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

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<1>
Accession Number
2035673812
Title
Transcaval access for transcatheter aortic valve implantation: A
meta-analysis and systematic review.
Source
International Journal of Cardiology. 419 (no pagination), 2025. Article
Number: 132720. Date of Publication: 15 Jan 2025.
Author
Abraham B.; Sous M.; Kaldas S.; Nakhla M.; Sweeney J.; Lee K.; Garcia S.;
Saad M.; Goel S.S.; Fortuin F.D.
Institution
(Abraham, Kaldas, Sweeney, Lee, Fortuin) Department of Cardiology, Mayo
Clinic, Phoenix, AZ, United States
(Sous) Department of Medicine, Amita Health Saint Francis Hospital,
Evanston, IL, United States
(Nakhla) Department of Internal Medicine, Saint Vincent Hospital,
Worcester, MA, United States
(Garcia) Department of Cardiovascular Disease, The Christ Hospital,
Cincinnati, OH, United States
(Saad) Lifespan Cardiovascular Institute and Division of Cardiology,
Warren Alpert Medical School of Brown University, Providence, RI, United
States
(Goel) Department of Cardiovascular Disease, Houston Methodist Hospital,
Houston, TX, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Anatomical factors may preclude transfemoral (TF) arterial
access for transcatheter aortic valve implantation (TAVI). Transcaval
(TCav) access has been utilized as an alternative access for these
patients. We aimed to investigate the outcomes of TCav access in patients
undergoing TAVI. Method(s): We performed a systematic review and
meta-analysis including all published studies from 1996 to November 2023
that examined TCav access in patients undergoing TAVI. The main outcomes
included all cause mortality, major vascular complications, major
bleeding, stroke, and myocardial infarction (MI). Outcomes were reported
at 30-day and 1-year follow-up. Result(s): We included 8
observational studies with a total of 517 patients (mean age 78.1+/-8
years, 56.6 % women, mean STS score 7 +/- 4.5). Mean (SD) procedure time
was 35 +/- 9.8 mins and mean (SD) contrast volume was 136.3 +/- 77.4 ml.
Procedure success was achieved in 94.3 % of the patients. At 30-day
follow-up, all-cause mortality occurred in 6.4 %, major bleeding in 12.2
%, blood transfusion in 23.3 %, retroperitoneal bleeding in 19 %, major
vascular complications in 7.9 %, MI in 2.8 %, and AKI in 6.4 % of
patients. At 1-year, all-cause mortality was 14.7 %. In a sub-group
analysis including 3 studies comparing TCav (n = 316) to alternative
accesses (including transcarotid, transaxillary, and transapical) (n =
303), there were no differences in all-cause mortality, major bleeding,
major vascular complications, blood transfusion, or stroke at 30-day.
 Conclusion(s): Transcaval approach is feasible and non-inferior to
other alternative accesses in TAVI patients with prohibitive iliofemoral
anatomy. Copyright © 2024 Elsevier B.V.

<2>
Accession Number
2035429857
Title
Timing of Aortic Valve Intervention in the Management of Aortic Stenosis.
Source
JACC: Cardiovascular Interventions. 17(21) (pp 2502-2514), 2024. Date of
Publication: 11 Nov 2024.
Author
Maznyczka A.; Prendergast B.; Dweck M.; Windecker S.; Genereux P.;
Hildick-Smith D.; Bax J.; Pilgrim T.
Institution
(Maznyczka, Windecker, Pilgrim) Department of Cardiology, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
(Prendergast) St Thomas' Hospital and Cleveland Clinic London, London,
United Kingdom
(Dweck) British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Edinburgh, United Kingdom
(Genereux) Department of Cardiology, Gagnon Cardiovascular Institute,
Morristown Medical Center, Morristown, NJ, United States
(Hildick-Smith) Sussex Cardiac Centre, Royal Sussex County Hospital,
University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
(Bax) Department of Cardiology, Leiden University Medical Center, Leiden,
Netherlands
Publisher
Elsevier Inc.
Abstract
Aortic stenosis (AS) affects about 12% of people aged >=75 years.
Accumulating evidence on the prognostic importance of cardiac damage in
patients with asymptomatic and less than severe AS supports the
proposition of advancing aortic valve replacement (AVR) to earlier disease
stages. Potential benefits of earlier treatment, including prevention of
cardiac damage progression and reduced cardiovascular hospitalizations,
need to be balanced against the earlier procedural risk and subsequent
lifetime management after AVR. Two small, randomized trials indicate that
early surgical AVR may improve survival in patients with asymptomatic
severe AS, and observational data suggest that AVR may reduce mortality
even in patients with moderate AS. A clear understanding of the
pathophysiology of cardiac damage secondary to AS is needed to develop
strategies to select patients for earlier AVR. Noninvasive imaging can
detect early cardiac damage, and indices such as fibrosis, global
longitudinal strain, and myocardial work index have potential use to guide
stratification of patients for earlier AVR. Ongoing randomized trials are
investigating the safety and efficacy of AVR for patients with
asymptomatic severe AS and those with moderate AS who have
symptoms/evidence of cardiac damage. Pathophysiological considerations and
accumulating evidence from clinical studies that support earlier timing of
AVR for AS will need to be corroborated by the results of these trials.
This review aims to evaluate the evidence for earlier AVR, discuss
strategies to guide stratification of patients who may benefit from this
approach, highlight the relevant ongoing randomized trials, and consider
the consequences of earlier intervention. Copyright © 2024 The
Authors

<3>
Accession Number
365367283
Title
A meta-analysis of renal benefits to pulsatile perfusion in cardiac
surgery.
Source
Journal of Extra-Corporeal Technology. 44(1) (pp 10-14), 2012. Date of
Publication: 2012.
Author
Sievert A.N.; Sistino J.
Institution
(Sievert, Sistino) Medical University of South Carolina, Charleston, SC,
United States
Publisher
American Society of Extra-Corporeal Technology
Abstract
Multiple studies have evaluated the efficacy of pulsatile flow during
cardiopulmonary bypass (CPB) showing controversial results. Suggested
benefits to pulsatile perfusion include reducing the systemic inflammatory
response syndrome associated with bypass, decreased need for inotropic
support, shortened hospital stay, and superior organ preservation. This
study aims to compare prior studies to determine if there is a significant
difference in post-operative renal function with pulsatile perfusion
compared to non-pulsatile perfusion during cardiac surgery. Studies
included in the analysis were identified by searching keywords - pulsatile
perfusion, pulse, pulsatile flow, cardiopulmonary bypass, and cardiac
surgery. To maintain a homogenous sample, manuscripts were included if
they met the following criteria: research was prospective in nature,
subjects were human, paper contained documented baseline demographics,
outcome data included markers of renal function. A meta-analysis was
performed to compare post-op renal function between pulsatile and
non-pulsatile perfusion groups. A total of 298 articles were screened. Ten
articles met the criteria, of these, 477 patients underwent non-pulsatile
perfusion while 708 received pulsatile perfusion during CPB. There was
insufficient evidence to show a difference in mean postoperative
creatinine or BUN between the groups, however, the pulsatile perfusion
group had significantly higher creatinine clearance (standardized
difference in means = 2.48, p =.004) and lower serum lactate levels
(standardized difference in means = -2.08, p =.012) in the intensive care
unit. This study found that there is great variability among pulsatile
perfusion research. The methods to create and assess effective pulsatility
on bypass varied widely among manuscripts. This analysis suggests that
pulsatile perfusion during CPB is beneficial in renal preservation and
should be considered. © 2011 AmSECT.

<4>
Accession Number
368635604
Title
Psychological depression and cardiac surgery: A comprehensive review.
Source
Journal of Extra-Corporeal Technology. 44(4) (pp 224-232), 2012. Date of
Publication: December 2012.
Author
Tully P.J.
Institution
(Tully) Department of Surgery, Flinders Medical Centre, Flinders
University of South Australia, Bedford Park, SA, Australia
(Tully) The School of Psychology, The University of Adelaide, Adelaide,
SA, Australia
(Tully) The Discipline of Psychiatry, The University of Adelaide,
Adelaide, SA, Australia
(Tully) The Heart Failure Self Management Program, Ambulatory and Primary
Healthcare Directorate, Hampstead Rehabilitation Centre, Northfield,
Australia
Publisher
American Society of Extra-Corporeal Technology
Abstract
The psychological and neurological impact of cardiac surgery has been of
keen empirical interest for more than two decades although reports showing
the prognostic influence of depression on adverse outcomes lag behind the
evidence documented in heart failure, myocardial infarction, and unstable
angina. The paucity of research to date is surprising considering that
some pathophysiological mechanisms through which depression is
hypothesized to affect coronary heart disease (e.g., platelet activation,
the inflammatory system, dysrhythmias) are known to be substantially
influenced by the use of cardiopulmonary bypass. As such, cardiac surgery
may provide a suitable exemplar to better understand the psychiatric
mechanisms of cardiopathogenesis. The extant literature is comprehensively
reviewed with respect to the deleterious impact of depression on cardiac
and neuropsychological morbidity and mortality. Research to date indicates
that depression and major depressive episodes increase major
cardiovascular morbidity risk after cardiac surgery. The association
between depressive disorders and incident delirium is of particular
relevance to cardiac surgery staff. Contemporary treatment intervention
studies are also described along with suggestions for future cardiac
surgery research.

<5>
Accession Number
2035709030
Title
Role of Beta Blockers After Acute Coronary Syndrome With Preserved
Ejection Fraction.
Source
American Journal of Cardiology. 235 (pp 73-75), 2025. Date of Publication:
15 Jan 2025.
Author
Singh S.; Bliden K.; Tantry U.S.; Gurbel P.A.; Kanjwal M.Y.; Lundgren S.W.
Institution
(Singh) Department of Medicine
(Bliden, Tantry) Sinai Center for Thrombosis Research, United States
(Gurbel, Kanjwal) Division of Cardiology, Sinai Hospital of Baltimore,
Baltimore, Maryland, United States
(Lundgren) Division of Cardiology, University of Nebraska Medical Center,
Omaha, NE, United States
Publisher
Elsevier Inc.

<6>
Accession Number
2034806637
Title
Efficacy of intravenous iron supplementation in reducing transfusion risk
following cardiac surgery: an updated meta-analysis of randomised
controlled trials.
Source
British Journal of Anaesthesia. 133(6) (pp 1137-1149), 2024. Date of
Publication: December 2024.
Author
Hung K.-C.; Chang L.-C.; Ho C.-N.; Hsu C.-W.; Yu C.-H.; Wu J.-Y.; Lin
C.-M.; Chen I.-W.
Institution
(Hung, Ho, Yu, Lin) Department of Anesthesiology, Chi Mei Medical Center,
Tainan City, Taiwan (Republic of China)
(Hung) Department of Hospital and Health Care Administration, College of
Recreation and Health Management, Chia Nan University of Pharmacy and
Science, Tainan City, Taiwan (Republic of China)
(Chang) Department of Anesthesiology, E-Da Hospital, I-Shou University,
Kaohsiung City, Taiwan (Republic of China)
(Ho) School of Medicine, College of Medicine, National Sun Yat-sen
University, Kaohsiung City, Taiwan (Republic of China)
(Hsu) Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and
Chang Gung University College of Medicine, Kaohsiung City, Taiwan
(Republic of China)
(Wu) Department of Nutrition, Chi Mei Medical Center, Tainan City, Taiwan
(Republic of China)
(Chen) Department of Anesthesiology, Chi Mei Medical Center, Liouying,
Tainan City, Taiwan (Republic of China)
Publisher
Elsevier Ltd
Abstract
Background: Previous meta-analyses of intravenous iron supplementation for
reducing red blood cell (RBC) transfusion risk after cardiac surgery were
inconclusive because of limited data. This updated meta-analysis
incorporates recent evidence. Method(s): Major databases were
searched on May 2, 2024 for randomised controlled trials comparing the
incidence of RBC transfusion between adult patients receiving intravenous
iron supplementation and those receiving controls (i.e. oral iron or
placebo) after cardiac surgery. The secondary outcomes included the number
of RBC units transfused, postoperative haemoglobin levels, iron status,
complications, and length of hospital stay. Trial sequential analysis was
conducted to examine the robustness of evidence. Result(s): Fourteen
randomised controlled trials including 2043 subjects were identified.
Intravenous iron supplementation was found to reduce the RBC transfusion
risk compared with controls (relative risk 0.77, 95% confidence interval
[CI] 0.65-0.91, P=0.002, n=1955, I2=61%, certainty of evidence:
moderate). The trial sequential analysis supported the robustness of the
evidence. Furthermore, haemoglobin levels were higher in the intravenous
iron supplementation group on postoperative days 4-10 (mean difference
0.17 g dl-1, 95% CI 0.06-0.29, n=1989) and >21 days (mean
difference 0.66 g/dl-1, 95% CI 0.36-0.95, n=1008).
Postoperative iron status also improved with Intravenous iron
supplementation, particularly on postoperative days 4-10. There were no
significant differences in other outcomes, including mortality.
 Conclusion(s): Intravenous iron supplementation can reduce RBC
transfusion risk and improve postoperative haemoglobin level and iron
status after cardiac surgery, supporting the implementation of Intravenous
iron supplementation in perioperative blood management strategies.
Systematic review protocol: CRD42024542206 (PROSPERO). Copyright
© 2024 British Journal of Anaesthesia

<7>
Accession Number
2034152688
Title
Edetate Disodium-Based Chelation for Patients With a Previous Myocardial
Infarction and Diabetes: TACT2 Randomized Clinical Trial.
Source
JAMA. 332(10) (pp 794-803), 2024. Date of Publication: 10 Sep 2024.
Author
Lamas G.A.; Anstrom K.J.; Navas-Acien A.; Boineau R.; Nemeth H.; Huang Z.;
Wen J.; Rosenberg Y.; Stylianou M.; Jones T.L.Z.; Joubert B.R.; Yu Q.;
Santella R.M.; Mon A.C.; Ujueta F.; Escolar E.; Nathan D.M.; Fonseca V.A.;
Aude Y.W.; Ehrman J.K.; Elliott T.; Prashad R.; Lewis E.F.; Lopes R.D.;
Farkouh M.E.; Elliott A.-M.; Newman J.D.; Mark D.B.
Institution
(Lamas, Mon, Ujueta, Escolar) Columbia University Division of Cardiology,
Mount Sinai Medical Center, Miami Beach, FL, United States
(Anstrom) Gillings School of Global Public Health, University of North
Carolina, Chapel Hill, United States
(Navas-Acien, Santella) Department of Environmental Health Sciences,
Columbia University Mailman School of Public Health, New York, NY, United
States
(Boineau, Yu) National Center for Complementary and Integrative Health,
National Institutes of Health, Bethesda, MD, United States
(Nemeth, Huang, Wen, Lopes, Elliott, Mark) Duke Clinical Research
Institute, Duke University, Durham, NC, United States
(Rosenberg, Stylianou) National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, MD, United States
(Jones) National Institute of Diabetes and Digestive and Kidney Diseases,
National Institutes of Health, Bethesda, MD, United States
(Joubert) National Institute of Environmental Health Sciences, National
Institutes of Health, Durham, NC, United States
(Nathan) Massachusetts General Hospital Diabetes Research Center, Harvard
Medical School, Boston, United States
(Fonseca) Tulane University School of Medicine, New Orleans, LA, United
States
(Aude) DHR Health Heart Institute, McAllen, TX, United States
(Ehrman) Division of Cardiovascular Medicine, Henry Ford Hospital,
Detroit, MI, United States
(Elliott) BC Diabetes Research Institute, Vancouver, BC, Canada
(Prashad) Ocala Research Institute, Ocala, FL, United States
(Lewis) Stanford University School of Medicine, Palo Alto, CA, United
States
(Farkouh) University of Toronto, Toronto, ON, Canada
(Newman) New York University School of Medicine, New York, United States
Publisher
American Medical Association
Abstract
Importance: In 2013, the Trial to Assess Chelation Therapy (TACT) reported
that edetate disodium (EDTA)-based chelation significantly reduced
cardiovascular disease (CVD) events by 18% in 1708 patients with a prior
myocardial infarction (MI). Objective(s): To replicate the finding of
TACT in individuals with diabetes and previous MI. Design, Setting,
and Participant(s): A 2 x 2 factorial, double-masked, placebo-controlled,
multicenter trial at 88 sites in the US and Canada, involving participants
who were 50 years or older, had diabetes, and had experienced an MI at
least 6 weeks before recruitment compared the effect of EDTA-based
chelation vs placebo infusions on CVD events and compared the effect of
high doses of oral multivitamins and minerals with oral placebo. This
article reports on the chelation vs placebo infusion comparisons.
 Intervention(s): Eligible participants were randomly assigned to 40
weekly infusions of an EDTA-based chelation solution or matching placebo
and to twice daily oral, high-dose multivitamin and mineral supplements or
matching placebo for 60 months. This article addresses the chelation
study. Main Outcomes and Measures: The primary end point was the
composite of all-cause mortality, MI, stroke, coronary revascularization,
or hospitalization for unstable angina. Median follow-up was 48 months.
Primary comparisons were made from patients who received at least 1
assigned infusion. Result(s): Of the 959 participants (median age, 67
years [IQR, 60-72 years]; 27% females; 78% White, 10% Black, and 20%
Hispanic), 483 received at least 1 chelation infusion and 476 at least 1
placebo infusion. A primary end point event occurred in 172 participants
(35.6%) in the chelation group and in 170 (35.7%) in the placebo group
(adjusted hazard ratio [HR], 0.93; 95% CI, 0.76-1.16; P =.53). The 5-year
primary event cumulative incidence rates were 45.8% for the chelation
group and 46.5% for the placebo group. CV death, MI, or stroke events
occurred in 89 participants (18.4%) in the chelation group and in 94
(19.7%) in the placebo group (adjusted HR, 0.89; 95% CI, 0.66-1.19). Death
from any cause occurred in 84 participants (17.4%) in the chelation group
and in 84 (17.6%) in the placebo group (adjusted HR, 0.96; 95% CI,
0.71-1.30). Chelation reduced median blood lead levels from 9.03 mug/L at
baseline to 3.46 mug/L at infusion 40 (P <.001). Corresponding levels in
the placebo group were 9.3 mug/L and 8.7 mug/L, respectively.
 Conclusions and Relevance: Despite effectively reducing blood lead
levels, EDTA chelation was not effective in reducing cardiovascular events
in stable patients with coronary artery disease who have diabetes and a
history of MI. Copyright © 2024 American Medical Association. All
Rights Reserved.

<8>
Accession Number
2035647763
Title
Complete Versus Culprit-Only Revascularization in Older Patients With
ST-Segment-Elevation Myocardial Infarction: An Individual Patient
Meta-Analysis.
Source
Circulation. 150(19) (pp 1508-1516), 2024. Date of Publication: 05 Nov
2024.
Author
Campo G.; Bohm F.; Engstrom T.; Smits P.C.; Elgendy I.Y.; McCann G.P.;
Wood D.A.; Serenelli M.; James S.; Hofsten D.E.; Boxm-De Klerk B.M.;
Banning A.; Cairns J.A.; Pavasini R.; Stankovic G.; Kala P.; Kelbaek H.;
Barbato E.; Srdanovic I.; Hamza M.; Banning A.S.; Biscaglia S.; Mehta S.
Institution
(Campo, Serenelli, Pavasini, Biscaglia) Cardiology Unit, Azienda
Ospedaliero Universitaria di Ferrara, Cona, Italy
(Bohm) Department of Cardiology, Karolinska Institute, Danderyd Hospital,
Sweden
(Engstrom) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Denmark
(Smits) Cardiology Department, Maasstad Hospital, Rotterdam, Netherlands
(Elgendy) Division of Cardiovascular Medicine, Gill Heart Institute,
University of Kentucky, Lexington, United States
(McCann, Banning) Department of Cardiovascular Sciences, University of
Leicester, The NIHR Leicester Biomedical Research Centre, Glenfield
Hospital, United Kingdom
(Wood) Centre for Heart Valve Innovation, St Paul's Hospital, University
of British Columbia, Vancouver, Canada
(James) Department of Medical Sciences, Uppsala University, Sweden
(Hofsten) Department of Cardiology, Heart Centre, Copenhagen University
Hospital, Rigshospitalet, Denmark
(Boxm-De Klerk) Statistics and Education, Franciscus Gasthuis en
Vlietland, Rotterdam, Netherlands
(Banning) Oxford Heart Centre, Oxford University Hospitals NHS Trust,
United Kingdom
(Cairns) University of British Columbia, Vancouver, Canada
(Cairns) Department of Cardiology, Clinical Center of Serbia, Belgrade,
Serbia
(Stankovic) Faculty of Medicine, University of Belgrade, Serbia
(Kala) University Hospital Brno, Medical Faculty of Masaryk University,
Brno, Czechia
(Kelbaek) Department of Cardiology, Zealand University Hospital, Roskilde,
Denmark
(Barbato) Department of Clinical and Molecular Medicine, Sapienza
University of Rome, Italy
(Srdanovic) Faculty of Medicine, University of Novi Sad, Institute of
Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
(Hamza) Department of Cardiology, Ain Shams University, Cairo, Egypt
(Mehta) Population Health Research Institute, Hamilton Health Sciences and
McMaster University, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Complete revascularization is the standard treatment for
patients with ST-segment-elevation myocardial infarction and multivessel
disease. The FIRE trial (Functional Assessment in Elderly Myocardial
Infarction Patients With Multivessel Disease) confirmed the benefit of
complete revascularization in a population of older patients, but the
follow-up is limited to 1 year. Therefore, the long-term benefit (>1 year)
of this strategy in older patients is debated. To address this, an
individual patient data meta-analysis was conducted in patients with
ST-segment-elevation myocardial infarction >=75 years of age enrolled in
randomized clinical trials investigating complete versus culprit-only
revascularization strategies. METHOD(S): PubMed, Embase, and the
Cochrane database were systematically searched to identify randomized
clinical trials comparing complete versus culprit-only revascularization.
Individual patient-level data were collected from the relevant trials. The
primary end point was death, myocardial infarction, or ischemia-driven
revascularization. The secondary end point was cardiovascular death or
myocardial infarction. RESULT(S): Data from 7 randomized clinical
trials encompassing 1733 patients (917 randomized to culprit-only and 816
to complete revascularization) were analyzed. The median age was 79
[interquartile range, 77-83] years. Of the patients, 595 (34%) were
female. Follow-up ranged from a minimum of 6 months to a maximum of 6.2
years (median, 2.5 [interquartile range, 1-3.8] years). Complete
revascularization reduced the primary end point up to 4 years (hazard
ratio, 0.78 [95% CI, 0.63-0.96]) but not at the longest available
follow-up (hazard ratio, 0.83 [95% CI, 0.69-1.01]). Complete
revascularization significantly reduced the occurrence of cardiovascular
death or myocardial infarction at the longest available follow-up (hazard
ratio, 0.76 [95% CI, 0.58-0.99]). This was observed even when censoring
the follow-up at each year. Long-term rate of death did not differ between
complete and culprit-only revascularization arms. CONCLUSION(S): In
this individual patient data meta-analysis of older patients with
ST-segment-elevation myocardial infarction and multivessel disease,
complete revascularization reduced the primary end point of death,
myocardial infarction, or ischemia-driven revascularization up to 4 years.
At the longest follow-up, complete revascularization reduced the composite
of cardiovascular death or myocardial infarction but not the primary end
point. Copyright © 2024 American Heart Association, Inc.

