EPICORE Embase Updates: EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 127

Results Generated From:
Embase <1980 to 2024 Week 44>
Embase Weekly Updates (updates since 2024-10-25)

<1>
Accession Number
2035260795
Title
Prospective study on the impact of different antithrombotic therapies on
subclinical leaflet thickening and its temporal dynamics in transcatheter
aortic valves-The NOTION-4 trial: Antithrombotic therapy and TAV-HALT.
Source
American Heart Journal. 279 (pp 1-8), 2025. Date of Publication: January
2025.
Author
Thuraiaiyah J.; Jorgensen T.H.; Jensen J.M.; Fuchs A.; Willemen Y.;
Terkelsen C.J.; Kofoed K.F.; Sondergaard L.; Linde Norgaard B.; De Backer
O.
Institution
(Thuraiaiyah, Jorgensen, Fuchs, Willemen, Kofoed, Sondergaard, De Backer)
The Heart Center, Rigshospitalet, Copenhagen University Hospital,
Copenhagen, Denmark
(Jensen, Terkelsen, Linde Norgaard) Department of Cardiology, Skejby,
Aarhus University Hospital, Aarhus, Denmark
(Sondergaard) Abbott, Santa Clara, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has become the
standard-of-care treatment for a majority of patients with severe,
symptomatic aortic stenosis. The postprocedural antithrombotic therapeutic
management is still a topic of debate and could affect the incidence of
HALT, a phenomenon which can be assessed by 4-dimensional computed
tomography (4DCT). Trial design: The NOTION-4 trial is a randomized
controlled trial comprising TAVR patients with no indication for oral
anticoagulant (OAC) therapy, comparing lifelong single antiplatelet
therapy (standard arm) versus early 3-month direct oral anticoagulant
(DOAC) therapy followed by single antiplateletet therapy (experimental
arm). The incidence of HALT and clinical endpoints will be evaluated in
both groups at 3 months, 1 year and 5 years after randomization. The
primary endpoint is the number of patients with at least 1 bioprosthetic
aortic valve leaflet with HALT as assessed by cardiac 4DCT imaging at 1
year. The trial is powered for superiority testing and started enrollment
in 2021. In total, 324 patients will be included. The last patient is
expected to be enrolled by the end of 2024 and the primary endpoint is to
be presented in 2026. Conclusion and perspective: The NOTION-4 trial aims
to study whether an early 3-month DOAC therapy after TAVR can result in a
sustained lower incidence of HALT in transcatheter aortic valves. This
trial holds the potential to give valuable insights into whether early OAC
therapy should be integrated in future guidelines for post-TAVR
antithrombotic therapeutic management. Trial registration: NOTION-4,
ClinicalTrials.gov ID NCT06449469,
https://clinicaltrials.gov/study/NCT06449469 Copyright © 2024
Elsevier Inc.

<2>
Accession Number
2035266535
Title
The safety and efficacy of NeVa mechanical thrombectomy device in acute
ischemic stroke: A systematic review and meta-analysis.
Source
Journal of Clinical Neuroscience. 130 (no pagination), 2024. Article
Number: 110892. Date of Publication: December 2024.
Author
Habibi M.A.; Mirjnani M.S.; Kargar-Soleimanabad S.; Akbari Javar M.T.;
Diyanati M.; Ahmadvand M.H.; Berglar I.K.; Dmytriw A.A.
Institution
(Habibi) Department of Neurosurgery, Shariati Hospital, Tehran University
of Medical Sciences, Tehran, Iraq
(Mirjnani) Student Research Committee, Qom University of Medical Sciences,
Qom, Iraq
(Kargar-Soleimanabad) Student Research Committee, Mazandaran University of
Medical Sciences, Sari, Iraq
(Akbari Javar, Diyanati) Student Research Committee, Rafsanjan University
of Medical Sciences, Rafsanjan, Iran, Islamic Republic of
(Ahmadvand) Faculty of Medicine, Tehran University of Medical Science,
Tehran, Iraq
(Berglar, Dmytriw) Neuroendovascular Program, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, United States
Publisher
Churchill Livingstone
Abstract
Background: Recent favorable cohort studies on endovascular therapy for
ischemic stroke have predominantly utilized NeVa thrombectomy
(NeVaTM) stent retrievers. We carried out a systematic review
and meta-analysis to investigate the efficacy and safety of this
second-generation stent retriever in acute ischemic stroke patients.
 Method(s): We conducted the study according to the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines. The electronic databases of PubMed, Embase, and Scopus were
searched until 26 November 2023 and was updated on August 1, 2024.
 Result(s): This meta-analysis systematically investigated 11 studies
with a total of 805 patients suffering from ischemic stroke. The mean age
of participants across the studies ranged from 65 to 77 years with a male
preponderance of 50.16 %. While ten studies reported on the etiology of
strokes, some studies reported the risk factors such as hypertension,
dyslipidemia, diabetes, history of coronary artery disease, and previous
stroke. The results of our study indicate that the all-hemorrhagic
complications rate was 0.32 (95 %CI: 0.18-0.45), while the complete
arterial recanalization rate was 0.76 [95 %CI: 0.49-1.04]. The overall
recanalization rate was found to be 0.97 [95 %CI: 0.94-1.00]. Moreover,
the postoperative hemorrhage rate was 0.28 [95 %CI: 0.14-0.41], while the
repeated re-thrombosis rate was 0.01 [95 %CI: -0.01-0.03]. Lastly, the
vasospasm rate was calculated to be 0.09 [95 %CI: -0.03-0.21].
 Conclusion(s): NeVaTM is a safe option capable of achieving a high
rate of recanalization and functional independence. Abbreviations: PRISMA,
Preferred Reporting Items for Systematic Reviews and Meta-Analyses;
PROSPERO, International Prospective Register of Systematic Reviews;
NeVaTM, NeVa Thrombectomy; ICH, Intracranial Hemorrhage; mTICI, modified
Thrombolysis in Cerebral Infarction; mRS, modified Rankin Scale; ACA,
Anterior Cerebral Artery; MCA, Middle Cerebral Artery; PCA, Posterior
Cerebral Artery; ICA, Internal Carotid Artery; NIHSS, National Institutes
of Health Stroke Scale. Copyright © 2024 Elsevier Ltd

<3>
Accession Number
2035056158
Title
Prospective Reassessment of the Association Between Pro-Inflammatory
Factors and Prognosis After on-Pump Cardiac Surgery.
Source
Kardiologiya. 64(9) (pp 87-95), 2024. Date of Publication: 2024.
Author
Huang Y.; Huang X.; Ling L.; Liu C.; Chen S.; Zhou J.; Du L.; Xiong J.
Institution
(Huang, Huang, Ling, Liu, Chen, Zhou) Sichuan University, West China
Hospital, Department of Laboratory Medicine, Sichuan, China
(Du, Xiong) Sichuan University, West China Hospital, Department of
Anesthesiology, Sichuan, China
Publisher
Limited Liability Company KlinMed Consulting
Abstract
Aim Elevated levels of pro-inflammatory factors in plasma have been linked
to worse prognosis after on-pump cardiac surgery, yet interventions that
reduce the levels in patients have failed to improve prognosis. Therefore,
we explored whether levels of pro-inflammatory factors are associated with
prognosis of patients after valve surgery with cardiopulmonary bypass.
Material and methods 244 patients were prospectively enrolled into
observational study. Levels of tumor necrosis factor (TNF) - alpha,
interleukin-8 and neutrophil elastase were measured once before and
several times after cardiopulmonary bypass. The levels were compared
between patients who experienced in-hospital adverse events or not, and
between patients who experienced major adverse cardiac or cerebrovascular
events (MACCEs) during three-year follow-up or not. Results Of the 244
patients enrolled, in-hospital adverse events occurred in 38 (15.6%); of
the 237 patients who completed follow-up, MACCEs occurred in 30 (12.7%).
Surgery led to significant increases in levels of all three
pro-inflammatory factors, with levels returning to pre-bypass baseline on
arrival in the intensive care unit (TNF-alpha), 4 h after arrival
(interleukin-8) or 20 h after arrival (neutrophil elastase). However, pre-
and post-bypass levels of all three factors did not differ significantly
between patients who experienced adverse events in-hospital or not, or
between patients who experienced MACCEs during follow-up or not.
Conclusions Levels of TNF-alpha, interleukin-8 and neutrophil elastase may
not be associated with poor prognosis after cardiopulmonary bypass. This
may help explain why "cytokine clearance" strategies fail to improve
clinical outcomes after on-pump cardiac surgery. Copyright © 2024
Limited Liability Company KlinMed Consulting. All rights reserved.

<4>
[Use Link to view the full text]
Accession Number
2034526612
Title
Stroke Prevention With Prophylactic Left Atrial Appendage Occlusion in
Cardiac Surgery Patients Without Atrial Fibrillation: A Meta-Analysis of
Randomized and Propensity-Score Studies.
Source
Circulation: Cardiovascular Interventions. 17(10) (pp e014296), 2024. Date
of Publication: 01 Oct 2024.
Author
Baudo M.; Sicouri S.; Yamashita Y.; Senzai M.; McCarthy P.M.; Gerdisch
M.W.; Whitlock R.P.; Ramlawi B.
Institution
(Baudo, Sicouri, Yamashita, Senzai, Ramlawi) Department of Cardiac Surgery
Research, Lankenau Heart Institute, Main Line Health, Wynnewood, PA,
United States
(Yamashita, Ramlawi) Lankenau Institute for Medical Research, Department
of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood,
PA, United States
(McCarthy) Division of Cardiac Surgery, Bluhm Cardiovascular Institute,
Northwestern Medicine, Chicago, IL, United States
(Gerdisch) Department of Cardiothoracic Surgery, Franciscan Health,
Indianapolis, IN, United States
(Whitlock) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Whitlock) Population Health Research Institute, Hamilton, ON, Canada
(Whitlock) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Whitlock) Division of Critical Care, Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Whitlock) Division of Cardiac Surgery, Department of Surgery, McMaster
University, Hamilton, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: The role of left atrial appendage occlusion (LAAO) in patients
without previous atrial fibrillation (AF) is not established. This
meta-analysis was conducted on patients with normal sinus rhythm who
underwent cardiac surgery, with and without concomitant LAAO, to evaluate
its effect on the incidence of cerebrovascular accidents (CVAs).
 METHOD(S): A systematic review was conducted from inception until
December 2023 for randomized and propensity-score studies comparing CVA in
patients without AF undergoing cardiac surgery with or without LAAO.
 RESULT(S): Six studies met our inclusion criteria with a total of
4130 patients: 2146 in the LAAO group and 1984 in the no-LAAO group. The
risk ratio of postoperative AF was 1.05 (95% CI, 0.86-1.28); P=0.628. The
CVA rates at 5 years were 6.8+/-1.0% in the no-LAAO group and 4.3+/-0.8%
in the LAAO group (log-rank P=0.021). The Cox regression analysis for CVA
in patients undergoing LAAO reported a hazard ratio of 0.65 (95% CI,
0.45-0.94); P=0.022. Landmark analysis at 4 years highlighted a
significant difference in overall survival between no-LAAO and LAAO
groups, 86+/-12.2% versus 89.6+/-11.0%; P=0.041. CONCLUSION(S): In
this meta-analysis of patients without previous AF undergoing cardiac
surgery, LAAO was associated with a decreased risk of CVA, no difference
in the incidence of postoperative atrial fibrillation, and a significant
overall survival benefit at a 4-year landmark analysis. Although these
findings support LAAO, the randomized LeAAPS trial (Left Atrial Appendage
Exclusion for Prophylactic Stroke Reduction Trial), LAA-CLOSURE trial (A
Randomized Prospective Multicenter Trial for Stroke Prevention by
Prophylactic Surgical Closure of the Left Atrial Appendage in Patients
Undergoing Bioprosthetic Aortic Valve Surgery), and LAACS-2 trial (Left
Atrial Appendage Closure by Surgery-2) will help define the effectiveness
of LAAO in patients undergoing cardiac surgery who have risk factors for
AF and CVA. Copyright © 2024 American Heart Association, Inc.

<5>
Accession Number
2030781274
Title
Paediatric postoperative acute kidney injury after non-cardiac surgery:
Protocol for a systematic review and meta-analysis.
Source
Acta Anaesthesiologica Scandinavica. 68(10) (pp 1561-1564), 2024. Date of
Publication: November 2024.
Author
Emami A.; Sivertsson E.; Westerbergh J.; Hultstrom M.; Danielsson J.;
Frykholm P.; Frithiof R.
Institution
(Emami, Sivertsson, Hultstrom, Frykholm, Frithiof) Anesthesiology and
Intensive Care, Department of Surgical Sciences, Uppsala University,
Uppsala, Sweden
(Westerbergh) Uppsala Clinical Research Center, Uppsala University,
Uppsala, Sweden
(Hultstrom) Department of Medical Cell Biology, Integrative Physiology,
Uppsala University, Uppsala, Sweden
(Danielsson) Department of Women's and Children's Health, Uppsala
University, Uppsala, Sweden
Publisher
John Wiley and Sons Inc
Abstract
Background: Paediatric acute kidney injury (AKI) is associated with
significant adverse outcomes such as increased mortality, progression to
chronic kidney disease and longer length of stay in hospital.
Postoperative AKI is a common and recognized complication after surgery in
adults. In the paediatric population, AKI postoperatively to cardiac
surgery has been extensively studied. However, the incidence of
postoperative AKI after non-cardiac surgery is less clear. Therefore, we
aim to assess the available literature on this topic. Method(s): We
will conduct a systematic review of observational and randomized
controlled trials assessing the incidence of paediatric postoperative AKI
after non-cardiac surgery. Pairs of reviewers will independently screen
the literature and extract data and assess risk of bias from eligible
studies. The databases Pubmed, Cochrane and Web of Sciences will be
searched. We will conduct the review in accordance with the Preferred
Reporting Items for Systematic Review and Meta-Analysis (PRISMA)
guidelines and the Grading of Recommendation, Assessment, Development and
Evaluation (GRADE) approach. If sufficient homogeneity within the included
trials we will conduct meta-analyses. Discussion(s): This systematic
review aims to investigate the incidence of postoperative AKI in the
paediatric non-cardiac surgery population. The results of this review will
provide a foundation for future research in the field of paediatric
postoperative AKI. Copyright © 2024 The Author(s). Acta
Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on
behalf of Acta Anaesthesiologica Scandinavica Foundation.

<6>
Accession Number
2035277497
Title
Secondary mitral regurgitation surgical management: a narrative review.
Source
Cardiovascular Diagnosis and Therapy. 14(5) (pp 958-973), 2024. Date of
Publication: 31 Oct 2024.
Author
Eapen S.R.; Zaky M.H.; Kostibas M.P.; Robich M.P.
Institution
(Eapen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Zaky) Division of Cardiac Surgery, Department of Surgery, Yale School of
Medicine, New Haven, CT, United States
(Kostibas) Division of Adult Cardiothoracic Anesthesiology, Department of
Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, United
States
(Robich) Division of Cardiac Surgery, Department of Surgery, Johns Hopkins
School of Medicine, Baltimore, MD, United States
Publisher
AME Publishing Company
Abstract
Background and Objective: The most common valvular heart disease in the US
is moderate to severe mitral regurgitation (MR). Function MR or secondary
MR comprises many of these cases. Moderate and severe secondary MR are
independently associated with increased all-cause mortality and
rehospitalization for heart failure. Both ischemic and nonischemic
cardiomyopathy can cause secondary MR via similar pathophysiology that
leads to inadequate valve leaflets coaptation. The management of secondary
MR is complex. The optimal treatment strategy for secondary MR remains
controversial, reflected in the vast array of treatment options and the
complexity of therapeutic decision-making. Several surgical mitral valve
repair techniques have been described in the literature. Many of these
aims to facilitate adequate valve leaflet coaptation. In this review, the
pathophysiology of MR is described with a focus on evaluating and managing
secondary MR. Method(s): A literature review was performed using
PubMed and Google Scholar. Clinical trials, meta-analyses, randomized
controlled trials, reviews, and systematic reviews were considered from
January 1, 1995 through December 31, 2022. Articles published in languages
other than English with limited text availability were excluded. Key
Content and Findings: Optimal therapeutic approach in severe secondary MR
is complex and several patient factor should be considered. We provide a
framework for the surgical management of secondary MR based on
echocardiographic parameters, the presence of ischemia, and myocardial
viability. Conclusion(s): Further study is needed to guide the
selection of patients most likely to benefit from mitral valve repair or
replacement in the setting of secondary MR. Copyright © AME
Publishing Company.

<7>
[Use Link to view the full text]
Accession Number
2035158349
Title
Topical Versus Intravenous Tranexamic Acid in Patients Undergoing Cardiac
Surgery: The DEPOSITION Randomized Controlled Trial.
Source
Circulation. 150(17) (pp 1315-1323), 2024. Date of Publication: 22 Oct
2024.
Author
Lamy A.; Sirota D.A.; Jacques F.; Poostizadeh A.; Noiseux N.; Efremov S.;
Demers P.; Akselrod B.; Wang C.Y.; Arora R.C.; Branny P.; McGuinness S.P.;
Brown C.D.; Jeanmart H.; Zhao Q.; Zhang H.; Belley-Cote E.P.; Whitlock
R.P.; Browne A.; Copland I.; Vincent J.; Khatun R.; Balasubramanian K.;
Bangdiwala S.I.; McGillion M.H.; Fox-Robichaud A.E.; Spence J.; Yusuf S.;
Devereaux P.J.
Institution
(Lamy, Belley-Cote, Whitlock, Copland, Vincent, Khatun, Balasubramanian,
Bangdiwala, McGillion, Spence, Yusuf, Devereaux) Population Health
Research Institute, Hamilton, ON, Canada
(Bangdiwala, Spence, Devereaux) Department of Health Research Methods,
Evidence, and Impact, McMaster University, Hamilton, ON, Canada
(Belley-Cote, Fox-Robichaud, Devereaux) Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Lamy, Whitlock) Department of Surgery, McMaster University, Hamilton, ON,
Canada
(Spence) Department of Anesthesia, McMaster University, Hamilton, ON,
Canada
(McGillion) Department of School of Nursing, McMaster University,
Hamilton, ON, Canada
(Fox-Robichaud) Thrombosis and Atherosclerosis Research Institute,
McMaster University, Hamilton, ON, Canada
(Sirota) E. Meshalkin National Medical Research Center, Novosibirsk,
Russian Federation
(Wang) Department of Anesthesiology, Faculty of Medicine, University of
Malaya, Kuala Lumpur, Malaysia
(Efremov) Saint Petersburg State University Hospital, Russian Federation
(McGuinness) Auckland City Hospital, New Zealand
(Jacques) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Universite Laval, Quebec, Canada
(Poostizadeh) Kelowna General Hospital, BC, Canada
(Noiseux) Centre de Recherche du Centre Hospitalier de l'Universite de
Montreal (CRCHUM), QC, Canada
(Demers) Montreal Heart Institute, University of Montreal, QC, Canada
(Akselrod) Petrovsky National Centre of Surgery, Moscow, Russian
Federation
(Arora) Division of Cardiac Surgery, University Hospitals Harrington Heart
and Vascular Institute, Cleveland, OH, United States
(Branny) Department of Cardiac Surgery, Hospital Agel Trinec-Podlesi,
Trinec, Czechia
(Brown) New Brunswick Heart Centre, Saint John, Canada
(Jeanmart) Centre Integre Universitaire de Sante et de Services Sociaux du
Nord-de-l'Ile-de-Montreal, Hopital du Sacre-Coeur de Montreal, QC, Canada
(Zhao) Rujin Hospital, Shanghai, China
(Zhang) Beijing Anzhen Hospital, China
(Browne) Hamilton Health Sciences, Hamilton General Hospital, ON, Canada
(Arora) Department of Surgery, Case Western Reserve University, Cleveland,
OH, United States
(Zhao) Shanghai Jiao Tong University School of Medicine, China
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Although intravenous tranexamic acid is used in cardiac
surgery to reduce bleeding and transfusion, topical tranexamic acid
results in lower plasma concentrations compared with intravenous
tranexamic acid, which may lower the risk of seizures. We aimed to
determine whether topical tranexamic acid reduces the risk of in-hospital
seizure without increasing the risk of transfusion among cardiac surgery
patients. METHOD(S): We conducted a multicenter, double dummy,
blinded, randomized controlled trial of patients recruited by convenience
sampling in academic hospitals undergoing cardiac surgery with
cardiopulmonary bypass. Between September 17, 2019, and November 28, 2023,
a total of 3242 patients from 16 hospitals in 6 countries were randomly
assigned (1:1 ratio) to receive either intravenous tranexamic acid
(control) through surgery or topical tranexamic acid (treatment) at the
end of surgery. The primary outcome was seizure, and the secondary outcome
was red blood cell transfusion. After the last planned interim analysis,
when 75% of anticipated participants had completed follow up, the data and
safety monitoring board recommended to terminate the trial, and upon
unblinding, the operations committee stopped the trial for safety.
 RESULT(S): Among 3242 randomized patients (mean age, 66.0 years;
77.7% male), in-hospital seizure occurred in 4 of 1624 patients (0.2%) in
the topical group, and 11 of 1628 patients (0.7%) in the intravenous group
(absolute risk difference, -0.5% [95% CI, -0.9 to 0.03]; P=0.07). Red
blood cell transfusion occurred in 570 patients (35.1%) in the topical
group and in 433 (26.8%) in the intravenous group (absolute risk
difference, 8.3% [95% CI, 5.2-11.5]; P=0.007). The absolute risk
difference in transfusion of >=4 units of red blood cells in the topical
group compared with the intravenous group was 8.2% (95% CI, 3.4-12.9).
 CONCLUSION(S): Among patients undergoing cardiac surgery, topical
administration of tranexamic acid resulted in an 8.3% absolute increase in
transfusion without reducing the incidence of seizure, compared with
intravenous tranexamic acid. Copyright © 2024 American Heart
Association, Inc.

<8>
Accession Number
2035203845
Title
Protective effect of intravenous amino acid on kidney function: A
systematic review and meta-analysis of randomized controlled trials.
Source
Journal of Critical Care. 85 (no pagination), 2025. Article Number:
154937. Date of Publication: February 2025.
Author
Jiang W.; Shi K.; Shao J.; Song L.; Shi Y.; Wang H.; Zhou L.; Li L.; Feng
Y.; Yu J.; Zheng R.
Institution
(Jiang, Shi, Shao, Song, Shi, Wang, Zhou, Li, Feng, Yu, Zheng) Department
of Critical Care Medicine, Northern Jiangsu People's Hospital Affiliated
to Yangzhou University, Yangzhou 225001, China
(Jiang, Shi, Shao, Song, Shi, Wang, Zhou, Li, Feng, Yu, Zheng) Department
of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou
225001, China
Publisher
W.B. Saunders
Abstract
Background: Acute kidney injury (AKI) is a common complication in
critically ill and cardiac surgery patients. Intravenous amino acids can
increase renal perfusion and replenish renal functional reserves. However,
the exact therapeutic efficacy of intravenous amino acids in reducing the
incidence of AKI remains uncertain. Therefore, this study aims to
comprehensively review the existing evidence to assess the potential of
intravenous amino acids in kidney protection. Method(s): EMBASE,
PubMed, MEDLINE, and the Cochrane Library were searched for randomized
controlled trials published on or before July 2, 2024, that examined the
relationship between Intravenous amino acids and renal function. We
extracted population characteristics and outcome variables related to
renal function from randomized controlled trials comparing intravenous
amino acid supplementation with no supplementation. We assessed this
evidence using the Risk of Bias 2 (RoB2) tool for randomized controlled
trials. Data were synthesized using a random-effects model.
 Result(s): This review included 7 randomized controlled trials with a
total of 505 patients. The results showed that compared with the control
group, intravenous amino acid administration significantly reduced the
incidence of AKI (RR: 0.81, 95 % CI: 0.68-0.97, P = 0.02) and increased
urine output (MD: 308.87, 95 % CI: 168.68-449.06, P < 0.0001). However,
intravenous amino acids did not reduce mortality or the incidence of
kidney replacement therapy, with no statistical difference in 30-day
mortality (RR: 0.93, 95 % CI: 0.65-1.34, P = 0.71), 90-day mortality
(RR:1.00, 95 % CI: 0.77-1.29, P = 0.98), or need for kidney replacement
therapy (RR: 0.92, 95 % CI: 0.41-2.06, P = 0.83). Subgroup analysis
suggested that, regardless of sample size, intravenous amino acid
administration reduced the incidence of AKI and was particularly
significant in patients undergoing cardiac and major vascular surgery.
Furthermore, intraoperative intravenous amino acid therapy demonstrated a
significant reduction in the incidence of AKI compared to postoperative
administration. Conclusion(s): Intravenous amino acids protect renal
function in patients at high risk of AKI, particularly after cardiac
surgery. It reduces the incidence of AKI and increases urine output, but
has no significant effect on KRT and mortality. Copyright © 2024

<9>
Accession Number
2035248193
Title
Unlocking vascular vitality: Exploring the impact of LIMA harvesting
technique on endothelial health.
Source
Cardiovascular Pathology. 74 (no pagination), 2025. Article Number:
107699. Date of Publication: 01 Jan 2025.
Author
Mola S.; Yildirim A.; Kandemir N.O.; Deniz G.; Gul E.B.; Unal E.U.
Institution
(Mola, Deniz, Gul) Cardiovascular Surgery Department, Ankara Bilkent City
Hospital, Ankara, Turkey
(Yildirim) Cardiovascular Surgery Department, Ankara Ataturk Sanatoryum
Training and Research Hospital, Ankara, Turkey
(Kandemir) Pathology Department, Ankara Bilkent City Hospital, Ankara,
Turkey
(Unal) Cardiovascular Surgery Department, Ufuk University, Ankara, Turkey
Publisher
Elsevier Inc.
Abstract
Background: This study investigates the impact of different harvesting
techniques on the morphology and endothelial function of the left internal
mammary artery (LIMA) grafts in coronary artery bypass grafting (CABG).
 Method(s): Fifty-three patients undergoing elective CABG were
randomly assigned to two groups based on the harvesting technique:
traditional clipping and nonclipping. Histological analyses revealed that
arteries in the nonclipped group exhibited greater dilation and preserved
endothelial integrity compared to the control group. Result(s): The
nonclipped group exhibited greater arterial dilation and preserved
endothelial integrity compared to the clipped group. Immunostaining for
endothelial nitric oxide synthase (eNOS) showed significantly higher
expression in the nonclipped group, conversly COX-2 staining showed fewer
expression in the nonclipped group indicating better endothelial function
preservation. Conclusion(s): These findings suggest that maintaining
perfusion during LIMA harvesting may improve endothelial function and
potentially enhance graft patency in the long term. Further research is
warranted to validate these results and optimize harvesting techniques for
CABG procedures. Copyright © 2024 Elsevier Inc.

<10>
Accession Number
2035247758
Title
A Qualitative Study of Electronic Patient-Reported Outcome Symptom
Monitoring After Thoracic Surgery.
Source
Journal of Surgical Research. 303 (pp 744-755), 2024. Date of Publication:
November 2024.
Author
Boisson-Walsh A.; Cox C.; O'Leary M.; Shrestha S.; Carr P.; Gentry A.L.;
Hill L.; Newsome B.; Long J.; Haithcock B.; Stover A.M.; Basch E.; Leeman
J.; Mody G.N.
Institution
(Boisson-Walsh, Stover) Gillings School of Public Health, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States
(Cox, Gentry, Hill, Newsome, Long, Haithcock, Mody) Department of Surgery,
University of North Carolina at Chapel Hill, Chapel Hill, NC, United
States
(O'Leary, Shrestha, Carr, Stover, Basch, Mody) Lineberger Comprehensive
Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill,
NC, United States
(Leeman) School of Nursing, University of North Carolina at Chapel Hill,
Chapel Hill, NC, United States
Publisher
Academic Press Inc.
Abstract
Introduction: Thoracic surgery is a mainstay of therapy for lung cancer
and other chronic pulmonary conditions, but recovery is often complicated.
Digital health systems can facilitate remote postoperative symptom
management yet obstacles persist in their routine clinical adoption. This
study aimed to identify patient-perceived barriers and facilitators to
using an electronic patient-reported outcome (ePRO) monitoring platform
specially designed to detect complications from thoracic surgery
postdischarge. Method(s): Patients (n = 16) who underwent thoracic
surgery and participated in an ePRO parent study completed semistructured
interviews, which were analyzed using thematic content analysis and
iterative team-based coding. Themes were mapped onto the three domains of
the Capability, Opportunity, and Motivation Model of behavior framework to
inform ePRO design and implementation improvements. Result(s):
Analysis demonstrated seven dominant themes, including barriers (1.
postoperative patient physical and mental health, 2. lack of access to
email and poor internet connectivity, 3. lack of clarity on ePRO use in
routine clinical care, and 4. symptom item redundancy) as well as
facilitators (5. ease of the ePRO assessment completion, 6. engagement
with the surgical care team on ePRO use, and 7. increased awareness of
symptom experience through ePRO use). Suggested ePRO improvements included
offering alternatives to web-based completion, tailoring symptom
assessments to individual patients, and the need for patient education on
ePROs for perioperative care. Conclusion(s): Addressable barriers and
facilitators to implementation of ePRO symptom monitoring in the thoracic
surgical patient population postdischarge have been identified. Future
work will test the impact of design improvements on implementation
outcomes of feasibility and acceptability. Copyright © 2024
Elsevier Inc.

<11>
[Use Link to view the full text]
Accession Number
2035023201
Title
Enhancing Guidewire Efficacy for Transradial Access: The EAGER Randomized
Controlled Trial.
Source
Circulation: Cardiovascular Interventions. 17(10) (pp e014529), 2024. Date
of Publication: 01 Oct 2024.
Author
Bland A.C.; Meere W.; Mikhail P.; Chuah E.; Redwood E.; Ferreira D.;
Howden N.; Perkovic A.; Saunders S.L.; Kelty A.; Kull T.; Hill A.; Spina
R.; Sarathy K.; May A.; Parkinson M.; Ishak M.; Collins N.; Boyle A.;
William M.; Jeyaprakash P.; Ford T.J.
Institution
(Bland, Meere, Mikhail, Chuah, Redwood, Howden, Perkovic, Saunders, Kelty,
Kull, Hill, Spina, Sarathy, May, Parkinson, Ishak, William, Jeyaprakash,
Ford) Cardiology Department, Gosford Hospital, Central Coast Local Health
District, Australia
(Ferreira, Collins, Boyle) Cardiology Department, John Hunter Hospital,
Hunter New England Local Health District, Newcastle, Australia
(Bland, Saunders, Collins, Boyle, William, Ford) School of Medicine and
Public Health, The University of Newcastle, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: The 1.5 mm Baby J hydrophilic narrow J-tipped wire is a
development of the standard 0.035" 3-mm J-tipped peripheral guidewire,
designed to improve efficiency of transradial coronary procedures by
safely navigating small caliber radial arteries to the aorta. There is
currently a lack of evidence comparing the procedural success and safety
of different peripheral guidewires used in transradial cardiac procedures.
We compared the efficacy and safety of a narrow J-tipped hydrophilic
0.035" wire (intervention, Radifocus Baby J guidewire; TERUMO Co, Tokyo,
Japan) versus a standard fixed-core 0.035" J wire (control).
 METHOD(S): Investigator-initiated, blinded, Australian, multicenter
randomized trial in patients undergoing clinically indicated coronary
angiography or percutaneous coronary intervention. Patients were
randomized 1:1 to use either the control guidewire or the intervention
guidewire. The primary end point (technical success) was defined as
gaining aortic root access with the randomized guidewire. RESULT(S):
In all, 330 patients were randomized between October 2022 and June 2023
(median age was 69 years, 36% were female, and body mass index was 29
kg/m2). The primary end point was achieved more frequently in
the intervention group (96% versus 84%; absolute risk reduction 12% [95%
CI, 5.7-18.3]; P<0.001). Women assigned to the control wire experienced a
higher failure rate compared with men (31% versus 8% in men; P<0.001).
Fluoroscopy time was significantly lower in the Baby J group (median, 344
versus 491 seconds; P=0.024). The main mechanisms of failure using the
control wire were radial artery spasm (15/26; 57%) and subclavian
tortuosity (5/26; 19.2%). There were no differences in overall procedure
times, major adverse cardiovascular events, or vascular complications
between guidewires. CONCLUSION(S): A narrow 1.5 mm J-tipped
hydrophilic guidewire resulted in greater technical success and reduced
fluoroscopy time compared with the standard 3-mm J-tipped nonhydrophilic
guidewire. The guidewire is safe and demonstrated key incremental benefits
for the transradial approach, particularly in women. Copyright ©
2024 American Heart Association, Inc.

<12>
Accession Number
2031953535
Title
Evidence-Based Data on the Diagnostic Role and Clinical Usefulness of
[18F]FDG PET/CT in Endocarditis and Cardiac Device Infections.
Source
Echocardiography. 41(11) (no pagination), 2024. Article Number: e15934.
Date of Publication: November 2024.
Author
Caporali E.; Paone G.; Moschovitis G.; De Perna M.L.; Lo Priore E.;
Bernasconi E.; Pedrazzini G.; Treglia G.
Institution
(Caporali, Moschovitis, De Perna, Pedrazzini) Division of Cardiology,
Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano,
Switzerland
(Caporali) Division of Cardiac Surgery, Cardiocentro Ticino Institute,
Ente Ospedaliero Cantonale, Lugano, Switzerland
(Paone, Treglia) Division of Nuclear Medicine, Imaging Institute of
Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona and Lugano,
Switzerland
(Paone, Bernasconi, Pedrazzini, Treglia) Faculty of Biomedical Sciences,
Universita della Svizzera italiana, Lugano, Switzerland
(Lo Priore, Bernasconi) Division of Infectious Diseases, Department of
Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
(Treglia) Faculty of Biology and Medicine, University of Lausanne,
Lausanne, Switzerland
Publisher
John Wiley and Sons Inc
Abstract
Infective endocarditis and infection of cardiac devices are conditions
characterized by high morbidity and mortality, thus requiring a prompt
diagnosis. Advanced imaging modalities are often required in the
management of infectious endocarditis according to guidelines. The aim of
this review is to collect and describe evidence-based knowledge about the
diagnostic role and clinical usefulness of [18F]FDG PET/CT in
endocarditis and cardiac device infections based on published systematic
reviews and meta-analyses on this topic and on recent guidelines.
[18F]FDG PET/CT is recommended only in selected cases. This
imaging method has good diagnostic accuracy in detecting prosthetic valve
endocarditis and cardiac device infection. Furthermore, it can identify
extra-cardiac infectious foci changing the clinical management in a
significant percentage of cases. Copyright © 2024 Wiley
Periodicals LLC.

<13>
Accession Number
2031941983
Title
Impact of admission glucose and 30-day major adverse cardiovascular events
on patients with chest pain in an emergency setting: insights from the
China EMPACT registry.
Source
Frontiers in Cardiovascular Medicine. 11 (no pagination), 2024. Article
Number: 1367704. Date of Publication: 2024.
Author
Yin X.; Pan X.; Zhang J.; Wu S.; Cui W.; Wang Y.; Li C.; Wang J.; Chen Y.
Institution
(Yin, Pan, Zhang, Wu, Cui, Wang, Li, Wang, Chen) Department of Emergency
and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
(Yin, Pan, Zhang, Wu, Cui, Wang, Li, Wang, Chen) Shandong Provincial
Clinical Research Center for Emergency and Critical Care Medicine, Qilu
Hospital of Shandong University, Jinan, China
(Yin, Pan, Zhang, Wu, Cui, Wang, Li, Wang, Chen) Key Laboratory of
Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital
of Shandong University, Jinan, China
(Yin, Pan, Zhang, Wu, Cui, Wang, Li, Wang, Chen) Key Laboratory of
Cardiovascular Remodeling and Function Research, Chinese Ministry of
Education, Chinese National Health Commission and Chinese Academy of
Medical Sciences, State and Shandong Province Joint Key Laboratory of
Translational Cardiovascular Medicine, Department of Cardiology, Qilu
Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
Publisher
Frontiers Media SA
Abstract
Objective: Although the association between admission glucose (AG) and
major adverse cardiac events (MACE) is well-documented, its relationship
with 30-day MACE in patients presenting with cardiac chest pain remains
unclarified. In light of this, this study aims to examine the correlation
between AG levels and the incidence of MACE in patients with chest pain in
an emergency setting. Material(s) and Method(s): We consecutively
enrolled patients who presented to the emergency department for chest pain
symptoms within 24 h from the EMPACT cohort in Eastern China
(clinicaltrials.gov, Identifier: NCT02536677). The primary outcome was
30-day MACE, including all-cause death, recurrent myocardial infarction,
urgent target vessel revascularization, stroke, cardiogenic shock, and
cardiac arrest (CA). The associations of AG levels with 30-day MACE were
analyzed using Kaplan-Meier analysis and Cox regression models.
 Result(s): Among 1,705 patients who were included in this study, 154
(9.03%) patients met the primary outcome at 30 days. The average age of
the patients was 65.23 +/- 12.66 years, with 1,028 (60.29%) being male and
500 (29.33%) having diabetes. The median AG levels were 7.60 mmol/L
(interquartile range: 6.30-10.20). Kaplan-Meier survival analysis revealed
significant differences in the 30-day MACE risk (P < 0.001 according to
the log-rank test). We found that the highest AG level (Q4) was associated
with increased MACE risk compared with the lowest AG level [adjusted
hazard radio (aHR): 2.14; 95% confidence interval (CI): 1.2-3.815; P =
0.010]. In addition, Q4 level was also associated with increased all-cause
death risk (aHR: 3.825; 95% CI: 1.613-9.07; P = 0.002) and increased CA
risk (aHR: 3.14; 95% CI: 1.251-7.884; P = 0.015). Conclusion(s): An
elevated AG level significantly correlates with a higher incidence of
30-day MACE in patients with acute chest pain. The findings reveal the
importance of managing AG levels to potentially reduce the risk of adverse
cardiac events. Copyright 2024 Yin, Pan, Zhang, Wu, Cui, Wang, Li,
Wang and Chen.

<14>
Accession Number
2031925088
Title
Association of liver dysfunction with outcomes after percutaneous coronary
intervention - a systematic review and meta-analysis.
Source
BMC Cardiovascular Disorders. 24(1) (no pagination), 2024. Article Number:
580. Date of Publication: December 2024.
Author
Caldonazo T.; Kirov H.; Tasoudis P.; Franz M.; Richter M.; Mukharyamov M.;
Zipprich A.; Shana'ah A.; Haji D.; Doenst T.
Institution
(Caldonazo, Kirov, Richter, Mukharyamov, Shana'ah, Haji, Doenst)
Department of Cardiothoracic Surgery, Jena University Hospital,
Friedrich-Schiller-University, University of Jena, Am Klinikum 1, Jena
07747, Germany
(Tasoudis) Division of Cardiothoracic Surgery, University of North
Carolina, Chapel Hill, United States
(Franz) Division of Cardiology, Department of Internal Medicine, Jena
University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
(Zipprich) Department of Internal Medicine IV (Gastroenterology,
Hepatology, Infectiology), Jena University Hospital,
Friedrich-Schiller-University Jena, Jena, Germany
Publisher
BioMed Central Ltd
Abstract
Background: Liver dysfunction is a known risk factor in the cardiovascular
field. It specifically increases perioperative risk in patients undergoing
coronary bypass surgery. Since percutaneous coronary intervention (PCI) is
the much less invasive procedure for the treatment of coronary artery
disease, we aimed to assess the relationship of liver dysfunction with
outcomes in patients undergoing PCI. Method(s): Three libraries were
searched (MEDLINE, Web of Science and The Cochrane Library). We performed
a meta-analysis of all studies in patients who underwent PCI that provided
information on the presence or absence of liver dysfunction. Primary
outcome was short-term mortality. Secondary outcomes were major adverse
cardio- and cerebrovascular events (MACCE), bleeding and acute kidney
injury. Random-effects model was applied. Result(s): Five studies
were selected and the data from 10,710,317 patients were included in the
final analysis. In comparison with the absence of liver dysfunction,
patients with liver dysfunction were associated with higher short-term
mortality (OR 2.97, 95%CI 1.23-7.18, p = 0.02), higher MACCE (OR 1.42,
95%CI 1.08-1.87, p = 0.01), and higher bleeding (OR 2.23, 95%CI 1.65-3.00,
p < 0.01). There was no significant difference regarding acute kidney
injury (OR 1.20, 95%CI 0.50-2.87, p = 0.69). Conclusion(s): The
analysis suggests that liver dysfunction in patients undergoing PCI is
independently associated with higher risk of short-term mortality and
increased occurrence of MACCE and bleeding. However, there appears to be
no association to acute kidney injury. Copyright © The Author(s)
2024.

<15>
Accession Number
2031924984
Title
Effects of an Exercise and Lifestyle Education Program in Brazilians
living with prediabetes or diabetes: study protocol for a multicenter
randomized controlled trial.
Source
Trials. 25(1) (no pagination), 2024. Article Number: 701. Date of
Publication: December 2024.
Author
Silva L.P.D.; Batalha A.P.D.B.; Ghisi G.L.D.M.; Seixas M.B.; Cisneros
L.L.; Jansen A.K.; Moreira A.P.B.; Pereira D.S.; Britto R.R.; Pereira
D.A.G.; Trevizan P.F.; Oh P.
Institution
(Silva, Seixas) Faculty of Physical Therapy, Federal University of Juiz de
Fora, Juiz de Fora, Brazil
(Silva, Batalha) Graduate Program in Physical Education, Faculty of
Physical Education and Sports, Federal University of Juiz de Fora, Juiz de
Fora, Brazil
(Ghisi, Oh) KITE Research Institute, University Health Network, University
of Toronto, Toronto, Canada
(Cisneros, Pereira, Britto, Pereira, Trevizan) Department of Physical
Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
(Jansen) Department of Nutrition, Federal University of Minas Gerais, Belo
Horizonte, Brazil
(Moreira) Department of Nutrition, Federal University of Juiz de Fora,
Juiz de Fora, Brazil
(Oh) Cardiovascular Rehabilitation and Prevention Program, Toronto
Rehabilitation Institute, University Health Network, Toronto, Canada
Publisher
BioMed Central Ltd
Abstract
Background: Patient education is a crucial strategy for promoting
prevention and diabetes self-management since glycemic control achievement
involves taking medications, medical nutrition therapy, physical exercise,
and behavior changes. However, patient education programs are still barely
implemented in low- and middle-income countries. This trial aims to
investigate whether a lifestyle education intervention added to physical
exercising is superior to sole physical exercising regarding functional
capacity, disease-related knowledge, health behaviors, cardiometabolic
health parameters, quality of life, depression, and diet quality in
individuals with prediabetes or diabetes. Method(s): Multicenter
double-blinded randomized controlled trial with two parallel arms
involving 12-week intervention and 6-month follow-up. The eligible
individuals (>= 18 years, living with prediabetes or diabetes, literate,
no clinical decompensation and/or physical and/or mental limitations that
contraindicate physical exercising, written physician permission for
exercise, no cognitive impairment, no vision limitations for reading, no
confirmed diagnosis of unstable coronary disease or heart failure, no
pacemaker and/or implantable cardioverter-defibrillator, no complex
ventricular arrhythmias, no intermittent claudication, no recent
cardiovascular event or cardiac surgery, and no currently enrolled in a
structured exercise program) were recruited from two Brazilian cities and
randomized to either (1) an Exercise and Lifestyle Education Program
(ExLE) or (2) an Exercise Program (Ex), which can be delivered on-site or
remotely based on the participants' internet access and technology
literacy. The primary outcomes will be changes in functional capacity and
disease-related knowledge. The secondary outcomes will involve changes in
health behaviors (health literacy, physical activity level, exercise
self-efficacy, and medication adherence) and cardiometabolic health
parameters (glycemic control, anthropometric measures, and cardiac
autonomic control). Program adherence, satisfaction with the program,
diabetes-related morbidity, and changes in quality of life, depression,
and diet quality will be the tertiary outcomes. Assessments will occur at
baseline, post-intervention, and after 6-month follow-up.
 Discussion(s): If superior effectiveness of ExLE compared to Ex
program to improve the outcomes measures is found, this program could be
delivered broadly in the Brazilian health system, especially in the
primary care facilities where most individuals living with prediabetes and
diabetes in our country are assisted. Trial registration:
ClinicalTrials.gov, NCT03914924. Registered on April 16,
2019. Copyright © The Author(s) 2024.

<16>
Accession Number
2031734636
Title
Cardiorespiratory fitness, atrial fibrillation and stroke: a review of the
evidence in 2024.
Source
Expert Review of Cardiovascular Therapy. 22(9) (pp 493-508), 2024. Date of
Publication: 2024.
Author
Kunutsor S.K.; Kurl S.; Laukkanen J.A.
Institution
(Kunutsor) Diabetes Research Centre, University of Leicester, Leicester
General Hospital, Leicester, United Kingdom
(Kunutsor) Section of Cardiology, Department of Internal Medicine, Max
Rady College of Medicine, Rady Faculty of Health Sciences, University of
Manitoba, Saint Boniface Hospital, Winnipeg, MB, Canada
(Kurl, Laukkanen) Institute of Public Health and Clinical Nutrition,
University of Eastern Finland, Kuopio, Finland
(Kurl) Brain Research Unit, Department of Neurology, School of Medicine,
University of Eastern Finland, Kuopio, Finland
(Kurl, Laukkanen) Institute of Clinical Medicine, University of Eastern
Finland, Kuopio, Finland
(Laukkanen) Department of Medicine, Wellbeing Services County of Central
Finland, Jyvaskyla, Finland
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: The body of evidence linking cardiorespiratory fitness (CRF)
levels with the risk of atrial fibrillation (AF) and stroke-two
interconnected cardiovascular conditions-is not entirely consistent.
Furthermore, specific CRF thresholds beyond which the risk of AF or stroke
might not decrease are not well defined. Areas covered: This review
summarizes research evidence on the role of CRF in the development of AF
and stroke including dose-response relationships in general population
participants, explores the biological mechanisms through which CRF may
exert its effects, assesses the potential implications for clinical care
and population health, identifies gaps in the current evidence, and
suggest directions for future research. MEDLINE and Embase were searched
from inception until July 2024 to identify observational longitudinal and
interventional studies as well as systematic reviews and meta-analyses
related to these study designs. Expert opinion: In the general population,
increasing levels of CRF, achieved through consistent physical activity,
can significantly reduce the likelihood of developing AF and stroke. The
findings also advocate for a tailored approach to exercise prescriptions,
acknowledging the plateau in benefits for AF risk beyond certain CRF
levels, while advocating for higher intensity or prolonged activity to
further reduce stroke risk. Copyright © 2024 Informa UK Limited,
trading as Taylor & Francis Group.

