Chen) School of Nursing, Fujian University of
Traditional Chinese Medicine, Fuzhou, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative cognitive deficits frequently occur in patients
undergoing cardiac surgery, leaving them with reduced cognitive function.
Cognitive training has been shown to improve cognitive function, however,
the role in patients after cardiac surgery is unclear. In this study, we
aimed to evaluate the effectiveness and safety of cognitive training in
patients undergoing cardiac surgery. Method(s): A systematic search
of PubMed, Embase, Cochrane Library, CINAHL, Ovid Medline, Web of Science,
CNKI, and Wanfang was conducted until March 2024. The risk of bias was
assessed using the Cochrane Risk of Bias Tool. Data were meta-analyzed
using RevMan 5.4 software. Potential bias and reliability of evidence were
fairly assessed by using the Cochrane risk of bias method and the GRADE
evidence grading method. Result(s): A total of 16 studies involving
1335 cardiac surgery patients were included in this study. Compared with
the control group, the cognitive training group had a significantly lower
incidence of postoperative cognitive dysfunction (RR 0.35, 95% CI
0.18-0.65, P = .001), significantly improved cognitive function (MD 2.54,
95% CI 1.27-3.81, P < .001), and a significantly higher quality of
life-mental component (MD 5.22, 95% CI 2.32-8.13, P < .001), anxiety (MD
-6.05, 95% CI -10.96 to -1.15, P = .02) and depression (MD -3.97, 95% CI
-7.15 to -0.80, P = .01) were significantly improved between groups.
However, the differences were not statistically significant for
postoperative delirium (RR 1, 95% CI 0.38-2.65, P = 1.00) and
postoperative hospitalization (MD -0.95, 95% CI -2.90 to 1.00, P = .34).
 Conclusion(s): The present study, based on a low to moderate quality
of evidence, suggests that cognitive training improves cognitive
functioning, reduces the incidence of postoperative cognitive dysfunction,
and has a positive impact on anxiety and depression in patients undergoing
cardiac surgery. However, current evidence does not allow for the
determination of effects on quality of life, postoperative delirium, and
postoperative length of stay. Copyright © 2024 the Author(s).
Published by Wolters Kluwer Health, Inc.

<16>
Accession Number
645721840
Title
Valve Choice for TAVR: Much Left to re-SOLVE.
Source
Journal of the American College of Cardiology. (no pagination), 2024.
Date of Publication: 25 Oct 2024.
Author
Butala N.M.; Krishnaswamy A.
Institution
(Butala) Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA;
University of Colorado School of Medicine, Aurora, Colorado, USA
(Krishnaswamy) Department of Cardiovascular Medicine, Heart, Vascular and
Thoracic Institute, Cleveland Clinic, United States

<17>
Accession Number
645720594
Title
Successful cutaneous sensory blockade following single-injection and
double-injection techniques of ultrasound-guided superficial parasternal
intercostal plane block: a randomized clinical trial.
Source
Regional anesthesia and pain medicine. (no pagination), 2024. Date of
Publication: 05 Nov 2024.
Author
Samerchua A.; Sroiwong C.; Lapisatepun P.; Leurcharusmee P.; Pipanmekaporn
T.; Sukhupragarn W.; Boonsri S.; Bunchungmongkol N.; Pansuan K.; Phothikun
A.
Institution
(Samerchua, Sroiwong, Leurcharusmee, Pipanmekaporn, Sukhupragarn, Boonsri,
Bunchungmongkol, Pansuan) Anesthesiology, Chiang Mai University Faculty of
Medicine, Chiang Mai, Thailand
(Lapisatepun) Anesthesiology, Chiang Mai University Faculty of Medicine,
Chiang Mai, Thailand
(Phothikun) Surgery, Chiang Mai University Faculty of Medicine, Chiang
Mai, Thailand
Abstract
BACKGROUND: While superficial parasternal intercostal plane blocks can
improve analgesia after cardiac surgery, the optimal site and the number
of injections remain uncertain. This study aimed to compare the efficacy
of single versus double injections of superficial parasternal blocks,
hypothesizing that double injections would achieve superior cutaneous
sensory blockade. METHOD(S): 70 cardiac patients undergoing median
sternotomy were randomly assigned to receive either single or double
injections of superficial parasternal blocks bilaterally. Each patient
received 40mL of 0.25% bupivacaine with epinephrine 5microg/mL and
dexamethasone 10mg. The single-injection group received 20mL/side at the
third costal cartilage, while the double-injection group received
10mL/injection at the second and fourth costal cartilages. The primary
outcome was a successful block, defined as sensory loss in the T2-T6
dermatomes. Secondary outcomes included sensory block of T1, T7, and T8
dermatomes, block-related complications, intraoperative hemodynamics,
postoperative pain intensity, opioid consumption, and recovery quality.
 RESULT(S): Double injections achieved an overall higher success rate
compared with the single-injection technique (81% vs 51%, relative risk
1.6; 95%CI 1.2, 2.0; p<0.001). Additionally, higher blockade percentages
were observed in dermatomes T1 (83% vs 59%, p=0.003), T7 (67% vs 46%,
p=0.017), and T8 (61% vs 39%, p=0.011) with double injections. Other
secondary outcomes did not differ significantly between groups.
 CONCLUSION(S): Compared with single injection, double injections of
superficial parasternal blocks provided more reliable coverage of the
T2-T6 dermatomes, crucial for median sternotomy. However, no differences
were observed in intraoperative hemodynamic effects or postoperative pain
control after cardiac surgery. TRIAL REGISTRATION NUMBER:
TCTR20230408004. Copyright © American Society of Regional
Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and
permissions. Published by BMJ.

<18>
Accession Number
645720587
Title
Effect of Valve Type and Anesthesia Strategy for TAVR: 5-Year Results of
the SOLVE-TAVI Trial.
Source
Journal of the American College of Cardiology. (no pagination), 2024.
Date of Publication: 21 Oct 2024.
Author
Feistritzer H.-J.; Kurz T.; Vonthein R.; Schroder L.; Stachel G.; Eitel
I.; Marquetand C.; Saraei R.; Kirchhof E.; Heringlake M.; Abdel-Wahab M.;
Desch S.; Thiele H.
Institution
(Feistritzer, Abdel-Wahab, Thiele) Heart Center Leipzig at University of
Leipzig, Leipzig, Germany
(Kurz, Eitel, Marquetand, Saraei, Heringlake) University Heart Center
Lubeck, Lubeck, Germany; German Center for Cardiovascular Research (DZHK),
Partner Site Hamburg-Kiel-Lubeck, Lubeck, Germany
(Vonthein, Schroder) Institute of Medical Biometry and Statistics, Lubeck,
Germany
(Stachel) Heart Center Leipzig at University of Leipzig, Leipzig, Germany;
Clinic and Policlinic for Cardiology, Leipzig University Clinic, Leipzig,
Germany
(Kirchhof) Helios Health Institute, Leipzig, Germany
(Desch) Heart Center Leipzig at University of Leipzig, Leipzig, Germany;
German Center for Cardiovascular Research (DZHK), Partner Site
Hamburg-Kiel-Lubeck, Lubeck, Germany
Abstract
BACKGROUND: In the randomized SOLVE-TAVI (compariSon of secOnd-generation
seLf-expandable vs. balloon-expandable Valves and gEneral vs. local
anesthesia in Transcatheter Aortic Valve Implantation) trial comparing
newer-generation self-expanding valves (SEV) and balloon-expandable valves
(BEV), as well as conscious sedation (CS) and general anesthesia (GA),
clinical outcomes were similar both for valve and anesthesia comparison at
30 days and 1 year. Prosthesis durability may affect clinical outcomes
during long-term follow-up. Moreover, the impact of the anesthesia
strategy on long-term clinical outcomes is unknown so far.
 OBJECTIVE(S): The authors sought to compare clinical outcomes during
5-year follow-up in the randomized SOLVE-TAVI trial. METHOD(S): In
the randomized, multicenter, 2 x 2 factorial, open-label SOLVE-TAVI trial,
447 intermediate- to high-risk patients with severe, symptomatic aortic
stenosis were randomly assigned to transfemoral transcatheter aortic valve
replacement (TAVR) using either SEV (Evolut R, Medtronic) or BEV (SAPIEN
3, Edwards Lifesciences) and also to CS vs GA. Patients were followed-up
for 5 years. RESULT(S): During 5 years of follow-up, the combined
predefined endpoint of all-cause mortality, stroke, moderate or severe
paravalvular leakage, and permanent pacemaker implantation was similar in
the SEV and BEV groups (67.7% vs 63.4%; HR: 0.89; 95% CI: 0.70-1.13; P =
0.34). Stroke rates at 5 years were lower in the SEV group (2.2% vs 9.6%;
HR: 4.84; 95% CI: 1.65-14.18; P = 0.002). Regarding the anesthesia
comparison, the primary endpoint of all-cause mortality, stroke,
myocardial infarction, and acute kidney injury occurred in 51.4% in the CS
group and 61.3% in the GA group (HR: 0.80; 95% CI: 0.62-1.04; P = 0.09).
All-cause mortality at 5 years was lower for CS (41.5% vs 54.3%; HR: 0.70;
95% CI: 0.53-0.94; P = 0.02). CONCLUSION(S): Transfemoral TAVR using
either SEV and BEV as well as CS and GA showed similar clinical outcomes
at 5 years using a combined clinical endpoint. Copyright © 2024
American College of Cardiology Foundation. Published by Elsevier Inc. All
rights reserved.

<19>
Accession Number
645720476
Title
Impact of intravenous infusion of lidocaine on intrapulmonary shunt and
postoperative cognitive function in patients undergoing one-lung
ventilation.
Source
Advances in clinical and experimental medicine : official organ Wroclaw
Medical University. (no pagination), 2024. Date of Publication: 06 Nov
2024.
Author
Yang D.; Yang Q.; Wang Y.; Liu F.; Xing Z.; Li S.; Zhang J.
Institution
(Yang, Yang, Wang, Liu, Xing, Zhang) Department of Anesthesiology,
Affiliated Hospital of Yangzhou University, China
(Li) Department of Anesthesiology, First People's Hospital Affiliated to
Shanghai Jiaotong University, China
Abstract
BACKGROUND: Intravenous infusion of lidocaine as an anesthesia adjuvant
can improve patient outcomes, but its impact on intrapulmonary shunt
during one-lung ventilation (OLV) has not been clarified.
 OBJECTIVE(S): To determine the effect of intravenous lidocaine
infusion on intrapulmonary shunt during OLV and postoperative cognitive
function in video-assisted thoracoscopic surgery (VATS). MATERIAL AND
METHODS: Sixty patients who underwent OLV for thoracic surgery were
randomized to receive intravenous infusion of lidocaine (lidocaine group,
n = 30) or normal saline (control group, n = 30) for anesthesia induction.
Arterial and venous blood gases were measured during two-lung ventilation
and at 15 and 30 min after OLV (OLV + 15 and OLV + 30). The Mini-Mental
State Examination was administered before the surgery and at postoperative
12 months to assess patient cognitive function. RESULT(S): No
significant difference was found in intrapulmonary shunt fraction (Qs/Qt)
between the lidocaine group and the control group at OLV + 15 (p = 0.493)
and OLV + 30 (p = 0.754). The lidocaine group used significantly lower
doses of propofol and remifentanil compared to the control group (both p <
0.001). Furthermore, no significant difference was observed in the
incidence of postoperative cognitive dysfunction between the lidocaine
group and the control group at 1 year post-operation (3.3% vs 6.7%, p =
0.554). CONCLUSION(S): Intravenous lidocaine administered in VATS had
no significant impact on intrapulmonary shunt during OLV or postoperative
cognitive function. However, it significantly reduced the doses of
anesthetics used during the surgery.

<20>
Accession Number
645720052
Title
HTK solution cardioplegia in paediatric patients: a meta-analysis.
Source
The Thoracic and cardiovascular surgeon. (no pagination), 2024. Date of
Publication: 05 Nov 2024.
Author
Capuchinho Scalioni Galvao L.K.; Felix de Farias Santos A.C.; Pimenta Dos
Santos N.; Valeriano Zamora F.; Brunow Ventura Biavatti B.; Costa Esteves
Almuinha Salles J.P.; Soares Mendonca H.
Institution
(Capuchinho Scalioni Galvao, Valeriano Zamora) Federal University of Minas
Gerais Medicine School, Belo Horizonte, Brazil
(Felix de Farias Santos) UNICID, Sao Paulo, Brazil
(Pimenta Dos Santos, Costa Esteves Almuinha Salles) UNIRIO, Rio de
Janeiro, Brazil
(Brunow Ventura Biavatti) UNICAMP, Campinas, Brazil
(Soares Mendonca) Prevent Senior Private Health Operator, Sao Paulo,
Brazil
Abstract
INTRODUCTION: Cardioplegia, a therapy designed to induce reversible
cardiac arrest, revolutionised cardiovascular surgery. Among the various
pharmacological approaches is the histidine-tryptophan-ketoglutarate (HTK)
solution. Despite numerous studies, no meta-analysis has investigated the
efficacy of the HTK solution in the paediatric population. Therefore, we
aim to conduct a meta-analysis comparing HTK and other cardioplegia
solutions in paediatric patients undergoing cardiovascular surgery.
 METHOD(S): PubMed, Embase and Cochrane databases were searched from
inception through April 2024. Endpoints were computed in odds ratios (OR)
with 95% Confidence Intervals (CI) for dichotomous variables, whereas
continuous variables were compared using mean differences (MD) with 95%
CI. RESULT(S): 11 studies comprising 1,349 patients were included, of
whom 677 (50.19%) received HTK cardioplegia. The results were similar
between groups regarding mortality (OR 0.98; 95% CI 0.29, 3.29), length of
hospital (MD 0.32 days; 95% CI -0.88, 1.51), MV (MD -17.72 hours; 95% IC
-51.29, 15.85), arrhythmias (OR 1.27; 95% CI 0.83, 1.95;) and delayed
sternal closure (OR 0.89; 95% 0.56, 1.43). However, transfusion volume was
lower in the HTK group (MD -452.39; 95% CI -890.24, -14.53; p=0.04).
 CONCLUSION(S): The use of HTK solution was demonstrated to be similar
regarding its clinical efficacy to other approaches for cardioplegia, and
it may present advantages to patients prone to hypervolemia. Copyright
Thieme. All rights reserved.

<21>
Accession Number
645719841
Title
Is the Use of a Buprenorphine Transdermal Patch More Effective Than Oral
Medications for Postoperative Analgesia After Arthroscopic Rotator Cuff
Repair? A Randomized Clinical Trial.
Source
Clinical orthopaedics and related research. (no pagination), 2024. Date
of Publication: 05 Nov 2024.
Author
Liu W.; Qin J.; Fang X.; Jiang G.; Wang P.; Ding M.; Xu R.
Institution
(Liu) Department of Pharmacy, Nanjing Drum Tower Hospital, Drum Tower
Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing,
China
(Qin, Jiang, Wang, Xu) Division of Sports Medicine and Adult
Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum
Tower Hospital, Affiliated Hospital of Medical School, Nanjing University,
Nanjing, China
(Fang, Ding) Department of Pharmacy, Nanjing Drum Tower Hospital, School
of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University,
Nanjing, China
(Xu) Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated
Hospital of Medical School, Nanjing University, Nanjing, China
Abstract
BACKGROUND: Appropriate analgesic protocols for patients following
arthroscopic rotator cuff repair remain controversial. Although
transdermal buprenorphine patches might potentially provide better pain
control and fewer side effects, it is worth noting that there is limited
evidence for this given a lack of direct comparisons with oral pain
regimens. QUESTIONS/PURPOSES: Among patients undergoing arthroscopic
rotator cuff repair, and compared with an analgesic approach using oral
tramadol plus celecoxib: (1) Does perioperative use of buprenorphine
patches provide better pain relief by a clinically important margin? (2)
Does perioperative use of buprenorphine patches improve shoulder joint
function recovery? (3) Does perioperative use of buprenorphine patches
have a lower frequency of adverse reactions? METHODS: This was a
prospective, single-center, randomized controlled trial. We included
patients who underwent arthroscopic rotator cuff repair for partial- or
full-thickness rotator cuff tears < 3 cm in size in the anterior to
posterior direction as estimated by preoperative MRI and excluded those
who had obesity, were pregnant, had opioid dependence, had history of
cardiac bypass surgery or ipsilateral rotator cuff repair, had allergies
to trial medications, were taking anticoagulants or antidepressants, were
being treated with other postsurgical pain management methods, or had
severe liver or kidney dysfunction. Based on these criteria, 64% (72 of
112) of patients were eligible. The patients were randomly assigned into
either the control group (oral tramadol and celecoxib) or the experimental
group (buprenorphine patches). The control group received 100 mg of
tramadol and 200 mg of celecoxib every 12 hours for 2 weeks after surgery.
The experimental group received buprenorphine patches about 48 hours
before surgery without any oral medication. A medication journal was given
to the patients to self-report their compliance in taking the drugs. The
dosage regimen adhered strictly to protocol. After enrollment, 11% (4 of
36) of patients in the control group and 17% (6 of 36) of patients in the
experimental group could not be fully analyzed because of loss to
follow-up or missing data. The surveillance period was 3 months, and there
was no crossover between groups. The groups did not differ at baseline in
terms of demographic parameters and relevant clinical characteristics,
including age, gender, BMI, American Society of Anesthesiologists
classification, tear size, concomitant procedures, and number of anchors.
The outcomes were (1) numeric rating scale (NRS) for pain score at rest or
with movement, which ranges from 0 to 10, where 0 indicates no pain, and
10 indicates the worst pain; (2) the American Shoulder and Elbow Surgeons
(ASES) score for joint function, which ranges from 0 to 100, with higher
scores indicating better shoulder joint function; and (3) the incidence of
postoperative adverse reactions. We defined the minimum clinically
important difference on the NRS as 2 of 10 points and on the ASES score as
15 of 100 points, based on anchor-based approaches reported in other
studies. RESULT(S): We found no clinically important between-group
differences in NRS pain scores at any time point, either at rest or with
movement. Likewise, we found no clinically important between-group
differences in ASES scores at any time point. Postoperative dizziness or
drowsiness (20% [6 of 30 patients] versus 44% [14 of 32 patients]; p =
0.04) and nausea (10% [3 of 30 patients] versus 34% [11 of 32 patients]; p
= 0.02) during the hospital stay were slightly lower in the experimental
group compared with the control group. CONCLUSION(S): In this
randomized trial, we found no clinically important advantages in pain or
function to the use of buprenorphine patches after arthroscopic rotator
cuff repair, and insufficient evidence exists to confirm whether the minor
differences in transient side effects could justify the use of a new and
largely untested analgesic approach in this context. That being so, we
recommend against the routine use of buprenorphine patches for this
indication. In general, we found that pain levels were low after the
procedure in both groups. Future studies, therefore, should focus on the
efficacy of buprenorphine patches for more invasive or more painful
procedures. LEVEL OF EVIDENCE: Level I, therapeutic study. Copyright
© 2024 by the Association of Bone and Joint Surgeons.

<22>
Accession Number
645718464
Title
Robotic Versus Thoracoscopic Minimally Invasive Mitral Valve Surgery: A
Systematic Review and Meta-Analysis of Matched Studies.
Source
Cardiology in review. (no pagination), 2024. Date of Publication: 05 Nov
2024.
Author
De Jesus J.; Estrella J.; Jesse J.; Binny V.; Sri Radhakrishnan
Parthasarathy P.; Kabir Y.; Nallamotu S.; Guntupalli S.V.; Cai L.Y.;
Al-Tawil M.
Institution
(De Jesus) From the Accident and Emergency Department, Queen Alexandra
Hospital, Portsmouth, United Kingdom
(Estrella) Acute Medicine Department, Queen Alexandra Hospital,
Portsmouth, United Kingdom
(Jesse) Department of Cardiology, Universidad de Montemorelos, Nuevo Leon,
Mexico
(Binny) Department of Cardiology, Gretchen Whitney High School, Cerritos,
CA, United States
(Sri Radhakrishnan Parthasarathy) Department of Cardiology, Tbilisi State
Medical University, Tbilisi, Georgia
(Kabir) Department of Cardiology, Hywel Dda University Health Board,
Wales, United Kingdom
(Nallamotu) Department of Cardiology, Kasturba Medical College, Manipal,
India
(Guntupalli) Department of Cardiology, Guntur Medical College, Guntur,
India
(Cai) Department of Cardiology, Caribbean Medical University, Willemstad,
Netherlands
(Al-Tawil) Department of Cardiovascular Surgery, Trier Heart Centre,
Trier, Germany
Abstract
Mitral regurgitation is the most prevalent form of valvular heart disease,
impacting over 24 million people globally. Robotic and thoracoscopic
minimally invasive mitral valve repair (MIMR) techniques have emerged as
viable alternatives to traditional open-heart surgery. However, the
comparative effectiveness and safety of these 2 approaches remain
underexplored. This systematic review and meta-analysis, conducted
according to Preferred Reporting Items for Systematic Review and
Meta-Analysis (PRISMA) guidelines, aimed to compare robotic and
thoracoscopic MIMR outcomes. A literature search was performed across
PubMed, Scopus, and Embase databases to identify studies comparing these 2
surgical techniques. Eligible studies included randomized controlled
trials and cohort studies. Six propensity score-matched studies and 1
retrospective cohort study, involving 11,823 patients, were included, with
5851 undergoing robotic mitral valve repair and 5972 receiving
thoracoscopic MIMR. No significant differences were found in perioperative
mortality [risk ratio (RR): 0.97, 95% confidence interval (CI): 0.65-1.45]
or pump/clamp times. Robotic surgery was associated with longer operative
times (mean difference: 33.01 minutes) and higher intraoperative
transfusion rates (RR: 1.53, 95% CI: 1.07-2.18), but a lower risk of
atrial fibrillation (RR: 0.89, 95% CI: 0.83-0.95). In conclusion, robotic
and thoracoscopic MIMR show comparable mortality and overall safety
profiles. However, robotic surgery may require longer operative times and
increased transfusion needs, while reducing the risk of atrial
fibrillation. Further high-quality, randomized studies are warranted to
validate these findings. Copyright © 2024 Wolters Kluwer Health,
Inc. All rights reserved.

<23>
Accession Number
2029010176
Title
Impact of fetal pulmonary valvuloplasty in in-utero critical pulmonary
stenosis: A systematic review and meta-analysis.
Source
International Journal of Cardiology Congenital Heart Disease. 15 (no
pagination), 2024. Article Number: 100485. Date of Publication: March
2024.
Author
Mendel B.; Kohar K.; Yumnanisha D.A.; Djiu R.J.; Winarta J.; Prakoso R.;
Siagian S.N.
Institution
(Mendel, Prakoso, Siagian) Division of Pediatric Cardiology and Congenital
Heart Disease, Department of Cardiology and Vascular Medicine, National
Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta,
Indonesia
(Mendel) Department of Cardiology and Vascular Medicine, Sultan Sulaiman
Government Hospital, Serdang Bedagai, North Sumatera, Indonesia
(Kohar, Yumnanisha, Djiu, Winarta) Faculty of Medicine Universitas
Indonesia, Jakarta, Indonesia
Publisher
Elsevier B.V.
Abstract
Background: Untreated critical pulmonary stenosis may develop into
pulmonary atresia with intact ventricular septum, which is associated with
a high risk of morbidity and mortality both in fetuses and neonates. In
this meta-analysis, we sought to discover the potential of fetal pulmonary
valvuloplasty that might affect patients' survival compared to other
available procedures. Method(s): This systematic review and
meta-analysis were conducted based on the PRISMA guideline. The authors
thoroughly searched the recognized and potential interventions for PA-IVS,
including FPV, total ventricular repair, and palliative procedures. The
primary outcome was the mortality rate. We used R software (version 4.1.3)
to calculate the overall proportion using the random-effects model of
proportional meta-analysis. Result(s): The FPV procedure was
performed at a mean gestational age of 26.28 weeks (95%CI: 24.83-27.73)
and was successful in 87.6 % (95 % CI: 78.3-96.3 %) of patients. A total
of 52.9 % patients attained biventricular circulation postnatally (95 %
CI: 31.2-74.7 %). Successful FPV was associated with a slightly higher
overall mortality rate [periprocedural death 4.7 % (95%CI: 0-10.7 %) and
postnatal death 8 % (95%CI: 3-13 %)] compared to the three currently
available definitive therapies, namely the Fontan procedure [10 % (95%CI:
4-17 %)], 1.5V repair [11 % (95%CI: 5-17 %), and 2V repair [8 % (95%CI:
1-15 %)]. Conclusion(s): FPV can potentially increase the likelihood
of biventricular circulation in fetuses with critical pulmonary valve
stenosis. Copyright © 2023 The Authors

<24>
Accession Number
2013205203
Title
Does medical or surgical treatment for aortic stenosis improve outcome in
dogs?.
Source
Veterinary Evidence. 6(2) (no pagination), 2021. Date of Publication:
2021.
Author
Thomas J.; Marshall S.; Conway G.; Gormley K.; Borgeat K.
Institution
(Thomas, Marshall, Conway, Gormley, Borgeat) University of Bristol,
Bristol Veterinary School, Langford House, Langford, Bristol BS40 5DU,
United Kingdom
Publisher
Royal College of Veterinary Surgeons

<25>
Accession Number
2031720060
Title
Prevalence and Impact of Chronic Obstructive Pulmonary Disease in Ischemic
Heart Disease: A Systematic Review and Meta-Analysis of 18 Million
Patients.
Source
International Journal of COPD. 19 (pp 2333-2345), 2024. Date of
Publication: 2024.
Author
Meng K.; Zhang X.; Liu W.; Xu Z.; Xie B.; Dai H.
Institution
(Meng, Xu, Dai) Capital Medical University, Beijing 100069, China
(Meng, Zhang, Liu, Xu, Xie, Dai) National Center for Respiratory Medicine,
Beijing 100029, China
(Meng, Zhang, Liu, Xu, Xie, Dai) National Clinical Research Center for
Respiratory Diseases, Beijing 100029, China
(Meng, Zhang, Liu, Xu, Xie, Dai) State Key Laboratory of Respiratory
Health and Multimorbidity, Beijing 100029, China
(Meng, Zhang, Liu, Xu, Xie, Dai) Department of Pulmonary and Critical Care
Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital,
Beijing 100029, China
(Zhang) Department of Clinical Research and Data Management, Center of
Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029,
China
(Liu, Dai) Institute of Respiratory Medicine, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing 100029, China
Publisher
Dove Medical Press Ltd
Abstract
Background: The prevalence of chronic obstructive pulmonary disease (COPD)
in patients with ischemic heart disease (IHD) remains uncertain, and its
association with adverse outcomes is frequently overlooked. This study
aimed to estimate the prevalence of COPD, and its impact on
pharmacological treatment, and clinical outcomes in patients with IHD.
 Method(s): A systematic literature search was conducted in Web of
Science, Embase, and PubMed until November 20, 2023. All studies that
reported the prevalence of COPD in IHD patients were included, and a
random-effects model was employed to calculate the pooled prevalence. Data
on cardiovascular risk factors/comorbidities, beta-blockers (BBs)
prescription, acute phase outcomes [inhospital mortality, major adverse
cardiovascular events (MACE), acute heart failure (AHF), and cardiogenic
shock], and long-term mortality were compared according to COPD status.
 Result(s): A total of 82 eligible studies that reported the
prevalence of COPD in 18 million IHD patients were included. The pooled
prevalence of COPD was 12.0% [95% confidence intervals (CI): 9.9%-14.1%]
in patients with IHD. In subgroup analysis, the prevalence of COPD was
highest in North America (15.3%), followed by Europe (10.0%), and Asia
(8.8%). In addition, COPD was associated with a higher burden of
cardiovascular risk factors/comorbidities, but lower BBs prescription
[odds ratio (OR) 0.50, 95% CI 0.38-0.66]. Moreover, COPD was linked to an
increased risk of in-hospital mortality (OR 1.47, 95% CI 1.37-1.58), MACE
(OR 1.81, 95% CI 1.44-2.27), AHF (OR 2.14, 95% CI 1.86-2.46), cardiogenic
shock (OR 1.30, 95% CI 1.01-1.68), as well as long-term mortality (OR
1.99, 95% CI 1.80-2.20). Conclusion(s): This meta-analysis
demonstrated that COPD is prevalent in IHD, involving 12.0% of IHD
patients, and is linked to a lower prescription of BBs, an increased
burden of comorbidities, and worse acute phase outcomes and long-term
mortality. Copyright © 2024 Meng et al.

<26>
Accession Number
2031365673
Title
Comparison of Clinical Outcomes of Posterior-Only Transforaminal
Debridement and Interbody Fusion With Preservation of Posterior
Ligamentous Complex Versus Conventional Posterior-Only Debridement and
Interbody Fusion for Thoracic Spine Tuberculosis: A Prospective,
Randomized, Controlled, Clinical Trial - A Pilot Study.
Source
Neurospine. 21(3) (pp 954-965), 2024. Date of Publication: Sep 2024.
Author
Wang Y.; Xiao S.; Zeng G.; Zhang H.; Alonge E.; Yang Z.
Institution
(Wang, Xiao, Zhang, Alonge, Yang) Department of Spine Surgery and
Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central
South University, Changsha, China
(Wang, Xiao, Zhang, Alonge, Yang) National Clinical Research Center for
Geriatric Disorder, Xiangya Hospital of Central South University,
Changsha, China
(Zeng) Department of Spine Surgery, Xiangya Boai Rehabilitation Hospital,
Changsha, China
Publisher
Korean Spinal Neurosurgery Society
Abstract
Objective: The main objective of this study was to analyze the efficacy
and feasibility of surgical management for patients with thoracic spinal
tuberculous spondylitis (STB) by using posterior-only transforaminal
debridement and interbody fusion (PTDIF) with preservation of posterior
ligamentous complex (PLC) and noninferior of PTDIF compared with
conventional posterior-only debridement and interbody fusion (CPDIF).
 Method(s): From January 2019 to January 2022, a prospective,
randomized, controlled trial was conducted in which patients with thoracic
STB were enrolled and assigned to undergo either the PTDIF group (group A)
or CPDIF group (group B) in a 1:1 ratio. The clinical efficacy was
evaluated on average operation time, blood loss, hospitalization
durations, visual analogue scale, Oswestry Disability Index scores,
erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), and
neurological function recovery using the American Spinal Injury
Association's impairment scale and operative complications. Radiological
measurements included kyphosis correction, loss of correction. The
outcomes were compared between the groups at preoperation, postoperaion,
and final follow-up. Result(s): All 65 patients were completely cured
during the follow-up. The intraoperative blood loss and operation time in
group B were more than that in group A. All patients were pain-free at the
final follow-up visit. ESR, CRP returned to normal limits in all patients
3 months after surgery. All patients had improved neurological signs. No
significant difference was found in kyphosis angle correction, loss of
correction between the 2 groups. Conclusion(s): PTDIF, with
preservation of PLC, achieved debridement, decompression, and
reconstruction of the spine's stability, similar to CPDIF in the surgical
treatment of thoracic STB. PTDIF has less surgical trauma with less
intraoperative blood loss and operation time. Copyright © 2024 by
the Korean Spinal Neurosurgery Society.

<27>
Accession Number
2030870550
Title
Effect of time of day on outcomes in elective surgery: a systematic
review.
Source
Anaesthesia. 79(12) (pp 1325-1334), 2024. Date of Publication: December
2024.
Author
Meewisse A.J.G.; Gribnau A.; Thiessen S.E.; Stenvers D.J.; Hermanides J.;
van Zuylen M.L.
Institution
(Meewisse, Gribnau, Hermanides, van Zuylen) Department of Anaesthesiology,
Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
(Thiessen) Department of Anaesthesiology, Intensive Care Medicine,
Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk,
Belgium
(Thiessen) Department of Anaesthesiology and Department of Cardiovascular
Sciences, KULeuven, Leuven, Belgium
(Stenvers) Department of Endocrinology, Amsterdam UMC, University of
Amsterdam, Amsterdam, Netherlands
(Stenvers) Amsterdam Gastroenterology, Endocrinology and Metabolism,
Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
(Hermanides) Amsterdam Public Health, Quality of Care, Amsterdam UMC,
University of Amsterdam, Amsterdam, Netherlands
(van Zuylen) Department of Paediatric Intensive Care, Amsterdam UMC,
University of Amsterdam, Amsterdam, Netherlands
Publisher
John Wiley and Sons Inc
Abstract
Background: The timing of elective surgery could affect clinical outcome
because of diurnal rhythms of patient physiology as well as surgical team
performance. Waiting times for elective surgery are increasing in many
countries, leading to increasing interest in undertaking elective surgery
in the evening or at night. We aimed to systematically review the
literature on the effect of the timing of elective (but not urgent or
emergency) surgery on mortality, morbidity and other clinical outcomes.
 Method(s): We searched databases for relevant studies combining the
terms 'circadian rhythm' and 'anaesthesia/surgery'. Additional relevant
articles were found by hand-searching the references. All studies were
screened for bias. Included studies examined daytime vs.
evening/night-time surgery, morning vs. afternoon surgery, multiple
timeslots or used time as a continuous variable. Result(s): Nineteen
retrospective cohort studies, one prospective cohort study and one
randomised controlled trial were included (n = 798,914).
Evening/night-time elective surgery was associated with a higher risk of
mortality when compared with daytime procedures in three studies (n =
611,230), with odds ratios (95%CI) for mortality ranging from 1.35
(1.16-1.56) to 3.98 (1.54-10.30), while no differences were found in three
other studies (n = 142,355). No differences were found for morning vs.
afternoon surgery (four studies, n = 3277). However, most studies had a
low quality of evidence due to their retrospective nature and because not
all studies corrected for patient characteristics. Moreover, the studies
were heterogeneous in terms of the reported time slots and clinical
outcomes. Conclusion(s): We found that evening/night-time elective
surgery is associated with a higher risk of mortality compared with
daytime surgery. However, the quality of evidence was graded as low, and
thus, future prospective research should publish individual patient data
and standardise outcome measures to allow firm conclusions and facilitate
interventions. Copyright © 2024 The Author(s). Anaesthesia
published by John Wiley & Sons Ltd on behalf of Association of
Anaesthetists.

<28>
Accession Number
2035510862
Title
Cangrelor versus crushed ticagrelor in patients with acute myocardial
infarction and cardiogenic shock: rationale and design of the randomised,
double-blind DAPT-SHOCK-AMI trial.
Source
EuroIntervention. 20(20) (pp e1309-e1318), 2024. Date of Publication: 21
Oct 2024.
Author
Motovska Z.; Hlinomaz O.; Mrozek J.; Kala P.; Geisler T.; Hromadka M.;
Akin I.; Precek J.; Kettner J.; Cervinka P.; Montalescot G.; Jarkovsky J.;
Belohlavek J.; Bis J.; Matejka J.; Vodzinska A.; Muzafarova T.; Tomasov
P.; Schee A.; Bartus S.; Andrasova A.; Olivier C.B.; Kovarik A.; Ostadal
P.; Demlova R.; Souckova L.; Vulev I.; Coufal Z.; Kochman J.; Marinov I.;
Kubica J.; Ducrocq G.; Karpisek M.; Klimsa Z.; Hudec M.; Widimsky P.;
Bhatt D.L.
Institution
(Motovska, Muzafarova, Widimsky) Cardiocentre, Third Faculty of Medicine,
Charles University, University Hospital Kralovske Vinohrady, Prague,
Czechia
(Hlinomaz) First Department of Internal Medicine - Cardioangiology, ICRC,
Faculty of Medicine, Masaryk University, St. Anne's University Hospital,
Brno, Czechia
(Hlinomaz, Vulev) CINRE, Bratislava, Slovakia
(Mrozek) Cardiovascular Department, University Hospital Ostrava, Faculty
of Medicine, University Ostrava, Ostrava, Czechia
(Kala) Department of Internal Medicine and Cardiology, Faculty of
Medicine, Masaryk University, University Hospital Brno, Brno, Czechia
(Geisler) Department of Cardiology and Angiology, University Hospital,
Eberhard Karls University, Tubingen, Germany
(Hromadka) Department of Cardiology, University Hospital, Faculty of
Medicine in Pilsen, Charles University, Pilsen, Czechia
(Akin) First Department of Medicine, University Medical Centre Mannheim
(UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim,
Germany
(Precek) Department of Internal Medicine I - Cardiology, Faculty of
Medicine and Dentistry, Palacky University, University Hospital, Olomouc,
Olomouc, Czechia
(Kettner) Cardiology Department, Institute of Clinical and Experimental
Cardiology, Prague, Czechia
(Cervinka) Department of Cardiology, Krajska zdravotni a.s., Masaryk
Hospital, Jan Evangelista Purkyne University, Usti nad Labem, Czechia
(Cervinka, Bis) Department of Medicine - Cardioangiology, University
Hospital Hradec Kralove, Hradec Kralove, Czechia
(Montalescot) Sorbonne Universite, ACTION Study Group, INSERM UMRS 1166,
Institut de Cardiologie, Pitie-Salpetriere Hospital, Assistance
Publique-Hopitaux de Paris, Paris, France
(Jarkovsky) Institute of Biostatistics and Analyses, Faculty of Medicine,
Masaryk University, Brno, Czechia
(Belohlavek) Second Department of Internal Medicine, Cardiovascular
Medicine, General Teaching Hospital, First Faculty of Medicine, Charles
University, Prague, Czechia
(Matejka) Department of Cardiology, Pardubice Hospital, Pardubice, Czechia
(Vodzinska) Department of Cardiology, Hospital Agel Trinec-Podlesi,
Trinec, Czechia
(Tomasov) Cardiology Department, Hospital Liberec, Liberec, Czechia
(Schee) Cardiocenter, Regional Hospital Karlovy Vary, Karlovy Vary,
Czechia
(Bartus) Institute of Cardiology, Jagiellonian University Medical College,
Krakow, Poland
(Bartus) Department of Cardiology, University Hospital, Krakow, Poland
(Andrasova) Cardiocenter Nitra, Nitra, Slovakia
(Olivier) Cardiovascular Clinical Research Center (CCRC), Department of
Cardiology and Angiology, University Heart Center Freiburg - Bad
Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
(Kovarik) Cardiocenter, Regional Hospital Ceske Budejovice, Ceske
Budejovice, Czechia
(Ostadal) Department of Cardiology, Na Homolce Hospital, Prague, Czechia
(Ostadal) Department of Cardiology, Second Faculty of Medicine, Charles
University, Motol University Hospital, Prague, Czechia
(Demlova, Souckova) CZECRIN, Faculty of Medicine, Masaryk University, St.
Anne's University Hospital, Brno, Czechia
(Coufal) T. Bata Regional Hospital Zlin, Zlin, Czechia
(Kochman) Department of Cardiology, Medical University of Warsaw, Warsaw,
Poland
(Marinov) Institute of Hematology and Blood Transfusion, Prague, Czechia
(Kubica) Department of Cardiology and Internal Medicine, Collegium
Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
(Ducrocq) Department of Cardiology, FACT (French Alliance for
Cardiovascular Trials), DHU-FIRE, Bichat-Claude Bernard University
Hospital, Paris, France
(Karpisek) BioVendor R&D, BioVendor-Laboratory Medicine, Brno, Czechia
(Klimsa) Department of Cardiology, Jihlava Hospital, Jihlava, Czechia
(Hudec) Department of Acute Cardiology, SUSCCH, Banska Bystrica, Slovakia
(Bhatt) Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
Publisher
Europa Group
Abstract
Cardiogenic shock (CS) is a devastating and fatal complication of acute
myocardial infarction (AMI). CS can affect the pharmacokinetics and
pharmacodynamics of medications. The unique properties of cangrelor make
it the optimal P2Y<inf>12</inf> inhibitor for CS-AMI, in terms of both
efficacy and safety. The DAPT-SHOCK-AMI trial (ClinicalTrials. gov:
NCT03551964; EudraCT: 2018-002161-19) will assess the benefits of
cangrelor in patients with an initial CS-AMI undergoing primary
angioplasty. This randomised, multicentre, placebo-controlled trial of
approximately 550 patients (with an allowed 10% increase) in 5 countries
using a double-blind design will compare initial P2Y<inf>12</inf>
inhibitor treatment strategies in patients with CS-AMI of (A) intravenous
cangrelor and (B) ticagrelor administered as crushed tablets at a loading
dose of 180 mg. The primary clinical endpoint is a composite of all-cause
death, myocardial infarction (MI), or stroke within 30 days. The main
secondary endpoints are (1) the net clinical endpoint, defined as death,
MI, urgent revascularisation of the infarct-related artery, stroke, or
major bleeding as defined by the Bleeding Academic Research Consortium
criteria; (2) cardiovascular-related death, MI, urgent revascularisation,
or heart failure; (3) heart failure; and (4) cardiovascular-related death,
all (1-4) within 1 year after study enrolment. A platelet reactivity study
that tests the laboratory antiplatelet benefits of cangrelor, when given
in addition to standard antiplatelet therapy, will be conducted using
vasodilator-stimulated phosphoprotein phosphorylation. The primary
laboratory endpoints are the periprocedural rate of onset and the
proportion of patients who achieve effective P2Y<inf>12</inf> inhibition.
The DAPT-SHOCK-AMI study is the first randomised trial to evaluate the
benefits of cangrelor in patients with CS-AMI. Copyright © Europa
Digital & Publishing 2024. All rights reserved.