<9>
Accession Number
2035602188
Title
Benefit of early aortic valve replacement in asymptomatic severe aortic
stenosis but questions remain.
Source
European Heart Journal. 45(42) (pp 4536-4538), 2024. Date of Publication:
07 Nov 2024.
Author
Martinsson A.; Jeppsson A.
Institution
(Martinsson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Martinsson, Jeppsson) Department of Molecular and Clinical Medicine,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Medicinaregatan 3, Gothenburg 413 90, Sweden
(Jeppsson) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Gothenburg 413 45, Sweden
Publisher
Oxford University Press

<10>
Accession Number
2035602185
Title
Benefit of isolated surgical valve repair or replacement for functional
tricuspid regurgitation and long-term outcomes stratified by the
TRI-SCORE.
Source
European Heart Journal. 45(42) (pp 4512-4522), 2024. Date of Publication:
07 Nov 2024.
Author
Dreyfus J.; Juarez-Casso F.; Sala A.; Carnero-Alcazar M.; Eixeres-Esteve
A.; Bohbot Y.; Bazire B.; Flagiello M.; Riant E.; Mbaki Y.; Tomasi J.;
Senage T.; Idrissi K.R.E.; Coisne A.; Eyharts D.; Doguet F.; Viau F.;
Eggenspieler F.; Heuts S.; Nia P.S.; Heitzinger G.; Galloo X.; Marsan
N.A.; Benfari G.; Badano L.; Muraru D.; Maisano F.; Topilsky Y.; Michelena
H.; Enriquez-Sarano M.; Bax J.; Bartko P.; Selton-Suty C.; Habib G.;
Lavie-Badie Y.; Modine T.; Chan V.; Le Tourneau T.; Donal E.; Lim P.; Radu
C.; Bernick J.; Wells G.A.; Tribouilloy C.; Iung B.; Obadia J.-F.; De
Bonis M.; Crestanello J.; Messika-Zeitoun D.
Institution
(Dreyfus, Bazire, Riant) Department of Cardiology, Centre Cardiologique du
Nord, 32-36 rue des moulins gemeaux, Saint-Denis 93200, France
(Juarez-Casso, Crestanello) Department of Cardiovascular Surgery, Mayo
Clinic, Rochester, MN, United States
(Sala, De Bonis) Department of Cardiac Surgery, Vita-Salute San Raffaele
University, IRCCS San Raffaele Scientific Institute, Milan, Italy
(Carnero-Alcazar) Department of Cardiac Surgery, Hospital Clinico San
Carlos, Madrid, Spain
(Eixeres-Esteve) Cardiac Surgery Department, Hospital 12 de Octubre,
Madrid, Spain
(Bohbot, Tribouilloy) Department of Cardiology, Amiens University
Hospital, Amiens, France
(Bohbot, Tribouilloy) UR UPJV 7517, Jules Verne University of Picardie,
Amiens, France
(Flagiello, Obadia) Department of Cardiovascular Surgery and
Transplantation, Louis Pradel Cardiovascular Hospital, Claude Bernard
University, Bron, France
(Mbaki, Donal) Cardiology Department, LTSI UMR1099, INSERM, Universite de
Rennes-1, CHU de RENNES, Rennes, France
(Tomasi) Department of Cardiac Surgery, CHU de RENNES, Universite de
Rennes-1, Rennes, France
(Senage) Department of Cardiac Surgery, INSERM 1246, Universite de Nantes,
CHU de Nantes, Nantes, France
(Idrissi, Chan) Division of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, ON, Canada
(Coisne) Department of Clinical Physiology and Echocardiography, Heart
Valve Clinic, CHU Lille, Lille, France
(Coisne) Institut Pasteur de Lille, U1011-EGID, Univ. Lille, Inserm, CHU
Lille, Lille, France
(Eyharts, Lavie-Badie) Heart Valve Center, Toulouse University Hospital,
Toulouse, France
(Doguet) Department of Cardiology and Cardiovascular Surgery, CHU Charles
Nicolle, Rouen, France
(Viau, Habib) Cardiology Department, APHM, La Timone Hospital, Marseille,
France
(Eggenspieler, Selton-Suty) Cardiology Department, CHU Nancy-Brabois,
Nancy, France
(Heuts, Nia) Department of Cardiothoracic Surgery, Maastricht University
Medical Center (MUMC+), Maastricht, Netherlands
(Heuts, Nia) Cardiovascular Research Institute Maastricht (CARIM),
University Maastricht, Maastricht, Netherlands
(Heitzinger, Bartko) Department for Internal Medicine II,, Cardiology,
Medical University of Vienna, Vienna, Austria
(Galloo, Marsan, Bax) Department of Cardiology, Leiden University Medical
Center, Leiden, Netherlands
(Galloo) Department of Cardiology, Free University Brussels (VUB),
University Hospital Brussels (UZ Brussel), Brussels, Belgium
(Benfari, Michelena) Cardiovascular Disease Department, Mayo Clinic,
Rochester, MN, United States
(Benfari) Section of Cardiology, Department of Medicine, University of
Verona, Verona, Italy
(Badano, Muraru) Department of Cardiology, Istituto Auxologico Italiano,
IRCCS, Milan, Italy
(Badano, Muraru) Department of Medicine and Surgery, University of
Milano-Bicocca, Milan, Italy
(Maisano) Cardiac Surgery and Heart Valve Center, Ospedale San Raffaele,
University Vita Salute, Milano, Italy
(Topilsky) Department of Cardiology, Tel Aviv Medical Center, Sackler
Faculty of Medicine, Tel Aviv, Israel
(Enriquez-Sarano) Valve Science Center, Minneapolis Heart Institute,
Minneapolis, MN, United States
(Modine) Department of Cardiology and Cardiovascular Surgery, Hopital
Cardiologique de Haut-Leveque, Bordeaux University Hospital, Bordeaux,
France
(Le Tourneau) CNRS, INSERM, l'institut du thorax, Universite de Nantes,
CHU de Nantes, Nantes, France
(Lim) Cardiology Department, Expert Valve Center, Henri Mondor Hospital,
Creteil, France
(Radu) Department of Cardiac Surgery, AP-HP, Henri Mondor Hospital,
Creteil, France
(Bernick, Wells) Cardiovascular Research Methods Center, University of
Ottawa Heart Institute, Ottawa, ON, Canada
(Iung) Cardiology Department, Bichat Hospital, APHP, INSERM LVTS U1148,
Universite de Paris, Paris, France
(Messika-Zeitoun) Division of Cardiology, University of Ottawa Heart
Institute, 40 Ruskin Street, Ottawa, ON, Canada
Publisher
Oxford University Press
Abstract
Background and Severe tricuspid regurgitation is associated with increased
mortality rates, but benefit of its correction and ideal timing are Aims
not clearly determined. This study aimed to identify patient subsets who
might benefit from the surgery. Methods In TRIGISTRY, an international
cohort study of consecutive patients with severe isolated functional
tricuspid regurgitation (33 centres, 10 countries), survival rates up to
10 years were compared between patients who underwent isolated tricuspid
valve surgery (repair or replacement) and those conservatively managed,
overall and according to TRI-SCORE category (low: <=3, intermediate: 4-5,
and high: >=6). Results One thousand and two hundred seventeen were
managed conservatively, and 551 underwent isolated tricuspid valve surgery
(200 repairs and 351 replacements). TRI-SCORE distribution was 33% low,
32% intermediate, and 35% high. At 10 years, survival rates were similar
between surgical and conservative management [41% vs. 36%; hazard ratio
(HR) .97; 95% confidence interval (CI) .88-1.08, P = .57]. Surgery
improved survival compared with conservative management in the low
TRI-SCORE category (72% vs. 44%; HR .27; 95% CI .20-.37, P < .0001), but
not in the intermediate (36% vs. 37%; HR 1.17; 95%CI .98-1.40, P = .09) or
high categories (20% vs. 24%; HR 1.06; 95% CI .91-1.25, P = .45). Both
repair and replacement improved survival in the low TRI-SCORE category
(84% and 61% vs. 44%; HR .11; 95% CI .06-.19, P < .0001, and HR .65; 95%
CI .47-.90, P = .009). Repair showed benefit in the intermediate category
(59% vs. 37%; HR .49; 95% CI .35-.68, P < .0001) while replacement was
possibly harmful (25% vs. 37%; HR 1.43; 95% CI 1.18-1.72, P = .0002).
Conclusions Higher survival rates were observed with repair than
replacement and benefit of intervention declined as TRI-SCORE increased
with no benefit of any type of surgery in the high TRI-SCORE category.
These results emphasize the importance of timely intervention and patient
selection to achieve the best outcomes and the need for randomized
controlled trials. Copyright © The Author(s) 2024. Published by
Oxford University Press on behalf of the European Society of Cardiology.
All rights reserved.

<11>
Accession Number
2035600092
Title
Aortic arch replacement in patients with previous repair of acute aortic
dissection: A systematic review and meta-Analysis.
Source
European Journal of Cardio-thoracic Surgery. 66(5) (no pagination), 2024.
Article Number: ezae396. Date of Publication: 01 Nov 2024.
Author
Sef D.; Thet M.S.; Acharya M.; Tyson N.; Hadjinikolaou L.; Mariscalco G.;
Oo A.; Benedetto U.; Luthra S.
Institution
(Sef, Acharya, Tyson, Hadjinikolaou, Mariscalco) Department of Cardiac
Surgery, University Hospital Leicester NHS Trust, Leicester, United
Kingdom
(Thet) Department of Surgery and Cancer, Faculty of Medicine, Imperial
College London and Imperial College Healthcare NHS Trust, London, United
Kingdom
(Thet, Oo) Department of Cardiothoracic Surgery, St Bartholomew's
Hospital, London, United Kingdom
(Benedetto) Department of Cardiac Surgery, University G. d'Annunzio,
Chieti, Italy
(Luthra) Wessex Cardiothoracic Centre, University Hospital Southampton,
Southampton, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Despite the popularity of the frozen elephant technique
procedure in recent years, evidence is scarce regarding its utilization
for aortic arch replacement following previous acute aortic dissection
repair. In this systematic review and meta-Analysis, we aimed to analyse
clinical outcomes of aortic arch replacement in patients with previous
repair of acute aortic dissection. METHOD(S): A systematic literature
search on PubMed, MEDLINE via Ovid, Embase, Scopus, and Web of Science
until March 2024 was performed for studies on open aortic arch replacement
with or without frozen elephant technique procedure in adult patients
after previous acute aortic dissection repair. Early and late
postoperative mortality were primary, while postoperative complications
were secondary outcomes of interest. Additionally, a meta-Analysis was
performed to pool the early and late postoperative mortality.
 RESULT(S): A total of 574 studies were identified, of which 9 studies
including a total of 677 patients met the eligibility criteria.
In-hospital or 30-day postoperative mortality and stroke were 0-17.5% and
0-7.7%, respectively. Duration of follow-up across all studies varied from
1.1 to 5.1 years. All-cause late mortality rate ranges from 5.9% to 30.5%.
Aortic reintervention rate was 4.8-38.7%. The pooled early and late
mortality rate were 8.7% [95% confidence interval (CI) 5.7-13%; I2 = 52%]
and 24.9% (95% CI 19.5-31.1%; I2 = 54%), respectively. CONCLUSION(S):
Current evidence suggest that relatively younger patients with chronic
post-dissection aneurysm or residual aortic dissection after acute aortic
dissection repair can undergo an aortic arch replacement by a dedicated
aortic team with acceptable mortality risk. However, postoperative
neurological deficit remains an issue. Copyright © 2024 The
Author(s). Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<12>
Accession Number
2032271925
Title
Different antithrombotic strategies to prevent cardiovascular
complications in Kawasaki patients: a systematic review and meta-analysis.
Source
BMC Pediatrics. 24(1) (no pagination), 2024. Article Number: 738. Date of
Publication: December 2024.
Author
Assempoor R.; Abroy A.S.; Azarboo A.; Ghaseminejad-Raeini A.; Najafi K.;
Hosseini K.
Institution
(Assempoor, Abroy, Azarboo, Hosseini) Tehran Heart Center, Cardiovascular
Diseases Research Institute, Tehran University of Medical Sciences, North
Kargar Ave, Tehran 1995614331, Iran, Islamic Republic of
(Ghaseminejad-Raeini) School of medicine, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Hosseini) Cardiac Primary Prevention Research Center, Cardiovascular
Diseases Research Institute, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Najafi) Hakim Children Hospital, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Publisher
BioMed Central Ltd
Abstract
Background: Coronary artery aneurysm (CAA) poses significant
cardiovascular risks, particularly in Kawasaki disease (KD) patients. This
systematic review and meta-analysis aim to evaluate and compare
antithrombotic strategies in preventing CAA formation secondary to
Kawasaki disease and the ensuing CAA cardiovascular complications.
 Method(s): Following PRISMA guidelines, we systematically searched
major databases, namely PubMed, Scopus, Web of Science, and Embase. Major
adverse cardiovascular events (MACE), myocardial infarction (MI),
stenosis, bleeding, occlusion, and coronary artery lesion (CAL) formation
were primary outcomes. Consolidated Standards of Reporting Trials
(CONSORT) and Strengthening the Reporting of Observational Studies in
Epidemiology (STROBE) scores assessed study quality. A meta-analysis, as
well as sensitivity analysis and meta-regression, was performed to compare
the efficacy of pharmacological strategies on the outcomes.
 Result(s): The study included 21 studies with 1045 patients for CAA
complications and 41536 patients for CAA formation prevention. In children
with CAA secondary to Kawasaki disease, the addition of warfarin to
aspirin was associated with a significantly lower odds of myocardial
infarction (OR = 0.26, 95% CI: 0.11-0.60, I2 = 25%) and
mortality (OR = 0.18, 95% CI: 0.04-0.88, I2 = 0%) compared to
aspirin alone. However, there was no significant difference in MACE (OR =
0.38, 95% CI: 0.08-1.93, I2 = 60%) and occlusion (OR = 0.17,
95% CI: 0.02-1.92, I2 = 58%). Sensitivity analysis showed
reduced thrombosis (OR = 0.29, 95% CI: 0.14-0.62, I2 = 0%),
MACE (OR [95% CI] = 0.22[0.06-0.84], I2 = 46%), and occlusion
(OR [95% CI] = 0.08[0.02-0.44], I2 = 36%). Meta-regression did
not yield significant results. Conclusion(s): As for the acute phase
of KD, no benefit was conferred from adding high-dose aspirin to the
routine IVIG alone regimen. However, the complexity of outcomes and the
diversity in antithrombotic interventions underscore the need for tailored
approaches and further research. Copyright © The Author(s) 2024.

<13>
Accession Number
2032254093
Title
L-arginine impact on inflammatory and cardiac markers in patients
undergoing coronary artery bypass graft: a systematic review and
meta-analysis of randomized controlled trials.
Source
BMC Cardiovascular Disorders. 24(1) (no pagination), 2024. Article Number:
641. Date of Publication: December 2024.
Author
Mohammadi Z.; Ravankhah M.; Ahmadi M.; Keshavarzian O.; Azari I.;
Abdollahi M.; Rezaei M.; Akbari H.
Institution
(Mohammadi) Student Research Committee, Fasa University of Medical
Sciences, Fasa, Iran, Islamic Republic of
(Ravankhah) Student Research Committee, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Ahmadi) Students' Scientific Research Center, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Keshavarzian) Shiraz School for Medicine, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Azari) Student Research Committee, Yasuj University of Medical Sciences,
Yasuj, Iran, Islamic Republic of
(Abdollahi) Student Research Committee, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Rezaei) Department of Cardiology, Fars-Iranian Heart Association, Fars
Society of Internal Medicine, Shiraz, Iran, Islamic Republic of
(Akbari) Cardiovascular Research Centre, Department of Pediatrics, Faculty
of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
Publisher
BioMed Central Ltd
Abstract
Background: Numerous studies have explored the effects of L-arginine,
whether administered in the form of a supplement or through infusion
during cardioplegia, on cardiac and inflammatory markers in individuals
undergoing coronary artery bypass grafting (CABG). However, these studies
presented contradictory findings. Consequently, the objective of this
study was to investigate the impact of l-arginine on these markers by
analyzing available randomized controlled trials (RCTs). Method(s):
We performed an extensive search across various databases, including
Embase, Medline/PubMed, Web of Science, Scopus, Cochrane Library, and
Google Scholar, covering research published until December 2023. To
analyze the mean changes in inflammatory and cardiac markers between the
L-arginine and control groups, we calculated the weighted mean difference
(WMD) along with the corresponding 95% confidence interval (CI) using a
random-effects model. Result(s): A total of 393 RCTs were identified
during the initial search. After screening and selection, 7 trials were
included. In a meta-analysis of three trials that reported troponin T
levels, we found a significant impact of L-arginine on reducing troponin T
levels (WMD = -0.61 ng/ml; 95% CI: -1.07, -0.15). Our analysis also showed
that L-arginine had a noticeable impact on decreasing interleukin-6 (IL-6)
levels (WMD = -7.72 pg/ml; 95% CI: -15.05, -0.39). However, we found no
considerable impact of L-arginine treatment on creatine phosphokinase-MB
(CPK-MB), tumor necrosis factor-alpha (TNF-alpha), and troponin I compared
to the placebo groups. Conclusion(s): Our findings suggest that
L-arginine may benefit patients undergoing CABG, as it helps reduce
inflammatory reactions and limits myocardial ischemia. This study
registered in the PROSPERO database (Registration No.
CRD42024508341). Copyright © The Author(s) 2024.

<14>
Accession Number
2035429854
Title
Decision-Making Approach to the Treatment of Young and Low-Risk Patients
With Aortic Stenosis.
Source
JACC: Cardiovascular Interventions. 17(21) (pp 2455-2471), 2024. Date of
Publication: 11 Nov 2024.
Author
Gupta T.; Malaisrie S.C.; Batchelor W.; Boudoulas K.D.; Davidson L.;
Ibebuogu U.N.; Kpodonu J.; Singh R.; Sultan I.; Theriot M.; Reardon M.J.;
Leon M.B.; Grubb K.J.
Institution
(Gupta) Division of Cardiology, University of Vermont Medical Center,
Burlington, VT, United States
(Malaisrie) Department of Cardiac Surgery, Northwestern University
Feinberg School of Medicine, Chicago, IL, United States
(Batchelor, Singh) Inova Schar Heart and Vascular Institute, Falls Church,
VA, United States
(Boudoulas) Division of Cardiovascular Medicine, The Ohio State
University, Columbus, OH, United States
(Davidson) Division of Cardiology, Northwestern University Feinberg School
of Medicine, Chicago, IL, United States
(Ibebuogu) Division of Cardiovascular Diseases, Department of Medicine,
University of Tennessee Health Science Center, Memphis, TN, United States
(Kpodonu) Division of Cardiac Surgery, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States
(Sultan) Division of Cardiac Surgery, Department of Cardiothoracic
Surgery, Center for Heart Valve Disease, University of Pittsburgh Medical
Center Heart and Vascular Institute, Pittsburgh, PA, United States
(Theriot) Lake Charles Memorial Hospital Heart & Vascular Center, Lake
Charles, LA, United States
(Reardon) Department of Cardiovascular Surgery, Houston Methodist DeBakey
Heart and Vascular Center, Houston, TX, United States
(Leon) Division of Cardiology, Columbia University Medical Center, New
York, NY, United States
(Leon) Cardiovascular Research Foundation, New York, NY, United States
(Grubb) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Atlanta, GA, United States
Publisher
Elsevier Inc.
Abstract
Over a decade of randomized controlled trial data demonstrate excellent
outcomes with transcatheter aortic valve replacement or surgical aortic
valve replacement for patients with symptomatic severe aortic stenosis
regardless of surgical risk. The 2020 American College of
Cardiology/American Heart Association guidelines recommend both options
for low-risk AS patients aged 65 to 80 years. However, the fastest growing
population of patients receiving transcatheter aortic valve replacement in
the United States is <65 years old, with little data to support the
practice. The American College of Cardiology's Cardiac Surgery Team
Section Leadership and Interventional Cardiology Councils, a
multidisciplinary collaboration of cardiologists and cardiac surgeons,
sought to summarize the relevant data into a decision-making tool for
heart valve teams. A literature review was completed, and guidelines,
randomized controlled trials, and large observational studies were
summarized into a pragmatic decision-making approach to treating young and
low-risk patients with AS. Copyright © 2024 American College of
Cardiology Foundation

<15>
Accession Number
2032261497
Title
Percutaneous coronary intervention versus coronary artery bypass grafting
in left main disease according to patients' sex: A meta-analysis.
Source
European Journal of Clinical Investigation. (no pagination), 2024. Date
of Publication: 2024.
Author
Meynet P.; Improta R.; Carbone M.L.; Pecoraro M.; Pagliassotto I.; Di
Pietro G.; Demetres M.; Bruno F.; Comitini G.; Leone A.; Martinengo E.;
Siliano S.; D'Ascenzo F.; Chieffo A.; De Ferrari G.M.; Gaudino M.; Mancone
M.; Di Franco A.; De Filippo O.
Institution
(Meynet, Carbone, Pecoraro, Pagliassotto, Bruno, Martinengo, Siliano,
D'Ascenzo, De Ferrari, De Filippo) Division of Cardiology, Cardiovascular
and Thoracic Department, "Citta della Salute e della Scienza" Hospital,
Turin, Italy
(Meynet, Carbone, Pecoraro, Pagliassotto, Martinengo, Siliano, D'Ascenzo,
De Ferrari) Department of Medical Sciences, University of Turin, Turin,
Italy
(Improta, Di Pietro, Comitini, Mancone) Department of Clinical Internal,
Anaesthesiological and Cardiovascular Sciences, Sapienza University of
Rome, Rome, Italy
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Leone) Division of Cardiology, SG Moscati Hospital, Avellino, Italy
(Leone) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Naples, Italy
(Chieffo) Interventional Cardiology Unit, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Chieffo) Vita Salute San Raffaele University, Milan, Italy
(Gaudino, Di Franco) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: The role of sex in choosing between coronary artery bypass
grafting (CABG) and percutaneous coronary intervention (PCI) for
unprotected left main coronary artery (ULMCA) disease has gained interest.
 Method(s): Randomized controlled trials and adjusted observational
studies comparing PCI versus CABG in ULMCA patients with outcomes by sex
were included. The primary endpoint was major adverse cardiovascular
events (MACE), with secondary endpoints being all-cause mortality and
repeated revascularization. Result(s): Ten studies (3 randomized, 7
observational) involving 22,141 ULMCA disease patients (13,411 PCI, 8730
CABG) with a median 5-year follow-up were included. Among males, PCI was
associated with a higher risk of MACE (HR 1.18, 95% CI 1.01-1.38), while
no significant difference was seen in females. However, moderator analysis
showed no significant interaction between sex and revascularization
strategy for MACE (p for interaction.422). No differences in all-cause
mortality were observed between PCI and CABG for either sex. Repeated
revascularization risk was significantly higher with PCI for both sexes
(HR 3.51, 95% CI 2.21-5.59 in males and HR 4.20, 95% CI 2.57-6.87 in
females). Conclusion(s): In males with ULMCA disease, CABG was
associated with a lower risk of MACE compared to PCI, while no significant
differences were seen in females. The lack of a significant interaction
between sex and revascularization strategy suggests that these findings
may not reflect true sex-based effect modification. PCI was linked to a
higher risk of repeated revascularization in both sexes compared to CABG.
Trial registration: The protocol was registered in the PROSPERO
International Prospective Register of Systematic Reviews (ID:
CRD42024537726). Copyright © 2024 The Author(s). European Journal
of Clinical Investigation published by John Wiley & Sons Ltd on behalf of
Stichting European Society for Clinical Investigation Journal Foundation.