<17>
Accession Number
2031408825
Title
Low Frequency Ventilation During Cardiopulmonary Bypass to Protect
Postoperative Lung Function in Cardiac Valvular Surgery: The PROTECTION
Phase II Randomized Trial.
Source
Journal of the American Heart Association. 13(19) (no pagination), 2024.
Article Number: e035011. Date of Publication: 01 Oct 2024.
Author
Rogers C.A.; Mazza G.; Maishman R.; Thirard R.; Evans J.; de Jesus S.;
Beard C.; Angelini G.; Millar A.; Jarad N.; Tomkins S.; Hillier J.;
Suleiman M.-S.; Ascione R.
Institution
(Rogers, Mazza, Maishman, Thirard, Evans, de Jesus, Beard) Bristol Trials
Centre, Bristol Medical School, United Kingdom
(Angelini, Tomkins, Hillier, Suleiman, Ascione) Faculty of Life and Health
Sciences, Bristol Heart Institute, United Kingdom
(Millar) University of Bristol, UK, Respiratory Medicine, Southmead
Hospital Bristol, United Kingdom
(Jarad) Department of Respiratory Medicine, University Hospital Bristol
and Weston NHS Foundation Trust, Bristol, United Kingdom
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Cardiac surgery with cardiopulmonary bypass (CPB) triggers
pulmonary injury. In this trial we assessed the feasibility, safety, and
efficacy of low frequency ventilation (LFV) during CPB in patients
undergoing valvular surgery. METHODS AND RESULTS: Patients with severe
mitral or aortic valve disease were randomized to either LFV or usual
care. Primary outcomes included release of generic inflammatory and
vascular biomarkers and the lung-specific biomarker sRAGE (soluble
receptor for advance glycation end products) up to 24 hours postsurgery.
Secondary outcomes included pulmonary function tests and 6-minute walking
test up to 8 weeks postdischarge. Sixty-three patients were randomized (33
LFV versus 30 usual care). Mean age was 66.8 years and 30% were female.
LFV was associated with changes of sRAGE (soluble receptor for advance
glycation end products) levels (geometric mean ratio, 3.05; [95% CI,
1.13-8.24] 10 minutes post CPB, and 1.07 [95% CI, 0.64-1.79], 0.84 [95%
CI, 0.55-1.27], 0.67 [95% CI, 0.42-1.07], and 0.62 [95% CI, 0.45-0.85] at
2, 6, 12, and 24 hours post CPB respectively). No changes were observed
for any of the generic biomarkers. Respiratory index soon after surgery
(mean difference, -0.61 [95% CI, -1.24 to 0.015] 10 minutes post end of
CPB), forced expiratory volume after 1 second/forced vital capacity ratio
(0.050 [95% CI, 0.007-0.093] at 6 to 8 weeks pos-surgery), Forced vital
capacity alone (95% CI, -0.191 L [-0.394 to 0.012]) and 6-minute walking
test score at discharge (63.2 m [95% CI, 12.9-113.6]) were better
preserved in the LFV group. No other differences were noted.
 CONCLUSION(S): The use of LFV during CPB in patients undergoing
valvular surgery was feasible and safe and was associated with changes in
sRAGE levels along with better preserved lung function and walking
performance. These observations warrant further investigation in larger
future studies. REGISTRATION: URL: https://www.isrctn.com; Unique
Identifier: ISRCTN75795633. Copyright © 2024 The Author(s).

<18>
Accession Number
2028262120
Title
Efficacy of the intertransverse process block: single or multiple
injection? A randomized, non-inferiority, blinded, cross-over trial in
healthy volunteers.
Source
Regional Anesthesia and Pain Medicine. 49(10) (pp 708-715), 2024. Date of
Publication: 08 Oct 2024.
Author
Nielsen M.V.; Tanggaard K.; Bojesen S.; Birkebaek A.D.L.F.; Therkelsen
A.S.; Sorensen H.; Klementsen C.; Hansen C.; Vazin M.; Poulsen T.D.;
Borglum J.
Institution
(Nielsen, Tanggaard, Birkebaek, Therkelsen, Sorensen, Klementsen, Hansen,
Vazin, Poulsen, Borglum) Department of Anesthesiology and Intensive Care
Medicine, Zealand University Hospital, Roskilde, Denmark
(Bojesen) Department of Plastic and Breast Surgery, Zealand University
Hospital, Roskilde, Denmark
(Borglum) Department of Clinical Medicine, University of Copenhagen,
Faculty of Health and Medical Sciences, Copenhagen, Denmark
Publisher
BMJ Publishing Group
Abstract
Introduction The intertransverse process block is increasingly used to
ameliorate postoperative pain following a plethora of surgical procedures
involving the thoracic wall. Nevertheless, the optimal approach and
cutaneous extent of the sensory block are currently unknown. We aimed to
further describe the intertransverse process block, single injection
versus multiple injection, and we hypothesized that the single-injection
intertransverse process block is a non-inferior technique. Methods Twelve
healthy male volunteers were cross-over randomized to receive either
single-injection intertransverse process block with 21 mL ropivacaine 7.5
mg/mL, including two sham injections, at the thoracic level T4/T5 or
multiple-injection intertransverse process block with three injections of
7 mL ropivacaine 7.5 mg/mL at the thoracic levels T2/T3, T4/T5 and T6/T7
at the first visit. At the second visit, the other technique was applied
on the contralateral hemithorax. A non-inferiority margin of 1.5
anesthetized thoracic dermatomes was chosen. Results The mean difference
(95% CI) in the number of anesthetized thoracic dermatomes was 0.82 (-0.41
to 2.05) p non-inf <0.01 indicating non-inferiority favoring the
single-injection technique. Both techniques anesthetized the ipsilateral
thoracic wall and demonstrated contralateral cutaneous involvement to a
variable extent. The multiple-injection intertransverse process block
anesthetized a significantly larger cutaneous area on the posterior
hemithorax and decreased mean arterial pressure at 30 and 60 min postblock
application. Thoracic thermography showed no intermodality temperature
differences yet compared with baseline temperatures both techniques showed
significant differences. Conclusions Single-injection intertransverse
process block is non-inferior to multiple injection in terms of
anesthetized thoracic dermatomes. Both techniques generally anesthetize
the hemithoracic wall to a variable extent. EU clinical trials register
2022-501312-34-01. Copyright © American Society of Regional
Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and
permissions. Published by BMJ.

<19>
Accession Number
2032939140
Title
Prognostic Value of CT-Derived Myocardial Biomarkers: Extracellular Volume
Fraction and Strain in Patients with Severe Aortic Stenosis Undergoing
Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-analysis.
Source
Academic Radiology. 31(11) (pp 4352-4364), 2024. Date of Publication:
November 2024.
Author
He X.; Li Y.; Wang Y.; Tian W.; Li Z.; Ge L.; Wang G.; Chen Z.
Institution
(He, Li, Wang, Tian, Li, Wang, Chen) Department of Radiology, The First
Hospital of Lanzhou University, The First Clinical Medical College of
Lanzhou University, Intelligent Imaging Medical Engineering Research
Center of Gansu Province, Accurate Image Collaborative Innovation
International Science and Technology Cooperation Base of Gansu Province,
Gansu Province Clinical Research Center for Radiology Imaging, Lanzhou
73000, China
(Ge) Evidence-Based Social Sciences Research Centre, School of Public
Health, Lanzhou University, Lanzhou 730030, China
Publisher
Elsevier Inc.
Abstract
Rationale and Objectives: This study aimed to investigate the prognostic
value of preoperative CT scan-derived myocardial biomarkers in patients
with severe aortic stenosis (AS) undergoing transcatheter aortic valve
replacement (TAVR). Material(s) and Method(s): In April 2024, three
databases (PubMed, Web of Science and Embase) were searched to identify
studies. A random-effects model for meta-analysis was conducted to
calculate pooled hazard ratios (HR) and 95% confidence intervals (CI) to
assess the prognostic value. The I2 statistic was used to
assess heterogeneity. Meta-regression analysis was conducted to appraise
which variables yielded a significant impact on the HR of included
biomarkers. Result(s): 11 studies were identified, of which six
studies involved 678 patients reporting extracellular volume fraction
(ECV), one study involved 300 patients reporting ECV and left ventricular
global longitudinal strain (LVGLS), three studies involved 868 patients
reporting LVGLS and one study involved 376 patients reporting LVGLS and
peak left atrial longitudinal strain (PALS). The endpoints included
all-cause mortality, major adverse cardiovascular events (MACE) and a
composite outcome of the previous two. The meta-analysis revealed that
ECV, whether considered as a dichotomous variable (pooled HR: 3.87, 95%
CI: 2.63-5.70, I2 = 0%), or as a continuous variable (pooled
HR: 1.12, 95% CI: 1.05-1.19, I2 = 66%), and LVGLS, whether
considered as a dichotomous variable (pooled HR: 1.70, 95% CI: 1.30-2.22,
I2 = 0%) or a continuous variable (pooled HR: 1.07, 95% CI:
1.04-1.10, I2 = 0%) were all significant predictors for
outcomes in patients with severe AS after TAVR. Age, sex, follow-up time
and mean pressure gradient had a significant impact on the model of ECV
(continuous). Conclusion(s): The higher CT-derived ECV and impaired
LVGLS are able to predict worse outcomes in patients with severe AS who
have undergone TAVR. Copyright © 2024 The Association of
University Radiologists

<20>
Accession Number
2015117362
Title
Cerebral near-infrared spectroscopy monitoring (NIRS) in children and
adults: a systematic review with meta-analysis.
Source
Pediatric Research. (no pagination), 2022. Date of Publication: 2022.
Author
Hansen M.L.; Hyttel-Sorensen S.; Jakobsen J.C.; Gluud C.; Kooi E.M.W.;
Mintzer J.; Fumagalli M.; Alarcon A.; Alderliesten T.; Greisen G.; Austin
T.; Bruckner M.; de Boode W.P.; Dempsey E.; Ergenekon E.; Gucuyener K.;
Levy P.T.; Liem K.D.; Martini S.; Naulaers G.; Neunhoeffer F.; Pellicer
A.; Pichler G.; Roehr C.C.; Roll C.; Schwarz C.E.; Szczapa T.; Urlesberger
B.; Wolf M.; Wong F.; Rhee C.J.; Lemmers P.
Institution
(Hansen, Greisen) Department of Neonatology, Copenhagen University
Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
(Hyttel-Sorensen) Department of Intensive Care, Copenhagen University
Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
(Jakobsen, Gluud) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, The Capital Region, Copenhagen University Hospital -
Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
(Jakobsen, Gluud) Department of Regional Health Research, The Faculty of
Health Sciences, University of Southern Denmark, Odense, Denmark
(Kooi) Division of Neonatology, University of Groningen, University
Medical Center Groningen, Beatrix Children's Hospital, Groningen,
Netherlands
(Mintzer) Department of Pediatrics, Division of Newborn Medicine,
Mountainside Medical Center, Montclair, NJ, United States
(de Boode, de Boode) Division of Neonatology, Department of Pediatrics,
Radboud University Medical Center, Radboud Institute for Health Sciences,
Amalia Children's Hospital, Nijmegen, Netherlands
(Fumagalli) Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Milan, Via Francesco Sforza 35, Milano 20122, Italy
(Fumagalli) Department of Clinical Sciences and Community Health,
University of Milan, Via Festa del Perdono 7, Milano 20122, Italy
(Alarcon) Department of Neonatology, Hospital Sant Joan de Deu, Passeig de
Sant Joan de Deu 2, Barcelona, Esplugues de Llobregat 08950, Spain
(Alderliesten) Department of Neonatology, University Medical Center
Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
(Austin) Topun Austin, Neonatal Intensive Care Unit, Cambridge University
Hospitals NHS Foundation Trust, Cambridge, United Kingdom
(Bruckner) Research Unit for Neonatal Micro- and Macrocirculation,
Department of Pediatrics and Adolescent Medicine, Medical University of
Graz, Graz, Austria
(Dempsey, Schwarz) Department of Paediatrics and Child Health, INFANT
Centre, University College Cork, Cork, Ireland
(Ergenekon) Division of Newborn Medicine, Department of Pediatrics, Gazi
University Hospital, Ankara, Turkey
(Gucuyener) Department of Pediatric Neurology, Gazi University Hospital,
Ankara, Turkey
(Levy) Boston Children's Hospital, Harvard Medical School, Harvard
University, Boston, MA, United States
(Liem) Department of Neonatology, Radboud University Medical Center,
Radboud Institute for Health Sciences, Amalia Children's Hospital,
Nijmegen, Netherlands
(Martini) Department of Medical and Surgical Sciences, Neonatal Intensive
Care Unit, S. Orsola-Malpighi University Hospital, University of Bologna,
Bologna, Italy
(Naulaers) Department of Development and Regeneration, Woman and Child, KU
Leuven, Leuven, Belgium
(Neunhoeffer) Department of Pediatric Cardiology, Pulmonology and
Pediatric Intensive Care Medicine, University Children's Hospital
Tubingen, Tubingen, Germany
(Pellicer) Department of Neonatology, La Paz University Hospital, Madrid,
Spain
(Pichler) Department of Pediatrics, Medical University of Graz, Graz,
Austria
(Roehr) Newborn Services, Southmead Hospital, North Bristol Trust,
Bristol, United Kingdom
(Roehr) National Perinatal Epidemiology Unit Clinical Trials Unit,
Nuffield Department of Population Health, Medical Sciences Division,
University of Oxford, Oxford, United Kingdom
(Roehr) Faculty of Health Sciences, University of Bristol, Bristol, United
Kingdom
(Roll) Department of Neonatology, Pediatric Intensive Care, Sleep
Medicine, Vest Children's Hospital Datteln, University Witten-Herdecke,
Datteln, Germany
(Schwarz) Department of Neonatology, University Children's Hospital
Tubingen, Tubingen, Germany
(Szczapa) Department of Neonatology, Biophysical Monitoring and
Cardiopulmonary Therapies Research Unit, Poznan University of Medical
Sciences, Poznan, Poland
(Urlesberger) Division of Neonatology, Department of Pediatrics and
Adolescent Medicine, Medical University of Graz, Graz, Austria
(Wolf) Biomedical Optics Research Laboratory, Department of Neonatology,
University Hospital Zurich, Zurich, Switzerland
(Wong) Monash Newborn, Monash Children's Hospital, Hudson Institute of
Medical Research, Department of Paediatrics, Monash University, Melbourne,
VIC, Australia
(Rhee) Section of Neonatology, Baylor College of Medicine, Texas
Children's Hospital, Houston, TX, United States
(Lemmers) Department of Neonatology, Wilhelmina Children's Hospital,
University Medical Center, Utrecht, Netherlands
Publisher
Springer Nature
Abstract
Background: Cerebral oxygenation monitoring utilising near-infrared
spectroscopy (NIRS) is increasingly used to guide interventions in
clinical care. The objective of this systematic review with meta-analysis
and Trial Sequential Analysis is to evaluate the effects of clinical care
with access to cerebral NIRS monitoring in children and adults versus care
without. Method(s): This review conforms to PRISMA guidelines and was
registered in PROSPERO (CRD42020202986). Methods are outlined in our
protocol (doi: 10.1186/s13643-021-01660-2). Result(s): Twenty-five
randomised clinical trials were included (2606 participants). All trials
were at a high risk of bias. Two trials assessed the effects of NIRS
during neonatal intensive care, 13 during cardiac surgery, 9 during
non-cardiac surgery and 1 during neurocritical care. Meta-analyses showed
no significant difference for all-cause mortality (RR 0.75, 95% CI
0.51-1.10; 1489 participants; I2 = 0; 11 trials; very low
certainty of evidence); moderate or severe, persistent cognitive or
neurological deficit (RR 0.74, 95% CI 0.42-1.32; 1135 participants;
I2 = 39.6; 9 trials; very low certainty of evidence); and
serious adverse events (RR 0.82; 95% CI 0.67-1.01; 2132 participants;
I2 = 68.4; 17 trials; very low certainty of evidence).
 Conclusion(s): The evidence on the effects of clinical care with
access to cerebral NIRS monitoring is very uncertain. Impact: The evidence
of the effects of cerebral NIRS versus no NIRS monitoring are very
uncertain for mortality, neuroprotection, and serious adverse events.
Additional trials to obtain sufficient information size, focusing on
lowering bias risk, are required.The first attempt to systematically
review randomised clinical trials with meta-analysis to evaluate the
effects of cerebral NIRS monitoring by pooling data across various
clinical settings.Despite pooling data across clinical settings, study
interpretation was not substantially impacted by heterogeneity.We have
insufficient evidence to support or reject the clinical use of cerebral
NIRS monitoring. Copyright © 2022, The Author(s).

<21>
Accession Number
2032003493
Title
Comparing the Effectiveness of Open and Minimally Invasive Approaches in
Coronary Artery Bypass Grafting: A Systematic Review.
Source
Clinics and Practice. 14(5) (pp 1842-1868), 2024. Date of Publication:
October 2024.
Author
Alsharif A.; Alshamrani G.; Abu Alsoud A.; Abdullah R.; Aljohani S.;
Alahmadi H.; Fuadah S.; Mohammed A.; Hassan F.E.
Institution
(Alsharif, Alshamrani, Abu Alsoud, Abdullah, Aljohani, Fuadah, Mohammed)
Department of Medicine and Surgery, Batterjee Medical College, Jeddah
21442, Saudi Arabia
(Alsharif) Department of Medicine and Surgery, Vision College, Jeddah
23643, Saudi Arabia
(Alahmadi) Faculty of Medicine, Taibah University, Al-Madinah Almunawwarah
41477, Saudi Arabia
(Hassan) Medical Physiology Department, Kasr Alainy, Faculty of Medicine,
Cairo University, Giza 11562, Egypt
(Hassan) General Medicine Practice Program, Department of Physiology,
Batterjee Medical College, Jeddah 21442, Saudi Arabia
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Coronary artery bypass grafting (CABG) is an essential operation for
patients who have severe coronary artery disease (CAD). Both open and
minimally invasive CABG methods are used to treat CAD. This in-depth
review looks at the latest research on the effectiveness of open versus
minimally invasive CABG. The goal is to develop evidence-based guidelines
that will improve surgical outcomes. This systematic review used databases
such as PubMed, MEDLINE, and Web of Science for a full electronic search.
We adhered to the PRISMA guidelines and registered the results in the
PROSPERO. The search method used MeSH phrases and many different study
types to find papers. After removing duplicate publications and conducting
a screening process, we collaboratively evaluated the full texts to
determine their inclusion. We then extracted data, including diagnosis,
the total number of patients in the study, clinical recommendations from
the studies, surgical complications, angina recurrence, hospital stay
duration, and mortality rates. Many studies that investigate open and
minimally invasive CABG methods have shown that the type of surgery can
have a large effect on how well the patient recovers and how well the
surgery works overall. While there are limited data on the possible
advantages of minimally invasive CABG, a conclusive comparison with open
CABG is still dubious. Additional clinical trials are required to examine
a wider spectrum of patient results. Copyright © 2024 by the
authors.

<22>
Accession Number
2031965555
Title
Post-operative delirium in different age groups and subtypes: a systematic
review of case reports.
Source
Frontiers in Neurology. 15 (no pagination), 2024. Article Number: 1465681.
Date of Publication: 2024.
Author
Guo J.; Guo X.; Liu W.; Zhou A.; Han J.; Yi R.; Dong L.; Zhou Y.
Institution
(Guo, Guo, Dong, Zhou) Department of Nursing, Zhongshan Hospital of
Traditional Chinese Medicine, Zhongshan, China
(Guo, Zhou, Han, Yi) The First School of Clinical Medicine, Xinxiang
Medical University, Xinxiang, China
(Liu) Department of Clinical Pharmacy, Zhongshan City People's Hospital,
Zhongshan, China
Publisher
Frontiers Media SA
Abstract
Aims: To explore the clinical presentations and outcomes among different
ages and subtypes of post-operative delirium patients. Design(s):
Systematic review of Published Cases. Methods and data sources: We
comprehensively searched PubMed, EMBASE, and MEDLINE for published case
reports of post-operative delirium up to April 2023. The systematic review
has been registered with PROSPERO. Two researchers independently conducted
unblinded reviews of the full-text articles. Result(s): This study
included 116 patients with post-operative delirium. Compared to
post-operative delirium patients aged 65 and above, those between 18 and
65 years old have lower rates of a history of hypertension, cardiovascular
disease and urinary system disorder comorbidities, as well as higher usage
rates of fentanyl analogs and lorazepam. Additionally, these patients
exhibit lower incidences of anemia and renal failure, along with a lower
mortality rate. Compared to post-operative delirium patients aged 65 and
above, those under 18 years old have a higher rate of fentanyl analog
usage and a higher incidence of post-operative delirium following
neurological surgeries. Among the hypoactive, hyperactive, and mixed
subtypes, the reasons for surgery, such as cardiovascular diseases,
reproductive system diseases, and neurological disorders, significantly
varied among these three subtypes. Furthermore, substance abuse history
and medication usage patterns also significantly varied among these three
subtypes. Conclusion(s): Our investigation has revealed noteworthy
insights into post-operative delirium in different patient populations.
Notably, age emerged as a pivotal factor. Compared to elderly patients
(>=65 years), those aged 18 to 65 demonstrate better prognosis.
Additionally, patients younger than 18 years with post-operative delirium
have a higher incidence of delirium following neurosurgical procedures
compared to those elderly patients. Additionally, a strong association was
found between a history of substance abuse and hyperactive delirium.
Variations in drug use patterns were observed across different subtypes.
Importantly, post-operative delirium patients younger than 18 years, as
well as those aged 18 to 65 with mixed-subtype delirium, exhibited similar
high mortality rates as elderly patients. This underscores the need for
increased attention to post-operative delirium patients under 65 and
highlights the necessity of rapid identification and early intervention
for these populations at risk of poor outcomes. Systematic review
registration:
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023473383,
Identifier [Registration ID: CRD 42023473383]. Copyright © 2024
Guo, Guo, Liu, Zhou, Han, Yi, Dong and Zhou.

<23>
Accession Number
2031956357
Title
Dexmedetomidine vs. propofol on arrhythmia in cardiac surgery: a
meta-analysis of randomized controlled trials.
Source
Frontiers in Cardiovascular Medicine. 11 (no pagination), 2024. Article
Number: 1433841. Date of Publication: 2024.
Author
Peng J.; Wu Y.; Li L.; Xia P.; Yu P.; Zhang J.; Liu X.
Institution
(Peng) Department of Anesthesiology, The Third Hospital of Nanchang,
Jiangxi, Nanchang, China
(Wu, Xia, Zhang) Department of Anesthesiology, The Second Affiliated
Hospital of Nanchang University, Jiangxi, Nanchang, China
(Li) Department of Traditional Chinese Medicine, Fujian University of
Traditional Chinese Medicine, Fuzhou, China
(Yu) Department of Endocrinology and Metabolism, The Second Affiliated
Hospital of Nanchang University, Nanchang, China
(Liu) Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun
Yat-sen University, Guangdong, Guangzhou, China
(Liu) Guangdong Provincial Key Laboratory of Arrhythmia and
Electrophysiology, Guangdong Provincial Key Laboratory of Malignant Tumor
Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for
RNA Medicine, Sun Yat-Sen University, Guangdong, Guangzhou, China
Publisher
Frontiers Media SA
Abstract
Background: Dexmedetomidine (DEX) and propofol are popular anesthetics,
but it remains unknown whether DEX reduces the incidence of arrhythmias
compared with propofol after cardiac surgery. Method(s): We performed
a comprehensive search for RCTs (Randomized Controlled Trials) that
compared the incidence of arrhythmias between DEX and propofol in adults
who had undergone cardiac surgery across three databases (PubMed, Embase,
the Cochrane Library), and ClinicalTrials.gov up to October 3, 2023. The
primary outcome was ventricular arrhythmias, the secondary outcomes were
bradycardia and atrial fibrillation (AF). Result(s): Our analysis
included 7 RCTs with 1,004 patients (mean age: 64.37, male: 71.11%)
undergoing cardiac surgery, and the incidence of in-hospital arrhythmia
was 22.01% (ventricular arrhythmias 2.75%, bradycardia 3.33%, AF 18.63%).
Perioperative or postoperative use of DEX reduced the incidence of
in-hospital ventricular arrhythmias [Odds Ratio (OR) 0.14, 95% Confidence
Interval (CI) 0.03-0.66], but increased the risk of in-hospital
bradycardia (OR 2.88, 95% CI 1.02-8.17) compared with propofol. The trial
sequence analysis verified the adequacy of sample size and robustness of
the ventricular arrhythmias and bradycardia. There was no significant
reduced incidence of the use of DEX in the incidence of AF (OR 0.69, 95%
CI 0.36-1.29). The GRADE assessment indicated a high certainty for
ventricular arrhythmias and bradycardia and a moderate certainty for AF.
 Conclusion(s): Our findings suggested the use of DEX reduces
in-hospital ventricular arrhythmias but increases bradycardia incidence
compared to propofol in adult patients undergoing cardiac surgery. Further
studies are needed to assess the impact of dexmedetomidine on atrial
fibrillation compared to propofol. Systematic Review Registration:
http://www.crd.york.ac.uk/prospero/ PROSPERO, identifier
(CRD42023482193). Copyright 2024 Peng, Wu, Li, Xia, Yu, Zhang and Liu.

<24>
Accession Number
2031946122
Title
Outcomes of left atrial appendage closure versus oral anticoagulant
therapy in patients with atrial fibrillation: an updated meta-analysis of
randomized control trials.
Source
Egyptian Heart Journal. 76(1) (no pagination), 2024. Article Number: 144.
Date of Publication: December 2024.
Author
Pramana K.A.A.P.; Cahyani N.G.A.M.S.D.; Pintaningrum Y.; Rahmat B.
Institution
(Pramana, Cahyani) General Practitioner, Faculty of Medicine Mataram
University, Mataram, Indonesia
(Pintaningrum, Rahmat) Interventional Cardiology Division, Cardiology and
Vascular Department, Faculty of Medicine, Mataram University, Mataram,
Indonesia
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: The purpose of this study is to compare the clinical results
of Left Atrial Appendage Closure (LAAC) and oral anticoagulation (OAC) in
individuals with AF. Method(s): For randomized controlled trials
(RCTs) comparing the clinical results of OAC to LAAC in patients with
atrial fibrillation (AF), we searched PubMed, ScienceDirect, and Cochrane.
The included publications were subjected to meta-analyses using Review
Manager v5.4. Result(s): In comparison to OAC, LAAC was linked with a
decreased incidence of all stroke (OR 0.68; 95% CI 0.55-0.84; p = 0.0004).
LAAC was also linked to a decreased risk of hemorrhagic stroke (OR 0.20,
95% CI 0.07-0.55; p = 0.002). There is no statistically significant
difference between the two groups in terms of ischemic stroke (OR 1.05;
95% CI 0.59-1.84; p = 0.88) or systemic embolization (OR 1.02; 95% CI
0.42-2.46; p = 0.97). Conclusion(s): According to our meta-analysis,
the LAAC was less likely than the OAC to have a complete or hemorrhagic
stroke. For the two groups, however, there was no difference in the risk
of ischemic stroke or systemic embolization. Copyright © The
Author(s) 2024.

<25>
Accession Number
2031545922
Title
Comparison of Long-Term Results of Endovenous Ablation Techniques and
Classical Stripping Operations in the Treatment of Venous Insufficiency.
Source
Journal of Ankara University Faculty of Medicine. 77(3) (pp 272-278),
2024. Date of Publication: September 2024.
Author
Dikmen N.; Kaya B.
Institution
(Dikmen, Kaya) Ankara University Faculty of Medicine, Department of
Cardiovascular Surgery, Ankara, Turkey
Publisher
Galenos Publishing House
Abstract
Objectives: Chronic venous insufficiency affects approximately 25% of the
population and is primarily associated with reflux in the great saphenous
vein. Traditional treatments like high ligation and stripping have been
effective but are burdened with complications such as postoperative pain,
wound infections, and nerve damage, alongside high recurrence rates. In
contrast, minimally invasive endovenous techniques, including
radiofrequency ablation, endovenous laser ablation (EVLA), and
ultrasound-guided foam sclerotherapy, have gained popularity due to their
lower complication rates and efficacy demonstrated in short-and
medium-term studies. This study synthesizes existing literature comparing
these treatment modalities and aims to evaluate the effectiveness of
classical stripping and endovenous ablation techniques in the treatment of
venous insufficiency. Material(s) and Method(s): Between October 2011
and January 2016, 832 patients underwent different procedures at Ankara
University Faculty of Medicine, Department of Cardiovascular Surgery, with
a total of 1,390 lower extremities treated. The study assessed patient
demographics, procedural outcomes, complications, and quality of life
(QoL) improvements following each intervention. Statistical analyses,
including t-tests, Mann-Whitney U tests, and logistic regression, were
employed to compare outcomes and identify influencing factors.
 Result(s): The findings underscored high procedural success across
all methods and significant QoL improvements post-treatment. However, no
statistically significant differences were observed in QoL outcomes
between treatment modalities. Complication rates varied, with EVLA showing
higher rates of postoperative ecchymosis and classical stripping
associated with increased wound infection incidence. Factors influencing
outcomes included body mass index, bilaterality of treatment, and use of
venoactive drugs. Conclusion(s): The study concluded with
recommendations for further randomized controlled trials to refine
treatment protocols and elucidate long-term efficacy. Copyright ©
2024 The Author.

<26>
Accession Number
2031545795
Title
The Effectiveness and Safety of Rhomboid Intercostal Block for
Postoperative Pain Management in Thoracic and Breast Surgical Procedures:
A Meta-analysis.
Source
Anesthesiology and Pain Medicine. 14(5) (no pagination), 2024. Article
Number: e150753. Date of Publication: 31 Oct 2024.
Author
Saputra T.; Sutiyono D.; Nurcahyo W.I.
Institution
(Saputra) Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
(Sutiyono, Nurcahyo) Department of Anesthesiology and Intensive Care,
Faculty of Medicine, Universitas Diponegoro/Dr. Kariadi General Hospital,
Semarang, Indonesia
Publisher
Brieflands
Abstract
Background: The rhomboid intercostal block (RIB) is an emerging regional
anesthesia (RA) technique used for pain control following thoracic and
breast surgery. However, comprehensive documentation on its effectiveness
and safety profile remains limited. This study aims to assess the
effectiveness and safety of RIB in thoracic and breast surgical
procedures. Method(s): A study search was conducted following PRISMA
2020 guidelines in PubMed, Cochrane Library, Embase, Scopus, and ProQuest
from 2016 to 2023 to identify randomized controlled trials (RCTs)
evaluating the effectiveness and safety of RIB in thoracic and breast
surgeries. The primary outcome was patient pain scores at rest, recorded
at one, six, 12, and 24 hours post-surgery. Secondary outcomes included
24-hour opioid consumption and rates of postoperative nausea and vomiting
(PONV). Result(s): This meta-analysis included five RCTs with a total
of 368 patients. Rhomboid intercostal block led to a significant reduction
in NRS scores one hour post-surgery (SMD =-1.33; 95% CI =-1.74 to-0.91; P
< 0.00001, I2 = 18%, P = 0.27), 12 hours post-surgery (SMD =-0.74; 95% CI
=-0.99 to-0.48; P < 0.00001, I2 = 36%, P = 0.21), and 24 hours
post-surgery (SMD =-1.62; 95% CI =-2.56 to-0.69; P = 0.00006, I2 = 91%, P
< 0.00001). Regarding secondary outcomes, the RIB group showed a
significant reduction in 24-hour opioid consumption (SMD =-4.49; 95% CI
=-6.09 to-2.90; P < 0.00001, I2 = 95%, P < 0.00001) and PONV rates (RR
=-0.29; 95% CI = 0.18 to 0.47; P < 0.00001, I2 = 0%, P = 0.88).
 Conclusion(s): Rhomboid intercostal block provides effective pain
reduction and lowers opioid consumption within 24 hours post-surgery,
while also minimizing PONV rates. Copyright © 2024, Saputra et
al.

<27>
Accession Number
2035167377
Title
Evaluating neuromuscular electrical stimulation for preventing and
managing intensive care unit-acquired weakness: Current evidence and
future directions.
Source
World Journal of Cardiology. 16(10) (pp 604-607), 2024. Date of
Publication: 26 Oct 2024.
Author
Kurian A.L.; Lucke-Wold B.
Institution
(Kurian) College of Medicine, Florida State University, Tallahassee, FL
32304, United States
(Lucke-Wold) Department of Neurosurgery, University of Florida,
Gainesville, FL 32611, United States
(Lucke-Wold) Department of Neurosurgery, University of Florida, 1505 SW
Archer Road, Gainesville, FL 32611, United States
Publisher
Baishideng Publishing Group Inc
Abstract
Intensive care unit-acquired weakness (ICU-AW) is a prevalent issue in
critical care, leading to significant muscle atrophy and functional
impairment. Aiming to address this, Neuromuscular Electrical Stimulation
(NMES) has been explored as a therapy. This systematic review assesses
NMES's safety and effectiveness in enhancing functional capacity and
mobility in pre- and post-cardiac surgery patients. NMES was generally
safe and feasible, with intervention sessions varying in frequency and
duration. Improvements in muscle strength and 6-minute walking test
distances were observed, particularly in preoperative settings, but
postoperative benefits were inconsistent. NMES showed promise in
preventing muscle loss and improving strength, although its impact on
overall functional capacity remained uncertain. Challenges such as short
ICU stays and body composition affecting NMES efficacy were noted. NMES
also holds potential for other conditions like cerebral palsy and stroke.
Further research is needed to optimize NMES protocols and better
understand its full benefits in preventing ICU-AW and improving patient
outcomes. Copyright © The Author(s) 2024. Published by Baishideng
Publishing Group Inc. All rights reserved.

<28>
Accession Number
2034992848
Title
Postoperative delirium in 47 379 individuals undergoing transcatheter
aortic valve replacement: a systematic review and meta-analysis.
Source
Annals of Medicine and Surgery. 85(9) (pp 4476-4490), 2023. Date of
Publication: 26 Jul 2023.
Author
Ochani S.; Adnan A.; Siddiqui A.; Kalwar A.; Kukreja S.; Ahmad M.; Ashraf
M.H.; Ali Asghar M.
Institution
(Ochani) Department of Medicine, Khairpur Medical College, Khairpur Mir's,
Pakistan
(Adnan, Siddiqui) Department of Medicine, Karachi Medical and Dental
College, Karachi, Pakistan
(Kalwar, Kukreja, Ashraf, Ali Asghar) Department of Medicine, Dow
University of Health Sciences, Karachi, Pakistan
(Ahmad) Department of Medicine, Ziauddin Medical University, Karachi,
Pakistan
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The study aims to discuss the assessment methods used for the
incidence of in-hospital postoperative delirium (IHPOD) in transcatheter
aortic valve replacement (TAVR) patients and explore possible strategies
for preventing and reducing postoperative complications in the geriatric
population. Methodology: An electronic search of PubMed, Embase,
BioMedCentral, Google Scholar, and the Cochrane Central Register of
Controlled Trials was conducted up to August 2021, to identify studies on
the IHPOD following TAVR in patients above 70 years. The primary objective
of the study was to determine the incidence of delirium following TAVR and
procedures like transfemoral (TF) and non-TF approaches. The secondary
objectives were to determine the incidence of stroke and incidence
according to the confusion assessment method (CAM) diagnostic tool. The
authors only included studies published in English and excluded patients
with comorbidities and studies with inaccessible full-text.
 Result(s): Among the selected 42 studies with 47 379 patients, the
incidence of IHPOD following TAVR was 10.5% (95% CI: 9.2-11.9%,
I2 = 95.82%, P < 0.001). Incidence based on CAM was 15.6% (95%
CI: 10.5-20.7%, I2 = 95.36%, P < 0.001). The incidence of IHPOD
after TF-TAVR was 9.3% (95% CI: 7.6-11.0%, I2 = 94.52%, P <
0.001), and after non-TF TAVI was 25.3% (95% CI: 15.4-35.1%, I2
= 92.45%, P < 0.001). The incidence of stroke was 3.7% (95% CI: 2.9-4.5%,
I2 = 89.76%, P < 0.001). Meta-regression analyses between mean
age (P = 0.146), logistic EuroSCORE (P = 0.099), or percentage of
participants treated using the TF approach (P = 0.276) were nonsignificant
while stroke (P = 0.010) was significant. When considering these
variables, the residual heterogeneity remained high indicating that other
variables influence the heterogeneity. Conclusion(s): IHPOD following
TAVR was observed in 10.5% of individuals and in 15.6% using CAM. Its
incidence was found to be three times higher after non-TF TAVR (25.3%)
compared to TF TAVR (9.3%). Stroke showed an incidence of 3.7% after TAVR
and was found to be significantly associated with the risk of developing
delirium following TAVR. Further studies are needed to evaluate possible
causes and risk factors responsible for delirium and to assess the role of
anesthesia and cerebral embolic protection in preventing delirium after
TAVR. Copyright © 2023 The Author(s).

<29>
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).

<30>
Accession Number
2035126736
Title
Platelet-sparing properties of aprotinin: A scoping review on mechanisms
and clinical effects.
Source
European Journal of Anaesthesiology. (no pagination), 2024. Article
Number: 10.1097/EJA.0000000000002081. Date of Publication: 2024.
Author
Vanglabeke L.L.W.; Rex S.; Van Den Eynde R.
Institution
(Vanglabeke, Rex, Van Den Eynde) The Department of Cardiovascular
Sciences, KU Leuven, Leuven, Belgium
(Vanglabeke, Rex, Van Den Eynde) The Department of Anesthesiology,
University Hospital of the KU Leuven, Leuven, Belgium
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND Cardiac surgery involving cardiopulmonary bypass (CPB) is
associated with the risk of acquired coagulopathy, including dysregulated
fibrinolysis, which can result in life-threatening bleeding complications.
Aprotinin, an antifibrinolytic agent, has been recommended for the
prevention of these complications. Its effectiveness has been attributed
to its ability to nonspecifically inhibit various serine proteases
involved in the coagulation and fibrinolysis cascade. Additionally,
aprotinin may protect platelets from CPB-induced dysfunction through a
platelet-sparing effect, further enhancing its efficacy. OBJECTIVES The
biochemical pathways underlying aprotinin's platelet-sparing effect remain
unclear. Furthermore, it is uncertain to what extent this effect
contributes to reducing blood loss and need for transfusion. DESIGN A
scoping review DATA SOURCES MEDLINE, Embase and Cochrane were searched
from inception until 21 December 2023. ELIGIBILITY CRITERIA Studies in
which a platelet-sparing effect of aprotinin was investigated. These
included systematic reviews; experimental, and observational studies
describing healthy humans, patients, or animals undergoing any type of
surgery; studies in which donated blood was used for in-vitro studies.
RESULTS Sixty-four studies were deemed eligible, the majority of which
observed a platelet-sparing effect, attributing it to the inhibition of
platelet aggregation (via protection of glycoprotein (GP) IIb/IIIa
receptors), platelet adhesion (by protection of GP Ib receptors), both
aggregation and adhesion receptors, proteolysis of protease-activated
receptor 1 receptors, platelet activation (by inhibition of plasmin) and
platelet activation (by inhibition of thrombin). A dose-dependency of the
platelet-sparing effect was investigated in both in-vitro studies and
randomised controlled trials, yielding mixed results. No studies have
explored the relative contribution of aprotinin's platelet-sparing effect
and its antifibrinolytic effect in reducing blood loss and need for
transfusion. CONCLUSIONS This review elucidated current knowledge on how
aprotinin influences platelets and exerts its platelet-sparing effect,
while highlighting gaps in the existing literature. Copyright ©
2024 European Society of Anaesthesiology and Intensive Care. Unauthorized
reproduction of this article is prohibited.

<31>
Accession Number
645618168
Title
Ten years survival benefit and appropriateness of surgical versus
percutaneous revascularization in synergy between percutaneous coronary
intervention with taxus and cardiac surgery randomized trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2024.
Date of Publication: 24 Oct 2024.
Author
Serruys P.W.; Ninomiya K.; Revaiah P.C.; Gao C.; Garg S.; van Klaveren D.;
Onuma Y.; Kappetein A.P.; Davierwala P.; Mack M.; Thuijs D.J.F.M.; Taggart
D.P.; Milojevic M.
Institution
(Serruys, Ninomiya, Revaiah, Onuma) CORRIB Research Centre for Advanced
Imaging and Core Laboratory, University of Galway, Galway, Ireland
(Gao) Department of Cardiology, Xijing Hospital, Xi'an, China
(Garg) Department of Cardiology, Royal Blackburn Hospital, Blackburn,
United Kingdom
(van Klaveren) Department of Public Health, Erasmus University Medical
Center, Rotterdam, Netherlands
(Kappetein, Thuijs, Milojevic) Department of Cardiothoracic Surgery,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Davierwala) Division of Cardiovascular Surgery, Peter Munk Cardiac
Centre, Toronto General Hospital, University Health Network, Toronto,
Ontario, Canada; Department of Surgery, University of Toronto, Toronto,
Canada
(Mack) Department of Cardiac Surgery, Baylor Scott and White- The Heart
Hospital, Plano, TX, United States
(Taggart) Nuffield Department of Surgical Sciences, Oxford University John
Radcliffe Hospital Oxford United Kingdom, United Kingdom
(Milojevic) Department of Anesthesiology and Critical Care Medicine,
Dedinje Cardiovascular Institute, Belgrade, Serbia
Abstract
OBJECTIVES: Average treatment effects from randomized trials do not
reflect the heterogeneity of an individual's response to treatment. This
study evaluates the appropriate proportions of patients for coronary
artery bypass grafting, or percutaneous intervention based on the
predicted/observed ratio of 10-year all-cause mortality in the SYNTAX
population. METHOD(S): The study included 1800 randomized patients
and 1275 patients in the nested percutaneous (n=198) or surgical (n=1077)
registries. The primary end-point was 10-year all-cause mortality. The
SYNTAX score II-2020 was validated internally in the randomized cohort and
externally in the registry cohort. Proportions of patients with survival
benefits from coronary artery bypass grafting or percutaneous intervention
were determined using SYNTAX score II-2020. RESULT(S): Ten-year
mortality was 23.8% for coronary artery bypass grafting 28.6% for
percutaneous intervention in the randomized cohort, 27.6% for coronary
artery bypass grafting, and 55.4% for percutaneous intervention in the
registries. In the coronary artery bypass grafting registry, the SYNTAX
score II-2020 predicted 10-year mortality with helpful calibration and
discrimination (C-index : 0.70, intercept : 0.00, slope : 0.76). The
proportion of patients deriving a predicted survival benefit from coronary
artery bypass grafting over percutaneous intervention was 82.4%
(2143/2602) and 17.7% (459/2602) for the entire SYNTAX trial population;
translating into a 4.7 to 1 appropriate ratio of treatment allocation to
coronary artery bypass grafting and percutaneous intervention.
 CONCLUSION(S): Choosing a revascularization modality should depend on
an individual's long-term prognosis rather than average treatment effects.
Additionally, patients should be informed about their predicted prognosis.
TRIAL REGISTRATION: Registered on clinicaltrial.govSYNTAXES: NCT03417050
(https://clinicaltrials.gov/ct2/show/NCT03417050);SYNTAX: NCT00114972
(https://www.clinicaltrials.gov/ct2/show/NCT00114972). Copyright
© The Author(s) 2024. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery.

<32>
Accession Number
645615559
Title
Pulmonary Artery Injury Following Endocardial Left Atrial Appendage
Occlusion: The Known and Unknown.
Source
JACC. Clinical electrophysiology. (no pagination), 2024. Date of
Publication: 08 Oct 2024.
Author
Katapadi A.; Garg J.; Mansabdar A.; Chelikam N.; Ehteshamuddin F.; Rane
M.; Nair D.; Marcum J.; Pope T.; Park P.; Ellis C.; Kabra R.; Lo M.;
Atkins D.; Saw J.; Shah A.; Lakkireddy D.
Institution
(Katapadi, Mansabdar, Chelikam, Ehteshamuddin, Park, Kabra, Atkins,
Lakkireddy) Overland Park, KS, United States
(Garg) Loma Linda University Medical Center, Loma Linda, CA, United States
(Rane, Marcum, Pope) Midwest Heart and Vascular Specialists, Overland
Park, KS, United States
(Nair) St. Bernards Medical Center, Jonesboro, AR, United States
(Ellis) Vanderbilt University Medical Center, Nashville, TN, United States
(Lo) Arkansas Heart Hospital, Little Rock, AR, United States
(Saw) University of British Columbia, Vancouver, BC, Canada
(Shah) University of Chicago, Chicago, IL, United States
Abstract
BACKGROUND: Left atrial appendage closure (LAAC) is frequent alternative
for stroke prophylaxis in patients for whom oral anticoagulation is
contraindicated. Pulmonary artery injury (PAI) is a feared yet rare
complication of endocardial LAAC, but its surrounding literature is
scarce. OBJECTIVE(S): The aim of the current study was to review
prior PAI published reports and the U.S. Food and Drug Administration
Manufacturer and User Facility Device Experience (MAUDE) database to
understand evidence and mechanisms of PAI after LAAC. METHOD(S): A
systematic review was conducted of the literature and MAUDE database for
previously reported cases of PAI, and cases were reviewed for patient
characteristics and outcomes. In addition, we identify risks and review
our strategies to avoid this injury. RESULT(S): Thirty-six cases (16
case reports and 20 MAUDE reports) of PAI were found. These patients had a
mean age of 73.6 +/- 8.2 years with a median CHA2DS2VASC score of 5
(quartile 1-quartile 3: 3-6). Most commonly, LAAC associated with PAI
involved a dual-seal (75%) followed by lobular occlusive devices (19.4%);
the device was unspecified in 2.8% of cases. PAI commonly presented
postprocedurally, either within the first 24 hours (50%) or beyond
(38.9%), with cardiac tamponade (61.1%) or cardiac arrest (19.4%).
Overall, 52.8% required surgery with or without antecedent
pericardiocentesis, and 16.7% were managed with pericardiocentesis. PAI
was associated with a high mortality rate (ie, 33.3%). Unfortunately, no
specific cardiac imaging or procedural details to predict PAI were noted
in the reports. CONCLUSION(S): Presentation of PAI after LAAC can
occur immediately following the procedure or be delayed. Thus, the
threshold for suspicion, especially with rapid and hemodynamically
significant pericardial effusion, after LAAC should be low. Copyright
© 2024 American College of Cardiology Foundation. Published by
Elsevier Inc. All rights reserved.