<29>
[Use Link to view the full text]
Accession Number
2035410784
Title
Diagnostic accuracy of NT-proBNP to predict the incidence of CSA-AKI: A
systematic review and meta-analysis.
Source
Medicine (United States). 103(43) (pp e39479), 2024. Date of Publication:
25 Oct 2024.
Author
Zhang J.; Li X.; Yu X.
Institution
(Zhang) Department of Nephrology, The Third Hospital of Mianyang, Sichuan
Mental Health Center, Sichuan, Mianyang, China
(Li) Department of Neurosurgery, Chengdu Third People's Hospital, Sichuan,
Chengdu, China
(Yu) Department of Cardiology, The Third Hospital of Mianyang, Sichuan
Mental Health Center, Sichuan, Mianyang, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a
severe complication following cardiac surgery. Early identification and
diagnosis are critical. In this study, we aim to systematically assess the
diagnostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP)
for CSA-AKI. Method(s): The PubMed, Embase, Web of Science, and
Cochrane Library databases were searched from January 1971 to October 2023
to identify prospective observational and retrospective observational
studies. Data extraction and study screening were carried out
independently by 2 authors. The methodological quality of the included
studies was evaluated by the Quality Assessment of Diagnostic Accuracy
Studies 2 standards, and all statistical analyses were conducted by Stata
15.0. Result(s): Seven studies including 37,200 patients were
identified. The pooled sensitivity of 0.67 (95% credible interval [CI] =
0.56-0.77), specificity of 0.55 (95% CI = 0.45-0.64), area under the
summary receiver operating characteristic curve of 0.65 (95% CI =
0.60-0.69), positive likelihood ratio of 1.5 (95% CI = 1.2-1.8), negative
likelihood ratio of 0.60 (95% CI = 0.46-0.79), and diagnostic odds ratio
of 2 (95% CI = 2-4) suggested that patients with higher preoperative
NT-proBNP levels (pg/mL) are at higher risk of developing acute kidney
injury after cardiac surgery. However, NT-proBNP lacks sufficient
sensitivity and specificity to reliably predict CSA-AKI.
 Conclusion(s): Our findings suggest that the diagnostic accuracy of
NT-proBNP to predict the incidence of CSA-AKI is limited. However, we
provide novel perspectives on the early detection of CSA-AKI biomarkers,
and it is urgent to identify more precise and practical biomarkers for the
early diagnosis of CSA-AKI. Copyright © 2024 the Author(s).

<30>
Accession Number
645703545
Title
Invasive Versus Conservative Strategy in Older Adults >=75Years of Age
With Non-ST-segment-Elevation Acute Coronary Syndrome: A Systematic Review
and Meta-Analysis of Randomized Controlled Trials.
Source
Journal of the American Heart Association. 13(21) (pp e036151), 2024. Date
of Publication: 05 Nov 2024.
Author
Rout A.; Moumneh M.B.; Kalra K.; Singh S.; Garg A.; Kunadian V.; Biscaglia
S.; Alkhouli M.A.; Rymer J.A.; Batchelor W.B.; Nanna M.G.; Damluji A.A.
Institution
(Rout) Division of Cardiology University of Louisville Louisville KY USA
(Moumneh, Kalra, Batchelor, Damluji) Inova Center of Outcomes Research
Falls Church VA USA
(Singh) Department of Medicine Sinai Hospital of Baltimore Baltimore MD
USA
(Garg) Division of Cardiology Ellis Hospital Schenectady NY USA
(Kunadian) Translational and Clinical Research Institute, Faculty of
Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom,
United Kingdom
(Kunadian) Cardiology Unit, Cardiothoracic Centre Freeman Hospital,
Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne
United Kingdom, United Kingdom
(Biscaglia) Azienda Ospedaliero-Universitaria di Ferrara Cona FE Italy
(Alkhouli) Department of Cardiology, Mayo Clinic School of Medicine
Rochester MN USA
(Rymer) Duke University School of Medicine Durham NC USA
(Rymer) Duke Clinical Research Institute Durham NC USA
(Nanna) Yale University School of Medicine New Haven CT USA
(Damluji) Johns Hopkins University School of Medicine Baltimore MD USA
Abstract
BACKGROUND: Older adults with non-ST-segment-elevation acute coronary
syndrome are less likely to undergo an invasive strategy compared with
younger patients. Randomized controlled trials traditionally exclude older
adults because of their high burden of geriatric conditions. METHODS AND
RESULTS: We searched for randomized controlled trials comparing invasive
versus medical management or a selective invasive (conservative) strategy
for older patients (age>=75years) with non-ST-segment-elevation acute
coronary syndrome. Fixed effects meta-analysis was conducted to estimate
the odds ratio (OR) with 95% CI for the composite of death or myocardial
infarction (MI) and individual secondary end points of all-cause death,
cardiovascular death, MI, revascularization, stroke, and major bleeding.
Nine studies with 2429 patients (invasive: 1228 versus control: 1201) with
a mean follow-up of 21months were included. An invasive strategy was
associated with a significantly decreased risk of a composite of death and
MI (OR, 0.67 [95% CI, 0.54-0.83], P<0.001), MI (OR, 0.56 [95% CI,
0.45-0.70], P<0.001) and subsequent revascularization (OR, 0.27 [95% CI,
0.16-0.48], P<0.001). There was no difference in all-cause death (OR, 0.84
[95% CI, 0.65-1.10], P=0.21), cardiovascular death (OR, 0.85 [95% CI,
0.63-1.15], P=0.30), stroke (OR, 0.74 [95% CI, 0.38-1.47], P=0.39), or
major bleeding (OR, 1.24 [95% CI, 0.42-3.66], P=0.70). CONCLUSION(S):
In older patients >=75years old with non-ST-segment-elevation acute
coronary syndrome, an invasive strategy reduced the risk of a composite of
death and MI, MI, and subsequent revascularization compared with a
conservative strategy alone. Older adults with higher burden of geriatric
conditions should be included in future trials to improve generalizability
to this growing population.

<31>
Accession Number
645660742
Title
Immediate Versus Staged Complete Revascularization for Patients With
ST-Segment-Elevation Myocardial Infarction and Multivessel Disease: A
Network Meta-Analysis of Randomized Trials.
Source
Journal of the American Heart Association. 13(21) (pp e035535), 2024. Date
of Publication: 05 Nov 2024.
Author
Elbadawi A.; Hamed M.; Gad M.; Elseidy S.A.; Barghout M.; Jneid H.; Mamas
M.A.; Alfonso F.; Elgendy I.Y.
Institution
(Elbadawi) Division of Cardiology Christus Good Shepherd Medical Center
Longview TX USA
(Elbadawi) Texas A&M School of Medicine Bryan TX USA
(Hamed) Division of Cardiology Florida Atlantic University Boca Raton FL
USA
(Gad) Division of Cardiology Baylor College of Medicine Houston TX USA
(Elseidy) Cardiology Department Ain Shams University Cairo Egypt, Egypt
(Barghout) Division of Cardiology Alpert Medical School of Brown
University, Lifespan Cardiovascular Institute Providence RI USA
(Jneid) Division of Cardiovascular Medicine University of Texas Medical
Branch Galveston TX USA
(Mamas) Keele Cardiovascular Research Group, Centre for Prognosis Research
Keele University Keele United Kingdom, United Kingdom
(Alfonso) Cardiology Department Hospital Universitario de La Princesa,
IIS-IP, Spain
(Elgendy) Division of Cardiovascular Medicine, Gill Heart and Vascular
Institute University of Kentucky Lexington 40536 KY USA
Abstract
BACKGROUND: The comparative outcomes with immediate, staged in-hospital,
and staged out-of-hospital complete revascularization for patients with
ST-segment-elevation myocardial infarction and multivessel disease remain
unclear. METHODS AND RESULTS: An electronic search of MEDLINE, SCOPUS, and
Cochrane databases was performed through August 2023 for randomized trials
evaluating immediate, staged in-hospital, and staged out-of-hospital
complete revascularization for patients with ST-segment-elevation
myocardial infarction and multivessel disease. The primary outcome was
major adverse cardiac events (MACEs). The final analysis included 9 trials
with 4270 patients. The weighted follow-up duration was 13.8months. On
pairwise meta-analysis, there were no statistically significant
differences between immediate versus staged nonculprit percutaneous
coronary intervention (PCI) in MACEs (odds ratio, 0.79 [95% CI,
0.54-1.16]). Network meta-analysis showed that there was no statistically
significant difference in MACEs with staged in-hospital nonculprit PCI
(odds ratio, 1.29-[95% CI, 0.91-1.82]) compared with immediate nonculprit
PCI, while there were higher odds of MACEs with out-of-hospital nonculprit
PCI (odds ratio, 1.67-[95% CI, 1.21-2.30]) compared with immediate
nonculprit PCI. Compared with immediate nonculprit PCI, there were higher
odds of ischemia-driven repeat revascularization with staged
out-of-hospital nonculprit PCI (odds ratio, 2.26-[95% CI, 1.37-3.72]), but
not with in-hospital staged nonculprit PCI. There were no significant
differences for the other outcomes among the 3 strategies.
 CONCLUSION(S): Among patients with ST-segment-elevation myocardial
infarction with multivessel disease, an immediate nonculprit PCI approach
was associated with similar clinical outcomes to the staged nonculprit PCI
approach. The staged out-of-hospital nonculprit PCI approach was
associated with a higher incidence of MACEs compared with the other
strategies, which was driven by higher risk for ischemia-driven repeat
revascularization.

<32>
Accession Number
645562072
Title
Trends in Transcatheter Versus Surgical Aortic Valve Replacement Outcomes
in Patients With Low-Surgical Risk: A Systematic Review and Meta-Analysis
of Randomized Trials.
Source
Journal of the American Heart Association. 13(21) (pp e036179), 2024. Date
of Publication: 05 Nov 2024.
Author
Kazemian S.; Fallahtafti P.; Sharifi M.; Mohammadi N.S.H.; Soleimani H.;
Moghadam A.S.; Karimi E.; Sattar Y.; Jenab Y.; Mehrani M.; Hajizeinali A.;
Iskander M.; Sabet M.F.; Salehi N.; Al-Azizi K.; Hakim D.; Alam M.;
Hosseini K.
Institution
(Kazemian, Mohammadi, Soleimani, Jenab, Mehrani, Hosseini) Cardiac Primary
Prevention Research Center Cardiovascular Diseases Research Institute,
Tehran University of Medical Sciences Tehran Iran, Iran, Islamic Republic
of
(Kazemian, Fallahtafti, Sharifi, Mohammadi, Soleimani, Moghadam, Karimi,
Jenab, Mehrani, Hajizeinali, Hosseini) Tehran Heart Center Cardiovascular
Diseases Research Institute, Tehran University of Medical Sciences Tehran
Iran, Iran, Islamic Republic of
(Fallahtafti, Karimi) School of Medicine, Tehran University of Medical
Sciences Tehran Iran, Iran, Islamic Republic of
(Sattar) Department of Cardiology West Virginia University Morgantown WV
USA
(Iskander) Department of Medicine-Cardiology Medical College of Wisconsin
Milwaukee WI USA
(Sabet) Department of Internal Medicine McLaren/Flint/Michigan State
University Flint MI USA
(Salehi) Heart, Vascular and Thoracic Institute, Cleveland Clinic Akron
General Hospital Akron OH USA
(Al-Azizi) Department of Cardiology Baylor Scott and White The Heart
Hospital Plano TX USA
(Hakim) Cardiovascular Division Brigham & Women's Hospital/Harvard Medical
School Boston MA USA
(Alam) Texas Heart Institute, Baylor College of Medicine Houston TX USA
Abstract
BACKGROUND: Limited data exist on long-term outcomes after transcatheter
aortic valve replacement (TAVR) and surgical aortic valve replacement
(SAVR). This meta-analysis aims to elucidate outcome trends following TAVR
versus SAVR in patients with severe aortic stenosis and low-surgical risk.
METHODS AND RESULTS: A systematic search was conducted in PubMed, Embase,
Scopus, and the Cochrane Library databases from inception until May 2024,
to identify studies comparing TAVR versus SAVR in patients with
low-surgical risk (Society of Thoracic Surgeons predicted risk of
mortality score <4%). The primary outcome was all-cause mortality.
Secondary outcomes included cardiovascular mortality, stroke, disabling
stroke, rehospitalization, myocardial infarction, aortic valve
reintervention, permanent pacemaker implantation, and new-onset atrial
fibrillation. Binary random-effects models were used to compare the risk
of each outcome across various follow-up intervals and the risk of bias
was assessed using the Cochrane Collaboration's Risk of Bias-2 tool. The
meta-analysis included 6 randomized trials including 4682 patients. TAVR
was associated with a lower risk of all-cause mortality than SAVR in the
30-day (hazard ratio [HR: 0.45] [95% CI: 0.26-0.77], I2: 0%) and 30-day to
1-year (HR: 0.55 [95% CI: 0.37-0.81], I2: 16%) follow-ups. However, the
risk of all-cause mortality was similar during >1-year follow-ups. TAVR
was associated with a significantly lower risk of cardiovascular
mortality, disabling stroke, rehospitalization, new-onset atrial
fibrillation, and a higher risk of permanent pacemaker implantation
compared with SAVR during the 30-day follow-up. CONCLUSION(S): TAVR
was associated with a lower risk of all-cause mortality within the first
year of post-procedural follow-up compared with SAVR. However, the risk of
all-cause mortality was similar in >1-year follow-ups.

<33>
Accession Number
645477922
Title
Extracorporeal Blood Purification and Acute Kidney Injury in Cardiac
Surgery: The SIRAKI02 Randomized Clinical Trial.
Source
JAMA. 332(17) (pp 1446-1454), 2024. Date of Publication: 05 Nov 2024.
Author
Perez-Fernandez X.; Ulsamer A.; Camara-Rosell M.; Sbraga F.;
Boza-Hernandez E.; Moret-Ruiz E.; Plata-Menchaca E.; Santiago-Bautista D.;
Boronat-Garcia P.; Gumucio-Sanguino V.; Penafiel-Munoz J.; Camacho-Perez
M.; Betbese-Roig A.; Forni L.; Campos-Gomez A.; Sabater-Riera J.
Institution
(Perez-Fernandez) Facultat de Medicina Campus de Bellvitge Universitat de
Barcelona L'Hospitalet de Llobregat, Barcelona, Spain
(Perez-Fernandez, Ulsamer, Plata-Menchaca, Gumucio-Sanguino,
Penafiel-Munoz, Sabater-Riera) Institut de Investigacio Biomedica de
Bellvitge L'Hospitalet de Llobregat, Barcelona, Spain
(Perez-Fernandez, Sbraga, Boza-Hernandez, Gumucio-Sanguino, Sabater-Riera)
Hospital universitari de Bellvitge L'Hospitalet de LLobregat, Barcelona,
Spain
(Camara-Rosell, Moret-Ruiz, Santiago-Bautista, Boronat-Garcia,
Campos-Gomez) Hospital universitari Germans Trias i Pujol Badalona,
Barcelona, Spain
(Camacho-Perez, Betbese-Roig) Hospital universitari Santa Creu i Sant Pau,
Barcelona, Spain
(Forni) Royal Surrey NHS Foundation Trust & School of Medicine, University
of Surrey, Guildford, United Kingdom
Abstract
Importance: Cardiac surgery-associated acute kidney injury (CSA-AKI)
remains a significant problem following cardiopulmonary bypass (CPB).
Various strategies are proposed to attenuate CSA-AKI, including
extracorporeal blood purification (EBP), but little is known about the
effect of EBP through an acrylonitrile-sodium
methallylsulfonate/polyethyleneimine membrane during CPB.
 Objective(s): To determine whether the use of an EBP device in a
nonemergent cardiac surgery population reduces CSA-AKI after CPB.
 Design, Setting, and Participant(s): This double-blind, randomized
clinical trial was conducted in 2 tertiary hospitals in Spain. Patients 18
years or older undergoing nonemergent cardiac surgery who were at high
risk for CSA-AKI were enrolled from June 15, 2016, through November 5,
2021, with follow-up data through February 5, 2022. Of 1156 patients
assessed, 343 patients were randomized (1:1) to either receive EBP or
standard care. Intervention(s): Nonselective EBP device connected to
the CPB circuit. Main Outcomes and Measures: The primary outcome was
the rate of CSA-AKI in the 7 days after randomization. Result(s):
Among 343 patients randomized (169 to receive EBP and 174 to receive usual
care), the mean (SD) age was 69 (9) years and 119 were females. The rate
of CSA-AKI was 28.4% (95% CI, 21.7%-35.8%) in the EBP group vs 39.7% (95%
CI, 32.3%-47.3%) in the standard care group (P=.03), with an adjusted
difference of 10.4% (95% CI, 2.3%-18.5%) using a log-binomial model
(P=.01). No significant differences (P>.05) were observed in most of the
predefined clinical secondary end points or post hoc exploratory end
points. In a sensitivity analysis, EBP was found to be more effective in
terms of CSA-AKI reduction in patients with chronic kidney disease,
diabetes, hypertension, low left ventricular ejection fraction (<40%), and
lower body mass index (<30). No differences were observed between the
groups in adverse events tracking. Conclusions and Relevance: The use
of a nonselective EBP device connected to the CPB circuit in a nonemergent
population of patients undergoing cardiac surgery was associated with a
significant reduction of CSA-AKI in the first 7 days after surgery. Trial
Registration: ClinicalTrials.gov Identifier: NCT02518087.

<34>
[Use Link to view the full text]
Accession Number
645155555
Title
Complete Versus Culprit-Only Revascularization in Older Patients With
ST-Segment-Elevation Myocardial Infarction: An Individual Patient
Meta-Analysis.
Source
Circulation. 150(19) (pp 1508-1516), 2024. Date of Publication: 05 Nov
2024.
Author
Campo G.; Bohm F.; Engstrom T.; Smits P.C.; Elgendy I.Y.; McCann G.P.;
Wood D.A.; Serenelli M.; James S.; Hofsten D.E.; Boxm-de Klerk B.M.;
Banning A.; Cairns J.A.; Pavasini R.; Stankovic G.; Kala P.; Kelbaek H.;
Barbato E.; Srdanovic I.; Hamza M.; Banning A.S.; Biscaglia S.; Mehta S.
Institution
(Campo, Serenelli, Pavasini, Biscaglia) Cardiology Unit, Azienda
Ospedaliero Universitaria di Ferrara, R.P., Cona, M.S, Italy
(Bohm) Department of Cardiology, Karolinska Institute and Danderyd
Hospital, Sweden
(Engstrom) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Denmark
(Smits) Cardiology Department, Maasstad Hospital, Rotterdam, Netherlands
(Elgendy) Division of Cardiovascular Medicine, Gill Heart Institute,
University of Kentucky
(McCann, Banning) Department of Cardiovascular Sciences, University of
Leicester and the NIHR Leicester Biomedical Research Centre, United
Kingdom (G.P.M., Glenfield Hospital
(Wood) Centre for Heart Valve Innovation, St Paul's Hospital, University
of British Columbia, Vancouver, Canada
(James) Department of Medical Sciences, Uppsala University, Sweden
(Hofsten) Department of Cardiology, Heart Centre, Copenhagen University
Hospital-Rigshospitalet, Denmark
(Boxm-de Klerk) Statistics and Education, Franciscus Gasthuis en
Vlietland, Rotterdam, Netherlands
(Banning) Oxford Heart Centre, Oxford University Hospitals NHS Trust,
United Kingdom (A.B.), United Kingdom
(Cairns) University of British Columbia, Vancouver, Canada
(Stankovic) Department of Cardiology, Clinical Center of Serbia, Serbia
and Faculty of Medicine, University of Belgrade (G.S.), Belgrade, United
States
(Kala) University Hospital Brno, Medical Faculty of Masaryk University
Brno, Czech Republic (P.K.), Czechia
(Kelbaek) Department of Cardiology, Zealand University Hospital, Roskilde,
Denmark
(Barbato) Department of Clinical and Molecular Medicine, Sapienza
University of Rome, Italy
(Srdanovic) Faculty of Medicine, University of Novi Sad, Institute of
Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
(Hamza) Department of Cardiology, Ain Shams University, Cairo, Egypt
(Mehta) Population Health Research Institute, Hamilton Health Sciences and
McMaster University, Canada
Abstract
BACKGROUND: Complete revascularization is the standard treatment for
patients with ST-segment-elevation myocardial infarction and multivessel
disease. The FIRE trial (Functional Assessment in Elderly Myocardial
Infarction Patients With Multivessel Disease) confirmed the benefit of
complete revascularization in a population of older patients, but the
follow-up is limited to 1 year. Therefore, the long-term benefit (>1 year)
of this strategy in older patients is debated. To address this, an
individual patient data meta-analysis was conducted in patients with
ST-segment-elevation myocardial infarction >=75 years of age enrolled in
randomized clinical trials investigating complete versus culprit-only
revascularization strategies. METHOD(S): PubMed, Embase, and the
Cochrane database were systematically searched to identify randomized
clinical trials comparing complete versus culprit-only revascularization.
Individual patient-level data were collected from the relevant trials. The
primary end point was death, myocardial infarction, or ischemia-driven
revascularization. The secondary end point was cardiovascular death or
myocardial infarction. RESULT(S): Data from 7 randomized clinical
trials encompassing 1733 patients (917 randomized to culprit-only and 816
to complete revascularization) were analyzed. The median age was 79
[interquartile range, 77-83] years. Of the patients, 595 (34%) were
female. Follow-up ranged from a minimum of 6 months to a maximum of 6.2
years (median, 2.5 [interquartile range, 1-3.8] years). Complete
revascularization reduced the primary end point up to 4 years (hazard
ratio, 0.78 [95% CI, 0.63-0.96]) but not at the longest available
follow-up (hazard ratio, 0.83 [95% CI, 0.69-1.01]). Complete
revascularization significantly reduced the occurrence of cardiovascular
death or myocardial infarction at the longest available follow-up (hazard
ratio, 0.76 [95% CI, 0.58-0.99]). This was observed even when censoring
the follow-up at each year. Long-term rate of death did not differ between
complete and culprit-only revascularization arms. CONCLUSION(S): In
this individual patient data meta-analysis of older patients with
ST-segment-elevation myocardial infarction and multivessel disease,
complete revascularization reduced the primary end point of death,
myocardial infarction, or ischemia-driven revascularization up to 4 years.
At the longest follow-up, complete revascularization reduced the composite
of cardiovascular death or myocardial infarction but not the primary end
point. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique
identifier: CRD42022367898.

<35>
Accession Number
645711199
Title
Low Prevalence of Class 1 Indications for Coronary Revascularization in
Patients Undergoing Prekidney Transplant Screening for Coronary Disease.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2024. San Diego, CA United States. 35 (pp 1120-1121), 2024. Date of
Publication: 2024.
Author
Israni A.; Sandorffy B.L.; Liu C.S.; Fraticelli Ortiz D.I.; Gross H.;
Nicholson J.; Cazes M.; Soomro Q.H.; Charytan D.M.
Institution
(Israni, Sandorffy, Liu, Fraticelli Ortiz, Gross, Nicholson, Cazes,
Soomro, Charytan) New York University, New York, NY, United States
Publisher
Wolters Kluwer Health
Abstract
Background: CVD is the most common cause of morbidity and mortality in
kidney transplant recipients. Screening for coronary disease is to reduce
the risk of perioperative cardiovascular complications, long term
cardiovascular morbidity and mortality is frequently required but coronary
intervention has not been shown to be beneficial except in complex
coronary disease. The likelihood of finding significant coronary artery
disease and benefit of routine pre-transplant screening is uncertain.
 Method(s): We performed a systematic review and meta-analysis to
quantify the frequency of detecting significant coronary lesions for
which-there are AHA Class 1 indications for revascularization: a) >50%
left main stenosis; or b) multi-vessel disease with EF < 35%. Medline &
Embase were searched to identify manuscripts reporting the results of
pre-transplant screening published between 1998 and 2024. Screening and
data collection was performed by 4 independent authors with disagreements
resolved by consensus. Quality assessment was performed using the Joanna
Briggs Institute scale. This review was registered with PROSPERO.
 Result(s): We identified 1281 studies, 148 required full text review
out of which 50 met eligibility criteria. We extracted data from 50
studies, 17 studies did not report ejection fraction. The mean prevalence
of a class 1 indication across these studies was 5.35 %. Analysis of the
number of patients with left main disease, triple vessel disease (without
an EF < 35%) will be updated. Conclusion(s): Identification of class
I indications for revascularization during pretransplant coronary
screening is rare and routine screening may not be warranted.

<36>
Accession Number
645709639
Title
Urine Output (UO) and AKI Diagnosis in Neonates and Infants: A Prospective
Study in Cardiac Surgery Patients with Indwelling Urinary Catheters.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2024. San Diego, CA United States. 35 (pp 89-90), 2024. Date of
Publication: 2024.
Author
Liborio A.B.; Girao A.T.; Cavalcante C.T.
Institution
(Liborio, Girao, Cavalcante) Universidade de Fortaleza, Fortaleza, Brazil
Publisher
Wolters Kluwer Health
Abstract
Background: AKI in neonates and younger infants is associated with
significant mortality, yet a precise definition, especially concerning UO
thresholds, remains elusive. This study aimed to evaluate UO thresholds
for AKI in neonates and infants (1 month to 2 years old) with indwelling
urinary catheters. Method(s): Six-year prospective cohort study
involving children aged 2 years or younger who were undergoing cardiac
surgery. All patients had indwelling urinary catheters for accurate urine
output measurements up to the second postoperative day and at least two
sCr measurements-one before surgery. The main objective of this study was
to determine the optimal UO thresholds for AKI definition and staging in
neonates and infants compared with the currently used criteria-neonatal
and KDIGO definitions. The outcome was a composite of severe AKI, KRT or
hospital mortality. Result(s): The study included 1,024 patients: 253
in the neonatal group and 772 in the infant group. In both groups, the
lowest UO at 24 h had good discriminatory capacity for the composite
outcome. In neonates, the best thresholds (evaluated by ROC curves) were
3.0, 2.0 and 1.0 mL/kg/h, and in infants, the thresholds were 1.8, 1.0 and
0.5 mL/kg/h. These values were used for modified AKI staging for each age
group. In neonates, this modified criterion was associated with the best
discriminatory capacity (see figure left) and net reclassification
improvement (NRI) - 17.3% in comparison with the neonatal KDIGO criteria.
In infants, the modified criteria was comparable to the adult KDIGO
criteria, and the NRI was near zero. sensitivity analysis according to
diuretic use was performed with similar results. Conclusion(s): For
the first time, using indwelling catheters for UO measurements, our study
reinforced that the current KDIGO criteria may require adjustments to
better serve the neonate population. Additionally, using the UO criteria,
we validated the adult KDIGO criteria in infants.

<37>
Accession Number
2032189431
Title
Evaluating Virtual Reality Patient Education in Cardiac Surgery: Impact on
Preoperative Anxiety and Postoperative Patient Satisfaction.
Source
Journal of Clinical Medicine. 13(21) (no pagination), 2024. Article
Number: 6567. Date of Publication: November 2024.
Author
el Mathari S.; Kuitert L.; Boulidam N.; Shehadeh S.; Klautz R.J.M.; de
Lind van Wijngaarden R.; Kluin J.
Institution
(el Mathari, Kuitert, Boulidam, Shehadeh, Klautz, de Lind van Wijngaarden)
Department of Cardiothoracic Surgery, Amsterdam University Medical Center,
Amsterdam 1105 AZ, Netherlands
(el Mathari, Kluin) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, Rotterdam 3015 GD, Netherlands
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Preoperative anxiety in cardiac surgery patients
can adversely affect mental well-being and postoperative outcomes. Virtual
reality (VR) patient education has been proposed as a novel method to
enhance patient education and potentially reduce preoperative anxiety. The
VR Patient Journey Trial aimed to evaluate the impact of VR patient
education on preoperative anxiety and patient satisfaction compared to
traditional education methods. Method(s): This randomized controlled
trial included 121 patients undergoing cardiac surgery. Participants were
randomized to receive either VR patient education (intervention group) or
traditional education (control group). Preoperative anxiety was measured
using the State-Trait Anxiety Inventory (STAI) and the Amsterdam
Preoperative Anxiety and Information scale (APAIS). Patient satisfaction
was assessed postoperatively through a custom questionnaire. Statistical
analyses included linear regression and non-parametric testing.
 Result(s): Neither STAI nor APAIS scores showed differences in
preoperative anxiety between both groups. However, the intervention group
reported significantly higher patient satisfaction with the information
provided (median score 9 vs. 8; p < 0.001). Furthermore, women reported
higher levels of anxiety than men (p = 0.01), and open-ended feedback from
participants indicated a need for more detailed information on
postoperative rehabilitation and potential risks. Conclusion(s): The
VR Patient Journey Trial revealed that, although VR patient education did
not significantly reduce preoperative anxiety levels, it significantly
improved patient satisfaction with the information provided. These results
suggest that VR patient education can be a valuable addition to
preoperative patient programs. Copyright © 2024 by the authors.

<38>
Accession Number
2032188593
Title
Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve
Replacement in Bicuspid Aortic Valve Stenosis-We Need a Well-Designed
Randomized Control Trial.
Source
Journal of Clinical Medicine. 13(21) (no pagination), 2024. Article
Number: 6565. Date of Publication: November 2024.
Author
Grubb K.J.; Tom S.K.; Xie J.; Kalra K.; Camaj A.
Institution
(Grubb, Kalra) Division of Cardiothoracic Surgery, School of Medicine,
Emory University, Atlanta, GA 30308, United States
(Tom) Department of Surgery, Emory University School of Medicine, Atlanta,
GA 30308, United States
(Xie, Camaj) Division of Cardiology, Department of Medicine, Emory
University School of Medicine, Atlanta, GA 30308, United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Bicuspid aortic stenosis is a common pathology, typically seen in patients
a decade younger than those with tricuspid valves. Surgical aortic valve
replacement has been the mainstay treatment for bicuspid disease,
especially considering the prevalence of concomitant aortic aneurysmal
pathology. Transcatheter aortic valve replacement has shown equivalent
results in bicuspid compared to tricuspid pathology in highly selected
patient populations in single-arm registries and observational studies.
For older patients with favorable bicuspid pathology, TAVR is reasonable.
However, as younger patients with longer life expectancy are now being
treated with TAVR, what is "best" is a question only answered by a
well-designed randomized controlled trial. Herein, we describe the current
evidence for treating bicuspid aortic stenosis and provide a framework for
future trials. Yet, the question of equipoise remains, and who will we
enroll? Copyright © 2024 by the authors.

<39>
Accession Number
2035619444
Title
Current status and challenges of cardiac transplantation in the MENA
region: A narrative review.
Source
Current Problems in Cardiology. 50(1) (no pagination), 2025. Article
Number: 102920. Date of Publication: January 2025.
Author
Tanashat M.; Zayed A.; Ayyad M.; Daoud M.A.; Tabbalat M.; Altobaishat O.;
Nusier J.; Deepak F.N.U.; Al-Ajlouni Y.A.
Institution
(Tanashat) Faculty of Medicine, Yarmouk University, Irbid, Jordan
(Zayed, Al-Ajlouni) Department of Internal Medicine, Staten Island
University Hospital/Northwell Health, Staten Island, NY, United States
(Ayyad) Department of Internal Medicine, Rutgers New Jersey Medical
School, Newark, NJ, United States
(Daoud) New York University Abu Dhabi (NYUAD), Abu Dhabi, United Arab
Emirates
(Tabbalat, Altobaishat, Nusier) Faculty of Medicine, Jordan University of
Science and Technology, Irbid, Jordan
(Deepak) Shaheed Mohtarma Benazir Bhutto Medical College, Karachi,
Pakistan
(Al-Ajlouni) Montefiore Medical Center, Bronx, NY, United States
Publisher
Elsevier Inc.
Abstract
Introduction: Cardiac transplantation has progressed markedly since 1967,
with advances in immunosuppression, surgical techniques, and postoperative
care that improve outcomes. However, challenges persist in the Middle East
and North Africa (MENA) region due to unique cultural, economic, and
infrastructural barriers. This review explores the status, innovations,
and challenges of cardiac transplantation within MENA countries, comparing
outcomes with global standards. Methodology: A comprehensive literature
search was conducted across PubMed, Web of Science, and Cochrane
databases, including studies from inception to May 2024. Search terms
targeted heart transplantation practices, challenges, and innovations in
the MENA region. Articles not in English, non-human studies, and
duplicates were excluded. Data extraction focused on patient demographics,
transplantation outcomes, and barriers specific to the MENA context.
 Result(s): Cardiac transplantation in MENA has made strides, with
established programs in Saudi Arabia, the UAE, and Lebanon. Innovations
like ex-vivo perfusion and Left Ventricular Assist Devices (LVAD) are
improving transplant outcomes, yet organ shortages remain critical.
Cultural and religious beliefs influence donation rates, and
infrastructure varies widely, with disparities in healthcare resources
across countries. Key barriers include low donor registration,
inconsistent brain death definitions, and limited public awareness.
Economic and infrastructure limitations further complicate access to
advanced transplantation techniques. Conclusion(s): While cardiac
transplantation has evolved in MENA, significant barriers hinder
widespread adoption. Enhancing public awareness, developing regional
networks, and implementing standardized protocols can improve outcomes.
Targeted immunosuppressive therapies and continued innovation in organ
preservation are essential to advance cardiac transplantation in
MENA. Copyright © 2024 Elsevier Inc.

<40>
Accession Number
2032189489
Title
Efficacy and Safety of Cardioband in Patients with Tricuspid
Regurgitation: Systematic Review and Meta-Analysis of Single-Arm Trials
and Observational Studies.
Source
Journal of Clinical Medicine. 13(21) (no pagination), 2024. Article
Number: 6393. Date of Publication: November 2024.
Author
Piragine E.; Veneziano S.; Trippoli S.; Messori A.; Calderone V.
Institution
(Piragine, Veneziano, Calderone) Department of Pharmacy, University of
Pisa, Pisa 56126, Italy
(Piragine) Specialization School in Hospital Pharmacy, University of Pisa,
Pisa 56126, Italy
(Trippoli, Messori) HTA Unit, Centro Operativo, Regione Toscana, Firenze
50136, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: The incidence and prevalence of tricuspid
regurgitation (TR) are increasing worldwide. "Traditional" drug therapy
with diuretics is often ineffective and the identification of new
strategies, including non-pharmacological ones, is an urgent need. The aim
of this study was to summarize the results on the efficacy and safety of
Cardioband, one of the few approved transcatheter tricuspid valve repair
systems, in patients with TR. Method(s): Three databases (Medline,
Scopus, and CENTRAL) were searched to identify clinical trials and
observational studies on the efficacy (primary outcome) and safety
(secondary outcome) of Cardioband. A random-effects meta-analysis was
performed with R software (version 4.3.3). Survival and freedom from heart
failure (HF) hospitalization were estimated with the method of
reconstructing individual patient data from Kaplan-Meier curves
(IPDfromKM). Result(s): Eleven studies were included in this
systematic review and meta-analysis. Cardioband significantly reduced
annulus diameter (-9.31 mm [95% Confidence Interval, CI: -11.47; -7.15]),
vena contracta (-6.41 mm [95% CI: -8.34; -4.49]), and effective
regurgitant orifice area (EROA) (-0.50 cm2 [95% CI: -0.72;
-0.28]) in patients with TR. Cardioband reduced the severity of TR and the
extent of heart failure in 91% [95% CI: 85; 97] and 63% [95% CI: 52-75] of
patients, respectively. Finally, Cardioband implantation was associated
with prolonged survival and freedom from HF hospitalization (80.1% and
57.8% at 24 months, respectively). Conclusion(s): This study
demonstrates that Cardioband implantation leads to cardiac remodeling and
mechanical improvements, reduces the severity of TR, and improves quality
of life. Therefore, Cardioband is an effective option for the
non-pharmacological treatment of TR. Copyright © 2024 by the
authors.