<16>
Accession Number
2032261248
Title
Effect of Ischemia Testing and Coronary Revascularization on Mortality and
Ventricular Tachycardia Recurrence in Patients With Monomorphic
Ventricular Tachycardia Without Acute Coronary Syndrome: A Meta-Analysis
and Systematic Review.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2024.
Date of Publication: 2024.
Author
Shah N.; Saraiya A.; Patel T.; Marchlinski F.E.; Pancholy S.
Institution
(Shah, Pancholy) The Wright Center for Graduate Medical Education,
Scranton, PA, United States
(Saraiya) Sidney Kimmel College of Medicine, Philadelphia, PA, United
States
(Patel) Apex Heart Institute, Ahmedabad, India
(Marchlinski) Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Studies show mixed results regarding the effect of coronary
revascularization on mortality benefit and ventricular tachycardia (VT)
recurrence in patients with monomorphic VT without acute coronary syndrome
(ACS). This meta-analysis aimed to assess the effect of ischemia testing
and/or coronary revascularization on mortality and VT recurrence in a
pooled data set. Method(s): Databases including PubMed, Google
Scholar, and the Cochrane Library were searched from January 2000 to
December 2023 for studies reporting event data on mortality and VT
recurrence in patients without ACS who presented with monomorphic VT. Data
were pooled and analyzed using random effects meta-analysis.
 Result(s): The pooled sample consisted of a total of five studies,
with 1062 patients, of whom 433 underwent ischemia testing and/or coronary
revascularization and 629 did not. There was no statistically significant
difference in the mortality and VT recurrence in the patients who
underwent ischemia testing and/or revascularization versus those who did
not (mortality odds ratio [OR]: 0.98; [95% confidence interval (CI): 0.62
to 1.53]; p = 0.92; VT recurrence OR: 1.07; [95% CI: 0.51 to 2.26]; p =
0.86). No publication bias was detected by examination of the funnel plot,
Begg-Mazumdar's test (p = 0.80), and Egger's test (p = 0.91).
 Conclusion(s): In conclusion, in patients with sustained monomorphic
VT in the absence of ACS, ischemia testing and/or revascularization does
not lead to improved mortality or a decrease in the incidence of VT
recurrence. Copyright © 2024 Wiley Periodicals LLC.

<17>
Accession Number
645776696
Title
Ciprofol versus propofol for anesthesia induction in cardiac surgery: a
randomized double-blind controlled clinical trial.
Source
BMC anesthesiology. 24(1) (pp 412), 2024. Date of Publication: 12 Nov
2024.
Author
Yu L.; Liu X.; Zhao X.; Shan X.; Bischof E.; Lu H.-H.
Institution
(Yu, Liu, Zhao, Shan, Lu) Department of Anesthesiology, East Hospital,
Tongji University School of Medicine, Shanghai 200120, China
(Bischof) Department of Medical Oncology, School of Medicine, Renji
Hospital, Shanghai Jiao Tong University, Shanghai, China
(Bischof) Shanghai University of Medicine and Health Sciences, Shanghai,
China
Abstract
BACKGROUND: Ciprofol, a novel intravenous general anesthetic with a
chemical structure similar to propofol, exhibits significantly enhanced
potency. It offers a rapid onset, reduced incidence of injection pain, and
has comparable effects on heart rate and blood pressure to propofol.
However, clinical data on its use for anesthesia induction in cardiac
surgery remain limited. METHOD(S): Seventy-eight patients undergoing
coronary artery bypass grafting or valve replacement surgery were randomly
assigned to receive either ciprofol (N=40) or propofol (N=38) for
anesthesia induction. Variables recorded included changes in mean arterial
pressure and heart rate during anesthesia, alterations in the oxygenation
index and lactic acid concentration before and 10 min after anesthesia
induction, and the incidence of adverse events such as bradycardia,
hypotension, and injection pain. RESULT(S): The incidence of
anesthesia-induced injection pain was significantly lower in the ciprofol
group compared to the propofol group (3% vs. 18%, P<0.05). The incidence
of other adverse events was similar between the groups. No significant
differences in hemodynamics or oxygenation index were observed during
anesthesia induction between ciprofol and propofol. CONCLUSION(S):
Ciprofol demonstrated a significantly lower incidence of injection pain
compared to propofol, potentially improving patient comfort during
anesthesia induction. Additionally, ciprofol showed comparable circulatory
stability to propofol during anesthesia induction in cardiac surgery,
suggesting it may be a suitable alternative to propofol for this
application. TRIAL REGISTRATION: The trial was registered at the
ClinicalTrials.gov on 03/10/2024 (NCT06312345). Copyright © 2024.
The Author(s).

<18>
Accession Number
2035760299
Title
Left Atrial Appendage Occlusion During Cardiac Surgery to Prevent Stroke:
A Systematic Review and Meta-Analysis.
Source
American Journal of Cardiology. 236 (pp 8-19), 2025. Date of Publication:
01 Feb 2025.
Author
Sayed A.; Kamal A.; Kamal I.; Fathallah A.H.; Nourelden A.Z.; Zaidi S.A.
Institution
(Sayed, Kamal, Zaidi) Department of Medicine, Mercy Hospital, University
of Pittsburgh Medical Center, Pittsburgh, PA, United States
(Sayed, Zaidi) Department of Critical Care Medicine, University of
Pittsburgh, Pittsburgh, PA, United States
(Kamal, Nourelden) Faculty of Medicine, Al-Azhar University, Cairo, Egypt
(Fathallah) Faculty of Medicine, Minia University, Minia, Egypt
(Zaidi) CRISMA Center, Department of Critical Care Medicine, University of
Pittsburgh, Pittsburgh, PA, United States
(Zaidi) Department of Critical Care Medicine, University of Pittsburgh
Medical Center, Pittsburgh, PA, United States
Publisher
Elsevier Inc.
Abstract
Atrial fibrillation accounts for 1/6 of all strokes, potentially leading
to significant disability and death. The left atrial appendage (LAA) is
the primary location for thrombus formation. Excluding the LAA has been
hypothesized to decrease the risk of ischemic stroke. This study examines
LAA occlusion (LAAO) with otherwise indicated cardiac surgery and its
effect on surgical outcomes. We followed the standards recommended by the
Cochrane Collaborative Group and Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) checklist to prepare this systematic
review and meta-analysis. Studies were retrieved through an online
bibliographic search, studies were screened, and data were extracted. We
compared the 2 study arms (LAAO and cardiac surgery without LAAO). A total
of 10 studies have been included in this study, and 6 randomized
controlled trials were included in the meta-analysis, with data pooled
from over 10,000 patients. LAAO is associated with no significant
difference in the overall mortality (p = 0.98) and systemic embolism (p =
0.31). Strokes, particularly, ischemic strokes, have significantly lower
risk in patients who underwent LAAO (p <0.0001 and p = 0.0007),
respectively. In conclusion, LAAO can be done safely as a concomitant
surgery with other cardiac surgeries, with a minimal incremental cost when
performed concurrently. LAAO is associated with a lower risk of all stroke
and ischemic strokes. Further studies are needed to shape guidance on the
continuation versus discontinuation of anticoagulation after LAAO,
especially in patient populations with a higher risk of
bleeding. Copyright © 2024 The Author(s)

<19>
Accession Number
2035790464
Title
Long-term outcomes comparison of Bentall-De Bono-versus valve-sparing
aortic root replacement: An updated systematic review and reconstructed
time-to-event meta-analysis.
Source
International Journal of Cardiology. 419 (no pagination), 2025. Article
Number: 132728. Date of Publication: 15 Jan 2025.
Author
Formica F.; Gallingani A.; D'Alessandro S.; Tuttolomondo D.;
Hernandez-Vaquero D.; Singh G.; Grassa G.; Pattuzzi C.; Maestri F.;
Nicolini F.
Institution
(Formica, Grassa, Pattuzzi, Nicolini) University of Parma, Department of
Medicine and Surgery, Parma, Italy
(Formica, Gallingani, Grassa, Pattuzzi, Maestri, Nicolini) Cardiac Surgery
Unit, University Hospital of Parma, Parma, Italy
(D'Alessandro) Cardiac Surgery Unit, San Giovanni Bosco Hospital, Turin,
Italy
(Tuttolomondo) Cardiology Unit, University Hospital of Parma, Parma, Italy
(Hernandez-Vaquero) Cardiac Surgery Department, Hospital Universitario
Central de Asturias, Oviedo, Spain
(Singh) Department of Critical Care Medicine and Division of Cardiac
Surgery, Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Background: For patients with aortic root dilatation and a structurally
normal aortic valve (AV) undergoing composite aortic valve-graft
(Bentall-De Bono) versus valve-sparing aortic root replacement (VSARR)
procedures there are conflicting data regarding early and long-term
benefits. We undertook a study-level meta-analysis to compare the results
of both procedures. Method(s): Three databases were assessed, and
both randomized trials and observational studies were considered eligible.
Kaplan-Meier curves of long-term survival and reoperation risk were
reconstructed and compared with Cox linear regression and incidence rate
ratios (IRR) with 95 % confidence intervals (CI). Landmark analysis and
time-varying hazard ratio (HR) were analyzed. Odds ratios (OR) were
calculated for early mortality, postoperative stroke, and re-exploration
for postoperative bleeding. A random effects model was used. Sensitivity
analyses included leave-one-out-analysis, meta-regression and subgroups
analysis. Result(s): 1456 articles were identified, including 39
observational studies, totaling 14,651 patients (Bentall-De Bono = 9557
and VSARR = 5094). Twelve studies were adjusted. The mean weighted
follow-up was 5.05 +/- 3.7 years. VSARR was associated with significantly
greater survival (HR = 0.50; 95 % CI, 0.45-0.57; p < 0.0001) at 15-year
follow-up. The reoperation risk was higher following VSARR (HR = 1.30; 95
% CI, 1.03-1.63; p = 0.02.), although time-varying HR model and landmark
analysis reported an increased risk of reoperation within 5 years after
VSARR (HR = 1.57; 95 % CI, 1.23-2.01; p < 0.001), after which the
difference disappeared. Subgroups analysis of studies excluding aortic
dissection showed a comparable rate of late reoperation.
 Conclusion(s): VSARR is associated with improved long-term survival
compared to Bentall-De Bono. The risk of late reoperation is higher within
5 years following VSARR, after which the two procedures are
comparable. Copyright © 2024 The Authors

<20>
Accession Number
2035724992
Title
Transcatheter Aortic Valve Implantation by Valve Type in Women with Small
Annuli: Results from the SMART Randomized Clinical Trial.
Source
JAMA Cardiology. 9(12) (no pagination), 2024. Article Number: e002373.
Date of Publication: 11 Dec 2024.
Author
Tchetche D.; Mehran R.; Blackman D.J.; Khalil R.F.; Mollmann H.;
Abdel-Wahab M.; Ben Ali W.; Mahoney P.D.; Ruge H.; Bleiziffer S.; Lin L.;
Szerlip M.; Grubb K.J.; Byku I.; Guerrero M.; Gillam L.D.; Petronio A.S.;
Attizzani G.F.; Batchelor W.B.; Gada H.; Rogers T.; Rovin J.D.; Whisenant
B.; Benton S.; Gardner B.; Padang R.; Althouse A.D.; Herrmann H.C.
Institution
(Tchetche) Department of Interventional Cardiology, Clinique Pasteur,
Toulouse, France
(Mehran) Center for Interventional Cardiovascular Research and Clinical
Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Blackman) Department of Cardiology, Leeds Teaching Hospitals, Leeds,
United Kingdom
(Khalil) Department of Cardiology, Allegheny General Hospital, Pittsburgh,
PA, United States
(Mollmann) Department of Cardiology, St Johannes Hospital Dortmund,
Dortmund, Germany
(Abdel-Wahab) Heart Center Leipzig, University of Leipzig, Leipzig,
Germany
(Ben Ali) Department of Surgery, Montreal Heart Institute, Montreal, QC,
Canada
(Mahoney) Department of Structural Interventional Cardiology, Sentara
Heart Hospital, Norfolk, VA, United States
(Ruge) Department of Cardiovascular Surgery, Institute Insure, German
Heart Center Munich, School of Medicine & Health, Technical University of
Munich, Munich, Germany
(Bleiziffer) Department of Thoracic and Cardiovascular Surgery, Herz-und
Diabeteszentrum North Rhine-Westphalia, Ruhr-Universitat Bochum, Bochum,
Germany
(Lin) Department of Interventional Cardiology, Morton Plant Hospital,
Clearwater, FL, United States
(Szerlip) Departments of Cardiology and Cardiac Surgery, Baylor Scott and
White Heart Hospital, Plano, TX, United States
(Grubb) Division of Cardiothoracic Surgery, Department of Surgery, Emory
University, Atlanta, GA, United States
(Byku) Structural Heart and Valve Center, Division of Cardiology,
Department of Surgery, Emory University, Atlanta, GA, United States
(Guerrero) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
MN, United States
(Gillam) Department of Cardiovascular Medicine, Morristown Medical
Center/Atlantic Health System, Morristown, NJ, United States
(Petronio) Department of Cardiology, University of Pisa, Azienda
Ospedaliera Universitaria Pisana University Hospital, Pisa, Italy
(Attizzani) Division of Cardiology, Harrington Heart and Vascular
Institute, University Hospitals Cleveland Medical Center, Ohio, United
States
(Batchelor) Interventional Heart Program, Inova Schar Heart and Vascular,
Falls Church, VA, United States
(Gada) Interventional Cardiology, University of Pittsburgh Medical Center,
Harrisburg, PA, United States
(Rogers) Section of Interventional Cardiology, MedStar Washington Hospital
Center, Washington, DC, United States
(Rovin) Center for Advanced Valve and Structural Heart Care, Morton Plant
Hospital, Clearwater, FL, United States
(Whisenant) Division of Cardiology, Intermountain Medical Center, Murray,
UT, United States
(Benton) Department of Cardiology, Wellspan York Hospital, York, PA,
United States
(Gardner) Department of Structural Heart Disease Cardiology, Intermountain
Medical Center, Murray, UT, United States
(Padang) Echocardiography Core Laboratory, Mayo Clinic, Rochester, MN,
United States
(Althouse) Structural Heart and Aortic, Medtronic, Minneapolis, MN, United
States
(Herrmann) Cardiovascular Division, Department of Medicine, Perelman
School of Medicine, The University of Pennsylvania, Philadelphia, United
States
Publisher
American Medical Association
Abstract
Importance: Historically, women with aortic stenosis have experienced
worse outcomes and inadequate recognition compared to men, being both
underdiagnosed and undertreated, while also facing underrepresentation in
clinical trials. Objective(s): To determine whether women with small
aortic annuli undergoing transcatheter aortic valve replacement have
better clinical and hemodynamic outcomes with a self-expanding valve (SEV)
or balloon-expandable valve (BEV). Design, Setting, Participants: The
Small Annuli Randomized to Evolut or SAPIEN Trial (SMART) was a
large-scale randomized clinical trial focusing on patients with small
aortic annuli undergoing transcatheter aortic valve replacement,
randomized to receive SEVs or BEVs and included 716 patients treated at 83
centers in Canada, Europe, Israel, and the US from April 2021 to October
2022. This prespecified secondary analysis reports clinical and
hemodynamic findings for all 621 women enrolled in SMART. Data for this
report were analyzed from February to April 2024. Intervention(s):
Transcatheter aortic valve replacement with an SEV or a BEV. Main
Outcomes and Measures: The composite coprimary clinical end point
comprised death, disabling stroke, or heart failure-related
rehospitalization. The coprimary valve function end point was the
incidence of bioprosthetic valve dysfunction, both assessed through 12
months. Secondary end points included the incidence of moderate or severe
prosthesis-patient mismatch. Result(s): A total of 621 women (mean
[SD] age, 80.2 [6.2] years; 312 randomized to the SEV group and 309 to the
BEV group) were included in the present analysis. At 12 months, there were
no significant differences in the coprimary clinical end point between the
SEV and BEV groups (9.4% vs 11.8%, absolute risk difference-2.3%; 95%
CI-7.2 to 2.5, P =.35). However, SEV implantation was associated with less
bioprosthetic valve dysfunction (8.4% vs 41.8%; absolute risk
difference,-33.4%; 95% CI,-40.4 to-26.4; P <.001). SEV implantation
resulted in lower aortic valve gradients and larger effective orifice
areas at 30 days and 12 months and less mild or greater aortic
regurgitation at 12 months compared to BEV implantation.
Prosthesis-patient mismatch was significantly lower with SEVs, regardless
of the definition used and adjustment for body mass index. Use of SEVs was
associated with better quality of life outcomes as assessed by the Valve
Academic Research Consortium-3 ordinal quality of life measure.
 Conclusions and Relevance: Among women with severe symptomatic aortic
stenosis and small aortic annuli undergoing transcatheter aortic valve
replacement, the use of SEVs, compared to BEVs, resulted in similar
clinical outcomes and a markedly reduced incidence of bioprosthetic valve
dysfunction through 12 months, including a lower risk of
prosthesis-patient mismatch and better 12-month quality of life. Trial
Registration: ClinicalTrials.gov Identifier: NCT04722250. Copyright
© 2024 American Medical Association. All rights reserved.

<21>
Accession Number
2032184884
Title
Postoperative bleeding outcome of fresh frozen plasma prime in pediatric
cardiac surgery: A systematic review & meta-analysis.
Source
Perfusion (United Kingdom). (no pagination), 2024. Date of Publication:
2024.
Author
Kesumarini D.; Widyastuti Y.; Boom C.E.; Laurentius A.; Dinarti L.K.
Institution
(Kesumarini, Boom) Department of Anesthesia and Intensive Care, National
Cardiovascular Center Harapan Kita, Jakarta, Indonesia
(Widyastuti) Department of Anesthesia and Intensive Therapy, University of
Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
(Laurentius) National Cardiovascular Center Harapan Kita, Jakarta,
Indonesia
(Dinarti) Department of Cardiology and Vascular Medicine, University of
Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
Publisher
SAGE Publications Ltd
Abstract
Introduction: Bleeding after cardiac surgeries holds risk of mortality and
morbidity in pediatrics. This systematic review aimed to evaluate
postoperative blood loss and blood transfusion requirements for pediatric
patients undergoing cardiac surgery with fresh frozen plasma (FFP)
priming. Method(s): In 2024, the search reviewed four databases on
randomized trials (RCTs) examining the impact of FFP prime intervention on
24-h postoperative blood loss and transfusion requirements in pediatric
cardiac surgeries. The journals were appraised using Grading of
Recommendation Assessment, Development, and Evaluation checklists, and
random effects models estimated the effect size with a 95% confidence
interval. Significance and study heterogeneity were indicated by p-values
and I2. Result(s): Of the screened 2070 articles, one
high-quality and four moderate-quality RCTs involving 354 children were
identified. No significant reduction in 24-h mean postoperative blood loss
was found following FFP priming (mean difference MD: -0.78, 95% CI [-3.3
to 1.75], p =.55) in general pediatric cardiac surgeries. However,
subgroup analysis showed significant decrease in blood loss for younger
children (<7 months) or those with lower body weight (<6 kg). There was no
significant difference between groups in FFP (MD: -0.19, 95% CI [-0.42 to
0.05], p =.13) or red blood cell transfusion (MD: -0.25, 95% CI [-0.51 to
0.02], p =.07). Conclusion(s): Administering FFP as prime fluid in
cardiac surgery did not reduce postoperative bleeding in general pediatric
patients, but younger children (<7 months) and those with lower weight (<6
kg) were the subjects who benefited from the FFP priming before
surgery. Copyright © The Author(s) 2024.

<22>
Accession Number
645773998
Title
Effect of acupuncture on quality of life in atrial fibrillation: study
protocol for a randomised controlled trial.
Source
BMJ open. 14(11) (pp e087460), 2024. Date of Publication: 14 Nov 2024.
Author
Li M.-T.; Shi G.-X.; Wang Y.; Wu B.-Q.; Zhang Z.-H.; Zhao Q.-Y.; Wang X.;
Li X.-B.; Guo W.-H.; He L.; Zhang H.-L.; Wang L.; Wang X.-W.; Tu J.-F.;
Wang H.-Y.; Yan S.-Y.; Lin Y.; Li H.-W.; Liu C.-Z.; Wang L.-Q.
Institution
(Li, Shi, Wang, Tu, Yan, Lin, Li, Liu, Wang) School of
Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine,
Beijing, China
(Wu) First Teaching Hospital of Tianjin University of Traditional Chinese
Medicine, Tianjin, China
(Zhang, Wang) Jiangsu Provincial People's Hospital, Nanjing, China
(Zhao, Wang) Renmin Hospital of Wuhan University, Wuhan, China
(Wang, Guo, Wang) Dongzhimen Hospital Affiliated to Beijing University of
Chinese Medicine, Beijing, China
(Li) Peking University People's Hospital, Beijing, China
(He) First Affiliated Hospital of Hebei University of Chinese Medicine,
Hebei, China
(Zhang) Peking University Third Hospital, Beijing, China
Abstract
INTRODUCTION: Atrial fibrillation (AF) is the prevalent cardiac arrhythmia
and can significantly impair the quality of life (QoL). Although catheter
ablation (CA) is an established treatment for AF,post-procedural
complications or perceived inadequate control of AF may diminish the QoL
for some patients, potentially even to levels lower than pre-procedure.
Preliminary findings from our previous pilot trial indicate that
acupuncture may positively influence QoL in AF patients post-CA. This
study aims to increase the sample size to evaluate the efficacy of
acupuncture as an adjunctive treatment to conventional medical therapy in
improving QoL of patients with AF after CA. METHODS AND DESIGN: This
multicentre randomised clinical trial will be conducted in China. A total
of 146 eligible patients will be randomly assigned in a 1:1 ratio to
either the acupuncture group or the sham acupuncture group. All patients
will receive standard postablation care and undergo 18 sessions of
acupuncture/sham acupuncture within 12 weeks following CA, followed by a
9-month follow-up period. The primary outcome is the change in the Atrial
Fibrillation Effect on Quality-of-Life (AFEQT) summary score from baseline
to months 6 after CA. Secondary outcomes include the changes in the AFEQT
subscale scores at months 6, the AFEQT summary and subscale score at
months 3 and 12, AF burden, AF recurrence, heart rate variability, number
of cardioversions, repeat CA procedures, European Heart Rhythm Association
score, number of arrhythmia-related hospitalisations, average heart rate,
use of Six-Dimensional Health State Short Form to assess health status,
costs incurred by disease treatment, Credibility/Expectancy Questionnaire
and blinded assessments. Adverse events will also be meticulously recorded
throughout the trial. ETHICS AND DISSEMINATION: Ethics approval has been
granted by the Ethics Committee of Beijing University of Traditional
Chinese Medicine (approval no: 2020BZYLL0802) and seven other subcentres.
The findings of the study results will be disseminated through
presentations at scientific conferences or publications in peer-reviewed
journals. TRIAL REGISTRATION NUMBER: ChiCTR2100049323. 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.

<23>
Accession Number
645773767
Title
Efficacy and safety of remimazolam tosylate for patients undergoing
off-pump coronary artery bypass grafting: a study protocol for a
non-inferiority randomised controlled trial in China.
Source
BMJ open. 14(11) (pp e085519), 2024. Date of Publication: 14 Nov 2024.
Author
Wang D.; Cui M.; Wu X.; Niu M.; Yu T.; Zhang Y.; Yue Y.; Wang Q.; Xu B.;
Feng N.; Si J.
Institution
(Wang, Xu) School of Anaesthesiology, Shandong Second Medical University,
Weifang, Shandong, China
(Cui) Department of Anaesthesiology, Zibo Maternal and Child Health
Hospital, Zibo, Shandong, China
(Wu, Niu, Zhang, Yue, Wang, Feng) Department of Anaesthesiology, Zibo
Central Hospital, Zibo, Shandong, China
(Yu) Department of Anaesthesiology, Binzhou Medical University, Binzhou,
Shandong, China
(Si) Department of Anaesthesiology, Zibo Central Hospital, Zibo, Shandong,
China
Abstract
INTRODUCTION: Maintaining haemodynamic stability is crucial but
challenging during the induction and maintenance of general anaesthesia
(GA) in patients undergoing off-pump coronary artery bypass grafting
(OPCABG). Remimazolam tosylate is a novel ultra-short-acting
benzodiazepine with minimal cardiovascular depression. Currently,
non-inferior studies comparing the haemodynamic changes induced by
remimazolam and etomidate are limited. This study aims to assess the
efficacy and safety of remimazolam tosylate for the induction and
maintenance of GA in patients undergoing OPCABG. METHOD AND ANALYSIS: This
two-armed non-inferiority randomised controlled trial will include 88
patients aged 18-75 years who are scheduled for OPCABG. Patients will be
randomly assigned in a 1:1 ratio to receive either remimazolam tosylate or
etomidate and propofol for anaesthesia induction and maintenance. The
primary outcome will be the fluctuation of mean artery pressure during
anaesthesia induction. Secondary outcomes will include adverse events,
adverse drug reactions, the cumulative dosage of vasoactive drugs, vital
signs and bispectral index values at different time points, lengths of
postoperative mechanical ventilation and tracheal intubation, lengths of
intensive care unit stay and hospital stay and hospital mortality.
Analyses will be conducted using both the intention-to-treat approach and
the per-protocol approach. ETHICS AND DISSEMINATION: This study was
approved by the Ethics Committee of Zibo Central Hospital (No. 2024001).
The trial results will be submitted to an international peer-reviewed
journal. TRIAL REGISTRATION NUMBER: ChiCTR.gov.cn:
ChiCTR2400079615. 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.