<33>
Accession Number
645614933
Title
Effectiveness of Non-Pharmacological Interventions in Improving Sleep
Quality After Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Journal of clinical nursing. (no pagination), 2024. Date of Publication:
24 Oct 2024.
Author
Xie Q.-Q.; Tang M.-Y.
Institution
(Xie) Department of Cardiovascular Medicine, Zhejiang Provincial People's
Hospital (Affiliated People's Hospital), People's Hospital of Hangzhou
Medical College, Zhejiang Chinese Medical University, Zhejiang, China
(Tang) Department of Cardiovascular Medicine, Nursing Department, Zhejiang
Provincial People's Hospital (Affiliated People's Hospital), People's
Hospital of Hangzhou Medical College, Zhejiang, China

<34>
Accession Number
645614619
Title
A Randomized Embedded Multifactorial Adaptive Platform for Extra Corporeal
Membrane Oxygenation (REMAP ECMO) - Design and Rationale of the Left
Ventricular Unloading trial domain.
Source
American heart journal. (no pagination), 2024. Date of Publication: 22
Oct 2024.
Author
van Steenwijk M.P.J.; van Rosmalen J.; Kraemer C.V.E.; Donker D.W.;
Hermens J.A.J.M.; Kraaijeveld A.O.; Maas J.J.; Akin S.; Montenij L.J.;
Vlaar A.P.J.; van den Bergh W.M.; Lansink-Hartgring A.O.; de Metz J.;
Voesten N.; Boersma E.; Scholten E.; Beishuizen A.; Lexis C.P.H.;
Peperstraete H.; Schiettekatte S.; Lorusso R.; Gommers D.A.M.P.J.; Tibboel
D.; de Boer R.A.; Van Mieghem N.M.D.A.; Meuwese C.L.
Institution
(van Steenwijk, Meuwese) Department of Intensive Care, Erasmus Medical
Center, Rotterdam, The Netherlands; Department of Cardiology, Thorax
Center, Cardiovascular Institute, Erasmus, MC, the Netherlands
(van Rosmalen) Departments of Biostatistics and Epidemiology, Erasmus
Medical Center, Rotterdam, Netherlands
(Kraemer, Maas) Department of Intensive Care, Leiden University Medical
Center, Leiden, Netherlands
(Donker) Department of Intensive Care, University Medical Center Utrecht,
Utrecht, The Netherlands; Cardiovascular and Respiratory Physiology,
University of Twente, Enschede, The Netherlands
(Hermens) Department of Intensive Care, University Medical Center Utrecht,
Utrecht, Netherlands
(Kraaijeveld) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Akin) Department of Intensive Care, Haga Hospital, The Hague, Netherlands
(Montenij) Department of Intensive Care, Catharina Hospital Eindhoven,
Eindhoven, Netherlands
(Vlaar) Department of Intensive Care, Amsterdam University Medical Center,
Amsterdam, Netherlands
(van den Bergh, Lansink-Hartgring) Department of Critical Care, University
Medical Center Groningen, Groningen, Netherlands
(de Metz) Department of Intensive Care, OLVG Amsterdam, Amsterdam,
Netherlands
(Voesten) Department of Intensive Care, Amphia Hospital Breda, Breda,
Netherlands
(Boersma, de Boer, Van Mieghem) Department of Cardiology, Thorax Center,
Cardiovascular Institute, Erasmus, Netherlands
(Scholten) Department of Intensive Care, Sint Antonius Hospital,
Nieuwegein, Netherlands
(Beishuizen) Department of Intensive Care, Medisch Spectrum Twente,
Enschede, Netherlands
(Lexis) Department of Intensive Care and Cardiology, Maastricht UMC,
Maastricht, Netherlands
(Peperstraete) Department of Intensive Care, Ghent University Hospital,
Ghent, Belgium
(Schiettekatte) Department of Cardiac Surgery, Ziekenhuis Oost-Limburg
Genk, Genk, Belgium
(Lorusso) Department of Cardiothoracic Surgery and Cardiovascular Research
Center, Maastricht UMC, Maastricht, Netherlands
(Gommers, Tibboel) Department of Intensive Care, Erasmus Medical Center,
Rotterdam, Netherlands
Abstract
BACKGROUND: The use of Extracorporeal Membrane Oxygenation (ECMO) remains
associated with high rates of complications, weaning failure and mortality
which can be partly explained by a knowledge gap on how to properly manage
patients on ECMO support. To address relevant patient management issues,
we designed a "Randomized Embedded Multifactorial Adaptive Platform
(REMAP)" in the setting of ECMO (REMAP ECMO) and a first embedded
randomized controlled trial (RCT) investigating the effects of routine
early left ventricular (LV) unloading through intra-aortic balloon pumping
(IABP). METHOD(S): REMAP ECMO describes a registry-based platform
allowing for the embedding of multiple response adaptive RCTs (trial
domains) which can perpetually address the effect of relevant patient
management issues on ECMO weaning success. A first trial domain studies
the effects of LV unloading by means of an IABP as an adjunct to
veno-arterial (V-A) ECMO versus V-A ECMO alone on ECMO weaning success at
30 days in adult cardiogenic shock patients admitted to the Intensive Care
Unit (ICU). The primary outcome of this trial is "successful weaning from
ECMO" being defined as a composite of survival without the need for
mechanical circulatory support, heart transplantation, or left ventricular
assist device (LVAD) at 30 days after initiation of ECMO. Secondary
outcomes include the need for interventional escalation of LV unloading
strategy, mechanistic endpoints, survival characteristics until one year
after ECMO initiation, and quality of life. Trial data will be analysed
using a Bayesian statistical framework. The adaptive design allows for a
high degree of flexibility, such as response adaptive randomization and
early stopping of the trial for efficacy or futility. The REMAP ECMO LV
unloading study is approved by the Medical Ethical Committee of the
Erasmus Medical Center and is publicly registered. CONCLUSION(S):
This REMAP ECMO trial platform enables the efficient roll-out of multiple
RCTs on relevant patient management issues. A first embedded trial domain
will compare routine LV unloading by means of an IABP as an adjunct to V-A
ECMO versus V-A ECMO alone. TRIAL REGISTRATION: ClinicalTrials.gov,
NCT05913622. Copyright © 2024 The Authors. Published by Elsevier
Inc. All rights reserved.

<35>
Accession Number
645614494
Title
Rationale and design of the multicentric randomized EVAOLD trial:
evaluation of a strategy guided by imaging versus routine invasive
strategy in elderly patients with ischemia.
Source
American heart journal. (no pagination), 2024. Date of Publication: 22
Oct 2024.
Author
Barone-Rochette G.; Vanzetto G.; Danchin N.; Steg P.G.; Hanon O.; Charlon
C.; David-Tchouda S.; Gavazzi G.; Simon T.; Bosson J.-L.
Institution
(Barone-Rochette) Department of Cardiology, University Hospital, Grenoble
Alpes, France; INSERM U1039, Bioclinic Radiopharmaceutics Laboratory,
Grenoble Alpes, France; French Alliance for Cardiovascular Trials.
Electronic address: gbarone@chu-grenoble.fr
(Vanzetto) Department of Cardiology, University Hospital, Grenoble Alpes,
France; INSERM U1039, Bioclinic Radiopharmaceutics Laboratory, Grenoble
Alpes, France; French Alliance for Cardiovascular Trials
(Danchin) French Alliance for Cardiovascular Trials; Department of
Cardiology, HEGP, AP-HP, 75015 Paris, France; Paris-Descartes University,
Sorbonne Paris Cite, 75006 Paris, France
(Steg) French Alliance for Cardiovascular Trials; Universite Paris Cite,
INSERM U-1148/LVTS, Paris, France; Assistance Publique-Hopitaux de Paris,
Hopital Bichat, Paris, France; Institut Universitaire de France, Paris,
France
(Hanon) Department of Geriatrics, AP-HP, Groupe Hospitalier Paris-Centre,
Broca Hospital, Paris, France; EA 4468, Universite Paris Descartes,
Sorbonne Paris Cite, Paris, France
(Charlon) Department of Cardiology, University Hospital, Grenoble Alpes,
France
(David-Tchouda) Grenoble Alpes University, CNRS, TIMC lab, Public Health
department Grenoble University Hospital, Grenoble, France; Department of
Health Economic and Clinical Research in Innovation, Grenoble University
Hospital, Grenoble, France
(Gavazzi) Geriatric department, Grenoble University Hospital, Grenoble
France; Grenoble Alpes University, CNRS, TIMC lab, Grepi team, France
(Simon) French Alliance for Cardiovascular Trials; Assistance
Publique-Hopitaux de Paris, Department of Clinical Pharmacology and the
Clinical Research Platform of East of Paris Hopital Saint-Antoine, Paris,
France; Sorbonne Universite, Faculte de Sante; Paris, France; Inserm
U-698, 75877 Paris, France
(Bosson) Grenoble Alpes University, CNRS, TIMC lab, Public Health
department Grenoble University Hospital, Grenoble, France; Centre
d'Investigation Clinique Innovation Technologique, Inserm CIC003, Grenoble
University Hospital, Grenoble, France
Abstract
BACKGROUND: The management of myocardial infarction without ST segment
elevation (NSTEMI) in elderly patients remains challenging, in particular
the benefit/risk balance of routine revascularization remains uncertain.
STUDY DESIGN: EVAOLD is s a multicenter, prospective, open-label trial
with 2 parallel arms in NSTEMI patients >= 80 years of age. The aim of the
trial is to test whether a strategy of selective invasive management
guided by ischemia stress imaging (IMG group) will be non-inferior in
preventing Major Adverse Cardiac and Cerebrovascular Events (MACCE, ie
all-cause death, non-fatal myocardial infarction, non-fatal stroke) rates
at 1 year compared with a routine invasive strategy (INV Group). Geriatric
assessment and cost- effectiveness analysis will also be performed. A
sample size of 1756 patients (assuming a 10% rate of patients lost to
follow-up) is needed to show non-inferiority with 80% power.
Non-inferiority based on exponential survival curves will be declared if
the upper limit of the one-sided 97.5% confidence interval for the hazard
ratio is lower than 1.24, corresponding to a non-inferiority margin of 7%
in absolute difference and an event rate of 40% in the INV group.
 CONCLUSION(S): EVAOLD is a nationwide, prospective, open-label trial
testing the non-inferiority of a strategy of selective invasive management
guided by ischemia stress imaging versus routine invasive strategy in
elderly NSTEMI patients. CLINICALTRIALS: gov Identifier:
NCT03289728. Copyright © 2024. Published by Elsevier Inc.

<36>
Accession Number
2035199716
Title
Prevalence, Clinical Manifestations, and Adverse Outcomes of Left
Ventricular Noncompaction in Adults: A Systematic Review and
Meta-Analysis.
Source
Cardiology Research. 15(5) (pp 377-395), 2024. Date of Publication: 2024.
Author
Llerena-Velastegui J.; Lopez-Usina A.; Mantilla-Cisneros C.
Institution
(Llerena-Velastegui, Lopez-Usina, Mantilla-Cisneros) Medical School,
Pontifical Catholic University of Ecuador, Quito, Ecuador
(Llerena-Velastegui) Research Center, Center for Health Research in Latin
America (CISeAL), Quito, Ecuador
Publisher
Elmer Press
Abstract
Background: Left ventricular noncompaction (LVNC) is recognized within the
spectrum of adult cardiomyopathies for its unique pathophysiologic
features and clinical challenges. This condition exhibits a wide range of
clinical manifestations, from asymptomatic states to severe cardiovascular
complications, making its diagnosis and management challenging. This study
aimed to synthesize current data on the prevalence, diagnostic methods,
clinical outcomes, and treatment efficacy of LVNC in adults to address
gaps in understanding and management strategies. Method(s): A
systematic review and meta-analysis of research from 2000 to March 2024
was conducted, focusing on studies involving adults diagnosed with LVNC.
This approach aimed to collect data on the prevalence of LVNC, the
diagnostic accuracy of different imaging modalities, clinical
manifestations, and the impact of different treatment strategies.
 Result(s): The study showed a prevalence of LVNC of 0.5%, with
cardiovascular magnetic resonance outperforming echocardiography in
diagnosis with a detection rate of 1.3%. Mortality and heart
transplantation rates were 12% and 7%, respectively. Significant
predictors of adverse outcomes included New York Heart Association (NYHA)
class III or IV, ventricular tachycardia, and reduced left ventricular
ejection fraction (LVEF), guiding a nuanced approach in tailoring
therapeutic strategies to optimize patient care and outcomes.
 Conclusion(s): This study advances the understanding of LVNC by
refining diagnostic criteria and evaluating management strategies,
highlighting the superiority of cardiovascular magnetic resonance. It
identifies predictors of adverse outcomes and assesses treatment efficacy,
urging precision in diagnosis and tailored treatments. Its comprehensive
analysis and methodological rigor make it a key resource advocating a
multidisciplinary approach to improve patient outcomes in
LVNC. Copyright Articles © The authors Journal compilation
© Cardiol Res and Elmer Press IncTM www.cardiologyres.org

<37>
Accession Number
2035086891
Title
Transcatheter versus surgical aortic valve replacement: a meta-analysis of
comparative outcomes in low- and intermediate-risk patients with severe
aortic stenosis.
Source
Heart, Vessels and Transplantation. 8(3) (no pagination), 2024. Date of
Publication: 2024.
Author
Almuzainy S.; Hamodat O.S.; Nizar S.
Institution
(Almuzainy, Hamodat, Nizar) Faculty of Medicine, University of Sharjah,
Sharjah, United Arab Emirates
Publisher
Bishkek: Center for Scientific Research and Development of Education
Abstract
Objective: Aortic stenosis is the most common valvular heart disease. This
study aims to systematically analyze randomized clinical trials (RCTs)
data comparing transcatheter aortic valve replacement (TAVR) and surgical
aortic valve replacement (SAVR) in intermediate and low-risk patients with
severe symptomatic aortic stenosis. Method(s): We conducted a
meta-analysis of RCTs, performing an exhaustive search of major databases
to identify studies comparing TAVR and SAVR in low- to intermediate-risk
patients. We assessed mortality, stroke, length of hospital stay, and
other perioperative outcomes. Result(s): Nine RCTs with 8,884
patients (average age 77.76 years; 49.47% male) met the inclusion
criteria. Baseline characteristics were comparable between TAVR and SAVR
groups, with a low risk of bias. Pooled results showed a significant
reduction in mortality for TAVR compared to SAVR (RR 0.75, 95% CI
0.61-0.92, p = 0.007, I2 = 51%). TAVR significantly reduced
stroke incidence (RR 0.66, 95% CI 0.49-0.89, p = 0.007, I2 =
69%) and myocardial infarction (RR 0.60, 95% CI 0.37-0.96, p = 0.03,
I2 = 0%). No significant difference was found for prosthetic
valve endocarditis (RR 1.06, 95% CI 0.55-2.06, p = 0.85, I2 =
0%). Length of stay was significantly shorter for TAVR (MD -4.30 days, 95%
CI -5.03 to - 3.57, p = 0.00001, I2 = 93%). Conclusion(s):
TAVR is a viable option for intermediate and low-risk patients with severe
symptomatic aortic stenosis. Future research should focus on long-term
outcomes and TAVR device durability, especially in younger, lower-risk
populations. Copyright ©2024 Heart, Vessels and Transplantation.

<38>
Accession Number
2034916334
Title
The Effects of Postoperative Trimetazidine Treatment on
Ischemia-Reperfusion Injury after Isolated Surgical Myocardial
Revascularization.
Source
Journal of Cardiovascular Emergencies. 10(3) (pp 89-94), 2024. Date of
Publication: 01 Sep 2024.
Author
Kamen S.; Bistra D.-Y.; Todor G.; Asen I.; Gencho N.
Institution
(Kamen, Todor, Asen, Gencho) Department of Cardiovascular Surgery, "St.
George" University Hospital, Plovdiv, Bulgaria
(Bistra) Department of Cardiology, "St. George" University Hospital,
Plovdiv, Bulgaria
Publisher
Sciendo
Abstract
Background: Surgical revascularization is the gold standard in the
management of patients with multi-vessel coronary artery disease (CAD). It
is well known that increased oxidative stress during ischemia-reperfusion
and post-revascularization procedures leads to the release of free radical
in the circulation. This process can cause reversible or irreversible
myocardial damage. Aim(s): The aim of this study was to assess the
effect of trimetazidine on decreasing postoperative ischemia-reperfusion
myocardial damage. Material(s) and Method(s): This prospective
single-blind randomized controlled trial included 90 patients with
elective surgery, operated between March 2018 and October 2018. The
patients were divided into two equal groups, a study group and a control
group; those in the study group received trimetazidine 35 mg b.d.,
immediately after tracheal extubation, in addition to their regular
therapy. Pre- and postoperative levels of specific blood biomarkers such
as high-sensitivity troponin T (hs-TnT), creatine kinase-MB (CK-MB), and
malondialdehyde (MDA) were evaluated. Patients were followed for a period
of 6 months after surgery. Result(s): MDA levels were lower in
patients who received trimetazidine, leading to a reduction in oxidative
stress and improved cardiomyocyte protection by augmentation of the
antioxidant status. The quality-of-life assessment with the Minnesota
Living with Heart Failure Questionnaire yielded excellent results.
 Conclusion(s): Improvement of myocardial cell metabolism and
decreasing the level of postoperative ischemia-reperfusion damage is
alleviated by postoperative regular trimetazidine therapy. Copyright
© 2024 Sciendo. All rights reserved.

<39>
Accession Number
2034813307
Title
SIGNET: protocol for a multicentre, single-blind prospective, group
sequential, randomised controlled trial to evaluate the benefits of a
single dose of simvastatin given to potential organ donors declared dead
by neurological criteria on outcomes in organ recipients.
Source
BMJ Open. 14(9) (no pagination), 2024. Date of Publication: 18 Sep 2024.
Author
Evans A.; Mawson P.; Thomas H.; Keen K.; Watson C.J.E.; McAuley D.F.;
MacGowan G.A.; Sheerin N.S.; Fisher A.; Shaw J.; Yates H.; Fallow A.;
Kounali D.; Banks J.; Stevens M.; Paul R.; Hodge R.; Lawson E.; Harvey D.;
Dark J.
Institution
(Evans, Keen, Paul, Hodge) Clinical Trials Unit, NHS Blood and Transplant,
Cambridge, United Kingdom
(Mawson, MacGowan, Sheerin, Fisher, Shaw, Dark) Newcastle University,
Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
(Thomas, Kounali, Banks) Clinical Trials Unit, NHS Blood and Transplant,
Bristol, United Kingdom
(Watson) Department of Surgery, University of Cambridge, The NIHR
Cambridge Biomedical Research Centre, Cambridge, United Kingdom
(McAuley) Centre for Experimental Medicine, Queen's University Belfast,
Belfast, United Kingdom
(MacGowan) Newcastle Upon Tyne Hospitals, NHS Foundation Trust, Newcastle
Upon Tyne, United Kingdom
(Yates, Fallow) Patient and Public Involvement, Newcastle upon Tyne,
United Kingdom
(Stevens, Lawson) NHS Blood and Transplant Organ Donation, Cambridge,
United Kingdom
(Harvey) Adult Intensive Care, Nottingham University Hospitals NHS Trust,
Nottingham, United Kingdom
(Harvey) NHS Blood & Transplant Organ Donation, Bristol, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Introduction Successful organ transplantation in patients with end-stage
organ failure improves long-term survival, improves quality of life and
reduces costs to the NHS. Despite an increase in the number of deceased
organ donors over the last decade, there remains a considerable shortfall
of suitable organs available for transplantation. Over half of UK donors
are certified dead by neurological criteria following brain stem
compression, which leads to severe physiological stress in the donor,
combined with a hyperinflammatory state. Brain stem death-related
dysfunction is an important reason for poor organ function and hence
utilisation. For example, more than 30% of donation after brain stem death
cardiac transplant recipients need short-term mechanical cardiac support,
reflecting donor heart dysfunction. A small, randomised study previously
showed improved outcomes for cardiac transplant recipients if the donor
was given simvastatin. SIGNET takes inspiration from that study and
hypothesises a potential reduction in damage to the heart and other organs
during the period after diagnosis of death and prior to organ retrieval in
donors that receive simvastatin. Methods and analysis SIGNET is a
multicentre, single-blind, prospective, group sequential, randomised
controlled trial to evaluate the benefits of a single high dose of
simvastatin given to potential organ donors diagnosed dead by neurological
criteria on outcomes in all organ recipients. The trial will run across a
minimum of 89 UK sites with a recruitment target of 2600 donors over 4
years. Ethics and dissemination SIGNET received a favourable opinion from
the London, Queen Square Research Ethics Committee (Ref: 21/LO/0412) and
following approval of substantial amendment 1 in January 2023, the current
protocol is version 2 (7 December 2022). Substantial amendment 1 clarified
consent procedures and added additional sites and prescribers. Findings
from the study will be publicly available and disseminated locally and
internationally through manuscript publications in peer-reviewed journals
and conference presentations at national and international
platforms. 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.

<40>
Accession Number
2035085887
Title
Inhibit progression of coronary artery calcification with vitamin K in
hemodialysis patients (the iPACK-HD study): a randomized,
placebo-controlled multi-center, pilot trial.
Source
Nephrology Dialysis Transplantation. 38(3) (pp 746-756), 2023. Date of
Publication: 01 Mar 2023.
Author
Holden R.M.; Booth S.L.; Zimmerman D.; Moist L.; Norman P.A.; Day A.G.;
Menard A.; Fu X.; Shea M.K.; Babiolakis C.S.; Nolan R.; Turner M.E.; Ward
E.; Kaufmann M.; Adams M.A.; Heyland D.K.
Institution
(Holden, Babiolakis) Department of Medicine, Queen's University, Kingston,
ON, Canada
(Holden, Turner, Ward, Kaufmann, Adams) Department of Biomedical and
Molecular Science, Queen's University, Kingston, ON, Canada
(Booth, Fu, Shea) Jean Mayer USDA Human Nutrition Research Center on
Aging, Tufts University, Boston, MA, United States
(Zimmerman) Department of Medicine, University of Ottawa, Ottawa, ON,
Canada
(Moist) Department of Medicine, Schulich School of Medicine and Dentistry,
Western University, London, ON, Canada
(Norman, Day) Kingston General Health Research Institute, Kingston Health
Sciences Center, Kingston, ON, Canada
(Norman, Day, Heyland) Department of Public Health Sciences, Queen's
University, Kingston, ON, Canada
(Day, Heyland) Clinical Evaluation Research Unit, Kingston Health Sciences
Center, Queen's University, Kingston, ON, Canada
(Menard, Nolan) Department of Radiology, Queen's University, Kingston, ON,
Canada
(Heyland) Department of Critical Care Medicine, Queen's University,
Kingston, ON, Canada
Publisher
Oxford University Press
Abstract
Background. Vitamin K activates matrix Gla protein (MGP), a key inhibitor
of vascular calcification. There is a high prevalence of sub-clinical
vitamin K deficiency in patients with end-stage kidney disease. Methods. A
parallel randomized placebo-controlled pilot trial was designed to
determine whether 10 mg of phylloquinone thrice weekly versus placebo
modifies coronary artery calcification progression over 12 months in
patients requiring hemodialysis with a coronary artery calcium score (CAC)
>=30 Agatston Units (ClinicalTrials.gov identifier NCT01528800). The
primary outcome was feasibility (recruitment rate, compliance with study
medication, study completion and adherence overall to study protocol). CAC
score was used to assess calcification at baseline and 12 months.
Secondary objectives were to explore the impact of phylloquinone on
vitamin K-related biomarkers (phylloquinone, dephospho-uncarboxylated MGP
and the Gla-osteocalcin to Glu-osteocalcin ratio) and events of clinical
interest. Results. A total of 86 patients with a CAC score >=30 Agatston
Units were randomized to either 10 mg of phylloquinone or a matching
placebo three times per week. In all, 69 participants (80%) completed the
trial. Recruitment rate (4.4 participants/month) and medication compliance
(96%) met pre-defined feasibility criteria of >=4.17 and >=90%,
respectively. Patients randomized to phylloquinone for 12 months had
significantly reduced levels of dephospho-uncarboxylated MGP (86%
reduction) and increased levels of phylloquinone and Gla-osteocalcin to
Glu-osteocalcin ratio compared with placebo. There was no difference in
the absolute or relative progression of coronary artery calcification
between groups. Conclusion. We demonstrated that phylloquinone treatment
improves vitamin K status and that a fully powered randomized trial may be
feasible. Copyright © The Author(s) 2022. Published by Oxford
University Press on behalf of the ERA.

<41>
Accession Number
645594849
Title
Electroencephalographic features in the cardiothoracic intensive care unit
following intraoperative aminocaproic acid administration.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 625-630), 2022. Date of
Publication: May 2022.
Author
Rabbin-Birnbaum C.; Garcia P.S.; Kuo P.; Jiang S.Y.; Weiss A.; Kandula P.;
Safavynia S.
Institution
(Rabbin-Birnbaum, Kuo, Jiang, Kandula, Safavynia) Weill Cornell Medical
College, New York, NY, United States
(Garcia) Columbia University, New York, NY, United States
(Weiss) Washington University in St. Louis, St. Louis, MO, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Tranexamic acid (TXA) and the lesspotent1 aminocaproic acid
(ACA) are commonly used antifibrinolytic agents in the perioperative
setting to reduce allogenic transfusion and decrease hemorrhageassociated
mortality.2 Despite potential benefits, there is concern that
antifibrinolytic administration may confer an increased risk of convulsive
seizures in humans,3 which is corroborated by animal data.4 These studies
point to a potential mechanism for cortical hyperexcitability as TXA and
ACA can antagonize both gamma-aminobutyric acid (GABA) and glycine
receptors.5 Indeed, recent large human trials studying TXA have shown a
strong association with postoperative seizures.3,6 However, meta-analyses
have not corroborated this finding.7,8 This may be partially because
seizure is not a consistent secondary outcome in many studies, and when
seizure is reported, it is largely based on the clinical presentation and
not electrographic findings. Moreover, the potential association between
ACA and seizure activity is not well-studied. This gap in knowledge is
underscored in cardiothoracic (CT) surgery patients who are routinely
administered antifibrinolytics and at high seizure risk from neurological
complications. Here, we performed a retrospective analysis of
electrographic findings of patients receiving continuous
electroencephalographic (EEG) monitoring in our hospital's CT surgery
intensive care unit (CT-ICU). Our primary outcome was electrographic
evidence of seizure activity in patients receiving ACA. METHOD(S):
After Institutional Review Board approval, we obtained electronic medical
records of patients admitted to our hospital's CT-ICU who underwent
continuous EEG (cEEG) monitoring from January 01, 2015 to December 31,
2019. Demographic information, diagnosis and procedure codes, operation
type, dose history, laboratory results, and cEEG reports were collected.
We included patients with a cEEG monitoring start date within seven days
of their date of surgery or CT-ICU admission (Figure 1). We compared
demographic characteristics, cEEG findings, and dose dependency with
respect to ACA administration. Categorical variables were compared via
Fisher's Exact test. Continuous variables were compared via Student's t,
Welch's t, and Mann-Whitney U tests where appropriate. P-value < 0.05 was
considered significant. RESULT(S): Of 124 patients with cEEG
monitoring in the CT-ICU, 83 met inclusion criteria. 41 received ACA; 42
did not receive antifibrinolytic (AF). Within the non- AF group, 21
underwent surgery prior to admission to the CT-ICU. There were no
significant differences in demographics between the ACA and non-AF groups
(Table 1). However, there was a significant association between surgery
and ACA administration (p < 0.001), reflecting perioperative AF
administration practices. There was a significant association between ACA
administration and electrographic seizure on cEEG monitoring (Table 2, p =
0.006). Among those with seizures on cEEG, the majority were subclinical
(not associated with motoric activity). Moreover, a greater proportion of
patients receiving ACA exhibited generalized seizures (Table 2, p = 0.03)
and markers of cortical hyperexcitability (Table 2, p = 0.0486). We
further observed a trend toward electrographic seizure and markers of
cortical hyperexcitability with increasing ACA dose (Figure 2, p = 0.1).
Patients with seizures on cEEG monitoring had significant associations
with advanced age, CT surgery, cardiopulmonary bypass, and acute
neurologic injury (Table 3). CONCLUSION(S): We found an increased
incidence of electrographic seizure and markers of cortical excitability
in patients receiving ACA, and a trend toward seizure and markers of
cortical excitability with increasing ACA dose. Our results suggest that
patients receiving ACA, known to be less potent for anti-fibrinolysis than
TXA, may still be vulnerable to hyperexcitable cortical states. Thus,
patients receiving AF therapy may warrant a lower threshold for cEEG
monitoring during and after AF administration. However, the retrospective
and exploratory nature of this study posits limitations, including a lack
of a control group, a small sample size, and selection bias, as most
patients undergoing cEEG monitoring had a witnessed clinical event
suspicious for seizure. Future prospective studies should be designed to
more fully elucidate the relationship of ACA administration and
hyperexcitable cortical states.

<42>
Accession Number
645594723
Title
In Vivo Effects of Fibrinogen Concentrate (FC) versus Cryoprecipitate on
the Neonatal Fibrin Network Structure after Cardiopulmonary Bypass (CPB).
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 842-845), 2022. Date of
Publication: May 2022.
Author
Downey L.A.; Moiseiwitsch N.; Nellenbach K.; Miller K.A.; DeSilva D.A.;
Brown A.; Guzzetta N.
Institution
(Downey, Miller, DeSilva) Children's Healthcare of Atlanta, Atlanta, GA,
United States
(Moiseiwitsch, Nellenbach, Brown) North Carolina State University,
Raleigh, NC, United States
(Guzzetta) Emory University, School of Medicine, Atlanta, GA, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Bleeding is a serious complication of cardiopulmonary bypass
(CPB) in neonates and is associated with substantial morbidity and
mortality.1 To adequately restore hemostasis, transfusion is often a
necessity. However, given the risks associated with blood product
transfusion, neonates would benefit from other effective, and safe,
therapies to augment hemostasis after CPB. Our prior studies suggest that
adult fibrinogen does not seamlessly integrate with neonatal fibrinogen
and may result in prolonged clot degradation, thus increasing the risk of
thrombotic events in neonates post-operatively. However, it is unclear if
this is a direct result of the adult fibrinogen molecule or the other clot
stabilizing factors (von Willebrand Factor (vWF) and Factor XIII (FXIII))
in cryoprecipitate.2 An alternative to cryoprecipitate, fibrinogen
concentrate (FC; RiaSTAP, CSL Behring, Marburg, Germany) contains purified
fibrinogen with a low volume of administration. The use of FC has been
growing in popularity, but it has not been adequately studied in pediatric
cardiac patients and the limited experience in adults may not be relevant
to pediatric practice. Our study in infants undergoing cardiac surgery
suggests that FC may be most beneficial in reducing post-CPB bleeding and
transfusions in neonates when compared to cryoprecipitate when used as
part of a post-CPB transfusion algorithm.3 In this randomized control
trial, we sought to compare clot structure, clot degradation rates, and
post-CPB blood transfusions in neonates who are randomized to receive
either FC or cryoprecipitate as part of a post-CPB transfusion algorithm.
 METHOD(S): After IRB approval, 36 neonates were block randomized 1:1
to receive either FC (FC group) or cryoprecipitate (control group) as part
of a post-CPB transfusion algorithm. Inclusion criteria for neonates
included: 36-42 weeks gestational age, age < 30 days, APGAR score >6 at 5
minutes, non-emergent surgery, parental consent. Blood samples were
collected from neonates undergoing cardiac surgery at four time points: 1)
baseline; 2) after either FC or cryoprecipitate; 3) arrival to ICU; 4) 24h
after ICU arrival. All samples were centrifuged to yield platelet poor
plasma Clots were formed ex vivo from each time point. We then analyzed
clots for fiber density (FD), clot degradation rates, and levels of
thrombin, fibrinogen, FXIII, and vWF. Demographic information, post-CPB
blood transfusions, and adverse events (AE) were collected. Based on our
previous data, to detect a difference in degradation times between clots
formed with neonatal fibrinogen and clots formed with adult fibrinogen
with 80% power, we will enroll at total of 36 patients, with 18 in
patients in each arm. All quantitative data will be analyzed using a
paired t-test or Wilcoxon rank-sum test to determine differences between
the two groups. Significance will be defined by a p-value less than or
equal to 0.05. RESULT(S): Eighteen neonates were enrolled in each
group. Demographics, intraoperative data, and post- CPB transfusion of
packed red blood cells (pRBCs), fresh frozen plasma (FFP), and platelets
were not different between groups (Table 1). Preoperative and
postoperative coagulation values on ICU arrival were similar between
groups. Three patients received prothrombin complex concentrate (PCC) as
part of rescue hemostatic therapy: 2 in control group and 1 in FC group.
Patients in the FC group received less cryoprecipitate (p=<0.001). There
were two deaths within 30 days (controls) and 4 thrombotic events, 2 in
each study group. Representative images of clots are shown in Figure 1.
Clots from both groups had similar FD and 24-h degradation rates (Figure
2A-C). Procoagulant levels were lower in the FC group, but not
statistically significant (Figure 3A-C). CONCLUSION(S): This study
suggests that while cryoprecipitate contains additional factors required
for clot strength and stabilization, there is no significant difference in
clot parameters in neonates who receive either cryoprecipitate or FC.
Clinically, patients receiving FC appear to have adequate hemostasis with
similar post-operative ICU labs and outcomes. FC may result in less
post-CPB allogenic transfusions. Our data shows no significant differences
in adverse events, including thrombotic events, between groups. FC may
provide an alternative strategy to achieve hemostasis and reduce overall
allogenic transfusions in neonates undergoing cardiac surgery without
increased risk of adverse events.

<43>
Accession Number
645594656
Title
Impact of Induced Total Spinal Anesthesia on Fast-track Strategy in
Pediatric Cardiac Surgery: Retrospective Study.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 119-120), 2022. Date of
Publication: May 2022.
Author
Sivamurugan A.; Rier A.; Samuelson B.; James A.; Subramani S.; Sondekoppam
R.V.; Hanada S.
Institution
(Sivamurugan, Rier, Samuelson, James, Subramani, Sondekoppam, Hanada)
University of Iowa, Carver College of Medicine, Iowa City, IA, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: The benefits of fast-tracking have been outlined in
pediatric cardiac surgery1. Thus, a neuraxial block, such as caudal,
epidural, or spinal anesthesia, has been combined with general anesthesia
(GA) in pediatric cardiac surgery patients to facilitate fast recovery by
blunting the surgical stress response and minimizing the negative effects
of opioid-induced respiratory suppression2-4. Total spinal anesthesia
(TSA) is a type of spinal anesthesia where total spinal block is
intentionally induced with a high dose of intrathecal bupivacaine. With
the concomitant use of intrathecal morphine, TSA combined with GA provides
adequate perioperative analgesia with minimal opioid use in cardiac
surgery5. Nevertheless, few studies have investigated the impact of TSA on
the fast-track extubation in pediatric cardiac surgery. METHOD(S):
Patients aged 1-day to 18-years who had open cardiac surgeries at our
institution from November 1, 2010 to December 31, 2017 were included.
Patients who were not a candidate for fast-track extubation were excluded.
The cases were divided into two groups: cases with TSA in combination with
GA (TSA group) and cases with GA without any additional neuraxial blocks
(GA group). In the TSA group, intrathecal medications were injected at a
lumbar level between L3 and L5 under GA. The intrathecal medications
consisted of 0.75% hyperbaric bupivacaine (0.2 mL/kg for the first 10 kg
weight, then additional 0.1 mL/kg, limited up to 8 mL) with
preservative-free morphine (7 mcg/kg, limited up to 500 mcg/kg).
Immediately after the intrathecal injection, the patient was placed in the
supine position at 30 to 45 degrees Trendelenburg to facilitate the
cephalad spread of spinal anesthesia. Mydriasis confirmed the completion
of total spinal block. GA was maintained with sevoflurane or isoflurane
(0.5-1.0 minimal alveolar concentration (MAC)). Few doses or no dose of
opioid, except for remifentanil, was used intravenously during the
intraoperative period in the TSA group. In GA group, no neuraxial block
was provided, and GA was maintained with sevoflurane or isoflurane
(0.5-1.0 MAC) with low-to-moderate doses of intravenous opioids
intraoperatively. Typical opioids used were fentanyl, hydromorphone and/or
morphine. An excessive dosage of opioids was avoided in order to
facilitate fast-track strategy. The comparison was made between the two
groups (TSA group vs GA group). The primary outcome was extubation in the
operating room. Secondary outcomes include time to extubation, length of
stay (LOS) in the ICU, and LOS in the hospital. RESULT(S): This is a
preliminary analysis of an ongoing data collection. A total of 520 cases
were analyzed (196 cases in the TSA group and 324 cases in the GA group).
The rate of extubation in the operating room was significantly higher in
the TSA group (n=128/196) vs GA group (n=109/324). A multinomial logistic
regression for the probability of extubating in the operating room was
performed with the group allocation (TSA and GA) as the main factor and
age, sex, BMI, use of CPB, ASA status and surgical duration as covariates.
The logistic regression model was statistically significant, 2(7) = 71.02,
p < .0001. Odds of extubation in the operating room was 3.39 (95% CI 2.11,
5.43, p<0.001) times more likely with the use of TSA. Other factors
affecting the model to a lesser degree was surgical duration (Odd ratio
1.006, 95% CI 1.003, 1.009, p<0.001). A log rank test to determine the
differences in time to extubation after surgery were statistically
significantly different, 2(1) = 8.006, p = .005 but such differences in
extubation times were not deemed to be clinically significant. Patients
were likely to have a shorter ICU and hospital LOS with the use of TSA
(see Table 1). CONCLUSION(S): The preliminary results of this
retrospective study suggests that the TSA technique may facilitate faster
recovery in pediatric cardiac surgery patients. A high dose of intrathecal
bupivacaine provides complete sensory block; thus, few intravenous opioids
are required intraoperatively. At the same time, intrathecal morphine can
provide adequate pain control immediately after surgery. A combination of
these intrathecal medications significantly reduces perioperative opioid
requirement while providing adequate analgesia, and this could contribute
to a fasttrack extubation. Further randomized controlled trial is
warranted to clarify this outcome.

<44>
Accession Number
645594606
Title
Neural biomarkers do not predict postoperative delirium in cardiac surgery
patients with cardiopulmonary bypass.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 116-117), 2022. Date of
Publication: May 2022.
Author
Voicu S.; Shaefi S.; Boone M.D.; Naseem H.; Gerber S.A.; Wiredu K.
Institution
(Voicu, Wiredu) Geisel School of Medicine at Dartmouth, Hanover, NH,
United States
(Shaefi, Naseem) Beth Israel Deaconess Medical Center, Boston, MA, United
States
(Boone) Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
(Gerber) Geisel School of Medicine at Dartmouth, Lebanon, NH, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Over 300,000 patients undergo cardiac surgery with
cardiopulmonary bypass (CPB) annually in the United States.1 Delirium is
commonly observed following CPB2-4 and is associated with longer hospital
stays, higher healthcare costs,5,6 longterm cognitive impairment,7,8 and
increased mortality.9,10 Phenotypical delirium following CPB may be due to
oxidative reperfusion injury11 and neuroinflammation.12 Prior studies have
demonstrated elevated neuronal biomarker levels, possibly reflecting these
injury patterns, following CPB.13 If these biomarkers are elevated in
patients who develop postoperative delirium, then we would better
understand the mechanism. Based on these findings, we hypothesized that
elevated levels of neuronal biomarkers following CPB will be associated
with delirium. To explore this association, we measured four biomarkers of
neuronal injury at two distinct time points and conducted postoperative
delirium assessments in adults undergoing cardiac surgery with CPB.
 METHOD(S): We conducted a nested case-control study of 46
participants originally enrolled in a singlecenter randomized controlled
trial investigating the effects of hyperoxia versus normoxia on delirium
and neurocognitive outcomes among cardiac surgery patients.14 Blood
samples were collected pre- and post-CPB; the serum concentrations of four
biomarkers were measured using a custom R&D Human Premixed Multi-Analyte
Panel. Two biomarkers (S100B and gamma enolase, ENO2, also known as
neuron-specific enolase, NSE) were selected based on their validity in
predicting neurocognitive outcomes supported by previous studies.15,16 Two
novel biomarkers that have not yet been studied in the context of
post-operative delirium (ubiquitin carboxyl-terminal hydrolase isozyme L1,
UCHL1 and chitinase-3-like protein 1, CH3L1) were also selected. Delirium
was assessed using the Confusion Assessment Method (CAM-S). Pre-operative
and postoperative biomarker levels were compared using paired student
t-test. A series of stratified analyses was used to compare pre-operative
and post-operative biomarker levels according to delirium/non-delirium
status, hyperoxia/normoxia treatment, sex, CPB duration, and BMI. Finally,
multiple regression analysis was used to model the relationship between
delirium/non-delirium status and biomarker levels, hyperoxia/normoxia
treatment, duration of CPB, or the interaction between these predictors.
 RESULT(S): Twelve patients (26%) were delirium cases. Of the four
biomarkers, UCHL1 was undetectable in the blood samples, and ENO2 and
CHI3L1 were not elevated relative to baseline (Figure 1). Postoperative
S100B levels were increased from baseline (8.04 to 10.14 pg/mL, P<0.001).
Stratified analyses show that this effect was present regardless of
delirium/non-delirium status (P<0.001), intraoperative oxygen treatment
(P<0.001), BMI (P<0.001), or sex (P=0.001). Multiple regression analysis
showed that neither postoperative change in S100B levels, duration of CPB,
hyperoxia treatment, nor the interactions between these variables
contributed significantly to the occurrence of delirium in this cohort.
 CONCLUSION(S): In our study of four biomarkers of neuronal injury,
only S100B was elevated from baseline following CPB. Elevated levels of
S100B following cardiopulmonary bypass were not associated with
post-operative delirium. Given the large burden of neurological injury
following cardiac surgery, future studies are needed to examine the
mechanism responsible for neurologic injury post anesthesia and cardiac
surgery.

<45>
Accession Number
645594576
Title
Perioperative neurocognitive and CSF Alzheimer's biomarker trajectories in
older patients randomized to Isoflurane or Propofol for Anaesthetic
Maintenance.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 488-490), 2022. Date of
Publication: May 2022.
Author
Villalobos D.; Berger M.; Cooter M.; Browndyke J.N.; Syed A.; Moretti E.;
Divinney M.
Institution
(Villalobos) Duke University, School of Medicine, Durham, NC, United
States
(Berger, Cooter, Browndyke, Syed, Moretti, Divinney) Duke University
Medical Center, Durham, NC, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Animal studies have suggested that isoflurane versus
propofol have differential effects on Alzheimer's Disease (AD) - related
neuropathological processes, such as amyloid beta1 and tau pathology2, 3,
and on memory function4. Whether these drugs also have differential
effects on cognition and AD neuropathology in actual patients is a
clinically important question, since over 19 million older Americans
undergo surgery each year5 and are at risk for AD or other related
dementias based on their age.6 METHODS: Patients age >= 60 undergoing
non-cardiac, non-neurologic surgery were prospectively enrolled and
randomized to receive isoflurane (N=54) or propofol (N=52) for anesthetic
maintenance. We collected CSF samples before, 24 hours and 6 weeks after
surgery (via lumbar punctures performed for research), to measure CSF AD -
related biomarker levels (ie, Abeta42, tau, and p-tau 181p) and performed
cognitive testing to assess the effect of anesthetic choice on cognitive
function. Wilcoxon rank sum tests were used to compare CSF AD-related
biomarkers between groups; univariable and multivariable linear regression
was used to evaluate the relationship between anesthetic treatment group
and cognitive outcomes. RESULT(S): There was no difference in the CSF
tau/Abeta ratio between patients randomized to isoflurane vs propofol
treatment groups before or 24 hrs after surgery (P = 0.186). All other CSF
AD - related biomarkers (Abeta , tau, p-tau/ Abeta, and p-tau 181p) showed
no significant difference between treatment groups before surgery, or 24
hours or 6 weeks after surgery. There was no significant difference in
overall cognitive change from before to 6- weeks after surgery among
propofol vs isoflurane treated patients (P = 0.881), nor were there any
significant differences between anesthetic groups in individual cognitive
domain changes over this time interval. CONCLUSION(S): The results
from this randomized controlled trial in over 100 older adults suggest
that there is no reason to favor inhaled vs intravenous anesthesia for
older adults concerned about their postoperative cognitive function and/or
risk of developing Alzheimer's disease. These data suggest that the choice
of anesthetic type (ie inhaled vs intravenous) should be made based on
other patient, procedural or institutional factors.

<46>
Accession Number
645594556
Title
Intraoperative Oxygen Concentration and Pulmonary Complications after
Cardiac Surgery - A Secondary Analysis of a Randomized Controlled Trial.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 108-111), 2022. Date of
Publication: May 2022.
Author
Joshi A.; Mueller A.; Naseem H.; Munoz-Acuna R.; O'Connor S.; Monteith E.;
Valencia J.; Shankar P.; O'Gara B.; Shaefi S.
Institution
(Joshi, Mueller) Massachusetts General Hospital, Boston, MA, United States
(Naseem, Valencia, Shankar, O'Gara, Shaefi) Beth Israel Deaconess Medical
Center, Boston, MA, United States
(Munoz-Acuna) BIDMC, Boston, MA, United States
(O'Connor, Monteith) Beth Israel Deaconess Medical Center, Boston, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Cardiac surgery with cardiopulmonary bypass carries
significant risk for postoperative pulmonary complications (PPCs), which
can increase postoperative length of stay, cost, morbidity, and
mortality1-5. While oxygen-related free radical production is implicated
in pulmonary adverse events1-3, the effect of hyperoxia on the development
of PPCs after cardiac surgery is not yet understood. This study
investigates the effect of intraoperative oxygen concentration on PPCs
after coronary artery bypass grafting (CABG) to determine if there is an
association between conservative oxygen therapy and fewer PPCs.
 METHOD(S): This study is a secondary analysis of a parallel arm
randomized controlled trial of 100 patients that evaluated the
relationship between intraoperative oxygen concentration and
neurocognitive outcomes after CABG6,7. Patients were prospectively
randomized to either receive normoxia (35% FiO2, experimental group) or
hyperoxia (100% FiO2, control group) intraoperatively. While on bypass,
the experimental group maintained a PaO2 of 100-150mmHg while the control
continued on 100% FiO2. Other anesthetic management occurred at the
discretion of the clinical team. Patients who required single-lung
ventilation, off-pump CABG, mechanical circulatory support, were in
cardiogenic shock, or for whom there were physician or nursing concerns
were excluded. Development of PPCs was abstracted from the medical record
(Table 1)2,3. The primary endpoint was the development of any PPC.
Secondary outcomes were individual PPCs, postoperative vasoplegia, time to
extubation, number of ventilator free days, reintubation, and readmission.
Demographic data, comorbidity data, and outcomes in the two groups were
assessed with a chi-squared test, Wilcoxon Rank Sum or t-test, based on
the variable type and distribution. RESULT(S): 51 patients were
randomized to normoxia, and 49 patients were randomized to hyperoxia.
Smoking status differed between groups, however other demographic measures
and medical comorbidities were similar (Table 2). The composite incidence
of PPC in the normoxia group was 22% (11/51), compared to 35% (17/49) in
the hyperoxia group (p = 0.14)(Table 3). While the development of most
PPCs was not statistically different between groups, the difference in
development of respiratory failure was statistically significant between
groups, with a greater incidence of respiratory failure in the hyperoxia
group (Table 4). The hyperoxia group also required higher mean
norepinephrine equivalents upon arrival to the intensive care unit than
the normoxia group (Table 3). The number of ventilator free days, time to
extubation, incidence of reintubation, and readmission did not differ
between groups. CONCLUSION(S): In our study, the normoxia group
trended toward having fewer PPCs when compared to the hyperoxia group,
driven by the increased development of respiratory failure in the
hyperoxia group. These data suggest that conservative and usual liberal
oxygen delivery may differ in the acute postoperative setting but do not
differ in the risk of long-term respiratory complications in patients
undergoing CABG. Given that our results are limited by sample size,
further work is necessary to understand the relationship between
intraoperative oxygen delivery and the development of PPCs, particularly
respiratory failure.