<41>
Accession Number
2032188910
Title
Brainstem Anesthesia and Cardiac Arrest Following Peribulbar Block: A Case
Report and Systematic Review of the Literature.
Source
Journal of Clinical Medicine. 13(21) (no pagination), 2024. Article
Number: 6572. Date of Publication: November 2024.
Author
Ripa M.; Schipa C.; Aceto P.; Kanikaram G.; Shah N.A.
Institution
(Ripa, Kanikaram, Shah) Department of Ophthalmology, Sankara Eye Hospital,
Rajasthan, Jaipur 302039, India
(Schipa, Aceto) Catholic University "Sacro Cuore", Lazio, Rome 00168,
Italy
(Schipa, Aceto) Department of Emergency, Anesthesiological and Reanimation
Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Lazio,
Rome 00168, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: We report a case of brainstem anesthesia (BSA) and subsequent
cardiac arrest following a routinary peribulbar block (PB) in a patient
scheduled for cataract extraction and intraocular lens (IOL) implantation,
thus providing a reference for further analysis of this potentially
catastrophic life-threatening complication and to evaluate the current
knowledge in terms of incidence, physiopathology management, and treatment
of the BSA following PB. Method(s): Three databases (PubMed, Embase,
and Scopus) were checked to perform a systematic review of all available
studies in the English Language following the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate
relevant studies that clearly described BSA following BSA. Result(s):
Our literature search identified 15 cases. All the patients experienced
BSA-related symptoms, including respiratory arrest, seizure, heart rate,
and blood pressure abnormalities. All the patients with respiratory arrest
required assisted ventilation with intubation, whereas patients with
seizures were administered intravenous midazolam. Only one patient
experienced cardiac arrest and underwent cardiac resuscitation. Surgery
was aborted and deferred in 5 out of 15 patients, whereas 4 out of 15
underwent surgery after extubation. Conclusion(s): Despite the BSA
incidence after the PB being very low, this possible life-threatening rare
event should be considered in patients losing their consciousness and
becoming apneic after the block. Therefore, prompt recognition and
immediate treatment are paramount to cope with this potentially
catastrophic scenario and save the patient's life. Copyright ©
2024 by the authors.

<42>
Accession Number
2032188164
Title
Quantification of Replacement Fibrosis in Aortic Stenosis: A Narrative
Review on the Utility of Cardiovascular Magnetic Resonance Imaging.
Source
Diagnostics. 14(21) (no pagination), 2024. Article Number: 2435. Date of
Publication: November 2024.
Author
Rajah M.R.; Doubell A.F.; Herbst P.G.
Institution
(Rajah, Doubell, Herbst) Division of Cardiology, Department of Medicine,
Faculty of Medicine and Health Sciences, Stellenbosch University and
Tygerberg Hospital, Cape Town 7505, South Africa
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Aortic stenosis (AS) is associated with the development of replacement
myocardial fibrosis/scar. Given the dose-dependent relationship between
scar and clinical outcomes after aortic valve replacement (AVR) surgery,
scar quantity may serve as an important risk-stratification tool to aid
decision-making on the optimal timing of AVR. Scar is non-invasively
assessed and quantified by cardiovascular magnetic resonance (CMR)
imaging. Several quantification techniques exist, and consensus on the
optimal technique is lacking. These techniques range from a visual manual
method to fully automated ones. This review describes the different scar
quantification techniques used and highlights their strengths and
shortfalls within the context of AS. The two most commonly used techniques
in AS include the semi-automated signal threshold versus reference mean
(STRM) and full-width half-maximum (FWHM) techniques. The accuracy and
reproducibility of these techniques may be hindered in AS by the
coexistence of diffuse interstitial fibrosis and the presence of
relatively small, non-bright scars. The validation of these techniques
against histology, which is the current gold standard for scar
quantification in AS, is limited. Based on the best current evidence, the
STRM method using a threshold of three standard deviations above the mean
signal intensity of remote myocardium is recommended. The high
reproducibility of the FWHM technique in non-AS cohorts has been shown and
merits further evaluation within the context of AS. Future directions
include the use of quantitative T1 mapping for the detection and
quantification of scar, as well as the development of serum biomarkers
that reflect the fibrotic status of the myocardium in AS. Copyright
© 2024 by the authors.

<43>
Accession Number
2032100835
Title
Biomarkers of glucose-insulin homeostasis and incident type 2 diabetes and
cardiovascular disease: results from the Vitamin D and Omega-3 trial.
Source
Cardiovascular Diabetology. 23(1) (no pagination), 2024. Article Number:
393. Date of Publication: December 2024.
Author
Qian F.; Guo Y.; Li C.; Liu Y.; Luttmann-Gibson H.; Gomelskaya N.; Demler
O.V.; Cook N.R.; Lee I.-M.; Buring J.E.; Larsen J.; Boring J.; McPhaul
M.J.; Manson J.E.; Pradhan A.D.; Mora S.
Institution
(Qian, Guo, Li, Liu, Luttmann-Gibson, Gomelskaya, Demler, Cook, Lee,
Buring, Manson, Pradhan, Mora) Division of Preventive Medicine, Center for
Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School,
Boston, MA, United States
(Qian) Department of Nutrition, Harvard T.H. Chan School of Public Health,
Boston, MA, United States
(Qian) Section of Cardiovascular Medicine, Boston Medical Center, Boston
University Chobanian and Avedisian School of Medicine, Boston, MA, United
States
(Luttmann-Gibson) Department of Environmental Health, Harvard T.H. Chan
School of Public Health, Boston, MA, United States
(Cook, Lee, Buring, Manson) Department of Epidemiology, Harvard T.H. Chan
School of Public Health, Boston, MA, United States
(Larsen, Boring, McPhaul) Quest Diagnostics Nichols Institute, San Juan
Capistrano, CA, United States
(Pradhan) Bristol Myers Squibb, Cambridge, MA, United States
(Mora) Division of Cardiovascular Medicine, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Mora) Divisions of Preventive and Cardiovascular Medicine, Center for
Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School,
900 Commonwealth Avenue, Boston, MA 02215, United States
Publisher
BioMed Central Ltd
Abstract
Background: Dysglycemia and insulin resistance increase type 2 diabetes
(T2D) and cardiovascular disease (CVD) risk, yet associations with
specific glucose-insulin homeostatic biomarkers have been inconsistent.
Vitamin D and marine omega-3 fatty acids (n-3 FA) may improve insulin
resistance. We sought to examine the association between baseline levels
of insulin, C-peptide, HbA1c, and a novel insulin resistance score (IRS)
with incident cardiometabolic diseases, and whether randomized vitamin D
or n-3 FA modify these associations. Method(s): VITamin D and OmegA-3
TriaL (NCT01169259) was a randomized clinical trial testing vitamin D and
n-3 FA for the prevention of CVD and cancer over a median of 5.3 years.
Incident cases of T2D and CVD (including cardiovascular death, myocardial
infarction, stroke, and coronary revascularization) were matched 1:1 on
age, sex, and fasting status to controls. Conditional logistic regressions
adjusted for demographic, clinical, and adiposity-related factors were
used to assess the adjusted odds ratio (aOR) per-standard deviation (SD)
and 95%CI of baseline insulin, C-peptide, HbA1c, and IRS (Insulinx0.0295 +
C-peptidex0.00372) with risk of T2D, CVD, and coronary heart disease
(CHD). Result(s): We identified 218 T2D case-control pairs and 715
CVD case-control pairs including 423 with incident CHD. Each of the four
biomarkers at baseline was separately associated with incident T2D, aOR
(95%CI) per SD increment: insulin 1.46 (1.03, 2.06), C-peptide 2.04 (1.35,
3.09), IRS 1.72 (1.28, 2.31) and HbA1c 7.00 (3.76, 13.02), though only
HbA1c remained statistically significant with mutual adjustments. For
cardiovascular diseases, we only observed significant associations of
HbA1c with CVD (1.19 [1.02, 1.39]), and IRS with CHD (1.25 [1.04, 1.50]),
which persisted after mutual adjustment. Randomization to vitamin D and/or
n-3 FA did not modify the association of these biomarkers with the
endpoints. Conclusion(s): Each of insulin, C-peptide, IRS, and HbA1c
were associated with incident T2D with the strongest association noted for
HbA1c. While HbA1c was significantly associated with CVD risk, a novel IRS
appears to be associated with CHD risk. Neither vitamin D nor n-3 FA
modified the associations between these biomarkers and cardiometabolic
outcomes. Copyright © The Author(s) 2024.

<44>
Accession Number
2032079028
Title
Comparing surgical outcomes of powered versus manual surgical staplers: a
systematic review and meta-analysis.
Source
Langenbeck's Archives of Surgery. 409(1) (no pagination), 2024. Article
Number: 331. Date of Publication: December 2024.
Author
Ho S.Y.A.; Muthiah V.K.; Tay K.V.
Institution
(Ho, Muthiah, Tay) Lee Kong Chian School of Medicine, Nanyang
Technological University, Singapore, Singapore
(Tay) Department of Surgery, Woodlands Health, Singapore, Singapore
(Tay) Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: The growing use of staplers, manual and powered, especially in
minimally invasive surgeries, necessitates evaluating their efficacy in
gastrointestinal and thoracic surgeries. Parameters analysed include
anastomotic and air leakage rates, bleeding, infection, cost, and
operative duration. Method(s): We searched Cochrane Library, CINAHL,
EMBASE, PubMed, and Web of Science using terms like "surgical staplers,"
"manual staplers," "automatic staplers," and "powered staplers." We
assessed study quality using the Joanna Briggs Institute (JBI) Critical
Appraisal tools and conducted meta-analysis using Review Manager software.
 Result(s): A total of 43,104 patients with a mean age of 60.8 were
involved in the studies. The meta-analysis revealed a significant
reduction in anastomotic leaks in GI surgery patients (OR 0.31, p =
0.0001) and a significant decrease in postoperative air leakage in
thoracic surgery patients (OR 0.65, p = 0.05) when powered staplers were
employed. Additionally, we observed a significant decline in
hemostasis-related complications for both thoracic and GI surgeries (OR
0.48, p = 0.002) with the use of powered staplers. Although individually
costlier than manual staplers, powered staplers significantly decreased
total hospitalisation costs (MD -1725.82, p < 0.00001) amoungst the
thoracic surgeries, due to the cost saved on remedying the lower rate of
complications compared to manual staplers. It also decreased the average
operative times in thoracic and GI surgeries, although not significant (p
= 0.06, p = 0.07 respectively). Conclusion(s): Powered staplers
surpass manual staplers by reducing operative duration, total hospital
costs, and complications like anastomotic leaks and bleeding. Hence, they
are poised to become the preferred alternative in future
surgeries. Copyright © The Author(s), under exclusive licence to
Springer-Verlag GmbH Germany, part of Springer Nature 2024.

<45>
Accession Number
2035610186
Title
Continuation versus discontinuation of renin-angiotensin aldosterone
system inhibitors before non-cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of Clinical Anesthesia. 99 (no pagination), 2024. Article Number:
111679. Date of Publication: December 2024.
Author
Ahmed M.; Fatima E.; Shafiq A.; Ahsan A.; Zulfiqar E.; Masood F.; Ahmed
R.; Yasmin F.; Asghar M.S.
Institution
(Ahmed) Department of Medicine, Rawalpindi Medical University, Rawalpindi,
Pakistan
(Fatima) Department of Medicine, Services Institute of Medical Sciences,
Lahore, Pakistan
(Shafiq, Zulfiqar) Department of Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Ahsan) Department of Medicine, Foundation University Medical College,
Islamabad, Pakistan
(Masood) Department of Anesthesia, King Abdulaziz Medical City, Riyadh,
Saudi Arabia
(Ahmed) Department of Cardiology, Royal Brompton Hospital, London, United
Kingdom
(Ahmed) Department of Cardiology, National Heart and Lung Institute,
Imperial College London, United Kingdom
(Yasmin) Department of Internal Medicine, Yale University School of
Medicine, New Haven, CT, United States
(Asghar) Division of Nephrology and Hypertension, Mayo Clinic, Rochester,
MN, United States
(Asghar) Department of Internal Medicine, AdventHealth, Sebring, FL,
United States
Publisher
Elsevier Inc.
Abstract
Background: A large number of patients undergoing noncardiac surgeries are
on long-term use of angiotensin-converting enzyme inhibitors (ACEi) or
angiotensin receptor blockers (ARBs). The current guidelines regarding the
continuation or discontinuation of renin-angiotensin-aldosterone system
inhibitors (RAAS) inhibitors before noncardiac surgery are conflicting.
This meta-analysis aims to evaluate whether continuing or withholding RAAS
inhibitors before noncardiac surgery influences perioperative mortality
and complications. Method(s): A thorough literature search was
performed across PubMed/MEDLINE, Embase, and the Cochrane Library from
their inception up to August 30, 2024 to identify eligible randomized
controlled trials (RCTs) and cohort studies. Clinical outcomes were
evaluated using a random-effects model to pool odds ratios (ORs) with 95 %
confidence intervals (CIs). Result(s): The analysis included 16
studies with a total of 59,105 patients on RAAS inhibitors before
noncardiac surgery. Withholding RAAS inhibitors was associated with a
significantly lower incidence of intraoperative hypotension (OR = 0.49; 95
% CI = 0.29 to 0.83) and acute kidney injury (AKI) (OR = 0.88; 95 % CI =
0.82 to 0.95) than continuing the therapy. However, there was no
statistically significant difference in reducing mortality (OR = 1.10; 95
% CI = 0.86 to 1.40), major adverse cardiovascular events (MACE) (OR =
1.27; 95 % CI = 0.75 to 2.16), myocardial infarction (OR = 0.83; 95 % CI =
0.27 to 2.59) or stroke events (OR = 0.70; 95 % CI = 0.36 to 1.36) between
the two groups. Conclusion(s): Withholding RAAS inhibitors before
noncardiac surgery reduces intraoperative hypotension and AKI with
nonsignificant effects on mortality and MACE. Copyright © 2024

<46>
Accession Number
2035605185
Title
Comparison of Inhalational and Intravenous Anesthesia Induction on
Electroencephalogram and Cerebral Perfusion in Children With Congenital
Heart Disease: A Secondary Analysis of a Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2024.
Date of Publication: 2024.
Author
Han D.; Xie S.; Pan S.; Ou Y.
Institution
(Han, Xie, Pan, Ou) Anesthesia Department, Children's Hospital affiliated
to Capital Institute of Pediatrics, Beijing, China
(Ou) Anesthesia Center, Beijing Anzhen Hospital affiliated to Capital
Medical University, Beijing, China
Publisher
W.B. Saunders
Abstract
Objectives: The effects of anesthetics on electroencephalograms and
cerebral perfusion remain understudied in children with congenital heart
disease. With regard to this, we compared inhalational anesthesia
induction and intravenous anesthesia induction. Design(s): A
randomized controlled trial. Setting(s): Operating room in 2 tertiary
hospitals. Participant(s): A cohort of 116 pediatrics patients
undergoing cardiac surgery. Measurements and Main Results: The
patients were randomly assigned to either the intravenous group (n = 58)
or the inhalational group (n = 58). The inhalational group received
anesthesia induction with 4% to 6% sevoflurane and a bolus of pipecuronium
0.2 mg/kg, whereas the intravenous group received anesthesia induction
with intravenous midazolam 0.2 mg/kg, pipecuronium 0.2 mg/kg, and
sufentanil 1 mug/kg. Ten minutes after tracheal intubation, the following
parameters were measured: spectral edge frequency, burst suppression
event, patient state index, middle cerebral artery blood flow velocity,
cerebral oxygen saturation, and hemodynamic parameters. In comparison with
the intravenous group, the inhalational group exhibited significant
increases in 95% spectral edge frequency, ratio of burst suppression
event, blood flow velocity in the middle cerebral artery, and cerebral
oxygen saturation (p < 0.05 for all), as well as decreases in systolic
pressure, diastolic pressure, cardiac index, and the maximal slope of
systolic upstroke (p < 0.05 for all). Conclusion(s): The
administration of sevoflurane for anesthesia induction results in more
burst suppression, while also demonstrating superior cerebral perfusion
when compared with the use of intravenous medications for anesthesia
induction. Trial registration: Chinese Clinical Trial Registry
(ChiCTR1800015946). Copyright © 2024 Elsevier Inc.

<47>
Accession Number
2031262674
Title
Prospective Multi-Center Longitudinal Study to Validate Accuracy of the
Global Anatomic Staging System (GLASS) Score in Predicting Major Acute
Limb Events in Patients With Chronic Limb Threatening Ischemia Undergoing
Endovascular Intervention: The PROMOTE-GLASS Study Protocol.
Source
Vascular and Endovascular Surgery. 59(1) (pp 29-38), 2025. Date of
Publication: January 2025.
Author
Darwish M.; D'Oria M.; Croo A.; Melo R.G.; Meecham L.
Institution
(Darwish, Meecham) Southeast Wales Vascular Network, University Hospital
of Wales, Cardiff, United Kingdom
(Darwish) The East Midlands Deanery, Health Education England, Leicester,
United Kingdom
(D'Oria) Department of Vascular and Endovascular Surgery, University
Hospital of Trieste, Trieste, Italy
(D'Oria) Medical School, University of Trieste, Trieste, Italy
(Croo) Department of Thoracic and Vascular Surgery, Ghent University
Hospital, Ghent, Belgium
(Melo) Department of Angiology and Vascular Surgery, Centro Hospitalar
Lisboa Norte, Lisboa, Portugal
(Melo) Department of Angiology and Vascular Surgery, Hospital da Luz
Torres de Lisboa, Lisboa, Portugal
Publisher
SAGE Publications Inc.
Abstract
Introduction: Developed by the Global Vascular Guidelines committee, the
Global Limb Anatomic Staging System (GLASS) is an angiographic scoring
system used for quantifying infrainguinal disease extent and predicting
treatment success with endovascular techniques (EVT). Currently, no other
risk prediction model is available for patients with chronic limb
threatening ischemia (CLTI) undergoing EVT. GLASS' validation and adoption
outside academic institutions for research are limited. Thus, this
longitudinal multicenter prospective study aims to examine GLASS' validity
and reliability in predicting major acute limb events and overall survival
(OS) in patients with CLTI undergoing EVT. Methods and Analysis: This
prospective, international, multicenter, observational study will include
patients with CLTI undergoing EVT (PROMOTE-GLASS) (ClinicalTrials.gov; ID:
NCT06186544) identified through routine clinical referrals and emergency
visits to vascular units in participating centers. Only patients who are
referred for EVT will be recruited. The primary outcomes are immediate
technical success, immediate technical failure, and 1-year limb base
patency. The secondary outcomes are major adverse limb events, major lower
limb amputation, and OS in patients presenting with CLTI who undergo EVT
up to 1 year after the procedure. Clinical and imaging data will be
analyzed at the end of follow-up to validate risk prediction. This
protocol outlines our approach for identifying cases, GLASS score
calculation, outcome measures assessment, and a statistical analysis plan.
Anticipated Implications: PROMOTE-GLASS holds significant implications and
can potentially revolutionize clinical decision-making by assisting
clinicians in identifying patients who are likely to benefit from EVT.
Ultimately, reduce the need for more invasive procedures and improve
patient outcomes. Furthermore, PROMOTE-GLASS can provide useful
information, including patient selection, for future randomized controlled
trials (RCTs) investigating EVT for CLTI. PROMOTE-GLASS anticipated
implications on the vascular community are rooted in its potential to
improve patient care, inform future research, and address limitations in
existing literature regarding CLTI treatment outcomes. Copyright
© The Author(s) 2024.

<48>
Accession Number
2031544351
Title
Expert opinion on design and endpoints for studies on catheter ablation of
atrial fibrillation.
Source
Journal of Cardiovascular Electrophysiology. 35(11) (pp 2182-2201), 2024.
Date of Publication: November 2024.
Author
Lewalter T.; Blomstrom-Lundqvist C.; Lakkireddy D.; Packer D.; Meyer R.;
Kuniss M.; Ladwig K.-H.; Jilek C.; Diener H.-C.; Boriani G.; Turakhia
M.P.; Schneider S.; Svennberg E.; Albers B.; Andrade J.G.; de Melis M.;
Brachmann J.
Institution
(Lewalter) Department of Cardiology and Intensive Unit Care, Hospital
Munich South, Peter Osypka Heart Center, Munich, Germany
(Lewalter) University of Bonn, Bonn, Germany
(Blomstrom-Lundqvist) Department of Cardiology, School of Medical
Sciences, Faculty of Medicine and Health, Orebro University, Orebro,
Sweden
(Blomstrom-Lundqvist) Department of Medical Science, Uppsala University,
Uppsala, Sweden
(Lakkireddy) Kansas City Heart Rhythm Institute and Research Foundation,
Overland Park, KS, United States
(Packer) Mayo Clinic-St. Mary's Hospital, Rochester, MN, United States
(Meyer) Director Clinical Research, Medtronic Cardiac Ablation Solutions,
Medtronic GmbH, Meerbusch, Germany
(Kuniss) Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim,
Germany
(Ladwig) Department of Psychosomatic Medicine and Psychotherapy, Klinikum
rechts der Isar, Technische Universitat Munchen, Munich, Germany
(Ladwig) German Center for Cardiovascular Research (DZHK), Partnersite
Munich Heart Alliance, Munich, Germany
(Jilek) Department of Cardiology, Peter Osypka Heart Center, Hospital
Munich South, Munich, Germany
(Jilek) Technical University Munich (TUM), Munich, Germany
(Diener) Institute for Medical Informatics, Biometry and Epidemiology,
Neurology Emeritus, Medical Faculty of the University Duisburg-Essen, Head
Unit of Neuroepidemiology, Essen-Werden, Germany
(Boriani) Cardiology Division, Department of Biomedical, Metabolic and
Neural Sciences, Italy University of Modena and Reggio Emilia, Modena
University Hospital, Modena, Italy
(Turakhia) Department of Medicine (Cardiovascular Medicine) and Center for
Digital Health, Stanford University, Stanford, CA, United States
(Schneider) Stiftung Institut fur Herzinfarktforschung - Foundation IHF,
Ludwigshafen, Germany
(Svennberg) Department of Medicine Huddinge, Karolinska Institute,
Karolinska University Hospital, Stockholm, Sweden
(Albers) Albers Clinical Evidence Consultancy, Winterswijk Woold,
Netherlands
(Andrade) Vancouver General Hospital, Vancouver, Canada
(de Melis) Medtronic Bakken Research Center, Maastricht, Netherlands
(Brachmann) Medical School REGIOMED, REGIOMED-Kliniken Coburg Germany and
University of Split School of Medicine, Split, Croatia
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Catheter ablation of atrial fibrillation (AF) is frequently
studied in randomized trials, observational and registry studies. The aim
of this expert opinion is to provide guidance for clinicians and industry
regarding the development of future clinical studies on catheter ablation
of AF, implement lessons learned from previous studies, and promote a
higher degree of consistency across studies. Background(s): Studies
on catheter ablation of AF may benefit from well-described definitions of
endpoints and consistent methodology and documentation of outcomes related
to efficacy, safety and cost-effectiveness. The availably of new,
innovative technologies warrants further consideration about their
application and impact on study design and the choice of endpoints.
Moreover, recent insights gained from AF ablation studies suggest a
reconsideration of some methodological aspects. Method(s): A panel of
clinical experts on catheter ablation of AF and designing and conducting
clinical studies developed an expert opinion on the design and endpoints
for studies on catheter ablation of AF. Discussions within the expert
panel with the aim to reach consensus on predefined topics were based on
outcomes reported in the literature and experiences from recent clinical
trials. Result(s): A comprehensive set of recommendations is
presented. Key elements include the documentation of clinical AF,
medication during the study, repeated ablations and their effect on
endpoint assessments, postablation blanking and the choice of
rhythm-related and other endpoints. Conclusion(s): This expert
opinion provides guidance and promotes consistency regarding design of AF
catheter ablation studies and identified aspects requiring further
research to optimize study design and methodology. CONDENSED ABSTRACT:
Recent insights from studies on catheter ablation of atrial fibrillation
(AF) and the availability of new innovative technologies warrant
reconsideration of methodological aspects related to study design and the
choice and assessment of endpoints. This expert opinion, developed by
clinical experts on catheter ablation of AF provides a comprehensive set
of recommendations related to these methodological aspects. The aim of
this expert opinion is to provide guidance for clinicians and industry
regarding the development of clinical studies, implement lessons learned
from previous studies, and promote a higher degree of consistency across
studies. Copyright © 2024 The Author(s). Journal of
Cardiovascular Electrophysiology published by Wiley Periodicals LLC.

<49>
Accession Number
2030982330
Title
Evaluating the evidence for genotype-informed Bayesian dosing of
tacrolimus in children undergoing solid organ transplantation: A
systematic literature review.
Source
British Journal of Clinical Pharmacology. 90(11) (pp 2724-2741), 2024.
Date of Publication: November 2024.
Author
Khatri D.; Felmingham B.; Moore C.; Lazaraki S.; Stenta T.; Collier L.;
Elliott D.A.; Metz D.; Conyers R.
Institution
(Khatri, Felmingham, Moore, Stenta, Collier, Elliott, Conyers) Cancer
Therapies, Stem Cell Medicine, Murdoch Children's Research Institute,
Parkville, Melbourne, VIC, Australia
(Moore, Elliott, Conyers) Department of Paediatrics, The University of
Melbourne, Parkville, Melbourne, VIC, Australia
(Lazaraki) Health Sciences Library, Royal Melbourne Hospital, Melbourne
Health, Australia
(Metz) Department of Nephrology, The Royal Children's Hospital, Melbourne,
VIC, Australia
(Metz) Murdoch Children's Research Institute, Melbourne, VIC, Australia
(Metz) Department of Paediatrics, Monash University, Melbourne, VIC,
Australia
(Conyers) Children's Cancer Centre, The Royal Children's Hospital,
Melbourne, VIC, Australia
Publisher
John Wiley and Sons Inc
Abstract
Tacrolimus, a calcineurin inhibitor, is a highly effective
immunosuppressant used in solid organ transplantation (SOT). However, it
is characterized by a narrow therapeutic range and high inter-patient
variability in pharmacokinetics. Standard weight-based dosing followed by
empiric dose titration is suboptimal in controlling drug concentrations,
increasing risk of rejection or toxicity, particularly in the initial
months post transplantation. This review explores the potential of
combined pre-transplant genotyping and pharmacokinetic (PK) modelling to
improve tacrolimus dosing in paediatric SOT recipients. A systematic
search of Medline, Embase and Cochrane databases identified studies
published between March 2013 and March 2023 that investigated genotype-
and PK model-informed tacrolimus dosing in children post-SOT. The
Newcastle-Ottawa Scale assessed study quality. Seven studies encompassing
paediatric kidney, heart, liver and lung transplants reported using
genotype and model-informed dosing. A combination of clinical and genetic
factors significantly impacts tacrolimus clearance and thus initial dose
recommendation. Body size, transplant organ and co-medications were
consistently important, while either time post-transplant or haematocrit
emerged in some studies. Several models were identified, however, with
limitations evident in some and with absence of evidence for their
effectiveness in optimizing initial and subsequent dosing. This review
highlights the development of PK models in paediatric SOT that integrate
genotype and clinical covariates to personalize early tacrolimus dosing.
While promising, prospective studies are needed to validate and confirm
their effectiveness in improving time to therapeutic concentrations and
reducing under- or overexposure. This approach has the potential to
optimize tacrolimus therapy in paediatric SOT, thereby improving
outcomes. Copyright © 2024 The Author(s). British Journal of
Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of
British Pharmacological Society.

<50>
Accession Number
2028975109
Title
Cryoballoon pulmonary vein isolation as first-line treatment of typical
atrial flutter: long-term outcomes of the CRAFT trial.
Source
Journal of Interventional Cardiac Electrophysiology. 67(7) (pp 1529-1538),
2024. Date of Publication: October 2024.
Author
Calvert P.; Ding W.Y.; Das M.; Tovmassian L.; Tayebjee M.H.; Haywood G.;
Martin C.A.; Rajappan K.; Bates M.G.D.; Temple I.P.; Reichlin T.; Chen Z.;
Balasubramaniam R.N.; Sticherling C.; Ronayne C.; Clarkson N.; Morgan M.;
Barton J.; Kemp I.; Mahida S.; Gupta D.
Institution
(Calvert, Ding, Tovmassian, Ronayne, Clarkson, Morgan, Barton, Kemp,
Mahida, Gupta) Liverpool Centre for Cardiovascular Science & amp;
Liverpool Heart and Chest Hospital, Liverpool Heart & amp; Chest Hospital
NHS Foundation Trust, Liverpool, United Kingdom
(Das) Department of Cardiology, The Newcastle Upon Tyne Hospitals NHS
Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
(Tayebjee) Department of Cardiology, Leeds Teaching Hospital NHS
Foundation Trust, Leeds, United Kingdom
(Haywood) Department of Cardiology, University Hospitals Plymouth NHS
Foundation Trust, Plymouth, United Kingdom
(Martin) Department of Cardiology, Royal Papworth Hospital NHS Foundation
Trust, Cambridge, United Kingdom
(Rajappan) Department of Cardiology, Oxford University Hospitals NHS
Foundation Trust, Oxford, United Kingdom
(Bates) Department of Cardiology, South Tees Hospitals NHS Foundation
Trust, James Cook University Hospital, Middlesbrough, United Kingdom
(Temple) Department of Cardiology, Manchester University NHS Foundation
Trust, Wythenshawe Hospital, Manchester, United Kingdom
(Reichlin) Department of Cardiology, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
(Chen) Department of Cardiology, Ashford and St Peter's Hospital NHS
Foundation Trust, Surrey, United Kingdom
(Balasubramaniam) Department of Cardiology, Royal Bournemouth and
Christchurch Hospital NHS Foundation Trust, Bournemouth, United Kingdom
(Sticherling) Department of Cardiology, University Hospital Basel,
University of Basel, Basel, Switzerland
Publisher
Springer
Abstract
Background: CRAFT was an international, multicentre, randomised controlled
trial across 11 sites in the United UK and Switzerland. Given the evidence
that pulmonary vein triggers may be responsible for atrial flutter (AFL)
as well as atrial fibrillation (AF), we hypothesised that cryoballoon
pulmonary vein isolation (PVI) would provide greater symptomatic
arrhythmia reduction than cavotricuspid isthmus (CTI) ablation, whilst
also reducing the subsequent burden of AF. Twelve-month outcomes were
previously reported. In this study, we report the extended outcomes of the
CRAFT study to 36 months. Method(s): Patients with typical AFL and no
evidence of AF were randomised 1:1 to cryoballoon PVI or radiofrequency
CTI. All patients received an implantable loop recorder (ILR) for
continuous cardiac rhythm monitoring. The primary outcome was
time-to-symptomatic arrhythmia recurrence > 30 s. Secondary outcomes
included time-to-first-AF episode >= 2 min. The composite safety outcome
included death, stroke and procedural complications. Result(s): A
total of 113 patients were randomised to cryoballoon PVI (n = 54) or
radiofrequency CTI ablation (n = 59). Ninety-one patients reconsented for
extended follow-up beyond 12 months. There was no difference in the
primary outcome between arms, with the primary outcome occurring in 12 PVI
vs 11 CTI patients (HR 0.97; 95% CI 0.43-2.20; p = 0.994). AF >= 2 min was
significantly less frequent in the PVI arm, affecting 26 PVI vs 36 CTI
patients (HR 0.48; 95% CI 0.29-0.79; p = 0.004). The composite safety
outcome occurred in 5 PVI and 6 CTI patients (p = 0.755).
 Conclusion(s): Cryoballoon PVI shows similar efficacy to
radiofrequency CTI ablation in reducing symptomatic arrhythmia recurrence
in patients presenting with isolated typical AFL but significantly reduces
the occurrence of subsequent AF. Graphical Abstract: (Figure
presented.) Copyright © The Author(s) 2024.

<51>
Accession Number
2028155831
Title
Efficacy and safety of catheter ablation for atrial fibrillation in
elderly patients: a systematic review and meta-analysis.
Source
Journal of Interventional Cardiac Electrophysiology. 67(7) (pp 1691-1707),
2024. Date of Publication: October 2024.
Author
Franca M.R.Q.; Morillo C.A.; Carmo A.A.L.; Mayrink M.; Miranda R.C.;
Naback A.D.N.; Nevis I.; Silva G.A.; Ribeiro A.L.P.; Nascimento B.R.
Institution
(Franca, Carmo, Mayrink, Naback, Silva, Ribeiro, Nascimento) Servico de
Cardiologia E Cirurgia Cardiovascular E Centro de Telessaude, Hospital das
Clinicas da Universidade Federal de Minas Gerais, MG, Belo Horizonte,
Brazil
(Morillo) Department of Cardiac Sciences, Libin Cardiovascular Institute,
University of Calgary, Calgary, Canada
(Carmo, Mayrink, Miranda, Silva) Centro de Tratamento Avancado Em
Arritmias, MG, Belo Horizonte, Brazil
(Nevis) Brock University, St. Catharines, ON, Canada
(Ribeiro, Nascimento) Departamento de Clinica Medica, Faculdade de
Medicina da Universidade Federal de Minas Gerais, MG, Belo Horizonte,
Brazil
(Nascimento) Servico de Hemodinamica, Hospital Madre Teresa, MG, Belo
Horizonte, Brazil
Publisher
Springer
Abstract
Background: Catheter ablation (CA) is a well-established therapy for
patients with atrial fibrillation (AF); however, there is paucity of data
for elderly patients. We aimed to assess long-term efficacy and safety of
CA for elderly patients with AF. Method(s): Medline, BVS, Cochrane,
and Embase were searched through April 2023 to investigate comparative
outcomes between elderly patients > 75 or 80 years, as per-study cutoff,
and individuals <= 75/80 years, undergoing CA. Primary efficacy and safety
endpoints (AF recurrence and procedure-related major complications) were
pooled with the Comprehensive Meta-Analysis 3.0 software. Subgroup
analyses were performed by age groups and type of procedure
(radiofrequency vs. cryoballoon). Result(s): Four thousand eight
hundred twenty-nine titles were screened, and 27 studies were included,
being 26 observational and 1 randomized trial, comprising 117,869
patients, being 8714 (7.4%) elderly > 75/80 years, with follow-up from
11.7 to 72.3 months. In comparative studies (N = 17 studies), elderly >
75/80 years had a higher risk of AF recurrence compared to those <= 75/80:
relative risk (RR) 1.16 (95% CI 1.05-1.27, p = 0.002. However, funnel plot
indicated publication bias, and after imputation of 5 studies, the groups
were similar (RR 1.07 (95% CI 0.97-1.19)). The rates of major
complications (N = 14 studies) were higher in elderly > 75/80 years (RR
1.30 (95% CI 1.10-1.54), I2 = 0, p = 0.002), but were similar
in cryoablation studies (N = 7) (RR 1.10, 95% CI 0.94-1.29, p = 0.24,
I2 = 0.0). Results were similar when individual study arms (N =
27 studies) were pooled. Conclusion(s): AF ablation is feasible in
elderly patients > 75/80 years, with success rates compared to younger
individuals. Complication rates, however, were higher. Graphical Abstract:
(Figure presented.) Copyright © The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature
2024.