<24>
Accession Number
2035507729
Title
Predictive potential of pre-procedural cardiac and inflammatory biomarkers
regarding mortality following transcatheter aortic valve implantation: A
systematic review and meta-analysis.
Source
Heart and Lung. 69 (pp 229-240), 2025. Date of Publication: 01 Jan 2025.
Author
AziziKia H.; Mousavi A.; Shojaei S.; Shaker F.; Salabat D.; Bahri R.A.;
Dolama R.H.; Radkhah H.
Institution
(AziziKia) Student Research Committee, School of Medicine, Shahroud
University of Medical Sciences, Shahroud, Iran, Islamic Republic of
(Mousavi, Shojaei, Shaker, Salabat, Bahri, Dolama) School of Medicine,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Mousavi, Shojaei, Shaker, Salabat, Dolama) Tehran Heart Center,
Cardiovascular Diseases Research Institute, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Radkhah) Sina Hospital Department of Internal Medicine, Tehran, Iran,
Islamic Republic of
Publisher
Elsevier Inc.
Abstract
Background: Aortic stenosis (AS) is a common heart valve disease,
especially in aging populations. While surgical aortic valve replacement
(SAVR) is the standard treatment, many patients are ineligible.
Transcatheter aortic valve implantation (TAVI) offers an alternative,
especially for high-risk patients, but is not without complications.
Identifying biomarkers that predict post-TAVI mortality is essential for
optimizing outcomes. Objective(s): The purpose of this systematic
review and meta-analysis is to evaluate the role of cardiac and
inflammatory biomarkers in predicting short-term and mid to long-term
mortality following TAVI. Method(s): We searched PubMed, Scopus,
Embase, and Web of Science for studies examining the impact of
inflammatory and cardiac biomarkers on mortality following TAVI. Mean
differences (MDs) and 95 % confidence interval (CI) were calculated using
a random-effect model. Result(s): Twenty-eight studies involving
10,560 patients were included, with 1867 in the mortality group. Mortality
was significantly associated with higher pre-procedural levels of
creatinine (0.41; 95 % CI: [0.35, 0.48]), brain natriuretic peptide (0.58;
95 % CI: [0.43, 0.73]), C-reactive protein (0.55; 95 % CI: [0.45, 0.64]),
and white blood cell count (0.18; 95 % CI: [0.06, 0.31]), and lower
pre-procedural levels of hemoglobin (-0.49; 95 % CI: [-0.60, -0.38]) and
albumin (-0.18; 95 % CI: [-0.24, -0.13]). These associations remained
statistically significant in subgroup analyses for both mid to long-term
mortality and short-term mortality, except for WBC levels, which were not
significantly associated with short-term mortality, and Hb, for which
short-term data were insufficient. Platelet count showed no significant
difference. Conclusion(s): These findings highlight the importance of
inflammatory and cardiac biomarkers in risk stratification and patient
management in TAVI procedures. Copyright © 2024 Elsevier Inc.

<25>
Accession Number
2032173505
Title
Risk factors for conversion from minimally invasive surgery to thoracotomy
in patients with lung cancer: outcomes from a pooled analysis.
Source
Journal of Robotic Surgery. 18(1) (no pagination), 2024. Article Number:
399. Date of Publication: December 2024.
Author
Lu Z.; Sun J.-Y.
Institution
(Lu, Sun) Department of Thoracic Surgery, Affiliated Hospital of Inner
Mongolia Medical University, Inner Mongolia, Hohhot, China
Publisher
Springer Nature
Abstract
The purpose of this study is to explore the risk factors for conversion
from minimally invasive surgery to thoracotomy in patients with lung
cancer through meta-analytic approach, and provide a better evidence-based
basis for clinicians to perform surgery. We conducted a comprehensive
search across databases including PubMed, Embase, Web of Science, and the
Cochrane Library database to identify relevant English-language studies
published up to February 2024. The pooled effect estimate was calculated
using the odds ratio (OR) and a 95% confidence interval (CI). We also
conducted sensitivity, subgroup, and publication bias tests. Meta-analysis
was performed by using stata18MP software. The study was registered with
PROSPERO(ID: CRD42024524790). We included a total of 8 studies. We
discovered that gender (OR: 1.58; 95% CI: 1.23-2.03; P < 0.001), chronic
obstructive pulmonary disease (COPD) (OR: 1.13; 95% CI: 1.04-1.23; P =
0.005), location of the tumor (OR: 1.21; 95% CI: 1.12-1.31; P < 0.001)
were all linked to an increased risk of conversion. Additionally, the type
of surgery (OR: 0.14; 95% CI: 0.05-0.39; P < 0.001) was associated with a
reduced risk of conversion. Nevertheless, age, smoking, and obesity showed
no association with the risk of conversion. The current meta-analysis
suggests that the male gender, COPD, upper lobe tumor location, and the
video-assisted approach are risk factors for conversion from minimally
invasive surgery to thoracotomy in patients with lung cancer. More
high-quality studies are required to validate the above results due to the
limited number and types of studies included. Copyright © The
Author(s), under exclusive licence to Springer-Verlag London Ltd., part of
Springer Nature 2024.

<26>
Accession Number
2032173222
Title
A visual laryngoscope combined with a fiberoptic bronchoscope improves
intubation outcomes in patients with predicted difficult airways in
thoracic surgery.
Source
BMC Pulmonary Medicine. 24(1) (no pagination), 2024. Article Number: 558.
Date of Publication: December 2024.
Author
Hu H.-Z.; Cheng X.-X.; Zhang T.; Zhang G.-L.; Zhang G.-J.; Wu W.-W.; Li
R.-H.
Institution
(Hu, Cheng, Zhang, Zhang, Zhang, Li) Department of Anesthesiology, Lu'an
Hospital of Anhui Medical University, Lu'an 237000, China
(Wu) Department of Anesthesiology, the First Affiliated Hospital of Anhui
Medical University, Hefei 230000, China
Publisher
BioMed Central Ltd
Abstract
Objective: To study the clinical effectiveness of visual laryngoscopy
combined with fiberoptic bronchoscopy-guided double-lumen endotracheal
tube intubation in thoracic surgery patients with predicted difficult
airways in thoracic surgery airways. Method(s): We randomly divided
162 patients with predicted difficult airways who required double-lumen
tracheal intubation for thoracic surgery and randomly divided them into
the video laryngoscopy group (Group VL, n = 54),fiberoptic bronchoscopy
group (Group F, n = 54), and video laryngoscopy combined with fiberoptic
bronchoscopy group (Group FVL, n = 54) according to the randomized number
table method. Then, the success rate of the first intubation, the duration
of intubation, the duration of positioning, the degree of exposure of the
vocal cords (Cormack-Lehane grade), and the adverse reactions during
intubation were recorded and analyzed. Result(s): The success rate of
first-time intubation was significantly higher in the FVL group than in
the F and VL groups (92.6% vs. 87.0% vs. 53.7%, P < 0.001), and the time
of intubation in the FVL group was significantly shorter than that in the
VL and F groups [(26.22 +/- 9.34) s vs. (42.35 +/- 11.21) s vs. (46.78 +/-
21.96) s, P < 0.001)]. The positioning time in the FVL group was
significantly shorter than that in the F and VL groups [(83.76 +/- 15.18)
s vs. (102.72 +/- 21.89) s vs. (145.41 +/- 20.12) s, F = 144.896, P <
0.001)].The number of patients with Cormack-Lehane grades I-II was
significantly lower in the FVL group and the VL group than in the F group
(88.9% vs. 77.8% vs. 59.3%, P < 0.05).The incidence of postoperative sore
throat was significantly lower in the FVL group and the F group than in
the VL group (22.4% vs. 27.6% vs. 50%, P < 0.001). Conclusion(s): In
difficult airway patients with high airway risk indices who require
double-lumen endotracheal intubation, visual laryngoscopy combined with
fiberoptic bronchoscopy improved the success rate of first-time intubation
and shortened the intubation and positioning time. Trial registration:
Chinese Clinical Trial Register (identifier: ChiCTR2300076304; Date of
registration: September 29, 2023). Copyright © The Author(s)
2024.

<27>
Accession Number
2032173211
Title
The effects of dexmedetomidine on thiol/disulphide homeostasis in coronary
artery bypass surgery: a randomized controlled trial.
Source
BMC Anesthesiology. 24(1) (no pagination), 2024. Article Number: 402. Date
of Publication: December 2024.
Author
Ozguner Y.; Altinsoy S.; Kulturoglu G.; Unal D.; Ergil J.; Neselioglu S.;
Erel O.
Institution
(Ozguner, Altinsoy, Kulturoglu, Unal, Ergil) Department of Anesthesiology
and Reanimation, Ankara Etlik City Hospital, Ankara, Turkey
(Neselioglu, Erel) Department of Clinical Biochemistry, Faculty of
Medicine, Yildirim Beyazit University, Ankara, Turkey
Publisher
BioMed Central Ltd
Abstract
Background: Thiol-disulfide homeostasis (TDH) plays a pivotal role in
various physiological mechanisms, including antioxidant defence,
detoxification, apoptosis, regulation of enzyme activities and cellular
signal transduction. TDH can be used as a biomarker to detect oxidative
stress (OS) levels and ischemia status in the tissues. Coronary artery
bypass grafting (CABG) surgery is a procedure associated with high
oxidative stress. Dexmedetomidine, an alpha-2 agonist anaesthetic agent,
has antioxidant effects. In this study, the effects of dexmedetomidine on
oxidative stress in CABG surgery were investigated. Method(s):
Patients who underwent on-pump CABG surgery were divided into two groups:
those receiving dexmedetomidine (Group D) and those not receiving
dexmedetomidine (Group C). From anesthesia induction to the end of
surgery, patients in Group D received intravenous infusions of 0.05-0.2
mcg/kg/min remifentanil and 0.2-0.7 mcg/kg/h dexmedetomidine. Patients in
Group C received intravenous infusion of 0.05-0.2 mcg/kg/min remifentanil.
Blood samples were collected from the patients 30 min before induction of
anesthesia (T1), 30 min after removal of the aortic cross-clamp (T2), and
at the end of the surgery (T3). Thiol-disulfide homeostasis (TDH) was
assessed using a novel method. A novel automated method enables the
determination of native thiols, total thiols and disulfides levels in
plasma, allowing the calculation of their respective ratios.
 Result(s): In patients receiving dexmedetomidine, lower postoperative
levels of disulfide, disulfide/native thiol, and disulfide/total thiol,
along with higher native thiol/total thiol, were observed compared to the
control group. (p < 0.05) Postoperative native thiol and total thiol
levels were similar for both groups. (p > 0.05) Conclusion(s): In our
study, through dynamic thiol-disulfide measurements, we found that levels
of oxidative stress (OS) were lower in patients who received
dexmedetomidine. We believe that the positive effects of dexmedetomidine
on OS could be beneficial in CABG surgery. Furthermore, we anticipate that
with further studies conducted in larger patient cohorts, the clinical
utilization of dexmedetomidine will become more widespread. Trial
registration number: NCT05895331 / 06.07.2023. Copyright © The
Author(s) 2024.

<28>
Accession Number
2035618898
Title
Effects of omega-3 fatty acids on coronary revascularization and
cardiovascular events: Is there a role for fibrates?.
Source
European Journal of Preventive Cardiology. 31(15) (pp e111), 2024. Date of
Publication: 01 Oct 2024.
Author
Sbrana F.; Dal Pino B.
Institution
(Sbrana, Dal Pino) Lipoapheresis Unit and Reference Center for Inherited
Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1,
Pisa 56124, Italy
Publisher
Oxford University Press

<29>
Accession Number
2034152742
Title
Intraoperative Oxygen Treatment, Oxidative Stress, and Organ Injury
Following Cardiac Surgery: A Randomized Clinical Trial.
Source
JAMA Surgery. 159(10) (pp 1106-1116), 2024. Date of Publication: 09 Oct
2024.
Author
Lopez M.G.; Shotwell M.S.; Hennessy C.; Pretorius M.; McIlroy D.R.;
Kimlinger M.J.; Mace E.H.; Absi T.; Shah A.S.; Brown N.J.; Billings F.T.
Institution
(Lopez, Pretorius, McIlroy, Billings) Department of Anesthesiology,
Vanderbilt University Medical Center, Vanderbilt University, School of
Medicine, Nashville, TN, United States
(Shotwell, Hennessy) Department of Biostatistics, Vanderbilt University
Medical Center, Vanderbilt University, School of Medicine, Nashville, TN,
United States
(Mace) Department of Surgery, Vanderbilt University Medical Center,
Vanderbilt University, School of Medicine, Nashville, TN, United States
(Absi, Shah) Department of Cardiac Surgery, Vanderbilt University Medical
Center, Vanderbilt University, School of Medicine, Nashville, TN, United
States
(Brown, Billings) Department of Medicine, Vanderbilt University Medical
Center, Vanderbilt University, School of Medicine, Nashville, TN, United
States
(Kimlinger) Vanderbilt University Medical Center, Vanderbilt University,
School of Medicine, Nashville, TN, United States
Publisher
American Medical Association
Abstract
Importance: Liberal oxygen (hyperoxia) is commonly administered to
patients during surgery, and oxygenation is known to impact mechanisms of
perioperative organ injury. Objective(s): To evaluate the effect of
intraoperative hyperoxia compared to maintaining normoxia on oxidative
stress, kidney injury, and other organ dysfunctions after cardiac surgery.
 Design, Setting, and Participant(s): This was a participant- and
assessor-blinded, randomized clinical trial conducted from April 2016 to
October 2020 with 1 year of follow-up at a single tertiary care medical
center. Adult patients (>18 years) presenting for elective open cardiac
surgery without preoperative oxygen requirement, acute coronary syndrome,
carotid stenosis, or dialysis were included. Of 3919 patients assessed,
2501 were considered eligible and 213 provided consent. Of these, 12 were
excluded prior to randomization and 1 following randomization whose
surgery was cancelled, leaving 100 participants in each group.
 Intervention(s): Participants were randomly assigned to hyperoxia
(1.00 fraction of inspired oxygen [FiO2]) or normoxia (minimum FiO2 to
maintain oxygen saturation 95%-97%) throughout surgery. Main Outcomes
and Measures: Participants were assessed for oxidative stress by measuring
F2-isoprostanes and isofurans, for acute kidney injury (AKI), and for
delirium, myocardial injury, atrial fibrillation, and additional secondary
outcomes. Participants were monitored for 1 year following surgery.
 Result(s): Two hundred participants were studied (median [IQR] age,
66 [59-72] years; 140 male and 60 female; 82 [41.0%] with diabetes).
F2-isoprostanes and isofurans (primary mechanistic end point) increased on
average throughout surgery, from a median (IQR) of 73.3 (53.1-101.1) pg/mL
at baseline to a peak of 85.5 (64.0-109.8) pg/mL at admission to the
intensive care unit and were 9.2 pg/mL (95% CI, 1.0-17.4; P =.03) higher
during surgery in patients assigned to hyperoxia. Median (IQR) change in
serum creatinine (primary clinical end point) from baseline to
postoperative day 2 was 0.01 mg/dL (-0.12 to 0.19) in participants
assigned hyperoxia and -0.01 mg/dL (-0.16 to 0.19) in those assigned
normoxia (median difference, 0.03; 95% CI, -0.04 to 0.10; P =.45). AKI
occurred in 21 participants (21%) in each group. Intraoperative oxygen
treatment did not affect additional acute organ injuries, safety events,
or kidney, neuropsychological, and functional outcomes at 1 year.
 Conclusion(s): Among adults receiving cardiac surgery, intraoperative
hyperoxia increased intraoperative oxidative stress compared to normoxia
but did not affect kidney injury or additional measurements of organ
injury including delirium, myocardial injury, and atrial fibrillation.
Trial Registration: ClinicalTrials.gov Identifier:
NCT02361944. Copyright © 2024 American Medical Association. All
rights reserved.

<30>
Accession Number
2033596016
Title
Long-term follow-up of the randomized, prospective Scandinavian heart
transplant everolimus de novo study with early calcineurin inhibitors
avoidance (SCHEDULE) trial.
Source
Journal of Heart and Lung Transplantation. 43(12) (pp 1948-1959), 2024.
Date of Publication: December 2024.
Author
Bollano E.; Andreassen A.K.; Eiskjaer H.; Gustafsson F.; Radegran G.; Gude
E.; Gullestad L.; Broch K.; Halden T.A.S.; Karason K.; Bartfay S.-E.;
Bergh N.
Institution
(Bollano, Bartfay) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Bollano, Karason, Bartfay) Department of Transplantation, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Bollano, Karason, Bartfay, Bergh) Institute of Medicine, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
(Andreassen, Gude, Gullestad, Broch) Department of Cardiology, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Gustafsson) Department of Clinical Medicine, University of Copenhagen,
Copenhagen, Denmark
(Radegran) Section for Heart Failure and Valvular Disease, Skane
University Hospital and Department of Clinical Sciences, Cardiology, Lund
University, Lund, Sweden
(Gullestad, Broch) KG Jebsen Center for Cardiac Research, University of
Oslo, Oslo, Norway
(Halden) Department of Immunology, Novartis Norge AS, Oslo, Norway
Publisher
Elsevier Inc.
Abstract
Background: Early substitution of calcineurin inhibitor (CNI) with
mammalian target of rapamycin inhibitors has been shown to improve kidney
function and reduce intimal hyperplasia in heart transplant (HTx)
recipients but data on long-term outcome of such a regime are still
sparse. Method(s): In the SCHEDULE trial, 115 de novo HTx recipients
were randomized to (1) everolimus with reduced exposure of CNI followed by
CNI withdrawal at week 7-11 post-transplant or (2) standard-exposure with
CNI. Both groups received mycophenolate mofetil and corticosteroids.
Herein we report on the 10-12-year long-term follow-up of the study.
 Result(s): A total of 78 patients attended the follow-up visit at a
median time of 11 years post-transplant. In the everolimus intention to
treat (ITT) group 87.5% (35/40 patients) still received everolimus and in
the CNI ITT group 86.8% (33/38) still received CNI. Estimated glomerular
filtration rate (eGFR) (least square mean (95% CI)) at the 10-12 years
visit was 82.7 (74.2-91.1) ml/min/1.73 m2 and 61.0 (52.3-69.7)
ml/min/1.73 m2 in the everolimus and CNI group, respectively (p
< 0.001). Graft function measured by ejection fraction, ECG, NT-proBNP and
drug safety were comparable between groups. During the study period there
was a total of 28 deaths, but there was no difference in survival between
the everolimus and the CNI group (aHR 0.61 (95% CI 0.29-1.30) p = 0.20).
For the composite endpoint of death, re-transplantation, myocardial
infarction, PCI, dialysis, kidney transplantation or cancer no between
group differences were found (aHR 1.0 (95% CI 0.57-1.77) p = 0.99).
 Conclusion(s): De novo HTx patients randomized to everolimus and low
dose CNI followed by CNI free therapy sustained significantly better
long-term kidney function than patients randomized to standard therapy.
The graft function at 10-12 years was similar in both groups and there was
no difference in survival. Copyright © 2024 The Authors

<31>
Accession Number
2032854968
Title
Povidone Iodine vs Chlorhexidine Gluconate in Alcohol for Preoperative
Skin Antisepsis: A Randomized Clinical Trial.
Source
JAMA. 332(7) (pp 541-549), 2024. Date of Publication: 20 Aug 2024.
Author
Widmer A.F.; Atkinson A.; Kuster S.P.; Wolfensberger A.; Klimke S.;
Sommerstein R.; Eckstein F.S.; Schoenhoff F.; Beldi G.; Gutschow C.A.;
Marschall J.; Schweiger A.; Jent P.
Institution
(Widmer, Klimke) Division of Infectious Diseases and Hospital
Epidemiology, University Hospital Basel, University of Basel, Basel,
Switzerland
(Atkinson) Pediatric Research Centre, University Children's Hospital
Basel, Basel, Switzerland
(Atkinson, Marschall) Division of Infectious Diseases, Department of
Internal Medicine, Washington University, School of Medicine in St. Louis,
St Louis, MO, United States
(Kuster, Wolfensberger) Department of Infectious Diseases and Hospital
Epidemiology, University Hospital Zurich, University of Zurich, Zurich,
Switzerland
(Sommerstein, Marschall, Jent) Department of Infectious Diseases,
Inselspital Bern University Hospital, University of Bern, Bern,
Switzerland
(Sommerstein) Department of Health Science and Medicine, University of
Lucerne, Lucerne, Switzerland
(Eckstein) Department of Cardiac Surgery, University Hospital Basel,
University of Basel, Basel, Switzerland
(Schoenhoff) Department of Cardiac Surgery, Inselspital Bern University
Hospital, University of Bern, Bern, Switzerland
(Beldi) Department of Visceral Surgery and Medicine, Inselspital Bern
University Hospital, University of Bern, Bern, Switzerland
(Gutschow) Department of Visceral and Transplantation Surgery, University
Hospital Zurich, University of Zurich, Zurich, Switzerland
(Schweiger) Division of Internal Medicine, Cantonal Hospital Zug, Baar,
Switzerland
Publisher
American Medical Association
Abstract
Importance: Preoperative skin antisepsis is an established procedure to
prevent surgical site infections (SSIs). The choice of antiseptic agent,
povidone iodine or chlorhexidine gluconate, remains debated.
 Objective(s): To determine whether povidone iodine in alcohol is
noninferior to chlorhexidine gluconate in alcohol to prevent SSIs after
cardiac or abdominal surgery. Design, Setting, and Participant(s):
Multicenter, cluster-randomized, investigator-masked, crossover,
noninferiority trial; 4403 patients undergoing cardiac or abdominal
surgery in 3 tertiary care hospitals in Switzerland between September 2018
and March 2020 were assessed and 3360 patients were enrolled (cardiac, n =
2187 [65%]; abdominal, n = 1173 [35%]). The last follow-up was on July 1,
2020. Intervention(s): Over 18 consecutive months, study sites were
randomly assigned each month to either use povidone iodine or
chlorhexidine gluconate, each formulated in alcohol. Disinfectants and
skin application processes were standardized and followed published
protocols. Main Outcomes and Measures: Primary outcome was SSI within
30 days after abdominal surgery and within 1 year after cardiac surgery,
using definitions from the US Centers for Disease Control and Prevention's
National Healthcare Safety Network. A noninferiority margin of 2.5% was
used. Secondary outcomes included SSIs stratified by depth of infection
and type of surgery. Result(s): A total of 1598 patients (26 cluster
periods) were randomly assigned to receive povidone iodine vs 1762
patients (26 cluster periods) to chlorhexidine gluconate. Mean (SD) age of
patients was 65.0 years (39.0-79.0) in the povidone iodine group and 65.0
years (41.0-78.0) in the chlorhexidine gluconate group. Patients were
32.7% and 33.9% female in the povidone iodine and chlorhexidine gluconate
groups, respectively. SSIs were identified in 80 patients (5.1%) in the
povidone iodine group vs 97 (5.5%) in the chlorhexidine gluconate group, a
difference of 0.4% (95% CI, -1.1% to 2.0%) with the lower limit of the CI
not exceeding the predefined noninferiority margin of -2.5%; results were
similar when corrected for clustering. The unadjusted relative risk for
povidone iodine vs chlorhexidine gluconate was 0.92 (95% CI, 0.69-1.23).
Nonsignificant differences were observed following stratification by type
of surgical procedure. In cardiac surgery, SSIs were present in 4.2% of
patients with povidone iodine vs 3.3% with chlorhexidine gluconate
(relative risk, 1.26 [95% CI, 0.82-1.94]); in abdominal surgery, SSIs were
present in 6.8% with povidone iodine vs 9.9% with chlorhexidine gluconate
(relative risk, 0.69 [95% CI, 0.46-1.02]). Conclusions and Relevance:
Povidone iodine in alcohol as preoperative skin antisepsis was noninferior
to chlorhexidine gluconate in alcohol in preventing SSIs after cardiac or
abdominal surgery. Trial Registration: ClinicalTrials.gov Identifier:
NCT03685604. Copyright © 2024 American Medical Association. All
rights reserved.