<47>
Accession Number
645594555
Title
Postoperative outcomes in polysomnography diagnosed obstructive sleep
apnea patients undergoing non-cardiac and cardiac surgeries: A
meta-analysis of prospective cohort studies.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 1094-1095), 2022. Date of
Publication: May 2022.
Author
Sun Y.; Pivetta B.; Nagappa M.; Chan M.; Chung F.F.
Institution
(Sun) University of Toronto, Toronto, ON, Canada
(Pivetta) University of Ottawa, Ottawa, Canada
(Nagappa) Western University, London, ON, Canada
(Chan) Chinese University of Hong Kong, Shatin, Hong Kong
(Chung) University of Toronto, Faculty of Medicine, Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Identifying surgical patients with obstructive sleep apnea
(OSA) may assist with risk stratification, anesthetic management, and
monitoring to minimize postoperative complications.1 Our aim was to
investigate the effect of OSA, diagnosed by objective measures such as
polysomnography (PSG) or home sleep apnea testing (HSAT), on postoperative
outcomes in cardiac and non-cardiac surgical patients. Therefore, we
designed this systematic review and metaanalysis (SRMA) of prospective
cohort studies using trial sequential analysis to minimize the risk of
type 1 error in evaluating the impact of OSA on postoperative outcomes in
surgical patients. METHOD(S): Multiple databases were systematically
searched to identify prospective studies related to OSA patients
undergoing surgery and postoperative outcomes. OSA patients were diagnosed
by PSG or HSAT. Outcomes included: (1) total postoperative complications;
(2) systemic complications: cardiovascular, respiratory, neurological,
renal, and infectious; and (3) specific complications: atrial
fibrillation, myocardial infarction, ICU admission, and mortality. The
SRMA was conducted to examine pooled odds ratios (OR) of postoperative
complications using inverse-variance random-effects model. RESULT(S):
The systematic search resulted in 12,717 articles and 20 prospective
cohort studies, enrolled from 11 different countries, were included for
meta-analysis (non-cardiac surgeries n=9; cardiac surgeries n=11). Total
of 3,756 patients were screened for OSA using PSG or HSAT with 2,127
patients diagnosed with OSA and 1,629 control patients without OSA. Mean
age of patients with OSA: 63.7+/-9.5 years; BMI of 29.5+/-9.1 kg/m2; 65.0%
male. Mean age of non-OSA patients: 58.5+/-10.3 years; BMI of
26.5+/-3.1kg/m2; 49.1% male. Overall, postoperative complications were
higher in the OSA than in the non-OSA group, with OR of 1.92 (95%CI: 1.52
- 2.42, P<0.05) and an absolute risk increase of 6.97% in OSA patients.
For non-cardiac surgeries: OR of 1.97 (95%CI: 1.31 - 2.96, P<0.05) and
absolute risk increase of 7.34% in OSA patients. For cardiac surgeries: OR
of 1.89 (95%CI: 1.43 - 2.49, P<0.05) and absolute risk increase of 7.80%
in OSA patients. There was also a significant increase in postoperative
cardiovascular OR of 1.56 (95%CI: 1.20-2.02, P<0.05) and respiratory OR of
1.91 (95%CI: 1.39-2.62, P<0.05) complications in OSA patients. Other
findings include increased neurological complications, hospital
readmissions, atrial fibrillation and arrhythmia postoperatively.
 CONCLUSION(S): OSA was associated with a nearly twofold increased
risk of total postoperative complications in patients undergoing either
non-cardiac or cardiac surgeries compared with patients without OSA. This
increased risk emphasizes the importance of preoperative screening of OSA,
especially with newly diagnosed OSA patients. Future investigation needed
to assess whether interventions can modify risk of OSA for cardiac and
non-cardiac surgeries.

<48>
Accession Number
645594526
Title
Validation of the STOP-Bang Questionnaire as a Preoperative Screening Tool
for Obstructive Sleep Apnea: A Systematic Review and Metaanalysis.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 1092-1093), 2022. Date of
Publication: May 2022.
Author
Hwang M.; Nagappa M.; Guluzade N.; Saripella A.; Englesakis M.; Chung F.F.
Institution
(Hwang) University of British Columbia, Vancouver, Canada
(Nagappa) Western University, London, ON, Canada
(Guluzade, Saripella) Toronto Western Hospital, Toronto, ON, Canada
(Englesakis) University Health Network, Toronto, ON, Canada
(Chung) University of Toronto, Faculty of Medicine, Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Obstructive sleep apnea (OSA) is the most common
sleep-related breathing disorder, characterized by frequent episodes of
hypopnea and apnea. Up to 68% of patients undergoing surgery with OSA can
be undiagnosed, resulting in increased risk of postoperative
cardiovascular and pulmonary complications.1 The STOP-Bang questionnaire
is a simple, rapid, and reliable tool used to screen for OSA.2 The
objective of this systematic review and meta-analysis is to evaluate
whether the STOP-Bang questionnaire is a valid screening tool for
unrecognized OSA in the surgical population. METHOD(S): Electronic
databases were systematically searched from 2008 to May 2021. The
inclusion criteria were: 1) the study evaluated the STOP-Bang
questionnaire as a screening tool for OSA in patients undergoing surgery;
2) polysomnography or home sleep apnea testing (HSAT) was performed to
confirm OSA diagnosis; 3) OSA was defined by an Apnea-Hypopnea Index (AHI)
or Respiratory Disturbance Index (RDI) cutoffs >= 5, >= 15, and >= 30
events per hour; and 4) data on predictive parameters of the STOP-Bang
questionnaire were provided. To address heterogeneity, a bivariate
random-effects model was used to obtain pooled predictive parameters
(sensitivity, specificity, positive (PPV) and negative predictive value
(NPV), and area under the curve (AUC) to assess the validity of the
STOPBang questionnaire for different AHI cut-offs: AHI >= 5, >= 15, and >=
30 events per hour. RESULT(S): The systematic search identified 4,641
articles, from which 10 studies (n=3,247) were included in the final
analysis. The mean age of the surgical population was 57.3 +/- 15.2 years,
the mean BMI was 32.5 +/- 10.1 kg/m2, and 47.4% were male. Surgical
procedures included bariatric surgery (n=4), non-cardiac elective surgery
(n=3), non-vascular abdominal surgery (n=1), coronary artery bypass
grafting (n=1), and total joint arthroplasty (n=1). The pooled predictive
parameters of the STOP-Bang questionnaire are presented in Figure 1 and
Table 1. The STOP-Bang questionnaire has high pooled sensitivities of 85%
(95%CI: 82-88%), 88% (95%CI: 85-89%), and 90% (95%CI: 87-93%) to screen
for all (AHI >= 5), moderate-to-severe (AHI >= 15), and severe (AHI >= 30)
OSA, respectively. The specificities were lower at 47% (95%CI: 42-52%),
29% (95%CI: 27-32%), and 27% (95%CI: 25-29%) for all, moderate-to-severe,
and severe OSA, respectively. The PPV was highest at 74.9% (95%CI:
71.8-77.7%) to detect all OSA. With a NPV of 93.2% (95%CI: 90.9-95.1%),
STOP-Bang is most effective in ruling out severe OSA. The AUC was 0.84,
0.67, and 0.63 respectively for all, moderate-to-severe, and severe OSA.
 CONCLUSION(S): The STOP-Bang questionnaire is a valid tool to screen
for OSA in surgical patients, with high sensitivity and high
discriminative power to exclude severe OSA with negative predictive value
(NPV) of 93.2%.

<49>
Accession Number
645594511
Title
Studying possible intraoperative EEG markers of postoperative delirium
using standardized propofol induction: The roles of burst suppression and
delta-band power.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 481-483), 2022. Date of
Publication: May 2022.
Author
Boncompte G.; Salas W.; Biggs D.M.; Zamora M.; Calderon N.; Contreras V.;
Carrasco M.; Cortinez I.; Pedemonte J.C.
Institution
(Boncompte) Pontificia Universidad Catolica de Chile, Santiago, Chile
(Salas, Biggs, Zamora, Calderon, Carrasco) Escuela de Medicina, Pontificia
Universidad Catlica de Chile, Santiago, Chile
(Contreras, Cortinez) Pontificia Universidad Catolica de Chile, Santiago
De Chile, Chile
(Pedemonte) Escuela de Medicina, Pontificia Universidad Catolica de Chile,
Santiago, Chile
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Postoperative delirium (POD) is the main cause of
preventable postoperative morbidity and mortality in older population.
Intraoperative markers that could reliably predict POD would be useful in
identifying, managing, and reducing its adverse effects. The etiology of
POD remains unknown but excessive anesthetic dosage has long been proposed
as a risk factor. Burst suppression (BS), an electroencephalogram (EEG)
activity pattern linked to anesthetic over-administration, has been
associated with POD in observational studies1, 2. However, randomized
controlled trials have produced controversial results3, 4. Here we studied
the association of BS with POD, and explored spectral bands powers as
possible POD markers, by analyzing intraoperative EEG of high POD risk
geriatric patients after a standardized propofol induction.
 METHOD(S): The present was a cohort, observational and prospective
study (ClinicalTrials NCT04713644). Inclusion criteria: patients >=65
years old undergoing elective cardiac surgery with CPB, ASA physical
status II-III. POD was evaluated twice daily (AM-PM) during the first 72
postoperative hours with CAM-ICU and structured chart review. Standardized
induction: Fentanyl 5-10ucg/Kg, Propofol 0.5mg/Kg (plus 0.5mg/Kg if
necessary) and Vecuronium 0.1mg/Kg plus halogenated gas (Isoflurane or
Sevoflurane; see Figure 1). 20 minutes of EEG signal, following propofol
injection, were recorded (Sedline ) and analyzed offline using R, Python
and JASP. BS was estimated by the number of seconds in isoelectricity (amp
< 10uV) per minute. We analyzed spectral power of canonical frequency
bands by means of FFT using Welch method. Statistical analyses were
conducted using Mann-Whitney U test. Power spectra differences were
analyzed using bootstrapping (5000 iterations). Statistical differences
between spectra were determined as frequency segments in which the value
zero was not within the 95% confidence interval of the difference between
conditions. A value of p < 0.05 was considered statistically significant.
 RESULT(S): 25 out of a total of 80 patients have been recruited so
far. Data from 5 patients were rejected due to poor signal quality or
incomplete POD evaluation. POD group was slightly older than no-POD (75
[73, 76] vs. 69 [66-73], p = 0.028; See table in Figure 2). We found no
difference in BS between groups (0.00 [0.00, 0.03] vs. 0.01 [0.00, 0.02],
p = 0.533, Figure 3). Patients that subsequently developed POD showed
increased spectral power (5.79 [3.44, 6.94] vs. 2.58 [2.19, 3.97], p =
0.017) in the Low Delta range (0.1 - 2Hz; Figure 3). No other frequency
band showed significant differences (Figure 4). CONCLUSION(S):
Isoelectricity during a standardized propofol induction was not associated
with POD in older patients. Intraoperative Low Delta activity was enhanced
in POD patients. Completion of recruitment is required to confirm these
results, however Low Delta band appears as a promising candidate.

<50>
Accession Number
645594448
Title
Post-operative Complications in Older Surgical Patients with Preoperative
Cognitive Impairment: A Systematic Review and Metaanalysis.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 473-474), 2022. Date of
Publication: May 2022.
Author
Au E.; Chen L.; Saripella A.; Kapoor P.; Yan E.; Chung F.F.
Institution
(Au, Chen, Saripella, Yan) Toronto Western Hospital, Toronto, ON, Canada
(Kapoor) University of Toronto, Toronto, ON, Canada
(Chung) University of Toronto, Faculty of Medicine, Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Cognitive impairment has been shown to be a risk factor for
poor postoperative outcomes?. With the projected rise in the older
population within the next few decades and the high prevalence of
cognitive impairment in the older population, it will become increasingly
important to understand the association between cognitive impairment and
postoperative adverse outcomes. The objective of this systematic review
and meta-analysis is to determine the association between preoperative
cognitive impairment and postoperative complications in older patients
undergoing elective and emergency non-cardiac surgery. METHOD(S):
Electronic databases including MEDLINE, PubMed, Embase, Cochrane CENTRAL,
PsycINFO, Web of Science, Scopus, and clinicaltrials.gov were searched
from their inception dates to March 30, 2021. Inclusion criteria were (1)
patients >= 60 years undergoing elective or emergency non-cardiac surgery;
(2) a preoperative cognitive impairment determined by a validated
cognitive assessment tool; (3) at least one postoperative complication
reported; (4) a comparator group with no preoperative cognitive impairment
present; and (7) English language. The primary outcomes were postoperative
delirium and mortality. Effect sizes were calculated as Odds ratio (OR)
based on random effect model analysis using the Cochrane Review Manager
Version 5.3. RESULT(S): The search identified 9,491 studies, of which
40 studies with 15,957 patients were included. The most common study
design was prospective cohort (n=29). Types of non-cardiac surgeries were
cancer (abdominal), general, gynecologic, head and neck, neurosurgery,
ophthalmologic, orthopedic, thoracic, urologic, vascular, and mixed. The
mean age was 77.5 +/- 11.9, of which 45.2% were male. The prevalence of
cognitive impairment among elective and emergency non-cardiac surgery
studies ranged from 7 to 80%. Overall, older patients with a preoperative
cognitive impairment were more likely to experience postoperative delirium
after elective non-cardiac surgery (25.1% vs. 12.6%; OR: 2.8; 95% CI:
1.6-4.8; I2: 76%; p=0.0002) (Figure 1) and emergency non-cardiac
(orthopedic) surgery (25% vs. 5%; OR: 9.0; 95% CI: 3.4-24.1; I2: 65%; p <
0.0001). Preoperative cognitive impairment significantly increased risk
for 1-year mortality after elective and emergency non-cardiac surgery
(26.2% vs. 13.2%; OR: 2.3; 95% CI: 1.4-3.7; I2: 73%; p =0.001). Subgroup
analysis of emergency orthopedic surgery demonstrated an increased risk
for 1-year mortality in older patients (33.8% vs.14.7%; OR: 3.0; 95% CI:
2.1-4.1; I2: 8%; p < 0.00001). CONCLUSION(S): Our systematic review
and meta-analysis indicates that preoperative cognitive impairment in
older surgical patients significantly increases risk for postoperative
delirium and 1-year mortality after elective and emergency non-cardiac
surgery.

<51>
Accession Number
645594436
Title
Impaired human resistance arteriole vascular reactivity is associated with
the development of acute kidney injury and delirium in cardiac surgery.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 213-214), 2022. Date of
Publication: May 2022.
Author
Lopez M.; Shotwell M.S.; Mace E.H.; Harrison D.G.; Billings F.
Institution
(Lopez, Mace, Harrison, Billings) Vanderbilt University Medical Center,
Nashville, TN, United States
(Shotwell) Vanderbilt University, Nashville, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Acute kidney injury (AKI) and delirium affect up to 30% of
patients undergoing cardiac surgery and are associated with increased risk
of death, duration of mechanical ventilation, and longer
hospitalization.1,2 AKI and delirium may be induced by impaired perfusion,
ischemia-reperfusion, oxidative damage, and inflammation, and each of
these mechanisms is regulated by the vascular endothelium. The endothelium
controls perfusion via its capacity to regulate smooth muscle tone. We
tested the hypothesis that impaired vascular reactivity is associated with
AKI and delirium in patients undergoing cardiac surgery. METHOD(S):
We measured vascular reactivity in resistance arterioles from mediastinal
fat collected from participants in a clinical trial of hyperoxia versus
normoxia during cardiac surgery.3 Arterioles were mounted on a wire
myograph. After inducing vasoconstriction with norepinephrine, we measured
endothelium-dependent and -independent vasodilation with escalating doses
of acetylcholine and sodium nitroprusside, respectively. We diagnosed AKI
using Kidney Disease Improving Global Outcomes creatinine criteria and
delirium using the Confusion Assessment Method for the ICU assessed twice
daily. We compared responses in patients who did and who did not develop
AKI using repeated measures ANOVA and nonlinear mixed effects regression
and repeated this in participants who did and who did not develop
delirium. Responses were compared with an omnibus test of the effective
concentration eliciting a half-maximal response (EC50), rate of the
response, and the maximal theoretical response (Emax). RESULT(S):
Thirty-five trial participants comprised the study sample. The median
(25th, 75th percentile) age was 67 years (59, 73), 15 (42.9%) participants
were diabetic, and the median left ventricle ejection fraction was 55%
(55,60). Eight participants (22.9%) developed AKI and 7 (20%) developed
delirium. Endothelium-dependent vascular reactivity (acetylcholine
response) was similar between subjects who did and who did not develop AKI
(P=0.36) and between those who did and did not develop delirium (P=0.70).
Endothelium-independent vascular reactivity (sodium nitroprusside
response) was impaired in participants who developed AKI, evidenced by a
1.7-fold increase in the EC50 and an 11.1% lower Emax compared to
participants who did not develop AKI (P<0.001; Fig.1). Similarly,
endothelium-independent vascular reactivity was impaired in those who
developed delirium, evidenced by a 10-fold increase in EC50 and a 11.9%
decreased Emax compared to those who did not develop delirium (P=0.008;
Fig. 2). CONCLUSION(S): Vascular reactivity was impaired in cardiac
surgery patients who subsequently developed AKI and in those who developed
delirium. Specifically, endothelium-independent vascular reactivity, but
not endothelium-dependent vascular reactivity, was impaired in those with
these organ injuries. Impairment of the endothelium-independent response
could be explained by impaired activation of soluble guanylyl cyclase in
participants who developed organ injury since nitric oxide from sodium
nitroprusside directly activates soluble guanylyl cyclase. The similar
endotheliumdependent response in patients with and without organ injury
may be explained by acetylcholine activation of other vasodilator pathways
in addition to activation of endothelial nitric oxide synthase. Future
investigations will determine if therapies that augment
endotheliumindependent vascular reactivity, such as soluble guanylyl
cyclase stimulators, decrease perioperative AKI and delirium.

<52>
Accession Number
645593909
Title
Systematic review of OR to ICU handoff standardization interventions
highlights need for focus on sustainability and patient outcomes.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 780-781), 2022. Date of
Publication: May 2022.
Author
Busch J.C.; Wu J.; Muralidharan M.; Lane-Fall M.
Institution
(Busch) University of Chicago, Chicago, IL, United States
(Wu, Muralidharan, Lane-Fall) University of Pennsylvania, Philadelphia,
PA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Operating room (OR) to the intensive care unit (ICU) handoff
standardization is a well-studied intervention to decrease preventable
patient harm. We conducted a systematic review to synthesize findings
about OR-to-ICU handoff intervention sustainability and their impact on
patient outcomes, attributes of these interventions that are not well
described in recent reviews of OR-to-ICU handoff studies. METHOD(S):
We searched 10 electronic bibliographic databases (including PubMed,
Scopus, and eight others) for studies published between 1995 and October
2021 describing OR-to-ICU handoffs. Search terms included synonyms of
'operating room,' 'intensive care unit,' and 'patient handoff,' using both
natural language terms and controlled vocabulary. Inclusion criteria
included full papers (i.e., not abstracts) describing original research
with intervention descriptions. We used the Cochrane Consumers and
Communication Review Group Study Quality Guide to evaluate each study
using the criteria pertaining to the study format and PRISMA guidelines
for reporting. RESULT(S): The initial search yielded 30,599 combined
results [Fig. 1]. De-duplication, abstract review, and full text review
yielded 43 papers published between 2007- 2021. Ten countries were
represented, with the largest number from the U.S. (n=19). ICU types
included cardiac (n=18), surgical (n=8), neurologic (n=2), neonatal (n=1),
pediatric (n=1), general (n=4), and unspecified (n=12). Study designs
included quasi-experimental before-andafter studies (n=42) and one
randomized controlled trial. Methods included surveys, interviews/focus
groups, observations, and chart reviews. Outcomes were clinician-,
patient-, or process-related. Of 35 using observations, 31 studies (88.6%)
had a pre-intervention period and 34 (97.1%) had a post-intervention
period. Thirteen (32.6%) of the studies described a sustainability period
following the initial implementation phase that lasted 6 months to 2.5
years. All studies with a sustainability period showed continued
improvement of at least one study outcome. Nine studies measured patient
outcomes, including unplanned or early extubations, delayed dosing of
antibiotics, unspecified post-surgical complications, ICU-level patient
mortality, length of stay, duration of mechanical ventilation, and
vasopressor or inotrope treatment duration. Of these, 7 (77.8%) reported
statistical significance improvement of patient outcomes, but none were
able to establish causation. Two studies reported no difference in any
outcomes. CONCLUSION(S): Current research in OR-to-ICU handoff
interventions focuses primarily on improving provider satisfaction and
information exchange, with less known about how these interventions affect
patient outcomes or how to enact lasting improvements to the handoff
process. Future research should focus on longer term studies of
interventions and evaluation of patient outcomes.

<53>
Accession Number
645593797
Title
Albumin in Cardiac Surgical Patients and Outcomes: A Retrospective
Database Review.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 289-290), 2022. Date of
Publication: May 2022.
Author
Turnadzic S.; Wilczynska P.; Mills T.; Cotter E.; Wirtz K.; Nazir N.;
Flynn B.C.
Institution
(Turnadzic) University of Missouri - Kansas City, Kansas City, MO, United
States
(Wilczynska, Mills, Cotter, Wirtz, Nazir) University of Kansas Medical
Center, Kansas City, KS, United States
(Flynn) University of Kanas, Kanas City, KS, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: This was a retrospective database review analyzing the use
of albumin in cardiac surgical patients. Albumin as a volume expander is
much more costly than crystalloid therapy. Some studies demonstrate
albumin and crystalloid as equivalent while other studies cite that
albumin use is associated with kidney injury, sepsis, and bleeding in
cardiac surgical patients. Due to high costs and controversial evidence
for albumin administration, we sought to determine if adverse outcomes
were associated with a higher dose of albumin. METHOD(S): Following
institutional review board approval, all data was collected from the
electronic medical record. The finalized database included 1,491 isolated
CAB, CAB+valve, and isolated valve(s) patients in the CTICU. We developed
a novel albumin:crystalloid (mg/mL) ratio (A:C) as the intervention based
on natural cut-offs for A:C dose as a continuous variable. High A:C was
determined to be > 2.7. The primary outcome was acute kidney injury based
on Kidney Disease: Improving Global Outcomes (KDIGO) score. Secondary
outcomes included sepsis, reoperation for bleeding and 30-day mortality.
In order to avoid confounding by preexisting cardiac dysfunction, we
stratified patients into three groups based on ejection fraction (EF)
(<30%, 31-50% and >50%). EF groups were compared using ANOVA and
chi-square test for continuous and discrete variables, respectively. Due
to small number of observations and skewness, high vs low A:C ratio groups
were compared using non-parametric Wilcoxon rank sum test for continuous
and Fisher's Exact test for discrete variables. RESULT(S): Exclusion
criteria included patients that died within the first 24 hours of surgery,
patients with end-stage renal disease preoperatively, and those who came
to the ICU on ECMO. Preoperative baseline characteristics were similar
among the cohorts stratified by EF, except diabetes was more common in
patients with EF < 30%. (Table 1) Patients who received higher doses of
albumin based on A:C ratio > 2.7, had no difference in incidence of renal
dysfunction (Table 2, Figure 1). There was also no difference in 30-day
mortality or sepsis. Furthermore, higher albumin doses do not appear to
increase risk of bleeding as there were no differences in blood product
administration or need for reoperation for bleeding. These findings hold
true despite patients in the low EF group possibly being more critically
ill as demonstrated by increased length of stay, increased ventilation
time and more diabetes. CONCLUSION(S): Based on these results,
albumin appears to be safe in cardiac surgical patients without increased
risk of renal failure or other previously associated adverse outcomes such
as bleeding and sepsis. These results hold true in each of the three
ejection fraction groups. Patients with lower ejection fraction appeared
to be more critically ill, however did not have increased renal failure
associated with A:C ratio. Furthermore, this study presents a novel
strategy to study albumin use in CTICU with the A:C ratio. The A:C ratio
is a feasible and straight-forward calculation to assess the effects of
the quantity of albumin administration in relation to crystalloid. Due to
the retrospective nature of this study, these results are hypothesis
generating and should be validated in future randomized controlled trials.

<54>
Accession Number
645594342
Title
The Lidocaine Infusion for the Management of Postoperative Pain and
Delirium (LIMPP) Trial.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 464), 2022. Date of Publication:
May 2022.
Author
Buren M.A.; Zuraek A.; Theologis A.; Behrends M.; Clark A.; Leung J.
Institution
(Buren, Zuraek, Theologis, Behrends, Clark, Leung) University of
California, San Francisco, CA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Postoperative delirium is a frequent adverse event following
elective non-cardiac surgery. Older patients are at significant risk of
postoperative delirium and while the problem is well documented and the
risk factors well defined, there are few effective therapies for its
prevention or treatment once it has developed. The occurrence of delirium
increases the risk of functional impairment, placement to facilities other
than home after discharge, cognitive impairment at discharge, as well as
in-hospital and long-term mortality. Unfortunately, there is a dearth of
efficacious strategies to minimize the risk from modifiable risk factors,
including postoperative pain control and the analgesic regimen. Use of
potent opioids, currently the backbone of postoperative pain control,
alters cognition and may contribute to an increased risk of postoperative
delirium. Literature supports the intraoperative use of lidocaine
infusions to decrease postoperative opioid requirements, expedite return
of bowel function, and decrease the risk of chronic post-surgical pain.
However, whether the use of postoperative lidocaine infusions is
associated with lower opioid requirements and subsequently a reduction in
postoperative delirium has not been investigated. METHOD(S): The
LIMPP trial is a randomized, doubleblinded clinical study of a
postoperative 48-hour infusion of lidocaine at 1.33mg/kg/hr vs. placebo in
older patients undergoing major reconstructive spinal surgery at UCSF.
Patients will be randomized, and the study medication started upon arrival
to the PACU/ICU. Our primary outcome is incident delirium (CAM) in the
first 3 postoperative days. Secondary outcomes include delirium severity
(MDAS), changes in cognition (TICS, digit symbol substitution test, timed
verbal fluency test, and the word list learning task), pain scores, opioid
use, incidence of opioid related side effects (respiratory depression,
nausea vomiting) and functional benefits including time to discharge and
improved recovery from surgery (SF- 36, ODI). Lidocaine safety will be
assessed with daily screening questionnaires and lidocaine plasma levels.
 RESULT(S): We have recently started recruiting patients for the
pilot/feasibility phase and results will be forthcoming upon conclusion of
the study. CONCLUSION(S): Our study will be one of the few
interventional studies to investigate the association between pain,
postoperative delirium, and other postoperative opioid-related adverse
effects. Although lidocaine has been used intraoperatively for years, with
prior data supporting its efficacy and safety for improved analgesic and
functional outcomes, the evidence supporting its postoperative use is
scant. Our study will be one of the first to standardize the
intraoperative anesthetic and separately investigate the potential
postoperative benefits of a continuous postoperative lidocaine infusion.
Data supporting our hypothesis that postoperative lidocaine is associated
with a reduction in postoperative delirium will provide insight into the
pathophysiology of postoperative delirium, particularly as to how delirium
is associated with pain and opioids.

<55>
Accession Number
645594289
Title
Programmed intermittent bolus via a thoracic paravertebral catheter
provides greater dermatomal spread compared to a continuous infusion in
video assisted thoracic surgery: A randomized control trial.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 1064-1066), 2022. Date of
Publication: May 2022.
Author
Bojaxhi E.; Ardon A.; Robards C.; Porter S.; Logvinov I.
Institution
(Bojaxhi, Robards) Mayo Clinic, Jacksonville, FL, United States
(Ardon) University of Florida, Jacksonville, FL, United States
(Porter) Mayo Clinic, College of Medicine and Science, Jacksonville, FL,
United States
(Logvinov) Mayo Clinic Florida, Jacksonville, FL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Video assisted thoracic surgery (VATS), though less invasive
than open thoracotomy, can still be associated with significant pain in
the early post-operative period. A paravertebral blockade and catheter use
can significantly reduce acute pain after a thoracic procedure. While
continuous infusions (CI)have traditionally been utilized to deliver local
anesthetic via peripheral nerve catheters, programed intermittent bolus
(PIB) has shown promise as an alternative mechanism to deliver analgesia.
Paravertebral catheters (PVC) are routinely used in our institution for
VATS and other thoracic surgeries. In this prospective doubleblinded
randomized control trial, we compare a PVC delivering local anesthetic via
a PIB setting vs CI. Our primary outcomes include pain and opioid use on
postop day 1, and dermatomal coverage between the two different pump
settings. Our secondary outcomes were a difference in the patient's
quality of recovery (QoR- 15), use of local anesthetic, post-operative
nausea and vomiting (PONV), and hospital length of hospital stay (hLOS).
 METHOD(S): After IRB approval, 50 opioid nave patients were
approached, and 46 agreed to participate in the study. The patients were
randomized on a 1:1 ratio between PIB and CI. All catheters were placed
preoperatively at the T5 level and the block was confirmed via lack of
sensation to cold over the corresponding dermatome. The pump was programed
to PIB or CI and connected to the catheter by an acute pain nurse not
participating in the data collection. All pumps were also programed with a
patient-controlled bolus dose. All patients received standardized
perioperative multimodal analgesia (acetaminophen 1000mg PO every 6 hours
and ketorolac 30 mg IV every 8 hours) and PONV prophylaxis (dexamethasone
10mg IV and ondansetron 4 mg IV prior to emergence). Opioid administration
included intraoperative IV fentanyl (titrated at the discretion of the
in-room provider), and postoperative oxycodone 5-10 mg PO every 4 hours
for moderate pain and hydromorphone 0.2-0.5 mg IV every 4 hours for severe
pain. Data collection and patient assessment was conducted by a member of
the acute pain service that was blinded to the pump setting and
randomization schedule. The primary timeframe of interest was the morning
of POD 1 since the initial injection of the PVB would have worn off and
the difference between the two pump settings could be best assessed. Data
collection was stopped on the evening of POD 1 since most PVC and chest
tubes were discontinued in the evening of POD 1 or morning of POD 2.
QoR-15 was assessed preop and evening of POD1. RESULT(S): Patient
demographics and intra-operative characteristics are show in Table 1 with
the average body mass index being slightly higher in the PIB group. As
shown on table 2, there was no significant difference in pain scores (with
rest or cough) or opioid use between the PIB and CI groups. However, there
was a significant difference between the average dermatome coverage of the
block on POD1 between the PIB and CI [5 vs 3 respectively (p=0.03)].
Figure 1 illustrates the differences in dermatomal coverage of the block
on POD1 between the PIB and CI groups. There was no difference between the
two groups with regards PONV, change in the QoR-15, hLOS, and total volume
of local anesthetic use through either pump. CONCLUSION(S): Delivery
of local anesthetic via PIB through a thoracic PVC provides greater
dermatomal spread of the block when compared to a CI. However, the
increased efficacy of the block did not translate to a significant
improvement in analgesia between the two groups in patients undergoing
VATS.

<56>
Accession Number
645594262
Title
The Efficacy of Serratus Anterior Plane Block for Postoperative Analgesia
after Video Assisted Thoracoscopic Surgery.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 1062-1063), 2022. Date of
Publication: May 2022.
Author
Scorsese G.; Jiang Y.; Greenspan S.H.; Jin Z.; Seiter C.; Lin J.
Institution
(Scorsese, Jin, Seiter) Stony Brook Medicine, Stony Brook, NY, United
States
(Jiang, Greenspan) Renaissance School of Medicine, Stony Brook University,
Stony Brook, NY, United States
(Lin) Stony Brook University, Health Sciences Center, Stony Brook, NY,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Pain is the most common adverse event after surgery. While
thoracic epidural anesthesia has been the gold standard for postoperative
analgesia after undergoing video assisted thoracoscopic surgery (VATS), it
is also associated with risks of dura and pleura injury, as well as
technical difficulty in placement. The serratus anterior plane block
(SAPB) is a fascial plane block which could be done quickly under
ultrasound guidance and yield comprable pain reduction. In this
meta-analysis, we evaluate the analgesic efficacy of SAP block in VATS.
 METHOD(S): We systematically searched PubMed for both prospective and
retrospective studies using the following criteria: adult patients
undergoing VATS under general anesthesia. The intervention of interest is
serratus anterior plane block (SABP) and control is general anesthesia
with systemic analgesia. The primary outcomes included 24-hour opioid
requirement, 24- hour area under the curve (AUC) of pain score. The
secondary outcome was PONV and incidence of other complications.
 RESULT(S): The last literature search was conducted on Sep 28, 2021 .
We identified a total of 7 studies which fulfilled the inclusion criteria.
Three studies reported 24-hour opioid requirement, pooled data
significantly favored SAPB [mean difference (MD)= 10.52 mg, 95% confidence
interval (CI) (8.02 to 13.01)]. Six studies reported the AUC of pain score
over the 24 hours after surgery, which again favored SAPB (standardized
MD= 3.26, 95% CI 2.07 to 4.46). SAPB arm also trended towards less PONV,
but was not statistically significant (Risk ratio=0.57, 95% CI 0.33 to
1.00). CONCLUSION(S): Serratus anterior plane block is potentially an
effective alternative mode of analgesia for VATS during the first 24 hours
after surgery. Compared to epidural anesthesia and paravertebral block, it
has the advantage of lower risk of dura and pleura injury. Further studies
are needed in comparing the analgesic efficacy of different regional
anesthesia options, as well as the potential of catheter-based techniques.

<57>
Accession Number
645594191
Title
Baseline metabolic dysregulation and response heterogeneity to pulmonary
vasoreactivity in right heart failure after cardiac surgery: Secondary
analysis of the INSPIRE-FLO clinical trial.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 186-187), 2022. Date of
Publication: May 2022.
Author
Ghadimi K.; Giamberardino S.; Nguyen N.; Parikh J.; St John-Williams L.;
Thompson J.W.; Moseley A.; Lorenzana-Saldivar E.D.; Bowles D.; Kwee L.;
Schroder J.N.; Bryner B.; Milano C.A.; Rajagopal S.; Shah S.
Institution
(Ghadimi, Parikh, Lorenzana-Saldivar, Bowles, Schroder, Bryner, Milano,
Rajagopal, Shah) Duke University Medical Center, Durham, NC, United States
(Giamberardino, Nguyen, Kwee) Duke Molecular Physiology Institute, Durham,
NC, United States
(St John-Williams, Thompson, Moseley) Duke Proteomics and Metabolomics
Shared Resource, Durham, NC, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: To protect against right heart failure (RHF) as a major
driver of shock after cardiac surgery, inhaled pulmonary vasodilators are
initiated to lower pulmonary vascular resistance (PVR) to improve right
ventricular performance. However, there is marked heterogeneity in the
pulmonary vasoreactive response to these inhaled agents. Given the central
role of metabolism in cardiac efficiency and failure, and prior work
identifying impaired mitochondrial fatty acid u-oxidation in heart
failure, we hypothesized that baseline plasma metabolites would be
associated with response to inhaled pulmonary vasodilators after cardiac
surgery. METHOD(S): We leveraged a biospecimen repository associated
with the INSPIRE-FLO randomized controlled trial that compared two inhaled
pulmonary vasodilators in major cardiac surgery (NCT03081052). We selected
63 patients with precapillary pulmonary hypertension before surgery
(baseline), diagnosed by mean pulmonary arterial pressure > 20 mm Hg and
PVR >= 3 Wood units.1 Targeted profiling of > 200 metabolites (MxP Quant
500 kit, Biocrates) was performed in baseline plasma. Principal components
analysis (PCA) was used for dimensionality reduction of metabolites;
generalized linear models were used to determine the nominal association
of baseline factors with clinical endpoints, including percent change in
PVR over the one day after surgery, response phenotype (classified as
responders vs. nonresponders to the allocated inhaled agent, based on PVR
< 3 Wood units vs. PVR remained >= 3 Wood units at one day after surgery)
and RHF development. In left ventricular assist device recipients alone,
factors were assessed for association with the European registry RHF risk
score.2 RESULTS: Of 63 patients, 28 were classified as responders and 35
as nonresponders. PCA identified twenty-one factors with metabolites
clustering in relevant biologic pathways (Table 1). Of these, two factors,
weighted heavily with glycerophospholipids (GPs) and amino acids (glu,
asp, ala, gln), were nominally associated with both percent change in PVR
and response phenotype. While none of the factors were linked to RHF
development for the full cohort, three factors, heavily weighted with GPs,
were nominally associated with the RHF risk score in left ventricular
assist device recipients. CONCLUSION(S): In this nested cohort of
pulmonary hypertensive patients from a clinical trial in cardiac surgery,
we found that GPs and select amino acids in baseline plasma were
associated with vasoreactive response to inhaled pulmonary vasodilators.
Glycerophospholipids alone were also associated with RHF risk scores in
left ventricular assist device recipients. Although GPs are essential to
mitochondrial membrane integrity and have been prominently featured in
plasma profiles of heart failure,3 the key amino acids in our study may be
indicative of underlying dysregulated hepatic metabolism4 and critical
illness that may predispose to RHF. Thus, targeted profiling in paired
right ventricular myocardium and plasma is needed to better characterize
metabolic dysregulation in pulmonary hypertensive patients that develop
RHF after cardiac surgery.

<58>
Accession Number
645593625
Title
Role Of Magnesium Alone Or In Combination With Diltiazem and / Or
Amiodarone In Prevention Of Post-Coronary Artery Bypass Grafting Atrial
Fibrillation.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2022 Annual
Meetings. Virtual. 134(5 Supplement) (pp 148), 2022. Date of Publication:
May 2022.
Author
Maheshwari A.; Tempe D.K.; Khurana P.; Fatima N.
Institution
(Maheshwari, Tempe, Khurana, Fatima) GB Pant Hospital, Delhi, India
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Atrial fibrillation (AF) is a frequently encountered
complication following CABG with an incidence of 20-40%. The occurrence of
AF increases the morbidity by causing hemodynamic deterioration,
increasing incidence of thromboembolism, postoperative stroke and
prolonging the hospital length of stay. Many different strategies have
been studied with limited success for the prevention of post-CABG AF.
 METHOD(S): This was a prospective observational uncontrolled trial
performed on 150 patients more than 18 years of age undergoing off-pump
CABG. Group M (patients without arterial grafts) received intraoperative
magnesium infusion at 30mg/kg over 1 hour, Group MD (patients receiving
arterial grafts) received magnesium infusion with diltiazem infusion at
0.05 mug/ kg/h throughout the intraoperative period; Group AMD (patients
receiving arterial grafts under the care of a particular surgeon who
routinely uses amiodarone preoperatively) received preoperative oral
amiodarone along with magnesium and diltiazem infusion as in other groups.
All patients were electively ventilated post operatively. The study
endpoint was occurrence of AF or end of postoperative day 4 whichever was
earlier. AF was defined as any AF lasting for more than 10 min or
requiring treatment by way of cardioversion or medicines. The incidence of
postoperative AF was compared using ANOVA/ Kruskal Wallis test between the
three groups. Our secondary objectives were duration of mechanical
ventilation; ICU and hospital length of stay; and neurological morbidity
(transient ischemic attack or cerebrovascular accident) RESULTS: Out of
150 patients (21 patients in group M; 78 patients in group MD; 51 patients
in group AMD);19 patients developed AF [4(19.05%) in group M; 9(11.54%) in
group MD and 6 ( 11.76%) in group AMD (P> 0.5)]. The other postoperative
parameters like duration of mechanical ventilation (21 +/- 2.93 hrs, 19.09
+/- 3.92 hrs, 20.69 +/- 2.66 hrs) , duration of ICU stay (6 +/- 2.35 days,
7.99 +/- 2.77 days, 7.55 +/- 4.54) days) and duration of hospital stay
(13.33 +/- 3.12 days, 13.18 +/- 4.37 days, 17.06 +/- 19.04 days) in groups
M, MD, and AMD respectively were similar in the three groups (P >0.05).
Only 1 patient developed neurological event (transient ischemic attack),
although he did not develop AF. No adverse effects related to any of the
drugs were observed. CONCLUSION(S): AF following CABG is well
studied; however, therapy is still unproven, contradictory and being
debated. A significant incidence of AF (12.67%) was observed in our cohort
of patients undergoing OPCABG. However, use of amiodarone and/or diltiazem
in addition to magnesium did not result in additional benefit in lowering
the incidence of of prevention of AF.

<59>
Accession Number
2035260196
Title
Current evidence of unicuspid aortic valve in young adults: A systematic
review and metanalysis.
Source
Current Problems in Cardiology. 50(1) (no pagination), 2025. Article
Number: 102884. Date of Publication: January 2025.
Author
Carbone A.; Ferrara F.; Bottino R.; Russo V.; Rega S.; Limongelli G.;
Bossone E.; Evangelista A.
Institution
(Carbone, Rega, Bossone) Department of Public Health, University of Naples
"Federico II", Via Pansini, 5, Naples 80131, Italy
(Carbone, Bottino) Unit of Cardiology, University of Campania "Luigi
Vanvitelli", Naples, Italy
(Ferrara) Heart Department, University Hospital of Salerno, Salerno, Italy
(Russo) Radiology Department, University Hospital of Salerno, Salerno,
Italy
(Limongelli) Inherited and Rare Cardiovascular Diseases, Department of
Translational Medical Sciences, Monaldi Hospital, University of Campania
"Luigi Vanvitelli", Naples, Italy
(Limongelli) Institute of Cardiovascular Science, University College
London, London, United Kingdom
(Evangelista) Teknon Medical Center, Heart Institute, Barcelona, Spain
Publisher
Elsevier Inc.
Abstract
Unicuspid aortic valve (UAV) is a rare congenital valvular anomaly, often
misdiagnosed as the more prevalent bicuspid aortic valve (BAV). The aim of
this study was to explore demographic, clinical characteristics,
diagnosis, surgical options, short and long term outcomes of young adults
with UAV. A systematic review and meta-analysis of literature were
conducted for studies (1971-2024) including patients (>= 14 years old)
with diagnosis of UAV. Among the 2953 studies retrieved, 67 case reports,
6 case series (n = 130) and 13 retrospective studies (n = 918), were
included in the analysis. Data from retrospective studies were aggregated
using a random effects model for estimating the pooled risk ratio and mean
difference. UAV is mostly unicommissural in adults (mean age 36 years old
at diagnosis, 76-79 % males). The most common conditions associated in UAV
patients were aortic coarctation (from 3.8 to 12 %), ventricular septal
defect (3 %) and Turner syndrome (3 %). In general, the diagnosis was
performed with TTE and confirmed with TEE (+/- 3D-TEE). The most common
types of surgery were AVR. Dilated ascending aorta was described in 44 %
and 35 % of retrospective studies and case reports, respectively.
Concomitant ascending aorta replacement/repair was reported 38 % and 27 %
of retrospective studies and case reports, respectively. Overall survival
was reported in 3 studies, ranging from 95 to 98 % at 10 years. UAV should
be considered a separate entity from BAV. Further investigations with
regards to the possibility of a familial incidence, associated
histopathological changes in the aorta, and ideal follow up and
intervention are needed. Copyright © 2024 The Author(s)

<60>
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

<61>
Accession Number
2035101565
Title
Evaluating the Impact of Trimetadizine on Myocardial Ischemia-Reperfusion
Injury through Mitochondrial ATP Pathway in Rats.
Source
Pakistan Veterinary Journal. 44(3) (pp 715-720), 2024. Date of
Publication: 2024.
Author
Wang X.; Xu Z.; Zhuang Y.; Guo X.; Hu K.; Su G.
Institution
(Wang, Xu, Su) Department of Cardiovascular, Jinan Central Hospital,
Cheeloo College of Medicine, Shandong University, No. 105, Jiefang Road,
Jinan, Shandong 250013, China
(Wang, Xu, Zhuang, Guo, Hu, Su) Department of Cardiovascular, Central
Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang
Road, Jinan, Shandong 250013, China
Publisher
University of Agriculture
Abstract
Myocardial ischemia/reperfusion injury (MIRI) refers to heart muscle
failure due to cellular and tissue structural damage following coronary
revascularization. Myocardial I/R injury is increasing in cats and dogs,
kept as pets. The occurrence of MIRI is complicated, and various pathways
are possible. Therefore, it is urgent to further explore the mechanism of
disease occurrence and development and find key regulatory factors to
achieve the goal for reducing MIRI. In this study, MIRI model was
established in SD rats through coronary artery ligation and randomized the
rats into the model group (MIRI), the trimetazidine group (TMZ), the
trimetazidine combined with diazepam treatment group (TMZ+DZ), and the
trimetazidine combined with 5-hydroxytryptamine treatment group
(TMZ+5-HD). Experimental results indicated that TMZ+DZ significantly
reduced myocardial cell apoptosis and inflammation levels in MIRI rats,
lowered Creatine Kinase (CK), Creatine Kinase MB Isoenzyme (CK-MB),
Lactate Dehydrogenase (LDH), and ROS levels, and decreased myocardial
infarct size and mass. While TMZ and TMZ+5-HD also improved these
indicators, the therapeutic effect of TMZ+DZ was notably superior to the
other two treatment groups. The results suggest that the combination
therapy of trimetazidine and diazepam ameliorated myocardial damage in
MIRI rats, providing experimental evidence for the treatment of MIRI with
the combination therapy of trimetazidine and diazepam. Copyright
© 2024 University of Agriculture. All rights reserved.

<62>
Accession Number
2031993983
Title
Who Lives Longer, the Valve or the Patient? The Dilemma of TAVI Durability
and How to Optimize Patient Outcomes.
Source
Journal of Clinical Medicine. 13(20) (no pagination), 2024. Article
Number: 6123. Date of Publication: October 2024.
Author
Cesario V.; Oliva O.; De Biase C.; Beneduce A.; Boiago M.; Dumonteil N.;
Tchetche D.
Institution
(Cesario, Oliva, De Biase, Beneduce, Boiago, Dumonteil, Tchetche) Groupe
Cardiovasculaire Interventionnel, Clinique Pasteur, 45 Avenue de Lombez,
CEDEX 3, Toulouse 31076, France
(Cesario) Cardiology Unit, Sant'Andrea Hospital, "Sapienza" University,
Via di Grottarossa, 1035/1039, Rome 00189, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Over the past few years, transcatheter aortic valve implantation (TAVI)
imposed itself as the first-choice therapy for symptomatic aortic stenosis
(AS) in elderly patients at surgical risk. There have been continuous
technological advancements in the latest iterations of TAVI devices and
implantation techniques, which have bolstered their adoption. Moreover,
the favorable outcomes coming out from clinical trials represent an
indisputable point of strength for TAVI. As indications for transcatheter
therapies now include a low surgical risk and younger individuals, new
challenges are emerging. In this context, the matter of prosthesis
durability is noteworthy. Initial evidence is beginning to emerge from the
studies in the field, but they are still limited and compromised by
multiple biases. Additionally, the physiopathological mechanisms behind
the valve's deterioration are nowadays somewhat clearer and classified.
So, who outlasts who-the valve or the patient? This review aims to explore
the available evidence surrounding this intriguing question, examining the
various factors affecting prosthesis durability and discussing its
potential implications for clinical management and current interventional
practice. Copyright © 2024 by the authors.