<52>
Accession Number
2035535238
Title
Effect of perioperative erythropoietin on postoperative morbidity and
mortality after cardiac surgery: a meta-analysis of randomized controlled
trials.
Source
Anaesthesia Critical Care and Pain Medicine. 43(6) (no pagination), 2024.
Article Number: 101428. Date of Publication: December 2024.
Author
Abraham D.; Leviner D.B.; Ronai T.; Schwartz N.; Levi A.; Sharoni E.
Institution
(Abraham, Leviner, Sharoni) Department of Cardiothoracic Surgery, Carmel
Medical Center, Haifa, Israel
(Abraham, Leviner, Ronai, Sharoni) The Ruth & Baruch Rappaport Faculty of
Medicine, Technion, Haifa, Israel
(Schwartz) Research Authority, Carmel Medical Center, Haifa, Israel
(Schwartz) School of Public Health-University of Haifa, Haifa, Israel
(Levi) Department of Cardiology, Rabin Medical Center, Petach Tikva,
Israel
(Levi) School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Publisher
Elsevier Masson s.r.l.
Abstract
Objective: Cardiac surgery is known to have high rates of perioperative
red blood cell (RBC) transfusions which are associated with increased
postoperative mortality and morbidity. Perioperative erythropoietin (EPO)
has been suggested to lower perioperative RBC transfusions, and the effect
on postoperative morbidity or mortality is unknown. Method(s): The
registered study protocol is available on PROSPERO (CRD42022314538). We
searched the Pubmed, EMbase, and Cochrane CENTRAL databases for randomized
controlled trials (RCT) of EPO in cardiac surgery. Outcomes were
short-term mortality, acute kidney injury (AKI), re-operation,
cerebrovascular accident (CVA), perioperative myocardial infarction (MI),
infectious complications, and RBC transfusions. RCT studies of
perioperative EPO that reported at least one prespecified outcome of
interest were included. Result(s): A total of 21 RCT's (n = 2,763
patients) were included. Mortality analysis included 17 studies (EPO 1,272
patients, control 1,235) and showed no significant difference (risk
difference (RD) 0.0004, 95%CI: -0.016, 0.009). EPO did not reduce the
incidence of AKI (RD -0.006, 95% CI: -0.038, 0.026) and reoperation (RD
0.001, 95% CI: -0.013, 0.015). The incidence of CVA (RD -0.004, 95% CI:
-0.015, 0.007) and perioperative MI (RD -0.008, 95% CI: -0.021, 0.005) was
similar between the groups. Conclusion(s): Although EPO had been
proven to reduce perioperative RBC transfusions, we did not find that it
reduces the incidence of postoperative short-term mortality, AKI, and
reoperation. The study results support that perioperative EPO is also
safe, with no rise in thrombotic events, including CVA and perioperative
MI. Copyright © 2024 Societe francaise d'anesthesie et de
reanimation (Sfar)

<53>
Accession Number
2035523330
Title
Quantitative flow ratio versus fractional flow reserve for coronary
revascularisation guidance (FAVOR III Europe): a multicentre, randomised,
non-inferiority trial.
Source
The Lancet. 404(10465) (pp 1835-1846), 2024. Date of Publication: 09 Nov
2024.
Author
Andersen B.K.; Sejr-Hansen M.; Maillard L.; Campo G.; Ramunddal T.; Stahli
B.E.; Guiducci V.; Serafino L.D.; Escaned J.; Santos I.A.; Lopez-Palop R.;
Landmesser U.; Dieu R.S.; Mejia-Renteria H.; Koltowski L.; Ziubryte G.;
Cetran L.; Adjedj J.; Abdelwahed Y.S.; Liu T.; Mogensen L.J.H.; Eftekhari
A.; Westra J.; Lenk K.; Casella G.; Belle E.V.; Biscaglia S.; Olsen N.T.;
Knaapen P.; Kochman J.; Santos R.C.; Scarsini R.; Christiansen E.H.; Holm
N.R.
Institution
(Andersen, Sejr-Hansen, Dieu, Mogensen, Westra, Christiansen, Holm)
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
(Maillard) GCS ES Axium Rambot, Clinique Axium, Aix-en-Provence, France
(Campo, Biscaglia) Cardiology Unit, Azienda Ospedaliera Universitaria di
Ferrara, Ferrara, Italy
(Ramunddal) Department of Cardiology, Sahlgrenska University Hospital,
Goteborg, Sweden
(Stahli) Department of Cardiology, University Heart Center, University
Hospital Zurich, Zurich, Switzerland
(Guiducci) Cardiology Unit, Azienda USL-IRCCS Reggio Emilia, Reggio
Emilia, Italy
(Serafino) Department of Advanced Biomedical Sciences, University of
Naples Federico II, Naples, Italy
(Escaned, Mejia-Renteria) Hospital Clinico San Carlos IDISSC, Complutense
University of Madrid, Madrid, Spain
(Escaned) Centro de Investigacion Biomedica En Red - Enfermedades
Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
(Santos) Hospital Clinico Universitario de Valladolid, Valladolid, Spain
(Lopez-Palop) Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
(Landmesser, Abdelwahed) Department of Cardiology, Angiology and Intensive
Care Medizin, Deutsches Herzzentrum Charite, Charite-Universitatsmedizin
Berlin, Berlin, Germany
(Landmesser, Abdelwahed) Deutsches Zentrum fur Herz-Kreislaufforschung
(DZHK), Partner Site Berlin, Berlin, Germany
(Koltowski, Kochman) 1st Department of Cardiology, Medical University of
Warsaw, Warsaw, Poland
(Ziubryte) Department of Cardiology, Hospital of Lithuanian University of
Health Sciences Kaunas Clinics, Kaunas, Lithuania
(Ziubryte) Institute of Cardiology, Lithuanian University of Health
Sciences, Kaunas, Lithuania
(Cetran) Hopital Haut-Leveque, Pessac, Bordeaux, France
(Adjedj) Institut Arnault Tzanck, Nice, France
(Liu) Department of Cardiology, Hagaziekenhuis, The Hague, Netherlands
(Eftekhari) Department of Cardiology, Aalborg University Hospital,
Aalborg, Denmark
(Lenk) Klinik und Poliklinik fur Kardiologie, Universitatsklinikum
Leipzig, Leipzig, Germany
(Casella) Cardiology Unit Ospedale Maggiore, AUSL Bologna, Bologna, Italy
(Belle) INSERM U1011 and Department of Interventional Cardiology, Lille
University, Lille, France
(Olsen) Department of Cardiology, Copenhagen University Hospital - Herlev
and Gentofte, Gentofte, Denmark
(Knaapen) VU University Medical Center, Amsterdam, Netherlands
(Santos) Hospital Universitario A Coruna, Coruna, Spain
(Scarsini) Division of Cardiology, Department of Medicine, University of
Verona, Verona, Italy
Publisher
Elsevier B.V.
Abstract
Background: Fractional flow reserve (FFR) or non-hyperaemic pressure
ratios are recommended to assess functional relevance of intermediate
coronary stenosis. Both diagnostic methods require the placement of a
pressure wire in the coronary artery during invasive coronary angiography.
Quantitative flow ratio (QFR) is an angiography-based computational method
for the estimation of FFR that does not require the use of pressure wires.
We aimed to investigate whether a QFR-based diagnostic strategy yields a
non-inferior 12-month clinical outcome compared with an FFR-based
strategy. Method(s): FAVOR III Europe was a multicentre, randomised,
open-label, non-inferiority trial comparing a QFR-based with an FFR-based
diagnostic strategy for patients with intermediate coronary stenosis.
Enrolment was performed in 34 centres across 11 European countries.
Patients aged 18 years or older with either chronic coronary syndrome or
stabilised acute coronary syndrome, and with at least one intermediate
non-culprit stenosis (40-90% diameter stenosis by visual estimate;
referred to here as a study lesion), were randomly assigned (1:1) to the
QFR-guided or the FFR-guided group. Randomisation was done using a
concealed web-based system and was stratified by diabetes and presence of
a left anterior descending coronary artery study lesion. The primary
endpoint was a composite of death, myocardial infarction, and unplanned
revascularisation at 12 months. The predefined non-inferiority margin was
3.4% and the primary analysis was performed in the intention-to-treat
population. The trial was registered with ClinicalTrials.gov (NCT03729739)
and long-term follow-up is ongoing. Finding(s): Between Nov 6, 2018,
and July 21, 2023, 2000 patients were enrolled and randomly assigned to
the QFR-guided strategy (1008 patients) or the FFR-guided strategy (992
patients). The median age was 67.3 years (IQR 59.9-74.7); 1538 (76.9%)
patients were male and 462 (23.1%) were female. Median follow-up time was
365 days (IQR 365-365). At 12 months, a primary endpoint event had
occurred in 67 (6.7%) patients in the QFR group, and in 41 (4.2%) patients
in the FFR group (hazard ratio 1.63 [95% CI 1.11-2.41]). The event
proportion difference was 2.5% (90% two-sided CI 0.9-4.2). The upper limit
of the 90% CI exceeded the prespecified non-inferiority margin of 3.4%.
Therefore, QFR did not meet non-inferiority to FFR. A total of 18 (1.8%)
patients in each group experienced an adverse procedural event, the most
frequent being procedure-related myocardial infarction, which occurred in
ten (1.0%) patients in the QFR group and seven (0.7%) in the FFR group.
One patient in the QFR group died in relation to the index procedure.
 Interpretation(s): The results of the FAVOR III Europe trial do not
support the use of QFR if FFR is available to guide revascularisation
decisions in patients with intermediate coronary stenosis. This finding
could have implications for current clinical guidelines recommending QFR
for this purpose. Funding(s): Medis Medical Imaging Systems and
Aarhus University. Copyright © 2024 Elsevier Ltd

<54>
[Use Link to view the full text]
Accession Number
2035207621
Title
Efficacy and safety of different oral anticoagulants for stroke prevention
in older patients with atrial fibrillation: A network meta-analysis.
Source
Medicine (United States). 103(42) (pp e39937), 2024. Date of Publication:
18 Oct 2024.
Author
Zhang H.; Liu F.; Lu X.
Institution
(Zhang, Lu) Department of Cardiology, Huaihe Hospital of Henan University,
Henan Province, Kaifeng, China
(Liu) Department of Intensive Care Unit, Huaihe Hospital of Henan
University, Henan Province, Kaifeng, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Various oral anticoagulants have been used for stroke
prevention in older patients with atrial fibrillation (AF). However, the
optimal anticoagulants for stroke prevention has not yet been developed.
We performed a systematic review and network meta-analysis to determine
the optimal instructions. Method(s): We searched for randomized
controlled trials (RCTs) from PubMed, Embase, and the Cochrane Library
without restriction for publication date or language at January 2024. Any
RCTs that compared the effectiveness of a direct oral anticoagulant and a
vitamin K antagonist (VKA) for stroke prevention in older patients with AF
were included in this network meta-analysis. The Bayesian network
meta-analysis used a random effects model and surface under the cumulative
ranking curve analysis to rank results. All analyses were done using R
software with gemtc package, with statistical significance set at P < .05.
 Result(s): We included 7 RCTs (79,003 patients) comparing 8 different
instructions including Apixaban 5 mg, Dabigatran 110 mg, Dabigatran 150
mg, Edoxaban 30 mg, Edoxaban 60 mg, Rivaroxaban 15 mg, Rivaroxaban 20 mg,
and VKA. Apixaban 5 mg, Dabigatran 110 mg, and Dabigatran 150 mg was more
effective than the VKA for reducing stroke or systemic embolism risks, and
the difference was statistically significant (P < .05). Apixaban 5 mg,
Dabigatran 110 mg, Dabigatran 150 mg, Edoxaban 30 mg, and Edoxaban 60 mg
was associated with a reduction of the intracranial hemorrhage rate than
the VKA (P < .05). The surface under the cumulative ranking curve shows
that Dabigatran 110 mg ranked first for reducing stroke or systemic
embolism risks. Edoxaban 60 mg ranked first for major bleeding. Dabigatran
110 mg ranked first for intracranial hemorrhage. Apixaban 5 mg ranked
first for all bleeding events. Conclusion(s): Direct oral
anticoagulants were found to have lower rates of thromboembolic events
compared to VKAs in older patients with AF. Apixaban 5 mg, Dabigatran 110
mg, Dabigatran 150 mg, Edoxaban 30 mg, and Edoxaban 60 mg were also
associated with a reduction of intracranial hemorrhage than
VKA. Copyright © 2024 the Author(s). Published by Wolters Kluwer
Health, Inc.

<55>
Accession Number
2034763580
Title
Safety and efficacy of protamine after transcatheter aortic valve
replacement.
Source
Indian Heart Journal. 76(5) (pp 352-354), 2024. Date of Publication: 01
Sep 2024.
Author
Kumaraguruparan L.D.; Anandaram A.; Sambandam K.G.; Chidambaram Y.;
Kidambi B.R.; Karthikeyan G.G.; Kasi M.; Abdulkader R.S.; Ramesh S.;
Ramalingam V.; Rajendran R.; Senguttuvan N.B.
Institution
(Kumaraguruparan, Ramesh, Senguttuvan) Department of Cardiology, Sri
Ramachandra Institute of Higher Education and Research (SRIHER), No.1,
Ramachandra Nagar, Porur, Tamil Nadu, Chennai 600116, India
(Anandaram) Department of Internal Medicine, Lehigh Valley Health Network,
Allentown, PA 18101, United States
(Sambandam) Department of Cardiac Anaesthesia, Sri Ramachandra Institute
of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur,
Tamil Nadu, Chennai 600116, India
(Chidambaram, Kasi) Department of Clinical Research, Sri Ramachandra
Institute of Higher Education and Research (SRIHER), No.1, Ramachandra
Nagar, Porur, Tamil Nadu, Chennai 600116, India
(Kidambi) Department of Cardiology, AI Dhannah Hospital, Ruwais, Abu
Dhabi, United Arab Emirates
(Karthikeyan) Department of Cardiology, PSRI Hospital, New Delhi, India
(Abdulkader) National Institute of Epidemiology, ICMR, Chennai &
Department of Statistics, Manonmaniam Sundaranar University,
Abishekapatti, Tamil Nadu, Tirunelveli, India
(Ramalingam) Department of Cardiology, Velammal Medical College and
Hospital, Madurai, India
(Rajendran) Department of Cardiology, Apollo Hospitals, Trichy, India
Publisher
Elsevier B.V.
Abstract
Transfemoral Trans-catheter Aortic Valve Replacement (TF-TAVR) is a safe
alternative to surgical aortic valve replacement (SAVR). Protamine is used
to reverse heparin and reduce post-TAVR bleeding, but concerns about risks
like valve thrombosis and stroke remain. This systematic review and
meta-analysis, following PRISMA guidelines, found no statistically
significant difference in major bleeding complications between the
protamine and control groups [(3.0 % vs. 14.4 %); RR: 0.56; P = 0.16]. No
differences were noted in life-threatening bleeding, blood transfusions,
30-day mortality, or stroke. Protamine appears safe post-TAVR without
increasing stroke risk, but its effectiveness in reducing bleeding needs
further investigation through a multicentric randomized
study. Copyright © 2024

<56>
Accession Number
2035433379
Title
Meta-analysis of the correlation between inflammatory response indices and
no-reflow after PCI in patients with acute STEMI.
Source
American Journal of Translational Research. 16(10) (pp 5168-5181), 2024.
Date of Publication: 2024.
Author
Yu L.; Chen J.; Zhang J.
Institution
(Yu) Department of Cardiology, The First Affiliated Hospital of Liaoning
University of Chinese Medicine, Liaoning, Shenyang 110032, China
(Chen) Department of General Practice, The First Affiliated Hospital of
Hainan Medical University, Hainan, Haikou 570102, China
(Zhang) Department of Cardiology, People's Hospital of Anji, Zhejiang,
Huzhou 313300, China
Publisher
E-Century Publishing Corporation
Abstract
Background: After percutaneous coronary intervention (PCI), patients with
acute ST-segment elevation myocardial infarction (STEMI) could have an
inflammatory response, which may lead to the risk of no-reflow due to
microvascular obstruction. However, the association between changes in the
levels of inflammatory response-related factors and no-reflow after PCI in
patients with acute STEMI is still controversial. Method(s): In this
study, a meta-analysis was conducted. Studies from the database
established before April 2024 were retrieved in PubMed, Web of Science,
and EMBASE. Case-control or cohort studies were included. Repetitive
publications, studies without full access and successful data extraction,
fragmentary information, animal experiments, summary, and systematic
reviews were excluded, and Review Manager 5.3 software was used to process
the data. Result(s): The meta-analysis showed that elevated levels of
high-sensitivity C-reactive protein (Hs-CRP) (Z = 22.87, P < 0.001),
platelet/lymphocyte ratio (PLR) (Z = 19.17, P < 0.001), leukocyte (Z =
9.98, P < 0.001), and neutrophil count (Z = 5.75, P < 0.001) were
significantly related with the risk of no-reflow. In addition, the
increase of red blood cell volume width (RDW) was also a risk factor for
no-reflow. Conclusion(s): Refined results of Hs-CRP, PLR, RDW,
leukocytes, and neutrophil can provide clinicians with effective tools to
reduce the risk of no-reflow in patients with acute STEMI after
PCI. Copyright © 2024 E-Century Publishing Corporation. All
rights reserved.

<57>
Accession Number
2035428784
Title
Clonal Hematopoiesis and Clinical Outcomes in Metastatic
Castration-Resistant Prostate Cancer Patients Given Androgen Receptor
Pathway Inhibitors (Alliance A031201).
Source
Clinical Cancer Research. 30(21) (pp 4910-4919), 2024. Date of
Publication: 01 Nov 2024.
Author
Jensen J.L.; Bobek O.; Chan I.C.C.; Miller B.C.; Hillman D.W.; Heller G.;
Druley T.; Armstrong A.J.; Morris M.J.; Milowsky M.I.; Beltran H.; Bolton
K.L.; Coombs C.C.
Institution
(Jensen, Miller, Milowsky) University of North Carolina, Lineberger
Comprehensive Cancer Center, Chapel Hill, NC, United States
(Bobek, Hillman) Alliance Statistics and Data Management Center, Mayo
Clinic, Rochester, MN, United States
(Chan, Druley, Bolton) Washington University, School of Medicine, St.
Louis, MO, United States
(Heller, Morris) Memorial Sloan Kettering Cancer Center, New York, NY,
United States
(Armstrong) Duke Cancer Institute, Center for Prostate and Urologic
Cancer, Duke University, Durham, NC, United States
(Beltran) Dana-Farber Cancer Institute, Harvard Medical School, Boston,
MA, United States
(Coombs) University of California Irvine, Irvine, CA, United States
Publisher
American Association for Cancer Research Inc.
Abstract
Purpose: Mutations in hematopoietic progenitor cells accumulate with age
leading to clonal expansion, termed clonal hematopoiesis (CH). CH in the
general population is associated with hematopoietic neoplasms and reduced
overall survival (OS), predominantly through cardiovascular adverse events
(CVAE). Because androgen receptor pathway inhibitors (ARPI) used in
metastatic castration-resistant prostate cancer (mCRPC) are also
associated with CVAEs and because CH negatively impacted survival in an
advanced solid tumor cohort, we hypothesized that CH in mCRPC may be
associated with increased CVAEs and inferior survival. Experimental
Design: A targeted DNA sequencing panel captured common CH mutations in
pretreatment blood samples from 957 patients enrolled in Alliance A031201:
a randomized trial of enzalutamide +/- abiraterone/prednisone in the
first-line mCRPC setting. The primary outcome was the impact of CH on OS;
the secondary outcomes were progression-free survival (PFS) and CVAEs.
 Result(s): Baseline comorbidities were similar by CH status. No
differences in OS/progression-free survival were detected regardless of
treatment arm or the variant allele frequency threshold used to define CH
[primary: 2% (normal-CH, N-CH); exploratory: 0.5% (low-CH) and 10%
(high-CH, H-CH)]. Patients with H-CH (7.2%) and TET2-mutated N-CH (6.0%)
had greater odds of any CVAE (14.5% vs. 4.0%; P = 0.0004 and 12.3% vs.
4.2%; P = 0.010, respectively). More major CVAEs were observed in patients
with H-CH (5.8% vs. 1.9%; P = 0.042) and N-CH (3.4% vs. 1.8%; P = 0.147).
 Conclusion(s): CH did not affect survival in patients with mCRPC
treated with ARPIs in A031201. H-CH and TET2-mutated CH were associated
with more CVAEs. These findings inform the risk/benefit discussion about
ARPIs in mCRPC. Copyright © 2024 American Association for Cancer
Research.

<58>
Accession Number
2035222764
Title
Meta-Analysis of Lowering LDL Cholesterol and its Impact on the
Cardiovascular System.
Source
Pakistan Journal of Medical and Health Sciences. 17(5) (pp 8-12), 2023.
Date of Publication: May 2023.
Author
Badalyan S.S.; Markosyan S.V.; Tariq H.; Malik Z.; Asghar A.
Institution
(Badalyan) (Organization) I.M. Sechenov First Moscow State Medical
University, Sechenov University, Russian Federation
(Markosyan) Yerevan State Medical University after Mkhitar Heratsi,
Armenia
(Tariq) Benazir Bhutto Shaheed Medical College, AJK, Pakistan
(Malik) University of Lahore, Pakistan
(Asghar) Institute of Pharmaceutical Sciences, University of Veterinary
and Animal Sciences, Lahore 54000, Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Background: By lowering LDL cholesterol levels, the risk of coronary heart
disease (CHD) and other serious vascular events can be significantly
reduced. In order to prevent cardiovascular illnesses (CVD), mainly
coronary heart disease, LDL-cholesterol (LDL-C) levels must be tightly
controlled on both a primary and secondary level (CHD). Despite the fact
that patients in primary prevention experience a higher absolute number of
atherosclerotic cardiovascular (CV) events than those in secondary
prevention of CVD, subjects in primary prevention frequently receive
little attention when it comes to the clinical management of LDL-C levels.
 Aim(s): To summarise the research supporting LDL cholesterol
reduction treatments for elderly people. Method(s): For this
meta-analysis, we searched PubMed, GOOGLE SCHOLAR, SCI.HUB, MEDLINE, and
Embase for publications released between January 1, 2017, and December 28,
2021. As recommended by the 2018 American Academy of Cardiology and
American Heart Association guidelines, randomised controlled trials
evaluating cardiovascular outcomes of an LDL cholesterol-lowering medicine
with a median follow-up of at least 2 years and data on older patients
(aged 75 years).The search for literature source was limited to randomized
controlled trials (human being). This meta-analysis, comprised of 24
trials from the Cholesterol Therapy Trialists' Collaboration meta-analysis
plus five other trials, used data from six journals. 21492 (8%) of the
244090 participants in 29 studies, were over the age of 75. Among them,
11750 (54%) came from statin trials, 6209 (28%) from ezetimibe trials, and
3533 (16%) from PCSK9 inhibitor trials. We conducted network meta-analyses
for the statins and non statin treatments. Result(s): Of the 244090
participants in 29 studies, 21492(8%) were over 75. These included 3533
(16%) from PCSK9 inhibitor studies, 11750 (54%) from statin trials, and
6209 (28%) from ezetimibe trials. A median follow-up period of 2 to 6
years was used. Without statistically differentiating from the risk
reduction in patients under the age of 75 (085 [078-092];
pinteraction=037), LDL cholesterol lowering significantly reduced the risk
of major vascular events (n=3519) by 26% for 1 mmol/L reduction in LDL
cholesterol (RR 074 [95% CI 061-089]; p=00019).In older patients, there
was no statistically significant difference in the RRs for statin (0.82
[0.73-0.91] and non-statin (0.67 [0.47-0.95]; pinteraction=0.64)
treatment. Reduced LDL cholesterol in older persons was shown to benefit
all components of the composite, including coronary revascularization (080
[066-096], stroke (073 [061-087], and myocardial infarction (080
[071-090]. Practical implication: This meta analysis can be used to
improve the treatment of people withlowering LDL cholesterol.
 Conclusion(s): The viability and security of diminishing LDL
cholesterol in more seasoned adults are now supported by further research
provided by this meta-analysis. By non-statin and statin LDL
cholesterol-bringing down medication, we identified a risk reduction for
major vascular events that were at least as effective as that observed in
younger patients Copyright © 2023 Lahore Medical And Dental
College. All rights reserved.

<59>
Accession Number
2035283773
Title
Impact of Dipyrone Administration on Postoperative Analgesia and Aspirin
Effect in Patients Undergoing Coronary Artery Bypass Grafting: The
Prospective Randomized DipASA Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2024.
Date of Publication: 2024.
Author
Petermichl W.; Ellmauer P.-P.; Benning A.; Zeman F.; Schmid C.; Stadlbauer
A.; Heimerl S.; Seyfried T.; Blecha S.
Institution
(Petermichl, Ellmauer, Blecha) Department of Anesthesiology, University
Medical Center Regensburg, Regensburg, Germany
(Benning, Zeman) Center for Clinical Studies, University Medical Center
Regensburg, Regensburg, Germany
(Schmid, Stadlbauer) Department of Cardiothoracic Surgery, University
Medical Center Regensburg, Regensburg, Germany
(Heimerl) Institute of Clinical Chemistry and Laboratory Medicine,
University Medical Center Regensburg, Germany
(Seyfried) Department of Anesthesiology, Hospital Vilshofen, Vilshofen,
Germany
Publisher
W.B. Saunders
Abstract
Objective: The aim of the study was to investigate the impact of dipyrone
administration on postoperative analgesia and acetylsalicylic acid (ASA)
effect in patients undergoing coronary artery bypass grafting (CABG).
 Design(s): A prospective randomized study. Setting(s):
Single-university hospital setting. Participant(s): Ninety-eight
patients who underwent CABG between April 2022 and May 2023.
 Intervention(s): The ASA effect was measured at 6 time points with
impedance aggregometry (Multiplate) and thromboelastography (TEG6s
Platelet Mapping). Patients were randomized to 1 of 3 groups: intravenous
ASA and dipyrone at the same time (group 1), intravenous ASA and dipyrone
with a 2-hour delay (group 2), and intravenous ASA alone (group 3).
Postoperative analgesic effects (numeric rating scale) and the prevalence
of potential ASA non-response (defined as ASPI >40 U and TEG-ASA
inhibition <50%) were recorded. Measurements and Main Results: Of 90
analyzed patients, 80 took ASA preoperatively. All patients received
intravenous ASA 100 mg from postoperative day 1. The effect of ASA did not
significantly differ between the study groups at any time for either
platelet function test. NRS values did not differ between the study groups
at any time (p = 0.469). Patients in group 3 received significantly more
additional co-analgesics than patients who received dipyrone (p = 0.005).
ASA non-response was detected in 38.9% and 67.8% on the seventh
postoperative day, respectively. Conclusion(s): Dipyrone given after
CABG seems safe and did not show any significant effect on platelet
inhibition after ASA administration. Patients taking dipyrone
postoperatively need significantly fewer additional coanalgesics. The ASA
effect on platelet function should be checked at least once after
surgery. Copyright © 2024 The Author(s)

<60>
Accession Number
2032120492
Title
Association of physical function with hospital readmissions among older
adults: A systematic review.
Source
Journal of Hospital Medicine. (no pagination), 2024. Date of Publication:
2024.
Author
Thomas E.M.; Smith J.; Curry A.; Salsberry M.; Ridgeway K.; Hunt B.;
Desanto K.; Falvey J.R.
Institution
(Thomas, Salsberry) School of Health and Rehabilitation Sciences, The Ohio
State University, Columbus, OH, United States
(Smith) Kinesiology Department, University of Connecticut, Storrs, CT,
United States
(Curry) Rehabilitation Services Department, Washington Hospital Healthcare
System, Fremont, CA, United States
(Ridgeway) Rehabilitation Therapy Services Department, University of
Colorado Hospital, UCHealth, Aurora, CO, United States
(Ridgeway) Physical Therapy Program, School of Medicine, University of
Colorado Anschutz Medical Campus, Aurora, CO, United States
(Hunt) Rehabilitation Services Department, Intermountain Health, Canyons
Region, Salt Lake, UT, United States
(Desanto) Strauss Health Sciences Library, University of Colorado Anschutz
Medical Campus, Aurora, CO, United States
(Falvey) Department of Physical Therapy and Rehabilitation Science and
Department of Epidemiology and Public Health, University of Maryland
School of Medicine, Baltimore, MD, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Hospital readmissions pose significant burdens on healthcare
systems, particularly among older adults. While efforts to reduce
readmissions have historically focused on medical management, emerging
evidence suggests physical function may also play a role in successful
care transitions. However, there is a limited understanding of the
relationship between functional measures and readmission risk. This
systematic review aims to assess the association between physical function
impairments and hospital readmissions. Objective(s): This systematic
review aims to assess the association between physical function
impairments and hospital readmissions. Method(s): A systematic review
was conducted following PRISMA guidelines, with studies identified through
databases including PubMed, CINAHL, Embase, and others published January
1, 2010-December 31, 2022. Inclusion criteria encompassed observational
studies of adults aged 50 and older in the United States, reporting
readmissions within 90 days of discharge and assessing physical function
across domains of the International Classification of Function model. Data
extraction and risk of bias assessment were independently conducted by two
authors using theScottish Intercollegiate Guidelines Network (SIGN) tool.
 Result(s): Seventeen studies, representing 80,008 participants, were
included in this systematic review. Patient populations included a wide
array of medical populations, including general medical inpatients and
those undergoing cardiac surgery. Across various functional measures
assessed before or during admission, impairments were consistently
associated with increased risk for hospital readmissions up to 90 days
after admission. Measures of participation, including life-space mobility,
were also associated with increased readmission risk. Conclusion(s):
Functional impairments are robust predictors of hospital readmissions in
older adults. Routine assessment of physical function during
hospitalization can improve risk stratification and may support successful
care transitions, particularly in older adults. Copyright © 2024
The Author(s). Journal of Hospital Medicine published by Wiley Periodicals
LLC on behalf of Society of Hospital Medicine.

<61>
Accession Number
2032072970
Title
3D vs. 2D-4 K: Performance and self-perception of laparoscopic novices in
a randomized prospective teaching intervention using standard tasks and
box trainers.
Source
Langenbeck's Archives of Surgery. 409(1) (no pagination), 2024. Article
Number: 330. Date of Publication: December 2024.
Author
Kolbel B.; Ragnitz J.; Schale K.; Witzenhausen M.; Axt S.; Beltzer C.
Institution
(Kolbel, Witzenhausen, Beltzer) Department of General, Visceral and
Thoracic Surgery, German Armed Forces Hospital Ulm, Oberer Eselsberg 40,
Ulm 89081, Germany
(Ragnitz) School of Medicine, HMU Health and Medical University,
Olympischer Weg 1, Potsdam 14471, Germany
(Schale) Department for Trauma Surgery and Orthopedics, Reconstructive and
Septic Surgery, Sportstraumatology, German Armed Forces Hospital Ulm,
Oberer Eselsberg, 40, Ulm 89081, Germany
(Axt) Department of General, Visceral and Transplant Surgery, Tubingen
University Hospital, Hoppe-Seyler-Str. 3, Tubingen 72076, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objective: The use of three-dimensional (3D) laparoscopy in surgical
practice and training has been an area of research and discussion. Studies
have suggested that 3D vision can improve speed and precision compared to
traditional two-dimensional (2D) displays, while other authors found no
benefits on the learning curves of laparoscopic novices. Modern
two-dimensional laparoscopy with a resolution of 3840 x 2160 pixels (2D-4
K) seems to improve laparoscopic view and helps learners orient without
stereopsis. However, evidence comparing these systems for laparoscopic
training is limited. Therefore, the impact of viewing mode (2D-4 K vs. 3D)
on learning and task proficiency remains unclear. Design(s): We
performed a two-hour teaching intervention on basic laparoscopic skills
for novices. In this parallel group randomized study, we randomly assigned
learners to 2D-4 K or 3D teaching and performed tasks of increasing
difficulty and complexity using standard laparoscopy box trainers. Before
the last and most challenging task, learners had to crossover to the other
laparoscopy setup. Our hypothesis was that learners would be faster and
more precise when using a 3D setup. The primary endpoint was task
proficiency measured by speed and failure rate. Secondary outcomes were
performance using the viewing mode of the other group without
familiarization, self-perception, and career aspirations before and after
the teaching intervention, expressed on a Likert scale. Setting(s):
The study was performed by the Department of General, Visceral and
Thoracic Surgery at the German Armed Forces Hospital Ulm, which is an
academic teaching hospital of the University of Ulm. Participant(s):
Thirty-eight laparoscopic novices, including medical students and junior
residents, participated voluntarily in this teaching intervention. Group
allocation was performed via the virtual coin flip method. Apparently,
participants and tutors were not blinded to group assignment. No formal
approval by the ethics committee was needed for this noninvasive study in
compliance with the World Medical Association Declaration of Helsinki as
discussed with the ethics committee of the University of Ulm.
 Result(s): Thirty-eight laparoscopy novices were randomized in the
study. The 3D group (n = 19) was significantly faster than the 2D-4 K
group (n = 19) (p =.008) in a standard box trainer model, with 134.45 +/-
41.45 s vs. 174.99 +/- 54.03 s for task 1 and 195.97 +/- 49.78 s vs.
276.56 +/- 139.20 s for task 2, and the effect was consistent throughout
the learning curve. The failure rate was not significantly affected by the
viewing mode. After crossover to the other laparoscopy system, precision
and time were not significantly different between the groups. Learners
rated the difficulty of laparoscopy lower on a Likert scale after having
two hours of basic laparoscopy training. The study was funded by the
hospital's teaching budget. Conclusion(s): Laparoscopic novices can
benefit from a 3D laparoscopy training setup. Exclusive 3D training prior
to a complex task on a 2D-4 K setup does not negatively affect the
learner's performance. Copyright © The Author(s) 2024.

<62>
Accession Number
2032194146
Title
Transcatheter Repair of Tricuspid Valve Regurgitation: A Systematic
Review.
Source
Journal of Clinical Medicine. 13(21) (no pagination), 2024. Article
Number: 6531. Date of Publication: November 2024.
Author
Srinivasan A.; Brown J.; Rhodes A.; Khan S.; Chinta V.; Loyalka P.; Kumar
A.
Institution
(Srinivasan, Brown, Rhodes) Department of Cardiology, HCA Houston
Healthcare Medical Center, Tilman J. Fertitta Family College of Medicine,
The University of Houston, Houston, TX 77004, United States
(Khan) Department of Internal Medicine, HCA Houston Healthcare Clear Lake,
Tilman J. Fertitta Family College of Medicine, The University of Houston,
Houston, TX 77004, United States
(Chinta, Loyalka, Kumar) Structural Heart & Valve Center, Houston Heart,
HCA Houston Healthcare Medical Center, Tilman J. Fertitta Family College
of Medicine, The University of Houston, Houston, TX 77004, United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Introduction: Clinically significant severe tricuspid regurgitation (TR)
is a common untreated pathology associated with increased mortality. Even
though surgical valve replacement has been the mainstay option,
transcatheter intervention is a novel and potentially effective tool. To
the best of our knowledge, this is the first systematic review that
assessed and compared clinical and echocardiographic outcomes of
coaptation and annuloplasty devices in patients with clinically
significant TR. Method(s): PubMed, the Cochrane Central Register of
Controlled Trials, and EMBASE were searched for articles published from
August 2016 until February 2023. Primary endpoints were technical and
procedural successes. Secondary endpoints were TR grade, NYHA, change in 6
min walk distance (6MWD), and echocardiographic parameters at 30-day
follow-up. Result(s): We included thirty-eight studies consisting of
2273 patients with severe symptomatic TR (NYHA III-IV 77% and
severe/massive/torrential TR 83.3%) and high surgical risk (mean EUROSCORE
of 7.54). The technical success for the annuloplasty devices was 96.7% and
for the coaptation device was 94.8%. The procedural success for the
annuloplasty devices was 64.6% and for the coaptation device was 81.4%.
The 6MWD increased by 17 m for the coaptation devices and increased by 44
m after 30 days for the annuloplasty devices. A reduction in TR grade to
<2 was seen in 70% of patients with coaptation and 59% of patients with
annuloplasty devices. Conclusion(s): Transcatheter tricuspid valve
intervention appears to be feasible and is associated with favorable
outcomes. Copyright © 2024 by the authors.

<63>
Accession Number
645703231
Title
Effectiveness of the Individualized Self-Care Program Based on Orem's
Self-Care Theory: Impact on Learning Needs and Self-Care Behaviors
Following Coronary Artery Bypass Surgery - A Randomized Controlled Trial.
Source
Asian nursing research. (no pagination), 2024. Date of Publication: 02
Nov 2024.
Author
Jamil Alkuwaisi M.; Alsaqri S.H.; Al-Rashidi A.M.; Ali Alshowkan A.;
Mostoles R.P.; Terence Ong L.
Institution
(Jamil Alkuwaisi) Medical Surgical Department, College of Nursing,
University of Hail, Saudi Arabia
(Alsaqri) Medical Surgical Department, College of Nursing, University of
Hail, Saudi Arabia
(Al-Rashidi) Medical Surgical Department, College of Nursing, University
of Hail, Saudi Arabia
(Ali Alshowkan) Community Nursing Department, College of Nursing,
University of Dammam, Dammam, Saudi Arabia
(Mostoles) Community Nursing Department, College of Nursing, University of
Hail, Saudi Arabia
(Terence Ong) Community Nursing Department, College of Nursing, University
of Hail, Saudi Arabia
Abstract
PURPOSE: This study aimed to investigate the specific learning needs of
patients within the experimental group after receiving the Individualized
Self-Care Program (ISCP) at two key time points: Time 2 (Day 2, Week 1)
and Time 3 (Day 15, Week 3). Furthermore, it aimed to compare the
effectiveness of the ISCP in improving self-care behavior between the
experimental group and the control group, which received standard health
education. METHOD(S): The study utilized a Randomized Controlled
Trial (RCT) design and included a consecutive sample of 128 patients who
had undergone their first CABG procedure. These patients were randomly
divided into two groups: the experimental group (n = 64) and the control
group (n = 64). The experimental group received an ISCP at Time 2 and Time
3 after being discharged, whereas the control group received standard
health education. Statistical analyses included paired t-tests to assess
differences in learning needs over time and Repeated Measures Analysis of
Variance (ANOVA) to evaluate the effectiveness of the ISCP on self-care
behavior. RESULT(S): A paired t-test indicated a statistically
significant difference in the total number of learning needs identified
within the experimental group between Time 2 and Time 3 assessments.
Patients in the experimental group initially identified more learning
needs at Time 2 (4.3+/-1.5), but their knowledge significantly improved at
Time 3, leading to fewer learning needs (2.6+/-1.1). Furthermore, an ANOVA
comparing the experimental and control groups showed that the ISCP
effectively improved self-care behavior in the experimental group, with
significantly greater improvements compared to the control group, which
received standard health education. CONCLUSION(S): ISCP delivered in
early recovery enhances self-care behaviors and addresses postdischarge
gaps. The study also revealed that patients' learning needs change over
time during home recovery, emphasizing the importance of tailored
self-care programs for CABG patients after discharge. Copyright ©
2024. Published by Elsevier B.V.

<64>
Accession Number
645704739
Title
Risk Factors for Reduced Long-term Survival Following Isolated Surgical
Aortic Valve Replacement in Different Age Groups.
Source
The Canadian journal of cardiology. (no pagination), 2024. Date of
Publication: 02 Nov 2024.
Author
Groenewoud R.; Peng D.; Gottschalk B.H.; Rokui S.; Gauthier C.; Ye J.
Institution
(Groenewoud, Gottschalk, Rokui, Gauthier, Ye) Division of Cardiac Surgery,
St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
(Peng) Division of Cardiac Surgery, St Paul's Hospital, University of
British Columbia, Vancouver, British Columbia, Canada; Centre for
Cardiovascular Innovation, University of British Columbia, Vancouver, BC,
Canada
Abstract
BACKGROUND: According to recent guidelines, the selection of transcatheter
vs. surgical aortic valve replacement (TAVR vs SAVR) in low-risk patients
depends on age and life expectancy. Our objective was to understand
independent risk factors for reduced life expectancy following isolated
SAVR and the rate of re-do aortic valve (AV) intervention in different age
groups, to delineate optimal intervention depending on patient
characteristics. METHOD(S): Between 2000-2015, 2026 patients
underwent isolated SAVR with Edwards pericardial tissue valves.
Multivariable models were conducted to determine independent risk factors
for long-term survival in three age groups. RESULT(S): The 10-year
survival rates were 83.4+/-2.3%, 72.7+/- 2.6% and 39.8+/-3.0% in Group I
(age <65 years, n=577), II (age 65 - <75 years, n=693) and III (age >=75
years, n=756), respectively. Independent factors for the reduced long-term
survival were pulmonary hypertension (PH), renal failure, peripheral
vascular disease, diabetes, and NYHA class IV in Group I; PH, diabetes,
current smoking, and atrial arrhythmia in Group II; and PH, anemia, and
NYHA class IV in Group III. The re-do AV intervention rate at 10 years was
much higher in Group I than in Groups II and III (14.7+/-2.5% vs.
3.4+/-1.1% and 0.8+/-0.4%, P<0.001). CONCLUSION(S): We identified
risk factors for reduced long-term survival following isolated SAVR in
different age groups and PH being the only risk factor across all ages,
which should assist in decision-making for SAVR vs. TAVR. Our results also
support the current recommendation of bioprostheses in patients aged >65
years given extremely low rate of re-do AV intervention. Copyright
© 2024. Published by Elsevier Inc.