<32>
Accession Number
2032122884
Title
Systematic review of microRNAs in human acute kidney injury.
Source
Renal Failure. 46(2) (no pagination), 2024. Article Number: 2419960. Date
of Publication: 2024.
Author
Douvris A.; Vinas J.L.; Akbari S.; Tailor K.; Lalu M.M.; Burger D.; Burns
K.D.
Institution
(Douvris, Vinas, Tailor, Burger, Burns) Division of Nephrology, Department
of Medicine and Kidney Research Centre, Ottawa Hospital Research
Institute, University of Ottawa, ON, Canada
(Douvris, Burger, Burns) Department of Cellular and Molecular Medicine,
University of Ottawa, Ottawa, ON, Canada
(Akbari) Division of Nephrology, Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Lalu) Department of Anesthesiology and Pain Medicine, Clinical
Epidemiology and Regenerative Medicine Program, Blueprint Translational
Research Group, The Ottawa Hospital Research Institute, The University of
Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Early diagnosis of acute kidney injury (AKI) is limited with
current tools. MicroRNAs (miRNAs) are implicated in AKI pathogenesis in
preclinical models, but less is known about their role in humans. We
conducted a systematic review to identify dysregulated miRNAs in humans
with AKI. Method(s): We searched Ovid MEDLINE, Embase, Web of
Science, and CENTRAL (August 21, 2023) for studies of human subjects with
AKI. We excluded reviews and pre-clinical studies without human data. The
primary outcome was dysregulated miRNAs in AKI. Two reviewers screened
abstracts, reviewed full texts, performed data extraction and quality
assessment (Newcastle Ottawa Scale). Result(s): We screened 2,456
reports and included 92 for synthesis without meta-analysis. All studies
except one were observational. Studies were grouped by etiology of AKI:
cardiac surgery-associated (CS-AKI, n = 13 studies), sepsis (n = 25),
nephrotoxic (n = 9), kidney transplant (n = 26), and other causes (n =
19). In total, 128 miRNAs were identified to be dysregulated across AKI
studies (45 miRNAs upregulated, 55 downregulated, 28 both). miR-21 was the
most frequently reported (n = 17 studies) and it was increased in all
etiologies except CS-AKI where it was decreased (n = 3 studies). Study
limitations included bias due to targeted approaches, absence of clinical
data/controls, and miRNA normalization methods. Overall study quality was
fair (median 5/9, range 2-8 points). Conclusion(s): Dysregulated
miRNAs, particularly miR-21, have potential as AKI biomarkers. These
results should be interpreted cautiously due to methodological
limitations. Standardized methods and unbiased approaches are needed to
validate candidate miRNA biomarkers. Registration: International
Prospective Register of Systematic Reviews (PROSPERO
CRD42020201253). Copyright © 2024 The Author(s). Published by
Informa UK Limited, trading as Taylor & Francis Group.

<33>
Accession Number
2030707953
Title
Acute changes in kidney function and outcomes following an acute
myocardial infarction: Insights from PARADISE-MI.
Source
European Journal of Heart Failure. 26(9) (pp 1984-1992), 2024. Date of
Publication: September 2024.
Author
Mc Causland F.R.; McGrath M.M.; Claggett B.L.; Barkoudah E.; East C.;
Fernandez A.; Jering K.S.; Lewis E.F.; McMurray J.J.V.; Mody F.V.; Solomon
S.D.; Tokmakova M.; van der Meer P.; Zhou Y.; Pfeffer M.A.
Institution
(Mc Causland, McGrath) Renal Division, Department of Medicine, Brigham and
Women's Hospital, Boston, MA, United States
(Mc Causland, McGrath, Claggett, Barkoudah, Jering, Solomon, Pfeffer)
Harvard Medical School, Boston, MA, United States
(Claggett, Jering, Solomon, Pfeffer) Cardiovascular Division, Department
of Medicine, Brigham and Women's Hospital, Boston, MA, United States
(Barkoudah) Department of Medicine, Brigham and Women's Hospital, Boston,
MA, United States
(East) Baylor Soltero CV Research Center, Baylor Scott and White Heart and
Vascular Hospital, Dallas, TX, United States
(Fernandez) Cardiology Service, Sanatorio Modelo Quilmes, Quilmes,
Argentina
(Lewis) Division of Cardiovascular Medicine, Stanford University School of
Medicine, Stanford University, Palo Alto, CA, United States
(McMurray) British Heart Foundation Glasgow Cardiovascular Research
Centre, School of Cardiovascular and Metabolic Health, University of
Glasgow, Glasgow, United Kingdom
(Mody) David Geffen School of Medicine at University of California Los
Angeles and Division of Cardiology, Veterans Affairs Greater Los Angeles
Health Care System, Los Angeles, CA, United States
(Tokmakova) University Multiprofile Hospital for Active Treatment Sv.
Georgi, Medical University Plovdiv, Plovdiv, Bulgaria
(van der Meer) Department of Cardiology, University Medical Center
Groningen, University of Groningen, Groningen, Netherlands
(Zhou) Novartis Pharmaceutical Corporation, East Hanover, NJ, United
States
Publisher
John Wiley and Sons Ltd
Abstract
Aims: Pharmacologic blockade of neurohormonal pathways in patients with
acute myocardial infarction (MI) can result in acute changes in biomarkers
of kidney function. We evaluated the effect of sacubitril/valsartan versus
ramipril on initial changes in serum creatinine and the association of
these changes with longer-term outcomes among participants in PARADISE-MI.
 Methods and Results: In this randomized, double-blind,
active-controlled, event-driven trial, 5661 patients with an acute MI were
assigned to receive sacubitril/valsartan or ramipril, with no run-in. The
frequency of an initial pre-specified increase in serum creatinine (>=26.5
or >=44 mumol/L) from baseline to week 1 was compared between arms.
Multivariable Cox regression models were fit to examine the association of
acute changes in serum creatinine with the primary cardiovascular
composite outcome (cardiovascular death, first heart failure
hospitalization, or outpatient heart failure), all-cause mortality, and
longer-term changes in estimated glomerular filtration rate (eGFR). An
initial increase in serum creatinine >=26.5 mumol/L occurred in 155 of
2604 (6.0%) patients assigned to sacubitril/valsartan and 120 of 2603
(4.6%) patients assigned to ramipril (odds ratio [OR] 1.32; 95% confidence
interval [CI] 1.03-1.68). The corresponding numbers for an increase >=44
mumol/L were 57 (2.2%) and 42 (1.6%), respectively (OR 1.37; 95% CI
0.92-2.05). A higher odds of increased serum creatinine >=26.5 and >=44
mumol/L for sacubitril/valsartan versus ramipril appeared to be restricted
to patients who had a greater decline in systolic blood pressure over the
same period (p-interaction = 0.05 and 0.001, respectively). In
multivariable analyses, neither an acute increase in serum creatinine
>=26.5 or >=44 mumol/L was associated with a higher risk of cardiovascular
outcomes, all-cause mortality, or differences in longer-term eGFR slope.
Findings were similar across the randomized treatment arms (p-interaction
>0.6 for all). Conclusion(s): Following acute MI, patients assigned
to sacubitril/valsartan had a higher frequency of initial increases in
serum creatinine at 1 week, compared with ramipril. In adjusted models,
initial increases in serum creatinine with either treatment were not
associated with adverse cardiovascular outcomes or changes in longer-term
kidney function. Copyright © 2024 European Society of Cardiology.

<34>
Accession Number
2030668437
Title
Evaluation of microcirculatory protection in percutaneous
revascularisation: A stent implantation technique and device comparison.
Source
Catheterization and Cardiovascular Interventions. 104(3) (pp 462-471),
2024. Date of Publication: 01 Sep 2024.
Author
Aetesam-ur-Rahman M.; Zhao T.X.; Paques K.; Oliveira J.; Chiu Y.-D.;
Duckworth M.; Khialani B.; Kyranis S.; Bennett M.R.; West N.E.J.; Hoole
S.P.
Institution
(Aetesam-ur-Rahman, Zhao, Paques, Oliveira, Chiu, Duckworth, Khialani,
Kyranis, West, Hoole) Department of Interventional Cardiology, Royal
Papworth Hospital, Cambridge, United Kingdom
(Bennett) Division of Cardiovascular Medicine, University of Cambridge,
Cambridge, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Background: Coronary microvascular dysfunction (CMD) after percutaneous
coronary intervention (PCI) is prognostically important and may also be a
cause of persistent angina. The stent balloon inflation technique or
material properties may influence the degree of CMD post-PCI.
 Method(s): Thirty-six patients with stable angina attending for
elective PCI were randomized to either slow drug eluting stent (DES)
implantation technique (DES slow group): +2 atm. every 5 s., maintained
for a further 30 s or a standard stent implantation technique (DES std
group): rapid inflation and deflation. PressureWire X with thermodilution
at rest and hyperemia and optical coherence tomography (OCT) were
performed pre- and post-PCI. Combined primary endpoints were changes in
index of microvascular resistance (delta IMR) and coronary flow reserve
(delta CFR) following PCI. The secondary endpoints included differences in
cardiac troponin I (delta cTnI) at 6 h post-PCI, Seattle angina
questionnaire (SAQ) at 1, 3, 6, and 12 months and OCT measures of stent
results immediately post-PCI and at 3 months. Result(s): Both groups
were well matched, with similar baseline characteristics and OCT-defined
plaque characteristics. Delta IMR was significantly better in the DES slow
PCI arm with a median difference of -4.14 (95% CI -10.49, -0.39, p =
0.04). Delta CFR was also numerically higher with a median difference of
0.47 (95% CI -0.52, 1.31, p = 0.46). This did not translate to improved
delta median cTnI (1.5 (34.8) vs. 0 (27.5) ng/L, p = 0.75) or median SAQ
score at 3 months, (85 (20) vs. 95 (17.5), p = 0.47). Conclusion(s):
Slow stent implantation is associated with less CMD after elective PCI in
patients with stable angina. Copyright © 2024 The Author(s).
Catheterization and Cardiovascular Interventions published by Wiley
Periodicals LLC.

<35>
Accession Number
2030646250
Title
Meta-long Papyrus: Meta-analysis of mid to long-term outcomes of PK
Papyrus covered stent.
Source
Catheterization and Cardiovascular Interventions. 104(3) (pp 492-498),
2024. Date of Publication: 01 Sep 2024.
Author
Jurado-Roman A.; Tebar-Marquez D.; Hernandez-Enriquez M.; Birkemeyer R.;
Rodriguez-Leor O.; Spinu R.; Belle L.; Galeote G.; Jimenez-Valero S.;
Moreno R.
Institution
(Jurado-Roman, Tebar-Marquez, Galeote, Jimenez-Valero, Moreno) Cardiology
Department, La Paz University Hospital, Madrid, Spain
(Jurado-Roman, Tebar-Marquez, Galeote, Jimenez-Valero, Moreno) Hospital La
Paz Institute for Health Research, IdiPAZ, Madrid, Spain
(Hernandez-Enriquez) Cardiology department, Catalunya General University
Hospital, Barcelona, Spain
(Birkemeyer) Herzklinik Ulm, Ulm, Germany
(Rodriguez-Leor) Institut del Cor, Germans Trias i Pujol University
Hospital, Barcelona, Spain
(Spinu, Belle) Cardiology Department, Hospital Of Annecy, Cannes, France
Publisher
John Wiley and Sons Inc
Abstract
Background: Although covered stents (CS) represent a potentially
life-saving intervention for coronary perforation (CAP), their application
has expanded to other contexts, including coronary aneurysms (CAA).
However, data regarding mid- and long-term outcomes of CS in these
settings scenarios remains limited. Aim(s): This meta-analysis aims
to evaluate major adverse cardiac events (MACE) from discharge through
long-term follow-up in patients undergoing percutaneous coronary
intervention with the new generation polyurethane-covered cobalt-chromium
PK Papyrus CS. Method(s): We conducted a meta-analysis of data from
three observational trials that included long-term follow-up of patients
who underwent PK Papyrus CS implantation: Papyrus-Spain, SOS PK Papyrus,
and PAST-PERF registry. Result(s): 332 patients underwent PK Papyrus
CS implantation, 236 (71.1%) for CAP, 70 (21.1%) for CAA and 26 (7.8%) for
other indications. After a mean follow-up of 16.2 months, the MACE was
14.3%, with Target Lesion Revascularization (TLR) being the most frequent
(8.5%), followed by stent thrombosis (ST), 3.3% and cardiac death (CD),
2.6%. Comparing CAP and CAA subgroups, the MACE rate in CAA was
significantly higher than CAP (21.4% vs 9.7%, p < 0.01), primary driven by
ST (CAA: 8.6% vs CAP: 1.3%; p = 0.0015). Conclusion(s): The clinical
outcomes following PK Papyrus CS implantation are deemed acceptable,
considering the challenging scenarios and the existing alternative
treatments. However, MACE rates in patients with CAA who received Papyrus
PK CS were significantly higher than in those with CAP, underscoring the
importance of meticulous patient selection and optimization of CS in these
complex patients and coronary anatomies. Copyright © 2024 Wiley
Periodicals LLC.

<36>
Accession Number
2030594223
Title
Predictors of outcomes after PCI with incomplete revascularization: Impact
of CTO and LAD vessel.
Source
Catheterization and Cardiovascular Interventions. 104(3) (pp 483-491),
2024. Date of Publication: 01 Sep 2024.
Author
Kuno T.; Weisz G.; Genereux P.; Claessen B.E.; Shechter M.; Alexander
K.P.; James S.K.; Ohman E.; Dressler O.; Mehran R.; Ben-Yehuda O.; Stone
G.W.
Institution
(Kuno, Mehran, Stone) The Zena and Michael A. Wiener Cardiovascular
Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Kuno) Department of Medicine, Mount Sinai Beth Israel Hospital, New York,
NY, United States
(Kuno) Division of Cardiology, Montefiore Medical Center, Bronx, NY,
United States
(Weisz) Division of Cardiology, Columbia University Medical Center,
NewYork Presbyterian Hospital, New York, NY, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Claessen) Department of Cardiology, Heart Center, Amsterdam UMC,
University of Amsterdam, Amsterdam, Netherlands
(Shechter) The Leviev Cardiothoracic & Vascular Center, Sheba Medical
Center, Tel Hashomer, Israel
(Alexander, Ohman) Duke Clinical Research Institute, Durham, NC, United
States
(James) Department of Medical Sciences and Uppsala Clinical Research
Center, Uppsala University, Uppsala, Sweden
(Dressler) Cardiovascular Research Foundation, New York, NY, United States
(Ben-Yehuda) Sulpizio Cardiovascular Institute, University of California
San Diego, San Diego, CA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Incomplete revascularization (ICR) after percutaneous coronary
intervention (PCI) is associated with mortality and morbidity.
 Aim(s): We sought to investigate whether ICR in the left anterior
descending artery (LAD) is worse than ICR of the right coronary artery
(RCA) or left circumflex artery (LCX); and whether ICR in patients with a
chronic total occlusion (CTO) is worse than in those without.
 Method(s): In the RIVER-PCI trial, 2651 patients with ICR after PCI
were randomly assigned to ranolazine or placebo. Angiograms were assessed
at an independent core laboratory in 2501 patients (94.3%). The primary
endpoint was the composite of ischemia-driven revascularization or
hospitalization. Result(s): A total of 1664 patients (66.5%) had ICR
involving the LAD, whereas 837 (33.5%) had ICR limited to the RCA or LCX.
At median follow-up of 643 days, the primary endpoint occurred in 26.9%
versus 26.5% of patients (adjusted HR [aHR]: 1.03, 95% confidence interval
[CI]: 0.88-1.21). A nonrecanalized CTO was present in 854 patients (34.1%)
with ICR after PCI. The primary endpoint occurred in 28.6% versus 25.9% of
ICR patients with versus without a CTO (aHR: 1.10, 95% CI: 0.94-1.29).
However, patients with a CTO had higher rates of ischemia-driven
hospitalization without revascularization (aHR: 1.27, 95% CI: 1.04-1.56),
heart failure hospitalization (aHR: 2.69, 95% CI: 1.61-4.59) and
myocardial infarction (aHR: 1.46, 95% CI: 1.11-1.92) compared with those
without. Conclusion(s): The 2-year prognosis was similar in post-PCI
patients with ICR whether the LAD was versus was not involved. ICR
patients with a CTO had more frequent hospitalizations for ischemia and
myocardial infarctions compared with those without. Copyright ©
2024 Wiley Periodicals LLC.

<37>
Accession Number
2030382936
Title
Long-term tafamidis efficacy in patients with transthyretin amyloid
cardiomyopathy by baseline left ventricular ejection fraction.
Source
European Journal of Heart Failure. 26(9) (pp 2038-2046), 2024. Date of
Publication: September 2024.
Author
Drachman B.; Damy T.; Hanna M.; Wang R.; Angeli F.S.; Garcia-Pavia P.
Institution
(Drachman) University of Pennsylvania Health System, Philadelphia, PA,
United States
(Damy) Referral Center for Cardiac Amyloidosis, CHU Henri Mondor, Creteil,
France
(Hanna) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Wang) Pfizer Inc., Groton, CT, United States
(Angeli) Pfizer Inc., New York, NY, United States
(Garcia-Pavia) Hospital Universitario Puerta de Hierro Majadahonda,
IDIPHISA, CIBERCV, Madrid, Spain
(Garcia-Pavia) Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
(Garcia-Pavia) Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcon,
Spain
Publisher
John Wiley and Sons Ltd
Abstract
Aims: Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) present
with diverse left ventricular ejection fraction (LVEF). This study
assessed tafamidis efficacy by baseline LVEF in the phase 3 Tafamidis in
Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT) and its long-term
extension (LTE) study. Methods and Results: Patients were randomized
to 30 months of tafamidis or placebo treatment in ATTR-ACT. On completion,
patients could join an LTE study to receive tafamidis. All-cause mortality
(death, heart transplant, or cardiac mechanical assist device
implantation) from baseline to the end of follow-up was assessed in
patients continuously treated with tafamidis (80 mg meglumine or 61 mg
free acid) or delayed tafamidis treatment (placebo in ATTR-ACT; tafamidis
in the LTE study) according to baseline LVEF (<50% or >=50%). Supportive
outcomes were evaluated over a shorter follow-up. Patients with baseline
LVEF <50% (n = 177: 88 tafamidis- and 89 placebo-treated) had signs of
more severe heart failure, a higher proportion were Black, and had variant
ATTR-CM than those with LVEF >=50% (n = 171: 85 tafamidis- and 86
placebo-treated). At the end of follow-up (median 60-64 months), all-cause
mortality was numerically higher in patients with baseline LVEF <50%;
however, consistent with supportive findings, continuous tafamidis
treatment was associated with a 47% reduction in mortality risk compared
with delayed tafamidis treatment in patients with LVEF <50% and >=50%
(hazard ratio 0.53 [95% confidence interval 0.367-0.758]; p < 0.001, and
0.53 [0.344-0.818]; p < 0.01, respectively). Conclusion(s): Early
initiation of tafamidis is associated with reduced mortality in patients
with ATTR-CM, irrespective of initial LVEF value. Clinical Trial
Registration: ClinicalTrials.gov NCT01994889, NCT02791230. Copyright
© 2024 The Author(s). European Journal of Heart Failure published by
John Wiley & Sons Ltd on behalf of European Society of Cardiology.

<38>
Accession Number
2031506123
Title
Transcarotid versus transfemoral transcatheter aortic valve replacement: A
systematic review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. 68 (pp 92-97), 2024. Date of
Publication: November 2024.
Author
Munguti C.; Ndunda P.M.; Abukar A.; Jawad M.A.; Vindhyal M.R.; Fanari Z.
Institution
(Munguti) Department of Internal Medicine, University of Kansas School of
Medicine, Wichita, KS, United States
(Munguti, Vindhyal) Department of Internal Medicine, University of Kansas
School of Medicine, Kansas City, KS, United States
(Ndunda) Division of Cardiology, Louisiana State University in Shreveport,
Shreveport, LA, United States
(Abukar, Fanari) Department of Internal Medicine, University of California
San Francisco, San Francisco, CA, United States
(Jawad) Division of Cardiology, Saint Luke's Mid America Heart Institute,
Kansas City, KS, United States
(Fanari) Division of Cardiology, University of California San Francisco,
Fresno, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: In the 2021 Transcatheter Valve Therapy (TVT) registry, 8.9 %
of patients underwent TAVR via access sites other than the femoral artery.
Transthoracic approaches may be contraindicated in some patients and may
be associated with poorer outcomes. Therefore other alternative access
routes are increasingly being performed. We conducted a systematic review
of the literature on transcarotid transcatheter aortic valve replacement
(TC-TAVR) and meta-analysis comparing outcomes of TC-TAVR and other access
routes. Method(s): We comprehensively searched for controlled
randomized and non-randomized studies from 4 online databases. We
presented data using risk ratios (95 % confidence intervals) and measured
heterogeneity using Higgins' I2. Result(s): Sixteen
observational studies on transcarotid TAVR were included in the analysis;
4 studies compared TC-TAVR vs TF-TAVR. The mean age and STS score for
patients undergoing TC-TAVR were 80 years and 7.6 respectively. For
TF-TAVR patients, mean age and STS score were 81.2 years and 6.5
respectively. There was no difference between patients undergoing TC-TAVR
and TF-TAVR in the following 30-day outcomes: MACE [8.4 % vs 6.7 %; OR
1.32 (95 % CI 0.71-2.46 p = 0.38) I2 = 0 %], mortality [5.6 %
vs 4.0 %; OR 0.42 (95 % CI 0.60-3.37, P = 0.42) I2 = 0 %] and
stroke [0.7 % vs 2.3 %; OR 0.49 (95 % CI 0.09-2.56, P = 0.40)
I2 = 0 %]. There was no difference in 30-day major vascular
complications [0.7 % vs 3 %; OR 0.55 (95 % CI 0.06-5.29, P = 0.61)
I2 = 39 %], major bleeding [0.7 % vs 3.8 %; OR 0.39 (95 % CI
0.09-1.67, P = 0.21) I2 = 0 %], and moderate or severe aortic
valve regurgitation [8.6 % vs 9.9 %; OR 0.89 (95 % CI 0.48-1.65, P = 0.72)
I2 = 0 %]. Conclusion(s): There are no significant
differences in mortality, stroke MACE and major or life-threatening
bleeding or vascular complications when TC-TAVR is compared to TF-TAVR
approaches. Copyright © 2024 The Authors

<39>
Accession Number
2031271987
Title
Impact of obstructive sleep apnoea on postoperative outcomes of patients
undergoing coronary artery bypass grafting: a systematic review and
meta-analysis.
Source
Sleep and Breathing. 28(6) (pp 2345-2353), 2024. Date of Publication:
December 2024.
Author
Ni Y.; Zhou Y.
Institution
(Ni) Respiratory medicine, Zhejiang Xinda Hospital, Huzhou, China
(Zhou) Department of Anesthesiology, Zhejiang Xinda Hospital, 288 Xinguang
Ave., Zhejiang Province, Huzhou 313000, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objective: To assess the association between obstructive sleep apnoea
(OSA) and postoperative complications in patients after coronary artery
bypass graft (CABG). Method(s): PubMed, Embase, Web of Science and
Scopus databases were explored to identify relevant observational studies
that reported incidences of OSA in CABG patients, and assessed OSA using
standard objective methods such as polysomnography (PSG). The primary
outcomes of interest were risk of major adverse cardiac and
cerebrovascular events (MACCE) and all-cause mortality. Pooled effect
sizes were reported as odds ratio (OR) with 95% confidence intervals.
 Result(s): Twelve studies were included. All studies, except one, had
a prospective cohort design. CABG patients with OSA had increased risk of
MACCE (OR 1.71, 95% CI: 1.16, 2.53), myocardial infarction (MI) (OR 2.21,
95% CI: 1.19, 4.13), pulmonary complications (OR 1.86, 95% CI: 1.03,
3.38), renal complications (OR 8.14, 95% CI: 2.07, 32.1), heart failure
(OR 1.86, 95% CI: 1.19, 2.89) and need for revascularization (OR 2.80, 95%
CI: 1.01, 7.75). However, risk of all-cause mortality (OR 1.63, 95% CI:
0.75, 3.52) was comparable in all patients. Conclusion(s): This study
showed that OSA significantly correlates with the increased risk of major
adverse events. Our results indicate that recognizing and managing OSA in
CABG patients is crucial for mitigating associated risks. Copyright
© The Author(s), under exclusive licence to Springer Nature
Switzerland AG 2024.