<63>
Accession Number
2031993828
Title
Evaluation of Red Blood Cell Biochemical Markers and Coagulation Profiles
Following Cell Salvage in Cardiac Surgery: A Systematic Review and
Meta-Analysis.
Source
Journal of Clinical Medicine. 13(20) (no pagination), 2024. Article
Number: 6073. Date of Publication: October 2024.
Author
Caceres-Matos R.; Luque-Oliveros M.; Pabon-Carrasco M.
Institution
(Caceres-Matos, Pabon-Carrasco) Research Group PAIDI-CTS-1050, "Complex
Care, Chronicity and Health Outcomes", Faculty of Nursing, Physiotherapy
and Podiatry, University of Seville, Seville 41009, Spain
(Luque-Oliveros) Cardiovascular and Thoracic Surgery Operating Theatre
Unit, Faculty of Nursing, Physiotherapy and Podiatry, Virgen Macarena
University Hospital, University of Seville, Seville 41009, Spain
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Individuals undergoing cardiac surgery face an increased risk
of bleeding, as well as alterations in biochemical and coagulation
patterns. Therefore, assessing the effectiveness of systems such as Cell
Salvage is necessary to prevent potential surgical complications.
 Objective(s): To evaluate the efficacy of Cell Salvage in relation to
the biochemical parameters of the red blood series and coagulation, as
well as the risk of hemorrhage. Method(s): A systematic review,
accompanied by a meta-analysis, was executed via an extensive literature
exploration encompassing Medline, CINAHL, Scopus, Web of Science, and the
Cochrane Library. The inclusion criteria comprised studies in English or
Spanish, without year restrictions, conducted in adults and with a
randomized controlled trial design. Result(s): Twenty-six studies
were included in the systematic review, involving a total of 2850 patients
(experimental group = 1415; control group = 1435). Cell Salvage did not
demonstrate superior outcomes compared to allogeneic transfusions in the
management of post-surgical hemorrhage, as well as in total blood loss,
platelet count, fresh frozen plasma, and fibrinogen. However, Cell Salvage
showed a greater effectiveness for hemoglobin (moderate evidence),
hematocrit (low evidence), post intervention D-dimer (low evidence), and
some coagulation-related parameters (low evidence) compared to allogeneic
transfusions. Finally, better results were found in the control group for
INR parameters. Conclusion(s): The use of the Cell Salvage system
holds high potential to improve the postoperative levels of biochemical
and coagulation parameters. However, the results do not provide definitive
evidence regarding its effectiveness for hemorrhage control, platelet
count, fresh frozen plasma, and fibrinogen. Therefore, it is recommended
to increase the number of studies to assess the impact of the Cell Salvage
system on improvements in the red blood cell count and patient coagulation
patterns. In addition, protocols should be homogenized, and variables such
as the sex of the participants should be taken into account. Copyright
© 2024 by the authors.

<64>
Accession Number
2031981364
Title
Bicuspid Aortic Valve in Children and Young Adults for Cardiologists and
Cardiac Surgeons: State-of-the-Art of Literature Review.
Source
Journal of Cardiovascular Development and Disease. 11(10) (no pagination),
2024. Article Number: 317. Date of Publication: October 2024.
Author
Nappi F.; Avtaar Singh S.S.; de Siena P.M.
Institution
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord,
Saint-Denis 93200, France
(Avtaar Singh) Department of Cardiothoracic Surgery, Royal Infirmary of
Edinburgh, Edinburgh EH16 4SA, United Kingdom
(de Siena) Department of Cardiothoracic Surgery, Royal Brompton and
Harefield Hospitals, Sydney St., London SW3 6NP, United Kingdom
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Bicuspid aortic valve disease is the most prevalent congenital heart
disease, affecting up to 2% of the general population. The presentation of
symptoms may vary based on the patient's anatomy of fusion, with
transthoracic echocardiography being the primary diagnostic tool. Bicuspid
aortic valves may also appear with concomitant aortopathy, featuring
fundamental structural changes which can lead to valve dysfunction and/or
aortic dilatation over time. This article seeks to give a comprehensive
overview of the presentation, treatment possibilities and long-term
effects of this condition. The databases MEDLINE, Embase, and the Cochrane
Library were searched using the terms "endocarditis" or "bicuspid aortic
valve" in combination with "epidemiology", "pathogenesis",
"manifestations", "imaging", "treatment", or "surgery" to retrieve
relevant articles. We have identified two types of bicuspid aortic valve
disease: aortic stenosis and aortic regurgitation. Valve replacement or
repair is often necessary. Patients need to be informed about the benefits
and drawbacks of different valve substitutes, particularly with regard to
life-long anticoagulation and female patients of childbearing age.
Depending on the expertise of the surgeon and institution, the Ross
procedure may be a viable alternative. Management of these patients should
take into account the likelihood of somatic growth, risk of
re-intervention, and anticoagulation risks that are specific to the
patient, alongside the expertise of the surgeon or centre. Further
research is required on the secondary prevention of patients with bicuspid
aortic valve (BAV), such as lifestyle advice and antibiotics to prevent
infections, as the guidelines are unclear and lack strong
evidence. Copyright © 2024 by the authors.

<65>
Accession Number
2031981357
Title
The Impact of Frailty and Surgical Risk on Health-Related Quality of Life
After TAVI.
Source
Journal of Cardiovascular Development and Disease. 11(10) (no pagination),
2024. Article Number: 333. Date of Publication: October 2024.
Author
van der Velden K.E.H.M.; Spaetgens B.P.A.; Buhre W.F.F.A.; Maesen B.; de
Korte-de Boer D.J.D.; van Kuijk S.M.J.; van 't Hof A.W.J.; Schreiber J.U.
Institution
(van der Velden, de Korte-de Boer, Schreiber) Department of Anesthesiology
and Pain Medicine, Maastricht University Medical Center+ (MUMC+),
Maastricht 6229 HX, Netherlands
(van der Velden, van 't Hof) Cardiovascular Research Institute Maastricht
(CARIM), Maastricht University, Maastricht 6200 MD, Netherlands
(Spaetgens) Department of Internal Medicine, Division of General Internal
Medicine, Section Geriatric Medicine, Maastricht University Medical
Center+ (MUMC+), Maastricht 6229 HX, Netherlands
(Buhre) Department of Anesthesiology, Division of Vital Functions,
University Medical Center Utrecht (UMCU), Utrecht 3584 CX, Netherlands
(Maesen) Department of Cardiothoracic Surgery, Maastricht University
Medical Center+ (MUMC+), Maastricht 6229 HX, Netherlands
(van Kuijk) Department of Clinical Epidemiology and Medical Technology
Assessment, Maastricht University Medical Center+ (MUMC+), Maastricht 6229
HX, Netherlands
(van 't Hof) Department of Cardiology, Division of Interventional
Cardiology, Maastricht University Medical Center+ (MUMC+), Maastricht 6229
HX, Netherlands
(van 't Hof) Department of Cardiology, Division of Interventional
Cardiology, Zuyderland Medical Center, Heerlen 6419 PC, Netherlands
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Symptomatic aortic stenosis and frailty reduce health-related quality of
life (HrQoL). Transcatheter aortic valve implantation (TAVI) in patients
at high to extreme risk has been proven to have a beneficial effect on
HrQoL. Currently, TAVI is also considered in patients at intermediate
risk. Our meta-analysis investigates whether benefits to HrQoL after TAVI
is more pronounced in frail patients and patients at high to extreme vs.
intermediate surgical risk. A systematic search of the literature was
performed in November 2021 and updated in November 2023 in PUBMED, EMBASE,
and the Cochrane Controlled Trials Register. Statistical analysis was
performed according to the inverse variance method and the random effects
model. A total of 951 studies were assessed, of which 19 studies were
included. Meta-analysis showed a mean increase in the Kansas City
Cardiomyopathy Questionnaire (KCCQ) score of 29.6 points (6.0, 33.1) in
high to extreme risk patients versus 21.0 (20.9, 21.1) in intermediate
risk patients (p < 0.00001) and 24.6 points (21.5, 27.8) in frail patients
versus 26.8 (20.2, 33.4) in the general TAVI population (p = 0.55).
However, qualitative analyses of non-randomized studies showed the
opposite results. In conclusion, TAVI improves HrQoL more in high to
extreme than intermediate risk patients. Frailty's impact on HrQoL
post-TAVI is inconclusive due to varying outcomes in RCTs vs.
non-RCTs. Copyright © 2024 by the authors.

<66>
Accession Number
2035284967
Title
Systematic Review of Case Manager Nurse in Heart Transplant and Heart
Failure Consultation.
Source
Transplantation Proceedings. (no pagination), 2024. Date of Publication:
2024.
Author
Villarreal-Granda P.; Recio-Platero A.; Martin-Bayo Y.; Durantez-Fernandez
C.; Cardaba-Garcia R.M.; Perez-Perez L.; Madrigal M.; Munoz-del Caz A.;
Bahillo Ruiz E.; Jimenez-Navascues L.; Prieto Zambrano P.;
Velasco-Gonzalez V.
Institution
(Villarreal-Granda, Martin-Bayo) Nursing Department (Graduate in
Nursing-Honorary collaborator), Faculty of Nursing, University of
Valladolid, Valladolid, Spain
(Recio-Platero) Unidad de Insuficiencia Cardiaca y Terapias Avanzadas,
Hospital Clinico Universitario de Valladolid, Valladolid, Spain
(Durantez-Fernandez, Cardaba-Garcia, Perez-Perez, Madrigal, Munoz-del Caz,
Bahillo Ruiz, Jimenez-Navascues, Velasco-Gonzalez) Nursing Department,
Faculty of Nursing, University of Valladolid, Valladolid, Spain
(Durantez-Fernandez, Cardaba-Garcia, Perez-Perez, Madrigal, Munoz-del Caz,
Velasco-Gonzalez) Nursing Care Research (GICE), Faculty of Nursing,
University of Valladolid, Valladolid, Spain
(Perez-Perez) Primary Care Management Valladolid West (SACYL), Valladolid,
Spain
(Munoz-del Caz) Hospital Clinico Universitario de Valladolid (HCUV),
Valladolid, Spain
(Bahillo Ruiz, Jimenez-Navascues) Nursing Department, Faculty of Health
Sciences, University of Valladolid, Soria, Spain
(Prieto Zambrano) Primary Care Management Valladolid East (SACYL),
Valladolid, Spain
Publisher
Elsevier Inc.
Abstract
Objective: To analyze the functions and activities of the case manager
nurse in the specialized practice of transplantation and heart failure.
 Method(s): This systematic review is reported according to the PRISMA
guidelines. Selected articles were subjected to a detailed critical
reading and the evidence levels and recommendation grades of the Joanna
Briggs Institute were verified. The field of documentation search was
limited to the last 5 years. Result(s): Health education provided by
nursing is key in patients with heart failure and heart transplants. It
must be evidence-based and focuses primarily on promoting self-care and
adherence to therapy, although it includes other aspects such as
recognition of signs and symptoms by the patient. Both activities are
essential to prevent decompensations of heart failure, thus reducing
hospital readmissions and mortality rates. Conclusion(s): Nursing has
an essential role in multidisciplinary programs for the care of heart
failure and heart transplant patients. Case manager nurse role stands out
for being cost effective, as well as for improving treatment compliance
and reducing hospital stay and mortality rates. Nursing functions in this
practice ensure continuity and coordination of care between the different
health levels, increasing the patients' quality of life. Copyright
© 2024 Elsevier Inc.

<67>
Accession Number
2035284661
Title
Discontinuation or continuation of renin-angiotensin system inhibitors
prior to non-cardiac surgery: Results of the STOP-or-NOT trial.
Source
Praticien en Anesthesie Reanimation. (no pagination), 2024. Date of
Publication: 2024.
Author
Legrand M.; Gayat E.
Institution
(Legrand) Department of Anesthesia and Perioperative Care, Division of
Critical Care Medicine, University of California, San Francisco (UCSF),
San Francisco, CA, United States
(Legrand, Gayat) INI-CRCT Network, Nancy, France
(Gayat) DMU PARABOL, service d'anesthesie-reanimation-CTB, hopital
Lariboisiere, universite Paris-Cite, AP-HP, Paris, France
(Gayat) Inserm, UMR-942 << MASCOT >>, Paris, France
Publisher
Elsevier Masson s.r.l.
Abstract
Many patients undergoing major surgery have a medical history of
hypertension, diabetes and/or heart failure. Often, these conditions
involve chronic use of an inhibitor of the renin-angiotensin system
(iSRA), including angiotensin-converting enzyme (ACE) inhibitors or
angiotensin receptor blockers (ARBs). Observational studies have suggested
that continuation of ARBs prior to major non-cardiac surgery may increase
the risk of intraoperative hypotension, which could lead to postoperative
complications such as acute renal failure, myocardial infarction (MI) or
cerebrovascular accident (CVA). However, firm recommendations on the
management of RASi prior to surgery are lacking due to the absence of
solid evidence, mainly limited to data from observational studies. The
STOP-OR-NOT trial was a large-scale multicenter randomized trial designed
to answer the question of whether chronic iSRA should be continued or
stopped before major non-cardiac surgery. The trial results showed that
there was no difference in the primary endpoint of all-cause mortality and
major postoperative complications within 28 days of surgery between the
treatment continuation and discontinuation groups, with a rate of death
and major postoperative complications of 22% in both groups. Patients in
the continuation group had a higher incidence of intraoperative
hypotension (54% vs. 41% in the discontinuation group). However, the
duration of mean arterial pressure below 60 mmHg was only slightly higher
in the treatment continuation group, with a mean absolute difference of
3.7 minutes (95% CI: 1.4-6.0). The results of the STOP-or-NOT trial
suggest that continuing iSRA is a safe option for patients undergoing
major non-cardiac surgery, provided that particular attention is paid to
the rapid correction of the risk of peroperative arterial
hypotension. Copyright © 2024 Elsevier Masson SAS

<68>
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)

<69>
Accession Number
2035023290
Title
A Randomized Controlled Trial Comparing Effectiveness of Different
Fibrinogen Preparations in Restoring Clot Firmness.
Source
Anesthesia and Analgesia. (no pagination), 2024. Date of Publication:
2024.
Author
Baryshnikova E.; Aloisio T.; Di Dedda U.; Anguissola M.; Barbaria A.;
Caravella G.; Ranucci M.
Institution
(Baryshnikova, Aloisio, Di Dedda, Anguissola, Barbaria, Ranucci) The
Departments of Cardiovascular Anesthesia and Intensive Care, IRCCS
Policlinico San Donato, Milan, San Donato Milanese, Italy
(Caravella) The Departments of Pharmacy Service, IRCCS Policlinico San
Donato, Milan, San Donato Milanese, Italy
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Different preparations of fibrinogen concentrate are currently
available. Two in vitro studies demonstrated the superiority of FibCLOT
(LFB) in increasing clot firmness with respect to RiaSTAP (CSL Behring).
The present trial involved a clinical model to test the hypothesis of
superiority, with the increase in clot firmness as the primary end point.
 METHOD(S): Forty cardiac surgery patients were randomly allocated to
receive a dose of 30 mg/kg FibCLOT or RiaSTAP after protamine
administration in the presence of microvascular bleeding and a FIBTEM
maximum clot firmness (MCF) <10 mm. Viscoelastic parameters were measured
before and after fibrinogen supplementation: FIBTEM MCF, EXTEM MCF, and
EXTEM clotting time (CT). RESULT(S): The mean increase in FIBTEM MCF
was 4 +/- 1.2 mm (mean and standard deviation) in the FibCLOT group and 4
+/- 1.6 mm in the RiaSTAP group (P = 1.000); the mean decrease in CT was
11. 2 +/- 12.2 (mean and standard deviation) seconds in the FibCLOT group
and 14. 8 +/- 13 seconds in the RiaSTAP group (P = .372). In both groups,
fibrinogen supplementation induced a significant (P = .001) increase in
the FIBTEM MCF and EXTEM CT. The proportions of patients who did not
experience an increase of 4 mm in the RiaSTAP group and the FibCLOT group
were not statistically significantly higher (35% vs 20%, respectively,
relative risk 2.15, 95% confidence interval 0.52-9.00, P = .288).
 CONCLUSION(S): In contrast to previous in vitro studies, we found
that the effect of FibCLOT on MCF and CT was not significantly greater
than that of RiaSTAP in cardiac surgery patients. Further studies in other
clinical settings are warranted. Copyright © 2024 International
Anesthesia Research Society.

<70>
Accession Number
645609051
Title
An aspirin-free strategy for percutaneous coronary intervention in
patients with diabetes: a pre-specified subgroup analysis of the
STOPDAPT-3 trial.
Source
European heart journal. Cardiovascular pharmacotherapy. (no pagination),
2024. Date of Publication: 23 Oct 2024.
Author
Yamamoto K.; Natsuaki M.; Watanabe H.; Morimoto T.; Obayashi Y.; Nishikawa
R.; Ando K.; Suwa S.; Isawa T.; Takenaka H.; Ishikawa T.; Ikari Y.; Kurita
T.; Kaitani K.; Sugimoto A.; Ogata N.; Ikuta A.; Hashimoto K.; Ishibashi
Y.; Masuda K.; Miyabe T.; Ono K.; Kimura T.
Institution
(Yamamoto, Ando) Department of Cardiology, Kokura Memorial Hospital,
Kitakyushu, Japan
(Natsuaki) Department of Cardiovascular Medicine, Saga University, Saga,
Japan
(Watanabe, Takenaka, Kimura) Department of Cardiology, Hirakata Kohsai
Hospital, Hirakata, Japan
(Morimoto) Department of Data Science, Hyogo Medical University, Japan
(Obayashi, Nishikawa, Ono) Department of Cardiovascular Medicine, Kyoto
University Graduate School of Medicine, Kyoto, Japan
(Suwa) Department of Cardiology, Juntendo University Shizuoka Hospital,
Izunokuni, Japan
(Isawa) Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
(Ishikawa) Department of Cardiology, Dokkyo Medical University Saitama
Medical Center, Koshigaya, Japan
(Ikari) Department of Cardiology, Tokai University Hospital, Isehara,
Japan
(Kurita) Department of Cardiology, Mie University Hospital, Tsu, Japan
(Kaitani) Department of Cardiology, Japanese Red Cross Otsu Hospital,
Otsu, Japan
(Sugimoto) Department of Cardiology, Sagamihara Kyodo Hospital,
Sagamihara, Japan
(Ogata) Department of Cardiology, Ageo Central General Hospital, Ageo,
Japan
(Ikuta) Department of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
(Hashimoto) Department of Cardiovascular Medicine, Minamino Cardiovascular
Hospital, Hachioji, Japan
(Ishibashi) Department of Cardiology, St. Marianna University Hospital,
Kawasaki, Japan
(Masuda) Department of Cardiovascular Medicine, Uji-Tokushukai Medical
Center, Uji, Japan
(Miyabe) Department of Cardiology, Tokyo Metropolitan Tama Medical Center,
Japan
Abstract
AIMS: Safety of aspirin-free strategy immediately after percutaneous
coronary intervention (PCI) for cardiovascular events in patients with
diabetes was unknown. METHODS AND RESULTS: We conducted the prespecified
subgroup analysis on diabetes in the STOPDAPT-3 trial, which randomly
compared prasugrel (3.75 mg/day) monotherapy (2984 patients) to dual
antiplatelet therapy (DAPT) with prasugrel and aspirin (2982 patients) in
patients with acute coronary syndrome or high bleeding risk. The
co-primary endpoints were major bleeding events (Bleeding Academic
Research Consortium 3 or 5) and cardiovascular events (a composite of
cardiovascular death, myocardial infarction, definite stent thrombosis, or
stroke) at 1 month. Of 5966 study patients, there were 2715 patients
(45.5%) with diabetes. Patients with diabetes more often had chronic
coronary syndrome, heart failure or cardiogenic shock, and comorbidities
than those without. Patients with diabetes compared to those without had
higher incidences of major bleeding and cardiovascular events. Regardless
of diabetes, the effect of no-aspirin relative to DAPT was not different
for the co-primary bleeding (diabetes: 5.05% versus 5.47%; HR, 0.92;
95%CI, 0.66-1.28 and non-diabetes: 3.99% versus 4.07%; HR, 0.98; 95%CI,
0.69-1.38; P for interaction = 0.81) and cardiovascular (diabetes: 5.54%
versus 5.15%; HR, 1.08; 95%CI, 0.78-1.49 and non-diabetes: 2.95% versus
2.47%; HR, 1.20; 95%CI, 0.79-1.82; P for interaction = 0.70) endpoints.
The incidences of subacute definite or probable stent thrombosis and any
coronary revascularization were higher in the no-aspirin group than in the
DAPT group regardless of diabetes. CONCLUSION(S): The effects of an
aspirin-free prasugrel monotherapy (3.75 mg/day) relative to DAPT for
major bleeding and cardiovascular events were not different regardless of
diabetes. Clinical trial registration: ShorT and OPtimal duration of Dual
AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3
[STOPDAPT-3]; NCT04609111. Copyright © The Author(s) 2024.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<71>
Accession Number
645607303
Title
Association between the High-density Lipoprotein Cholesterol Efflux
Capacity and the Long-term Prognosis in Patients with Coronary Artery
Disease: A Meta-analysis.
Source
Journal of atherosclerosis and thrombosis. (no pagination), 2024. Date of
Publication: 24 Oct 2024.
Author
Hisauchi I.; Ishikawa T.; Yamada K.; Ukaji T.; Shimura M.; Tamura Y.;
Kondo Y.; Takeyama T.; Mori K.; Arai M.; Hori Y.; Nakahara S.; Itabashi
Y.; Kobayashi S.; Taguchi I.
Institution
(Hisauchi, Ishikawa, Yamada, Ukaji, Shimura, Tamura, Kondo, Takeyama,
Mori, Arai, Hori, Nakahara, Itabashi, Kobayashi, Taguchi) Department of
Cardiology, Dokkyo Medical University Saitama Medical Center
Abstract
AIM: We aimed to determine whether baseline high-density lipoprotein (HDL)
cholesterol efflux capacity (CEC) at the time of coronary angiography
(CAG) could serve as a prognostic marker for future major adverse
cardiovascular events (MACE) in patients with coronary artery disease
(CAD) through a systematic review and meta-analysis. METHOD(S): The
MEDLINE, Cochrane, and Embase databases were used for data collection. As
of April 2024, 2,871 studies have been identified. Clinical studies
comparing MACEs over an observational interval exceeding 12 months in
patients with angiographically defined CAD with estimated hazard ratios
(HRs) of MACEs in the higher or top-quartile HDL-CEC (H-HDL-CEC) group
compared with the lower or bottom-quartile HDL-CEC (L-HDL-CEC) group,
after adjusting for six confounding variables, including HDL-C, were
included. HRs of 1) overall cardiovascular outcomes, composite of
cardiovascular mortality, myocardial infarction, any coronary
revascularization, and all-cause mortality (Model-1), and 2)
cardiovascular outcomes excluding all-cause mortality from Model-1
(Model-2), compared between the L-HDL-CEC and H-HDL-CEC groups, were
estimated using a random-effects model, respectively. RESULT(S): In
five studies, 5,725 patients with CAD with a mean observational interval
of 4.9 years were included. The H-HDL-CEC group had significantly lower
risks for both estimates (Model-1: HR: 0.34, 95% confidence interval [CI]:
0.18-0.63 [p=0.0005], and I2=59.8% [p=0.04]; Model-2: HR: 0.28, 95% CI:
0.13-0.60 [p=0.0013], and I2=64% [p=0.04]). CONCLUSION(S): This is
the first systematic review and meta-analysis to demonstrate a significant
inverse relationship between the baseline HDL-CECs on CAG and long-term
MACEs in CAD patients.

<72>
Accession Number
645607202
Title
Management of heart disease in renal transplant recipients: a national
Delphi survey-based SET/SEC/SEN consensus document.
Source
Revista espanola de cardiologia (English ed.). (no pagination), 2024.
Date of Publication: 21 Oct 2024.
Author
Garcia-Cosio M.D.; Cruzado J.M.; Farrero M.; Peiro M.T.B.; Crespo M.;
Jimenez J.F.D.; Molina B.D.; Rivera C.F.; Bravo I.P.G.; Jimenez V.L.;
Melilli E.; Perez S.M.; Tamajon M.L.P.; Sousa D.R.; Calabia E.R.; Marrero
D.H.
Institution
(Garcia-Cosio) Servicio de Cardiologia, Hospital Universitario 12 de
Octubre, Instituto de Investigacion Sanitaria Hospital 12 de Octubre
(imas12), Madrid, Spain; Centro de Investigacion Biomedica en Red de
Enfermedades Cardiovasculares (CIBERCV), Spain. Electronic address:
lolagcosio@gmail.com
(Cruzado) Centro de Investigacion Biomedica en Red de Enfermedades
Cardiovasculares (CIBERCV), Spain
(Farrero) Servicio de Nefrologia, Hospital Universitario de Bellvitge,
Instituto de Investigacion Biomedica de Bellvitge (IDIBELL), Universidad
de Barcelona, Barcelona, Spain
(Peiro) Servicio de Cardiologia, Hospital Clinic, Barcelona, Spain
(Crespo) Servicio de Cardiologia, Hospital Universitario Miguel Servet,
Zaragoza, Spain
(Jimenez) Servicio de Nefrologia, Hospital del Mar, Instituto de
Investigaciones Medicas Hospital del Mar, National Network for Kidney
Research RICORS2040 RD21/0005/0022, Barcelona, Spain
(Molina) Centro de Investigacion Biomedica en Red de Enfermedades
Cardiovasculares (CIBERCV), Spain; Servicio de Cardiologia, Hospital
Universitario 12 de Octubre, Instituto de Investigacion Sanitaria Hospital
12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain
(Rivera) Servicio de Cardiologia, Hospital Universitario Central de
Asturias, Oviedo, Asturias, Spain
(Bravo) Servicio de Nefrologia, Complexo Hospitalario Universitario A
Coruna, A Coruna, Spain
(Jimenez) Servicio de Cardiologia, Hospital Clinico Universitario Virgen
de la Arrixaca, El Palmar, Murcia, Spain
(Melilli) Servicio de Nefrologia, Hospital Regional Universitario de
Malaga, National Network for Kidney Research RICORS2040 RD21/0005/0012,
Instituto Biomedico de Investigacion de Malaga (IBIMA), Universidad de
Malaga, Malaga, Spain
(Perez) Servicio de Nefrologia, Hospital Universitario de Bellvitge,
Barcelona, Spain
(Tamajon) Centro de Investigacion Biomedica en Red de Enfermedades
Cardiovasculares (CIBERCV), Spain; Servicio de Cardiologia, Hospital de la
Santa Creu i Sant Pau, Barcelona, Spain
(Sousa) Servicio de Nefrologia, Complejo Hospitalario Universitario de
Canarias, Santa Cruz de Tenerife, Spain
(Calabia) Servicio de Cardiologia, Hospital Universitario Virgen del
Rocio, Seville, Spain
(Marrero) Servicio de Nefrologia, Hospital Universitario Marques de
Valdecilla, Instituto de Investigacion Valdecilla (IDIVAL), Santander,
Cantabria, Spain. Electronic address: domingohernandez@gmail.com
Abstract
Renal transplantation improves the survival and quality of life of
patients with end-stage renal disease. Cardiovascular disease is the
leading cause of morbidity and mortality in renal transplant recipients.
The bidirectional relationship between renal and heart disease creates a
unique clinical scenario that demands a comprehensive and personalized
approach. This expert consensus, drafted by the Spanish Society of
Transplantation, the Spanish Society of Cardiology, and the Spanish
Society of Nephrology, aims to assess current practices and propose
strategies for the management of heart disease in renal transplant
recipients. A panel of Spanish nephrologists and cardiologists with
expertise in renal and heart transplantation reviewed the scientific
evidence concerning the current management of heart disease in renal
transplant recipients. Subsequently, consensus statements were created
through a 2-round Delphi methodology, resulting in 30 statements covering
key topics such as the identification of renal transplant candidates, the
management of heart disease in renal transplant recipients, and
eligibility for combined heart-kidney transplantation in patients with
both end-stage renal disease and cardiac disease. These consensus
statements provide expert guidance for the management of heart disease in
renal transplant recipients, an area where published clinical evidence
remains limited. Copyright © 2024. Published by Elsevier Espana,
S.L.U.

<73>
Accession Number
634167015
Title
A prospective randomized trial comparing biatrial and isolated left atrial
ablation in patients with long-standing persistent atrial fibrillation
undergoing CABG.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. Virtual. 41(SUPPL 2) (pp 445), 2020. Date of
Publication: November 2020.
Author
Kalybekova A.; Chernyavskyi A.; Lukinov V.
Institution
(Kalybekova, Chernyavskyi, Lukinov) Meshalkin National Medical Research
Center, Novosibirsk, Russian Federation
Publisher
Oxford University Press
Abstract
Purpose: To compare the efficacy and safety of left atrial ablation (LAA)
with those of biatrial ablation (BA) in patients with long-standing
persistent atrial fibrillation (AF) in common with CABG.
 Background(s): AF is the most common heart rhythm disorder, while CAD
is the most common cardiovascular disease. Chronic coronary syndrome and
atrial fibrillation coexist in many patients. Long-standing persistent
atrial fibrillation (AF) is frequent pathology in patients undergoing
CABG. Surgical ablation in such patients is currently an effective
treatment of AF. Pulmonary vein isolation (PVI) may reduce AF recurrences
in 70% of patients with paroxysmal form of AF. However, the efficacy of
ablation in patients with long-standing persistent AF is rather low.
Clinical studies have shown that the right atrium can also be involved in
the AF initiation and maintenance. Areas localized in both atrias are
characterized by rapid electrical activity, which is critical in the AF
persistence. Therefore, we have hypothesized that in long-standing
persistent AF BA could be more effective than isolated LAA.
 Method(s): Between 2016 and 2019, 116 patients with long-standing
persistent AF and CAD who underwent open-heart surgery were included in
this single blind prospective randomized study and divided into two
groups: 58 patients in group 1 underwent isolated LAA + CABG, and group II
(58 patients) - BA + CABG. All the patients had Reveal LINQ ICM System
(Medtronic, USA) implanted during the index procedure. The mean age was 65
[61; 67.75] years versus 62 [58; 66] years (p=0.050) and 83% versus 84%
(p>0.999) were men in BA and LAA groups, respectively. The follow-up time
was 22+/-3 months for two groups. The primary endpoint was freedom from AF
during 24-month follow-up based on 24-hour Holter monitoring ECG
registration and Reveal device data. Result(s): This study has
demonstrated that in CAD patients with longstanding persistent AF, PVI in
combination with multiple linear lesions in the right atrium while GABG
produce a significantly higher success rate than PVI alone. After 24
months, AF recurred in 38% of patients in the BA group and in 64% - in the
LAA group (p=0.010). Univariate logistic regression analysis showed
indicators as long axis of left atria in mm (OR 3.45, 95%; CI 1.77 to
7.64, p=0.001) in LAA group and (OR 2.02, 95%; CI 1.03 to 4.26, p=0.049)
in-group BA increases the risk of AF. Chronic kidney disease (OR 2.95, 95%
CI 1.05 to 9.22, p=0,048), and mitral regurgitation (OR 1.18, 95% CI 1.01
to 1.41, p=0.047) have been found the independent predictors of AF
recurrence in the LAA group. Arrhythmia on the third day after procedure
increases the risk of AF (OR 3.79, 95% CI 1.45 to 10. 58, p=0.008) in the
LAA group in a long-term follow-up. Conclusion(s): The study has
demonstrated that BA is more effective for treatment of long-standing
persistent AF in CAD patients undergoing CABG.

<74>
Accession Number
634166074
Title
Computed tomography derived predictors of permanent pacemaker implantation
after transcatheter aortic valve implantation: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2020. Virtual. 41(SUPPL 2) (pp 2582), 2020. Date of
Publication: November 2020.
Author
Maier O.; Zeus T.; Jung C.; Westenfeld R.; Polzin A.; Kelm M.; Veulemans
V.
Institution
(Maier, Zeus, Jung, Westenfeld, Polzin, Kelm, Veulemans) University
Hospital Duesseldorf, Duesseldorf, Germany
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a
wellestablished alternative to surgery for the treatment of patients with
severe symptomatic aortic stenosis at high and intermediate surgical risk.
Unfortunately, the occurrence of electrical conduction disturbances
remains one of the most frequent complications of the procedure. While the
impact of electrocardiographic and procedural predictors on PPI is well
examined, there is still a lack of knowledge regarding anatomical
predictors screened by multislice computed tomography (MSCT).
 Purpose(s): We performed a meta-analysis to summarize available
studies that reported the incidence of PPI after TAVI with new-generation
devices and provided raw data for preprocedural MSCT. Method(s): The
authors conducted a literature search in PubMed database until December
31, 2019 to identify studies that investigated preprocedural MSCT data and
rate of PPI following TAVI with new-generation devices. Twelve
observational studies (n=3133) met inclusion criteria for final analysis.
 Result(s): PPI was performed in 509 patients (16.2%) after TAVI,
mostly due to high degree atrioventricular (AV) block (80.8%). The rate of
PPI varied widely from 7.9% to 35.8% in individual studies. Regarding
secondary endpoints' analysis of relative risk (RR) and mean difference
(MD) electrocardiographic PPI-predictors after TAVI appeared to be
pre-existing atrial fibrillation (AF) (RR 1.21; 95% CI 1.05-1.40;
p=0.008), right bundle branch block (RBBB) (RR 4.22; 95% CI 3.30-5.41;
p<0.0001) and AV block grade I (RR 1.63; 95% CI 1.16-2.29; p=0.005).
Patients requiring PPI had larger annulus perimeter (MD 1.66 mm; 95% CI
0.67-2.66 mm; p=0.001) and shorter membranous septum length (MD -0.86 mm;
95% CI -1.74-0.02 mm; p=0.05) assessed by preprocedural MSCT. Concerning
calcium load of device landing zone, pacemaker dependent patients showed
increased calcification of the non-coronary cusp (MD 39.76 mm3; 95% CI
18.60- 60.93 mm3; p=0.0002), the left-coronary cusp (LCC) (MD 47.60 mm3;
95% CI 19.40-75.81 mm3; p=0.0009) and the total left ventricular outflow
tract (LVOT) (MD 19.17 mm3; 95% CI 6.68-31.66 mm3; p=0.003). Lower
implantation depth (MD 0.83 mm from NCC; 95% CI 0.20-1.47 mm; p=0.01) and
oversizing by annulus diameter/area (MD 1.76%; 95% CI 0.68-2.84%; p=0.001)
were procedural predictors of PPI following TAVI. Conclusion(s): This
structured meta-analysis proved PPI rate in 16.2% of patients following
TAVI. Beside well-known electrocardiographic (AF, RBBB, AV block grade I)
and procedural predictors (implantation depth, oversizing) this
meta-analysis showed for the first time that MSCT derived anatomical
values (annulus perimeter, membranous septum length) and distribution of
device landing zone's calcification (NCC, LCC, LVOT) are associated with
increased risk of PPI following TAVI.

<75>
Accession Number
2034998726
Title
Minimally invasive approaches versus conventional sternotomy for aortic
valve replacement in patients with aortic valve disease: a systematic
review and meta-analysis of 17 269 patients.
Source
Annals of Medicine and Surgery. 86(7) (pp 4005-4014), 2024. Date of
Publication: 04 Jun 2024.
Author
Khalid S.; Hassan M.; Ali A.; Anwar F.; Siddiqui M.S.; Shrestha S.
Institution
(Khalid, Hassan, Ali, Anwar, Siddiqui) Department of Medicine, Dow
University of Health Sciences, Karachi, Pakistan
(Shrestha) Upendra Devkota Memorial National Institute of Neurological and
Allied Sciences Bansbari, Kathmandu, Nepal
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Aortic valve replacement (AVR) is a common procedure for
aortic valve pathologies, particularly in the elderly. While traditional
open AVR is established, minimally invasive techniques aim to reduce
morbidity and enhance treatment outcomes. The authors' meta-analysis
compares these approaches with conventional sternotomy, offering insights
into short and long-term mortality and postoperative results. This study
provides valuable evidence for informed decision-making between
conventional and minimally invasive approaches for AVR. Material(s)
and Method(s): Till August 2023, PubMed, Embase, and MEDLINE databases
were searched for randomized controlled trials (RCT) and propensity score
matched (PSM) studies comparing minimally invasive approaches
[mini-sternotomy (MS) and right mini-thoracotomy (RMT)] with full
sternotomy (FS) for AVR. Various outcomes were analyzed, including
mortality rates, bypass and clamp times, length of hospital stay, and
complications. Risk ratios (RR) and the weighted mean differences (WMD)
with corresponding 95% CIs were calculated using Review Manager.
 Result(s): Forty-eight studies were included having 17 269 patients
in total. When compared to FS, there was no statistically significant
difference in in-hospital mortality in MS (RR:0.80; 95% CI:0.50-1.27;
I2 = 1%; P = 0.42) and RMT (RR:0.70; 95% CI:0.36-1.35;
I2 = 0%; P = 0.29). FS was also linked with considerably longer
cardiopulmonary bypass duration than MS (MD:8.68; 95% CI:5.81-11.56;
I2 = 92%; P = 0.00001). The hospital length of stay was
determined to be shorter in MS (MD: - 0.58; 95% CI: - 1.08 to - 0.09;
I2 = 89%; P = 0.02) with no statistically significant
difference in RMT (MD: - 0.67; 95% CI: - 1.42 to 0.08; I2 =
84%; P = 0.08) when compared to FS. Conclusion(s): While mortality
rates were comparable in minimally invasive approaches and FS, analysis
shows that MS, due to fewer respiratory and renal insufficiencies, as well
as shorter hospital and ICU stay, may be a safer approach than both RMT
and FS. Copyright © 2024 The Author(s).

<76>
Accession Number
2034993376
Title
Comparison between novel zipper device and conventional methods for skin
closure: a systematic review and meta-analysis.
Source
Annals of Medicine and Surgery. 86(3) (pp 1631-1640), 2024. Date of
Publication: 05 Feb 2024.
Author
Shrestha O.; Basukala S.; Karki S.; Thapa N.; Bhugai N.; Bohara S.; Joshi
N.; Paudel S.
Institution
(Shrestha, Basukala, Karki, Thapa, Bhugai, Joshi, Paudel) Department of
Surgery, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
(Bohara) Department of Surgery, Nepal Mediciti, Lalitpur, Nepal
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The zipper device is a wound closure device that can be
directly applied over the intact skin on either side of the wound edges
and does not need anchoring into the skin or subcutaneous plane. The
noninvasive nature of the zipper device makes it less time-consuming and
less painful, but its effectiveness and related complications need to be
studied. Method(s): Prospective registration of the protocol followed
in this study was done. Electronic databases were searched for relevant
articles, and their screening was completed, followed by data extraction
and analysis. The odds ratio, mean difference, or standardised mean
difference were used as an effect measure per the nature of the variables.
Surgical site infection, wound dehiscence, skin closure time, scar score,
and patient satisfaction were compared in this study. Result(s): A
total of 10 studies were identified, out of which eight compared zippers
with sutures and two compared zippers with stapler devices. Compared to
the suture, the zipper device took 4.9 min less to close the incision, and
the scar scale outcome reported after one month was inferior, while other
results were not significant. Staples showed a lower patient satisfaction
level and no difference in complications. Conclusion(s): The zipper
device is a less technically demanding and less time-consuming method of
skin closure, with no significant difference in the complication rate
compared to conventional methods. The zipper device is an effective
measure to use in settings with less expertise or at health institutions
after assessing the cost at the local level. Copyright © 2024 The
Author(s).

<77>
Accession Number
2034993313
Title
Effect of family-centered care on the anxiety levels among family members
of patients undergoing cardiac surgery: A randomized controlled trial.
Source
Annals of Medicine and Surgery. 86(3) (pp 1370-1375), 2024. Date of
Publication: 22 Jan 2024.
Author
Lotfalipoor R.; Jafaraghaee F.; Kazemnejad Leyli E.; Ghorbani Vajargah P.;
Karkhah S.; Javadi-Pashaki N.
Institution
(Lotfalipoor) School of Nursing and Midwifery, Guilan University of
Medical Sciences, Rasht, Iran, Islamic Republic of
(Jafaraghaee, Ghorbani Vajargah, Karkhah, Javadi-Pashaki) Department of
Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan
University of Medical Sciences, Rasht, Iran, Islamic Republic of
(Kazemnejad Leyli) Department of Biostatistics, School of Health, Road
Trauma Research Center, Guilan University of Medical Sciences, Rasht,
Iran, Islamic Republic of
(Kazemnejad Leyli) Social Determinants of Health Research Center (SDHRC),
Guilan University of Medical Sciences, Rasht, Iran, Islamic Republic of
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The present study aims to determine the effect of
family-centered care on anxiety levels among family members of patients
undergoing cardiac surgery. Material(s) and Method(s): This study was
a randomized clinical trial study that was conducted on the families of
Iranian cardiac surgery patients. In the intervention group,
family-centered care was implemented, and the content of the intervention
included providing informational and emotional support to the family
member and the family member's participation in patient care according to
the set framework. Result(s): A total of 144 family members of
patients undergoing cardiac surgery were included in this study. Among the
144 family members, 71 were in the intervention group, and 73 were in the
control group. The changes in the state anxiety score before and after the
intervention were significant between the two groups, and the changes were
higher in the control group (P=0.043). Also, there was no significant
difference in the changes in trait anxiety before and after the
intervention between the two groups (P>0.05). Conclusion(s): In
general, the high prevalence of anxiety in patients' families has negative
functional consequences on both patients and their families. To reduce the
level of anxiety, special attention should be paid to knowing the
effective factors and appropriate coping methods. Nevertheless, it is
important to note that additional research is warranted to delve deeper
into this matter in future studies. Copyright © 2024 The
Author(s). Published by Wolters Kluwer Health, Inc.

<78>
Accession Number
2031408814
Title
Online Personal Training in Patients With Marfan Syndrome: A Randomized
Controlled Study of Its Impact on Quality of Life and Physical Capacity.
Source
Journal of the American Heart Association. 13(19) (no pagination), 2024.
Article Number: e033024. Date of Publication: 01 Oct 2024.
Author
Jouini S.; Milleron O.; Eliahou L.; Jondeau G.; Vitiello D.
Institution
(Jouini, Vitiello) Universite Paris Cite, URP 3625-Institut des Sciences
du Sport Sante de Paris (I3SP), Paris, France
(Milleron, Eliahou, Jondeau) Centre national de reference pour le syndrome
de Marfan et pathologies apparentes, Assistance Publique-Hopitaux de
Paris, Hopital Bichat, Paris, France
(Milleron, Eliahou, Jondeau) Service de Cardiologie, Centre National de
Reference Pour le Syndrome de Marfan et Apparentes, AP-HP, Hopital Bichat,
Paris, France
(Jondeau) Laboratory for Vascular Translational Science, Universite Paris
Cite, INSERM U1148, Hopital Bichat-Claude-Bernard, Paris, France
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Marfan syndrome (MFS) is a genetic disorder affecting the
vascular and musculoskeletal systems. Limited knowledge exists regarding
the exercise benefits for this population. This study aimed to explore the
impact of a structured exercise program on the quality of life (QoL) and
physical capabilities of patients with MFS. METHODS AND RESULTS: This was
a randomized, controlled, parallel-group trial. Patients with MFS were
randomized in a 1:1 ratio to either a training group or a control group.
The trial included a 3-month online supervised training program. Seventy
patients with MFS were compared with healthy subjects. They were
randomized into a training group (MFS-T) and a control group (MFS-C). The
training consisted of 2 supervised online sessions weekly for 3 months.
The primary outcome was QoL, assessed using the Medical Outcomes Study
Short-Form 36 questionnaire. Baseline QoL in all dimensions was lower in
patients with MFS. Their peak oxygen uptake was 25% lower, and muscle
elasticity was diminished compared with healthy subjects.
Postintervention, significant improvements were observed in the MFS-T
group relative to the MFS-C group: QoL (+20.2+/-14.3 versus +0.7+/-0.5),
peak oxygen uptake (+34% versus +14%), muscle elasticity index (11.5+/-8.2
versus +1.2+/-1.7), reduced blood pressures during isometric squats
(systolic -19+/-30 versus 0+/-6; diastolic -27+/-39 versus +2+/-15), and
reduced pulse wave velocity at rest (-1.20+/-1.89 versus -0.40+/-1.61) and
postexercise (-0.42+/-0.45 versus +0.08+/-0.48). The aortic diameter
remained stable in both groups (MFS-T-0.19+/-1.1 versus
MFS-C+0.11+/-0.78). After training, QoL remained lower in MFS-T than in
healthy subjects, but peak oxygen uptake, pulse wave velocity at rest, and
postexercise were similar to those of healthy subjects.
 CONCLUSION(S): The 3-month online training program significantly
enhanced QoL and cardiovascular/muscular metrics in patients with MFS
without affecting aortic root diameter, suggesting its potential as part
of a management strategy for MFS. Copyright © 2024 The Author(s).

<79>
Accession Number
2031408802
Title
Ramipril After Transcatheter Aortic Valve Implantation in Patients Without
Reduced Ejection Fraction: The RASTAVI Randomized Clinical Trial.
Source
Journal of the American Heart Association. 13(19) (no pagination), 2024.
Article Number: e035460. Date of Publication: 01 Oct 2024.
Author
Amat-Santos I.J.; Lopez-Otero D.; Nombela-Franco L.; Peral-Disdier V.;
Gutierrez-Ibanes E.; Jimenez-Diaz V.; Munoz-Garcia A.; Valle R.D.;
Regueiro A.; Ibanez B.; Romaguera R.; Ramon C.C.; Garcia B.; Sanchez P.L.;
Gomez-Herrero J.; Gonzalez-Juanatey J.R.; Tirado-Conte G.;
Fernandez-Aviles F.; Raposeiras S.; Revilla-Orodea A.; Lopez-Diaz J.;
Gomez I.; Carrasco-Moraleja M.; San Roman J.A.
Institution
(Amat-Santos, Regueiro, Gomez-Herrero, Lopez-Diaz, San Roman) Cardiology
Department, Hospital Clinico Universitario de Valladolid, Spain
(Amat-Santos, Lopez-Otero, Peral-Disdier, Gutierrez-Ibanes, Munoz-Garcia,
Valle, Regueiro, Ibanez, Ramon, Garcia, Sanchez, Gonzalez-Juanatey,
Fernandez-Aviles, Revilla-Orodea, Lopez-Diaz, Gomez, Carrasco-Moraleja,
San Roman) CIBERCV (Centro de Investigacion biomedica en red-Enfermedades
Cardiovasculares), Instituto de Salud Carlos III, Madrid, Spain
(Lopez-Otero, Gonzalez-Juanatey) Cardiology Department, IDIS, Complejo
Hospitalario Universitario de Santiago de Compostela, Spain
(Nombela-Franco, Tirado-Conte) Cardiovascular Institute, Hospital Clinico
San Carlos, Instituto de Investigacion Sanitaria Hospital Clinico San
Carlos (IdISSC), Madrid, Spain
(Peral-Disdier) Cardiology Department, Hospital Universitari Son Espases
(HUSE), Institut d'Investigacio Sanitaria Illes Balears (IdISBa), Balearic
Islands, Palma, Spain
(Gutierrez-Ibanes, Fernandez-Aviles) Cardiology Department, Hospital
Gregorio Maranon, Madrid, Spain
(Jimenez-Diaz, Raposeiras) Cardiology Department, Hospital Alvaro
Cunqueiro, University Hospital of Vigo, Pontevedra, Spain
(Munoz-Garcia) Cardiology Department, Hospital Virgen de la Victoria,
Malaga, Spain
(Valle) Cardiology Department, Hospital U. Central de Asturias, Oviedo,
Spain
(Regueiro) Cardiology Department, Instituto Clinic Cardiovascular,
Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer
(IDIBAPS), Barcelona, Spain
(Ibanez) Cardiology Department, Fundacion Jimenez Diaz, Madrid, Spain
(Ibanez) Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
(Romaguera) Cardiology Department, Hospital Bellvitge, Barcelona, Spain
(Ramon) Cardiology Department, Hospital Clinico de Leon, Spain
(Garcia) Cardiology Department, Hospital Vall d'Hebron, Barcelona, Spain
(Sanchez) Cardiology Department, Hospital Clinico de Salamanca, Spain
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Patients with aortic stenosis may continue to have an
increased risk of heart failure, arrhythmias, and death after successful
transcatheter aortic valve implantation. Renin-angiotensin system
inhibitors may be beneficial in this setting. We aimed to explore whether
ramipril improves the outcomes of patients with aortic stenosis after
transcatheter aortic valve implantation. METHODS AND RESULTS: PROBE
(Prospective Randomized Open, Blinded Endpoint) was a multicenter trial
comparing ramipril with standard care (control) following successful
transcatheter aortic valve implantation in patients with left ventricular
ejection fraction >40%. The primary end point was the composite of cardiac
mortality, heart failure readmission, and stroke at 1-year follow-up.
Secondary end points included left ventricular remodeling and fibrosis. A
total of 186 patients with median age 83 years (range 79-86), 58.1% women,
and EuroSCORE-II 3.75% (range 3.08-4.97) were randomized to receive either
ramipril (n=94) or standard treatment (n=92). There were no significant
baseline, procedural, or in-hospital differences. The primary end point
occurred in 10.6% in the ramipril group versus 12% in the control group
(P=0.776), with no differences in cardiac mortality (ramipril 1.1% versus
control group 2.2%, P=0.619) but lower rate of heart failure readmissions
in the ramipril group (3.2% versus 10.9%, P=0.040). Cardiac magnetic
resonance analysis demonstrated better remodeling in the ramipril compared
with the control group, with greater reduction in end-systolic and
end-diastolic left ventricular volumes, but nonsig-nificant differences
were found in the percentage of myocardial fibrosis. CONCLUSION(S):
Ramipril administration after transcatheter aortic valve implantation in
patients with preserved left ventricular function did not meet the primary
end point but was associated with a reduction in heart failure
re-admissions at 1-year follow-up. REGISTRATION: URL:
https://www.clinicaltrials.gov; Unique Identifier:
NCT03201185. Copyright © 2024 The Author(s).