<65>
Accession Number
2035604500
Title
The Effect of Teleprehabilitation on Adverse Events After Elective Cardiac
Surgery: A Randomized Controlled Trial.
Source
Journal of the American College of Cardiology. (no pagination), 2024.
Date of Publication: 2024.
Author
Scheenstra B.; van Susante L.; Bongers B.C.; Lenssen T.; Knols H.; van
Kuijk S.; Nieman M.; Maessen J.; van't Hof A.; Sardari Nia P.
Institution
(Scheenstra, van Susante, Maessen, Sardari Nia) Department of
Cardiothoracic Surgery, Heart and Vascular Center, Maastricht University
Medical Center, Maastricht, Netherlands
(Scheenstra, Maessen, Sardari Nia) Department of Cardiothoracic Surgery,
Cardiovascular Research Institute Maastricht, Maastricht University,
Maastricht, Netherlands
(Bongers) Department of Nutrition and Movement Sciences, Institute of
Nutrition and Translational Research in Metabolism, Maastricht University,
Maastricht, Netherlands
(Bongers) Department of Surgery, Institute of Nutrition and Translational
Research in Metabolism, Maastricht University, Maastricht, Netherlands
(Lenssen) Department of Physical therapy, Maastricht University Medical
Center, Maastricht, Netherlands
(Knols) Department of Psychiatry and Psychology, Maastricht University
Medical Center, Maastricht, Netherlands
(van Kuijk) Department of Clinical Epidemiology and Medical Technology
Assessment, Maastricht University Medical Center, Maastricht, Netherlands
(Nieman) Department of Pulmonology, Maastricht University Medical Center,
Maastricht, Netherlands
(van't Hof) Department of Cardiology, Heart and Vascular Center,
Maastricht University Medical Center, Maastricht, Netherlands
(van't Hof) Department of Cardiology, Zuyderland Medical Center, Heerlen,
Netherlands
Publisher
Elsevier Inc.
Abstract
Background: Patients scheduled for cardiac surgery and procedures often
present with modifiable risk factors for adverse perioperative outcomes.
Prehabilitation has shown potential to enhance mental and physical
fitness; however, its effect on clinical cardiovascular endpoints in this
population has not been studied. Objective(s): The current trial was
designed to evaluate the effect of a personalized multimodal
teleprehabilitation on the incidence of composite endpoint on major
adverse cardiovascular events in patients scheduled for elective cardiac
surgery. Method(s): In a multicenter randomized controlled trial, 394
patients awaiting elective cardiac surgery and procedures were enrolled.
Of these, 197 patients were randomized to an online multimodal
personalized teleprehabilitation program through shared decision-making by
a multidisciplinary team, and 197 were assigned to a control group. The
primary outcome was major adverse cardiovascular events (ie,
cardiovascular death, myocardial infarction, stroke, hospitalization for
heart failure or other life-threatening cardiac events, and earlier or
repeated intervention), as measured from the randomization until 1-year
postoperatively. All events were adjudicated by a blinded event committee.
Secondary outcomes included length of hospital stay, postoperative
complications, quality of life, adherence to the program, and effect on
the incidence of modifiable risk factors. Sensitivity analyses of the
primary outcome were conducted adjusting for baseline characteristics to
evaluate the consistency of treatment effects. Result(s): From
randomization until 1 year postoperatively, the primary endpoint occurred
in 33 patients (16.8%) in the teleprehabilitation group and 50 patients
(25.5%) in the control group (difference 8.8%; 95% CI: 0.7%-16.8%; P =
0.032). This difference was primarily driven by a reduction in
hospitalizations, and the sensitivity analyses showed that treatment
effect was mainly in the patients undergoing a cardiac surgery rather than
transcatheter procedures with adjusted OR of 0.54 (95% CI: 0.30-0.96; P =
0.035). Teleprehabilitation also reduced the incidence of active smokers,
elevated pulmonary risk scores, and elevated depression scores. There was
no significant difference in postoperative length of hospital stay,
occurrence of postoperative complications, physical fitness, incidence of
obesity, or malnutrition. Conclusion(s): Multimodal personalized
teleprehabilitation resulted in a clinically relevant and statistically
significant reduction of the primary endpoint in patients undergoing
cardiac surgery. (Digital Cardiac Counseling Trial: DCC Trial [DCC];
NCT04393636) Copyright © 2024 The Authors

<66>
Accession Number
2035319992
Title
Lived experiences of persons with heart transplantation: A systematic
literature review and meta-synthesis.
Source
Heart and Lung. 69 (pp 174-184), 2025. Date of Publication: 01 Jan 2025.
Author
Nour El Hadi S.; Zanotti R.; Danielis M.
Institution
(Nour El Hadi) Department of Anesthesia and Intensive Care, University
Hospital of Padua, Padua, Italy
(Zanotti, Danielis) Laboratory of Studies & Evidence Based Nursing,
Department of Cardiac, Thoracic, Vascular Sciences and Public Health,
University of Padua, Padua, Italy
Publisher
Elsevier Inc.
Abstract
Background: Heart transplantation (HT) recipients often report improved
quality of life and increased overall happiness, viewing the
transplantation as a rebirth and a second chance at life. However,
interpretations of normality vary among individuals. Understanding
patients' and caregivers' experiences in depth is crucial to adjust
clinical care paths and avoid complications. Objective(s): To examine
the experiences of patients and caregivers after cardiac transplantation.
 Method(s): A systematic search of the literature was performed from
January 1, 2013, to September 30, 2023, using the MEDLINE (PubMed), CINHAL
(EBSCO), SCOPUS, Web of Science, and Embase (OVID) databases. Full-text,
primary qualitative articles written in English, which reported patients'
experiences of daily life after HT, were included. Result(s): The
search yielded 5,114 articles; 13 articles that fully met the inclusion
criteria were selected for extraction and synthesis. The inductive
approach led to the identification of 28 codes, which were then grouped
into seven categories and three themes: 1) Undergoing an emotionally
charged journey, 2) Balancing personal health and social dynamics, and 3)
Fostering existential reflection. Conclusion(s): This review
underscores the importance of further research and the development of a
standardized assessment framework for post-HT patients, emphasizing the
need to consider not just clinical factors but also psychological and
personal aspects to improve outcomes and quality of life. Additionally,
the review identified a lack of comprehensive information about the
experiences of caregivers, highlighting the need for further studies to
better understand and support their roles in the post-transplant
journey. Copyright © 2024 The Author(s)

<67>
Accession Number
2030665607
Title
Effects of starting one lung ventilation and applying individualized PEEP
right after patients are placed in lateral decubitus position on
intraoperative oxygenation for patients undergoing thoracoscopic pulmonary
lobectomy: study protocol for a randomized controlled trial.
Source
Trials. 25(1) (no pagination), 2024. Article Number: 500. Date of
Publication: December 2024.
Author
Wang Q.-Y.; Zhou Y.; Wang M.-R.; Jiao Y.-Y.
Institution
(Wang, Zhou, Wang, Jiao) Department of Anesthesiology, Peking University
Third Hospital, NO. 49, North Garden Road, Haidian District, Beijing,
China
Publisher
BioMed Central Ltd
Abstract
Background: For patients receiving one lung ventilation in thoracic
surgery, numerous studies have proved the superiority of lung protective
ventilation of low tidal volume combined with recruitment maneuvers (RM)
and individualized PEEP. However, RM may lead to overinflation which
aggravates lung injury and intrapulmonary shunt. According to CT results,
atelectasis usually forms in gravity dependent lung regions, regardless of
body position. So, during anesthesia induction in supine position,
atelectasis usually forms in the dorsal parts of lungs, however, when
patients are turned into lateral decubitus position, collapsed lung tissue
in the dorsal parts would reexpand, while atelectasis would slowly
reappear in the lower flank of the lung. We hypothesize that applying
sufficient PEEP without RM before the formation of atelectasis in the
lower flank of the lung may beas effective to prevent atelectasis and thus
improve oxygenation as applying PEEP with RM. Method(s): A total of
84 patients scheduled for elective pulmonary lobe resection necessitating
one lung ventilation will be recruited and randomized totwo parallel
groups. For all patients, one lung ventilation is initiated the right
after patients are turned into lateral decubitus position. For patients in
the study group, individualized PEEP titration is started the moment one
lung ventilation is started, while patients in the control group will
receive a recruitment maneuver followed by individualized PEEP titration
after initiation of one lung ventilation. The primary endpoint will be
oxygenation index measured at T4. Secondary endpoints will include
intrapulmonary shunt, respiratory mechanics, PPCs, and hemodynamic
indicators. Discussion(s): Numerous previous studies compared the
effects of individualized PEEP applied alone with that applied in
combination with RM on oxygenation index, PPCs, intrapulmonary shunt and
respiratory mechanics after atelectasis was formed in patients receiving
one lung ventilation during thoracoscopic surgery. In this study, we will
apply individualized PEEP before the formation of atelectasis while not
performing RM in patients allocated to the study group, and then we're
going to observe its effects on the aspects mentioned above. The results
of this trial will provide a ventilation strategy that may be conductive
to improving intraoperative oxygenation and avoiding the detrimental
effects of RM for patients receiving one lung ventilation. Trial
registration: www.Chictr.org.cn ChiCTR2400080682. Registered on February
5, 2024. Copyright © The Author(s) 2024.

<68>
Accession Number
2035507729
Title
Predictive potential of pre-procedural cardiac and inflammatory biomarkers
regarding mortality following transcatheter aortic valve implantation: A
systematic review and meta-analysis.
Source
Heart and Lung. 69 (pp 229-240), 2025. Date of Publication: 01 Jan 2025.
Author
AziziKia H.; Mousavi A.; Shojaei S.; Shaker F.; Salabat D.; Bahri R.A.;
Dolama R.H.; Radkhah H.
Institution
(AziziKia) Student Research Committee, School of Medicine, Shahroud
University of Medical Sciences, Shahroud, Iran, Islamic Republic of
(Mousavi, Shojaei, Shaker, Salabat, Bahri, Dolama) School of Medicine,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Mousavi, Shojaei, Shaker, Salabat, Dolama) Tehran Heart Center,
Cardiovascular Diseases Research Institute, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Radkhah) Sina Hospital Department of Internal Medicine, Tehran, Iran,
Islamic Republic of
Publisher
Elsevier Inc.
Abstract
Background: Aortic stenosis (AS) is a common heart valve disease,
especially in aging populations. While surgical aortic valve replacement
(SAVR) is the standard treatment, many patients are ineligible.
Transcatheter aortic valve implantation (TAVI) offers an alternative,
especially for high-risk patients, but is not without complications.
Identifying biomarkers that predict post-TAVI mortality is essential for
optimizing outcomes. Objective(s): The purpose of this systematic
review and meta-analysis is to evaluate the role of cardiac and
inflammatory biomarkers in predicting short-term and mid to long-term
mortality following TAVI. Method(s): We searched PubMed, Scopus,
Embase, and Web of Science for studies examining the impact of
inflammatory and cardiac biomarkers on mortality following TAVI. Mean
differences (MDs) and 95 % confidence interval (CI) were calculated using
a random-effect model. Result(s): Twenty-eight studies involving
10,560 patients were included, with 1867 in the mortality group. Mortality
was significantly associated with higher pre-procedural levels of
creatinine (0.41; 95 % CI: [0.35, 0.48]), brain natriuretic peptide (0.58;
95 % CI: [0.43, 0.73]), C-reactive protein (0.55; 95 % CI: [0.45, 0.64]),
and white blood cell count (0.18; 95 % CI: [0.06, 0.31]), and lower
pre-procedural levels of hemoglobin (-0.49; 95 % CI: [-0.60, -0.38]) and
albumin (-0.18; 95 % CI: [-0.24, -0.13]). These associations remained
statistically significant in subgroup analyses for both mid to long-term
mortality and short-term mortality, except for WBC levels, which were not
significantly associated with short-term mortality, and Hb, for which
short-term data were insufficient. Platelet count showed no significant
difference. Conclusion(s): These findings highlight the importance of
inflammatory and cardiac biomarkers in risk stratification and patient
management in TAVI procedures. Copyright © 2024 Elsevier Inc.

<69>
Accession Number
2035502617
Title
The effects of thoracic epidural blockade on ventilation-perfusion
matching during one-lung ventilation: An exploratory study.
Source
Journal of Clinical Anesthesia. 99 (no pagination), 2024. Article Number:
111678. Date of Publication: December 2024.
Author
Wang Y.; Wei Y.; Chen G.; Wang Z.; Fan Y.; Wang J.; Yang Y.; Zhou D.;
Zhong M.
Institution
(Wang, Chen, Yang, Zhong) Department of Critical Care Medicine, Zhongshan
Hospital, Fudan University, Shanghai, China
(Wei, Zhong) Shanghai Institute of Infectious Disease and Biosecurity,
School of Public Health, Fudan University, Shanghai, China
(Wang, Fan, Wang, Zhou) Department of Anesthesiology, Zhongshan Hospital,
Fudan University, Shanghai, China
(Zhong) Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai,
China
Publisher
Elsevier Inc.
Abstract
Objective: Electrical impedance tomography (EIT) enables continuous image
acquisition, facilitating real-time measurements of ventilation and
perfusion at the clinical bedside. Experimental and clinical studies on
controversial effects of thoracic epidural blockade (TEB) with local
anesthetics on ventilation-perfusion(V/Q) matching and hypoxia during one
lung ventilation (OLV) are rare. The aim of this study was to use EIT to
investigate the effects of TEB combined with general anesthesia on
pulmonary perfusion distribution and V/Q matching during one-lung
ventilation. Design(s): Single-centered, prospective, unblinded,
randomized, parallel-group clinical trial. Setting(s): Surgical suite
of a university-affiliated teaching hospital. Patient(s): Thirty
patients prepared for thoracic surgery were randomly assigned to either
the control group or the TEB group, which received a combination of
thoracic epidural blockade and general anesthesia. Measurements: EIT
measurements and blood gas analysis were conducted in the lateral position
during two-lung ventilation(T<inf>0</inf>), 15 min after
OLV(T<inf>1</inf>), and 15 min after administration of 0.25 % ropivacaine
or 0.9 % saline via epidural delivery during OLV(T<inf>2</inf>).
Hemodynamic and respiratory parameters were recorded, and Dead Space%,
Shunt%, and V/Q Match% were calculated based on blood gas analysis and EIT
images. Result(s): Mean arterial pressure (p < 0.05) significantly
decreased 15 min after TEB, while there were no significant changes in
heart rate among the 30 patients (p = 0.547). OLV resulted in a
significant decrease in arterial oxygen partial pressure/inspired oxygen
fraction (PaO<inf>2</inf>/FiO<inf>2</inf>) from T<inf>0</inf> to
T<inf>1</inf> in both groups. The PaO<inf>2</inf>/FiO<inf>2</inf> in the
TEB group was significantly lower after epidural administration of the
local anesthetic (p < 0.05). Shunt- ABG (%) was significantly higher in
the TEB group compared to the control group at T<inf>2</inf> (p < 0.05).
TEB increased non-ventilated perfusion distribution(p < 0.05), and
Shunt-EIT % (p < 0.05) and reduced Matched Region % (p < 0.05), while Dead
Space-EIT % remained (p = 0.499). Conclusion(s): Based on the
contrast-enhanced EIT evaluation of pulmonary perfusion and ventilation,
TEB appears to induce a V/Q mismatch in patients undergoing OLV in the
lateral position for thoracic surgery. Trial registration:
ClinicalTrials.gov, NCT04730089. Registration on January 25th,
2021. Copyright © 2024

<70>
Accession Number
2035209223
Title
Use of wearable devices to monitor post-operative activity following
cardiac surgery: a systematic scoping review.
Source
European Journal of Cardiovascular Nursing. 23(7) (pp 697-710), 2024. Date
of Publication: 01 Oct 2024.
Author
Edney J.; McDonall J.; Khaw D.; Hutchinson A.F.
Institution
(Edney) Cardiac Surgery Department, Epworth HealthCare, 189 Bridge Rd
Richmond, Melbourne, VIC 3004, Australia
(McDonall, Khaw, Hutchinson) School of Nursing & Midwifery, Institute of
Health Transformation, Centre for Quality and Patient Safety Research,
Epworth Health Care Partnership, Deakin University, Melbourne, VIC,
Australia
Publisher
Oxford University Press
Abstract
Aims: There is an emerging trend of using wearable digital technology to
monitor patient activity levels in acute care contexts. However, the
overall extent and quality of evidence for their use in acute cardiac
surgery care are unclear. The purpose of this systematic scoping review
was to evaluate current literature regarding the use of wearable activity
trackers/accelerometers to monitor patient activity levels in the first 30
days following cardiac surgery. Method and results: A systematic scoping
review was conducted. A search of CINAHL and MEDLINE Complete databases
identified all peer reviewed research evidence published in English
between 2010 and 2023. Studies evaluating the use of wearable technology
in adults who had undergone coronary artery bypass graft surgery and valve
replacement were included. Study data were summarized thematically. A
total of 853 citations were identified. Once duplicates were removed, 816
studies were screened by title and abstract, 54 full-text studies were
assessed for eligibility, and 11 studies were included. Accelerometers
were able to capture changing exercise and physical activity levels over
an acute care admission. Device use was acceptable to clinicians and
patients. Low activity levels in the early post-operative period were
associated with longer length of stay and higher 30-day readmissions.
 Conclusion(s): Wearable devices are acceptable and feasible to use in
acute care. The use of wearable activity trackers by acute cardiac
patients may increase patient participation in exercise and identify more
sedentary patients who are a greater risk of increased length of stay and
hospital readmission. Copyright © 2024 The Author(s).

<71>
Accession Number
2035209197
Title
What are the determinants of change in walking fitness in patients with a
history of depression following cardiac rehabilitation?.
Source
European Journal of Cardiovascular Nursing. 23(7) (pp 756-762), 2024. Date
of Publication: 01 Oct 2024.
Author
Sever S.; Harrison A.; Doherty P.
Institution
(Sever, Harrison, Doherty) Department of Health Sciences, University of
York, York YO105DD, United Kingdom
(Sever) Department of Health Sciences, Usak University, Usak, Turkey
Publisher
Oxford University Press
Abstract
Aims: This study aims to investigate the demographic, clinical, and
service-level factors determining change in walking fitness in cardiac
rehabilitation (CR) patients with a history of depression following the CR
programme. Methods and Results: The National Audit of Cardiac
Rehabilitation clinical data were used to identify 1476 patients with a
history of depression who had their pre- and post-incremental shuttle walk
test (ISWT) recorded between 1 January 2016 and 31 January 2020. A
multiple linear regression was conducted to examine the determinants of
change in walking fitness (m) following CR. Mean age was 61 (SD 10.45),
and mean ISWT distance at baseline and outcome was 352.06m (SD 169.48) and
463.43m (SD 197.65), respectively. Multivariate analysis revealed that
change in walking distance reduced by 1.6m for each year increase in age
at baseline (P < 0.001). Females and unemployed patients had less
improvement in walking fitness (23.1 and 21.5, respectively). Having a
body mass index (BMI) > 30 was associated with lower improvement (24.2m, P
< 0.001), while physically active patients had 14.6m higher change. Higher
baseline ISWT quintiles were associated with less improvement, and
increased waiting time to start CR was associated with reduced change in
walking fitness following CR. Conclusion(s): Older age, female
gender, unemployment, higher baseline BMI, longer waiting time, and lower
physical activity were associated with reduced walking fitness improvement
in patients with a history of depression. Targeted intervention and prompt
access to CR can optimize outcomes. Copyright © 2024 The
Author(s).

<72>
[Use Link to view the full text]
Accession Number
2035089394
Title
Beta-Blocker Interruption or Continuation after Myocardial Infarction.
Source
New England Journal of Medicine. 391(14) (pp 1277-1286), 2024. Date of
Publication: 10 Oct 2024.
Author
Silvain J.; Cayla G.; Ferrari E.; Range G.; Puymirat E.; Delarche N.;
Guedeney P.; Cuisset T.; Ivanes F.; Lhermusier T.; Petroni T.; Lemesle G.;
Bresoles F.; Labeque J.-N.; Pommier T.; Dillinger J.-G.; Leclercq F.;
Boccara F.; Lim P.; des Horts T.B.; Fourme T.; Jourda F.; Furber A.;
Lattuca B.; Redjimi N.; Thuaire C.; Deharo P.; Procopi N.; Dumaine R.;
Slama M.; Payot L.; El Kasty M.; Aacha K.; Diallo A.; Vicaut E.;
Montalescot G.
Institution
(Silvain) ACTION Group, Sorbonne Universite, Pitie-Salpetriere Hospital,
Paris Institut de Cardiologie, 83 Boulevard de l'Hopital, Paris 75013,
France
(Silvain, Guedeney, Procopi, Aacha, Montalescot) Sorbonne Universite,
ACTION Group, INSERM Unite Mixte de Recherche (UMRS) 1166, Hopital
Pitie-Salpetriere Assistance Publique-Hopitaux de Paris (AP-HP), Paris,
France
(Puymirat) The Department of Cardiology, Hopital Europeen Georges
Pompidou, AP-HP, Universite Paris Cite, Paris, France
(Lemesle) FACT (French Alliance for Cardiovascular Trials), Paris, France
(Dillinger) The Department of Cardiology, Universite Paris Cite, Hopital
Lariboisiere, AP-HP, INSERM Unite 942, Paris, France
(Boccara) The Cardiology Department, Hopital Saint-Antoine, ACTION Group,
Sorbonne Universite, INSERM UMRS 938, Paris, France
(Slama) The Cardiology Department Hopital Bichat, AP-HP, Paris, France
(Diallo, Vicaut) Unite de Recherche Clinique, ACTION Group, Hopital
Fernand Widal (AP-HP), Paris, France
(Diallo, Vicaut) SAMM (Statistique, Analyse et Modelisation
Multidisciplinaire) EA 4543, Universite Paris 1 Pantheon Sorbonne, Paris,
France
(Cayla, Lattuca) The Cardiology Department, Nimes University Hospital,
Montpellier University, ACTION Group, Nimes, France
(Ferrari, Redjimi) The Cardiology Department, Pasteur University Hospital,
Nice, France
(Range, Thuaire) The Cardiology Department, Hopitaux de Chartres, ACTION
Group, Hopital Louis Pasteur, Chartres, France
(Delarche) Cardiology Department, Hopital Centre Francois Mitterrand de
Pau, Pau, France
(Cuisset, Deharo) Departement de Cardiologie, Centre
Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille
University, INSERM, Marseille, France
(Ivanes) The Cardiology Department, CHU Tours, INSERM Unite 1327,
ISCHEMIA, Universite de Tours, Tours, France
(Lhermusier) The Cardiology Department, CHU de Toulouse, Toulouse, France
(Petroni) The Cardiology Department, Clinique du Pont de Chaume,
Montauban, France
(Lemesle) The Heart and Lung Institute, University Hospital of Lille,
Institut Pasteur of Lille, INSERM Unite 1011-EGID, Lille, France
(Bresoles) The Cardiology Department, CHU d'Avignon, Avignon, France
(Labeque) The Cardiology Group of the Cote Basque, Bayonne, France
(Pommier) The Cardiology Department, CHU de Dijon Bourgogne, Dijon, France
(Leclercq) The Cardiology Department, CHU de Montpellier, Montpellier,
France
(Lim) The Cardiology Department, CHU Henri Mondor, Creteil, France
(des Horts) The Cardiology Department, Centre Hospitalier (CH)
Metropole-Savoie (Hopital Chambery), Chambery, France
(Fourme) The Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de
Grenoble, Grenoble, France
(Jourda) The Cardiology Department, CHU d'Auxerre, Auxerre, France
(Furber) Cardiology Department, CHU Angers et UMR Centre National de la
Recherche Scientifique (CNRS) 6015, INSERM Unite 1083 Equipe
Physiopathologie Cardiovasculaire, Unite de Formation et de Recherche
(UFR) Sante, Angers, France
(Dumaine) Grands Pres Cardiac Rehabilitation Centre, St. Denis, France
(Payot) The Cardiology Department, General Hospital Yves Le Foll,
Saint-Brieuc, France
(El Kasty) The Cardiology Department, Grand Hopital de l'Est Francilien
Site Marne-La-Vallee, Jossigny, France
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The appropriate duration of treatment with beta-blocker drugs
after a myocardial infarction is unknown. Data are needed on the safety
and efficacy of the interruption of long-term beta-blocker treatment to
reduce side effects and improve quality of life in patients with a history
of uncomplicated myocardial infarction. METHODS In a multicenter, open
label, randomized, noninferiority trial conducted at 49 sites in France,
we randomly assigned patients with a history of myocardial infarction, in
a 1:1 ratio, to interruption or continuation of beta-blocker treatment.
All the patients had a left ventricular ejection fraction of at least 40%
while receiving long-term beta-blocker treatment and had no history of a
cardiovascular event in the previous 6 months. The primary end point was a
composite of death, nonfatal myocardial infarction, nonfatal stroke, or
hospitalization for cardiovascular reasons at the longest follow-up
(minimum, 1 year), according to an analysis of noninferiority (defined as
a between-group difference of <3 percentage points for the upper boundary
of the two-sided 95% confidence interval). The main secondary end point
was the change in quality of life as measured by the European Quality of
Life-5 Dimensions questionnaire. RESULTS A total of 3698 patients
underwent randomization: 1846 to the interruption group and 1852 to the
continuation group. The median time between the last myocardial infarction
and randomization was 2.9 years (interquartile range, 1.2 to 6.4), and the
median follow-up was 3.0 years (interquartile range, 2.0 to 4.0). A
primary-outcome event occurred in 432 of 1812 patients (23.8%) in the
interruption group and in 384 of 1821 patients (21.1%) in the continuation
group (risk difference, 2.8 percentage points; 95% confidence interval
[CI], <0.1 to 5.5), for a hazard ratio of 1.16 (95% CI, 1.01 to 1.33;
P=0.44 for noninferiority). Beta-blocker interruption did not seem to
improve the patients' quality of life. CONCLUSIONS In patients with a
history of myocardial infarction, interruption of long-term beta-blocker
treatment was not found to be noninferior to a strategy of beta-blocker
continuation. Copyright © 2024 Massachusetts Medical Society.

<73>
Accession Number
2034302246
Title
Cardiac Papillary Fibroelastoma and Cerebrovascular Events: A Systematic
Review.
Source
CJC Open. 6(11) (pp 1259-1273), 2024. Date of Publication: November 2024.
Author
Neupane G.; Sharma R.; Parajuli R.; Mathews A.; Khalili H.
Institution
(Neupane) Department of Internal Medicine, Mercy Hospital, Springfield,
MO, United States
(Sharma) Department of Internal Medicine, Florida Atlantic University,
Boca Raton, FL, United States
(Parajuli) Odum School of Ecology, University of Georgia, Athens, GA,
United States
(Parajuli) Department of Geosciences, Florida Atlantic University, Boca
Raton, FL, United States
(Mathews) Department of Cardiology, Tampa General Hospital, FL, United
States
(Khalili) Department of Cardiology, Memorial Healthcare System, FL, United
States
Publisher
Elsevier Inc.
Abstract
Background: Cardiac papillary fibroelastomas (CPFs) are benign endocardial
tumours with embolic potential. This article is a systematic review to
identify the clinical profile, diagnosis, tumour characteristics, and
treatment modalities in patients with CPF presenting with stroke or
transient ischemic attack (TIA). Method(s): This systematic review
was conducted using the PubMed and Embase databases, including case
reports and/or series and observational studies (for a search period of up
until April 2022). A descriptive summary of case reports and/or series,
and a narrative summary of observational studies, were completed.
 Result(s): A total of 161 cases were identified from 133 case reports
and 11 case series. The mean age of patients was 54.8 years, and 46.6%
were male. TIA and stroke were reported in 32.3% and 67.8%, respectively.
The most common stroke territory was multiple brain sites (36.6%). The
mean tumour size was 11.8 mm. Most of the tumours were left-sided (98.7%).
The mitral valve was the most involved valve (38.9%), with the anterior
leaflet being the commonest site (61.3%). A total of 91.4% of tumours were
independently mobile; 10.6% of tumours missed by transthoracic
echocardiography were identified on transesophageal echocardiography.
Antiplatelet and anticoagulation treatment were used in 87.9% and 12.1% of
cases, respectively. Simple excision, valve repair, and valve replacement
were performed in 66.7%, 16.7%, and 16.7%, respectively. The logistic
regression model revealed that age was the only significant predictor; an
increase in the log-odds of recurrent cerebrovascular events occurred with
increasing age. Conclusion(s): CPFs are a differential diagnosis of
cryptogenic stroke, especially if the initial workup for stroke is
negative. Transesophageal echocardiography serves as a better imaging
tool, compared to transthoracic echocardiography, in identifying CPF.
Although the consensus for CPF management remains controversial, surgical
excision is the primary approach for left-sided CPF presenting as stroke
or TIA. Copyright © 2024 The Authors

<74>
Accession Number
2032035491
Title
Transplant Trial Watch.
Source
Transplant International. 37 (no pagination), 2024. Article Number: 13860.
Date of Publication: 2024.
Author
Knight S.R.; O'Callaghan J.M.
Institution
(Knight, O'Callaghan) Centre for Evidence in Transplantation, Nuffield
Department of Surgical Sciences, University of Oxford, Oxford, United
Kingdom
(Knight) Oxford Transplant Centre, Churchill Hospital, Oxford, United
Kingdom
(O'Callaghan) University Hospitals Coventry & Warwickshire, Coventry,
United Kingdom
Publisher
Frontiers Media SA

<75>
Accession Number
2030781326
Title
Prognostic implications of genotype findings in non-ischaemic dilated
cardiomyopathy: A network meta-analysis.
Source
European Journal of Heart Failure. 26(10) (pp 2155-2168), 2024. Date of
Publication: October 2024.
Author
Anastasiou V.; Papazoglou A.S.; Gossios T.; Zegkos T.; Daios S.; Moysidis
D.V.; Koutsiouroumpa O.; Parcharidou D.; Tziomalos G.; Katranas S.;
Rouskas P.; Didagelos M.; Karamitsos T.; Ziakas A.; McKenna W.J.;
Kamperidis V.; Efthimiadis G.K.
Institution
(Anastasiou, Gossios, Zegkos, Daios, Parcharidou, Tziomalos, Katranas,
Rouskas, Didagelos, Karamitsos, Ziakas, Kamperidis, Efthimiadis) 1st
Department of Cardiology, School of Medicine, Faculty of Health Sciences,
Aristotle University of Thessaloniki, Thessaloniki, Greece
(Papazoglou) Athens Naval Hospital, Athens, Greece
(Moysidis) 424 General Military Hospital, Thessaloniki, Greece
(Koutsiouroumpa) Evidence Synthesis Methods Team, Department of Primary
Education, School of Education, University of Ioannina, Ioannina, Greece
(McKenna) Institute of Cardiovascular Medicine, University College London,
London, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Aims: Evidence on the relative impact of diverse genetic backgrounds
associated with non-ischaemic dilated cardiomyopathy (DCM) remains
contradictory. This study sought to synthesize the available data
regarding long-term outcomes of different gene groups in DCM. Methods
and Results: Electronic databases were systematically screened to identify
studies reporting prognostic data on pre-specified gene groups. Those
included pathogenic/likely pathogenic (P/LP) variants, truncating titin
variants (TTNtv), lamin A/C variants (LMNA), and desmosomal proteins.
Outcomes were divided into composite adverse events (CAEs), malignant
ventricular arrhythmic events (MVAEs) and heart failure events (HFEs). A
total of 26 studies (n = 7255) were included in the meta-analysis and 6791
patients with genotyped DCM were analysed. Patients with P/LP variants had
a higher risk for CAEs (odds ratio [OR] 2.10, 95% confidence interval [CI]
1.67-2.65), MVAEs (OR 1.86, 95% CI 1.52-2.26), and HFEs (OR 2.01, 95% CI
1.08-3.73) than genotype-negative patients. The presence of TTNtv was
linked to a higher risk for CAEs (OR 1.78, 95% CI 1.20-2.63), but not
MVAEs or HFEs. LMNA and desmosomal groups suffered a higher risk for CAEs,
MVAEs, and HFEs compared to non-LMNA and non-desmosomal groups,
respectively. When genes were indirectly compared, the presence of LMNA
resulted in a more detrimental effect that TTNtv, with respect to all
composite outcomes but no significant difference was found between LMNA
and desmosomal genes. Desmosomal genes harboured a higher risk for MVAEs
compared to TTNtv. Conclusion(s): Different genetic substrates
associated with DCM result in divergent natural histories. Routine
utilization of genetic testing should be employed to refine risk
stratification and inform therapeutic strategies in DCM. Copyright
© 2024 The Author(s). European Journal of Heart Failure published by
John Wiley & Sons Ltd on behalf of European Society of Cardiology.

<76>
Accession Number
2034992801
Title
Does ozaki procedure have a future as a new surgical approach for aortic
valve replacement? A systematic review and meta-analysis.
Source
Annals of Medicine and Surgery. 85(9) (pp 4454-4462), 2023. Date of
Publication: 17 Jul 2023.
Author
Awad A.K.; Farahat R.A.; Gad E.R.; Abdelgalil M.S.; Hassaballa A.S.
Institution
(Awad, Gad, Abdelgalil) Faculty of Medicine, Cairo University, Cairo,
Egypt
(Awad, Abdelgalil, Hassaballa) Cardiothoracic Surgery Department, Faculty
of Medicine, Ain Shams University, Cairo University, Cairo, Egypt
(Farahat) Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh,
Egypt
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In 2014, Ozaki et al.introduced the neo-cuspidation (Ozaki
procedure), a new valve from the pericardium, to reduce or even prevent
the risk of chronic autoimmune inflammation and subsequent rejection or
valve degeneration.Thus, the authors aimed to assess the safety and
efficacy of the Ozaki technique in treating aortic valve
diseases.Materials and methods: A comprehensive search was performed via
PubMed, the Cochrane Library, Scopus, and the Web of Science up to 20
February 2022.Random-effects meta-analysis models were employed to
estimate the pooled mean and SD or event to the total of the Ozaki
procedure.Relevant records were retrieved and analyzed by OpenMeta analyst
software. Result(s): A total of 2863 patients from 21 studies were
finally included in our analysis.Ac.Ozaki technique showed statistical
significance in terms of mean cardiopulmonary bypass time of 148 mins (95%
CI 144-152.2, P < 0.001), mean aortic cross-clamp time of 112.46 mins (95%
CI 105.116, 119.823, P < 0.001), reoperation with a low risk of 0.011 (95%
CI 0.005, 0.016, P = 0.047), conversion to aortic valve replacement with a
low risk of 0.004 (95% CI - 0.001, 0.008, P = 0.392), finally ICU stay
(days) and hospital length of stay (days) with a mean of 2.061 days (95%
CI 1.535, 2.587, P < 0.001) and 8.159 days (95% CI 7.183-9.855, P <
0.001), respectively. Conclusion(s): The Ozaki procedure provides a
safe surgical technique with low mean cardiopulmonary bypass time and
aortic cross-clamp time; moreover, a mean of 2-day-postoperative hospital
stay was observed with the Ozaki procedure with a low risk of conversion
to aortic valve replacement, reoperation, ICU and hospital stay, and
death. Copyright © 2023 The Author(s).

<77>
Accession Number
2032095893
Title
Ectopic Calcification in Congenital Heart Surgery: A Material-Centric
Review.
Source
Pediatric Cardiology. (no pagination), 2024. Date of Publication: 2024.
Author
Watanabe T.; Yuhara S.; Leland J.T.; Spiess J.L.; Thodla A.; Ramachandiran
R.; Kelly J.M.; Shinoka T.; Breuer C.K.
Institution
(Watanabe, Yuhara, Leland, Spiess, Thodla, Ramachandiran, Kelly, Shinoka,
Breuer) Center for Regenerative Medicine, Research Institute at Nationwide
Children's Hospital, Columbus, OH, United States
(Kelly, Shinoka) The Heart Center, Nationwide Children's Hospital,
Columbus, OH, United States
(Shinoka) Department of Cardiothoracic Surgery, Nationwide Children's
Hospital, Columbus, OH, United States
(Breuer) Department of Surgery, Nationwide Children's Hospital, Columbus,
OH, United States
(Breuer) Department of Surgery, The Ohio State University College of
Medicine, Columbus, OH, United States
Publisher
Springer
Abstract
The modern congenital heart surgeon has an array of materials available
for cardiovascular repair. With advancements in the surgical outcomes for
pediatric cardiac defects, choice of material has become increasingly
dependent on late-term complications associated with each material.
Calcification is a leading long-term complication and is increasing in
prevalence with materials lasting longer in patients. Material
calcification can impair functionality, lead to subsequent complications,
and require additional interventions. A comprehensive literature review
was conducted to investigate ectopic calcification of commonly used
materials for congenital heart defect repair. Mechanisms of ectopic
calcification among commonly used materials were investigated. Ectopic
calcification is initiated by material-specific immunological reactions.
Recent efforts have focused on developing new materials that are not prone
to calcification. ePTFE was widely used in cardiovascular applications but
still has reported instances of calcification in various situations, such
as long-term use. Tissue engineering techniques have shown reduced
calcification in reports. Calcification can occur in all conventional
materials we reviewed and, in some cases, has led to life-threatening
complications. Favorable outcomes have been reported with
tissue-engineered materials, with the expectation of continued positive
results in future reports. With an array of synthetic and biological
materials now displaying acceptable surgical and short-term outcomes,
there is a pressing need to review the long-term viability of these
materials, especially considering improved patient survival to adulthood.
Furthermore, developing new materials to mitigate calcification remains a
promising avenue of research in this field. Copyright © The
Author(s), under exclusive licence to Springer Science+Business Media,
LLC, part of Springer Nature 2024.