<40>
Accession Number
2035549873
Title
Effect of exercise prehabilitation on quality of recovery after cardiac
surgery: a single-centre randomised controlled trial.
Source
British Journal of Anaesthesia. (no pagination), 2024. Date of
Publication: 2024.
Author
Yau D.K.W.; Ng F.F.; Wong M.-K.H.; Underwood M.J.; Wong R.H.L.; Joynt
G.M.; Lee A.
Institution
(Yau, Ng, Joynt, Lee) Department of Anaesthesia and Intensive Care,
Chinese University of Hong Kong, Hong Kong SAR, China
(Wong) Department of Anaesthesia and Intensive Care, Prince of Wales
Hospital, SAR, Hong Kong, China
(Underwood) Cardiovascular Services, Auckland City Hospital, Auckland, New
Zealand
(Wong) Division of Cardiothoracic Surgery, Department of Surgery, Chinese
University of Hong Kong, Hong Kong SAR, China
(Yau) Department of Rehabilitation Sciences, Hong Kong Polytechnic
University, Hung Hom, Hong Kong, China
Publisher
Elsevier Ltd
Abstract
Background: Physical prehabilitation can enhance patient resilience to
surgical stress, but its effects are unclear in vulnerable and frail
patients. We aimed to determine the effect of a structured exercise
prehabilitation programme on the quality of recovery after cardiac surgery
in vulnerable and frail participants. Method(s): This single-blinded,
parallel-arm, superiority, randomised controlled trial recruited patients
with a Clinical Frailty Scale of 4-6 undergoing cardiac surgery. Patients
were randomised to either physical prehabilitation (twice weekly) or
standard care (control); both arms received standard perioperative care.
The primary outcome was Quality of Recovery-15 (QoR-15) score on the third
day after surgery. Secondary outcomes included major adverse cardiac and
cerebrovascular events (MACCE), days alive and at home (DAH<inf>30</inf>),
and the World Health Organization Disability Assessment Schedule (WHODAS)
2.0 metric. Result(s): Of 164 randomised patients, 138 were included
in the primary analysis (median age 64 [interquartile range 60-69] yr; 70%
males). Compliance with the 5-week prehabilitation programme was high
(82%), with no adverse exercise-induced events reported. There were no
between-group differences in QoR-15 scores (median difference -3, 95%
confidence interval [CI] -9 to 3), early and late MACCE, and
DAH<inf>30</inf> (P=0.779). Prehabilitated patients had lower disability
levels than control patients (P=0.022) at 90 days after surgery (mean
difference -9%, 95% CI -17% to -2%). Conclusion(s): A 5-week
programme of physical prehabilitation in predominately prefrail patients
was safe, but it did not enhance quality of recovery scores after surgery.
Prehabilitation resulted in a clinically meaningful decrease in disability
scores at 90 days after surgery. Clinical trial registration:
ChiCTR1800016098. Copyright © 2024 British Journal of Anaesthesia

<41>
Accession Number
2034583513
Title
European Society of Clinical Microbiology and Infectious Diseases/European
Committee on infection control clinical guidelines on pre-operative
decolonization and targeted prophylaxis in patients colonized by
multidrug-resistant Gram-positive bacteria before surgery.
Source
Clinical Microbiology and Infection. 30(12) (pp 1537-1550), 2024. Date of
Publication: December 2024.
Author
Righi E.; Mutters N.T.; Guirao X.; Dolores del Toro M.; Eckmann C.;
Friedrich A.W.; Giannella M.; Presterl E.; Christaki E.; Cross E.L.A.;
Visentin A.; Sganga G.; Tsioutis C.; Tacconelli E.; Kluytmans J.
Institution
(Righi, Visentin, Tacconelli) Division of Infectious Diseases, Department
of Diagnostics and Public Health, University of Verona, Verona, Italy
(Mutters) University Hospital Bonn, Institute for Hygiene and Public
Health, Bonn, Germany
(Guirao) Department of General Surgery, Surgical Endocrine Unit, Surgical
Site Prevention Unit, Consorci Corporacio Sanitaria Parc Tauli, Sabadell,
Spain
(Dolores del Toro) Division of Infectious Diseases and Microbiology,
University Hospital Virgen Macarena, Seville, Spain
(Dolores del Toro) Department of Medicine, University of Sevilla, Centro
de Investigacion Biomedica en Red en Enfermedades Infecciosas
(CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
(Eckmann) Department of Klinikum Hannoversch-Muenden, Academic Hospital of
Goettingen University, Gottingen, Germany
(Friedrich) University Hospital Munster, Munster, Germany
(Giannella) Department of Infectious Diseases Unit, IRCCS Azienda
Ospedaliero Universitaria di Bologna, Bologna, Italy
(Giannella) Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy
(Presterl) Department of Infection Control and Hospital Epidemiology,
Medical University of Vienna, Austria (on behalf of the ESCMID Study Group
on Nosocomial Infections - ESGNI), Vienna, Austria
(Christaki) Department of Internal Medicine, Faculty of Medicine, School
of Health Sciences, University of Ioannina, Ioannina, Greece
(Cross) Department of Global Health and Infection, Brighton and Sussex
Medical School, Brighton, United Kingdom
(Sganga) Department of Emergency Surgery and Trauma, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Universita Cattolica Del Sacro
Cuore, Rome, Italy
(Tsioutis) School of Medicine, European University Cyprus, Nicosia, Cyprus
(Kluytmans) Department of Medical Microbiology, University Medical Center
Utrecht, Utrecht University, Netherlands
Publisher
Elsevier B.V.
Abstract
Scope: The aim of these guidelines is to provide recommendations for
decolonization and perioperative antibiotic prophylaxis (PAP) in
multidrug-resistant Gram-positive bacteria (MDR-GPB) adult carriers before
inpatient surgery. Method(s): These European Society of Clinical
Microbiology and Infectious Diseases/European Committee on Infection
Control guidelines were developed following a systematic review of
published studies targeting methicillin-resistant Staphylococcus aureus
(MRSA), vancomycin-resistant enterococci, methicillin-resistant
coagulase-negative Staphylococci, and pan-drug-resistant-GPB. Critical
outcomes were the occurrence of surgical site infections (SSIs) caused by
the colonizing MDR-GPB and SSIs-attributable mortality. Important outcomes
included the occurrence of SSIs caused by any pathogen, hospital-acquired
infections, all-cause mortality, and adverse events associated with the
interventions, including resistance development to the agents used and the
incidence of Clostridioides difficile infections. The last search of all
databases was performed on 1 November 2023. The level of evidence and the
strength of each recommendation were defined according to the Grading of
Recommendations Assessment, Development, and Evaluation approach.
Consensus of a multidisciplinary expert panel was reached for the final
list of recommendations. Antimicrobial stewardship considerations were
included. Recommendations: The guideline panel reviewed the impact of
decolonization, targeted PAP, and combined interventions (e.g.
decolonization and targeted PAP) on the risk of SSIs and other outcomes in
MDR-GPB carriers, according to the type of bacteria and type of surgery.
We recommend screening for S. aureus before high-risk operations, such as
cardiothoracic and orthopaedic surgery. Decolonization with intranasal
mupirocin with or without a chlorhexidine bath is recommended in patients
colonized with S. aureus before cardiothoracic and orthopaedic surgery and
suggested in other surgeries. The addition of vancomycin to standard
prophylaxis is suggested for MRSA carriers in cardiothoracic surgery,
orthopaedic surgery, and neurosurgery. Combined interventions (e.g.
decolonization and targeted prophylaxis) are suggested for MRSA carriers
undergoing cardiothoracic and orthopaedic surgery. No recommendation could
be made regarding screening, decolonization and targeted prophylaxis for
vancomycin-resistant enterococci because of the lack of data. No evidence
was retrieved for methicillin-resistant coagulase-negative Staphylococci
and pan-drug-resistant-GPB. Careful consideration of the laboratory
workload and involvement of antimicrobial stewardship and infection
control teams are warranted before implementing screening procedures or
performing changes in PAP policy. Future research should focus on novel
decolonizing techniques, on the monitoring of resistance to decolonizing
agents and PAP regimens, and on standardized combined interventions in
high-quality studies. Copyright © 2024 The Authors

<42>
Accession Number
2032189518
Title
Sodium-glucose co-transporter 2 inhibitors in left ventricular assist
device and heart transplant recipients: a mini-review.
Source
Heart Failure Reviews. (no pagination), 2024. Date of Publication: 2024.
Author
Alyaydin E.; Parianos D.; Hermes-Laufer J.; Nagele M.P.; Castro L.;
Papathanasiou M.; Reinecke H.; Flammer A.J.
Institution
(Alyaydin, Parianos, Hermes-Laufer, Nagele, Flammer) Department of
Cardiology, University Hospital Zurich, Zurich, Switzerland
(Castro) Department of Cardiovascular Surgery, University Heart and
Vascular Center Hamburg, Hamburg, Germany
(Papathanasiou) Department of Cardiology, Angiology and Intensive Care
Medicine, Goethe University Hospital, Frankfurt, Germany
(Reinecke) Department of Cardiology I - Coronary and Peripheral Vascular
Disease, Heart Failure, University Hospital Muenster, Muenster, Germany
Publisher
Springer
Abstract
In recent years, sodium-glucose co-transporter 2 inhibitors (SGLT2i)
emerged as promising therapeutic agents in managing heart failure (HF).
They demonstrated a significant impact on reducing HF hospitalizations and
related mortality in patients with reduced and preserved ejection
fraction. However, evidence supporting their use in patients with left
ventricular assist device (LVAD) and heart transplant (HT) recipients is
still limited. We identified six key studies investigating the safety and
efficacy of SGLT2i in LVAD and HT recipients. In patients with LVAD,
prescription of SGLT2i was predominantly associated with improved fluid
management and reduced pulmonary artery pressures. However, the results
regarding their effects on body weight, hemoglobin A1c, diuretic use, and
right ventricular function were contradictory. In terms of safety, SGLT2i
were generally well-tolerated in the LVAD population, and the reported
incidence of adverse events was low. In HT recipients, SGLT2i were
associated with better glycemic control and weight reduction. No relevant
adverse events were reported. Despite these encouraging results, the
long-term safety and efficacy of SGLT2i in these vulnerable patient
populations are yet to be investigated. Future randomized controlled
trials are needed to address existing gaps in evidence and help integrate
SGLT2i into clinical practice for LVAD and HT recipients. Graphical
abstract: (Figure presented.) Copyright © The Author(s) 2024.

<43>
Accession Number
645758745
Title
Transcatheter Valve Repair in Heart Failure with Moderate to Severe Mitral
Regurgitation.
Source
The New England journal of medicine. 391(19) (pp 1799-1809), 2024. Date of
Publication: 14 Nov 2024.
Author
Anker S.D.; Friede T.; von Bardeleben R.-S.; Butler J.; Khan M.-S.; Diek
M.; Heinrich J.; Geyer M.; Placzek M.; Ferrari R.; Abraham W.T.; Alfieri
O.; Auricchio A.; Bayes-Genis A.; Cleland J.G.F.; Filippatos G.;
Gustafsson F.; Haverkamp W.; Kelm M.; Kuck K.-H.; Landmesser U.; Maggioni
A.P.; Metra M.; Ninios V.; Petrie M.C.; Rassaf T.; Ruschitzka F.; Schafer
U.; Schulze P.C.; Spargias K.; Vahanian A.; Zamorano J.L.; Zeiher A.;
Karakas M.; Koehler F.; Lainscak M.; Oner A.; Mezilis N.;
Theofilogiannakos E.K.; Ninios I.; Chrissoheris M.; Kourkoveli P.;
Papadopoulos K.; Smolka G.; Wojakowski W.; Reczuch K.; Pinto F.J.;
Wiewiorka L.; Kalarus Z.; Adamo M.; Santiago-Vacas E.; Ruf T.F.; Gross M.;
Tongers J.; Hasenfuss G.; Schillinger W.; Ponikowski P.
Institution
(Anker, Friede, von Bardeleben, Butler, Khan, Diek, Heinrich, Geyer,
Placzek, Ferrari, Abraham, Alfieri, Auricchio, Bayes-Genis, Cleland,
Filippatos, Gustafsson, Haverkamp, Kelm, Kuck, Landmesser, Maggioni,
Metra, Ninios, Petrie, Rassaf, Ruschitzka, Schafer, Schulze, Spargias,
Vahanian, Zamorano, Zeiher, Karakas, Koehler, Lainscak, Oner, Mezilis,
Theofilogiannakos, Ninios, Chrissoheris, Kourkoveli, Papadopoulos, Smolka,
Wojakowski, Reczuch, Pinto, Wiewiorka, Kalarus, Adamo, Santiago-Vacas,
Ruf, Gross, Tongers, Hasenfuss, Schillinger, Ponikowski) From the
Department of Cardiology of German Heart Center Charite and the Institute
of Health Center for Regenerative Therapies, German Center for
Cardiovascular Research (DZHK) Partner Site Berlin, Charite
Universitatsmedizin (S.D.A., M.D., W.H.), the Department of Cardiology,
Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charite,
Campus Benjamin Franklin, the Berlin Institute of Health, and DZHK Partner
Site Berlin (U.L.), Deutsches Herzzentrum der Charite, the Department of
Cardiology, Angiology, and Intensive Care Medicine, Campus Charite Mitte,
the Center for Cardiovascular Telemedicine, and DZHK Partner Site Berlin,
Charite Universitatsmedizin (F.K.), Berlin, the Departments of Cardiology
and Pneumology (S.D.A., M.D., G.H., W.S.) and Medical Statistics (T.F.,
M.P.) and the Clinical Trial Unit (J.H.)
Abstract
BACKGROUND: Whether transcatheter mitral-valve repair improves outcomes in
patients with heart failure and functional mitral regurgitation is
uncertain. METHOD(S): We conducted a randomized, controlled trial
involving patients with heart failure and moderate to severe functional
mitral regurgitation from 30 sites in nine countries. The patients were
assigned in a 1:1 ratio to either transcatheter mitral-valve repair and
guideline-recommended medical therapy (device group) or medical therapy
alone (control group). The three primary end points were the rate of the
composite of first or recurrent hospitalization for heart failure or
cardiovascular death during 24 months; the rate of first or recurrent
hospitalization for heart failure during 24 months; and the change from
baseline to 12 months in the score on the Kansas City Cardiomyopathy
Questionnaire-Overall Summary (KCCQ-OS; scores range from 0 to 100, with
higher scores indicating better health status). RESULT(S): A total of
505 patients underwent randomization: 250 were assigned to the device
group and 255 to the control group. At 24 months, the rate of first or
recurrent hospitalization for heart failure or cardiovascular death was
37.0 events per 100 patient-years in the device group and 58.9 events per
100 patient-years in the control group (rate ratio, 0.64; 95% confidence
interval [CI], 0.48 to 0.85; P=0.002). The rate of first or recurrent
hospitalization for heart failure was 26.9 events per 100 patient-years in
the device group and 46.6 events per 100 patient-years in the control
group (rate ratio, 0.59; 95% CI, 0.42 to 0.82; P=0.002). The KCCQ-OS score
increased by a mean (+/-SD) of 21.6+/-26.9 points in the device group and
8.0+/-24.5 points in the control group (mean difference, 10.9 points; 95%
CI, 6.8 to 15.0; P<0.001). Device-specific safety events occurred in 4
patients (1.6%). CONCLUSION(S): Among patients with heart failure
with moderate to severe functional mitral regurgitation who received
medical therapy, the addition of transcatheter mitral-valve repair led to
a lower rate of first or recurrent hospitalization for heart failure or
cardiovascular death and a lower rate of first or recurrent
hospitalization for heart failure at 24 months and better health status at
12 months than medical therapy alone. (Funded by Abbott Laboratories;
RESHAPE-HF2 ClinicalTrials.gov number, NCT02444338.). Copyright ©
2024 Massachusetts Medical Society.

<44>
Accession Number
645757743
Title
Transcatheter Repair versus Mitral-Valve Surgery for Secondary Mitral
Regurgitation.
Source
The New England journal of medicine. 391(19) (pp 1787-1798), 2024. Date of
Publication: 14 Nov 2024.
Author
Baldus S.; Doenst T.; Pfister R.; Gummert J.; Kessler M.; Boekstegers P.;
Lubos E.; Schroder J.; Thiele H.; Walther T.; Kelm M.; Hausleiter J.;
Eitel I.; Fischer-Rasokat U.; Bufe A.; Schmeisser A.; Ince H.; Lurz P.;
von Bardeleben R.S.; Hagl C.; Noack T.; Reith S.; Beucher H.;
Reichenspurner H.; Rottbauer W.; Schulze P.C.; Muller W.; Frank J.;
Hellmich M.; Wahlers T.; Rudolph V.
Institution
(Baldus, Doenst, Pfister, Gummert, Kessler, Boekstegers, Lubos, Schroder,
Thiele, Walther, Kelm, Hausleiter, Eitel, Fischer-Rasokat, Bufe,
Schmeisser, Ince, Lurz, von Bardeleben, Hagl, Noack, Reith, Beucher,
Reichenspurner, Rottbauer, Schulze, Muller, Frank, Hellmich, Wahlers,
Rudolph) From the Department of Internal Medicine III (S.B., R.P.), the
Institute of Medical Statistics and Computational Biology (W.M., J.F.,
M.H.), and Cardiothoracic Surgery (T. Wahlers), Faculty of Medicine and
University Hospital Cologne, University of Cologne, Cologne, the
Department of Cardiothoracic Surgery (T.D.) and Cardiology (P.C.S.), Jena
University Hospital, Friedrich-Schiller-University of Jena, Jena, Thoracic
and Cardiovascular Surgery (J.G.) and General and Interventional
Cardiology/Angiology (V.R.), Heart and Diabetes Center NRW, University
Hospital of the Ruhr-University Bochum, Medical Faculty OWL, Bad
Oeynhausen, the Department of Cardiology, Ulm University Heart Center, Ulm
(M. Kessler, W.R.), the Faculty of Health, School of Medicine (P.B.), and
Helios Klinikum Krefeld (A.B.), University Witten/Herdecke, Witten,
Marienkrankenhaus (E.L.)
Abstract
BACKGROUND: Current treatment recommendations for patients with heart
failure and secondary mitral regurgitation include transcatheter
edge-to-edge repair and mitral-valve surgery. Data from randomized trials
comparing these therapies are lacking in this patient population.
 METHOD(S): In this noninferiority trial conducted in Germany,
patients with heart failure and secondary mitral regurgitation who
continued to have symptoms despite guideline-directed medical therapy were
randomly assigned, in a 1:1 ratio, to undergo either transcatheter
edge-to-edge repair (intervention group) or surgical mitral-valve repair
or replacement (surgery group). The primary efficacy end point was a
composite of death, hospitalization for heart failure, mitral-valve
reintervention, implantation of an assist device, or stroke within 1 year
after the procedure. The primary safety end point was a composite of major
adverse events within 30 days after the procedure. RESULT(S): A total
of 210 patients underwent randomization. The mean (+/-SD) age of the
patients was 70.5+/-7.9 years, 39.9% were women, and the mean left
ventricular ejection fraction was 43.0+/-11.7%. Within 1 year, at least
one of the components of the primary efficacy end point occurred in 16 of
the 96 patients with available data (16.7%) in the intervention group and
in 20 of the 89 with available data (22.5%) in the surgery group
(estimated mean difference, -6 percentage points; 95% confidence interval
[CI], -17 to 6; P<0.001 for noninferiority). A primary safety end-point
event occurred in 15 of the 101 patients with available data (14.9%) in
the intervention group and in 51 of the 93 patients with available data
(54.8%) in the surgery group (estimated mean difference, -40 percentage
points; 95% CI, -51 to -27; P<0.001). CONCLUSION(S): Among patients
with heart failure and secondary mitral regurgitation, transcatheter
edge-to-edge repair was noninferior to mitral-valve surgery with respect
to a composite of death, rehospitalization for heart failure, stroke,
reintervention, or implantation of an assist device in the left ventricle
at 1 year. (Funded by Abbott Vascular; MATTERHORN ClinicalTrials.gov
number, NCT02371512.). Copyright © 2024 Massachusetts Medical
Society.

<45>
Accession Number
2035748548
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. 279 (pp 81-93), 2025. Date of Publication: January
2025.
Author
van Steenwijk M.P.J.; van Rosmalen J.; Elzo Kraemer C.V.; 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.; Oude Lansink-Hartgring A.; 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, Gommers, Tibboel, Meuwese) Department of Intensive Care,
Erasmus Medical Center, Rotterdam, Netherlands
(van Steenwijk, Boersma, de Boer, Van Mieghem, Meuwese) Department of
Cardiology, Thorax Center, Cardiovascular Institute, Erasmus Medical
Center, Rotterdam, Netherlands
(van Rosmalen) Departments of Biostatistics, Erasmus Medical Center,
Rotterdam, Netherlands
(van Rosmalen) Department of Epidemiology, Erasmus Medical Center,
Rotterdam, Netherlands
(Elzo Kraemer, Maas) Department of Intensive Care, Leiden University
Medical Center, Leiden, Netherlands
(Donker, Hermens) Department of Intensive Care, University Medical Center
Utrecht, Utrecht, Netherlands
(Donker) Cardiovascular and Respiratory Physiology, University of Twente,
Enschede, 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, Oude 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
(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
Publisher
Elsevier Inc.
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 1 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 Author(s)

<46>
Accession Number
2035649211
Title
Effectiveness of Vibrapep (OPEP) on Pulmonary Functions in Phase One of
Cardiac Rehabilitation-A Randomized Controlled Trial.
Source
Nepalese Heart Journal. 21(2) (pp 25-34), 2024. Date of Publication: 2024.
Author
Gaonkar A.; Naik V.
Institution
(Gaonkar, Naik) Department of Cardiovascular and Pulmonary Physiotherapy,
KLE Institute of Physiotherapy, KLES Dr. Prabhakar Kore Hospital and
Medical Research Centre, Karnataka, Belagavi, India
Publisher
Cardiac Society of Nepal
Abstract
Background and Aims: According to the WHO report 2022, coronary artery
disease is the most prevalent cardiac disease worldwide. Impaired
respiratory muscle function, increased secretions and reduced vital
capacity are pulmonary complications commonly associated with CABG and
Valve replacement surgeries. The purpose of this study was to compare the
effect of Vibrapep and standard phase one of cardiac rehabilitation
exercises on pulmonary functions. Method(s): A Randomized Controlled
Trial was conducted on 46 participants. Participants were randomly
allocated into two groups, Vibrapep and phase one of cardiac exercises
were given to Group A (n = 23), while Group B (n = 23) received only phase
one cardiac rehabilitation exercises. The intervention was administered
for twice a day for 5 days. Outcome measures such as Sputum volume,
maximal inspiratory and expiratory pressure, thoracic expansion, SPO2
level, blood pressure and Peak expiratory flow rate were evaluated at
baseline and on 5th day of the study. Result(s): Wilcoxon test of
within-group analysis revealed statistically significant improvements in
all parameters for both the interventional and control groups (p<0.05*),
except in diastolic blood pressure, whereas, between group analysis done
using Mann Whitney U test also showed statistical improvement in both
groups on all parameters with (p<0.05*). Conclusion(s): Vibrapep
exhibited to be an effective bronchial hygiene therapy in phase one of
cardiac rehabilitation with respect to enhancing pulmonary functions such
as sputum reduction, chest expansion, improved respiratory pressure's,
Peak Expiratory Flow Rate along with Cardiac rehabilitation. Copyright
© 2024 Cardiac Society of Nepal. All rights reserved.