<80>
Accession Number
2031408781
Title
Surgery Versus Thrombolytic Therapy for the Management of Left-Sided
Prosthetic Valve Thrombosis Without Hemodynamic Compromise: A Systematic
Review and Meta-Analysis.
Source
Journal of the American Heart Association. 13(19) (no pagination), 2024.
Article Number: e035143. Date of Publication: 01 Oct 2024.
Author
Chopard R.; Vidoni C.; Besutti M.; Ismail M.; Ecarnot F.; Favoulet B.;
Badoz M.; Schiele F.; Perrotti A.; Meneveau N.
Institution
(Chopard, Vidoni, Besutti, Ecarnot, Favoulet, Badoz, Schiele, Meneveau)
Department of Cardiology, University Hospital Besancon, France
(Chopard, Ecarnot, Badoz, Schiele, Meneveau) SINERGIES, University of
Franche-Comte, Besancon, France
(Ismail, Perrotti) Department of Thoracic and Cardio-Vascular Surgery,
University Hospital Besancon, France
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: The optimal strategy in prosthetic heart valve thrombosis
(PVT) remains controversial, with no randomized trials and conflicting
observational data. We performed a systematic review and meta-analysis of
evidence comparing systemic thrombolysis and cardiac surgery in PVT.
METHODS AND RESULTS: We searched PubMed, the Cochrane Library, and Embase
for studies on treatment strategies in patients with left-sided PVT since
2000. The primary outcome was death, and the secondary outcomes were major
bleeding and thromboembolism during follow-up (International Prospective
Register of Systematic Reviews No. CRD42022384092). We identified 2298
studies, of which 16 were included, comprising 1389 patients with PVT
(mean age, 50.4+/-9.3 years; 60.0% women). Among them, 67.2% were New York
Heart Association stage III/IV at admission. Overall, 48.1% were treated
with systemic thrombolysis and 51.9% with cardiac surgery. The mortality
rate was 10.8% in the thrombolysis group and 15.3% in the surgery group.
The pooled risk difference for death with systemic thrombolysis was 1.13
(exact CI, 0.74-1.79; zeta2=0.89; P<0.001) versus cardiac
surgery. Rates of both transient ischemic attack and non-central nervous
system embolism were higher in the thrombolysis group (P=0.002 and P=0.02,
respectively). Treatment success, major bleeding, and stroke were similar
between groups. Sensitivity analysis including studies that used low-dose
or slow-infusion thrombolysis showed that the mortality rate was lower,
and treatment success was higher, in patients referred to systemic
thrombolysis, with similar rates of other secondary outcomes.
 CONCLUSION(S): There is evidence to suggest that thrombolysis might
be the preferred option for the management of PVT without cardiogenic
shock, pending future randomized controlled trials or larger observational
studies. Copyright © 2024 The Author(s).

<81>
Accession Number
2031314980
Title
Insights on prevalence and incidence of anemia and rapid up-titration of
oral heart failure treatment from the STRONG-HF study.
Source
Clinical Research in Cardiology. 113(11) (pp 1589-1603), 2024. Date of
Publication: November 2024.
Author
Celutkiene J.; Cerlinskaite-Bajore K.; Cotter G.; Edwards C.; Adamo M.;
Arrigo M.; Barros M.; Biegus J.; Chioncel O.; Cohen-Solal A.; Damasceno
A.; Diaz R.; Filippatos G.; Gayat E.; Kimmoun A.; Leopold V.; Deniau B.;
Metra M.; Novosadova M.; Pagnesi M.; Pang P.S.; Ponikowski P.; Saidu H.;
Sliwa K.; Takagi K.; Ter Maaten J.M.; Tomasoni D.; Lam C.S.P.; Voors A.A.;
Mebazaa A.; Davison B.
Institution
(Celutkiene, Cerlinskaite-Bajore) Clinic of Cardiac and Vascular Diseases,
Institute of Clinical Medicine, Faculty of Medicine, Vilnius University,
Vilnius, Lithuania
(Cotter, Cohen-Solal, Gayat, Leopold, Deniau, Mebazaa, Davison) Universite
Paris Cite, INSERM UMR-S 942 (MASCOT), Paris, France
(Cotter, Davison) Heart Initiative, Durham, NC, United States
(Cotter, Edwards, Barros, Novosadova, Takagi, Davison) Momentum Research
Inc, Durham, NC, United States
(Adamo, Metra, Pagnesi, Tomasoni) Cardiology, Cardiology, ASST Spedali
Civili and Department of Medical and Surgical Specialties, Radiological
Sciences, and Public Health, University of Brescia, Brescia, Italy
(Arrigo) Department of Internal Medicine, Stadtspital Zurich, Zurich,
Switzerland
(Biegus, Ponikowski) Institute of Heart Diseases, Wroclaw Medical
University, Wroclaw, Poland
(Chioncel) Emergency Institute for Cardiovascular Diseases "Prof.
C.C.Iliescu", University of Medicine "Carol Davila", Bucharest, Romania
(Cohen-Solal) Department of Cardiology, APHP Nord, Lariboisiere University
Hospital, Paris, France
(Damasceno) Faculty of Medicine, Eduardo Mondlane University, Maputo,
Mozambique
(Diaz) Estudios Clinicos Latinoamerica, Instituto Cardiovascular de
Rosario, Rosario, Argentina
(Filippatos) National and Kapodistrian University of Athens, School of
Medicine, Attikon University Hospital, Athens, Greece
(Gayat, Leopold, Deniau, Mebazaa) Department of Anesthesiology and
Critical Care and Burn Unit, Saint-Louis and Lariboisiere Hospitals, FHU
PROMICE, DMU Parabol, APHP.Nord, Paris, France
(Kimmoun) Universite de Lorraine, Nancy; INSERM, Defaillance Circulatoire
Aigue Et Chronique; Service de Medecine Intensive Et Reanimation Brabois,
CHRU de Nancy, Vandoeuvre-Les-Nancy 54511, France
(Pang) Department of Emergency Medicine, Department of Medicine, Indiana
University School of Medicine, Indianapolis, IN, United States
(Saidu) Murtala Muhammed Specialist Hospital / Bayero University Kano,
Kano, Nigeria
(Sliwa) Cape Heart Institute, Division of Cardiology, Department of
Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town,
South Africa
(Ter Maaten, Voors) Department of Cardiology, Medical Centre Groningen,
Groningen, Netherlands
(Lam) National Heart Centre Singapore and Duke-National University of
Singapore, Singapore, Singapore
(Lam) Baim Institute for Clinical Research, Boston, MA, United States
(Lam) University Medical Centre Groningen, Groningen, Netherlands
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Anemia is one of the most frequent comorbidities in patients
with heart failure (HF), which potentially can interfere with the effect
of guideline-recommended HF medical therapy and can be associated with the
use of neurohormonal blockers. Aim(s): The aim of this analysis was
to determine the prevalence and changes of anemia status in the STRONG-HF
study, its association with clinical endpoints, and possible interaction
of the presence of anemia with the efficacy and safety of high-intensity
HF treatment. Method(s): The design and main results of the study
have been previously described. Patients were randomized within 2 days
prior to anticipated hospital discharge after HF worsening in a 1:1
fashion to either high-intensity care (HIC) or usual care (UC). Baseline
characteristics, clinical and safety outcomes, and treatment effect of HIC
vs. UC on the primary and secondary outcomes were compared in groups based
on baseline anemia. In addition, dynamics of hemoglobin during the study
follow-up and predictors of incident anemia at 90 days were investigated.
 Result(s): The proportion of anemia in 1077 STRONG-HF patients at
enrollment was 27.2%, while at 90 days, it changed to 32.1%. The primary
composite outcome occurred in 18.2% of patients without baseline anemia,
and 22.5% of patients with baseline anemia (unadjusted HR 1.27; 95% CI
0.90-1.80), a difference that did not reach statistical significance.
However, patients with baseline anemia had significantly less improvement
of EQ-VAS questionnaire values from baseline to day 90 (adjusted LS-Mean
difference -2.34 (-4.37, -0.31), P = 0.02). During the study, anemia
developed in 19.4 and 14.6% in HIC and UC groups, respectively. The
opposite phenomenon-recovery of anemia-occurred in 27.6 and 28.8% in HIC
and UC groups (P = 0.1379). The predictors of incident anemia at 90 days
were male sex, geographical region other than Europe, ischemic etiology,
higher glucose, and elevated uric acid at baseline. The percentages of
optimal doses of renin-angiotensin system inhibitors, beta-blockers, and
mineralocorticoid receptor antagonists were not different between anemic
and non-anemic patients. High-intensity care strategy did not increase
rate of incident anemia at 90 days and reduced the rate of primary and
secondary endpoints regardless of baseline hemoglobin. Conclusion(s):
Hemoglobin level and status of anemia have a dynamic nature in the acute
HF patients in the post-discharge period dependent on multiple factors.
High-intensity HF treatment is safe and beneficial regardless of baseline
hemoglobin level and presence of anemia. The improvement of quality of
life is significantly lower in anemic HF patients implying specific
attention to correction of this condition. Graphical abstract: (Figure
presented.) Copyright © Springer-Verlag GmbH Germany, part of
Springer Nature 2024.

<82>
Accession Number
2031033760
Title
Systematic Literature Review of the Presentation and Management of
Pediatric Relapsing Polychondritis.
Source
Annals of Otology, Rhinology and Laryngology. 133(11) (pp 933-939), 2024.
Date of Publication: November 2024.
Author
Montero M.L.; Panda R.M.; Palacios V.J.; Solis R.N.; Levi J.R.
Institution
(Montero, Panda, Palacios) University of Nevada, Reno School of Medicine,
United States
(Solis) Department of Otolaryngology - Head and Neck Surgery, University
of California, Davis, United States
(Levi) Department of Otolaryngology/Head and Neck Surgery, Boston Medical
Center, United States
Publisher
SAGE Publications Inc.
Abstract
Introduction: Pediatric Relapsing Polychondritis (RP) is a rare autoimmune
disorder that causes inflammation and damage to cartilage in children.
Common symptoms include pain, swelling and deformities in the ears, nose,
trachea, joints, and eyes. The lack of research on the pediatric
population necessitates further evaluation of the literature on pediatric
RP to summarize existing patterns in presentation, management, and
treatment. Method(s): A systematic review was conducted on PubMed and
Embase from 1947 to April 2023 on RP in patients under 21 years old
abiding by the 2020 PRISMA checklist. Only patient presentations meeting
McAdam criteria for RP and including information on management were
included. Result(s): From the 304 initial studies, 54 studies were
included for final analysis with a total of 68 patients, who were
predominantly female (65%). With a median diagnostic delay of 1 year, the
mean age of onset was 12 years old. The most common symptoms on
presentation included bilateral auricular chondritis (69%), nasal
cartilage inflammation (62%), and respiratory tract chondritis (63%). The
most commonly reported information in the literature for the initial
workup usually included CT/MRI (72%), bronchoscopy (57%), biopsy (51%),
and labs (88%), which most commonly displayed elevated ESR (59%). The most
common medications were corticosteroids (91%) and methotrexate (35%) and
the most common procedural treatment was tracheostomy (38%). The most
efficacious treatment options were monoclonal antibodies (87%, n = 15) and
corticosteroids (66%, n = 62) used in 22% and 91% of patients,
respectively. The most commonly used monoclonal antibody therapy was
infliximab (13%, n = 9). Conclusion(s): The most common presentation
for pediatric RP includes chondritis of the ear, nose, and respiratory
tract. The most effective treatment options include corticosteroids and
monoclonal antibody therapy, such as infliximab. Our findings highlight
increasing remission achieved with anti-rheumatic drugs and monoclonal
antibody treatment, especially alongside corticosteroids. Copyright
© The Author(s) 2024.

<83>
Accession Number
2032045953
Title
Systematic review and meta-analysis of randomized and nonrandomized
studies on fractional flow reserve-guided revascularization.
Source
Revista Espanola de Cardiologia. 77(11) (pp 885-895), 2024. Date of
Publication: November 2024.
Author
Mangiacapra F.; Paolucci L.; Johnson N.P.; Viscusi M.M.; Ussia G.P.;
Grigioni F.; De Bruyne B.; Barbato E.
Institution
(Mangiacapra, Paolucci, Viscusi, Ussia, Grigioni) Research Unit of
Cardiovascular Science, Department of Medicine and Surgery, Universita
Campus Bio-Medico di Roma, Roma, Italy
(Mangiacapra, Paolucci, Viscusi, Ussia, Grigioni) Fondazione Policlinico
Universitario Campus Bio-Medico, Roma, Italy
(Johnson) Division of Cardiology, Department of Medicine, Weatherhead PET
Center, McGovern Medical School at UTHealth and Memorial Hermann Hospital,
Houston, TX, United States
(Viscusi, De Bruyne, Barbato) Cardiovascular Center, OLV Clinic, Aalst
(Barbato) Department of Clinical and Molecular Medicine, Sapienza
University of Rome, Roma, Italy
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction and objectives: Several studies have investigated the
effectiveness of fractional flow reserve (FFR) guidance in improving
clinical outcomes after myocardial revascularization, yielding conflicting
results. The aim of this study was to compare clinical outcomes in
patients with coronary artery disease following FFR-guided or
angiography-guided revascularization. Method(s): Both randomized
controlled trials (RCTs) and nonrandomized intervention studies were
included. Coprimary endpoints were all-cause death, myocardial infarction,
and major adverse cardiovascular events (MACE). The study is registered
with PROSPERO (CRD42022344765). Result(s): A total of 30 studies
enrolling 393 588 patients were included. FFR-guided revascularization was
associated with significantly lower rates of all-cause death (OR, 0.63;
95%CI, 0.53-0.73), myocardial infarction (OR, 0.70; 95%CI, 0.59-0.84), and
MACE (OR, 0.77; 95%CI, 0.70-0.85). When only RCTs were considered, no
significant difference between the 2 strategies was observed for any
endpoints. However, the use of FFR was associated with reduced rates of
revascularizations and treated lesions. Metaregression suggested that the
higher the rate of revascularized patients the lower the benefit of FFR
guidance on MACE reduction compared with angiography guidance (P = .012).
Similarly, higher rates of patients with acute coronary syndromes were
associated with a lower benefit of FFR-guided revascularization (P =
.039). Conclusion(s): FFR-guided revascularization was associated
with lower rates of all-cause death, myocardial infarction and MACE
compared with angiographic guidance, with RCTs and nonrandomized
intervention studies yielding conflicting data. The benefits of
FFR-guidance seem to be less evident in studies with high
revascularization rates and with a high prevalence of patients with acute
coronary syndrome. Copyright © 2024 Sociedad Espanola de
Cardiologia

<84>
Accession Number
2034992974
Title
Dexmedetomidine as a myocardial protector in pediatric heart surgery using
cardiopulmonary bypass: a systematic review.
Source
Annals of Medicine and Surgery. 85(10) (pp 5075-5084), 2023. Date of
Publication: 08 Aug 2023.
Author
Kesumarini D.; Widyastuti Y.; Boom C.E.; Dinarti L.K.
Institution
(Kesumarini, Boom) Department of Anesthesia and Intensive Therapy,
National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
(Kesumarini) Doctoral Programme, Faculty of Medicine and Public Health,
University of Gadjah, Mada, Yogyakarta, Indonesia
(Widyastuti) Department of Anesthesia and Intensive Therapy, University of
Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
(Dinarti) Department of Cardiology and Vascular Medicine, University of
Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In recent years, dexmedetomidine has been studied as a
cardioprotective agent. However, studies on its application in pediatric
heart surgery using cardiopulmonary bypass (CPB) remain limited. This
systematic review aimed to provide information on the cardioprotective
effect of dexmedetomidine in children undergoing heart surgery using CPB.
 Method(s): The authors searched several databases (MEDLINE, Embase,
Cochrane Library, etc.) to identify all trials comparing the levels of
myocardial injury via biomarkers, including pediatric patients undergoing
heart surgery using CPB who received dexmedetomidine versus placebo or
other anesthetic agents. Literatures from non-primary studies were
excluded. Two reviewers independently screened studies for eligibility and
extracted data. The Cochrane Risk-of-Bias tool was implemented to evaluate
any potential biases. Information from eligible studies was summarized and
correspondingly reviewed based on any quantitative outcomes.
 Result(s): We identified six trials composed of 419 participants,
three of which (n = 241) showed significantly reduced interleukin-6 (IL-6)
levels in the dexmedetomidine group, while one study (n = 40) showed no
IL-6 difference between groups. Cardiac troponin I (cTnI) and creatinine
kinase-myocardial band (CK-MB), as myocardial injury biomarkers, were
found to be lower in two trials (n = 180). Despite several limitations
hindering this review from pooling the data objectively, the majority of
published studies indicated that dexmedetomidine is a seemingly
efficacious agent protecting against cardiac injury during bypass.
 Conclusion(s): These studies suggest that dexmedetomidine has
cardioprotective effects through the lowering of cardiac injury biomarkers
while improving its clinical outcomes after heart surgery using
bypass. Copyright © 2023 The Author(s). Published by Wolters
Kluwer Health, Inc.

<85>
[Use Link to view the full text]
Accession Number
2034995843
Title
Effectiveness of Single Chest Tube vs Double Chest Tube Application
Postdecortication: Prospective Randomized Controlled Study.
Source
Journal of the American College of Surgeons. 236(6) (pp 1217-1231), 2023.
Date of Publication: 01 Jun 2023.
Author
Hart J.M.; Hussien A.M.; Tesfaye S.; Nadamo S.M.; Senbu M.F.; Wadaja D.F.;
Bacha I.T.; Tebeje H.G.
Institution
(Hart, Bacha, Tebeje) Department of Surgery, Tikur Anbessa Specialized
Hospital, Addis Ababa University, Addis Ababa, Ethiopia
(Hussien) Department of Surgery, Yekatit 12 Hospital Medical College,
Addis Ababa, Ethiopia
(Tesfaye) Department of Surgery, Jimma University Medical Center, Jimma,
Ethiopia
(Nadamo) Department of Surgery, Hawassa University Comprehensive
Specialized Hospital, Hawassa, Ethiopia
(Senbu, Wadaja) Department of Surgery, Adama Comprehensive Specialized
Hospital and Medical College, Adama, Ethiopia
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Draining the chest cavity with 2 tubes is a common practice
among thoracic surgeons. This research was conducted in Addis Ababa from
March 2021 to May 2022. A total of 62 patients were included. STUDY
DESIGN: This study was conducted to investigate the superiority of either
single or double tube insertion after decortication. Patients were
randomized in a ratio of 1:1. In group A, 2 tubes were inserted; in group
B, single 32F tubes were inserted. Statistical analyses were performed
using Statistical Package for Social Sciences version 27.0, Student's t
test and Pearson chi-square test. RESULT(S): The age range of
patients was 18 to 70 years, with a mean of 44 +/- 14.4434 years; the male
to female ratio was 2.9:1. The dominant underlying pathologies were
tuberculosis and trauma (45.2% vs 35.5%); the right side was more involved
(62.3%). Drain output was 1,465 +/- 1,887.9751 mL in group A vs 1,018 +/-
802.5662 mL in group B (p value = 0.00001); the duration of drains was
7.5498 +/- 11.3137 days in group A vs 3.8730 +/- 1.4142 days in group B (p
value = 0.000042). The degree of pain was 2.6458 +/- 4.2426 vs 2.000 +/-
2.1213 in group A and group B, respectively (p value = 0.326757). The
length of hospital stay was 21.5818 +/- 11.9791 days in group A vs 13.6091
+/- 6.2048 days in group B (p value = 0.00001). Group A had air leak of
90.3% vs 74.2% in group B; subcutaneous emphysema was 9.7% in group A and
12.9% in group B. There was no fluid recollection, and no patients
required tube reinsertion. CONCLUSION(S): The placement of a single
tube after decortication is effective in reducing drain output, time of
drain, and hospital stay. There was no association with pain, and there
was no effect on other endpoints. Copyright © 2023 The Author(s).

<86>
Accession Number
2035206293
Title
Hydroxocobalamin Versus Methylene Blue for Treatment of Vasoplegic Shock
Following Cardiopulmonary Bypass: A Systematic Review and Meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2024.
Date of Publication: 2024.
Author
Cadd M.; Watson U.; Kilpatrick T.; Hardy B.; Gallop L.; Gerard A.; Cabaret
C.
Institution
(Cadd, Kilpatrick, Gerard, Cabaret) Anaesthetics Department, Royal Sussex
County Hospital, University Hospitals Sussex, United Kingdom
(Watson, Gallop) Anaesthetics Department, Worthing Hospital, University
Hospitals Sussex, United Kingdom
(Hardy) Department of Cardiothoracic Anesthesia and the Cardiovascular
Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
Publisher
W.B. Saunders
Abstract
Objectives: To summarize the evidence of the hemodynamic effects and
vasopressor requirements of adult cardiac surgery patients with vasoplegic
shock treated with hydroxocobalamin or methylene blue. Design(s):
Systematic review and meta-analysis. Setting(s): Multi-institutional.
 Participant(s): Adult cardiac surgery patients with vasoplegic shock.
 Intervention(s): Administration of hydroxocobalamin or methylene
blue. Measurements and Main Results: A total of 263 patients in four
retrospective observational studies were included in a pooled analysis.
There was no significant difference in the primary outcome, vasopressor
requirement at 1 hour (mean difference [MD]: 0.00 mcg/kg/min
norepinephrine equivalent [NEE], 95% confidence interval [CI]: -0.09 to
0.08). Hydroxocobalamin was associated with a significant improvement in
mean arterial pressure at 1 hour (MD: 5.30 mmHg, 95% CI: 2.98 to 7.62),
total vasopressor dose at 1 hour (MD: -0.13 mcg/kg/min NEE, 95% CI: -0.25
to -0.01), total vasopressor at 6 hours (MD: -0.15 mcg/kg/min NEE, 95% CI:
-0.21 to -0.08). No differences were observed in systemic vascular
resistance or mortality between groups. Three studies were deemed at
moderate risk of bias and one at serious risk. Conclusion(s):
Hydroxocobalamin has been shown to have a beneficial effect on
hemodynamics and vasopressor requirements in vasoplegic cardiac surgery
patients compared with methylene blue, although evidence is limited, and
further well-powered randomized controlled trials are
required. Copyright © 2024 Elsevier Inc.

<87>
Accession Number
2035248105
Title
ACUTE KIDNEY INJURY AFTER CARDIAC SURGERY; A PROSPECTIVE RANDOMIZED TRIAL
COMPARING DEXTRAN BASED WITH CRYSTALLOID BASED PRIMING SOLUTION.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTAIC
2024 Conference. Freiburg Germany. 38(12 Supplement) (pp 32-33), 2024.
Date of Publication: December 2024.
Author
Juvakka O.; Moller-Sorensen P.H.; Wallinder A.; Jeppsson A.; Lannemyr L.
Institution
(Juvakka, Lannemyr) Department of Anesthesia and Intensive Care -
Sahlgrenska Academy, Gothenburg, Sweden
(Moller-Sorensen) Rigshospitalet - Department of Cardiothoracic
Anesthesiology, Copenhagen, Denmark
(Jeppsson) Department of Molecular and Clinical Medicine - Sahlgrenska
Academy, Gothenburg, Sweden
(Jeppsson, Lannemyr) Department of Cardiothoracic Surgery - Sahlgrenska
University Hospital, Gothenburg, Sweden
(Wallinder) XVIVO Perfusion, Gothenburg, Sweden
Publisher
W.B. Saunders
Abstract
Objective: Up to one-third of patients undergoing cardiac surgery with
cardiopulmonary bypass (CPB) develop acute kidney injury (AKI). Previous
studies have shown that using a CPB priming solution containing dextran 40
can improve perioperative fluid balance and reduce hemolysis and renal
tubular injury. Our objective was to investigate if dextran-based priming
solution, compared to crystalloid-based priming solution, could reduce the
incidence of postoperative AKI in high-risk patients. Design and method:
In this randomized, controlled, double blinded multicenter trial, adult
patients with an expected incidence of postoperative AKI>50% (according to
the Leicester AKI score) were allocated to either a dextran 40-based or a
crystalloid-based priming solution for the CPB circuit. The primary
outcome was incidence of AKI according to the KDIGO criteria within 96
hours after surgery. Secondary outcomes were hemolysis, fluid balance and
need for postoperative renal replacement therapy. Result(s) and
Conclusion(s): Results Due to slow enrollment, the study was terminated
after 101 out of the planned 366 patients had been recruited. Ninety-two
patients were included in the final analysis, 47% in the dextran group and
53% in the crystalloid group. The incidence of AKI was increased in the
dextran group compared to the crystalloid group, 83% vs. 54%, p=0.0036; RR
1.54 (1.15-2.06). Net fluid balance (p=0.006) and postoperative plasma
hemoglobin (p=0.004) were higher in the crystalloid group. There were no
differences in postoperative bleeding, use of renal replacement therapy or
adverse events between the groups. The amount of priming solution used,
CPB-time, clamptime and the distribution of different cardiac procedures
were similar between groups. Conclusion(s): The results indicate an
increased risk for AKI in a population with a high risk of postoperative
kidney injury when a dextran-based priming solution is used compared to
when a crystalloid-based priming solution is used for CPB. Based on these
findings dextran-based priming solutions cannot be recommended for
prevention of AKI in a high risk cohort. Copyright © 2024

<88>
Accession Number
2035248038
Title
The impact of frailty and surgical risk on quality of life after TAVI: A
systematic review and meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTAIC
2024 Conference. Freiburg Germany. 38(12 Supplement) (pp 78-79), 2024.
Date of Publication: December 2024.
Author
van der Velden K.; Spaetgens B.; Buhre W.; Maesen B.; Boer D.D.K.-D.; van
Kuijk S.; van 't Hof A.; Schreiber J.
Institution
(van der Velden, Boer, van 't Hof, Schreiber) Department of Anesthesiology
and Pain Medicine, Maastricht University Medical Center+ (MUMC+),
Maastricht, THE NETHERLANDS, Netherlands
(van der Velden, van 't Hof) Cardiovascular Research Institute Maastricht
(CARIM), Maastricht University, Maastricht, THE NETHERLANDS, Netherlands
(Spaetgens) Department of Internal Medicine, Division of General Internal
Medicine, Section Geriatric Medicine, MUMC+, Maastricht, THE NETHERLANDS,
Netherlands
(Buhre) Department of Anesthesiology, Division of Vital Functions,
University Medical Center Utrecht, Utrecht, THE NETHERLANDS, Netherlands
(Maesen) Department of Cardiothoracic Surgery, MUMC+, Maastricht, THE
NETHERLANDS, Netherlands
(van Kuijk) Department of Clinical Epidemiology and Medical Technology
Assessment, MUMC+, Maastricht, THE NETHERLANDS, Netherlands
(van 't Hof) Department of Cardiology, Division of Interventional
Cardiology, MUMC+, Maastricht, THE NETHERLANDS, Netherlands
(van 't Hof) Department of Cardiology, Division of Interventional
Cardiology, Zuyderland Medical Center, Heerlen, THE NETHERLANDS,
Netherlands
Publisher
W.B. Saunders
Abstract
Objective: Symptomatic aortic stenosis and frailty reduce quality of life
(QoL). Transcatheter aortic valve implantation (TAVI) in patients at
high-extreme risk has proven it's beneficial effect on QoL. Currently,
TAVI is also considered in patients at intermediate risk. Our
meta-analysis investigates whether QoL benefit after TAVI is more
pronounced in frail patients and patients at high-extreme vs. intermediate
surgical risk. Design and method: A systematic search of the literature
was performed in November 2021 and updated in November 2023 in PUBMED,
EMBASE, and the Cochrane Controlled Trials Register for randomized
controlled trials (RCTs) and observational studies. Statistical analysis
was performed according to the inverse variance method and the random
effects model. Heterogeneity was calculated using I2 statistics.
 Result(s) and Conclusion(s): Results A total of 951 studies were
assessed of which 19 studies were included (17 cohort studies and 2 RCTs).
Meta-analysis showed a mean increase of Kansas City Cardiomyopathy
Questionnaire (KCCQ) score of 26.8 points [20.2, 33.4] in the general TAVI
population (p <. 00001). In addition, subanalyses showed a KCCQ increase
of 29.6 points [26.0, 33.1] in high-extreme risk patients versus 21.0
[20.9, 21.1] in intermediate risk patients at 1 year after TAVI ((p<
0.00001) (Figure 1). Analysis in frail patients calculated a KCCQ score
increase of 24.6 points [21.5, 27.8] (p = .02). This was not statistically
significant compared to the general TAVI population with a mean KCCQ score
increase of 26.8 points [20.2, 33.4] (p=0.55) (Figure 2). However,
qualitative analyses of nonrandomized studies showed opposite results.
 Conclusion(s): TAVI improves QoL significantly in the general TAVI
population, more so in high-extreme compared to intermediate risk
patients. Frailty's impact on QoL post-TAVI are inconclusive, due to
varying outcomes in RCT's vs. non-RCTs, preventing a definitive
conclusion. Copyright © 2024

<89>
Accession Number
2035248032
Title
Opioid-sparing effect of Continuous Erector Spinae Plane Block in Robotic
Cardiac Surgery: Preliminary Results of a Randomized Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTAIC
2024 Conference. Freiburg Germany. 38(12 Supplement) (pp 15-16), 2024.
Date of Publication: December 2024.
Author
Italiano S.; Baamonde M.L.; Medina J.L.A.; Cubells P.M.; Linares J.M.P.;
Bunuel A.; Albiol M.P.; Otero S.M.; Esteve C.I.; Gimenez M.J.A.; Casado
M.J.C.; Mila M.G.; Jimenez P.M.; Canudas I.R.; Londono F.U.; Ripoll R.N.
Institution
(Italiano, Baamonde, Medina, Cubells, Linares, Bunuel, Albiol, Otero,
Esteve, Gimenez, Casado, Mila, Jimenez, Canudas, Ripoll) Hospital Clinic,
Department of Anaesthesiology, Barcelona, Spain
(Londono) Hospital Dexeus, Department of Anaesthesiology, Barcelona, Spain
Publisher
W.B. Saunders
Abstract
Objective: Robotic cardiac surgery (RCS) has been demonstrated to be
feasible and safe by many groups. Several studies reported better outcomes
of RCS (lower complication rate, reduced length of stay, improved quality
of life) compared to non-robotic technique In minimally invasive cardiac
surgery locoregional aneasthesia (LRA) has been demonstrated to improve
postoperative pain control. Specific to RCS, the optimal LRA technique has
yet to be determined. Erector spinae plane (ESP) block is an
easy-to-perform technique that can provide an adequate pain control in
chest surgery, reducing the postoperative dose of opioids. The aim of the
present study is to assess the beneficial effects of continuous unilateral
ESP block in the management of the postoperative pain after RCS. Design
and method: Design A randomized controlled trial. Setting Single-center,
university tertiary-care institution. Participants Patients undergoing
non-coronary robotic-assisted cardiac surgery. Interventions Patients were
randomized to the "ESP" group, receiving an ESP block (intraoperative
loading dose of 20 ml followed by continuous infusion of ropivacaine 0.2%
for 24 hours) versus "control" group, receiving conventional perioperative
pain management (continuous infusion of intravenous morphine). In
addition, all patients received multimodal analgesia including
acetaminophen, dexamethasone and patient-controlled analgesia with
intravenous morphine. Measurements The primary outcomes were morphine
consumption at 12 and 24 hours, as well as the total postoperative dose.
The secondary outcomes were pain scores on a Numeric Rating Scale (NRS) at
6, 12, 24, and 48 hours after surgery. Result(s) and Conclusion(s):
Main Results Fifty-four patients were randomized. However, 24 patients
were withdrawn from the trial for various reasons. The main reasons
included inability to assess analgesia (n=5), seizures (n=3), and other
issues (n=16), such as catheter dysfunction or removal, reconversion to
sternotomy, and postoperative bleeding. The data from the remaining 30
patients were analysed appropriately. ESP block was successfully performed
in all patients in the intervention group without observing any
perioperative adverse effects. In comparison with the control group, a
trend of lower opioid consumption was observed in the ESP group, with a
significant difference in morphine use 12 hours after surgery (p = 0.049,
Table 1 and Figure 1). No difference was observed in postoperative pain
scores measured by the NRS (Table 2 and Figure 2). Table 1: Comparison of
the postoperative opioid consumption between ESP group and control group.
Data expressed as median (interquartile range). Figure 1: Box-plot
representing the data of Table 1. Table 2: Comparison of the postoperative
pain between ESP group and control group. Data expressed as median
(interquartile range). Figure 2: Box-plot representing the data of Table
2. Conclusion(s): In RCS continuous ESP block is a safe and feasible,
providing an adequate pain relief. Compared to conventional multimodal
analgesia, this technique can improve perioperative pain management
decreasing opioid consumption, especially during the first postoperative
period. If validated by the analysis of the complete study sample, these
preliminary findings suggest that continuous ESP block could be considered
an affordable opioid-sparing strategy in patients undergoing
RCS. Copyright © 2024

<90>
Accession Number
2035248028
Title
LOW DOSE VASOPRESSIN INFUSION POST-CARDIOPULMONARY BYPASS IN PATIENTS WITH
LEFT VENTRICULAR DYSFUNCTION: A RANDOMIZED CONTROLLED TRIAL.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTAIC
2024 Conference. Freiburg Germany. 38(12 Supplement) (pp 58-59), 2024.
Date of Publication: December 2024.
Author
Ganesan R.; Chakraborty K.; Biswas I.; Negi S.; Mishra A.; Agarwal P.;
Gourav K.P.
Institution
(Ganesan, Chakraborty, Biswas, Negi, Mishra, Agarwal, Gourav) Postgraduate
Institute of Medical Education and Research, Chandigarh, India
Publisher
W.B. Saunders
Abstract
Objective: The usefulness of low-dose infusion of vasopressin in patients
having left ventricle(LV) dysfunction undergoing cardiac surgery with
cardiopulmonary bypass(CPB) is not well studied. Our study aimed to
evaluate the hemodynamic and clinical effects of low-dose vasopressin
infusion in this patient population. Our primary hypothesis is that
vasopressin infusion reduces the cardiac index measured at the end of CPB.
Design and method: This randomised double-blinded controlled trial was
conducted in 36 patients of age above 18 years, planned for elective
cardiac surgery with CPB and presenting with LV dysfunction
preoperatively. Patients in the vasopressin group (n=18) received 1.2
units per hour of vasopressin infusion started at the end of CPB while
patients in the control group (n=18) received normal saline. Hemodynamic
parameters, blood gas analyses, and echocardiographic estimates of cardiac
output were collected at baseline, 30 minutes post-CPB, at receiving in
the Intensive Care Unit (ICU), and 6,12 and 24 hours after receiving in
the ICU. The primary outcome was the cardiac index in the two groups at 30
minutes post-CPB. Result(s) and Conclusion(s): Cardiac index at 30
minutes post-CPB was not statistically significantly different between the
two groups(3.22+/-1.44 l/minute/m2 in the vasopressin group vs.
2.64+/-0.88 l/minute/m2 in the control group, P=0.157). The heart rate and
MAP were statistically significantly higher in the vasopressin group than
the control group at 6 hours after receiving in ICU (102.55+/-17.92 vs.
86.67+/-15.15 beats per minute, P=0.007 and 72.50+/-8.60 vs.
66.17+/-9.08mm Hg, P=0.039, respectively). The diastolic blood pressure
was statistically significantly higher in the vasopressin group than the
control group at 12 and 24 hours after receiving in ICU (69.64+/-8.08 vs.
63.88+/-8.2 mm Hg, P=0.044 at 12 hours and 70.17+/-6.44 vs. 61.72+/-5.85mm
Hg, P=0.001 at 24 hours). There was no statistically significant
difference in the serum lactate, mixed venous oxygen saturation and
delta-partial pressure of carbon dioxide between the two groups at any
time. The fluid balance at 24 hours was statistically significantly lower
in the vasopressin group than in the control group (15.20+/-27.77 vs.
34.69+/-12.60 ml/kg, respectively, P=0.11). The two groups had no
statistically significant difference in the mechanical ventilation
duration, ICU stay and 30-day outcome. No patient developed new-onset
atrial fibrillation in the postoperative period in either group. The
results of the present study indicate that the use of low dose vasopressin
infusion in cardiac surgical patients with left ventricle dysfunction may
not reduce the cardiac index at the end of cardiopulmonary bypass.
Vasopressin infusion does not affect the clinical surrogates of cardiac
output and clinical outcomes. Copyright © 2024

<91>
Accession Number
2035248001
Title
ONE-LUNG VENTILATION WITH FIXED AND VARIABLE TIDAL VOLUMES ON OXYGENATION
AND PULMONARY OUTCOMES: A RANDOMIZED TRIAL.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTAIC
2024 Conference. Freiburg Germany. 38(12 Supplement) (pp 37-38), 2024.
Date of Publication: December 2024.
Author
Balla B.; Szamos K.; Paloczi B.; Enyedi A.; Sessler D.I.; Fulesdi B.; Vegh
T.
Institution
(Balla, Szamos, Paloczi, Enyedi, Sessler, Fulesdi, Vegh) University of
Debrecen, Department of Anesthesiology and Intensive Care, Debrecen,
Hungary
(Vegh) University of Debrecen, Institute of Surgery, Department of
Thoracic Surgery, Debrecen, Hungary
(Vegh) Department of Outcomes Research, Cleveland Clinic, Cleveland,
United States
Publisher
W.B. Saunders
Abstract
Objective: Objective: Test the hypothesis that one-lung ventilation with
variable tidal volume improves intraoperative oxygenation and reduces
postoperative pulmonary complications after lung resection.
 Background(s): Constant tidal volume and respiratory rate ventilation
can lead to atelectasis. Animal and human ARDS studies indicate that
oxygenation improves with variable tidal volumes. Since one-lung
ventilation shares characteristics with ARDS, we tested the hypothesis
that one-lung ventilation with variable tidal volume improves
intraoperative oxygenation and reduces postoperative pulmonary
complications after lung resection. Design and method: Design: Randomized
trial. Setting(s): Operating rooms and a post-anesthesia care unit.
 Patient(s): Adults having elective open or video-assisted
thoracoscopic lung resection surgery with general anesthesia were randomly
assigned to intraoperative ventilation with fixed (n = 70) or with
variable (n = 70) tidal volumes. Intervention(s): Patients assigned
to fixed ventilation had a tidal volume of 6 mlL/kgPBW, whereas those
assigned to variable ventilation had tidal volumes ranging from 6 ml/kg
PBW +/- 33% which varied randomly at 5-min intervals. Measurements: The
primary outcome was intraoperative oxygenation; secondary outcomes were
postoperative pulmonary complications, mortality within 90 days of
surgery, heart rate, and SpO2/FiO2 ratio. Result(s) and
Conclusion(s): Results: Data from 128 patients were analyzed with 65
assigned to fixed-tidal volume ventilation and 63 to variable-tidal volume
ventilation. The time-weighted average PaO2 during one-lung ventilation
was 176 (86) mmHg in patients ventilated with fixed-tidal volume and 147
(72) mmHg in the patients ventilated with variable-tidal volume, a
difference that was statistically significant (p < 0.01) but less than our
pre-defined clinically meaningful threshold of 50 mmHg. At least one
composite complication occurred in 11 (17%) of patients ventilated with
variable-tidal volume and in 17 (26%) of patients assigned to fixed-tidal
volume ventilation, with a relative risk of 0.67 (95% CI 0.34-1.31, p =
0.24). Atelectasis in the ventilated lung was less common with
variable-tidal volumes (4.7%) than fixed-tidal volumes (20%) in the
initial three postoperative days, with a relative risk of 0.24 (95% CI
0.01-0.8, p = 0.02), but there were no significant late postoperative
differences. No other secondary outcomes were both statistically
significant and clinically meaningful. Conclusion(s): One-lung
ventilation with variable tidal volume does not meaningfully improve
intraoperative oxygenation, and does not reduce postoperative pulmonary
complications. Copyright © 2024

<92>
Accession Number
2035248000
Title
PROSPECTIVE ASSESSMENT OF EARLY EXTUBATION AS PER CS-ERAS GUIDELINES IN
CARDIAC SURGICAL PATIENTS (CASE SERIES).
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTAIC
2024 Conference. Freiburg Germany. 38(12 Supplement) (pp 11-12), 2024.
Date of Publication: December 2024.
Author
Mohamed A.; Elsayed M.; Prabhu M.; ElAdawy M.; Eisa A.
Institution
(Mohamed, Elsayed, Prabhu, ElAdawy, Eisa) Freeman hospital, cardiothoracic
anaesthesia and ICU, Newcastle Upon Tyne, United Kingdom
Publisher
W.B. Saunders
Abstract
Objective: * A prospective investigation of implementation of
perioperative measures taken to ensure early extubation on table or within
2 hrs after surgery and their outcome. Design and method: A prospective
investigation of early extubation and its outcome in 50 cardiac surgical
patients in the year 2023. * Data was collected from the patients
e-records. * The recommendations from the CS-ERAS 2019 guidelines and 2024
consensus update were used as a reference to compare with our data. * The
data collected: 1. Demographic data 2. Type of surgery 3. Time to
extubation 4. Pain score 2 hours after extubation 5. Multimodal analgesia
6. Pecto-intercostal block 7. Length of ICU stay. 8. Length of hospital
stay. 9. Use of vasopressors and inotropes. 10. Incidence of postoperative
Atrial fibrillation. 11. Incidence of re-intubation Result(s) and
Conclusion(s): Analysis of ITU stay > 2 days:. Two patients stayed 5 days:
1. CABG: DCM, CRDT, Prolonged stay on Adrenaline. 2. AVR: CHB stayed in
ITU awaiting PPM.. Two patients stayed 4 days: 1. tAVR: High BMI (119 kg),
Bibasal atelectasis, Postop AF. 2. CABG: Rt pleural effusion and lung
collapse Incidence of AF: only one patient. Incidence of re-intubation:
none CONCLUSION(S): * Implementing standardized anaesthesia protocol
alongside MMA was associated with: 1. Extubation on table or within 2
hours after surgery. 2. Less incidence of vasopressor support. 3. Short
LOS in ICU 4. Short LOS in hospital * Introduction of PIB as part of the
intra-operative MMA helped in short extubation time Copyright ©
2024

<93>
Accession Number
2035247983
Title
Comparison of Lung Ultrasound and Auscultation for confirmation of
bilateral air entry after endotracheal intubation at two different tidal
volumes in cardiac surgical patients - A Crossover Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTAIC
2024 Conference. Freiburg Germany. 38(12 Supplement) (pp 60), 2024. Date
of Publication: December 2024.
Author
DIXIT A.; TEWARI P.; MAJUMDAR G.; TRIPATHI S.
Institution
(DIXIT, MAJUMDAR, TRIPATHI) MEDANTA HOSPITAL, LUCKNOW, India
(TEWARI) SGPGI, LUCKNOW, India
Publisher
W.B. Saunders
Abstract
Objective: The study aims to compare the efficacy and speed of lung
ultrasonography (LUSG) with chest auscultation (CA) for confirming
bilateral air entry after endotracheal intubation with a single lumen
endotracheal tube, particularly at two different tidal volumes (TV),
conventional and low TV, in adult cardiac surgical patients. Design and
method: This double-blind, prospective, randomized crossover study
included 100 adult patients undergoing elective cardiac surgery under
general anesthesia with endotracheal intubation in a tertiary care
teaching hospital. Patients were divided into two groups and assessed in
supine position with both CA and LUSG at baseline during spontaneous
breathing at resting TV and post-intubation at both TV, 7 ml/kg or 10
ml/kg of predicted body weight. In group 1, 7 ml/kg TV was first used,
followed by 10 ml/kg, while in group 2, the sequence was reversed. The
study was conducted by three anesthesiologists and a technician, with
defined roles and blinded to each other. Statistical analysis included
descriptive and inferential methods. Result(s) and Conclusion(s): The
distribution of age, body mass index, and predicted body weight was
similar in both groups. There were more females in Group 1. The study
found that CA was generally more rapid than LUSG in detecting air entry,
particularly in mechanically ventilated patients at both TVs. Time taken
for CA at 7 ml/kg TV was significantly more than at 10 ml/kg in group 2,
however, still being less than LUSG. CA showed lesser efficacy in
detecting air entry compared to baseline spontaneous breathing scores at 7
ml/kg TV in both groups. LUSG showed comparable efficacy with CA in group
1 while significantly less efficacy than CA in group 2 in detecting air
entry at both TVs. LUSG detected significantly better air entry at four
check points at 10 ml/kg TV compared to baseline values at spontaneous
breathing in both groups. There was no significant correlation between the
time taken and the scores achieved for both techniques, suggesting that
increased observation time did not necessarily lead to improved scores.
The distribution of scores was different on the left and right sides, with
gender distribution influencing the results. In conclusion, lung
ultrasonography (LUSG) emerges as a valuable tool for detecting air entry
by pleural sliding in cardiac surgical patients, particularly in those
ventilated with low tidal volume. While chest auscultation (CA) remains
rapid and cost-effective, LUSG provides an alternative method, albeit more
time-consuming. In mechanically ventilated patients, auscultation at 10
ml/kg TV was faster and more efficacious than lung ultrasonography in
detecting air entry in four-point auscultation. At 7 ml/kg TV, both
techniques were equally efficacious, but LUSG was more time-consuming. The
findings underscore the importance of considering patient factors, tidal
volume settings, availability of time, and necessary equipment when
choosing between CA and LUSG for air entry confirmation post-endotracheal
intubation in cardiac surgery. Further research is needed to explore the
implications of gender differences and differential air entry on the left
and right sides, as noted in this study. Copyright © 2024