<78>
Accession Number
2032095824
Title
The effect of spironolactone in reducing the risk of postoperative atrial
fibrillation in patients undergoing coronary artery bypass graft surgery:
randomized single-blind placebo-controlled study.
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2024. Date
of Publication: 2024.
Author
Farzaneh A.; Moradi M.; Safarpoor G.; Karamian A.
Institution
(Farzaneh, Moradi) Department of Cardiology, School of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Safarpoor) Department of Cardiac Surgery, Hamadan University of Medical
Sciences, Hamadan, Iran, Islamic Republic of
(Karamian) School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Springer
Abstract
Background: Postoperative atrial fibrillation (POAF), one of the most
common cardiac arrhythmias following coronary artery bypass graft (CABG)
surgery is associated with unfavorable outcomes. Objective(s): This
study investigated the effect of spironolactone administered two weeks
before surgery on the incidence of POAF in patients undergoing CABG.
 Method(s): This randomized single-blind placebo-controlled study was
conducted on 130 CABG patients. All patients were randomly divided into
intervention and control groups including 65 cases for each group. In the
intervention group, patients received 50 mg of spironolactone orally daily
for 2 weeks before surgery, and in the control group patients received
placebo daily from 2 weeks before surgery. All patients were continuously
monitored for the occurrence of POAF for two weeks postoperatively.
 Result(s): The mean age of the patients in the intervention and
control groups was 61.7 +/- 5.4 and 60 +/- 6.7 years, respectively. The
incidence of POAF in the intervention and control groups was 7.7% and 20%,
respectively (Odds Ratio = 0.33, P = 0.042). All demographic and clinical
variables were similar in patients with and without POAF (all P > 0.05).
 Conclusion(s): Our findings revealed that in comparison to placebo,
the use of spironolactone is associated with reduced incidence of POAF in
CABG candidates. Copyright © The Author(s), under exclusive
licence to The Japanese Association for Thoracic Surgery 2024.

<79>
Accession Number
2032095775
Title
Correction to: Superficial parasternal intercostal plane blocks in cardiac
surgery: a systematic review and meta-analysis (Canadian Journal of
Anesthesia/Journal canadien d'anesthesie, (2024), 71, 6, (883-895),
10.1007/s12630-024-02726-0).
Source
Canadian Journal of Anesthesia. (no pagination), 2024. Date of
Publication: 2024.
Author
Cameron M.J.; Long J.; Kardash K.; Yang S.S.
Institution
(Cameron, Long, Kardash, Yang) Faculty of Medicine, McGill University,
Montreal, QC, Canada
(Cameron) Department of Anesthesia, Jewish General Hospital, K1401-3755
Cote Sainte Catherine, Montreal, QC H3T 1E2, Canada
(Cameron, Yang) Lady Davis Research Institute, Montreal, QC, Canada
(Kardash, Yang) Department of Anesthesia, Jewish General Hospital,
Montreal, QC, Canada
Publisher
Springer
Abstract
The correct reference for reference 19 is Kumar et al., 2021.1
Reference 32 should have been reference 21 of the manuscript, Zhang et
al., 2022.2 References 33 to 38 have been renumbered to
correspond to the order in which they appear. Copyright ©
Canadian Anesthesiologists' Society 2024.

<80>
Accession Number
2035415921
Title
Anesthetic Management of Intracardiac Migration of Medical Devices.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2024.
Date of Publication: 2024.
Author
Holloway J.; Lee M.; Stephens B.; Byun W.Y.; Saklayen S.; Anam K.; Awad H.
Institution
(Holloway, Saklayen, Anam, Awad) Department of Anesthesiology, The Ohio
State University, Columbus, OH, United States
(Lee) College of Nursing, Nurse Anesthesia Program, Otterbein University,
Columbus, OH, United States
(Stephens) Department of Anesthesiology & Perioperative Medicine,
University of Pittsburgh Medical Center, Pittsburgh, PA, United States
(Byun) College of Medicine, The Ohio State University, Columbus, OH,
United States
Publisher
W.B. Saunders
Abstract
The use of endovascular, percutaneous interventions to treat cardiac,
arterial, and venous pathologies is becoming increasingly common in
medical practice. While endovascular device placement typically carries a
low risk, device migration remains a persistent problem with these
procedures for which anesthesia providers must have a high index of
suspicion. Anesthesia providers should be aware of the wide range of
indications for such devices, potential migration locations, and
hemodynamic consequences of both the inciting pathology and device
migration so they can safely care for patients in these settings. This
article aims to discuss a case series of five different device migration
events, review the literature surrounding the migration of each device,
and propose unique anesthetic considerations as well as a systematic
approach by which to approach these complications. Copyright ©
2024 Elsevier Inc.

<81>
Accession Number
645676352
Title
Comparing Intravascular Volume Status and Intraoperative Hypotension in
Elective ERAS Patients Versus Inpatient Urgent Surgery Patients.
Source
Anesthesia and Analgesia. Conference: Annual Meetings of the International
Anesthesia Research Society and Society of Critical Care
Anesthesiologists, IARS and SOCCA 2023. Denver, CO United States. 136(5
Supplement) (pp 839-840), 2023. Date of Publication: May 2023.
Author
Wrobel J.; Magin J.; Flynn D.; McLean D.; Grant S.
Institution
(Wrobel, Flynn) University of North Carolina, Chapel Hill School of
Medicine, United States
(Magin, McLean, Grant) University of North Carolina, School of Medicine,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Hypotensive episodes during surgery have been shown to
increase the risk of subsequent organ injury and mortality.1,2 As part of
Enhanced Recovery After Surgery (ERAS) protocols, select elective surgery
patients are given a carbohydrate rich beverage 2 hours before their
procedure which has traditionally been aimed at reducing postoperative
nausea and vomiting.3,4 However, no studies have been performed to assess
the effects of a preoperative carbohydrate beverage on post-induction
hypotension. The primary objective of this study was to compare the
incidence of post-induction hypotension between patients subject to the
ERAS protocols and inpatients undergoing urgent surgery, who are often
fasted from midnight prior to their surgery.5 Additionally, we aimed to
compare inferior vena cava (IVC) collapsibility index, a non-invasive
estimate of intravascular volume status, between these two groups and
assess its ability to predict post-induction hypotension as previous
studies have suggested.6,7 Methods: This prospective, observational study
included spontaneously breathing patients over the age of 18 at a single
center with no known history of heart failure or valvular disease. A total
of 25 ERAS and 25 inpatient, urgent patients undergoing various
non-cardiac surgeries were recruited. Bedside ultrasound was used to
measure IVC collapsibility in the preoperative holding area. Blood
pressure measurements and drug administration for the 10 minutes after
induction of general anesthesia were pulled from patients' charts.
Hypotensive episodes were characterized by a drop in mean arterial
pressure (MAP) below 60 mmHg, a decrease in MAP greater than 20 percent
from baseline, or administration of vasopressors or positive inotropes
during the 10 minutes following induction. Mean IVC collapsibility between
ERAS and inpatients were compared by two-sample t-test. Comparison of
incidence of hypotensive episodes between ERAS and inpatients was done by
chi-squared test. A receiver operating characteristic (ROC) curve was
created to assess the utility of IVC collapsibility as a screening tool
for post-induction hypotension. Result(s): Post-induction hypotension
was more common among inpatients (60.0%, 95% CI 48.4-82.8%) than ERAS
patients (40.0%, 23.4-59.3%; p=0.047). Average IVC collapsibility was
higher for inpatients (56.8%, 52.5 61.1%) compared to ERAS patients
(40.0%, 33.4-46.6%; p<0.001). The IVC collapsibility ROC area under the
curve was 0.634 (0.486-0.766). Conclusion(s): These results suggest
that inpatients are at greater risk of post-induction hypotension and have
lower intravascular volume prior to surgery compared to patients subject
to ERAS protocols. However, this study found IVC collapsibility to be a
relatively poor predictor of post-induction hypotension compared to
previous studies.7 Future work should focus on determining whether
preoperative fluid interventions can lower inpatient's risk of
post-induction hypotension during surgery. (Figure Presented).

<82>
Accession Number
645675833
Title
The Association of Perioperative Dexmedetomidine Utilization with Kidney
Transplant Outcomes - A Systematic Review and Meta-Analysis.
Source
Anesthesia and Analgesia. Conference: Annual Meetings of the International
Anesthesia Research Society and Society of Critical Care
Anesthesiologists, IARS and SOCCA 2023. Denver, CO United States. 136(5
Supplement) (pp 907-908), 2023. Date of Publication: May 2023.
Author
Azevedo T.; Soares J.; Pasqualotto E.; Rodrigues A.C.L.F.; Nogueira B.V.;
Navarro J.S.F.; Gosling A.
Institution
(Azevedo) Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Brazil
(Soares) Hospital Geral de Goiania, Brazil
(Pasqualotto) Federal University of Santa Catarina, Brazil
(Rodrigues) Department of Medicine, Positivo University, Brazil
(Nogueira) Serra dos Orgaos University Center, Brazil
(Navarro) Federal University of Mato Grosso, Brazil
(Gosling) University of Alabama at Birmingham, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Dexmedetomidine, is a highly selective alpha-2 agonist.
Perioperative administrationuse of dexmedetomidine has been associated
with improved renal outcomes in cardiac surgery. Recently, more data have
emerged in non-cardiac surgery populations. Several mechanisms might play
a role in the renoprotective effects of dexmedetomidine, such as the
inhibition of renin release, increased glomerular filtration rate, and
increased excretion of sodium and water. Whether dexmedetomidine is
associated with improved outcomes in patients undergoing kidney
transplantation remains unclear. We performed a systematic review and
meta-analysis comparing the perioperative use of dexmedetomidine versus
placebo in patients undergoing kidney transplantation. Method(s): We
searched the Medline, Embase, and Cochrane databases for trials published
up to July 20, 2022 using the following terms: "dexmedetomidine",
"kidney", "renal", "renoprotection", "transplant". All steps were
conducted in compliance with the Cochrane's Handbook for Systematic
Reviews and PRISMA's checklist. This systematic review and meta-analysis
was also registered in PROSPERO. Quality assessment was performed per
Cochrane recommendations. Odds ratios (OR) with 95% CI were pooled across
trials. The primary endpoint of interest was the presence of delayed graft
function. Acute rejection was chosen as a secondary outcome.
 Result(s): A total of 140 studies were initially screened. 5 studies
met inclusion criteria, being 4 randomized controlled trials (RCT) and 1
observational study, with a total of 1119 patients. Dexmedetomidine
utilization was associated with reduced delayed graft function (OR 0.71;
95% CI 0.52-0.97; p=0.03; I2 =0%). There was no difference between
dexmedetomidine and placebo regarding acute rejection (OR 0.75; 95% CI
0.42-1.34; p=0.67; I 2 =0%). The intervention varied in relation to dose
and timing of administration. A subgroup analysis was conducted including
studies with only intraoperative infusion of dexmedetomidine. There was no
difference in the incidence of DGF (OR 0.72; 95% CI 0,23-2,24; p=0.57; I 2
=0%) or acute rejection (OR 0.84; 95% CI 0.28-2.53; p=0.76; I2 =0%). The
quality assessment was conducted in compliance with Cochrane's Handbook
for Systematic Reviews. One observation study presented a moderate risk of
bias and one RCT was classified as high. The studies showed a symmetrical
distribution according to weight of outcomes on funnel plot analysis.
 Conclusion(s): In this meta-analysis, perioperative dexmedetomidine
utilization was associated with reduced delayed graft function in patients
undergoing kidney transplantation. Dexmedetomidine may be considered as an
adjuvant during the perioperative care of renal transplant patients. More
studies are needed to establish whether it may influence affect other
patient centered outcomes. (Figure Presented).

<83>
Accession Number
645675728
Title
Concurrent Cerebral Desaturation and EEG Burst Suppression in Cardiac
Surgery Patients.
Source
Anesthesia and Analgesia. Conference: Annual Meetings of the International
Anesthesia Research Society and Society of Critical Care
Anesthesiologists, IARS and SOCCA 2023. Denver, CO United States. 136(5
Supplement) (pp 472-476), 2023. Date of Publication: May 2023.
Author
Ramachandran R.V.; Behera A.; Orui H.; Hussain Z.; Peck J.;
Ananthakrishnan A.; Al-Dhamen Z.; Mathur P.; Banner-Goodspeed V.;
Muehlschlegel J.; Pittet J.-F.; Bardia A.; Schonberger R.; Marcantonio E.;
Kveraga K.; Subramaniam B.
Institution
(Ramachandran, Behera, Orui, Hussain, Peck, Ananthakrishnan, Al-Dhamen,
Mathur, Banner-Goodspeed, Marcantonio, Kveraga, Subramaniam) Beth Israel
Deaconess Medical Center, Harvard Medical School, United States
(Muehlschlegel) Brigham and Women's Hospital, United States
(Pittet) University of Alabama at Birmingham, United States
(Schonberger) Yale School of Medicine, Department of Anesthesiology,
United States
(Bardia) Massachusetts General Hospital, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The use of raw electroencephalogram (EEG) parameters as
opposed to processed EEG is a promising development in the perioperative
management of brain health. Intraoperative EEG burst suppression is
associated with increased postoperative delirium (1). An algorithm
combining processed EEG with cerebral oximetry was proposed to reduce
burst suppression in a clinical case series (2). The incidence of
simultaneous EEG burst suppression and cerebral desaturation is unknown.
 Method(s): In a multisite randomized controlled trial evaluating
postoperative intravenous acetaminophen for the prevention of
postoperative delirium, blinded EEG and cerebral oxygen desaturation was
collected with the SEDLine monitor. We analyzed 13,577 intraoperative
single site observations at one-minute intervals from 51 patients. The
inclusion and exclusion criteria have been previously published (3). 6,825
minute interval observations were used for adjusted analysis. Burst
suppression events were defined as observations with Suppression Ratio >0.
Cerebral oximetry measurements were obtained from right and left cerebral
hemispheres and desaturation events were defined as cerebral oximetry
values <60% (4). Association between burst suppression and cerebral
desaturation was analyzed using Pearson's Chi-squared test. Burst
suppression was compared using the generalized linear mixed effect model
with compound symmetry as the covariance matrix with cerebral
desaturation, age, gender, BMI, and inhalational anesthetic concentration
values as covariates. Result(s): Of the 13,577-minute interval
events, 21% had burst suppression and 47% had cerebral desaturations
(either left or right, Table 1). Co-existing desaturation and burst
suppression was seen in 12% of these events. Associations of burst
suppression with only left or right sided cerebral desaturations are shown
in Table 2. The odds of a significant burst suppression event having a
co-existing cerebral desaturation (left or right) was 1.6 [1.5 - 1.8], p <
0.01) compared to events without burst suppression. On adjusted analysis,
the association was still significant (OR 1.8 [1.5 - 2.3], p <0.001), as
shown in Table 3. Conclusion(s): Significant association was seen
between burst suppression events and cerebral desaturations in cardiac
surgery patients. Further exploration is required with simultaneous
monitoring of oxygen desaturation with routine EEG to determine causality
of burst suppression (anesthetic vs. reduced perfusion). (Figure
Presented).

<84>
Accession Number
645675513
Title
The Diagnostic Utility of Urinary IL-18 and TIMP2 in AKI after
Cardiopulmonary Bypass.
Source
Anesthesia and Analgesia. Conference: Annual Meetings of the International
Anesthesia Research Society and Society of Critical Care
Anesthesiologists, IARS and SOCCA 2023. Denver, CO United States. 136(5
Supplement) (pp 145-149), 2023. Date of Publication: May 2023.
Author
Wiredu K.; O'Connor S.; Premraj L.; Perez D.G.; Valencia J.; Naseem H.;
Shaefi S.
Institution
(Wiredu, Premraj) Massachusetts General Hospital, United States
(O'Connor, Perez, Valencia, Naseem, Shaefi) Beth Israel Deaconess Medical
Center, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Acute kidney injury (AKI) is a common complication following
cardiac surgery with cardiopulmonary bypass (CPB).[1-3] Characterized by
the rapid deterioration of kidney function in the immediate postoperative
period, AKI after CPB (AKI-CPB) is an important predictor of in-hospital
morbidity and postoperative stroke, increased dependence on renal
replacement therapy, and longer length of hospitalization.[4-6] In the
long-term, patients are at a higher risk of all-cause mortality and rapid
progression to chronic kidney disease.[7, 8] The incidence rate varies
widely between 18 - 30%. The complex etiology of AKI-CPB underscores the
need for definitive molecular signatures to allow for accurate
identification of cases. Recent biomarker studies from plasma have
provided clarity on the potential role of iron metabolism, heme toxicity,
and oxidative stress in the development of AKI-CPB.[9-11] However, it
remains unclear whether biomarkers tested from less-invasive and easily
accessible biofluids, such as urine, offer similar diagnostic utility. In
this current study, we sought to examine the diagnostic and/or prognostic
utility of four biomarkers of acute kidney injury: insulin-like growth
factor-binding protein 7 (IGFBP7), neutrophil gelatinase-associated
lipocalin (NGAL), metalloproteinase inhibitor 2 (TIMP2) and interleukin-
18 (IL-18) in a population of patients who were randomized to receive
normoxia or hyperoxia during cardiac surgery with CPB. Method(s): In
a nested case-control design, urine samples at baseline, post-CPB and on
postoperative day one (PO1) from 52 age- and sex-matched participants were
analyzed for levels of IGFBP7, NGAL, TIMP2 and IL-18. All data were
acquired using a custom plex biomarker panel for human kidney injury (Eve
Technologies, Canada). Univariate analyses were conducted to examine the
trends in these urinary biomarkers over time. Multivariate analyses,
adjusted for age, biological sex, bypass time, cross-clamp time and
interaction between biomarker levels and oxygen treatment, were also
performed. Structural equation modeling was the basis for mediation
analyses of biomarkers between perioperative oxygen exposure and KDIGO AKI
outcome. Lastly, the prognostic and/or diagnostic utility of biomarkers
was established using receiver operator curve (ROC) analyzes. All analyses
were performed in R language for statistical computing, at a significance
level, alpha <= 0.05. Result(s): 23 subjects (44%) demonstrated AKI
with at least KDIGO stage 1. There were no statistically significant
differences in age, biological sex, body mass index, CPB duration, or
cross-clamp time (XCT) (Table 1). Although IGFBP7 and TIMP2 levels
increased significantly after CPB and decreased toward baseline levels at
PO1, IL-18 and NGAL levels consistently increased over time beyond
baseline levels (Figure 1). Except for baseline levels of IL-18 which were
higher for patients who later developed AKI, all remaining biomarkers were
not significantly different by KDIGO stage of study subject across time
(Table 2). After adjusting for age, biological sex, and BMI, baseline
levels of IL-18 remained a significant predictor of AKI (beta = 0.19, p =
0.04). We found that higher levels of IL-18 at baseline were associated
with higher odds of worse AKI outcome (OR = 2.53, 95% CI = 1.21 - 5.77).
Furthermore, there was a significant interaction effect between TIMP2
levels on PO1 and perioperative oxygen treatment, such that lower TIMP2
levels protected patients with AKI in those who received hyperoxia (OR =
0.31, 95% CI = 0.08 - 0.87). However, we did not find any of the measured
biomarkers to significantly mediate the relationship between perioperative
oxygen treatment and AKI outcomes. Using ROC analyses (Figure 2), the
precision of baseline IL-18 levels in predicting subjects with AKI was
72.9% (58.2 - 87.6%). Similarly, the classification accuracy of the PO1
levels of TIMP2 to discriminate subjects with AKI after perioperative
oxygen treatment was 75.4% (59.8 - 90.8%). Conclusion(s): Our data
suggest that biomarker levels to aid the identification of subjects with
AKI may be possible using easily accessible biofluids such as urine.
Although higher baseline levels of IL-18 predicted a worse AKI outcome in
our cohort, lower levels of TIMP2 after surgery may suggest favorable
outcomes. Our findings warrant further studies to definitively establish
the prognostic value of IL-18 and the diagnostic utility of TIMP2 in
patients undergoing cardiac surgery with CPB.

<85>
Accession Number
645676060
Title
Norepinephrine versus Phenylephrine for Treating Hypotension During
General Anesthesia in Adult Patients Undergoing Major Non-Cardiac Surgery:
Multicenter, Open-Label, Cluster-Randomized Trial (VEGA-1 trial).
Source
Anesthesia and Analgesia. Conference: Annual Meetings of the International
Anesthesia Research Society and Society of Critical Care
Anesthesiologists, IARS and SOCCA 2023. Denver, CO United States. 136(5
Supplement) (pp 104-106), 2023. Date of Publication: May 2023.
Author
Legrand M.; Kothari R.; Fong N.; Palaniappa N.; Boldt D.; Chen L.-L.;
Kurien P.; Gabel E.; Sturgess-Daprato J.; Harhay M.; Pirracchio R.; Bokoch
M.
Institution
(Legrand, Fong, Palaniappa, Kurien, Harhay) UCSF, San Francisco, United
States
(Kothari) Thomas Jefferson University Hospital, San Francisco, United
States
(Boldt, Gabel) UCLA Medical Center, San Francisco, United States
(Chen, Sturgess-Daprato) University of California San Francisco, San
Francisco, United States
(Pirracchio) UCSF Departmnent of Anesthesia, San Francisco, United States
(Bokoch) University of California, San Francisco, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Treatment of intraoperative hypotension prevents
postoperative complications. The use of vasopressors is often required to
correct anesthesiainduced hypotension. The best first-line vasopressor has
not been established. The goal of this study was to to evaluate the
feasibility of a cluster-randomized trial to compare phenylephrine vs
norepinephrine as the first-line vasopressor and the impact of drug choice
on outcomes. Method(s): Multicenter, open-label, cluster-randomized
trial in Five hospitals in California. Amng patients undergoing major
non-cardiac surgery under general anesthesia we randomized centers to use
continuous intravenous phenylephrine (PE) vs norepinephrine (NE) infusion
as the first-line vasopressor. First-line vasopressor alternated monthly
at each hospital for 6 months. Primary endpoint was first-line vasopressor
administration compliance. Secondary endpoints were acute kidney injury
(AKI), 30-day mortality, myocardial injury after non-cardiac surgery
(MINS), adverse cardio-renal events, hospital length of stay, and
rehospitalization via the emergency department within 30 days.
 Result(s): 3626 patients were enrolled over 6 months at each site;
1809 patients were randomized in the NE group, 1817 in the PE group. All
randomized patients were analyzed. 88.2% received the assigned firstline
vasopressor. Doses of vasopressors received significantly differed between
groups (Figure 1). No drug infiltrations requiring treatment were reported
in either group. Patients were median 63 years old, 50% female, 58% white.
Median duration of surgery was 230 minutes. Blood pressure was not
diffeent between groups (Figure 2). AKI occurred in 9.4% in the NE vs 8.9%
in the PE group (p=0.6), 30-day mortality was 1.1% in the NE vs 1.2% in
the PE group (p=0.868), MINS 2.4% in the NE vs 2.1% in the PE group
(p=0.312), emergent rehospitalization occurred in 3.1% in the NE vs 3.6%
in the PE group (p=0.257). Hospital length of stay was 4.06 (Q1-Q3
2.10-7.03) days in the NE vs 4.10 (2.08- 7.46) days in the PE group
(p=0.257). In a generalized, linear, mixed-effects model, randomization in
the NE group vs PE group was not significantly associated with post
operative outcomes. Adjusted odds of AKI 0.91 (0.27, 3.02; p=0.873),
30-day mortality 0.89 (0.21, 3.73; p=0.869), MINS 1.18 (0.36, 3.85;
p=0.782), adverse cardio-renal events 1.44 (0.35, 5.94; p=0.615),
readmission via the ED within 30 days in the NE group compared to the PE
group was 0.25 (95% CI 0.05, 1.23; p=0.087, Figure 3). No subgroups were
associated with significantly increased odds of developing AKI when
randomized to the NE versus the PE group. Conclusion(s): In this
multicenter pragmatic trial, we successfully randomized patients
undergoing major surgery under general anesthesia to receive
norepinephrine or phenylephrine infusion as the first-line vasopressors.
Wedid not observe statistically significant differences in postoperative
outcomes, but the trial was not powered for these outcomes.

<86>
Accession Number
645675954
Title
Erythropoietin With and Without Iron Therapy for Perioperative Anemia in
Cardiac Surgery: A Systematic Review and Network Meta-Analysis.
Source
Anesthesia and Analgesia. Conference: Annual Meetings of the International
Anesthesia Research Society and Society of Critical Care
Anesthesiologists, IARS and SOCCA 2023. Denver, CO United States. 136(5
Supplement) (pp 92-95), 2023. Date of Publication: May 2023.
Author
Xu F.W.X.; Cheong A.J.Y.; Fong K.Y.; Chia C.Y.E.; Jain S.R.; Ho C.Y.; Ng
K.T.; Sim M.A.; James J.J.; Chew S.T.H.; Ti L.K.
Institution
(Xu, Cheong, Chia, Ho, Ng, Sim, James, Chew) National University of
Singapore, Singapore
(Fong) Yong Loo Lin School of Medicine, National University of Sing,
Singapore
(Jain) Yong Loo Lin School of Medicine, Singapore
(Ti) National University Health System, Singapore
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Preoperative anemia affects 25-40% of cardiac surgical
patients,1,2 and is associated with greater transfusion requirements,
morbidity and mortality. 3-5 Therapeutic options include Erythropoietin
(EPO) and Iron. While intravenous iron is recommended as a first line
agent,6 its benefits are debatable.7,8 EPO has been widely used in mixed
surgical cohorts, but remains non-FDA approved for use in cardiac surgery
due to prior concerns of thromboembolic complications and mortality. 9 In
recent times, EPO has been used in Enhanced Recovery After Cardiac Surgery
(ERACS) programmes, but has yet to be formally inducted into guidelines.10
Our systematic review and network meta-analysis aims to evaluate the
safety and efficacy of perioperative EPO and Iron use in cardiac surgery.
 Method(s): A systematic review and meta-analysis was undertaken
following PRISMA guidelines. A comprehensive search of PubMed, Embase and
Cochrane was conducted up to 1 May 2022. We included all randomised
controlled trials (RCTs) and cohort studies meeting our inclusion
criteria: (1) involved adult patients undergoing cardiac surgery; (2)
administered EPO perioperatively, with or without iron; (3) reported
outcome data on blood transfusion requirements, incidence of postoperative
complications like cardiac surgery associated acute kidney injury
(CSA-AKI), stroke and myocardial infarction, length of hospitalisation and
allcause mortality. Study quality was assessed using the Cochrane Risk of
Bias 2.0 tool for randomised studies and the Newcastle-Ottawa Scale for
cohort studies. Result(s): Of 743 citations, 34 randomised controlled
trials and cohort studies totalling 4474 subjects were included, comparing
EPO, EPO with Iron, Iron and placebo. Our network analysis showed reduced
transfusion risk with EPO-Iron use, compared to Iron alone (OR 0.59; 95%CI
0.41 to 0.85; I2=85%). EPO use correlated with reduced volume blood
transfusion compared to placebo (OR -0.65; 95%CI -0.91 to -0.39, I2=17%).
Preoperative EPO administration was associated with reduced CSA-AKI
incidence (OR 0.59; 95%CI 0.35 to 0.99; I2=62%). Regarding its safety
profile, EPO use did not increase risk of thromboembolic events including
myocardial infarction and stroke, length of hospitalisation or mortality.
 Conclusion(s): While cardiac surgical guidelines have yet to include
EPO in preoperative anemia treatment, our findings suggest that its
benefits are multifold. EPO is efficacious in lowering blood transfusion
requirements and CSA-AKI occurrence. Moreover, combining EPO with Iron has
synergistic effects in reducing transfusion risk compared to Iron alone.
Despite prior concerns of thromboembolic complications or mortality, our
study suggests no significant risk increment with EPO use. The optimal EPO
dosage, length of therapy, and post-treatment hemoglobin targets would be
best answered by future RCTs.

<87>
Accession Number
645675934
Title
Local Anesthetic Dosing and Toxicity of Truncal Catheters: A Systematic
Review and Regression Analysis.
Source
Anesthesia and Analgesia. Conference: Annual Meetings of the International
Anesthesia Research Society and Society of Critical Care
Anesthesiologists, IARS and SOCCA 2023. Denver, CO United States. 136(5
Supplement) (pp 928-930), 2023. Date of Publication: May 2023.
Author
Fettiplace M.; Bungart B.; Joudeh L.
Institution
(Fettiplace, Bungart, Joudeh) Massachusetts General Hospital, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Truncal local-anesthetic catheters arose following the
popularization of paravertebral catheters by Sabanathan and colleagues in
1988.1 Despite more than 30 years of use, the characterization of dosing
is sparse. Expert recommendations advise a 400 mg daily limit of
bupivacaine2, 770 mg daily limit of ropivacaine (package insert) and
0.1-0.3 mg/kg/hr in pediatrics3. As such, we conducted a systematic review
to characterize the dose, administration details and complications of two
of the most frequent truncal blocks: the paravertebral block (PVB) and the
transversus abdominis plane (TAP) block. Method(s): Institutional
Review Board exempted full review. The study was registered in PROSPERO.
We conducted a systematic review of the literature and identified studies
of PVB or TAP catheters using bupivacaine or ropivacaine and extracted
data including concentration and volume of bolus, infusion and
breakthrough doses along with duration, complications, adjuvants, local
anesthetic systemic toxicity and toxic blood levels. Bolus dose, infusion
dose, and cumulative 24 hour doses were calculated on a patient specific
level in Matlab. Statistical analysis in Prism compared numerical data
with t-tests or Mann Whitney-U tests for dosing comparisons. Linear
regression was conducted on a patient level to identify contributors to 24
hour dose based on R2 and convergence of slope term; subsequent
multiple-linear regression incorporated terms on an infusion level in a
step-wise fashion based on R2 and p-value while maintaining
multicollinearity variance inflation factor <4.0 and normality of
residuals. Result(s): Screening identified 548 articles on PubMed and
932 articles on Europe PMC. Following exclusions, we extracted data from
252 papers with data from 32 pediatric studies, 108 adult bupivacaine
studies and 121 adult ropivacaine studies with a total of 6802 adult
patients and 331 pediatric patients. Mean adult dosing for bupivacaine
over 24 hours was 6.0 mg/ kg (95%CI 2.1 - 13.6) and maximum was 7.5mg/kg
(2.1 - 13.4, n=3223) translating to 420mg and 525mg in a 70 kg patient
(Figure 1). Mean adult dosing for ropivacaine over 24 hours was 7.75 mg/kg
(95%CI 2.1 16.1, n=3579) and maximum was 9.3mg/kg (95%CI: 2.2.-19.6)
translating to 543mg and 651mg in a 70 kg patient (Figure 1).
Multiple-linear regression of adult data converged (261 degrees of
freedom, R2 =0.95) with normal residuals (D'Agostino K2 = 0.23, p=0.89)
and multiple factors contributing to the 24 hour dose (Table 1). Patient
weight, age, on-demand delivery, PVB vs. TAP, duration of infusion and
level did not contribute to 24 hour dose. Mean pediatric dosing for
bupivacaine over 24 hours was 0.29 mg/kg/hr (0.12 - 1.0, n=172, Figure 2)
and maximum dosing was 0.5 mg/kg/hr (0.12 - 1.0). Mean pediatric dosing
for ropivacaine over 24 hours was 0.5 mg/kg/hr (range: 0.2 - 0.68, n=213,
Figure 2) and maximum dosing was of 0.5 mg/kg/hr (0.2 - 0.75).
Multiple-linear regression converged (42 degrees of freedom, R2 = 0.89)
with normal residuals (D'Agostino K2 = 2.0, p=0.37) and multiple factors
contributing to the 24 hour dose (Table 2). On demand use, infusion rate,
year of publication and patient age of less than 6 months did not
contribute to dose. There were 29 reports of toxicity, 17 from ropivacaine
in adults, 12 from bupivacaine in adults and 0 in pediatrics with at least
67 additional reports of toxic blood levels (Table 3). Excluding case
reports, toxicity occurred in 26 of the 6939 patients (0.4%) with symptoms
of toxicity ranging from tinnitus to death. A disproportionate amount of
toxic events occurred in cardiac cases (n=11) and at least two cases
occurred following breakthrough dosing. Conclusion(s): Mean total
dosing of bupivacaine and ropivacaine in the published literature
frequently exceeded recommendations with linear regression indicating
modifiable risk factors for high dose. Given the expansion of truncal
regional anesthesia,4 patient safety would benefit from more specific
dosing recommendations including weight-based dosing, break-through dosing
and recommendations about continuous infusion versus intermittent bolus
methods. Data also indicate the need for prospective evaluation about safe
dosing of intermittent bolus catheters (based on their lower total doses)
and dosing in high risk groups including cardiac surgery patients who may
suffer from reduced cardiac output or hepatic dysfunction elevating the
risk of toxicity. (Figure Presented).

<88>
Accession Number
645675910
Title
Comparative Post-Operative Outcomes of Volatile and Intravenous
Anesthetics: A Network Meta- Analysis.
Source
Anesthesia and Analgesia. Conference: Annual Meetings of the International
Anesthesia Research Society and Society of Critical Care
Anesthesiologists, IARS and SOCCA 2023. Denver, CO United States. 136(5
Supplement) (pp 86-89), 2023. Date of Publication: May 2023.
Author
Heybati K.; Zhou F.; Baltazar M.; Poudel K.; Ochal D.; Ellythy L.; Deng
J.; Chelf C.; Welker C.; Ramakrishna H.
Institution
(Heybati, Zhou, Baltazar, Poudel, Ochal, Ellythy, Welker, Ramakrishna)
Mayo Clinic, United States
(Deng) Temerty Faculty of Medicine, United States
(Chelf) Mayo Clinic Libraries, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Volatile and total intravenous anesthesia (TIVA) are
commonly used as primary anesthetics and volatile agents have been
associated with cardioprotective effects.1 However, various trials and
meta-analyses have demonstrated conflicting findings of no difference or a
possible mortality benefit with volatile anesthesia.2-4 Many trials,
though, have administered the anesthetics at different perioperative
periods. Therefore, it remains unclear whether patients may experience
different outcomes when receiving specific agents as primary anesthetics
for maintenance. Additionally, there is limited pooled data on the
treatment effects of specific regimens and the potential combination of
volatile and intravenous drugs. We conducted a network metaanalysis (NMA)
to compare specific regimens used as primary anesthetics in patients
undergoing cardiac, thoracic, and vascular surgery. Method(s): This
frequentist, random-effects NMA was prospectively registered
(CRD42022316328) and conducted according to PRISMA-NMA. Literature
searches were conducted from inception to April 1st, 2022, in MEDLINE,
EMBASE, CENTRAL, Web of Science, Scopus, and through citations of past
reviews. We included randomized controlled trials (RCTs) enrolling adults
(>=18) undergoing cardiac, thoracic, and vascular surgery, using the same
induction regimens, and comparing volatile and/or TIVA for the maintenance
of anesthesia. As most trials focused on cardiac surgery, analyses were
restricted to this cohort to ensure sufficient power. Outcomes included
ICU length of stay (LOS), myocardial infarction (MI), in-hospital and 30-
day mortality, stroke, and delirium. Risk of bias (RoB) and confidence of
evidence were assessed by RoB-2 and CINeMA, respectively. Sensitivity
analyses were conducted with patients undergoing coronary artery bypass
grafting (CABG), and excluding studies with a high RoB. Result(s): We
included 54 (N=8,362) RCTs, of which 47 (N=6,881) enrolled those
undergoing cardiac surgery (Image 1). About a quarter of patients were
female (2,109, 25.2%) and the average age ranged from 28.85 to 76 years
old. Twenty-six (48.1%) were rated as having low RoB, 24 (44.4%) had some
concerns, and 4 (7.4%) had a high RoB. No publication bias was detected.
Across 19 trials (N=1,821), studying 9 unique intervention arms, compared
with propofol alone, sevoflurane + propofol was associated with decreased
ICU LOS (N=100; MD -18.26 hours; 95% CI: -34.78 to -1.73 hours; P=0.03;
low confidence) while midazolam + propofol (N=36; MD 17.51 hours; 95% CI:
2.78 to 32.25 hours; P=0.02; low confidence) was associated with a
significant increase (Image 2). There was substantial heterogeneity (I2 =
64.5%). Both treatment effects were significant following the exclusion of
trials with a high RoB. Among patients undergoing CABG, sevoflurane +
propofol was no longer significant and midazolam + propofol was not
studied. Among 27 trials (N=4,080) with 10 unique intervention arms,
compared with propofol, midazolam was associated with a significantly
greater risk of MI (N=110; RR 1.94; 95% CI: 1.01 to 3.71; P=0.05; low
confidence; Image 3). There was no heterogeneity (I2 = 0%). This finding
persisted following the exclusion of studies with a high RoB (N=110; RR
1.96; 95% CI: 1.02 to 3.75; P=0.04; I2 = 0%) and among patients undergoing
CABG (N=110; RR 2.06; 95% CI: 1.06 to 4.02; P=0.03; I2 = 0%). When
compared with propofol, none of the studied regimens were associated with
a significant difference in in-hospital (Image 4) or 30-day (Image 5)
mortality, stroke, or delirium. Across 5 trials (N=762) in vascular
surgery, none found significant differences, and in-hospital was not
studied. Across 2 trials (N=719) in thoracic surgery, neither found
significant differences in mortality, nor ICU LOS. Other outcomes of
interest were not studied. Conclusion(s): Among the studied agents in
the cardiac surgical population, sevoflurane + propofol was associated
with decreased ICU LOS, when compared with propofol alone. Midazolam +
propofol was associated with longer ICU LOS versus propofol, however, this
should be interpreted with caution given the limited sample sizes.
Midazolam was associated with an increased risk of MI, however, given its
limited use as a primary agent for maintenance, further investigation is
required. When compared with propofol, none of the treatment arms had a
significant impact on in-hospital or 30-day mortality. Larger, randomized
trials, particularly in the thoracic and vascular surgical populations,
are required.