<47>
Accession Number
2035645609
Title
Ten-year 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. 66(5) (no pagination), 2024.
Article Number: ezae391. Date of Publication: 01 Nov 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, Shannxi, 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, Milojevic) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, Rotterdam, Netherlands
(Davierwala) Division of Cardiovascular Surgery, Peter Munk Cardiac
Centre, Toronto General Hospital, University Health Network, Toronto, ON,
Canada
(Davierwala) Department of Surgery, University of Toronto, Toronto, Canada
(Mack) Department of Cardiac Surgery, Baylor Scott and White, The Heart
Hospital, Plano, TX, United States
(Thuijs) Department of Cardiothoracic Surgery, Erasmus University Medical
Centre, Rotterdam, Netherlands
(Taggart) Nuffield Department of Surgical Sciences, Oxford University John
Radcliffe Hospital, Oxford, United Kingdom
(Milojevic) Department of Cardiac Surgery and Cardiovascular Research,
Dedinje Cardiovascular Institute, Belgrade, Serbia
Publisher
European Association for Cardio-Thoracic Surgery
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. Copyright © The Author(s) 2024.

<48>
Accession Number
2035547501
Title
The role of teamwork and mentorship in pediatric and congenital heart
surgery.
Source
Translational Pediatrics. 13(10) (pp 1870-1878), 2024. Date of
Publication: 31 Oct 2024.
Author
Francis J.; George J.; Peng E.; Corno A.F.
Institution
(Francis) Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary,
Aberdeen, United Kingdom
(George) Department of Cardiothoracic Surgery, Birmingham Women's and
Children's Hospital, Birmingham, United Kingdom
(Peng) Royal Hospital for Children, Glasgow and University of Glasgow,
Glasgow, United Kingdom
(Corno) Faculty of Science and Engineering, Manchester Metropolitan
University, Manchester, United Kingdom
(Corno) School of Engineering, University of Leicester, Leicester, United
Kingdom
Publisher
AME Publishing Company
Abstract
Pediatric and congenital cardiac surgery, characterized by its complexity
and high-stakes nature, demands superior technical expertise and
multidisciplinary teamwork. With limited surgeons worldwide, the role of
continuous skill refinement and collaborative practice is crucial for
patient safety and successful outcomes. A literature search was performed
using the PubMed, Cochrane, SCOPUS and Web of Science databases for
studies published until September 2024. Articles were analysed to
summarize findings on the impact of mentorship and teamwork within
pediatric and congenital cardiac surgery. This article explores the dual
importance of teamwork and mentorship in shaping the next generation of
pediatric and congenital cardiac surgeons. The study examines the impact
of mentorship on reducing learning curves and improving surgical outcomes
whilst highlight the unique challenges faced by surgeons in low-income
countries (LICs). Effective mentorship can serve as a bridge between
knowledge and practice, ensuring that surgeons in resource-constrained
environments can confidently adapt to challenges and improve patient
outcomes despite the limited resources. By emphasizing a culture of
innovation and collaborative teamwork, pediatric and congenital cardiac
surgery continues to achieve increasingly better patient outcomes on a
global scale. This study highlights how continuous mentorship and teamwork
not only enhance technical proficiency but also drive advancements in
surgical techniques and overall care, contributing to the ongoing global
progress in pediatric and congenital cardiac surgery. Copyright ©
AME Publishing Company.

<49>
Accession Number
2035750545
Title
Conduction Disturbances After Transcatheter Aortic Valve Replacement: An
Update on Epidemiology, Preventive Strategies, and Management.
Source
JACC: Cardiovascular Interventions. 17(22) (pp 2575-2595), 2024. Date of
Publication: 25 Nov 2024.
Author
Nuche J.; Ellenbogen K.A.; Mittal S.; Windecker S.; Benavent C.; Philippon
F.; Rodes-Cabau J.
Institution
(Nuche, Benavent, Philippon, Rodes-Cabau) Quebec Heart and Lung Institute,
Laval University, Quebec City, QC, Canada
(Nuche) Servicio de Cardiologia, Hospital Universitario 12 de Octubre,
Instituto de Investigacion Sanitaria 12 de Octubre, Madrid, Spain
(Nuche) Consorcio de Investigacion Biomedica en Red-Cardiovascular,
Madrid, Spain
(Ellenbogen) Virginia Commonwealth University School of Medicine,
Richmond, VA, United States
(Mittal) Valley Hospital and the Snyder Center for Comprehensive Atrial
Fibrillation, Paramus, NJ, United States
(Windecker) Inselspital Bern University Hospital, University of Bern,
Bern, Switzerland
(Rodes-Cabau) Hospital Clinic de Barcelona, Barcelona, Spain
Publisher
Elsevier Inc.
Abstract
Conduction disturbances (CDs) are common after transcatheter aortic valve
replacement. Continuous improvements in preprocedural planification,
implant techniques, and device design have markedly reduced periprocedural
complications. However, CDs rate remains in the double-digit range.
Because CDs after TAVR are associated with poorer outcomes, seeking a
reduction in their occurrence is paramount. Several nonmodifiable and
modifiable factors are associated with an increased risk of CDs. Previous
right bundle branch block has been shown to have a strong association with
pacemaker implant after TAVR. Among the modifiable factors, a lower
implantation depth seems to be associated with a higher risk of CDs, and
several implant strategies aiming to obtain a higher implant depth have
shown promising results. This literature review provides a detailed
description of updated evidence about the epidemiology, impact, and
preventive and management strategies of CDs after TAVR. Also, based on
these updated data, a fast-track protocol CDs management is
proposed. Copyright © 2024 American College of Cardiology
Foundation

<50>
Accession Number
2035744332
Title
Prognostic Impact of Anemia and Blood Transfusions on Cardiovascular
Outcomes in Patients Undergoing Vascular Surgery: A Scoping Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2024.
Date of Publication: 2024.
Author
Nisi F.; Ratibondi L.; Hagger M.; Giustiniano E.; Piccioni F.; Badalamenti
G.; Lepidi S.; D'Oria M.
Institution
(Nisi, Ratibondi, Hagger, Giustiniano, Piccioni) Department of Anesthesia
and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Rozzano,
Italy
(Badalamenti, Lepidi, D'Oria) Division of Vascular and Endovascular
Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI,
Trieste, Italy
Publisher
W.B. Saunders
Abstract
Objective: Prior studies suggest an association of anemia and blood
transfusion with increased morbidity and mortality in patients undergoing
cardiac surgery. However, the impact of perioperative anemia and blood
transfusion on clinical outcomes in patients undergoing major vascular
surgery has been poorly defined yet. The primary objectives of this
scoping review were to determine the extent of the evidence base that
links anemia and blood transfusions to mortality and cardiovascular
outcomes in patients undergoing major vascular surgery, and identify
recurring themes or gaps in the literature to guide future research.
 Method(s): A scoping review of the literature from PubMed, Cochrane,
and EMBASE databases was conducted up to December 2023 to identify
articles related to the impact of anemia and blood transfusions on
postoperative cardiovascular outcomes on patients undergoing vascular
surgery. Methodology followed the PRISMA Protocols Extension for Scoping
Reviews. Result(s): Twenty-two articles met the inclusion criteria,
including 15 retrospective and 6 observational prospective studies. Anemia
definition varied across studies, mainly based on hemoglobin cut-off
levels. An association with older age, coronary artery disease,
hypertension, diabetes, and other comorbidities was reported. Particularly
in peripheral and endovascular aortic surgery, anemia was linked
consistently with higher mortality, major adverse cardiac events, and
other postoperative complications, such as respiratory and renal issues,
surgical site infections, and longer hospital stays, depending on
hemoglobin levels. Anemia itself is an important predictor of
transfusions. Transfusions in anemic patients were associated with
increased mortality, postoperative complications, and increased need for
major amputation. Conclusion(s): The weight of the evidence suggests
that anemia carries a substantial burden of cardiovascular complications,
mortality, and multiorgan complications, resulting in increased health
care costs. Peripheral and endovascular aortic surgery are affected deeply
by the impact of anemia. Anemia itself stands out as a crucial predictor
for requiring transfusions. In turn, the effect of transfusion of blood
products is associated with worse outcomes and
complications. Copyright © 2024 Elsevier Inc.

<51>
Accession Number
2035741529
Title
Skin cancer after heart transplantation: a systematic review.
Source
Anais Brasileiros de Dermatologia. (no pagination), 2024. Date of
Publication: 2024.
Author
Aguzzoli N.H.G.; Bueno A.L.; Halezeroglu Y.; Bonamigo R.R.
Institution
(Aguzzoli, Bueno, Bonamigo) Dermatology Department, Universidade Federal
de Ciencias da Saude de Porto Alegre, RS, Porto Alegre, Brazil
(Halezeroglu) Medical School Department, University of California, San
Francisco, CA, United States
(Halezeroglu) Medical School Department, University of California Berkeley
School of Public Health and University of California San Francisco School
of Medicine, Berkely, CA, United States
(Bonamigo) Dermatology Department, Universidade Federal do Rio Grande do
Sul, RS, Porto Alegre, Brazil
Publisher
Elsevier Espana S.L.U
Abstract
Background: Cancer is an important cause of morbidity and mortality after
solid organ transplants. Skin cancer is the most prevalent non-lymphoid
malignancy occurring during heart transplantation follow-up. Due to the
complexity of immunosuppressive therapy and the high prevalence and
incidence of skin cancer in this population, dermatologists play an
important role in the short and long-term follow-up of heart transplant
recipients. Objective(s): The goal of this study is to present data
from a systematic literature review focusing on the occurrence of skin
cancer in patients who have undergone heart transplantation.
 Method(s): The authors conducted a systematic review of the
literature in the EMBASE and PubMed databases from August to September
2021 to investigate the incidence of skin cancer in heart transplant
patients. The authors selected retrospective and prospective cohort
studies presenting data on the frequency of skin cancer in patients
following heart transplantation. Exclusion criteria included articles that
did not stratify the organ transplant type and studies that did not
evaluate the frequency of skin cancer in the specific population.
 Result(s): Based on the search strategy, the authors found 2589
studies, out of which 37 were eligible for inclusion in this study.
Provided data are from 20 different countries, over the period 1974 to
2015. Incidence of non-melanoma skin cancer (NMSC) ranges from 0.97% to
52.8%. The incidence of squamous cell carcinoma (SCC) ranges from 1.19% to
89% and the incidence of basal cell carcinoma (BCC) ranges from 2% to 63%.
Malignant Melanoma (MM) incidence ranges from 0.94% to 4.6% Study
limitations: The analysis involved an exclusive focus on heart transplant
patients, and the statistical analysis of the sample may have been
hampered. The significant heterogeneity among the studies emerged as a
challenge during the analysis of the results. Furthermore, the study is
limited by variations in follow-up periods among the included studies.
 Conclusion(s): Although gathering methodologically heterogeneous
data, this systematic review was able to show the epidemiological
importance of skin cancer in heart transplant patients. This study
reinforces the important role dermatologists play in the short and
long-term follow-up of heart transplant patients. Copyright ©
2024

<52>
Accession Number
2032293619
Title
Is there a rationale for hyperbaric oxygen therapy in the patients with
Post COVID syndrome?: A critical review.
Source
European Archives of Psychiatry and Clinical Neuroscience. (no
pagination), 2024. Date of Publication: 2024.
Author
Pawlik M.T.; Rinneberg G.; Koch A.; Meyringer H.; Loew T.H.; Kjellberg A.
Institution
(Pawlik, Rinneberg, Meyringer) Department of Anesthesiology and Intensive
Care Medicine, Caritas-Hospital St. Joseph, University of Regensburg,
Regensburg, Germany
(Pawlik, Koch) Institute of Experimental Medicine,
Christian-Albrechts-University of Kiel c/o German Naval Medical Institute,
Kronshagen, Germany
(Kjellberg) Department of Physiology and Pharmacology, Karolinska
Institutet, Solna, Sweden
(Kjellberg) Perioperative Medicine and Intensive Care, Medical Unit
Intensive Care and Thoracic surgery, Karolinska University Hospital,
Stockholm, Sweden
(Loew) Department of Psychosomatic Medicine, University Hospital
Regensburg, Regensburg, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
The SARS-CoV-2 pandemic has resulted in 762 million infections worldwide
from 2020 to date, of which approximately ten percent are suffering from
the effects after infection in 2019 (COVID-19) [1, 40]. In Germany, it is
now assumed that at least one million people suffer from post-COVID
condition with long-term consequences. These have been previously reported
in diseases like Myalgic Encephalomyelitis (ME) and Chronic Fatigue
Syndrome (CFS). Symptoms show a changing variability and recent surveys in
the COVID context indicate that 10-30 % of outpatients, 50 to 70% of
hospitalised patients suffer from sequelae. Recent data suggest that only
13% of all ill people were completely free of symptoms after recovery [3,
9]. Current hypotheses consider chronic inflammation, mitochondrial
dysfunction, latent viral persistence, autoimmunity, changes of the human
microbiome or multilocular sequelae in various organ system after
infection. Hyperbaric oxygen therapy (HBOT) is applied since 1957 for
heart surgery, scuba dive accidents, CO intoxication, air embolisms and
infections with anaerobic pathogens. Under hyperbaric pressure, oxygen is
physically dissolved in the blood in higher concentrations and reaches
levels four times higher than under normobaric oxygen application.
Moreover, the alternation of hyperoxia and normoxia induces a variety of
processes at the cellular level, which improves oxygen supply in areas of
locoregional hypoxia. Numerous target gene effects on new vessel
formation, anti-inflammatory and anti-oedematous effects have been
demonstrated [74]. The provision of intermittently high, local oxygen
concentrations increases repair and regeneration processes and normalises
the predominance of hyperinflammation. At present time only one
prospective, randomized and placebo-controlled study exists with positive
effects on global cognitive function, attention and executive function,
psychiatric symptoms and pain interference. In conclusion, up to this date
HBO is the only scientifically proven treatment in a prospective
randomized controlled trial to be effective for cognitive improvement,
regeneration of brain network and improvement of cardiac function. HBOT
may have not only theoretical but also potential impact on targets of
current pathophysiology of Post COVID condition, which warrants further
scientific studies in patients. Copyright © The Author(s) 2024.

<53>
Accession Number
645759017
Title
Complete versus culprit-only coronary revascularization in patients with
myocardial infarction and multivessel disease undergoing percutaneous
coronary intervention: an updated meta-analysis.
Source
Panminerva medica. (no pagination), 2024. Date of Publication: 07 Nov
2024.
Author
Rodriguez-Granillo A.M.; Masson W.; Lobo M.; Mieres J.; Perez-Valega L.;
Barbagelata L.; Waisten K.; Fernandez-Pereira C.; Rodriguez A.E.
Institution
(Rodriguez-Granillo) Centro de Estudios en Cardiologia Intervencionista
(CECI), Buenos Aires, Argentina
(Rodriguez-Granillo) Department of Interventional Cardiology, Sanatorio
Otamendi, Buenos Aires, Argentina
(Masson, Barbagelata) Department of Cardiology, Italian Hospital of Buenos
Aires, Buenos Aires, Argentina
(Lobo) Department of Cardiology, Campo de Mayo Military Hospital, Buenos
Aires, Argentina
(Mieres, Fernandez-Pereira, Rodriguez) Department of Interventional
Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina
(Perez-Valega) Department of Cardiology, Canning, Argentina
(Waisten) Department of Cardiology, Buenos Aires, Argentina
(Fernandez-Pereira, Rodriguez) Centro de Estudios en Cardiologia
Intervencionista (CECI), Buenos Aires, Argentina
Abstract
INTRODUCTION: Recently, the FFR-Guidance for Complete Nonculprit
Revascularization (FULL REVASC) trial in ST elevation myocardial
infarction (STEMI) patients with multiple vessel disease (MVD) did not
show differences in the composite endpoint of death from any cause,
myocardial infarction, or unplanned revascularization than
culprit-lesion-only percutaneous coronary intervention (PCI) at 4.8 years,
although complete revascularization is a recommendation IA in current
guidelines. We want to determine through an updated meta-analysis whether
complete revascularization is associated with decreased mortality and hard
clinical endpoints compared to culprit lesion only PCI. EVIDENCE
ACQUISITION: We searched MEDLINE, Embase, ISI Web of Science, and Cochrane
Central Register of Controlled Trials) from January 1990 to April 2024
using the terms "percutaneous coronary intervention" combined with "non
culprit lesions" or "culprit lesion" or "complete revascularization" or
"incomplete revascularization." Additionally, a "snowball search" was
conducted. Only randomized clinical trials (RCT) reporting mortality,
re-infarction or new revascularization after at least 12 months and using
predominantly drug eluting stents were included. The summary effect of
different revascularization strategies on cardiovascular endpoints was
estimated and measures of effect size were expressed as odds ratios (ORs).
EVIDENCE SYNTHESIS: Eight RCT involving 9515 patients were included, with
a follow-up range between 12 months and 4.8 years. Main findings show that
culprit lesion revascularization was associated with an increased risk of
MI (OR: 1.38; 95% CI: 1.05 to 1.81, I2 42%) and ischemia-guided
revascularization (OR: 2.81; 95% CI: 1.86 to 4.26, I2 80%) compared to
complete revascularization, without differences in overall mortality (OR:
1.15; 95% CI: 0.98 to 1.36, I2 2%). CONCLUSION(S): In patients with
STEMI and MVD without cardiogenic shock, our metanalysis showed that
complete revascularization with PCI significantly reduced the risk of
non-fatal myocardial reinfarction and ischemic-driven revascularization
compared to culprit vessel-only revascularization, without differences in
overall mortality.

<54>
Accession Number
358619357
Title
Evaluation of hemodynamic and regional tissue perfusion effects of
minimized extracorporeal circulation (MECC).
Source
Journal of Extra-Corporeal Technology. 42(1) (pp 30-39), 2010. Date of
Publication: March 2010.
Author
Bauer A.; Diez C.; Schubel J.; El-Shouki N.; Metz D.; Eberle T.; Hausmann
H.
Institution
(Bauer) Department of Cardiovascular Technology, MediClin Heart Center
Coswig, Lerchenfeld 1, 06869 Coswig, Sachsen-Anhalt, Germany
(Diez) Department of Cardiothoracic and Vascular Surgery, University
Hospital of Regensburg, Regensburg, Germany
(Schubel, El-Shouki, Metz, Hausmann) Department of Cardiovascular Surgery,
MediClin Heart Centre Coswig, Sachsen Anhalt, Germany
(Eberle) Department of Cardio - Anesthesiology, MediClin Heart Centre
Coswig, Sachsen Anhalt, Germany
Publisher
American Society of Extra-Corporeal Technology
Abstract
Minimized extracorporeal circulation (MECC , Maquet, Cardiopulmonary AG,
Hirrlingen, Germany) is an established procedure to perform coronary
revascularization. Studies showed positive effects of MECC compared to
conventional cardiopulmonary bypass (CCPB) procedures in terms of
transfusion requirements, less inflammation reactions, and neurological
impairments. Recent retrospective studies showed higher mean arterial
pressure (MAP) and a lower frequency of vasoactive drug use. We addressed
this issue in this study. The hypothesis was to find a higher MAP during
coronary bypass grafting surgery in patients treated with MECC systems .
We performed a prospective, controlled, randomized trial with 40 patients
either assigned to MECC ( n = 18) or CCPB ( n = 22) undergoing coronary
bypass grafting. Primary endpoints were the perioperative course of mean
arterial pressure, and the consumption of norepinephrine. Secondary
endpoints were the regional cerebral and renal oxygen saturation
(rSO<inf>2</inf>) as an indicator of area perfusion and the course of
hematocrit. Clinical and demographic characteristics did not significantly
differ between both groups. Thirty-day mortality was 0%. At four of five
time points during extracorporeal circulation (ECC) MAP values were
significantly higher in the MECC group compared to CCPB patients (after
starting the ECC 60 +/- 11 mmHg vs. 49 +/- 10 mmHg, p = .002). MECC
patients received significantly less norepinephrine (MECC 22.5 +/- 35 mug
vs. CCPB 60.5 +/- 75 mug, p = .045). The rSO<inf>2</inf> measured at right
and left forehead and the renal area was similar for both groups during
ECC and significantly higher at CCPB group 1 and 4 hours after termination
of CPB. Minimized extracorporeal circulation provides a higher mean
arterial pressure during ECC and we found a lower consumption of
vasoactive drugs in the MECC group. There was a decrease in regional
tissue saturation at 1 and 4 hours post bypass in the MECC group possibly
due to increased systemic inflammation and extravascular fluid shift in
the CCPB group.