<94>
Accession Number
2035247974
Title
Effects of increased cardiopulmonary bypass pump flow on renal filtration,
perfusion, oxygenation and tubular injury in cardiac surgery - a
randomized controlled trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTAIC
2024 Conference. Freiburg Germany. 38(12 Supplement) (pp 32), 2024. Date
of Publication: December 2024.
Author
Lannemyr L.; Wijk J.; Cordefeldt-Keiller A.; Bragadottir G.; Redfors B.;
Ricksten S.-E.
Institution
(Lannemyr, Wijk, Bragadottir, Redfors, Ricksten) Department of Anesthesia
and Intensive Care, Sahlgrenska Academy, Gothenburg, Sweden
(Cordefeldt-Keiller) Department of Surgery, Sahlgrenska Academy,
Gothenburg, Sweden
Publisher
W.B. Saunders
Abstract
Objective: Cardiac surgery with cardiopulmonary bypass (CPB) is associated
with impaired renal oxygenation and acute kidney injury. We aimed to
investigate whether a higher than our standard blood flow during CPB could
improve renal perfusion, oxygenation and function, as well as, attenuate
tubular injury. Design and method: In a single center trial, adult
patients scheduled for open cardiac surgery were randomized to high flow
(2.9 L/min/m2) or standard flow (2.4 L/min/m2) during CPB. Patients with
previous stroke, planned hypothermia during CPB or body mass index > 32
kg/m2 were excluded. Systemic hemodynamics and renal variables were
measured before, during and after CPB. Glomerular filtration rate was
measured by infusion clearance of iohexol and renal plasma flow by
infusion clearance and renal extraction of para-aminohippuric acid, using
a renal vein catheter. Renal oxygenation was estimated from the renal
oxygen extraction and tubular injury assessed by urinary
N-acetyl-beta-D-glucosaminidase (NAG). Linear mixed model analyses were
used for repeated measures within and between groups, and group comparison
of non-normal data were made with Mann-Whitney U-tests. Result(s) and
Conclusion(s): In total, 36 patients were included in the analysis, and
allocated to high flow ( n =1 9) or standard flow (n=17). During CPB,
glomerular filtration rate increased (10%) in the high flow group
(p=0.004), but not in the standard flow group (p=0.044 between-groups).
This increase in glomerular filtration rate was not accompanied by
impaired renal oxygenation. Renal blood flow and oxygen consumption
remained unchanged during CPB in both groups. Renal extraction of
para-aminohippuric acid decreased in the high flow group (p=0.002), which
was not seen in the standard flow group. The urinary excretion of
N-acetyl-beta-D-glucosaminidase was 62% lower in the high flow group after
weaning from CPB (p=0.049). High flow increased systemic oxygen delivery
(26%) and target mean arterial pressure was maintained at a lower
norepinephrine dose (p=0.048) compared to standard flow.
 Conclusion(s): A 20% higher than standard CPB flow during cardiac
surgery increased glomerular filtration rate with no change in renal blood
flow or renal oxygenation compared to standard flow. A fall in the renal
extraction of PAH was seen in the in the high flow group suggesting a
redistribution of RBF from the cortex to the medulla. A higher than normal
CPB flow was associated with a less pronounced tubular injury compared to
standard flow. Whether the use of higher flow rates during CPB translates
into improved renal outcomes after cardiac surgery is the focus of an
ongoing trial. Copyright © 2024

<95>
Accession Number
2035247958
Title
Does mannitol prime help patients with renal dysfunction during cardiac
surgery? A randomized trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTAIC
2024 Conference. Freiburg Germany. 38(12 Supplement) (pp 33-34), 2024.
Date of Publication: December 2024.
Author
Skold A.; Pierre L.; Dardashti A.; Lindstedt S.; Hyllen S.
Institution
(Skold, Pierre, Dardashti, Lindstedt, Hyllen) Department of Cardiothoracic
Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund,
Sweden
(Skold, Pierre, Dardashti, Lindstedt, Hyllen) Lund University, Department
of Clinical Sciences, Lund, Cardiothoracic Surgery, Lund, Sweden
Publisher
W.B. Saunders
Abstract
Objective: There is no recommendation regarding the optimal prime solution
for the cardiopulmonary bypass (CPB) circuit in adult cardiac surgery.
Despite the lack of scientific evidence, mannitol has been used widely in
the priming for CPB with the intention of preventing acute kidney injury.
The aim of this study was to investigate the impact of mannitol in CPB
prime in patients with preoperative renal dysfunction. Design and method:
This prospective, randomized, double-blind study included 70 patients, who
underwent coronary artery bypass grafting. One group received 1200 mL of a
prime based on Ringer's acetate (n=35), and the other a prime consisting
of 1000 mL Ringer's acetate and 200 mL mannitol (n=35). Changes in
renal-related parameters, electrolytes, osmolality and acid-base status
were monitored. Result(s) and Conclusion(s): No significant
differences in cystatin C (p=0.442) (Figure 1A), creatinine (p=0.177),
estimated glomerular filtration rate (p=0.172) and urea (p=0.141) between
the groups could be detected. The mannitol group showed a more pronounced
reduction in sodium levels (Figure 1B), from 138.6+/-2.2 mmol/L at
anesthesia onset to 133.8+/-2.4 mmol/L after CPB commencement (p <0.001)
and a greater increase in osmolality, 11.7+/-4.0 mOsm/kg compared to the
Ringer's acetate group 5.7+/-2.9 mOsm/kg, p<0.001. In patients with
preoperative renal dysfunction, the addition of mannitol in the prime
solution did not impact upon short- or midterm renal function parameters,
compared to a CPB prime based on Ringer's acetate. Although the mannitol
group displayed increased peroperative diuresis, the preventive effect of
mannitol against cardiac surgery-associated acute kidney injury is not
confirmed by his study. Additionally, short-term changes in osmolality and
electrolytes including hyponatremia questions the use of mannitol in CPB
prime. The role of mannitol as part of the treatment of the established
CS-AKI requires further investigation. Copyright © 2024

<96>
Accession Number
2035247952
Title
Beyond ESP Block : Bilateral Continuous ESP Block in Analgesia of Rib
Fracture - Case Report.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTAIC
2024 Conference. Freiburg Germany. 38(12 Supplement) (pp 82), 2024. Date
of Publication: December 2024.
Author
Akyuz M.B.; Koselerli E.; Kahya Y.; Guclu C.Y.
Institution
(Akyuz, Koselerli, Guclu) University of Ankara School of Medicine,
Department of Anaesthesiology and ICU, Ankara, Turkey
(Kahya) University of Ankara School of Medicine, Department of Thoracic
Surgery, Ankara, Turkey
Publisher
W.B. Saunders
Abstract
Objective: Rib fractures, affecting 10% of trauma patients, significantly
impact morbidity and mortality by hampering respiratory mechanics due to
pain, leading to ineffective coughing and shallow breathing. Optimal pain
control is crucial for secretion clearance and preventing complications
like atelectasis and pneumonia. Innovations like Erector Spinae Plane
(ESP) blocks offer promising alternatives, particularly continuous ESP
blocks with catheterization, providing advantages over neuroaxial blocks.
These include suitability for patients with coagulopathy, and potentially
reduced risks of pneumothorax or spinal cord injury. Such advancements are
critical for enhancing outcomes and reducing complications associated with
rib fractures, as demonstrated in our case report. Design and method: A
69-year-old female patient presented to the emergency department with
right-sided 4th, 5th, 6th, 7th, and 9th minimally displaced rib fractures
and left-sided 3rd, 4th, 5th, and 6th anterior stepwise rib fractures
following a fall from the same level. Imaging studies revealed no
additional pathological conditions. The patient, who had isolated
bilateral multiple rib fractures, was transferred to the thoracic surgery
clinic for close observation. Under ultrasonographic guidance in the
operating room, a bolus dose of bupivacaine and lidocaine was administered
at T6 on the right hemithorax and T5 on the left hemithorax, followed by
catheterization for continuous analgesia. The total volume administered
was 30 ml, consisting of 75 mg of 0.5% bupivacaine, 100 mg of 2%
lidocaine, and 10 ml of saline. An infusion of 0.15 ml/kg/hour of 0.125%
bupivacaine was planned, with a maximum total dose adjusted not to exceed
3 mg/kg within 24 hours. The patient's VAS scores at rest, during
movement, and coughing were recorded before and after the procedure at 0,
2, 6, 10, 14, 18, 24, and 72 hours. Post-procedure, the patient's VAS
scores improved significantly: from 10 to 3 at rest and 4 during movement
and coughing. Subsequent assessments showed VAS scores at rest not
exceeding 2 and 4 during movement and coughing. Two doses of 1 g
paracetamol were administered as supplementary analgesia. Catheters were
safely removed on the 4th day without complications, and the patient was
discharged after outpatient follow-up. Result(s) and Conclusion(s):
Rib fractures necessitate effective analgesia due to their substantial
morbidity and mortality risks and potential for chronic pain. While ESP
block efficacy is supported by case reports, controlled randomized studies
are lacking. Adhikary et al. and Palachick et al. demonstrated pain
improvement and spirometry enhancement post-ESP block without
complications. Meta-analyses favor thoracic epidural analgesia for rib
fractures, though recent trials found comparable pain relief and
spirometry values between epidural and ESP block, with fewer hypotensive
events in ESP. Yayik et al. placed an ESP catheter for postoperative
analgesia in a patient with rib fractures, yielding positive outcomes. Our
review highlights ESP block's role in rib fracture analgesia, offering
safety advantages over epidural. Multimodal analgesia, including ESP
catheter placement and paracetamol, proved effective in our case. Further
studies are warranted to determine the optimal regional technique, but ESP
block stands out for its outpatient potential, ease of use, bilateral
applicability, and fewer contraindications compared to neuroaxial
techniques. Copyright © 2024

<97>
Accession Number
2035247941
Title
Videolaryngoscope-Assisted vs. Conventional Technique for Insertion of
Transesophageal Echocardiography Probe: An Updated Systematic Review and
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTAIC
2024 Conference. Freiburg Germany. 38(12 Supplement) (pp 22-23), 2024.
Date of Publication: December 2024.
Author
Arias J.A.; Wegner B.F.M.; Filardi K.F.X.C.; Silva L.S.; Filardi R.G.M.
Institution
(Arias) Universidade Federal da Bahia, Hospital Ana Nery, Salvador, Brazil
(Wegner) Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
(Filardi, Filardi) Universidade de Sao Paulo, Sao Paulo, Brazil
(Silva) Escola Bahiana de Medicina e Saude Publica, Salvador, Brazil
Publisher
W.B. Saunders
Abstract
Objective: Transesophageal echocardiography (TEE) is an indispensable tool
in both intensive care and cardiac surgery, crucial for precise and
immediate diagnosis, management of specific clinical situations, and
enhancing intraoperative decision-making to improve patient outcomes.
While highly beneficial, the physical insertion of the TEE probe carries
inherent risks that can lead to severe complications. A previous
meta-analysis demonstrated that videolaryngoscope-assisted (VL-assisted)
insertion of TEE probes result in fewer secondary complications. However,
the studies included in that analysis featured varied control techniques.
This update meta-analysis of randomized trials aims to compare the
insertion of TEE probes with videolaryngoscope (VL) assistance versus
conventional blind insertion. By standardizing comparisons across a larger
and more diverse patient sample, the study seeks to provide a more
definitive assessment of the efficacy and safety of VL-assisted TEE probe
insertion. Design and method: Design: This is a systematic review of
randomized clinical trials (RCTs) and meta-analysis. Setting(s):
Searches were conducted for studies published up to March 26, 2024, and
included the PubMed, Embase, Cochrane Library, and Web of Science
databases. Participant(s): This meta-analysis included 3 RCTs with
549 patients from cardiovascular surgery and ICU. Intervention(s):
This study examines the use of VL-assisted TEE probe insertion, comparing
VL assistance with conventional blind insertion techniques. Result(s)
and Conclusion(s): Measurements and Mean Outcomes: The aggregated analysis
of attempts revealed a statistically significant advantage for the use of
the VL (RR = 1.61, 95% CI = 1.19 to 2.17, I2 = 83%, p = 0.002). The first
attempt for TEE probe insertion showed a moderate advantage for the VL
group (RR = 1.47, 95% CI = 1.02 to 2.11, I2 = 89%, p = 0.04). Furthermore,
complications such as pharyngo-laryngeal injuries showed a statistically
significant difference favoring the VL (n=549, RR = 0.36, 95% CI = 0.19 to
0.65, I2 = 23%, p = 0.0007). Conclusion(s): The findings indicate
that VL-assisted insertion is superior to conventional blind insertion in
reducing injuries during TEE probe insertion and enhancing its success
rate. Copyright © 2024

<98>
Accession Number
2031889772
Title
Challenging anticoagulation decisions in atrial fibrillation: a narrative
review.
Source
Therapeutic Advances in Cardiovascular Disease. 18 (no pagination), 2024.
Date of Publication: January-December 2024.
Author
Griffin M.; Proietti R.; Lip G.Y.H.; Abdul-Rahim A.H.
Institution
(Griffin, Proietti, Lip, Abdul-Rahim) Liverpool Centre for Cardiovascular
Science, University of Liverpool, Liverpool John Moores University,
Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE,
United Kingdom
(Proietti, Lip, Abdul-Rahim) Liverpool Centre for Cardiovascular Science
at University of Liverpool, Liverpool John Moores University and Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Lip) Danish Center for Health Services Research, Department of Clinical
Medicine, Aalborg University, Aalborg, Denmark
(Abdul-Rahim) Stroke Division, Department of Medicine for Older People,
Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust,
Prescot, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Atrial fibrillation (AF) is common and warrants consideration of oral
anticoagulant (OAC) medication. Usually, the decision is straightforward,
following the pathway outlined in the European Society of Cardiology's
guideline; however, certain situations fall outside of this evidence base
- such as a diagnosis of subclinical AF made via implanted devices or
wearable electrocardiogram monitors, or alternatively diagnosis of
'secondary AF' following a major stressor. Subclinical AF is associated
with stroke, though not to the extent of clinical AF, and the benefits of
anticoagulation appear to be lower. Longer episodes are more clinically
meaningful, and recent randomised controlled trials have demonstrated that
some patients derive benefit from OAC. Similarly, when AF is triggered by
sepsis or non-cardiac surgery, specific evidence supporting OAC initiation
is lacking and clinician behaviour is variable. Observational data
demonstrate poorer outcomes in these patients, implying that the
perception of a transient, reversible phenomenon may not be correct.
Contrastingly, cardiac surgery very frequently induces AF, and the
benefits of anticoagulation rarely outweigh the risks of bleeding.
Following ischaemic stroke, recent evidence suggests that early
(re-)initiation of OAC should be considered as this does not increase the
risk of haemorrhagic transformation as previously hypothesised. This
narrative review summarises the available literature and outlines, where
possible, practical advice for clinicians facing these common clinical
dilemmas. Copyright © The Author(s), 2024.

<99>
Accession Number
645589960
Title
Effect of mild hypothermia vs normothermia cardiopulmonary bypass on
postoperative bleeding in patients undergoing coronary artery bypass
grafting: protocol of a multi-center, randomized, controlled trial.
Source
BMC surgery. 24(1) (pp 323), 2024. Date of Publication: 22 Oct 2024.
Author
Wang T.; Zhang H.; Zhang Q.; Liu G.; Yan S.; Wang Q.; Teng Y.; Wang J.; Hu
Q.; Ji B.
Institution
(Wang, Wang, Zhang, Zhang, Liu, Yan, Wang, Teng, Wang, Hu, Ji) Department
of Cardiopulmonary Bypass, National Center for Cardiovascular Disease,
Chinese Academy of Medical Sciences & Peking Union Medical College,
National Clinical Research Center for Cardiovascular Diseases, Fuwai
Hospital, No. 167 Beilishi Road, Xicheng District, Beijing 10010, China
Abstract
BACKGROUND: Coronary artery bypass grafting (CABG) is often performed with
hypothermic cardiopulmonary bypass (CPB) to reduce metabolic demands and
protect the myocardium. However, hypothermia can increase bleeding risks
and other complications. METHOD(S): This is a prospective,
multi-center, randomized controlled trial. From September 2023 to December
2024, a total of 336 eligible patients planning to undergo on-pump CABG
will be enrolled. All participants will be randomly divided into mild
hypothermia CPB group (target oxygenator arterial outlet blood temperature
at 32-33) or normothermia CPB group (target oxygenator arterial outlet
blood temperature at 35-36). The primary endpoint is Universal Definition
of Perioperative Bleeding (UDPB) class 2-4. Secondary endpoints are class
of UDPB, levels of coagulation and inflammatory factors, in-hospital
mortality, perioperative related complications, ICU length of stay, and
hospital length of stay. DISCUSSION: This clinical trial aims to compare
the effects of different target temperature during CPB on postoperative
bleeding and to explore optimal temperature strategy to provide new
clinical evidence. TRIAL REGISTRATION: Chictr.org.cn : ChiCTR2300075405.
The trial was prospectively registered on 4 September 2023. Copyright
© 2024. The Author(s).

<100>
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.

<101>
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.

<102>
Accession Number
645580934
Title
Primary delayed sternal closure in adult cardiac surgery: a systematic
review of protocols.
Source
The Journal of cardiovascular surgery. (no pagination), 2024. Date of
Publication: 22 Oct 2024.
Author
McMullen H.L.; Blitzer D.; Copeland H.
Institution
(McMullen) Department of Cardiothoracic Surgery, Stanford Health Care,
Palo Alto, CA, United States
(Blitzer) Columbia University Vagelos College of Physicians and Surgeons,
Department of Cardiac Surgery, New York Presbyterian Hospital, New York,
NY, USA
(Copeland) Department of Cardiac Surgery, Lutheran Hospital, Fort Wayne,
IN, United States
Abstract
INTRODUCTION: Primary delayed sternal closure (DSC) is a useful tool in
the management of certain critically unstable patients after cardiac
surgery, but there is a paucity of consensus management guidelines. This
review aimed to identify critical key areas in DSC management. EVIDENCE
ACQUISITION: Systematic literature search was conducted in January 2023
and performed using Embase and PubMed. For original research articles were
included that described outcomes and/or protocols for primary adult DSC
patients, excluding articles on pediatric patients and secondary DSC.
EVIDENCE SYNTHESIS: Eleven retrospective review original articles examined
protocols for adult patients undergoing DSC. Hemodynamic instability and
uncontrolled bleeding/coagulopathy were the two most common indications.
Time to chest closure ranged 22 hours - 8.7 days. A range of dressings
were employed, including Esmark and VAC dressings, with about half of
authors not disclosing details. VAC was endorsed by several authors
specifically for management of uncontrolled hemorrhage/coagulopathy. There
was no consensus regarding irrigation solution for mediastinal prepping,
with or without antibiotic solution. There was a lack of consensus on
antibiotic selection and duration, varying from 2 and 3 multidrug regimens
of broad-spectrum antibiotics, with/without antifungals. Mediastinal
re-exploration varied from undefined intervals to regimented 24-48-hour
interval re-explorations, with final closures in the OR or ICU.
 CONCLUSION(S): The optimum care for the patient with an open chest is
evolving, and although there is a lack of a consensus DSC protocol, this
review identifies mediastinal management, antimicrobial prophylaxis, and
mediastinal re-exploration schedules/protocols as key areas for study to
determine optimal care for DSC patients.

<103>
Accession Number
2034585743
Title
Efficacy and safety of therapeutic alpha-1-microglobulin RMC-035 in
reducing kidney injury after cardiac surgery: a multicentre, randomised,
double-blind, parallel group, phase 2a trial.
Source
eClinicalMedicine. 76 (no pagination), 2024. Article Number: 102830. Date
of Publication: October 2024.
Author
Zarbock A.; Larsson T.E.; Noiseux N.; Mazer C.D.; Bohm J.; Laflamme M.;
Matschke K.; Burkert J.; de Varennes B.; Myjavec A.; Boning A.; Koyner
J.L.; Engelman D.; Reusch M.; Thielmann M.; Nazar B.A.; Brown C.; East C.;
Iglesias A.G.; Helms S.; Kress D.; Lamy A.; Albaiceta G.M.; Carvajal I.M.;
Osaki S.; Copa G.R.; Ronco C.; Scavo V.; Shelstad R.; Swaminathan M.;
Szabo G.; Teman N.; Vojacek J.; Wahlers T.
Institution
(Zarbock) Department of Anaesthesiology, Intensive Care and Pain Medicine,
University Hospital Munster, Munster, Germany
(Larsson, Reusch) Guard Therapeutics International AB, Stockholm, Sweden
(Noiseux) Centre de Recherche du Centre Hospitalier de l'Universite de
Montreal, Montreal, Quebec, Canada
(Mazer) St. Michael's Hospital, University of Toronto, Toronto, Canada
(Bohm) Department of Cardiovascular Surgery, Institute Insure, German
Heart Center Munich, Technical University of Munich, Munich, Germany
(Laflamme) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec, Canada
(Matschke) Klinik fur Herzchirurgie, Herzzentrum Dresden
Universitatsklinik, Dresden, Germany
(Burkert) Fakultni Nemocnice v Motole, Prague, Czechia
(de Varennes) McGill University Health Centre - Royal Victoria Hospital,
Montreal, Canada
(Myjavec) Department of Cardiac Surgery, Charles University, Faculty of
Medicine and University Hospital in Hradec Kralove, Hradec Kralove,
Czechia
(Boning) Department of Cardiovascular Surgery, Justus-Liebig-University
Giessen, Germany
(Koyner) Section of Nephrology, University of Chicago, Chicago, IL, United
States
(Engelman) Division of Cardiac Surgery, Baystate Medical Center,
Springfield, MA, United States
(Thielmann) Klinik fur Thorax- und Kardiovaskulare Chirurgie,
Westdeutsches Herz- und Gefaszentrum Essen, Universitat Duisburg-Essen,
Germany
Publisher
Elsevier Ltd
Abstract
Background: Cardiac surgery invariably triggers acute kidney stress
causing adverse renal outcomes. The AKITA study evaluated the efficacy and
safety of RMC-035, a novel analogue of alpha-1-microglobulin, for reducing
cardiac surgery-associated kidney injury. Method(s): In this
randomised double-blind placebo-controlled phase 2a study, we randomly
assigned (1:1) adult hospitalised patients undergoing open-chest cardiac
surgery at high risk for acute kidney injury (AKI) at 21 sites in North
America and Europe to receive either RMC-035 (1.3 or 0.65 mg/kg) or
placebo (1:1) for 2 days (5 intravenous infusions), stratified by region
and renal function. Eligible patients had at least one pre-defined AKI
risk factor. Patients with severe renal impairment (estimated glomerular
filtration rate [eGFR] <30 mL/min/1.73 m2) were excluded. The
co-primary efficacy and safety endpoints were AKI (Kidney Disease:
Improving Global Outcomes definition) within 72 h after surgery and
nature, frequency, and severity of treatment-emergent adverse events
(TEAEs). Secondary endpoints included eGFR and Major Adverse Kidney Events
(MAKE) up to Day 90. Randomised patients who had received at least one
dose of study drug were analysed for primary and safety analyses.
Participants, investigators and sponsor were masked to treatment
allocation. This study is registered at ClinicalTrials.gov (NCT05126303)
and EudraCT (2021-004040-19). Finding(s): Patient enrolment was
stopped at interim analysis due to futility. Between March 31, 2022 and
July 12, 2023, 177 patients (RMC-035: 89, placebo: 88) were randomised and
treated. AKI rate for RMC-035 vs placebo was 50.6% (n = 45) and 39.8% (n =
35) (relative risk [RR]: 1.30, 90% confidence interval [90% CI]: 0.99,
1.71; p = 0.12). A short-lived creatinine increase was observed with the
higher RMC-035 dose. Treatment with RMC-035 was associated with improved
secondary renal outcomes at Day 90: placebo-adjusted eGFR change from
baseline 4.3 mL/min/1.73 m2, 90% CI 0.51-8.12, p = 0.06; and
MAKE 6.7% (n = 6) vs 15.9% (n = 14); RR: 0.41, 90% CI: 0.19, 0.88, p =
0.05. The most frequently reported TEAEs for RMC-035 were chills (30.3%),
nausea (21.3%), anaemia (20.2%); and atrial fibrillation (29.5%), anaemia
(20.5%), hypervolemia (14.8%) for placebo. The majority of TEAEs in both
treatment groups were mild or moderate in severity. In the RMC-035 group,
26 (29.2%) patients experienced at least one severe or life-threatening
TEAE and in the placebo group 16 (18.2%) patients. There were 4 deaths per
treatment arm (one treatment-related, in placebo group).
 Interpretation(s): In this proof-of-concept study, RMC-035 did not
reduce AKI 72 h after cardiac surgery. Evaluations may have been
confounded by a drug-induced transient creatinine increase in a subgroup
of patients. RMC-035 was associated with improved secondary renal
outcomes. These results merit further investigation and should be
interpreted with caution, as the study was not powered for these outcomes.
 Funding(s): Guard Therapeutics. Copyright © 2024 The
Author(s)

<104>
Accession Number
2035174190
Title
Left atrial appendage occlusion devices vs direct oral anticoagulants for
atrial fibrillation: An updated systematic review and meta-analysis.
Source
Current Problems in Cardiology. 50(1) (no pagination), 2025. Article
Number: 102880. Date of Publication: January 2025.
Author
Fernandes J.M.; Pinheiro R.P.S.; Serpa F.; de Andrade N.M.; Pereira V.;
Sbardelotto A.E.E.; Gomes W.F.
Institution
(Fernandes) Faculdade Israelita de Ciencias da Saude Albert Einstein, Rua
Comendador Elias Jafet, 755- Sao Paulo, Sao Paulo 05653-000, Brazil
(Pinheiro, Sbardelotto) Universidade Federal do Rio de Janeiro, Rua
Professor Rodolpho Paulo Rocco, 255- Rio de Janeiro, Rio de Janeiro
21941-617, Brazil
(Serpa) Department of Internal Medicine, University of Texas Southwestern
Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States
(de Andrade) Escola Bahiana de Medicina e Saude Publica- Bahia, Av. Dom
Joao VI, 275, Bahia, Salvador 40290-000, Brazil
(Pereira) Facultad Ciencias Biomedicas, Universidad Austral, Av. Juan
Domingo Peron, 1500- Pilar, Buenos Aires B1629, Argentina
(Gomes) INC Hospital, Department of Interventional Cardiology,
Universidade Federal do Parana, Faculdades Pequeno Principe, Hospital
Santa Casa de Misericordia de Curitiba, Rua Jeremias Maciel Perretto, 300,
Parana, Curitiba 81210-310, Brazil
Publisher
Elsevier Inc.
Abstract
Background: Direct Oral Anticoagulants (DOACs) are the first line
anticoagulation for patients with non-valvular atrial fibrillation (NVAF).
Percutaneous Left Atrial Appendage Occlusion (LAAO) has emerged as a new
therapy and its safety and effectiveness compared with DOACs are still
controversial. Method(s): A systematic review of randomized
controlled trials and observational studies was conducted, focusing on
patients with NVAF. Outcomes analyzed included: (1) all-cause mortality;
(2) cardiovascular (CV) mortality; (3) thromboembolic events; (4) stroke
or transient ischemic attack (TIA); (5) bleeding events; and a (6)
composite of death, hemorrhagic, and thromboembolic events. We performed a
subgroup analysis of major bleeding according to different definitions:
(1) Bleeding Academic Research Consortium (BARC); (2) International
Society on Thrombosis and Haemostasis (ISTH); and (3) other definitions.
 Result(s): Ten studies involving 18,507 patients were included, with
42.35 % undergoing LAAO. In pooled analysis, LAAO was associated with
lower rates of all-cause mortality (HR 0.63; 95 % CI 0.50-0.80),
cardiovascular mortality (HR 0.56; 95 % CI 0.45-0.70), and of the
composite outcome (HR 0.73; 95 % CI 0.58-0.92). A trend towards lower
stroke/TIA events was observed but not statistically significant. Overall
bleeding events did not significantly differ between groups; using the
ISTH definition, LAAO showed significantly lower incidence of bleeding
events (HR 0.63; 95 % CI 0.43-0.91). No difference was found in
thromboembolic events. Conclusion(s): LAAO was associated with a
significantly lower all-cause mortality and cardiovascular mortality, as
well as the composite of death, hemorrhagic or thromboembolic events, as
compared with DOACs. Copyright © 2024 Elsevier Inc.

<105>
Accession Number
2035201600
Title
Cardiac Resynchronization Therapy in Ischemic Versus Nonischemic
Cardiomyopathy: Patient-Level Meta-Analysis of 7 Randomized Clinical
Trials.
Source
JACC: Heart Failure. 12(11) (pp 1915-1924), 2024. Date of Publication:
November 2024.
Author
Sudesh S.; Abraham W.T.; Cleland J.G.F.; Curtis A.B.; Friedman D.J.; Gold
M.R.; Kutyifa V.; Linde C.; Tang A.S.; Olivas-Martinez A.; Inoue L.Y.T.;
Sanders G.D.; Al-Khatib S.M.
Institution
(Sudesh, Friedman, Sanders, Al-Khatib) Division of Cardiology, Duke
University School of Medicine, Durham, NC, United States
(Sudesh, Friedman, Sanders, Al-Khatib) Duke Clinical Research Institute,
Duke University School of Medicine, Durham, NC, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Cleland) National Heart and Lung Institute, Royal Brompton and Harefield
Hospitals, Imperial College, London, United Kingdom
(Cleland) British Heart Foundation Centre of Research Excellence, School
of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow,
United Kingdom
(Curtis) Department of Medicine, University at Buffalo, Buffalo, NY,
United States
(Gold) Department of Medicine, Medical University of South Carolina,
Charleston, SC, United States
(Kutyifa) Division of Cardiology, Department of Medicine, University of
Rochester Medical Center, Rochester, NY, United States
(Linde) Karolinska Institutet and Department of Cardiology, Karolinska
University, Stockholm, Sweden
(Tang) Department of Medicine, Western University, London, ON, Canada
(Olivas-Martinez, Inoue) Department of Biostatistics, University of
Washington, Seattle, WA, United States
Publisher
Elsevier Inc.
Abstract
Background: Data on whether cardiac resynchronization therapy (CRT)
results in better clinical and echocardiographic outcomes in patients with
nonischemic cardiomyopathy (NICM) vs ischemic cardiomyopathy (ICM) are
conflicting. Objective(s): The authors conducted this meta-analysis
of 7 clinical trials of CRT to determine the association between etiology
of cardiomyopathy and clinical and echocardiographic outcomes.
 Method(s): The authors analyzed patient-level data using Bayesian
Hierarchical Weibull survival regression modeling to determine the
association between etiology of cardiomyopathy and time to all-cause death
or heart failure hospitalization (HFH). Linear regression was used to
assess the association between etiology of cardiomyopathy and
echocardiographic measurements. Result(s): Of 6,252 patients
included, 4,717 (75%) were men, median age was 66 years (IQR: 58-73
years), 3,704 (59%) had ICM, and 3,778 (60%) received CRT. CRT increased
the time to HFH or all-cause death (HR: 0.67; 95% credible interval [CrI]:
0.56-0.82; P < 0.001) with no difference by etiology of cardiomyopathy (HR
ratio: 1.06 [95% CrI: 0.87-1.29]; P = 0.57). Likewise, CRT increased the
time to all-cause death (HR: 0.71 [95% CrI: 0.55-0.93]; P = 0.019) with no
difference by etiology of cardiomyopathy (HR ratio: 1.06 [95% CrI:
0.80-1.43]; P = 0.70). Echocardiographic data that were available for
2,430 (39%) patients showed that CRT improvements in left ventricular
ejection fraction, left ventricular end-diastolic diameter, and left
ventricular end-systolic diameter were larger for patients with NICM.
 Conclusion(s): Although CRT led to greater increases in left
ventricular ejection fraction and reductions in ventricular dimensions for
patients with NICM compared with those with ICM, CRT significantly
increased the time to HFH or all-cause death independently of the etiology
of cardiomyopathy. Further studies on improving patient selection for CRT
are needed. Copyright © 2024 American College of Cardiology
Foundation

<106>
Accession Number
2034976976
Title
A Behavioral Change-Based Mobile Intervention for Promoting Regular
Physical Activity in Medical Rehabilitation Maintenance of Patients With
Coronary Artery Disease: Controlled Trial.
Source
Journal of Medical Internet Research. 26 (no pagination), 2024. Article
Number: e56480. Date of Publication: 2024.
Author
Waranski M.; Garbsch R.; Kotewitsch M.; Teschler M.; Schmitz B.; Mooren
F.C.
Institution
(Waranski, Garbsch, Kotewitsch, Teschler, Schmitz, Mooren) Department of
Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke,
Witten, Germany
(Waranski, Garbsch, Kotewitsch, Teschler, Schmitz, Mooren) DRV Clinic
Konigsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
Publisher
JMIR Publications Inc.
Abstract
Background: Cardiac rehabilitation is known to reduce coronary artery
disease (CAD) severity and symptoms, but adoption of a healthy
postrehabilitation lifestyle remains challenging. Innovative eHealth
solutions could help, but behavioral change-based eHealth maintenance
programs for patients with CAD are scarce. RehaPlus+ aims to improve
postrehabilitation outcomes with a personalized eHealth intervention built
on behavioral change concepts emphasizing healthy lifestyle changes,
especially regular physical activity (PA). Objective(s): This study
aims to evaluate the effectiveness of the personalized eHealth program
RehaPlus+ for promoting regular PA against usual care. Method(s): A
total of 169 patients with CAD who had undergone stent implantation or
bypass surgery were recruited after completing center-based phase II
rehabilitation. They were then divided, without blinding, into 2 groups
using a quasi-experimental approach: a case manager-assisted 24-week
eHealth program (RehaPlus+; n=84) and a conventional physician-assisted
outpatient program (usual care; n=85). The study was designed as a
noninferiority trial. RehaPlus+ participants received motivational
messages twice weekly for 6 months, and the usual care group engaged in a
6-month outpatient program (twenty-four 90-minute strength and endurance
training sessions). The primary outcomes, evaluated using the
self-assessed Bewegungs- und Sportaktivitat questionnaire, were regular PA
(>=150 min/wk) and weekly activities of daily living (ADLs) 6 months after
rehabilitation. Secondary outcomes involved PA during work and floors
climbed weekly (measured by Bewegungs- und Sportaktivitat questionnaire),
psychological well-being (assessed by the 5-item World Health Organization
Well-Being Index), cardiac self-efficacy, health-related quality of life
(measured by the 36-Item Short Form Survey), and work ability (using the
Work Ability Index). Result(s): Data of 105 patients (RehaPlus+:
n=44, 41.9%; usual care: n=61, 58.1%; male patients: n=80, 76.2%; female
patients: n=25, 23.8%; mean age 56.0, SD 7.3 years) were available at the
6-month follow-up. At 6 months after discharge from phase II cardiac
rehabilitation, the RehaPlus+ group exhibited 182 (SD 208) minutes per
week of PA and the usual care group exhibited 119 (SD 175) minutes per
week of PA (P=.15), with no interaction effect (P=.12). The RehaPlus+
group showed an ADL level of 443 (SD 538) minutes per week compared to the
usual care group with 308 (SD 412) minutes per week at the 6-month
follow-up, with no interaction effect (P=.84). The differences observed in
PA and ADL levels between the RehaPlus+ and usual care groups were within
the predefined 1-sided noninferiority margin, indicating that the
RehaPlus+ intervention is not inferior to usual care based on these
outcomes. There were no differences between the groups for all secondary
outcomes (P>.05). Conclusion(s): RehaPlus+ is not inferior to the
usual care program, as both groups improved PA and ADLs to a similar
extent. These findings emphasize the potential of eHealth interventions to
assist in maintaining healthy lifestyles after
rehabilitation. Copyright © Melina Waranski, Rene Garbsch, Mona
Kotewitsch, Marc Teschler, Boris Schmitz, Frank C Mooren.

<107>
[Use Link to view the full text]
Accession Number
2034969058
Title
Projection of visual material on postoperative delirium in patients
undergoing cardiac surgery: A double blind randomized clinical trial.
Source
Medicine (United States). 103(40) (pp e39470), 2024. Date of Publication:
04 Oct 2024.
Author
Mendez-Martinez C.; Casado-Verdejo I.; Fernandez-Fernandez J.A.;
Sanchez-Valdeon L.; Bello-Corral L.; Mendez-Martinez S.; Sandoval-Diez A.;
Gomez-Salgado J.; Garcia-Suarez M.; Fernandez-Garcia D.
Institution
(Mendez-Martinez, Casado-Verdejo, Fernandez-Fernandez, Sanchez-Valdeon,
Bello-Corral, Garcia-Suarez, Fernandez-Garcia) Health Research Nursing
Group (GREIS), University of Leon, Leon, Spain
(Mendez-Martinez, Mendez-Martinez, Sandoval-Diez, Garcia-Suarez)
University Hospital of Leon, Leon, Spain
(Casado-Verdejo, Fernandez-Fernandez, Sanchez-Valdeon, Bello-Corral,
Fernandez-Garcia) Department of Nursing and Physiotherapy, University of
Leon, Leon, Spain
(Gomez-Salgado) Department of Sociology, Social Work and Public Health,
Faculty of Labour Sciences, University of Huelva, Huelva, Spain
(Gomez-Salgado) Safety and Health Postgraduate Program, Universidad
Espiritu Santo, Guayaquil, Ecuador
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative delirium is a neurobehavioral disorder that can
appear after surgery. It is characterized by an altered level of
consciousness and impaired cognitive function. The aim of this study was
to evaluate the impact of visual projection of images of relatives or
loved ones in patients undergoing cardiac surgery in the immediate
postoperative period, and its influence on the incidence and development
of postoperative delirium. Method(s): A randomized, double-blind
clinical trial was designed in the immediate postoperative period of adult
patients undergoing cardiac surgery. Consolidated Statement of Reporting
Trials guidelines were followed. A control group (CG) and an intervention
group (IG) were established. In the IG, the patients underwent a visual
projection, while the usual unit treatment was carried out with the CG.
Sociodemographic, anthropometric, anesthetic, and surgical variables were
also recorded. The postoperative delirium assessment scale used was the
confusion assessment method for diagnosing delirium in intensive care unit
patients. Result(s): Information was collected from 104 patients
undergoing cardiac surgery. Most of the patients included in the study
were men (66.35%) and the most performed surgical intervention was aortic
valve replacement (34.62%). In the CG, positive patients in postoperative
delirium increased from 19.23% to 25%, while in the IG they decreased from
5.77% to 1.92%. The logistic regression analysis presents a prediction
model where the variables that influence the model are gender and group
membership, meaning that being female and belonging to the IG
significantly reduce the presence of delirium. Conclusion(s): The
projection of visual material reduced the incidence of postoperative
delirium in patients undergoing cardiac surgery, although it cannot be
established that it is effective as a treatment once the pathology is
already established. Copyright © 2024 the Author(s). Published by
Wolters Kluwer Health, Inc.

<108>
Accession Number
2034919290
Title
Ferric carboxymaltose and exercise capacity in heart failure with
preserved ejection fraction and iron deficiency: The FAIR-HFpEF trial.
Source
European Heart Journal. 45(37) (pp 3789-3800), 2024. Date of Publication:
01 Oct 2024.
Author
Von Haehling S.; Doehner W.; Evertz R.; Garfias-Veitl T.; Derad C.; Diek
M.; Karakas M.; Birkemeyer R.; Fillippatos G.; Lainscak M.; Butler J.;
Ponikowski P.; Bohm M.; Friede T.; Anker S.D.
Institution
(Von Haehling, Evertz, Garfias-Veitl) Department of Cardiology and
Pneumology, University Medical Center Goettingen, Georg-August University,
Robert-Koch-Strasse 40, Goettingen D-37075, Germany
(Von Haehling, Evertz, Garfias-Veitl, Derad, Friede) DZHK (German Center
for Cardiovascular Research), Partner Site Lower Saxony,
Robert-Koch-Strasse 40, Goettingen D-37075, Germany
(Doehner, Anker) Berlin Institute of Health-Center for Regenerative
Therapies (BCRT), Charite-Universitatsmedizin Berlin, Augustenburger Platz
1, Berlin D-13353, Germany
(Doehner, Diek, Anker) Deutsches Herzzentrum der Charite, Department of
Cardiology (Campus Virchow), German Centre for Cardiovascular Research
(DZHK) Partner Site Berlin, Charite Universitatsmedizin Berlin,
Augustenburger Platz 1, Berlin D-13353, Germany
(Doehner) Center for Stroke Research Berlin, Charite-Universitatsmedizin
Berlin, Berlin, Germany
(Derad, Friede) Department of Medical Statistics, University Medical
Center Gottingen, Gottingen, Germany
(Karakas) Department of Intensive Care Medicine, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
(Karakas) DZHK (German Center for Cardiovascular Research), Partner Site
HH/Kiel/HL, Hamburg, Germany
(Birkemeyer) Herzklinik Ulm, Ulm, Germany
(Fillippatos) Department of Cardiology, School of Medicine, National and
Kapodistrian University of Athens, Attikon University Hospital, Athens,
Greece
(Lainscak) Division of Cardiology, General Hospital Murska Sobota, Murska
Sobota 9000, Slovenia
(Lainscak) Faculty of Medicine, University of Ljubljana, Ljubljana,
Slovenia
(Butler) Department of Medicine, University of Mississippi Medical Center,
Jackson, MS, United States
(Butler) Baylor Scott and White Research Institute, Dallas, TX, United
States
(Ponikowski) Center for Heart Diseases, University Hospital, Wroclaw
Medical University, Wroclaw, Poland
(Bohm) Department of Internal Medicine Clinic III, Saarland University
Hospital, Homburg/Saar, Germany
Publisher
Oxford University Press
Abstract
Background and Aims: Evidence is lacking that correcting iron deficiency
(ID) has clinically important benefits for patients with heart failure
with preserved ejection fraction (HFpEF). Method(s): FAIR-HFpEF was a
multicentre, randomized, double-blind trial designed to compare
intravenous ferric carboxymaltose (FCM) with placebo (saline) in 200
patients with symptomatic HFpEF and ID (serum ferritin < 100 ng/mL or
ferritin 100-299 ng/mL with transferrin saturation < 20%). The primary
endpoint was change in 6-min walking test distance (6MWTD) from baseline
to week 24. Secondary endpoints included changes in New York Heart
Association class, patient global assessment, and health-related quality
of life (QoL). Result(s): The trial was stopped because of slow
recruitment after 39 patients had been included (median age 80 years, 62%
women). The change in 6MWTD from baseline to week 24 was greater for those
assigned to FCM compared to placebo [least square mean difference 49 m,
95% confidence interval (CI) 5-93; P =. 029]. Changes in secondary
endpoints were not significantly different between groups. The total
number of adverse events (76 vs. 114) and serious adverse events (5 vs.
19; rate ratio 0.27, 95% CI 0.07-0.96; P =. 043) was lower with FCM than
placebo. Conclusion(s): In patients with HFpEF and markers of ID,
intravenous FCM improved 6MWTD and was associated with fewer serious
adverse events. However, the trial lacked sufficient power to identify or
refute effects on symptoms or QoL. The potential benefits of intravenous
iron in HFpEF with ID should be investigated further in a larger
cohort. Copyright © 2024 The Author(s).

<109>
Accession Number
2034916772
Title
Role of Prophylactic N-Acetylcysteine Supplementation on Postoperative
Outcomes in Patients Undergoing Elective Double-Valve Replacement (Aortic
and Mitral Valve).
Source
Annals of Cardiac Anaesthesia. 27(4) (pp 324-329), 2024. Date of
Publication: 2024.
Author
Ram Kiran K.S.; Trivedi V.; Rajesh V.S.P.; Sharma M.; Haranal M.; Pandya
H.
Institution
(Ram Kiran, Trivedi, Rajesh, Sharma) Department of Cardiac Anesthesia,
U.N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil
Hospital (Medicity Campus), Asarwa, Gujarat, Ahmedabad, India
(Haranal) Department of Cardiovascular and Thoracic Surgery, UN Mehta
Hospital, Gujarat, Ahmedabad, India
(Pandya) Department of Reaseach, UN Mehta Hospital, Gujarat, Ahmedabad,
India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Aims and Objectives: The incidence of postoperative liver dysfunction is
high in patients undergoing double-valve replacement-mitral and aortic
valve replacement (DVR). This study aims to evaluate N-acetylcysteine's
free radical scavenging property (NAC) to prevent postoperative liver
dysfunction in these patients, thus affecting overall clinical outcomes.
 Method(s): A single-center, prospective, randomized, double-blinded
interventional study of 60 patients divided into two groups of 30 each.
Group N received prophylactic intravenous NAC, and Group C received
volume-matched 5% dextrose. Data comprised demographics, liver function
tests (LFT), renal function tests (RFT), vasoactive-inotropic scores (VIS)
score, and C-reactive protein (CRP) at various time intervals.
Postoperative parameters such as ventilation duration, length of stay in
ICU (LOS-ICU), length of hospital stay (LOHS), atrial fibrillation (AF),
acute kidney injury (AKI) requiring hemodialysis, and mortality were
noted. Statistical analysis was performed with the Student's t-test and
Chi-square test (SPSS 22 software). Result(s): All postoperative LFT
parameters (total bilirubin, serum glutamic oxaloacetic transaminase
(SGOT), serum glutamic pyruvate transaminase (SGPT), and alkaline
phosphatase (ALP)) were significantly lower (P < 0.05) at 24, 48, and 72
hours in Group N compared to Group C. RFT and VIS scores were lower in
Group N; however, were not statistically significant except for Serum
Creatinine at 48 hours (P = 0.0478). Ventilation duration (P = 0.0465) and
LOS-ICU (P = 0.0431) were significantly lower in Group N. Other outcomes
like AF, LOHS, and mortality were lower in Group N but were not
statistically significant. Conclusion(s): Our study showed that
prophylactic administration of NAC in patients undergoing DVR is
associated with a reduction in the incidence of postoperative liver
dysfunction with a positive impact on postoperative outcomes. ©
2024 Copyright: 2024 Annals of Cardiac Anaesthesia.