<89>
Accession Number
645675900
Title
Effectiveness of Erector Spinae Plane Block in Patients Post-midline
Sternotomies: A Systematic Review and Meta-analysis.
Source
Anesthesia and Analgesia. Conference: Annual Meetings of the International
Anesthesia Research Society and Society of Critical Care
Anesthesiologists, IARS and SOCCA 2023. Denver, CO United States. 136(5
Supplement) (pp 921-924), 2023. Date of Publication: May 2023.
Author
Fayed M.; Patel N.; Maroun W.; Mitchell J.; Forrest P.; Yeldo N.
Institution
(Fayed) Henry Ford Hospital, United States
(Patel, Forrest) Henry Ford Health System, United States
(Maroun, Yeldo) Henry Ford Health, United States
(Mitchell) Henry Ford Health, Michigan State University CHM, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: With advancements in the field of regional anesthesia, there
is a shift in paradigm away from the liberal use of opioids towards
multimodal analgesic techniques. The erector spinae plane block (ESPB)
emerged as a relatively new player in regional anesthesia for managing
thoracic pain. In 2016, it was first detailed by Forero et al. as a
sensory block acting at the dorsal and ventral rami of the thoracic spinal
nerves1. Many studies have demonstrated the analgesic effectiveness and
comprehensive opioid-sparing advantages of ESPB in numerous surgical
specialties2,3. Nonetheless, there remains to be a gap in knowledge and
critical appraisal of clinical data relating to ESPB in cardiac surgery
patients, especially the limited number of patients in each published
study. In this meta-analysis, we aim to investigate postoperative pain
management and other outcomes, including ventilation days in cardiac
surgery patients with post-midline sternotomies who received ESPB compared
to standard care. Method(s): This systematic meta-analysis used the
Preferred Reporting Items for Systematic Reviews and Meta-Analysis
(PRISMA) statement guidelines. The search engine used MEDLINE, Embase, Web
of Science, Cochrane Library, and ClinicalTrials.gov. Interventions and
Comparators: Intervention was defined as Erector Spinae Plane Block.
Comparators were no regional technique performed. Outcome(s): The
primary outcome was opioid consumption and pain relief. Secondary outcomes
were ICU time, hospital length, postoperative nausea and vomiting (PONV),
mechanical ventilation time, rescue analgesia, and ambulation time.
Weighted mean difference (WMD) and 95% confidence interval (CI) were
calculated and reported for continuous outcomes, and odds ratio with 95%
CI for dichotomous variables. The standardized mean difference was used to
determine the effect measure for continuous outcomes measured in different
scales. The inverse variance model was used for continuous data, and the
dichotomous data, the Mantel-Haenszel model, was used. All data were
analyzed with the random effects model to generalize the findings.
Heterogeneity between studies was evaluated with I2 statistics with
thresholds of low (25-50%), moderate (50-75%), and high (>75%). A p-value
of <0.05 was considered statically significant. All statistical analysis
was performed using Comprehensive Meta-analysis Version 3. Result(s):
Screening results: A total of 3264 articles were identified through a
literature search. A total of 192 articles were evaluated for full-text
review, resulting in 178 being omitted (figure 1). One thousand eight
hundred one records were excluded for duplicates, and an additional 1271
articles were excluded after a review of titles and abstracts. The final
results are: 4 studies were RCTs, and 3 Non-RCT trials (Prospective,
Retrospective matched control, and Consecutive patient matched control)
(Table 1). Primary Outcome: Intraoperative opioid use: a significant
reduction of intraoperative IV fentanyl for sternotomy patients of WMD
-445 mcg (95% CI, -814 to -75, p = 0.018, I2 = 99.9) Figure2). Pain
scores: ESPB on postsurgical pain at 0 h following surgery displayed a
significant effect, with WMD of -1 (95% CI, -1.7 to -0.6, p < 0.001, I2 =
74.2). An analysis of pain scores at 4-6 hours postoperatively was
conducted, which showed a WMD of -1 (95% CI, -1.7 to -0.2, p = 0.018, I2 =
83.7) in the ESPB group. Secondary Outcomes: sternotomy patients have
significantly less mechanical ventilation time (mean difference -2.4
hours), ICU duration (mean difference -22.3 hours), and PONV OR 0.39
(table 2). Conclusion(s): This meta-analysis demonstrates that ESPBs
offer several advantages post-cardiac surgery, including decreased
postoperative and intraoperative opioid use, lower pain, shorter
mechanical ventilation time, decreased ICU duration, and reduced
postoperative nausea and vomiting. (Figure Presented).

<90>
Accession Number
2035549873
Title
Effect of exercise prehabilitation on quality of recovery after cardiac
surgery: a single-centre randomised controlled trial.
Source
British Journal of Anaesthesia. (no pagination), 2024. Date of
Publication: 2024.
Author
Yau D.K.W.; Ng F.F.; Wong M.-K.H.; Underwood M.J.; Wong R.H.L.; Joynt
G.M.; Lee A.
Institution
(Yau, Ng, Joynt, Lee) Department of Anaesthesia and Intensive Care,
Chinese University of Hong Kong, Hong Kong SAR, China
(Wong) Department of Anaesthesia and Intensive Care, Prince of Wales
Hospital, SAR, Hong Kong, China
(Underwood) Cardiovascular Services, Auckland City Hospital, Auckland, New
Zealand
(Wong) Division of Cardiothoracic Surgery, Department of Surgery, Chinese
University of Hong Kong, Hong Kong SAR, China
(Yau) Department of Rehabilitation Sciences, Hong Kong Polytechnic
University, Hung Hom, Hong Kong, China
Publisher
Elsevier Ltd
Abstract
Background: Physical prehabilitation can enhance patient resilience to
surgical stress, but its effects are unclear in vulnerable and frail
patients. We aimed to determine the effect of a structured exercise
prehabilitation programme on the quality of recovery after cardiac surgery
in vulnerable and frail participants. Method(s): This single-blinded,
parallel-arm, superiority, randomised controlled trial recruited patients
with a Clinical Frailty Scale of 4-6 undergoing cardiac surgery. Patients
were randomised to either physical prehabilitation (twice weekly) or
standard care (control); both arms received standard perioperative care.
The primary outcome was Quality of Recovery-15 (QoR-15) score on the third
day after surgery. Secondary outcomes included major adverse cardiac and
cerebrovascular events (MACCE), days alive and at home (DAH<inf>30</inf>),
and the World Health Organization Disability Assessment Schedule (WHODAS)
2.0 metric. Result(s): Of 164 randomised patients, 138 were included
in the primary analysis (median age 64 [interquartile range 60-69] yr; 70%
males). Compliance with the 5-week prehabilitation programme was high
(82%), with no adverse exercise-induced events reported. There were no
between-group differences in QoR-15 scores (median difference -3, 95%
confidence interval [CI] -9 to 3), early and late MACCE, and
DAH<inf>30</inf> (P=0.779). Prehabilitated patients had lower disability
levels than control patients (P=0.022) at 90 days after surgery (mean
difference -9%, 95% CI -17% to -2%). Conclusion(s): A 5-week
programme of physical prehabilitation in predominately prefrail patients
was safe, but it did not enhance quality of recovery scores after surgery.
Prehabilitation resulted in a clinically meaningful decrease in disability
scores at 90 days after surgery. Clinical trial registration:
ChiCTR1800016098. Copyright © 2024 British Journal of Anaesthesia

<91>
Accession Number
645696664
Title
Use of dexmedetomidine during light versus deep anaesthesia on
postoperative delirium among elderly patients undergoing major non-cardiac
surgery: protocol for a multicentre randomised factorial trial.
Source
BMJ open. 14(10) (pp e083312), 2024. Date of Publication: 01 Nov 2024.
Author
Shi H.-J.; Zhuang M.-Y.; Hu J.-H.; Long Y.-Q.; Gao Y.-P.; Zheng Z.; Feng
X.-M.; Ji F.-H.; Peng K.
Institution
(Shi, Zhuang, Hu, Long, Ji, Peng) Department of Anaesthesiology, First
Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
(Shi, Zhuang, Hu, Long, Ji, Peng) Institute of Anaesthesiology, Soochow
University, Suzhou, Jiangsu, China
(Gao) Department of Anaesthesiology, Zhangjiagang First People's Hospital,
Zhangjiagang, Jiangsu, China
(Zheng) Department of Anaesthesiology, First Peoples of Hospital of
Taicang, Jiangsu, China
(Feng) Department of Anaesthesiology, University of Utah Health, Salt Lake
City, UT, United States
Abstract
INTRODUCTION: Elderly patients are at a high risk of postoperative
delirium (POD), leading to increased postoperative morbidity and
mortality. The use of dexmedetomidine and depth of anaesthesia may
influence POD. This study aims to determine the effects of dexmedetomidine
infusion versus normal saline placebo during light versus deep anaesthesia
on POD among elderly patients undergoing major non-cardiac surgery.
METHODS AND ANALYSIS: This prospective, multicentre, randomised,
controlled, factorial trial will be conducted at three tertiary hospitals
in Jiangsu, China. We will recruit a total of 420 patients who are at
least 60 years old and undergoing major non-cardiac surgery (thoracic,
abdominal, urology, orthopaedic and spine surgery) under general
anaesthesia. Patients will be randomised (1:1:1:1) to receive one of four
anaesthesia regimens: (1) dexmedetomidine and light anaesthesia, (2)
dexmedetomidine and deep anaesthesia, (3) placebo and light anaesthesia or
(4) placebo and deep anaesthesia. Dexmedetomidine will be infused at
0.5microg/kg/h throughout surgery, and intraoperative bispectral index
target will be 55 for light anaesthesia and 40 for deep anaesthesia. The
primary outcome is the occurrence of POD during the first 7days
postoperatively or until hospital discharge, assessed using the 3-min
Confusion Assessment Method two times per day. The secondary outcomes
include days with POD, type of POD, pain scores at rest and on movement at
24 and 48hours postoperatively, patient-controlled intravenous fentanyl
consumption during 0-24 and 24-48hours postoperatively, hypotension,
bradycardia, postoperative nausea and vomiting, non-delirium
complications, length of postoperative hospital stay, 30-day cognitive
function and 30-day mortality. Data will be analysed on a modified
intention-to-treat basis. ETHICS AND DISSEMINATION: This trial was
approved by the Ethics Committee of the First Affiliated Hospital of
Soochow University and each participating centre. The trial results will
be published in a peer-reviewed journal. TRIAL REGISTRATION: Chinese
Clinical Trial Registry (ChiCTR2300073271). Copyright © Author(s)
(or their employer(s)) 2024. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.

<92>
Accession Number
2032188923
Title
Ultrasound-Guided Intranodal Lipiodol Lymphangiography for the Assessment
and Treatment of Chylous Leaks: A Retrospective Case Series from a Single
Center in Switzerland and a Systematic Review of the Literature.
Source
Journal of Clinical Medicine. 13(21) (no pagination), 2024. Article
Number: 6432. Date of Publication: November 2024.
Author
Schulz S.N.; Miftaroski A.; Rouiller B.; Egger B.; Lutz J.A.; Widmer L.
Institution
(Schulz) Department of Reconstructive, Esthetic, and Plastic Surgery,
Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, Geneve 1205,
Switzerland
(Miftaroski) Department of General Surgery, Geneva University Hospital,
Rue Gabrielle-Perret-Gentil 4, Geneve 1205, Switzerland
(Rouiller, Lutz) Department of Thoracic Surgery, Fribourg Cantonal
Hospital, Chem. des Pensionnats 2/6, Villars-sur-Glane 1752, Switzerland
(Egger) Department of General Surgery, Fribourg Cantonal Hospital, Chem.
des Pensionnats 2/6, Villars-sur-Glane 1752, Switzerland
(Widmer) Department of Diagnostic and Interventional Radiology, Fribourg
Cantonal Hospital, Chem. des Pensionnats 2/6, Villars-sur-Glane 1752,
Switzerland
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Lymphatic leaks are well-known complications of major thoracic
or abdominal surgeries, which significantly heighten morbidity and
mortality rates. While the existing literature provides insights into
managing these post-operative leaks, with a step-up approach from
conservative measures (CMs) to surgical intervention, there are no
standardized treatment guidelines. The purpose of this paper is to offer a
management algorithm of post-operative lymphatic leaks based on a
systematic literature review (SLR) of the therapeutic effect of Lipiodol
lymphangiography (LL), completed by a case series of five patients who
underwent LL in our department. Method(s): In this IRB-approved
study, we conducted an SLR following the PRISMA guidelines, using a PICOS.
A quality assessment was performed for each study. The case series
consisted of consecutive patients who underwent LL for diagnostic and
therapeutic purposes at our institution between September 2018 and
December 2020. Result(s): A total of 39 observational studies were
included in the SLR comprising 11 retrospective case reviews (Group 1),
and 3 case series as well as 25 case reports (Group 2). In total, these
studies report cases of 557 patients (51.52% presenting oncological
diagnoses; 43.98% having benefited from lymphadenectomy). Lymphatic or
chylous fistulas were the most encountered complication, followed by
chylothorax. The median volume of Lipiodol injected during lymphography
was 11.7 mL (range: 9.8-75 mL). Overall, LL was technically successful in
77.7% (366/471) of patients. The clinical success of all technically
successful LLs was 80.6% (295/366). Time-to-leak resolution after
lymphography varied between 1 and 31 days. The factors associated with
treatment failure were a high leak output (>500 mL/day) and Lipiodol
extravasation on post-LL imaging. Our case series consisted of five
patients (mean age: 62 +/- 9.24 years; 20% female; 100% oncological
diagnoses; 60% having beneficiated from lymphadenectomy). Technical and
clinical successes were 80% (4/5) and 75% (3/4), respectively.
Time-to-leak resolution varied between 1 and 4 days. The volume and
technique of LL was not different from that identified in the SLR.
 Conclusion(s): LL is a safe procedure with high technical and
clinical success rates that could be proposed as both a diagnostic and
therapeutic solution for patients with post-operative central lymphatic
lesions. Copyright © 2024 by the authors.

<93>
Accession Number
2035420456
Title
Subcostal transversus abdominis plane block for epigastric cardiac
pacemaker operation A randomised controlled trial.
Source
European Journal of Anaesthesiology. (no pagination), 2024. Article
Number: 10.1097/EJA.0000000000002092. Date of Publication: 2024.
Author
Kim J.-T.; Min J.; Park J.-B.; Jang Y.-E.
Institution
(Kim, Park, Jang) The Department of Anaesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Min) Department of Thoracic and Cardiovascular Surgery, Seoul National
University Hospital, Seoul National University College of Medicine, Seoul,
South Korea
Publisher
Lippincott Williams and Wilkins

<94>
Accession Number
645698493
Title
Safety outcomes of oral anticoagulants in patients with an indication of
anti-coagulants after TAVR: A meta-analysis.
Source
Progress in cardiovascular diseases. (no pagination), 2024. Date of
Publication: 30 Oct 2024.
Author
Abdelaziz A.; Atta K.; Gadelmawla A.F.; Abdelaziz M.; Desouky M.; Negida
Y.; Ibrahim A.A.; Eldosoky D.A.; Helmi A.; Ramadan S.; Singer E.;
Tafur-Soto J.
Institution
(Abdelaziz, Abdelaziz) Medical Research Group of Egypt (MRGE), Negida
Academy, Arlington, MA, USA; Faculty of Medicine, Al-Azhar University,
Cairo, Egypt
(Atta) Medical Research Group of Egypt (MRGE), Negida Academy, Arlington,
MA, USA; Institute of Medicine, National Research Mordovia State
University, Saransk, Russia
(Gadelmawla, Ibrahim) Medical Research Group of Egypt (MRGE), Negida
Academy, Arlington, MA, USA; Faculty of Medicine, Menoufia University,
Menoufia, Egypt
(Desouky) Brooklyn Hospital Center, Brooklyn, NY, United States
(Negida) Medical Research Group of Egypt (MRGE), Negida Academy,
Arlington, MA, USA; Faculty of Medicine, Zagazig University, Zagazig,
Egypt
(Eldosoky) Medical Research Group of Egypt (MRGE), Negida Academy,
Arlington, MA, USA; Faculty of Medicine, Kafrelsheikh University,
Kafrelsheikh, Egypt
(Helmi) Medical Research Group of Egypt (MRGE), Negida Academy, Arlington,
MA, USA; Faculty of Medicine, Alexandria University, Alexandria, Egypt
(Ramadan) Medical Research Group of Egypt (MRGE), Negida Academy,
Arlington, MA, USA; Faculty of Medicine, Ain Shams University, Cairo,
Egypt
(Singer) University of Texas MD Anderson, Houston, TX, United States
(Tafur-Soto) John Ochsner Heart and Vascular Institute, Department of
Cardiovascular Diseases, Ochsner Clinical School, University of Queensland
School of Medicine, New Orleans, LA, United States

<95>
Accession Number
645696920
Title
Goal-directed perfusion to reduce acute kidney injury after pediatric
cardiac surgery.
Source
The Annals of thoracic surgery. (no pagination), 2024. Date of
Publication: 30 Oct 2024.
Author
Long F.; Zhang Y.; Luo M.; Liu T.; Qin Z.; Wang B.; Zhou Y.; Zhou R.
Institution
(Long, Zhang, Luo, Liu, Qin, Wang, Zhou) Department of Anesthesiology,
West China Hospital of Sichuan University, Chengdu, Sichuan, China
(Zhou) Henan Medical School of Zhengzhou University, Zhengzhou, Henan,
China
Abstract
BACKGROUND: Although the goal-directed perfusion (GDP) during
cardiopulmonary bypass (CPB) has been discussed a lot in adult studies, no
pediatric indexed oxygen delivery (DO2i) thresholds are universally
accepted, and no pediatric randomized controlled trial (RCT) is reported
until now. This study aimed to determine whether the GDP initiative
(maintaining DO2i >= 360 mL/min/m2 during CPB) could reduce the incidence
of acute kidney injury (AKI) after pediatric cardiac surgery and improve
clinical outcomes. METHOD(S): This single-center RCT enrolled 312
pediatric patients, who were randomized to receive either the GDP strategy
or a conventional perfusion strategy during CPB. The primary outcome was
the rate of postoperative AKI. Secondary outcomes included major
postoperative complications, all-cause mortality within 30 days and
short-term clinical outcomes after surgery. RESULT(S): AKI occured in
43 patients (28.1%) in the GDP group and in 65 patients (42.2%) in the
control group (relative risk, 0.67; 95% confidence interval, 0.49-0.91; P
= 0.010). In the subgroup analysis, The GDP group had a lower AKI rate
compared with the control group among patients with age less than 1 year,
with nadir temperature greater than 32degreeC and nadir hemoglobin less
than 8 g/L during CPB, with preoperative cyanosis, and with CPB duration
from 60 to 120 minutes. CONCLUSION(S): The GDP strategy aimed at
maintaining DO2i >= 360 mL/min/m2 during CPB is effective in reducing the
risk of AKI after pediatric cardiac surgery. Copyright © 2024.
Published by Elsevier Inc.

<96>
Accession Number
645694997
Title
Use of Antibacterial Envelopes in Neuromodulation Surgeries With
Implantable Device Insertion: A Systematic Review and Meta-Analysis.
Source
Neurosurgery. (no pagination), 2024. Date of Publication: 01 Nov 2024.
Author
de Oliveira H.M.; Barbosa L.M.; Zamora F.V.; de Paula B.O.; de Paula G.O.;
Pilitsis J.G.; da Costa P.R.F.
Institution
(de Oliveira, de Paula, de Paula) Department of Medicine, Federal
University of Mato Grosso, Sinop, Mato Grosso, Brazil
(Barbosa) Department of Medicine, Federal University of Minas Gerais, Belo
Horizonte, Minas Gerais, Brazil
(Zamora) Department of Medicine, State University of Rio de Janeiro, Rio
de Janeiro, Brazil
(Pilitsis) Professor and Chair of the Department of Neurosurgery,
University of Arizona, Tucson, AZ, United States
(Pilitsis) Physician Executive for Functional Neurosurgery, Banner Health
System, Tucson, AZ, United States
(da Costa) Department of Functional Neurosurgery, Sinedor Clinic, Sinop,
Mato Grosso, Brazil
Abstract
BACKGROUND AND OBJECTIVES: Neuromodulation is an advanced therapeutic
intervention for managing various neurological, psychiatric, and
functional disorders. However, a significant challenge is the risk of
infections at the device implantation site. Previous studies have shown
that antibacterial envelopes used in cardiovascular surgeries
significantly reduce infection risk. It is postulated that similar
benefits could occur in neurosurgeries involving implant insertion, but
the literature lacks studies analyzing this efficacy. This study aimed to
evaluate the effectiveness of antibacterial envelopes in reducing
infection rates associated with neuromodulation implants. METHOD(S):
We systematically searched PubMed, Embase, and the Cochrane Central
Register of Controlled Trials databases up to August 2024 for clinical
trials comparing the use of antibacterial impregnated envelopes in
patients undergoing neuromodulation-related implant insertion. This study
followed Preferred Reporting Items for Systematic Reviews and
Meta-Analysis guidelines. Statistical analyses were performed using R
version 4.3.2. Risk of bias was assessed using the Risk Of Bias In
Nonrandomized Studies-of Interventions tool, and the quality of evidence
was evaluated using the Grading of Recommendations Assessment, Development
and Evaluation assessment. The study was registered in Prospective
Register of Systematic Reviews. RESULT(S): Four studies, comprising
1242 patients, were included, of whom 704 (56.7%) received antibacterial
envelopes. The pooled analysis showed that the odds of infection were 77%
lower in patients using the antibacterial envelope compared with the
control group (odds ratios = 0.23; 95% CI = 0.10-0.51; P < .001; I2 = 2%).
 CONCLUSION(S): The use of an antibacterial envelope significantly
reduces the odds of infection in patients undergoing
neuromodulation-related implant insertion by 77%. These findings
underscore the potential of antibacterial envelopes to improve
postoperative outcomes. Copyright © Congress of Neurological
Surgeons 2024. All rights reserved.

<97>
Accession Number
645694069
Title
Amino acids and the kidney; friends or foes?.
Source
Current opinion in clinical nutrition and metabolic care. (no
pagination), 2024. Date of Publication: 22 Oct 2024.
Author
Baiardo Redaelli M.; Landoni G.; Monti G.; Bellomo R.
Institution
(Baiardo Redaelli, Landoni, Monti) Department of Anesthesia and Intensive
Care, IRCCS San Raffaele Scientific Institute
(Landoni, Monti) Vita-Salute San Raffaele University, Milan, Italy
(Bellomo) Department of Critical Care, University of Melbourne
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Monash University, Melbourne, United Kingdom
(Bellomo) Department of Intensive Care, Austin Hospital
Abstract
PURPOSE OF REVIEW: Acute kidney injury (AKI) is common in hospitalized
patients and is independently associated with morbidity and mortality.
Moreover, AKI increases the risk of chronic kidney disease, which is a
major healthcare problem. Currently, no single therapy has been proven to
be effective in preventing AKI. The role of amino acids in the context of
kidney function and AKI prevention has been controversial and most of the
evidence is available from nutritional studies. However, knowledge of
amino acids in recruiting renal functional reserve and their potential
role to protect renal function under stress has recently expanded. RECENT
FINDINGS: The nephroprotective effects of amino acids were first
postulated in 1973. Recently, this strategy gained renewed interest and
has been more extensively studied, reintroducing their use in clinical
situations characterized by a high incidence of AKI. Intravenous amino
acids administration for kidney protection is now supported by a large
multinational randomized double-blind controlled trial in cardiac surgery
and by experimental and observational data. All such data support the
rationale for a biologically and clinically important nephroprotective
effect. SUMMARY: The infusion of amino acids was recently found to reduce
the incidence of AKI in cardiac surgery patients and surgical patients.
This strategy for the protection of renal function is supported by a
multicenter, international, double-blind randomized trial, with a huge
potential for additional application in several clinical fields. Several
mechanisms of action support the robustness of these findings and are
summarized in this manuscript. Copyright © 2024 Wolters Kluwer
Health, Inc. All rights reserved.

<98>
Accession Number
645687837
Title
Foot Reflexology for Pain and Anxiety Associated with Chest Tube Removal
in Patients After Coronary Artery Bypass Graft: A Randomized Controlled
Trial.
Source
Alternative therapies in health and medicine. (no pagination), 2024. Date
of Publication: 31 Oct 2024.
Author
Budak Erturk E.; Karadag M.
Abstract
Background: Reflexology is a method used to control the pain and anxiety
associated with chest tube removal in patients undergoing cardiovascular
surgery. Primary Study Objective: This study aimed to identify the effect
of foot reflexology applied before chest tube removal on pain and anxiety
levels in patients with coronary artery bypass graft surgery.
Methods/Design: This study was a randomized controlled clinical trial.
 Setting(s): This study was conducted in the cardiovascular surgery
intensive care unit of the Baskent University Ankara Hospital.
 Participant(s): Patients, who underwent coronary artery bypass graft
surgery, were randomly assigned either to the reflexology group or the
control group (n = 28 individuals/group). Intervention(s): The
reflexology group received foot reflexology for 30 minutes in two sessions
(first postoperative day and before chest tube removal). Primary Outcome
Measures: The primary outcomes of the surgery were pain, evaluated using a
Numeric Pain-Rating Scale; and anxiety, evaluated using the Profile of
Mood States Scale Tension-Anxiety Subscale. Pain and anxiety were
determined on the first (before and after the reflexology) and second
postoperative days (before and after the reflexology and immediately, 15
min, 1 hour (only pain level) after chest tube removal). Result(s):
The mean pain scores of the control and intervention groups were similar
during chest tube removal, 15 minutes after, and 1 hour after (P > .05).
Although mean anxiety scores were comparable after chest tube removal in
both groups (P > .05), a significant difference was found 15 minutes later
(P < .05). The increase in pain (P = .0001) and anxiety (P = .032) levels
before and after the removal was significantly less in the intervention
group compared to the control group, based on pain and anxiety scores.
 Conclusion(s): Foot reflexology significantly reduced the increase in
pain and anxiety during chest tube removal in patients with coronary
artery bypass graft surgery.

<99>
Accession Number
2035303550
Title
Women: More susceptible to develop unfavorable in-hospital outcomes after
transcatheter aortic valve replacement.
Source
International Journal of Cardiology. 419 (no pagination), 2025. Article
Number: 132678. Date of Publication: 15 Jan 2025.
Author
Yang Y.; Ye Y.
Institution
(Yang) Department of Cardiology, The First College of Clinical Medical
Science, China Three Gorges University & Yichang Central People's
Hospital, Hubei, Yichang, China
(Ye) Department of radiology, The First College of Clinical Medical
Science, China Three Gorges University & Yichang Central People's
Hospital, Hubei, Yichang, China
Publisher
Elsevier Ireland Ltd

<100>
Accession Number
2035283506
Title
Single-Leaflet Device Attachment After Mitral Transcatheter Edge-to-Edge
Repair: Systematic Review and Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 17(21) (pp 2571-2574), 2024. Date of
Publication: 11 Nov 2024.
Author
Bhatia K.; Gupta S.; Carter K.; Petrovic M.; Shetty S.V.; Aggarwal D.;
Casso Dominguez A.; Lerakis S.; Argulian E.
Institution
(Bhatia, Petrovic, Aggarwal, Casso Dominguez, Argulian) Mount Sinai Fuster
Heart, Mount Sinai Morningside Hospital, New York, NY, United States
(Gupta, Carter, Shetty) Mount Sinai Morningside/West, New York, NY, United
States
(Lerakis) Mount Sinai Fuster Heart, Mount Sinai Hospital, New York, NY,
United States
Publisher
Elsevier Inc.

<101>
Accession Number
2035277153
Title
Addition of Ezetimibe to Intensive Lipid-Lowering Therapy Is Associated
With a Lower Incidence of Heart Failure in Patients With Acute Coronary
Syndrome.
Source
Circulation Journal. 88(11) (pp 1819-1824), 2024. Date of Publication:
November 2024.
Author
Yoshikawa M.; Honda A.; Arashi H.; Shibahashi E.; Otsuki H.;
Kawada-Watanabe E.; Ogawa H.; Yamaguchi J.; Hagiwara N.
Institution
(Yoshikawa, Arashi, Shibahashi, Otsuki, Kawada-Watanabe, Ogawa, Yamaguchi,
Hagiwara) Department of Cardiology, Tokyo Women's Medical University,
Tokyo, Japan
(Honda) Department of Cardiology, Tokyo Women's Medical University Yachiyo
Medical Center, Chiba, Japan
(Arashi) Department of Cardiovascular Medicine, Tokyo Women's Medical
University Adachi Medical Center, Tokyo, Japan
Publisher
Japanese Circulation Society
Abstract
Background: This study investigated whether intensive lipid-lowering
therapy with pitavastatin and ezetimibe lowers the incidence of heart
failure (HF) events in patients with acute coronary syndrome (ACS).
 Methods and Results: In the HIJ-PROPER study, 1,734 patients with ACS
were randomly assigned to either pitavastatin plus ezetimibe therapy
(n=864) or pitavastatin monotherapy (n=857). We examined the incidence of
HF between these 2 groups over a 3.9-year period after ACS. The primary
endpoint of the study was hospitalization for HF. The mean low-density
lipoprotein cholesterol levels during the follow-up period were 65.1 mg/dL
in the pitavastatin plus ezetimibe group and 84.6 mg/dL in the
pitavastatin monotherapy group. The incidence of HF hospitalization was
significantly lower in the pitavastatin plus ezetimibe group than in the
pitavastatin monotherapy group (19 [2.2%] vs. 40 [4.7%] patients; hazard
ratio 0.47, 95% confidence interval 0.27-0.81; P<0.005). This trend was
consistent after multivariable analysis using multiple models.
 Conclusion(s): Intensive lipid-lowering therapy with pitavastatin and
ezetimibe is associated with a lower incidence of hospitalization for HF
in patients with ACS. Copyright © 2024 Japanese Circulation
Society. All rights reserved.

<102>
Accession Number
2035260207
Title
Hemodynamic and clinical outcomes with balloon-expandable valves versus
self-expanding valves in patients with small aortic annulus undergoing
transcatheter aortic valve replacement: A meta-analysis of randomized
controlled trials and propensity score matched studies.
Source
IJC Heart and Vasculature. 55 (no pagination), 2024. Article Number:
101542. Date of Publication: December 2024.
Author
Ahmed M.; Ahsan A.; Tabassum S.; Tariq I.; Zulfiqar E.; Raja M.F.; Mahmood
A.; Ahmed R.; Shahid F.; Gardezi S.K.M.; Alam M.; Bagur R.; Mamas M.A.
Institution
(Ahmed) Rawalpindi Medical University, Rawalpindi, Pakistan
(Ahsan) Foundation University Medical College, Islamabad, Pakistan
(Tabassum) King Edward Medical College, Lahore, Pakistan
(Tariq) United Medical and Dental College, Karachi, Pakistan
(Zulfiqar) Dow University of Health Sciences, Karachi, Pakistan
(Raja, Mahmood) Allama Iqbal Medical College, Lahore, Pakistan
(Ahmed) Department of Cardiology, Royal Brompton Hospital, London, United
Kingdom
(Ahmed) National Heart and Lung Institute, Imperial College London, United
Kingdom
(Shahid) Department of Interventional Cardiology, Queen Elizabeth
Hospital, Birmingham, United Kingdom
(Gardezi) College of Medicine and Health Sciences, Khalifa University, Abu
Dhabi, United Arab Emirates
(Alam) Department of Interventional Cardiology, Baylor College of
Medicine, Houston, TX, United States
(Bagur) Division of Cardiology, London Health Sciences Centre, Western
University, London, ON, Canada
(Mamas) Keele Cardiovascular Research Group, Centre for Prognosis
Research, Keele University, Stoke-On-Trent, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Transcatheter aortic valve replacement (TAVR) is considered more effective
than surgical aortic valve implantation for patients with a small aortic
annulus (SAA), however, the comparative efficacy of different
transcatheter heart valves (THVs) remains uncertain. A literature search
was performed across databases from their inception until June 2024 to
identify eligible randomized controlled trials (RCTs) and propensity-score
matched (PSM) studies. Clinical outcomes were evaluated using a
random-effects model to pool risk ratios (RRs) with 95 % confidence
intervals (CIs). The analysis included 10 studies with 2,960 patients.
BEVs were associated with a significantly smaller indexed effective
orifice area (MD: -0.18, 95 % CI: -0.27 to -0.10), and a higher
transvalvular mean pressure gradient (MD: 5.07, 95 % CI 3.43 to 6.71) than
SEVs. The risk for prosthesis-patient mismatch (PPM) (RR = 1.89, 95 % CI:
1.42 to 2.51) and severe PPM (RR = 2.80, 95 % CI: 1.96 to 4.0) was
significantly higher for patients receiving BEVs than those receiving
SEVs. Although nonsignificant differences were observed between BEVs and
SEVs regarding 30-day and 1-year all-cause mortality, 30-day stroke rates,
vascular complication, paravalvular leak, and permanent pacemaker
implantation (p > 0.05), patients receiving BEVs were associated with a
significantly increased risk of 1-year cardiovascular mortality (RR =
1.61, 95 % CI: 1.05 to 2.47) compared to those receiving SEVs. In patients
with SAA, BEVs demonstrated worse hemodynamic performance as determined by
the higher risk of moderate and severe PPM compared to SEVs. Moreover, the
use of BEVs was associated with a higher risk of 1-year cardiovascular
mortality. Copyright © 2024 The Authors

<103>
Accession Number
2034583035
Title
Myocardial Infarction and Multivessel Disease: Completing the Story.
Source
Journal of the American College of Cardiology. 84(20) (pp 2023-2025),
2024. Date of Publication: 12 Nov 2024.
Author
Ahmad Y.; Reddy R.K.; Mehta S.R.
Institution
(Ahmad) University of California-San Francisco, San Francisco, CA, United
States
(Reddy) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Reddy) Nuffield Department of Population Health, University of Oxford,
Oxford, United Kingdom
(Mehta) Population Health Research Institute, McMaster University and
Hamilton Health Sciences, Hamilton, ON, Canada
Publisher
Elsevier Inc.

<104>
Accession Number
2032739633
Title
Direct Oral Anticoagulant Therapy With A Fully Magnetically Levitated LVAD
and Bridging to Heart Transplantation: A DOT-HM3 Study Analysis.
Source
Journal of Cardiac Failure. 30(11) (pp 1512-1515), 2024. Date of
Publication: November 2024.
Author
NETUKA I.V.A.N.; TUCANOVA Z.; MEHRA M.R.
Institution
(NETUKA, TUCANOVA) Institute for Clinical and Experimental Medicine,
Prague, Czechia
(MEHRA) Brigham and Women's Hospital and Harvard Medical School, Boston,
MA, United States
Publisher
Elsevier B.V.

<105>
Accession Number
2031993871
Title
Genetics of Calcific Aortic Stenosis: A Systematic Review.
Source
Genes. 15(10) (no pagination), 2024. Article Number: 1309. Date of
Publication: October 2024.
Author
Vassiliou V.S.; Johnson N.; Langlands K.; Tsampasian V.
Institution
(Vassiliou, Johnson, Tsampasian) Norwich Medical School, University of
East Anglia, Norwich NR4 7TJ, United Kingdom
(Vassiliou) Fitzwilliam College, University of Cambridge, Cambridge CB3
0DG, United Kingdom
(Langlands) Institute of Continuing Education, University of Cambridge,
Cambridge CB23 8AQ, United Kingdom
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Calcific aortic stenosis is the most prevalent valvular
abnormality in the Western world. Factors commonly associated with
calcific aortic stenosis include advanced age, male sex, hypertension,
diabetes and impaired renal function. This review synthesises the existing
literature on genetic associations with calcific aortic stenosis.
 Method(s): A systematic search was conducted in the PubMed, Ovid and
Cochrane libraries from inception to 21 July 2024 to identify human
studies investigating the genetic factors involved in calcific aortic
stenosis. From an initial pool of 1392 articles, 78 were selected for
full-text review and 31 were included in the final qualitative synthesis.
The risk of bias in these studies was assessed using the Newcastle Ottawa
Scale. Result(s): Multiple genes have been associated with calcific
aortic stenosis. These genes are involved in different biological
pathways, including the lipid metabolism pathway (PLA, LDL, APO, PCSK9,
Lp-PLA2, PONS1), the inflammatory pathway (IL-6, IL-10), the calcification
pathway (PALMD, TEX41) and the endocrine pathway (PTH, VIT D, RUNX2,
CACNA1C, ALPL). Additional genes such as NOTCH1, NAV1 and FADS1/2
influence different pathways. Mechanistically, these genes may promote a
pro-inflammatory and pro-calcific environment in the aortic valve itself,
leading to increased osteoblastic activity and subsequent calcific
degeneration of the valve. Conclusion(s): Numerous genetic
associations contribute to calcific aortic stenosis. Recognition of these
associations can enhance risk stratification for individuals and their
first-degree relatives, facilitate family screening, and importantly, pave
the way for targeted therapeutic interventions focusing on the identified
genetic factors. Understanding these genetic factors can also lead to gene
therapy to prevent calcific aortic stenosis in the future. Copyright
© 2024 by the authors.

<106>
Accession Number
2034982504
Title
Scar-Related Ventricular Tachycardia: Pathophysiology, Diagnosis, and
Management.
Source
Cardiology in Review. (no pagination), 2024. Article Number:
10.1097/CRD.0000000000000799. Date of Publication: 2024.
Author
Biswas R.; Kapoor A.; Maheta D.; Agrawal S.P.; Mendha A.; Frishman W.H.;
Aronow W.S.
Institution
(Biswas) Department of Medicine, All India Institute of Medical Sciences,
Patna, India
(Kapoor) Department of Medicine, B.J. Medical College, Ahmedabad, India
(Maheta) Department of Public Health, New York Medical College, Valhalla,
NY, United States
(Agrawal) Department of Internal Medicine, New York Medical College,
Landmark Medical Center, Woonsocket, RI, United States
(Mendha) Department of Medicine, Grodno State Medical University, Belarus
(Frishman) Department of Medicine, New York Medical College, Valhalla, NY,
United States
(Aronow) Departments of Cardiology and Medicine, Westchester Medical
Center, New York Medical College, Valhalla, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Scar-related ventricular tachycardia (VT) commonly results from scarring
in the myocardium, principally produced by antecedent myocardial
infarction, cardiomyopathy, or prior cardiac surgery. The resultant
arrhythmogenic substrate from scarred tissue and the alteration of normal
cardiac electrical conduction predispose patients to reentrant circuits,
followed by VT. This literature review synthesizes current research on
pathophysiology, diagnostic methods, and treatment modalities of
scar-related VT. The primary contents of the review are descriptions of
the mechanisms through which myocardial fibrosis results in VT, clinical
presentations of the condition, and advanced diagnostic techniques,
including electrophysiological studies and mapping. Furthermore, the
review outlines the various management strategies, such as implantable
cardioverter-defibrillators, catheter ablation, stereotactic arrhythmia
radioablation, and surgical ablation. The discussion also includes
emerging therapeutics, such as gene therapy, artificial intelligence, and
precision medicine in managing scar-related VT, emphasizing the ongoing
advancements aimed at improving patient outcomes. Copyright ©
2024 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article
is prohibited.