<110>
Accession Number
2034916770
Title
Diagnostic Accuracy of a Novel Wireless, Bluetooth-Enabled Simultaneous
12-Lead Portable ECG Device Compared with Standard ECG in Preoperative
Patient Population.
Source
Annals of Cardiac Anaesthesia. 27(4) (pp 309-315), 2024. Date of
Publication: 2024.
Author
Borde D.P.; Khade S.; Joshi P.; Bhosale R.; Shinde P.; Takalkar U.;
Takalkar M.; Wavhal D.; George A.; Borgaonkar D.
Institution
(Borde, Khade, Joshi, Bhosale, Shinde) Ozone Anesthesia Group,
Maharashtra, Aurangabad, India
(Takalkar, Wavhal) Department of Surgery, Care Ciigma Hospital,
Maharashtra, Aurangabad, India
(Takalkar) Department of Anesthesia, Care Ciigma Hospital, Maharashtra,
Aurangabad, India
(George) Department of Cardiac Anesthesia, Lissie Hospital, Kerala, Kochi,
India
(Borgaonkar) Department of Cardiology, Seth Nandlal Dhoot Hospital,
Maharashtra, Aurangabad, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Objectives: Significant proportion of patients undergoing
various surgeries have abnormal ECG findings and it is known to have
prognostic value. Recently, portable ECG with Bluetooth technology with
smartphone have been gaining popularity. One such novel device, Wellnest
is a Bluetooth enabled portable ECG machine, can capture simultaneous 12
lead ECG on smartphone application. This is probably only such device
available device in India. The objective of this study was to test
diagnostic accuracy of Wellnest 12L ECG device compared to standard 12
lead ECG. Methods and Material: This was a Prospective, observational,
diagnostic accuracy study conducted at a tertiary care level hospital.
During, pre-anaesthesia check-up visit of 109 patients undergoing cardiac
and non-cardiac surgeries, whenever indicated, a preoperative 12 lead ECG
was done. The Wellnest 12 lead ECG was done within 24 hours of standard
ECG. Matching was done between Minnesota codes assigned to ECG findings of
Wellnest and standard 12 lead ECG. Also, grading of Wellnest ECG quality
was done as excellent, good, bad and poor. Result(s): In all, 216
various Minnesota codes were assigned to 109 patients undergoing various
surgeries. The primary endpoint of Wellnest ECG in comparison to standard
ECG were- sensitivity of 96.51% (CI 90.14- 99.27%); specificity of 86.96%
(CI 66.41- 97.22%); positive likelihood ratio of 7.4 (CI 2.57- 21.27) and
negative likelihood ratio of 0.04 (CI 0.01- 0.12). Performance of Wellnest
ECG as per individual Minnesota Codes compared to standard ECG was also
acceptable. Wellnest ECG was graded as excellent in 55(50%) patients, good
in 51(47%) patients and only 3 (3%) patients were graded as bad.
 Conclusion(s): Wellnest ECG had satisfactory performance in
comparison with standard 12 lead ECG in preoperative patient population.
It is easy to use, portable and can give simultaneous 12 leads ECG and its
use in preoperative population can be recommended. Copyright ©
2024 Annals of Cardiac Anaesthesia.

<111>
Accession Number
2034810020
Title
Effect of mannitol on postoperative delirium in patients undergoing
coronary artery bypass graft: a randomised controlled trial.
Source
Open Heart. 11(2) (no pagination), 2024. Article Number: e002743. Date of
Publication: 22 Aug 2024.
Author
Hemmati Maslakpak M.; Negargar S.; Farbod A.; Khalili A.; Bilehjani E.;
Alinejad V.; Faravan A.
Institution
(Hemmati Maslakpak) Maternal and Childhood Obesity Research Center,
Nursing and Midwifery School, Urmia University of Medical Sciences, Urmia,
Iran, Islamic Republic of
(Negargar, Bilehjani) Department of Anesthesia, Faculty of Medicine,
Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Farbod, Khalili) Cardiovascular Research Center, Madani Heart Center,
Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Alinejad) Department of Biostatistics, Urmia University of Medical
Sciences, Urmia, Iran, Islamic Republic of
(Faravan) Student Research Committee, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
Publisher
BMJ Publishing Group
Abstract
Objective Postoperative delirium (POD), especially after cardiac surgery
with cardiopulmonary bypass (CPB), is a relatively common and severe
complication increasing side effects, length of hospital stay, mortality
and healthcare resource costs. This study aimed to determine the impact of
using mannitol serum in the prime of CPB for preventing the occurrence of
delirium in patients undergoing coronary artery bypass surgery. Methods
This study is a single-centre, double-blinded, randomised, controlled
trial that was conducted from December 2022 to May 2023. Patients in the
age range of 18-70 who underwent elective coronary artery bypass surgery
were included in the study. In the control group (n=45), the prime
solution included Ringer's lactate serum. In the intervention group
(n=45), the prime solution consisted of 200 mL mannitol serum and Ringer's
lactate serum. The primary outcome of the study was the incidence of POD.
Secondary outcomes included the duration of mechanical ventilation, length
of stay in the intensive care unit (ICU) and 30-day in-hospital mortality.
Results There were no statistically significant differences in demographic
characteristics and risk factors between the control and intervention
groups (p<0.05). However, the incidence of POD was significantly lower in
the intervention group compared with the control group (22.25% vs 42.2%,
p=0.035). There were no significant differences between the two groups
regarding CPB time, aortic cross-clamp time, duration of mechanical
ventilation and length of stay in ICU (p<0.05). Additionally, mortality
rates and rates of return to the operating room did not differ
significantly between the two groups (p<0.05). Conclusions This study
concluded that adding mannitol to the prime of CPB pump can help reduce
the incidence of delirium after cardiac surgery. Copyright ©
Author(s) (or their employer(s)) 2024.

<112>
Accession Number
2034797011
Title
Anti-inflammatory effect of colchicine on organ damage during the
perioperative period of cardiac surgery: A study protocol for a
multicentre, randomised, double-blind, placebo-controlled clinical trial.
Source
BMJ Open. 14(9) (no pagination), 2024. Article Number: e084368. Date of
Publication: 12 Sep 2024.
Author
Li X.; Luo Y.; Cai X.; Lv Z.; Kong Y.; Guo Q.; Zhu J.; Pan T.; Wang D.
Institution
(Li, Luo, Guo, Pan, Wang) Department of Cardiac Surgery, Nanjing Drum
Tower Hospital, Chinese Academy of Medical Sciences, Peking Union Medical
College, Graduate School of Peking Union Medical College, Beijing, China
(Cai, Kong) Department of Cardiac Surgery, Nanjing Drum Tower Hospital,
Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
(Lv, Wang) Department of Cardiac Surgery, Nanjing Drum Tower Hospital, The
Affiliated Hospital, Nanjing University Medical School, Nanjing
University, Nanjing, China
(Zhu, Wang) Department of Cardiac Surgery, Nanjing Drum Tower Hospital,
Clinical College, Nanjing Medical University, Nanjing, China
Publisher
BMJ Publishing Group
Abstract
Introduction The systemic inflammatory response syndrome during the
perioperative period of cardiac surgery can lead to serious postoperative
complications and significantly increase the hospital mortality rate.
Colchicine, a widely used traditional anti-inflammatory drug, has good
clinical value in cardiovascular anti-inflammatory therapy. Our
preliminary single-centre study had confirmed the protective value of
colchicine in patients undergoing cardiac surgery with cardiopulmonary
bypass. For this multicentre investigation, we aim to further validate the
anti-inflammatory and organ-protective effects of low-dose colchicine
during the perioperative period in a low-risk population. Methods and
analysis This study is a multicentre, randomised, double-blind,
placebo-controlled clinical trial. A total of 768 patients undergoing
elective cardiac surgery will be enrolled from eight heart centres in
China. The participants will be randomly assigned to two groups: the
colchicine group will receive low-dose colchicine (0.5 mg once-a-day
dosing regimen (QD) orally for 3 days before the surgery and 0.5 mg dosing
frequency of every other day (QOD) continuously for 10 days after the
surgery), whereas the placebo group will be given starch tablets for the
same time and dosage. Primary endpoints are the occurrence of
postoperative inflammatory diseases, including postoperative atrial
fibrillation, acute respiratory distress syndrome, preoperative myocardial
injury and post-pericardiotomy syndrome. Secondary endpoints included
laboratory tests on postoperative days 1, 3, 5, 7 and 10, intensive care
unit data, APACHE II score, Murray lung injury score, medication-related
gastrointestinal reactions, 30-day and 90-day all-cause mortality,
surgical data, chest radiograph on postoperative days 1, 2 and 3, and
chest CT within 14 days after surgery. Ethics and dissemination This
research has received approval from the Medical Ethics Committee of
Affiliated Nanjing Drum Tower Hospital, Nanjing University Medical College
(approval number 2023-366-01). The study findings will be made available
by publishing them in an open access journal. Copyright ©
Author(s) (or their employer(s)) 2024.

<113>
Accession Number
2034429593
Title
Seated Pulmonary Artery Pressure Monitoring in Patients With Heart
Failure: Results of the PROACTIVE-HF Trial.
Source
JACC: Heart Failure. 12(11) (pp 1879-1893), 2024. Date of Publication:
November 2024.
Author
Guichard J.L.; Bonno E.L.; Nassif M.E.; Khumri T.M.; Miranda D.; Jonsson
O.; Shah H.; Alexy T.; Macaluso G.P.; Sur J.; Hickey G.; McCann P.; Cowger
J.A.; Badiye A.; Old W.D.; Raza Y.; Masha L.; Kunavarapu C.R.; Bennett M.;
Sharif F.; Kiernan M.; Mullens W.; Chaparro S.V.; Mahr C.; Amin R.R.;
Stevenson L.W.; Hiivala N.J.; Owens M.M.; Sauerland A.; Forouzan O.; Klein
L.
Institution
(Guichard, Bonno) Department of Medicine, Division of Cardiology, Section
for Advanced Heart Failure, Pulmonary Hypertension, and Mechanical
Circulatory Support, Prisma Health-Upstate, Greenville, SC, United States
(Nassif, Khumri) Saint Luke's Mid-American Heart Institute, Kansas City,
MO, United States
(Miranda, Bennett) Department of Cardiology, Minneapolis Heart Institute,
Minneapolis, MN, United States
(Jonsson) Department of Cardiology, Sanford Heart Hospital, Sioux Falls,
SD, United States
(Shah) Department of Cardiology, University of Kansas Medical Center,
Kansas City, KS, United States
(Alexy) Department of Cardiology, University of Minnesota Medical Center,
Minneapolis, MN, United States
(Macaluso, Sur) Department of Cardiology, Advocate Christ Medical Center,
Oak Lawn, IL, United States
(Hickey) Department of Cardiology, University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
(McCann) Department of Cardiology, Prisma Health, Columbia, SC, United
States
(Cowger) Division of Cardiovascular Medicine, Henry Ford Hospital,
Detroit, MI, United States
(Badiye, Old) Department of Cardiology, Sentara Healthcare, Norfolk, VA,
United States
(Raza) Department of Cardiology, Northwestern, Chicago, IL, United States
(Masha) Department of Cardiology, Oregon Health and Science University,
Portland, OR, United States
(Kunavarapu) Department of Cardiology, Methodist Healthcare, San Antonio,
TX, United States
(Sharif) Department of Cardiology, Galway University Hospital, Saolta
Group, CURAM and University of Galway, Galway, Ireland
(Kiernan) Cardiovascular Center, Division of Cardiology, Tufts Medical
Center, Boston, MA, United States
(Mullens) Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
and Hasselt University, Hasselt, Belgium
(Chaparro) Miami Cardiac and Vascular Institute, Division of Cardiology,
Baptist Health South Florida, Miami, FL, United States
(Mahr) Institute for Advanced Cardiac Care, Medical City, Dallas, TX,
United States
(Amin) Department of Cardiology, Ascension Sacred Heart Hospital,
Pensacola, FL, United States
(Stevenson) Division of Cardiology, Section of Heart Failure and Cardiac
Transplantation, Vanderbilt University Medical Center, Nashville, TN,
United States
(Hiivala, Owens, Sauerland, Forouzan) Clinical Science, Endotronix Inc,
Naperville, IL, United States
(Klein) Advanced Heart Failure Comprehensive Care Center and Division of
Cardiology, University of California-San Francisco, San Francisco, CA,
United States
Publisher
Elsevier Inc.
Abstract
Background: Monitoring supine pulmonary artery pressures to guide heart
failure (HF) management has reduced HF hospitalizations in select
patients. Objective(s): The purpose of this study was to evaluate the
effect of managing seated mean pulmonary artery pressure (mPAP) with the
Cordella Pulmonary Artery sensor on outcomes in patients with HF.
 Method(s): Following GUIDE-HF (Hemodynamic-GUIDEd Management of Heart
Failure Trial), with U.S. Food and Drug Administration input, PROACTIVE-HF
(A Prospective, Multi-Center, Open Label, Single Arm Clinical Trial
Evaluating the Safety and Efficacy of the Cordella Pulmonary Artery Sensor
System in NYHA Class III Heart Failure Patients trial) was changed from a
randomized to a single-arm, open label trial, conducted at 75 centers in
the USA and Europe. Eligible patients had chronic HF with NYHA functional
class III symptoms, irrespective of the ejection fraction, and recent HF
hospitalization and/or elevated natriuretic peptides. The primary
effectiveness endpoint at 6 months required the HF hospitalization or
all-cause mortality rate to be lower than a performance goal of 0.43
events/patient, established from previous hemodynamic monitoring trials.
Primary safety endpoints at 6 months were freedom from device- or
system-related complications or pressure sensor failure. Result(s):
Between February 7, 2020, and March 31, 2023, 456 patients were
successfully implanted in modified intent-to-treat cohort. The 6-month
event rate was 0.15 (95% CI: 0.12-0.20) which was significantly lower than
performance goal (0.15 vs 0.43; P < 0.0001). Freedom from device- or
system-related complications was 99.2% and freedom from sensor failure was
99.8% through 6 months. Conclusion(s): Remote management of seated
mPAP is safe and results in a low rate of HF hospitalizations and
mortality. These results support the use of seated mPAP monitoring and
extend the growing body of evidence that pulmonary artery pressure-guided
management improves outcomes in heart failure. (Multi-Center, Open Label,
Single Arm Clinical Trial Evaluating the Safety and Efficacy of the
Cordella Pulmonary Artery Sensor System in NYHA Class III Heart Failure
Patients trial [PROACTIVE-HF]; NCT04089059) Copyright © 2024 The
Authors

<114>
Accession Number
2031873257
Title
Skin infections due to bacteria in pediatric organ transplant recipients:
a systematic review.
Source
Archives of Dermatological Research. 316(10) (no pagination), 2024.
Article Number: 694. Date of Publication: December 2024.
Author
Mehta S.; Metko D.; Sibbald C.
Institution
(Mehta) Temerty Faculty of Medicine, University of Toronto, Toronto, ON,
Canada
(Metko) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Sibbald) Division of Pediatric Dermatology, The Hospital for Sick
Children, University of Toronto, Toronto, ON, Canada
Publisher
Springer Nature

<115>
Accession Number
2031863097
Title
Omega-3 Supplementation in Coronary Artery Bypass Graft Patients: Impact
on ICU Stay and Hospital Stay-A Systematic Review and Meta-Analysis.
Source
Nutrients. 16(19) (no pagination), 2024. Article Number: 3298. Date of
Publication: October 2024.
Author
Ouagueni A.; Shi Z.; Shraim M.; Al-Zoubi R.M.; Zarour A.; Al-Ansari A.;
Bawadi H.
Institution
(Ouagueni, Shi, Bawadi) Department of Human Nutrition, College of Health
Science, QU-Health, Qatar University, Doha 2713, Qatar
(Shraim) Department of Public Health, College of Health Science,
QU-Health, Qatar University, Doha 2713, Qatar
(Al-Zoubi, Al-Ansari) Surgical Research Section, Department of Surgery,
Hamad Medical Corporation, Doha 576214, Qatar
(Al-Zoubi) Department of Chemistry, Jordan University of Science and
Technology, P.O. Box 3030, Irbid 22110, Jordan
(Al-Zoubi) Department of Biomedical Sciences, College of Health Science,
Qatar University, Doha 2713, Qatar
(Zarour) Acute Care Surgery Division, Department of Surgery, Hamad Medical
Corporation, Doha 576214, Qatar
(Al-Ansari) Department of Surgery, Division of Urology/Andrology, Hamad
Medical Corporation, Doha 576214, Qatar
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Coronary artery bypass graft (CABG) is associated
with inflammation and complications, potentially leading to prolonged ICU
and hospital stays. Omega-3 PUFA has anti-inflammatory properties, thought
to potentially reduce complications in CABG patients. This study aims to
systematically review and meta-analyze the impact of perioperative omega-3
PUFA supplementation on total ICU and total hospital stays in CABG
patients; Methods: Randomized controlled trials examining the effects of
omega-3 PUFA supplementation (IV/oral) on ICU and hospital stays in CABG
patients were included. Studies were searched for in PubMed, EMBASE,
PsychINFO, CINAHL, and the Cochrane Central Register of Controlled Trial
databases, along with hand searching of reference lists. The quality and
risk of bias of the included studies were evaluated by two independent
reviewers using the revised Cochrane risk-of-bias tool. Meta-analysis was
performed using fixed or random effects models according to the level of
heterogeneity by mean difference with their 95% confidence intervals;
Results: Twelve studies were included in the qualitative analysis and
seven in the meta-analysis. Omega-3 PUFA was associated with a significant
reduction in days of hospital stay (-0.58 (95% CI -1.13, -0.04)). Subgroup
analysis showed that only oral omega-3 PUFA supplementation resulted in a
statistically significant reduction in length of hospitalization after
subgroup analysis with MD -0.6 (95% CI -1.17, -0.04); Conclusion(s):
This study suggests that perioperative omega-3 PUFA supplementation may
reduce the length of hospitalization in CABG patients, especially when
administered orally. However, the findings should be interpreted
cautiously due to the high level of heterogeneity. Copyright ©
2024 by the authors.

<116>
Accession Number
2031845473
Title
Ischemic stroke incidence in intermediate or high-risk patients undergoing
transcatheter aortic valve replacement versus surgical aortic valve
replacement: a comparative systematic review and meta-analysis.
Source
Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 60(1) (no
pagination), 2024. Article Number: 125. Date of Publication: December
2024.
Author
Rehman S.; Ghani M.; Riaz A.; Raza S.S.M.; Zahid M.; Malik M.H.Z.; Amir
A.; Lokesh E.; Ashrita K.; Kachhadia M.P.; Karmani V.K.
Institution
(Rehman) Department of Neurology, Jinnah Sindh Medical University, Sindh,
Karachi, Pakistan
(Ghani) Department of Internal Medicine, Allama Iqbal Medical College,
Punjab, Lahore, Pakistan
(Riaz) Ziauddin University, Sindh, Karachi, Pakistan
(Raza) Department of Internal Medicine, Karachi Medical and Dental
College, Sindh, Karachi, Pakistan
(Zahid) Department of Internal Medicine, Ziauddin University, Sindh,
Karachi, Pakistan
(Malik) Department of Internal Medicine, Jinnah Medical and Dental
College, Sindh, Karachi, Pakistan
(Amir) Department of Internal Medicine, Dow University of Health, Sindh,
Karachi, Pakistan
(Lokesh, Ashrita) Department of Internal Medicine, Osmania Medical
College, Gujarat, Hyderabad, India
(Kachhadia) Department of Internal Medicine, Pandit Deendayal Upadhyay
Medical College Rajkot, Gujarat, Rajkot, India
(Karmani) Department of Internal Medicine, Jinnah Sindh Medical
University, Sindh, Karachi, Pakistan
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background and purpose: This comparative systematic review and
meta-analysis investigated the incidence of ischemic stroke in
intermediate-to-high-risk patients undergoing transcatheter aortic valve
replacement versus surgical aortic valve replacement. Method(s): We
conducted a systematic review and meta-analysis following the PRISMA
guidelines, searching PubMed, Google Scholar, Embase, Web of Science, and
Cochrane CENTRAL databases from their inception to December 2023. The
evaluated outcomes were primarily incidence of stroke and transient
ischemic attack (TIA), along with other secondary safety end-points at 30
days and 1 year post-procedure. Odds ratios (ORs) with 95% confidence
intervals (CIs) were utilized for each study, employing a random-effects
model for data synthesis irrespective of heterogeneity. Statistical
heterogeneity was assessed using I2 statistics. All statistical
analyses were conducted using Review Manager. Result(s): We screened
8028 articles and included 8 studies consisting of 5 randomized controlled
trials and 3 observational studies. The studies examining 30-day and
1-year stroke incidence found no significant difference between TAVR and
SAVR patients (OR 0.83, 95% CI 0.59 to 1.17, p = 0.30, OR 0.92, 95% CI
0.64 to 1.33, p = 0.67, respectively). Both TAVR and SAVR also had a
comparable risk of having a transient ischemic attack within 30 days (OR
0.93, 95% CI 0.24 to 3.63, p = 0.92, I2 52%) and 1 year (OR
1.15, 95% CI 0.72 to 1.82, p = 0.56, I2 0%) following the
procedure. Regarding safety endpoints, TAVR had lower rates of all-cause
mortality and acute kidney injury at 1 year post-procedure, but a higher
incidence of major vascular complications at both 30 days and 1 year
compared with SAVR. Conclusion(s): The results suggest that TAVR and
SAVR have comparable outcomes for both TIA and stroke incidence at 30 days
and 1 year post-procedure, but display varying safety profiles in
intermediate-to-high surgical risk patients. Copyright © The
Author(s) 2024.

<117>
Accession Number
2031055150
Title
Predictive significance of cardio ankle vascular index for the assessment
of cardiovascular risk in hypertensive patients: A systematic review.
Source
Journal of Clinical Hypertension. 26(9) (pp 1005-1014), 2024. Date of
Publication: September 2024.
Author
Saravanan C.R.; Chowdhury S.R.; Inban P.; Chandrasekaran S.H.; Pattani
H.H.; Santoshi K.; Bamba H.; Singh G.; Prajjwal P.; Ranjan R.; Marsool
M.D.M.; Amir O.
Institution
(Saravanan) Internal Medicine, Madras Medical College, Chennai, India
(Chowdhury) Cardiology, Lincoln County Hospital, Lincoln, United Kingdom
(Inban) Internal Medicine, St. Mary's General Hospital and Saint Clare's
Health, New York, NY, United States
(Chandrasekaran) Internal Medicine, Vijaya Hospitals, Chennai, India
(Pattani) Internal Medicine, Gujarat University, Ahmedabad, India
(Santoshi) Internal Medicine, MNR Medical College, Sangareddy, India
(Bamba, Singh) Internal Medicine, Government Medical College and Hospital,
Chandigarh, India
(Prajjwal) Internal Medicine, Bharati Vidyapeeth Medical College Pune,
Pune, India
(Ranjan) SCGMC Nanded, Nanded, India
(Marsool) Internal Medicine, Al-Kindy College of Medicine, University of
Baghdad, Baghdad, Iraq
(Amir) Internal Medicine, Al-Manhal Academy, Khartoum, Sudan
Publisher
John Wiley and Sons Inc
Abstract
Cardio-ankle vascular index (CAVI) is an innovative indicator of
large-artery stiffness, which is evaluated by the pulse wave velocity
(PWV) measurement. Mortality and morbidity due to cardiovascular diseases
among the general public with high-risk conditions such as hypertension
are usually associated with arterial stiffness. CAVI modelizes the hazard
of future cardiovascular events with standard risk factors. Additionally,
the "European Society of Hypertension and Cardiology" included the aortic
PWV assessment in managing hypertension in their updated guidelines in
2007. We conducted this systematic review to collect, summarize, and
evaluate the evidence from relevant reported studies. A literature search
of four databases was conducted comprehensively until February 2024.
Cardiovascular events are the primary outcome of interest in this study,
cardiovascular events that have been defined as major adverse cardiac
events include "heart failure", "stroke", "myocardial infarction",
"cardiovascular deaths", "stable angina pectoris", "coronary
revascularization", and "unstable angina pectoris". We included five
studies with a 11 698 sample size in this systematic review. All five
prospective studies investigated composite cardiovascular events as an
outcome. Three of them revealed a statistically significant prediction
ability of CAVI to assess Cardiovascular disease (CVD) risk. Further
analysis is required. Current evidence is insufficient to confirm the
predictive power of CAVI in the assessment of cardiovascular risk in
hypertensive patients. CAVI is modestly associated with incidents of CVD
risk. It is necessary to conduct further studies to assess CAVI concerning
CVD predictor measures in the masses and nations other than
Asia. Copyright © 2024 The Author(s). The Journal of Clinical
Hypertension published by Wiley Periodicals LLC.

<118>
Accession Number
2030743585
Title
Effect of Alvimopan on Postoperative Ileus and Length of Hospital Stay in
Patients Undergoing Bowel Resection: A Systematic Review and
Meta-Analysis.
Source
American Surgeon. 90(12) (pp 3272-3283), 2024. Date of Publication:
December 2024.
Author
Murtaza R.; Clarke O.; Sivakanthan T.; Al-Sarireh H.; Al-Sarireh A.; Raza
M.M.; Navid A.Z.; Ali B.; Hajibandeh S.
Institution
(Murtaza) Department of General Surgery, Royal Gwent Hospital, Newport,
United Kingdom
(Clarke, Sivakanthan) Department of General Surgery, University Hospital
of Wales, Cardiff, United Kingdom
(Al-Sarireh) University of Leeds, Leeds, United Kingdom
(Al-Sarireh) University of Cambridge, Cambridge, United Kingdom
(Raza) King's School, Chester, United Kingdom
(Navid) Department of General Surgery, Royal Shrewsbury Hospital,
Shrewsbury, United Kingdom
(Ali) Department of General Surgery, Royal Oldham Hospital, Oldham, United
Kingdom
(Hajibandeh) Department of General surgery, Royal Stoke University
Hospital, Stoke-on-Trent, United Kingdom
(Hajibandeh) Department of General Surgery, Morriston Hospital, Swansea,
United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Aims: The aim is to investigate the effect of alvimopan on postoperative
ileus and length of hospital stay in patients undergoing bowel resection.
 Method(s): The PRISMA statement standards were followed to conduct a
systematic review and meta-analysis. The available literature was searched
to identify all studies comparing alvimopan with no alvimopan in patients
undergoing bowel resection. Postoperative ileus and length of hospital
stay were the primary outcomes, and time to first bowel motion was the
secondary outcome. Random-effects modeling was applied for analyses.
 Result(s): Analysis of 94 833 patients from 26 studies showed that
alvimopan was associated with lower risk of postoperative ileus (OR:.57,
95% CI.48 to.67, P <.00001; high GRADE certainty), shorter length of
hospital stay (MD: -1.08 day, 95% CI -1.36 to -.81, P <.00001; moderate
GRADE certainty), and shorter time to first bowel motion (MD: -.43 day,
95% CI -.58 to -.28, P <.00001; moderate GRADE certainty). Separate
analyses of randomized controlled trials and observational studies showed
similar findings. Subgroup analyses suggested consistent findings in
patients undergoing elective bowel resection, emergency bowel resection,
and open surgery; however, alvimopan did not improve the outcomes in
patients undergoing minimally invasive surgery. Conclusion(s): Robust
evidence supports the routine use of alvimopan in patients undergoing open
bowel resection as indicated by lower risk of postoperative ileus and
shorter length of hospital stay. We support incorporation of alvimopan
into enhanced recovery after surgery programs for the procedures involving
open bowel resection. The role of alvimopan in minimally invasive bowel
resection needs more research. Copyright © The Author(s) 2024.

<119>
Accession Number
2029060633
Title
Cytomegalovirus Treatment in Solid Organ Transplantation: An Update on
Current Approaches.
Source
Annals of Pharmacotherapy. 58(11) (pp 1122-1133), 2024. Date of
Publication: November 2024.
Author
Hardinger K.L.; Brennan D.C.
Institution
(Hardinger) Division of Pharmacy Practice and Administration, School of
Pharmacy, University of Missouri-Kansas City, Kansas, MO, United States
(Brennan) Johns Hopkins Comprehensive Transplant Center, Baltimore, MD,
United States
Publisher
SAGE Publications Inc.
Abstract
Objective: The article reviews the safety and efficacy of treatments for
cytomegalovirus (CMV) in solid organ transplantation. Data Sources: A
literature review was conducted in PubMed, MEDLINE, and Clinicaltrials.gov
from database inception through January 2024, using terms CMV, therapy,
and solid organ transplantation. Study Selection and Data Extraction:
Clinical trials, meta-analyses, cohort studies, case reports, and
guidelines were included. Letters to the editor, reviews, and commentaries
were excluded. Data Synthesis: After abstract screening and full-text
review of 728 citations for eligibility, 53 were included. Valganciclovir
and intravenous ganciclovir are drugs of choice for CMV management and,
until recently, the availability of alternative options has been
restricted due to toxicity. For instance, foscarnet and cidofovir serve as
second-line agents due to potential bone marrow and renal toxicity. In
patients with refractory or resistant CMV, maribavir, a novel oral agent,
has proven efficacy and a lower adverse effect profile. However, in
refractory or resistant CMV, foscarnet and cidofovir are preferred in
invasive disease (CMV gastritis, CMV retinitis, and CMV encephalitis),
high viral loads, and inability to tolerate oral preparations. Relevance
to Patient Care and Clinical Practice: Consensus guidelines have not been
revised since approval of novel antivirals in solid organ transplantation.
Valganciclovir and ganciclovir remain drugs of choice for initial CMV
therapy. Foscarnet, cidofovir, and maribavir are treatments for refractory
or resistant-CMV. Conclusion(s): Selection of CMV antiviral treatment
should be determined by patient-specific factors, including severity of
illness, resistant or refractory disease, dose-limiting adverse effects,
and the preferred route of administration. Copyright © The
Author(s) 2024.

<120>
Accession Number
2034992789
Title
The Syria and Turkey earthquakes: A note for cardiothoracic surgeons.
Source
Annals of Medicine and Surgery. 85(9) (pp 4199-4200), 2023. Date of
Publication: 31 Jul 2023.
Author
Mashadi A.H.; Alassiri A.K.; Abdelwahab M.M.; Awad A.K.
Institution
(Mashadi) Department of Biomedical Sciences, Rosalind Franklin School of
Medicine and Science, Chicago, IL, United States
(Abdelwahab) University of Minnesota Twin Cities Medical School,
Minneapolis, MN, United States
(Alassiri) Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi
Arabia
(Awad) Faculty of Medicine, Ain Shams University, Cairo, Egypt
Publisher
Lippincott Williams and Wilkins

<121>
Accession Number
645570465
Title
Outcomes with revascularisation versus conservative management of
participants with 3-vessel coronary artery disease in the ISCHEMIA trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
20(20) (pp e1276-e1287), 2024. Date of Publication: 21 Oct 2024.
Author
Bangalore S.; Rhodes G.; Maron D.J.; Anthopolos R.; O'Brien S.M.; Jones
P.G.; Mark D.B.; Reynolds H.R.; Spertus J.A.; Stone G.W.; White H.D.; Xu
Y.; Fremes S.E.; Hochman J.S.; Ischemia Research Group O.B.O.T.
Institution
(Bangalore, Anthopolos, Reynolds, Xu, Hochman) Department of Medicine, New
York University Grossman School of Medicine, New York, NY, USA
(Rhodes, O'Brien, Mark) Duke Clinical Research Institute, Durham, NC,
United States
(Maron) Department of Medicine, Stanford University, Stanford, CA, United
States
(Jones, Spertus) Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City, MO, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, USA
(White) Te Whatu Ora Health New Zealand, Green Lane Cardiovascular
Services and University of Auckland, Auckland, New Zealand
(Fremes) University of Toronto, Sunnybrook Health Sciences Centre,
Toronto, ON, Canada
Abstract
BACKGROUND: Whether revascularisation (REV) improves outcomes in patients
with three-vessel coronary artery disease (3V-CAD) is uncertain. AIMS: Our
objective was to evaluate outcomes with REV (percutaneous coronary
intervention [PCI] or coronary artery bypass graft surgery [CABG]) versus
medical therapy in patients with 3V-CAD. METHOD(S): ISCHEMIA
participants with 3V-CAD on coronary computed tomography angiography
without prior CABG were included. Outcomes following initial invasive
management (INV) with REV (PCI or CABG) versus initial conservative
management (CON) with medical therapy alone were evaluated. Regression
modelling was used to estimate the outcomes if all participants were to
undergo prompt REV versus those assigned to CON. Outcomes were
cardiovascular (CV) death/myocardial infarction (MI), death, CV death, and
quality of life. Bayesian posterior probability for benefit (Pr [benefit])
for 1 percentage point lower 4-year rates with REV versus CON were
evaluated. RESULT(S): Among 1,236 participants with 3V-CAD (612
INV/624 CON), REV was associated with lower 4-year CV death/MI (adjusted
4-year difference: -4.4, 95% credible interval [CrI] -8.7 to -0.3
percentage points, Pr [benefit]=94.8%) when compared with CON, with
similar results for PCI versus CON (-5.8, 95% CrI: -10.8 to -0.5
percentage points, Pr [benefit]=96.4%) and CABG versus CON (-3.7, 95% CrI:
-8.8 to 1.5 percentage points, Pr [benefit]=84.7%). Adjusted 4-year REV
versus CON differences were as follows: death -1.2 (95% CrI: -4.7 to 2.2)
percentage points, CV death -2.3 (95% CrI: -5.5 to 0.8) percentage points,
with similar results for PCI and for CABG. The Pr (benefit) for death with
REV (PCI or CABG) versus CON was 49-63%. The adjusted 12-month Seattle
Angina Questionnaire-7 summary score differences favoured REV: REV versus
CON 4.6 (95% CrI: 2.7-6.4) percentage points; PCI versus CON 3.6 (95% CrI:
1.2-5.8) percentage points and CABG versus CON 4.3 (95% CrI: 1.5-6.9)
percentage points with high Pr (benefit). CONCLUSION(S): In
participants with 3V-CAD, REV (either PCI or CABG) was associated with a
lower 4-year CV death/MI rate and improved quality of life, with similar
results for PCI versus CON and CABG versus CON. The differences in
all-cause mortality between REV and CON were small with wide confidence
intervals. (ClinicalTrials.gov: NCT01471522).

<122>
Accession Number
644836730
Title
Effects of telephone nursing education and counselling on discharge
satisfaction level and self-care strength of patients after coronary
artery bypass grafting.
Source
ANZ journal of surgery. 94(10) (pp 1768-1775), 2024. Date of Publication:
01 Oct 2024.
Author
Ilgin V.E.; Oral S.E.; Gurkan Z.; Ozer N.
Institution
(Ilgin, Ozer) Faculty of Nursing, Department of Surgical Nursing, Ataturk
University, Erzurum, Turkey
(Oral) Faculty of Nursing, Department of Surgical Nursing, Kars
University, Kars, Turkey
(Gurkan) Faculty of Health Sciences, Department of Surgical Nursing,
Yuzuncu Yil University, Van, Turkey
Abstract
BACKGROUND: The aim of this study was to determine the effects of nursing
education and counselling provided by telephone to individuals undergoing
coronary artery bypass graft surgery on their discharge satisfaction
levels and self-care power levels. METHOD(S): The study was conducted
using a randomized controlled experimental research model with a
pre-test-post-test control group (30 individuals in the experiment group
and 30 individuals in the control group). Routine nursing care was applied
to the patients in the control group throughout their attendance, and no
training or intervention was made after discharge. By contrast, in
addition to routine nursing care, the for 4weeks in the experimental group
received nursing education and counselling services by phone in the
post-discharge period. A 'Personal Information Form,' 'Discharge Training
Satisfaction Scale,' and 'Self-Care Strength Scale,' which were prepared
by the researchers and included the personal information of the patients,
were used to collect the data. RESULT(S): The difference between the
pre-test self-care power scale and discharge education satisfaction scale
sub-dimensions of the groups and the mean score of the total score was not
statistically significant. The post-test self-care power scale and
discharge education satisfaction scale sub-dimensions and total score
averages of the patients in the experimental group were higher than in the
control group, and the difference between them was statistically
significant (P<0.05). CONCLUSION(S): The nursing education and
counselling services given to the patients on the phone increased their
self-care skill levels and discharge satisfaction levels. Copyright
© 2024 Royal Australasian College of Surgeons.

<123>
Accession Number
2031824815
Title
Augmented Reality Implementation in Minimally Invasive Surgery for Future
Application in Pulmonary Surgery: A Systematic Review.
Source
Surgical Innovation. 31(6) (pp 646-658), 2024. Date of Publication:
December 2024.
Author
Doornbos M.-C.J.; Peek J.J.; Maat A.P.W.M.; Ruurda J.P.; De Backer P.;
Cornelissen B.M.W.; Mahtab E.A.F.; Sadeghi A.H.; Kluin J.
Institution
(Doornbos, Peek, Maat, Mahtab, Sadeghi, Kluin) Department of
Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Doornbos) Educational Program Technical Medicine, Leiden University
Medical Center, Delft University of Technology, Erasmus University Medical
Center Rotterdam, Leiden, Netherlands
(Ruurda) Department of Surgery, University Medical Center Utrecht,
Utrecht, Netherlands
(De Backer) ORSI Academy, Melle, Belgium
(Cornelissen) Department of Cranio-Maxillofacial surgery, Erasmus MC,
Rotterdam, Netherlands
(Mahtab) Department of Cardiothoracic Surgery, Leiden University Medical
Center, Leiden, Netherlands
(Sadeghi) Department of Cardiothoracic Surgery, University Medical Center
Utrecht, Netherlands
Publisher
SAGE Publications Inc.
Abstract
Objective: This systematic review investigates of Augmented Reality (AR)
systems used in minimally invasive surgery of deformable organs, focusing
on initial registration, dynamic tracking, and visualization. The
objective is to acquire a comprehensive understanding of the current
knowledge, applications, and challenges associated with current
AR-techniques, aiming to leverage these insights for developing a
dedicated AR pulmonary Video or Robotic Assisted Thoracic Surgery
(VATS/RATS) workflow. Method(s): A systematic search was conducted
within Embase, Medline (Ovid) and Web of Science on April 16, 2024,
following the Preferred Reporting items for Systematic Reviews and
Meta-Analyses (PRISMA). The search focused on intraoperative AR
applications and intraoperative navigational purposes for deformable
organs. Quality assessment was performed and studies were categorized
according to initial registration and dynamic tracking methods.
 Result(s): 33 articles were included, of which one involved pulmonary
surgery. Studies used both manual and (semi-) automatic registration
methods, established through anatomical landmark-based, fiducial-based, or
surface-based techniques. Diverse outcome measures were considered,
including surgical outcomes and registration accuracy. The majority of
studies that reached an registration accuracy below 5 mm applied
surface-based registration. Conclusion(s): AR can potentially aid
surgeons with real-time navigation and decision making during anatomically
complex minimally invasive procedures. Future research for pulmonary
applications should focus on exploring surface-based registration methods,
considering their non-invasive, marker-less nature, and promising
accuracy. Additionally, vascular-labeling-based methods are worth
exploring, given the importance and relative stability of broncho-vascular
anatomy in pulmonary VATS/RATS. Assessing clinical feasibility of these
approaches is crucial, particularly concerning registration accuracy and
potential impact on surgical outcomes. Copyright © The Author(s)
2024.

<124>
Accession Number
2031924427
Title
Meta-analysis of improved mitral regurgitation after aortic valve
replacement.
Source
Perfusion (United Kingdom). (no pagination), 2024. Date of Publication:
2024.
Author
Naito N.; Takagi H.
Institution
(Naito, Takagi) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Publisher
SAGE Publications Ltd
Abstract
Background: This meta-analysis aimed to compare survival outcomes among
patients experiencing improvement in untreated significant mitral
regurgitation (MR) following surgical aortic valve replacement (SAVR) or
transcatheter aortic valve replacement (TAVR) for severe aortic stenosis,
in contrast to those without improvement. Method(s): We conducted a
comprehensive search through February 2024. Pooled hazard ratios (HR) with
95% confidence intervals (CI) were computed. Kaplan-Meier curves depicting
all-cause mortality were reconstructed using individual patient data
derived from the included studies. Result(s): A systematic review
identified twelve non-randomized studies encompassing 4040 patients. The
pooled all-cause mortality of the meta-analysis demonstrated a significant
reduction in patients whose MR improved compared to those with persistent
MR after aortic valve replacement (AVR) (HR [95% CI] = 0.55 [0.47-0.64], p
<.01). The hazard ratio, derived from reconstructed time-to-event data,
indicated lower all-cause mortality in patients with improved MR after AVR
relative to the other cohort (HR [95% CI] = 0.50 [0.40-0.62], p <.01 in
all patients, 0.48 [0.34-0.68], p <.01 in patients undergoing SAVR, and
0.58 [0.42-0.80], p <.01 in those receiving TAVR). Conclusion(s): In
conclusion, this meta-analysis revealed that improved MR after AVR,
whether surgically or by transcatheter approach, correlates with superior
survival. The benefits of simultaneous or staged intervention on the
mitral valve in individuals undergoing AVR warrant validation in future
investigations. Copyright © The Author(s) 2024.

<125>
Accession Number
2031898020
Title
The prognostic utility of galectin-3 in patients undergoing cardiac
surgery: a scoping review.
Source
Biomarkers. (no pagination), 2024. Date of Publication: 2024.
Author
Shah A.; Ding Y.; Walji D.; Rabinovich G.A.; Pelletier M.; El-Diasty M.
Institution
(Shah) School of Medicine, Queen's University, Kingston, ON, Canada
(Ding) Institute of Biomedical Engineering, Faculty of Applied Science and
Engineering, University of Toronto, Toronto, ON, Canada
(Walji, El-Diasty) Faculty of Health Sciences, Queen's University,
Kingston, ON, Canada
(Rabinovich) Laboratorio de Glicomedicina, Instituto de Biologia y
Medicina Experimental, Consejo Nacional de Investigaciones Cientificas y
Tecnicas (CONICET) and Facultad de Ciencias Exactas y Naturales,
Universidad de Buenos Aires, Buenos Aires, Argentina
(Pelletier, El-Diasty) Cardiac Surgery Department, University Hospitals
Cleveland Medical Center, Cleveland, OH, United States
Publisher
Taylor and Francis Ltd.
Abstract
Objective: To review the utility of galectin-3 (Gal-3) as a biomarker for
postoperative adverse outcomes in patients undergoing cardiac surgery.
 Method(s): This review was conducted in compliance with the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines. Electronic database search was conducted in October 2023.
Studies that measured pre- and/or postoperative plasma Gal-3 levels in
adult patients undergoing cardiac surgery were included. Primary outcomes
included postoperative morbidity and mortality. Result(s): Out of 391
studies screened, eight studies met the inclusion criteria. Two of the
three studies showed that preoperative plasma levels of Gal-3 were
associated with acute kidney injury (AKI) after cardiac surgery. Two of
the three studies reported a significant increase in preoperative Gal-3
levels in patients who developed postoperative atrial fibrillation (POAF).
The addition of Gal-3 to the EuroSCORE II model was found to statistically
improve the prediction of both AKI and POAF. Three of the five studies
suggested that Gal-3 levels can predict postoperative mortality. Finally,
one study suggested that lower preoperative Gal-3 levels was associated
with a higher likelihood of achieving left ventricular reverse remodeling
(LVRR) after surgery. Conclusion(s): Gal-3 may play a promising role
in predicting adverse outcomes in patients undergoing cardiac surgery. The
addition of Gal-3 to clinical risk prediction scores may improve their
discriminatory power in this group of patients. Future studies are
warranted to justify its incorporation into routine clinical
practice. Copyright © 2024 Informa UK Limited, trading as Taylor
& Francis Group.

<126>
Accession Number
645577202
Title
Large bore access for transcatheter aortic valve replacement, endovascular
aortic repair, and thoracic endovascular aortic repair. A review of
anatomic challenges and operative considerations.
Source
The Journal of cardiovascular surgery. (no pagination), 2024. Date of
Publication: 22 Oct 2024.
Author
Pozolo C.G.; Giese A.S.; Babrowski T.A.
Institution
(Pozolo) Division of Vascular Surgery, Department of Surgery, Mike
O'Callaghan Military Medical Center, Nellis Air Force Base, NV, United
States
(Giese) Division of Vascular and Endovascular Surgery, Department Surgery,
University of California - Davis, Sacramento, CA, United States
(Babrowski) Section of Vascular Surgery and Endovascular Therapy,
Department of Surgery, University of Chicago Medical Center, Chicago, IL,
United States
Abstract
INTRODUCTION: Transcatheter aortic valve replacement (TAVR), endovascular
aortic repair (EVAR), and thoracic endovascular aortic repair (TEVAR) are
standard and prolific procedures in the modern cardiovascular world, and
appropriate delivery of these endoprostheses requires adequate
understanding of the requisite large bore access. Percutaneous large bore
access is the preferred route but may be accompanied by complications like
thrombosis, hemorrhage, or inability to deliver the device. Anatomic
limitations such as vessel tortuosity, small size, and heavy calcification
may require alternative approaches for successful large bore access. This
study aimed to better define large bore access, as well as to elucidate
optimal adjuncts and alternatives to enable successful delivery of large
bore endoprostheses. EVIDENCE ACQUISITION: A systematic review for "large
bore access" in the cardiovascular literature was conducted on PubMed and
the Cochrane Library Central according to PRISMA guidelines. Identified
articles were filtered and sub-selected for TAVR, EVAR, and TEVAR; studies
related to other large bore interventions were excluded. EVIDENCE
SYNTHESIS: A representative selection of 39 full-text studies included
both cardiac and vascular studies and was critically interpreted to
identify a consensus definition for large bore access, challenging
anatomy, and adjuncts or alternative approaches to the standard
transfemoral approach. CONCLUSION(S): Transfemoral access remains the
first-line approach but in the setting of unfavorable anatomy, adjunct
maneuvers (e.g. intravascular lithotripsy, endoconduits) or alternative
approaches (supra-aortic, transcaval) help decrease morbidity, mortality,
length of procedure, and overall health care cost in large bore access.

<127>
Accession Number
645576531
Title
Does the experience of the endoscopic vein harvester matter to the quality
of the vein conduit: A critical thematic literature review.
Source
Journal of perioperative practice. (pp 17504589241288512), 2024. Date of
Publication: 22 Oct 2024.
Author
Kay M.; Abouelela Y.; Raaj S.; Krishnamoorthy B.
Institution
(Kay, Abouelela) Department of Cardiothoracic Surgery, Essex
Cardiothoracic Centre, Basildon, United Kingdom
(Raaj) Faculty of Medicine, Imperial College School of Medicine, London,
United Kingdom
(Krishnamoorthy) School of Nursing & Midwifery, University of Salford,
Manchester, United Kingdom
(Krishnamoorthy) Department of Cardiothoracic Surgery, Manchester NHS
Foundation Trust, Manchester, United Kingdom
Abstract
Coronary artery bypass graft surgery remains the golden standard surgical
option for multiple vessel disease. Harvesting the long saphenous vein
using endoscopic vein harvesting requires advanced surgical skills
dexterity, but the lack of a national standardised training programme
allows for variance in the learning curve and the quality of the vein
during the learning cycle is unknown. A search of bibliographic databases:
CINHAL Plus, Embase, Pubmed and the Cochrane register for randomised
controlled trials identified 11 articles eligible for review. The themes
emerging were learning curve-associated injuries to the long saphenous
vein, intimal wall remodelling of the long saphenous vein and incidence of
graft patency rates. Harvesting practitioners with less than 100 cases of
experience inflict more conduit injuries leading to endothelial
remodelling and narrowed vein grafts at the six-month point resulting in
lumen loss. Practitioners with more than 100 cases demonstrated reduced
learning curve-related injuries on the conduit. Adopting a formalised
structured training programme such as the Manchester Endoscopic Learning
Tool has shown to reduce endothelial injury to the long saphenous vein
minimising early vein graft failure during the learning cycle.

EPICORE Embase Updates

Saturday, November 2, 2024

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

No comments:

Post a Comment

Followers

Blog Archive

About Me