<107>
Accession Number
2032105651
Title
Components of home-based palliative and supportive care for adults with
heart failure: A scoping review.
Source
Palliative Medicine. (no pagination), 2024. Date of Publication: 2024.
Author
Perera M.; Halahakone U.; Senanayake S.; Kularatna S.; Parsonage W.; Yates
P.; Singh G.K.
Institution
(Perera, Yates, Singh) Cancer and Palliative Care Outcomes Centre, School
of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
(Perera, Halahakone, Senanayake, Kularatna, Parsonage, Yates, Singh)
Centre for Healthcare Transformation, Faculty of Health, Queensland
University of Technology, Brisbane, QLD, Australia
(Halahakone, Senanayake, Kularatna, Parsonage) Australian Centre for
Health Service Innovation, Queensland University of Technology, Brisbane,
QLD, Australia
(Senanayake, Kularatna) Health Services and Systems Research, Duke-NUS
Medical School, Singapore, Singapore
(Senanayake, Kularatna) National Heart Research Institute Singapore,
National Heart Centre Singapore, Singapore, Singapore
(Parsonage) Department of Cardiology, Royal Brisbane & Women's Hospital,
Brisbane, QLD, Australia
Publisher
SAGE Publications Ltd
Abstract
Background: Palliative care and supportive care provided in the home for
people with heart failure can improve quality of life, caregiver wellbeing
and reduce healthcare costs. Identifying components of home-based
palliative and supportive care in heart failure is useful to inform
tailored care to people with heart failure. Aim(s): To identify and
describe components of home-based palliative and supportive care in adults
with heart failure. Design(s): A scoping review was undertaken in
accordance with Joanna Briggs Institute guidelines. The protocol was
registered prospectively with the Open Science Framework
(https://doi.org/10.17605/OSF.IO/GHCME). Data sources: Embase, PubMed,
CINAHL and Cochrane databases were searched from inception in May 2023 and
re-run in January 2024. Original research focussed on palliative and
supportive care in the home setting that included adults diagnosed with
heart failure who have not undergone nor awaiting a heart transplant was
included. Result(s): Results were extracted from 13 papers based on
eight studies. The findings highlight that nurses supported by a
multidisciplinary team, providing symptom management, patient and carer
education and discussion of goals of care and advance care planning,
facilitates home-based palliative and supportive care for people with
heart failure. Conclusion(s): Ensuring patient and caregiver-centred
care supported by a multidisciplinary team is essential to delivering
home-based palliative and supportive care for people with heart failure.
Further research focussed on the role of digital interventions in
home-based palliative and supportive care, the composition of the
multidisciplinary team and research which includes individuals across all
stages of heart failure is needed. Copyright © The Author(s)
2024.

<108>
Accession Number
645670254
Title
Comparison of Ultrasound-Guided Single-Injection Erector Spinae Plane
Block, Retrolaminar Block and Paravertebral Block for Postoperative
Analgesia in Single-Incision Video-Assisted Thoracoscopic Surgery: A
Three-Arm, Double-Blind, Randomized Controlled Non-Inferiority Trial.
Source
The Clinical journal of pain. (no pagination), 2024. Date of Publication:
31 Oct 2024.
Author
Zhu Y.; Yang Y.; Zhang Q.; Li X.; Xue W.; Liu Y.; Zhao Y.; Xu W.; Yan P.;
Li S.; Fang Y.; Huang J.
Institution
(Zhu) Department of Anesthesiology, First Affiliated Hospital of Kunming
Medical University, Kunming, Yunnan, China
Abstract
OBJECTIVE: Effective postoperative analgesia is critical for thoracic
surgery. This study compares the analgesic efficacy of the erector spinae
plane block (ESPB), retrolaminar block (RLB), and paravertebral block
(TPVB) in single-incision video-assisted thoracoscopic surgery (SITS).
 METHOD(S): Seventy-six patients underwent general anesthesia followed
by ultrasound-guided nerve blocks with 20 mL of 0.5% ropivacaine. Primary
outcomes included the area under the curve (AUC) of Numeric Rating Scale
(NRS) scores during rest and coughing over 24 hours. Secondary outcomes
included perioperative opioid use, plasma biomarkers, and postoperative
recovery measures. RESULT(S): The AUC for NRS was 107.8+/-10.53 in
the ESPB group, 104.8+/-8.05 in the RLB group, and 103.6+/-10.42 in the
TPVB group, demonstrating non-inferiority for ESPB (difference: 4.2+/-3.0,
95% CI -1.82 to 10.22) and RLB (difference: 1.2+/-2.6, 95% CI -3.97 to
6.37) compared to TPVB. No significant differences were observed in opioid
use, plasma biomarkers, QoR-15 scores, or adverse events. DISCUSSION: ESPB
and RLB provide non-inferior analgesia compared to TPVB in SITS patients
and are effective alternatives that enhance safety. Copyright ©
2024 Wolters Kluwer Health, Inc. All rights reserved.

<109>
Accession Number
645670109
Title
Transcatheter Valve Replacement in Severe Tricuspid Regurgitation.
Source
The New England journal of medicine. (no pagination), 2024. Date of
Publication: 30 Oct 2024.
Author
Hahn R.T.; Makkar R.; Thourani V.H.; Makar M.; Sharma R.P.; Haeffele C.;
Davidson C.J.; Narang A.; O'Neill B.; Lee J.; Yadav P.; Zahr F.;
Chadderdon S.; Eleid M.; Pislaru S.; Smith R.; Szerlip M.; Whisenant B.;
Sekaran N.K.; Garcia S.; Stewart-Dehner T.; Thiele H.; Kipperman R.;
Koulogiannis K.; Lim D.S.; Fowler D.; Kapadia S.; Harb S.C.; Grayburn
P.A.; Sannino A.; Mack M.J.; Leon M.B.; Lurz P.; Kodali S.K.
Institution
(Hahn, Makkar, Thourani, Makar, Sharma, Haeffele, Davidson, Narang,
O'Neill, Lee, Yadav, Zahr, Chadderdon, Eleid, Pislaru, Smith, Szerlip,
Whisenant, Sekaran, Garcia, Stewart-Dehner, Thiele, Kipperman,
Koulogiannis, Lim, Fowler, Kapadia, Harb, Grayburn, Sannino, Mack, Leon,
Lurz, Kodali) From Columbia University Irving Medical Center, New York
(R.T.H., M.B.L., S.K.K.); Cedars-Sinai Medical Center, Los Angeles (R.M.,
M.M.), and Stanford University, Stanford (R.P.S., C.H.) - both in
California; Piedmont Heart Institute, Marcus Heart Valve Center, Atlanta
(V.H.T., P.Y.); Northwestern University Feinberg School of Medicine,
Chicago (C.J.D., A.N.); Henry Ford Hospital, Detroit (B.O., J.L.); Oregon
Health and Science University, Portland (F.Z., S.C.); Mayo Clinic,
Rochester, MN (M.E., S.P.); Baylor Scott and White Heart Hospital Plano
(R.S., M.S., P.A.G., M.J.M.) and Baylor Scott and White Research Institute
Cardiac Imaging Core Laboratory (P.A.G., A.S.) - both in Plano, TX;
Intermountain Medical Center, Murray, UT (B.W., N.K.S.); Christ Hospital,
Cincinnati (S.G., T.S.-D.), and the Cleveland Clinic Foundation, Cleveland
(S.K., S.C.H.); Heart Center Leipzig at Leipzig University, Leipzig
(H.T.), and University Medical Center Mainz, Mainz (P.L.) - both in
Germany; Morristown Medical Center, Morristown, NJ (R.K., K.K.); and the
University of Virginia, Charlottesville (D.S.L., D.F.)
Abstract
BACKGROUND: Severe tricuspid regurgitation is associated with disabling
symptoms and an increased risk of death. Data regarding outcomes after
percutaneous transcatheter tricuspid-valve replacement are needed.
 METHOD(S): In this international, multicenter trial, we randomly
assigned 400 patients with severe symptomatic tricuspid regurgitation in a
2:1 ratio to undergo either transcatheter tricuspid-valve replacement and
medical therapy (valve-replacement group) or medical therapy alone
(control group). The hierarchical composite primary outcome was death from
any cause, implantation of a right ventricular assist device or heart
transplantation, postindex tricuspid-valve intervention, hospitalization
for heart failure, an improvement of at least 10 points in the score on
the Kansas City Cardiomyopathy Questionnaire overall summary (KCCQ-OS), an
improvement of at least one New York Heart Association (NYHA) functional
class, and an improvement of at least 30 m on the 6-minute walk distance.
A win ratio was calculated for the primary outcome by comparing all
possible patient pairs, starting with the first event in the hierarchy.
 RESULT(S): A total of 267 patients were assigned to the
valve-replacement group and 133 to the control group. At 1 year, the win
ratio favoring valve replacement was 2.02 (95% confidence interval [CI],
1.56 to 2.62; P<0.001). In comparisons of patient pairs, those in the
valve-replacement group had more wins than the control group with respect
to death from any cause (14.8% vs. 12.5%), postindex tricuspid-valve
intervention (3.2% vs. 0.6%), and improvement in the KCCQ-OS score (23.1%
vs. 6.0%), NYHA class (10.2% vs. 0.8%), and 6-minute walk distance (1.1%
vs. 0.9%). The valve-replacement group had fewer wins than the control
group with respect to the annualized rate of hospitalization for heart
failure (9.7% vs. 10.0%). Severe bleeding occurred in 15.4% of the
valve-replacement group and in 5.3% of the control group (P=0.003); new
permanent pacemakers were implanted in 17.4% and 2.3%, respectively
(P<0.001). CONCLUSION(S): For patients with severe tricuspid
regurgitation, transcatheter tricuspid-valve replacement was superior to
medical therapy alone for the primary composite outcome, driven primarily
by improvements in symptoms and quality of life. (Funded by Edwards
Lifesciences; TRISCEND II ClinicalTrials.gov number,
NCT04482062.). Copyright © 2024 Massachusetts Medical Society.

<110>
Accession Number
645669166
Title
Comparison of strategies for vascular ACCESS closure after transcatheter
aortic valve implantation: the ACCESS-TAVI randomized trial.
Source
European heart journal. (no pagination), 2024. Date of Publication: 29
Oct 2024.
Author
Rheude T.; Ruge H.; Altaner N.; Pellegrini C.; Alvarez Covarrubias H.;
Mayr N.P.; Cassese S.; Kufner S.; Taniguchi Y.; Thilo C.; Klos M.;
Erlebach M.; Schneider S.; Jurisic M.; Laugwitz K.-L.; Lange R.; Schunkert
H.; Kastrati A.; Krane M.; Xhepa E.; Joner M.
Institution
(Rheude, Altaner, Pellegrini, Alvarez Covarrubias, Cassese, Kufner,
Taniguchi, Jurisic, Schunkert, Kastrati, Xhepa, Joner) Department of
Cardiovascular Diseases, German Heart Center Munich, Technical University
Munich University Hospital, Munich, Germany
(Ruge, Erlebach, Lange, Krane) Department of Cardiovascular Surgery,
German Heart Center Munich, School of Medicine & Health, Technical
University of Munich, Lazarettstrasse 36, Munich 80636, Germany
(Alvarez Covarrubias) Hospital de Cardiologia, IMSS, Centro Medico
Nacional Siglo XXI, Ciudad de Mexico, Mexico
(Mayr) Institute of Anaesthesiology, German Heart Center Munich, Technical
University Munich University Hospital, Munich, Germany
(Kufner, Laugwitz, Schunkert, Kastrati, Krane, Joner) DZHK (German Center
for Cardiovascular Research), Partner Site Munich Heart Alliance, Germany
(Thilo) Department of Internal Medicine I, RoMed Klinikum Rosenheim,
Germany
(Klos) Medicum Tegernsee, Germany Germany
(Schneider) Department of Cardiology, Benedictus Krankenhaus Tutzing,
Germany
(Laugwitz) Department of Internal Medicine I, Technical University Munich
University Hospital, Munich, Germany
Abstract
BACKGROUND AND AIMS: Data from randomized trials investigating different
access closure strategies after transfemoral transcatheter aortic valve
implantation (TF-TAVI) remain scarce. In this study, two vascular closure
device (VCD) strategies to achieve hemostasis after TF-TAVI were compared.
 METHOD(S): The ACCESS-TAVI (Comparison of Strategies for Vascular
ACCESS Closure after Transcatheter Aortic Valve Implantation) is a
prospective, multicenter trial in which patients undergoing TF-TAVI were
randomly assigned to a strategy with a combined suture-/plug-based VCD
strategy (suture/plug group) using one ProGlideTM/ProStyleTM (Abbott
Vascular) and one Angio-Seal (Terumo) versus a suture-based VCD strategy
(suture-only group) using two ProGlidesTM/ProStylesTM. The primary
endpoint was a composite of major or minor access site-related vascular
complications during index hospitalization according to Valve Academic
Research Consortium (VARC)-3 criteria. Key secondary endpoints included
time to hemostasis, VARC-3 bleeding type >=2 and all-cause mortality over
30 days. RESULT(S): Between September 2022 and April 2024, 454
patients were randomized. The primary endpoint occurred in 27% (62/230) in
the suture/plug group and 54% (121/224) in the suture-only group (relative
risk [RR] 0.55 [95% confidence interval: 0.44;0.68]; p<0.001). Time to
hemostasis was significantly shorter in the suture/plug group compared to
the suture-only group (108+/-208 s vs. 206+/-171 s; p <0.001). At 30 days,
bleeding type >=2 occurred less often in the suture/plug group compared to
the sutureonly group (6.2% vs. 12.1%, RR 0.66 [0.43;1.02]; p=0.032), with
no significant difference in mortality. CONCLUSION(S): With regard to
the composite of major or minor access-related vascular complications, a
combined suture-/plug-based VCD strategy was superior to a suturebased VCD
strategy for vascular access closure in patients undergoing
TF-TAVI. Copyright © The Author(s) 2024. Published by Oxford
University Press on behalf of the European Society of Cardiology. All
rights reserved. For commercial re-use, please contact reprints@oup.com
for reprints and translation rights for reprints. All other permissions
can be obtained through our RightsLink service via the Permissions link on
the article page on our site-for further information please contact

<111>
Accession Number
645669056
Title
Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke:
A Systematic Review and Meta-Analysis.
Source
The American journal of cardiology. (no pagination), 2024. Date of
Publication: 28 Oct 2024.
Author
Sayed A.; Kamal A.; Kamal I.; Fathallah A.H.; Nourelden A.Z.; Zaidi S.A.
Institution
(Sayed) University of Pittsburgh Medical Center, Pittsburgh, PA, USA;
University of Pittsburgh, Pittsburgh, PA, USA
(Kamal) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
(Kamal, Nourelden) Faculty of Medicine, Al-Azhar University, Cairo, Egypt
(Fathallah) Faculty of Medicine, Minia University, Minia, Egypt
(Zaidi) University of Pittsburgh Medical Center, Pittsburgh, PA, USA;
University of Pittsburgh, Pittsburgh, PA, USA; CRISMA Center, Department
of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA;
Department of Critical Care Medicine, University of Pittsburgh Medical
Center, Pittsburgh, PA, USA
Abstract
BACKGROUND: Atrial fibrillation accounts for one-sixth of all strokes,
potentially leading to significant disability and death. The left atrial
appendage (LAA) is the primary location for thrombus formation. Excluding
the LAA has been hypothesized to decrease the risk of ischemic stroke.
 OBJECTIVE(S): This study examines LAA occlusion (LAAO) with otherwise
indicated cardiac surgery and its effect on surgical outcomes.
 METHOD(S): We followed the standards recommended by the Cochrane
Collaborative Group and PRISMA checklist to prepare this systematic review
and meta-analysis. Studies were retrieved through an online bibliographic
search, studies were screened, and data were extracted. We compared the
two study arms (LAAO and cardiac surgery without LAAO). Ten studies have
been included in this study, and six Randomized Controlled Trials (RCTs)
were included in the meta-analysis, with data pooled from over 10,000
patients. RESULT(S): LAAO is associated with no significant
difference in the overall mortality (p=0.98) and systemic embolism
(p=0.31). Strokes and ischemic strokes, in particular, have significantly
lower risk in patients who underwent LAAO (p< 0.0001 and p =0.0007),
respectively. CONCLUSION(S): LAAO can be done safely as a concomitant
surgery with other cardiac surgeries with a minimal incremental cost when
performed concurrently. LAAO is associated with a lower risk of all stroke
and ischemic strokes. Further studies are needed to shape guidance on the
continuation versus discontinuation of anticoagulation after LAAO,
especially in patient populations with a higher risk of
bleeding. Copyright © 2024. Published by Elsevier Inc.

<112>
Accession Number
645668545
Title
Culprit vessel revascularization prior to complete angiography as a
strategy to minimize delays in primary percutaneous coronary intervention
for patients with ST-elevation myocardial infarction: a systematic review
and meta-analysis.
Source
Coronary artery disease. (no pagination), 2024. Date of Publication: 31
Oct 2024.
Author
Bulhoes E.; Antunes V.L.J.; Defante M.L.R.; Mazetto R.; Garcia A.C.;
Garcia T.C.C.; Guida C.
Institution
(Bulhoes) Medicine Department, College of Higher Education of the United
Amazon, Redencao, Para, Brazil
(Antunes) Medicine Department, Federal University of Health Sciences of
Porto Alegre, Porto Alegre, Brazil
(Defante) Medicine Department, Redentor University Center, Itaperuna,
Brazil
(Mazetto) Medicine Department, Amazonas State University, Manaus, Brazil
(Garcia) Division of Cardiology, Goias Military Police Hospital, Goias,
Brazil
(Garcia, Guida) Division of Cardiology, Dante Pazzanese Institute of
Cardiology, Sao Paulo, Brazil
Abstract
The rapid restoration of blood flow in patients with acute myocardial
infarction with ST elevation through percutaneous coronary intervention
(PCI) is crucial for the survival of this population. Attempts to decrease
the time from diagnosis of ST-segment elevation myocardial infarction
(STEMI) to arrival at the catheterization laboratory have been extensively
investigated. However, strategies during the procedure aiming to reduce
the time to reperfusion are lacking. We conducted a meta-analysis to
evaluate culprit vessel revascularization prior to complete angiography as
a strategy to minimize delays in primary PCI for patients with STEMI. We
searched PubMed, Embase, and Cochrane Central. Outcome(s): vascular
access-to-balloon, door-to-balloon, and first medical contact-to-balloon
times; death, reinfarction in 30 days, Bleeding Academic Research
Consortium >=3 type, coronary artery bypass grafting referral, and left
ventricular ejection fraction %. Statistical analysis was performed using
the R program (version 4.3.2). Heterogeneity was assessed with I2
statistics. We included 2050 patients from six studies, of which two were
randomized controlled trials and four were observational studies. Culprit
vessel revascularization prior to complete angiography was associated with
a statistically significant decrease of times: vascular access-to-balloon
time (mean difference -6.79 min; 95% CI: -8.00 to -5.58; P < 0.01; I2 =
82%) and door-to-balloon time (mean difference -9.02 min; 95% CI: -12.83
to -5.22; P < 0.01; I2 = 93%). In this meta-analysis, performing PCI on
the culprit lesion prior to complete coronary angiography led to
significantly shorter reperfusion times, with no discernible differences
in complication rates. Copyright © 2024 Wolters Kluwer Health,
Inc. All rights reserved.

<113>
Accession Number
645668068
Title
Transcatheter Aortic Valve Replacement in Patients With Systolic Heart
Failure and Moderate Aortic Stenosis: TAVR UNLOAD.
Source
Journal of the American College of Cardiology. (no pagination), 2024.
Date of Publication: 22 Oct 2024.
Author
Van Mieghem N.M.; Elmariah S.; Spitzer E.; Pibarot P.; Nazif T.M.; Bax
J.J.; Hahn R.T.; Popma A.; Ben-Yehuda O.; Kallel F.; Redfors B.; Chuang
M.L.; Alu M.C.; Lindeboom W.; Kolte D.; Zahr F.E.; Kodali S.K.; Strote
J.A.; Hermanides R.S.; Cohen D.J.; Tijssen J.G.P.; Leon M.B.
Institution
(Van Mieghem) Department of Cardiology, Thoraxcenter, Cardiovascular
Institute, Erasmus University Medical Center, Rotterdam, Netherlands
(Elmariah) Division of Cardiology, University of San Francisco, San
Francisco, CA, United States
(Spitzer) Department of Cardiology, Thoraxcenter, Cardiovascular
Institute, Erasmus University Medical Center, Rotterdam, the Netherlands;
Cardialysis, Rotterdam, the Netherlands
(Pibarot) Department of Medicine, Quebec Heart and Lung Institute, Laval
University, Quebec City, QC, Canada
(Nazif, Kodali) Division of Cardiology, NewYork-Presbyterian
Hospital/Columbia University Irving Medical Center, NY, United States
(Bax) Department of Cardiology, Leiden University Medical Center, Leiden,
Netherlands
(Hahn, Alu, Leon) Division of Cardiology, NewYork-Presbyterian
Hospital/Columbia University Irving Medical Center, New York, New York,
USA; Cardiovascular Research Foundation, New York, New York, USA
(Popma, Chuang) Cardiovascular Research Foundation, NY, United States
(Ben-Yehuda) Division of Cardiovascular Medicine, University of California
San Diego, San Diego, CA, United States
(Kallel) Edwards Lifesciences, Irvine, CA, United States
(Redfors) Cardiovascular Research Foundation, New York, New York, USA;
Department of Population Health Sciences, Weill Cornell Medicine, New
York, New York, USA; Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden; Wallenberg Laboratory, Institute of
Medicine, University of Gothenburg, Gothenburg, Sweden
(Lindeboom) Cardialysis, Rotterdam, Netherlands
(Kolte) Cardiology Division, Massachusetts General Hospital, Boston,
Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
(Zahr) Oregon Health and Science University, Portland, Oregon, USA
(Strote) Medical Center of the Rockies, Loveland, CO, United States
(Hermanides) Department of Cardiology, Isala Heart Center, Zwolle,
Netherlands
(Cohen) Cardiovascular Research Foundation, New York, New York, USA; St
Francis Hospital, Roslyn, New York, USA
(Tijssen) Cardialysis, Rotterdam, the Netherlands; Department of
Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the
Netherlands
Abstract
BACKGROUND: Neurohormonal modulation and afterload reduction are key for
treatment of heart failure with reduced ejection fraction (HFrEF). In
HFrEF patients with concomitant moderate aortic stenosis (AS), treatment
with transcatheter aortic valve replacement (TAVR) may be complementary to
guideline-directed medical therapy (GDMT). OBJECTIVE(S): This study
sought to determine whether TAVR for moderate AS provides clinical benefit
in patients with HFrEF on top of GDMT. METHOD(S): We performed an
investigator-initiated, international, randomized controlled trial in
patients with HFrEF on GDMT with moderate AS who were suitable for
transfemoral TAVR with a balloon-expandable valve. Patients were
randomized 1:1 to TAVR or clinical aortic stenosis surveillance (CASS)
with aortic valve replacement upon progression to severe AS. The primary
endpoint was the hierarchical occurrence of: 1) all-cause death; 2)
disabling stroke; 3) disease-related hospitalizations and heart failure
equivalents; and 4) change from baseline in the Kansas City Cardiomyopathy
Questionnaire Overall Summary Score analyzed using the win ratio.
 RESULT(S): From January 2017 to December 2022, 178 patients were
randomized to TAVR (n = 89) or AS surveillance (n = 89). The mean age was
77 years, 20.8% were female, and 55.6% were in NYHA functional class III
or IV. The median follow-up duration was 23 months (Q1-Q3: 12-33 months).
A total of 38 (43%) patients in the CASS group (of whom 35 had progressed
to severe AS) underwent TAVR at a median of 12 months postrandomization.
TAVR was associated with wins in 47.6% of pairs, compared with 36.6% in
the CASS group, resulting in a win ratio of 1.31 (95% CI: 0.91-1.88; P =
0.14). At 1 year, TAVR resulted in a greater improvement in the Kansas
City Cardiomyopathy Questionnaire Overall Summary Score compared with the
CASS group (12.8 +/- 21.9 points vs 3.2 +/- 22.8 points; P = 0.018).
 CONCLUSION(S): TAVR was not superior to AS surveillance for the
primary hierarchical composite endpoint in patients with moderate AS and
HFrEF on GDMT. Preemptive TAVR for moderate AS was safe and may provide
clinically meaningful quality-of-life benefits. Copyright © 2024
American College of Cardiology Foundation. Published by Elsevier Inc. All
rights reserved.

<114>
Accession Number
645667230
Title
Coronary artery bypass grafting vs. percutaneous coronary intervention in
severe ischaemic cardiomyopathy: long-term survival.
Source
European heart journal. (no pagination), 2024. Date of Publication: 29
Oct 2024.
Author
Bloom J.E.; Vogrin S.; Reid C.M.; Ajani A.E.; Clark D.J.; Freeman M.; Hiew
C.; Brennan A.; Dinh D.; Williams-Spence J.; Dawson L.P.; Noaman S.; Chew
D.P.; Oqueli E.; Cox N.; McGiffin D.; Marasco S.; Skillington P.; Royse
A.; Stub D.; Kaye D.M.; Chan W.
Institution
(Bloom) Cardiology Division, Columbia University Medical Center, 161 Fort
Washington Ave ,Herbert Irving Pavilion ,6th Floor, NY, NY 10032, United
States
(Bloom, Dawson, Stub, Kaye, Chan) Department of Cardiology, Alfred Health,
55 Commercial Road, Melbourne, VIC 3004, Australia
(Bloom, Dinh, Kaye, Chan) Heart Failure Research Group, Baker Heart and
Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
(Bloom, Reid, Brennan, Williams-Spence, Dawson, Stub) School of Public
Health and Preventive Medicine, Monash University, 553 St. Kilda Road,
Melbourne, VIC 3004, Australia
(Vogrin, Royse, Chan) Melbourne Medical School, University of Melbourne,
Grattan Street, Melbourne, VIC 3010, Australia
(Reid) School of Population Health, Curtin University, Kent Street, Perth,
WA 6102, Australia
(Ajani) Department of Cardiology, The Royal Melbourne Hospital, Grattan
Street, Melbourne, VIC 3010, Australia
(Clark) Department of Cardiology, Austin Hospital, 145 Studley Road,
Heidelberg, VIC 3084, Australia
(Freeman) Department of Cardiology, Eastern Health, 8 Arnold Street ,Box
Hill, VIC 3128, Australia
(Hiew) Department of Cardiology, University Hospital Geelong, Bellarine
Street, Geelong, VIC 3220, Australia
(Noaman, Cox, Chan) Department of Cardiology, Western Health, Furlong
Road, St Albans, VIC 3021, Australia
(Chew) Victorian Heart Institute, Monash University, Melbourne, Australia
(Oqueli) Department of Cardiology, Grampians Health Ballarat, Central VIC
3350, 1 Drummond Street N, Ballarat, Australia
(Oqueli) Faculty of Health, School of Medicine, Deakin University,
Geelong, VIC, Australia
(McGiffin, Marasco) Department of Cardiothoracic Surgery, Alfred Health,
55 Commercial Road, Melbourne, VIC 3004, Australia
(Skillington, Royse) Department of Cardiothoracic Surgery, The Royal
Melbourne Hospital, Grattan Street, Melbourne, VIC 3010, Australia
Abstract
BACKGROUND AND AIMS: The optimal revascularization strategy in patients
with ischaemic cardiomyopathy remains unclear with no contemporary
randomized trial data to guide clinical practice. This study aims to
assess long-term survival in patients with severe ischaemic cardiomyopathy
revascularized by either coronary artery bypass grafting (CABG) or
percutaneous coronary intervention (PCI). METHOD(S): Using the
Australian and New Zealand Society of Cardiac and Thoracic Surgeons and
Melbourne Interventional Group registries (from January 2005 to 2018),
patients with severe ischaemic cardiomyopathy [left ventricular ejection
fraction (LVEF) <35%] undergoing PCI or isolated CABG were included in the
analysis. Those with ST-elevation myocardial infarction and cardiogenic
shock were excluded. The primary outcome was long-term National Death
Index-linked mortality up to 10 years following revascularization. Risk
adjustment was performed to estimate the average treatment effect using
propensity score analysis with inverse probability of treatment weighting
(IPTW). RESULT(S): A total of 2042 patients were included, of whom
1451 patients were treated by CABG and 591 by PCI. Inverse probability of
treatment weighting-adjusted demographics, procedural indication, coronary
artery disease extent, and LVEF were well balanced between the two patient
groups. After risk adjustment, patients treated by CABG compared with
those treated by PCI experienced reduced long-term mortality [adjusted
hazard ratio 0.59, 95% confidence interval (CI) 0.45-0.79, P = .001] over
a median follow-up period of 4.0 (inter-quartile range 2.2-6.8) years.
There was no difference between the groups in terms of in-hospital
mortality [adjusted odds ratio (aOR) 1.42, 95% CI 0.41-4.96, P = .58], but
there was an increased risk of peri-procedural stroke (aOR 19.6, 95% CI
4.21-91.6, P < .001) and increased length of hospital stay (exponentiated
coefficient 3.58, 95% CI 3.00-4.28, P < .001) in patients treated with
CABG. CONCLUSION(S): In this multi-centre IPTW analysis, patients
with severe ischaemic cardiomyopathy undergoing revascularization by CABG
rather than PCI showed improved long-term survival. However, future
randomized controlled trials are needed to confirm the effect of any such
benefits. Copyright © The Author(s) 2024. Published by Oxford
University Press on behalf of the European Society of Cardiology. All
rights reserved. For commercial re-use, please contact reprints@oup.com
for reprints and translation rights for reprints. All other permissions
can be obtained through our RightsLink service via the Permissions link on
the article page on our site-for further information please contact

<115>
Accession Number
645666411
Title
Cerebral Embolic Protection by Geographic Region: A Post Hoc Analysis of
the PROTECTED TAVR Randomized Clinical Trial.
Source
JAMA cardiology. (no pagination), 2024. Date of Publication: 29 Oct 2024.
Author
Makkar R.R.; Gupta A.; Waggoner T.E.; Horr S.; Karha J.; Satler L.; Stoler
R.C.; Alvarez J.; Sakhuja R.; MacDonald L.; Modolo R.; Leon M.B.; Linke
A.; Kapadia S.R.
Institution
(Makkar, Gupta) Cedars-Sinai Medical Center, Los Angeles, CA, United
States
(Waggoner) US Heart & Vascular, Tucson Medical Center Healthcare, Tucson,
AZ, United States
(Horr) Centennial Medical Center, Nashville, TN, United States
(Karha) Baylor Scott & White, College Station, TX, United States
(Satler) Washington Hospital Center, WA, United States
(Stoler) Baylor Heart & Vascular Hospital, Dallas, TX, United States
(Alvarez) Methodist Healthcare System, San Antonio, TX, United States
(Sakhuja) Division of Cardiology, Massachusetts General Hospital, Boston,
United States
(MacDonald) South Denver Heart Center, Littleton, CO, United States
(Modolo) Boston Scientific Corporation, Marlborough, Massachusetts
(Leon) Columbia University Medical Center, NY, United States
(Linke) University of Technology Dresden, Heart Center, University
Hospital, Dresden, Germany
(Kapadia) Department of Cardiovascular Medicine, Cleveland Clinic
Foundation, Cleveland, OH, United States
Abstract
Importance: Transcatheter aortic valve replacement (TAVR) is an
established treatment option for many patients with severe symptomatic
aortic stenosis; however, debris dislodged during the procedure can cause
embolic stroke. The Sentinel cerebral embolic protection (CEP) device is
approved for capture and removal of embolic material during TAVR but its
efficacy has been debated. Objective(s): To explore regional
differences in the association of CEP utilization with stroke outcomes in
patients undergoing TAVR. Design, Setting, and Participant(s): This
post hoc analysis of a prospective, postmarket, randomized clinical trial
evaluating TAVR performed with or without the CEP took place at 51
hospitals in the US, Europe, and Australia from February 2020 to January
2022. Patients with symptomatic aortic stenosis treated with transfemoral
TAVR were included. Randomization was stratified according to center,
operative risk, and intended TAVR valve type. Patients were excluded if
the left common carotid or brachiocephalic artery had greater than 70%
stenosis or if the anatomy precluded placement of the CEP device. Data for
this post hoc study were analyzed from August to October 2024.
 Intervention(s): TAVR with or without CEP. Main Outcomes and
Measures: The primary end point was the rate of all stroke events at
hospital discharge or 72 hours post-TAVR, whichever came first.
Neurological examinations were performed at baseline and postprocedure to
identify stroke, disabling stroke, and other neurological outcomes.
 Result(s): The Stroke Protection With Sentinel During Transcatheter
Aortic Valve Replacement (PROTECTED TAVR) trial enrolled and randomized
3000 patients (1803 [60.1%] male; mean [SD] age, 78.9 [7.8] years): 1833
in the US cohort (TAVR alone: 919, TAVR with CEP: 914) and 1167 patients
in the outside the US (OUS) cohort (TAVR alone: 580, TAVR with CEP: 587).
Patients in the US cohort were younger, more predominantly male, had a
lower prevalence of atrial fibrillation, and had a higher prevalence of
bicuspid aortic valve, diabetes, and peripheral vascular disease compared
with the OUS cohort. In the main trial, the incidence of stroke within 72
hours after TAVR or before discharge did not differ significantly between
the CEP group and the control group, and there was no interaction by
geographic region. In this post hoc analysis, patients treated with CEP in
the US cohort exhibited a 50% relative risk reduction for overall stroke
and a 73% relative risk reduction for disabling stroke compared to TAVR
alone; a treatment effect on stroke risk reduction was not observed in the
OUS cohort. Conclusion and Relevance: The PROTECTED TAVR trial could not
show that the use of CEP had a significant effect on the incidence of
periprocedural stroke during TAVR. Although there was no significant
interaction by geographic region, this exploratory post hoc analysis
suggests a trend toward greater stroke reduction in the US cohort but not
in the OUS cohort. These findings are hypothesis generating, and further
research is needed to determine if regional differences in patient
characteristics or procedural practices affect CEP efficacy. Trial
Registration: ClinicalTrials.gov Identifier: NCT04149535.

<116>
Accession Number
645666151
Title
Tricuspid transcatheter edge-to-edge repair for severe tricuspid
regurgitation: 1-year outcomes from the TRILUMINATE randomized cohort.
Source
Journal of the American College of Cardiology. (no pagination), 2024.
Date of Publication: 23 Oct 2024.
Author
Tang G.H.L.; Hahn R.T.; Whisenant B.K.; Hamid N.; Naik H.; Makkar R.R.;
Tadros P.; Price M.J.; Singh G.D.; Fam N.P.; Kar S.; Mehta S.R.; Bae R.;
Sekaran N.K.; Warner T.; Makar M.; Zorn G.; Benza R.; Jorde U.P.; McCarthy
P.M.; Thourani V.H.; Ren Q.; Trusty P.M.; Sorajja P.; Adams D.H.
Institution
(Tang, Benza, Adams) Mount Sinai Health System, New York, NY, USA
(Hahn) New York-Presbyterian Columbia University Medical Center, New York,
NY, USA
(Whisenant, Sekaran) Intermountain Medical Center, Murray, UT, United
States
(Hamid, Bae, Sorajja) Allina Health Minneapolis Heart Institute at Abbott
Northwestern Hospital, Minneapolis, MN, United States
(Naik, Warner) St. Joseph's Hospital and Medical Center, Phoenix, AZ,
United States
(Makkar, Makar) Cedars-Sinai Medical Center, Los Angeles, CA, United
States
(Tadros, Zorn) Kansas University Medical Center, Kansas City, KS, United
States
(Price) Scripps Clinic, La Jolla, CA, United States
(Singh) University of California - Davis Medical Center, Sacramento, CA,
United States
(Fam) St. Micheal's Hospital, Toronto, ON, Canada
(Kar) Los Robles Regional Medical Center, HCA Healthcare, Thousand Oaks,
CA, United States
(Mehta) Hamilton Health Science, Hamilton, Ontario, Canada
(Jorde) Montefiore Medical Center, Bronx, NY, United States
(McCarthy) Northwestern University, Chicago, IL, United States
(Thourani) Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA,
United States
(Ren, Trusty) Abbott Structural Heart, Santa Clara, CA, United States
Abstract
BACKGROUND: Tricuspid regurgitation (TR) is a right-sided valvular disease
independently associated with morbidity and mortality. The TRILUMINATE
Pivotal trial is the first randomized, controlled trial assessing the
impact of TR reduction with tricuspid transcatheter edge-to-edge repair
(T-TEER). OBJECTIVE(S): Outcomes from the full randomized cohort of
the TRILUMINATE Pivotal trial have not been previously reported, and the
additional enrollment may further support the safety and effectiveness of
T-TEER through 1 year. METHOD(S): The TRILUMINATE Pivotal trial is an
international RCT of T-TEER with the TriClip device in patients with
symptomatic, severe TR. Adaptive trial design allowed enrollment past the
primary analysis population. The primary outcome was a hierarchical
composite of all-cause mortality or tricuspid valve surgery, heart failure
hospitalizations (HFH), and quality-of-life improvement measured by Kansas
City Cardiomyopathy Questionnaire (KCCQ) at 1 year. RESULT(S):
Between August 21, 2019 and June 29, 2022, 572 subjects were randomized,
including the primary cohort (n=350) and subsequent enrollment (n=222).
Subjects were elderly (78.1+/-7.8 years) and predominantly female (58.9%),
with atrial fibrillation (87.8%) and prior HFH (23.8%). The primary
endpoint was met for the full cohort (win ratio=1.84, p<0.0001). Freedom
from all-cause mortality and tricuspid valve surgery through 12 months was
90.6% and 89.9% for the device and control groups, respectively (p=0.82).
Annualized HFH rate was comparable between device and control subjects
(0.17 vs 0.20 events/patient-year, p=0.40). A significant treatment effect
was observed for change in quality of life with 49.5% of device subjects
achieving a >=15-point KCCQ score improvement (compared to 25.6% of
control subjects, p<0.0001). All secondary endpoints favored T-TEER:
moderate or less TR at 30 days (88.9% vs 5.3%, p<0.0001), KCCQ change at 1
year (13.0+/-1.4 vs -0.5+/-1.4 points, p<0.0001), and six-minute walk
distance change at 1 year (1.7+/-7.5 vs -27.4+/-7.4 meters, p<0.0001).
Freedom from major adverse events was 98.9% for T-TEER (vs. performance
goal: 90%, p<0.0001). CONCLUSION(S): TriClip was safe and effective
in the full randomized cohort of TRILUMINATE Pivotal with significant TR
reduction and improvements in six-minute walk distance and health status.
Rates of all-cause mortality or TV surgery and HFH through 1 year were not
reduced by T-TEER. Copyright © 2024 The Authors. Published by
Elsevier Inc. All rights reserved.

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