<55>
Accession Number
2034152637
Title
Routine Protamine Administration for Bleeding in Transcatheter Aortic
Valve Implantation: The ACE-PROTAVI Randomized Clinical Trial.
Source
JAMA Cardiology. 9(10) (pp 901-908), 2024. Date of Publication: 09 Oct
2024.
Author
Vriesendorp P.A.; Nanayakkara S.; Heuts S.; Ball J.; Chandrasekar J.; Dick
R.; Haji K.; Htun N.M.; McGaw D.; Noaman S.; Palmer S.; Cairo S.; Shulman
M.; Lin E.; Hastings S.; Waldron B.; Proimos G.; Soon K.H.; Yudi M.B.;
Zimmet A.; Stub D.; Walton A.S.
Institution
(Vriesendorp, Nanayakkara, Haji, Htun, Noaman, Palmer, Shulman, Lin,
Hastings, Waldron, Zimmet, Stub, Walton) Heart Centre, The Alfred
Hospital, Melbourne, Australia
(Vriesendorp) Heart+Vascular Center, Department of Cardiology, Maastricht
University Medical Center, Maastricht, Netherlands
(Vriesendorp, Heuts) Cardiovascular Research Institute Maastricht,
Maastricht University, Maastricht, Netherlands
(Nanayakkara) Heart Failure Research Group, Baker Heart and Diabetes
Institute, Melbourne, Australia
(Nanayakkara, Ball, Stub, Walton) School of Public Health and Preventive
Medicine, Monash University, Melbourne, Australia
(Heuts) Department of Cardiothoracic Surgery, Maastricht University
Medical Center, Maastricht, Netherlands
(Chandrasekar, Dick, Haji, Noaman, Proimos, Soon, Yudi, Walton) Department
of Cardiology, Epworth HealthCare, Melbourne, Australia
(Chandrasekar) Department of Cardiology, Eastern Health, Melbourne,
Australia
(Chandrasekar) Eastern Health Clinical School, Monash University,
Melbourne, Australia
(McGaw, Stub) Department of Cardiology, Cabrini Health, Melbourne,
Australia
(Palmer, Cairo, Soon) Department of Medicine, The University of Melbourne,
Melbourne, Australia
(Cairo, Shulman, Lin, Hastings, Waldron) Cabrini Anaesthetics Department,
Cabrini Health, Melbourne, Australia
(Yudi) Department of Cardiology, Austin Health, Melbourne, Australia
Publisher
American Medical Association
Abstract
Importance: Vascular complications after transfemoral transcatheter aortic
valve implantation (TAVI) remain an important cause of procedure-related
morbidity. Routine reversal of anticoagulation with protamine at the
conclusion of transfemoral TAVI could reduce complications, but data
remain scarce. Objective(s): To evaluate the efficacy and safety of
routine protamine administration after transfemoral TAVI. Design,
Setting, and Participant(s): The ACE-PROTAVI trial was an
investigator-initiated, double-blind, placebo-controlled randomized
clinical trial performed at 3 Australian hospitals between December 2021
and June 2023 with a 1-year follow-up period. All patients accepted for
transfemoral TAVI by a multidisciplinary heart team were eligible for
enrollment. Intervention(s): Eligible patients were randomized 1:1
between routine protamine administration and placebo. Main Outcomes
and Measures: The coprimary outcomes were the rate of hemostasis success
and time to hemostasis (TTH), presented as categorical variables and
compared with a chi2 test or as continuous variables as mean (SD) or
median (IQR), depending on distribution. The major secondary outcome was a
composite of all-cause death, major and minor bleeding complications, and
major and minor vascular complications after 30 days, reported in odds
ratios (ORs) with 95% CIs and P values. Result(s): The study
population consisted of 410 patients: 199 patients in the protamine group
and 211 in the placebo group. The median (IQR) patient age in the
protamine group was 82 (77-85) years, and 68 of 199 patients receiving
protamine (34.2%) were female. The median (IQR) patient age in the placebo
group was 80 (75-85) years, and 89 of 211 patients receiving the placebo
(42.2%) were female. Patients receiving up-front protamine administration
had a higher rate of hemostasis success (188 of 192 patients [97.9%]) than
patients in the placebo group (186 of 203 patients [91.6%]; absolute risk
difference, 6.3%; 95% CI, 2.0%-10.6%; P =.006); in addition, patients
receiving up-front protamine had a shorter median (IQR) TTH (181 [120-420]
seconds vs 279 [122-600] seconds; P =.002). Routine protamine
administration resulted in a reduced risk of the composite outcome in the
protamine group (10 of 192 [5.2%]) vs the placebo group (26 of 203
[12.8%]; OR, 0.37; 95% CI, 0.1-0.8; P =.01). This difference was
predominantly driven by the difference in the prevalence of minor vascular
complications. There were no adverse events associated with protamine use.
 Conclusions and Relevance: In the ACE-PROTAVI randomized clinical
trial, routine administration of protamine increased the rate of
hemostasis success and decreased TTH. The beneficial effect of protamine
was reflected in a reduction in minor vascular complications, procedural
time, and postprocedural hospital stay duration in patients receiving
routine protamine compared with patients receiving placebo. Trial
Registration: anzctr.org.au Identifier: ACTRN12621001261808. Copyright
© 2024 American Medical Association. All rights reserved.

<56>
Accession Number
2034060465
Title
Effect of a polyherbal Unani formulation on left ventricular diastolic
dysfunction in hypertensive patients - A randomized single blind placebo
controlled clinical trial.
Source
Drug Metabolism and Personalized Therapy. 39(3) (pp 137-144), 2024. Date
of Publication: 01 Sep 2024.
Author
Khanum A.; Khan J.A.; Shahid A.; Riyazuddin M.; Siddiqui M.A.
Institution
(Khanum) Department of Moalajat, Rehbar Ayurvedic & Unani Tibbi Medical
College Hospital and Research Centre, Punjab, Sangrur, India
(Khan) Department of Ilaj Bit-Tadbeer, Rehbar Ayurvedic & Unani Tibbi
Medical College Hospital and Research Centre, Punjab, Sangrur, India
(Shahid) Ayush Wellness Centre, Rashtrapati Bhawan, New Delhi, India
(Riyazuddin, Siddiqui) Department of Moalajat (Medicine), National
Institute of Unani Medicine, Kottigepalya, Magadi Main Road, Karnataka,
Bengaluru 560091, India
Publisher
Walter de Gruyter GmbH
Abstract
Objectives: Diastolic dysfunction represents an important
pathophysiological intermediate between hypertension and heart failure. In
the last two decades, the prevalence of heart failure patients having
normal or near normal ejection fraction (EF) has increased to around 60%.
It thus poses a great morbidity and mortality risk to the population. In
view of present scenario of high prevalence, lack of evidence-based
therapy, and limited clinical trials, this study aimed to evaluate how a
Unani formulation affects the improvement of the left ventricular
diastolic function. Method(s): This clinical trial was set up as a
randomized, placebo-controlled study involving 35 participants, with 18
individuals in the test group and 17 in the control group. Test group
received 3.5g of a polyherbal Unani formulation in capsule form along with
35mL of an extract of Borago officinalis L. (Arq-e-Gaozaban), divided into
two doses after meals. Meanwhile, the control group received a placebo in
the same manner over an eight-week period. Follow-ups were conducted every
15 days to assess both subjective and objective parameters in all
participants. Result(s): The test formulation shows significant
improvement in dyspnea and diastolic function from baseline to the end of
trial (p<0.05), slight improvement in palpitations (p>0.05) and highly
significant improvement in easy fatigability (p=0.001) as compared to the
control. Conclusion(s): The present study shows the effectiveness of
the test drug in enhancing the diastolic function of left ventricle and
alleviating other symptoms associated with ventricular diastolic
dysfunction. Nevertheless, additional research with longer follow-up
durations is necessary to clarify its efficacy and establish optimal
treatment approaches for ventricular diastolic dysfunction in Unani
medicine. Copyright © 2024 Walter de Gruyter GmbH, Berlin/Boston.

<57>
Accession Number
2032154963
Title
Effect of high-flow nasal therapy on patient-centred outcomes in patients
at high risk of postoperative pulmonary complications after cardiac
surgery: update to the statistical analysis plan for NOTACS, a multicentre
adaptive randomised controlled trial.
Source
Trials. 25(1) (no pagination), 2024. Article Number: 741. Date of
Publication: December 2024.
Author
Dawson S.N.; Chiu Y.-D.; Klein A.A.; Earwaker M.; Villar S.S.; Steel J.;
Devine T.; Shetty S.; Affandi J.; Temple E.; Duckworth M.
Institution
(Dawson, Chiu, Villar) MRC Biostatistics Unit, School of Clinical
Medicine, University of Cambridge, East Forvie Building, Forvie Site,
Robinson Way, Cambridge Biomedical Campus, Cambridge CB2 0SR, United
Kingdom
(Dawson, Earwaker) Papworth Trials Unit Collaboration, Royal Papworth
Hospital NHS Foundation Trust, Cambridge, United Kingdom
(Klein) Department of Anaesthesia and Intensive Care, Royal Papworth
Hospital, Cambridge, United Kingdom
Publisher
BioMed Central Ltd
Abstract
Background: The NOTACS trial will assess the efficacy, safety and
cost-effectiveness of high-flow nasal therapy (HFNT) compared to standard
oxygen therapy (SOT) on the outcomes of patients after cardiac surgery.
Methods/design: NOTACS is an adaptive, international, multicentre,
parallel group, randomised controlled trial, with a pre-planned interim
sample size re-estimation (SSR). A minimum of 850 patients will be
randomised 1:1 to receive either HFNT or SOT. The primary outcome is days
alive and at home in the first 90 days after the planned surgery (DAH90),
with a number of secondary analyses and cost-effectiveness analyses also
planned. The interim SSR will take place after a minimum of 300 patients
have been followed up for 90 days and will allow for the sample size to
increase up to a maximum of 1280 patients. Result(s): This manuscript
provides detailed descriptions of the design of the NOTACS trial and the
analyses to be undertaken at the interim and final analyses. The main
purpose of the interim analysis is to assess safety and to perform a
sample size re-estimation. The main purpose of the final analysis is to
examine the safety, efficacy and cost-effectiveness of HFNT compared to
SOT on the outcomes of patients after cardiac surgery. Discussion(s):
This manuscript outlines the key features of the NOTACS statistical
analysis plan and was submitted to the journal before the final analysis
in order to preserve scientific integrity under an adaptive design
framework. A previous version of this SAP was published prior to the
interim analysis (Dawson, 2022). The NOTACS SAP closely follows published
guidelines for the content of SAPs in clinical trials (Gamble, 2017).
Trial registration: ISRCTN14092678. (13 May 2020). Copyright ©
The Author(s) 2024.

<58>
Accession Number
2031794539
Title
TELE-SPACER - a randomized clinical trial protocol: Cardioneuroablation
versus pacemaker implantation in the treatment of vagally-mediated
atrio-ventricular block.
Source
Cardiology Journal. 31(5) (pp 766-773), 2024. Date of Publication: 2024.
Author
Stodolkiewicz-Nowarska E.; Stec S.; Wileczek A.; Skoczynski P.;
Goscinska-Bis K.; Magielski P.; Zajac M.; Ratajska A.; Kustron A.; Sledz
J.; Wasek W.; Milewski K.
Institution
(Stodolkiewicz-Nowarska) CardioMedicum Medical Center, Krakow, Poland
(Stec, Wileczek, Kustron, Sledz) Elmedica, EP-Network, SKA, Poland
(Stec, Wileczek) Department of Electrophysiology, Cardioneuroablation,
Catheter Ablation and Cardiac Stimulation, Subcarpathian Center for
Cardiovascular Intervention, Sanok, Poland
(Skoczynski) Department of Cardiology, Center for Heart Diseases,
4thMilitary Hospital, Wroclaw, Poland
(Skoczynski) Department of Emergency Medicine, Wroclaw Medical University,
Wroclaw, Poland
(Goscinska-Bis) Department of Electrocardiology and Heart Failure, Medical
University of Silesia, Katowice, Poland
(Goscinska-Bis) Telemedycyna Polska S.A, Katowice, Poland
(Magielski) Scientia Research Institute, Bydgoszcz, Poland
(Zajac) Department of Pedagogy, University of Kazimierz Wielki, Bydgoszcz,
Poland
(Ratajska) Psychological Therapeutic and Research Center, University
Hospital No. 2, Bydgoszcz, Poland
(Ratajska) Department of Humanization, Medicine and Sexology, Institute of
Health Sciences, University of Zielona Gora, Poland
(Wasek) Department of Internal Medicine, Institute of Health Sciences,
College of Medical Sciences, Rzeszow University, Poland
(Milewski) American Heart of Poland SA, Center of Cardiology and Cardiac
Surgery, Bielsko-Biala, Poland
Publisher
Via Medica

<59>
Accession Number
2031776668
Title
Prophylactic cranial irradiation in patients with resected small-cell lung
cancer: A systematic review and meta-analysis.
Source
Thoracic Cancer. 15(32) (pp 2309-2318), 2024. Date of Publication:
November 2024.
Author
Peng H.; Hao J.; Dong B.; Chen M.; Li Z.; Chen C.; Liu L.
Institution
(Peng, Hao, Dong, Chen, Li, Chen, Liu) Department of Thoracic Surgery,
West China Hospital, Sichuan University, Chengdu, China
Publisher
John Wiley and Sons Inc
Abstract
Prophylactic cranial irradiation (PCI) was recommended for limited-stage
small-cell lung cancer (SCLC) patients with complete or partial response
to primary chemoradiotherapy. But it is still controversial regarding its
role in SCLC patients who have had radical resection. This meta-analysis
aims to evaluate the efficacy of PCI in resected SCLC patients. We
searched PubMed, EMBASE, Web of Science, CENTRAl, and ClinicalTrials for
controlled trials and cohort studies regarding PCI in postoperative SCLC
patients. The correlation between PCI and post-operative outcomes in SCLC
patients, including survival and brain metastasis rate (BMR), was examined
using hazard ratios (HRs) and risk ratios with corresponding 95%
confidence intervals. Quality of studies was assessed by the
Newcastle-Ottawa Scale (NOS), and publication bias was assessed by Begg's
test. Meta-analysis of eight studies with 2688 patients in total showed
PCI was associated with improved overall survival (OS) for resected SCLC
(HR: 0.65, 95% CI: 0.57-0.75, p < 0.01). In addition, subgroup analysis on
three studies including 923 patients confirmed the protective role of
postoperative PCI in N0 SCLC patients (HR: 0.79, 95% CI: 0.61-0.97, p <
0.05). There was also a significant reduction in BMR in the PCI group
pooled from six studies (HR: 0.58, 95% CI: 0.40-0.85, p < 0.01). The use
of PCI delayed brain recurrence and improved OS in patients with resected,
stage I-III SCLC. Importantly, patients with N0 SCLC can also benefit from
postoperative PCI. In future studies, PCI's role in patients with resected
N0 SCLC at different T stage may need to be explored. Copyright ©
2024 The Author(s). Thoracic Cancer published by John Wiley & Sons
Australia, Ltd.

<60>
Accession Number
2031677230
Title
One-month DAPT after biodegradable-polymer everolimus-eluting stent
implantation in women at high-bleeding risk: Insights from the POEM trial.
Source
Catheterization and Cardiovascular Interventions. 104(6) (pp 1129-1138),
2024. Date of Publication: 15 Nov 2024.
Author
Maurina M.; Pivato C.A.; Kunadian V.; Testa L.; Briguori C.; Pacchioni A.;
Latini A.C.; Cesani N.; Piccolo R.; Musto C.; Sardella G.; Indolfi C.;
Regazzoli D.; Paradies V.; Stefanini G.
Institution
(Maurina, Pivato, Latini, Cesani, Regazzoli, Stefanini) Department of
Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4,
Pieve Emanuele, Milan, Italy
(Pivato, Latini, Cesani, Stefanini) Cardio Center, IRCCS Humanitas
Research Hospital, via Manzoni 56, Rozzano, Milan, Italy
(Kunadian) Translational and Clinical Research Institute, Faculty of
Medical Sciences, Newcastle University Medical School, Newcastle upon
Tyne, United Kingdom
(Kunadian) Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne
Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
(Testa) IRCCS Policlinico San Donato, Milan, Italy
(Briguori) Mediterranea Cardiocentro, Naples, Italy
(Pacchioni) Mirano Hospital, Mirano, Italy
(Piccolo) Department of Advanced Biomedical Sciences, "Federico II"
University of Naples, Naples, Italy
(Musto) Department of Cardiosciences A.O. San Camillo-Forlanini Hospital,
Rome, Italy
(Sardella) Policlinico Umberto I University, Rome, Italy
(Indolfi) Department of Medical and Surgical Sciences, "Magna Graecia"
University, Catanzaro, Italy
(Paradies) Department of Cardiology Maasstad Hospital Rotterdam,
Rotterdam, Netherlands
Publisher
John Wiley and Sons Inc
Abstract
Aims: We conducted a prespecified subanalysis of the POEM trial to assess
the association between sex and clinical outcomes following a short
1-month dual-antiplatelet-therapy (DAPT) period after percutaneous
coronary intervention (PCI) with bioresorbable polymer everolimus-eluting
stent (BP-EES) among patients at high bleeding risk (HBR).
 Background(s): Shortening the DAPT period after PCI is an effective
bleeding avoidance strategy with contemporary drug-eluting stents. Whether
sex affects the risk of adverse events following PCI is still debated.
 Method(s): Patients at HBR undergoing PCI with BP-EES were enrolled
and treated with 1-month DAPT. If anticoagulation was needed, study
participants received an oral anticoagulant (OAC) in addition to a
P2Y<inf>12</inf> inhibitor for 1 month, followed by OAC only thereafter.
The primary endpoint was a composite of cardiac death, myocardial
infarction, or definite/probable stent thrombosis at 12 months. We report
sex-based outcomes of patients included in the POEM study. Result(s):
We enrolled 129 (29.1%) women and 314 (70.9%) men. Women were older, with
lower hemoglobin levels, and worse renal function. Accordingly, they had a
trend for a greater number of HBR criteria fulfilled and a higher PARIS
bleeding score. However, they were not at a significantly higher risk for
the primary endpoint (men vs. women: 5.17% vs. 3.94%; HR 1.30; 95% CI:
0.48-3.54, p = 0.61), or any of the hemorrhagic and ischemic secondary
endpoints. Conclusion(s): This prespecified subanalysis of the POEM
trial suggests that 1-month DAPT following PCI with BP-EES may be a safe
and effective therapeutic strategy for women at HBR. Copyright ©
2024 The Author(s). Catheterization and Cardiovascular Interventions
published by Wiley Periodicals LLC.

<61>
Accession Number
2031626999
Title
Validation of virtual fractional flow reserve pullback curves.
Source
Catheterization and Cardiovascular Interventions. 104(6) (pp 1178-1188),
2024. Date of Publication: 15 Nov 2024.
Author
Seki R.; Collison D.; Ikeda K.; Sonck J.; Munhoz D.; Bertolone D.T.; Ko
B.; Maeng M.; Otake H.; Koo B.-K.; Storozhenko T.; Bouisset F.; Belmonte
M.; Leone A.; Shumkova M.; Ford T.J.; Mahendiran T.; Berry C.; De Bruyne
B.; Oldroyd K.; Sakai K.; Mizukami T.; Collet C.
Institution
(Seki, Ikeda, Sonck, Munhoz, Bertolone, Storozhenko, Bouisset, Belmonte,
Leone, Shumkova, Mahendiran, De Bruyne, Sakai, Mizukami, Collet)
Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(Collison, Berry) Department of cardiology, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Collison, Berry, Oldroyd) School of Cardiovascular & Metabolic Health,
University of Glasgow, Glasgow, United Kingdom
(Munhoz, Bertolone, Belmonte, Leone) Department of Advanced Biomedical
Sciences, University Federico II, Naples, Italy
(Ko) Monash Cardiovascular Research Centre, Monash University and Monash
Heart, Monash Health, Clayton, VIC, Australia
(Maeng) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Maeng) Department of Clinical Medicine, Health, Aarhus University,
Aarhus, Denmark
(Otake) Division of Cardiovascular Medicine, Department of Internal
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
(Koo) Department of Internal Medicine and Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Storozhenko) L.T. Malaya Therapy National Institute NAMSU, Kharkiv,
Ukraine
(Bouisset) Department of Cardiology, Toulouse Rangueil University
Hospital, Toulouse, France
(Ford) Department of cardiology, Faculty of Health and Medicine,
University of Newcastle, Newcastle, NSW, Australia
(Mahendiran, De Bruyne) Department of Cardiology, University Hospital of
Lausanne, Lausanne, Switzerland
(Sakai) Division of Cardiology, Department of Medicine, Showa University
School of Medicine, Tokyo, Japan
(Sakai) Department of Cardiology, St Francis Hospital and Heart Center,
Roslyn, NY, United States
(Mizukami) Division of Clinical Pharmacology, Department of Pharmacology,
Showa University, Tokyo, Japan
Publisher
John Wiley and Sons Inc
Abstract
Background: Angiography-derived fractional flow reserve (virtual FFR) has
shown excellent diagnostic performance compared with wire-based FFR.
However, virtual FFR pullback curves have not been validated yet.
 Objective(s): To validate the accuracy of virtual FFR pullback curves
compared to wire-based FFR pullbacks and to assess their clinical utility
using patient-reported outcomes. Method(s): Pooled analysis of two
prospective studies, including patients with hemodynamically significant
(FFR <= 0.80) coronary artery disease (CAD). Virtual and wire-based FFR
pullbacks were compared to assess the accuracy of virtual pullbacks to
characterize CAD as focal or diffuse. Pullbacks were analyzed visually and
quantitatively using the pullback pressure gradient (PPG). Patients
underwent PCI, and the Seattle Angina Questionnaire (SAQ) was administered
at 3-month follow-up. Result(s): A total of 298 patients (300
vessels) with both virtual and wire-based pullbacks who underwent PCI were
included in the analysis. The mean age was 61.8 +/- 8.8, and 15% were
female. The agreement on the visual adjudication of the CAD pattern was
fair (Cohen's Kappa: 0.31, 95% confidence interval: 0.18-0.45). The mean
PPG were 0.65 +/- 0.18 from virtual pullbacks and 0.65 +/- 0.13 from
wire-based pullbacks (r = 0.68, mean difference 0, limits of agreement
-0.27 to 0.28). At follow-up, patients with high virtual PPG (>0.67) had
higher SAQ angina frequency scores (i.e., less angina) than those with low
virtual PPG (SAQ scores 92.0 +/- 14.3 vs. 85.5 +/- 23.1, p = 0.022).
 Conclusion(s): Virtual FFR pullback curves showed moderate agreement
with wire-based FFR pullbacks. Nonetheless, patients with focal disease
based on virtual PPG reported greater improvement in angina after
PCI. Copyright © 2024 Wiley Periodicals LLC.

<62>
Accession Number
2030547575
Title
Concomitant tricuspid valve surgery in patients with significant tricuspid
regurgitation undergoing left ventricular assist device implantation: A
systematic review and meta-analysis.
Source
Artificial Organs. 48(12) (pp 1392-1403), 2024. Date of Publication:
December 2024.
Author
Hwang B.; Doyle M.; Williams M.L.; Joshi Y.; Iyer A.; Watson A.; Jansz P.;
Hayward C.
Institution
(Hwang, Doyle, Williams, Joshi, Iyer, Watson, Jansz) Department of
Cardiothoracic Surgery, St Vincent's Hospital, Sydney, NSW, Australia
(Hwang) Faculty of Medicine, University of New South Wales, Sydney, NSW,
Australia
(Hayward) Department of Cardiology, St Vincent's Hospital, Sydney, NSW,
Australia
Publisher
John Wiley and Sons Inc
Abstract
Background: Significant tricuspid regurgitation (TR) is a predictor of
right heart failure (RHF) and increased mortality following left
ventricular assist device (LVAD) implantation, however the benefit of
tricuspid valve surgery (TVS) at the time of LVAD implantation remains
unclear. This study compares early and late mortality and RHF outcomes in
patients with significant TR undergoing LVAD implantation with and without
concomitant TVS. Method(s): A systematic search of four electronic
databases was conducted for studies comparing patients with moderate or
severe TR undergoing LVAD implantation with or without concomitant TVS.
Meta-analysis was performed for primary outcomes of early and late
mortality and RHF. Secondary outcomes included rate of stroke, renal
failure, hospital and ICU length of stay. An overall survival curve was
constructed using aggregated, reconstructed individual patient data from
Kaplan-Meier (KM) curves. Result(s): Nine studies included 575
patients that underwent isolated LVAD and 308 patients whom received
concomitant TVS. Both groups had similar rates of severe TR (46.5% vs.
45.6%). There was no significant difference seen in risk of early
mortality (RR 0.90; 95% CI, 0.57-1.42; p = 0.64; I2 = 0%) or
early RHF (RR 0.82; 95% CI, 0.66-1.19; p = 0.41; I2 = 57) and
late outcomes remained comparable between both groups. The aggregated KM
curve showed isolated LVAD to be associated with overall increased
survival (HR 1.42; 95% CI, 1.05-1.93; p = 0.023). Conclusion(s):
Undergoing concomitant TVS did not display increased benefit in terms of
early or late mortality and RHF in patients with preoperative significant
TR. Further data to evaluate the benefit of concomitant TVS stratified by
TR severity or by other predictors of RHF will be
beneficial. Copyright © 2024 The Author(s). Artificial Organs
published by International Center for Artificial Organ and Transplantation
(ICAOT) and Wiley Periodicals LLC.

<63>
Accession Number
2035621228
Title
Upper- vs Lower-Extremity Secondary Access during Transcatheter Aortic
Valve Implantation: A Randomized Clinical Trial.
Source
JAMA Network Open. 7(10) (pp e2438578), 2024. Date of Publication: 16 Oct
2024.
Author
Versteeg G.A.A.; Rooijakkers M.J.P.; Hemelrijk K.I.; Vlaar P.J.; Overduin
D.C.; Van Wely M.H.; Aarts H.M.; Van Ginkel D.-J.; Van Nunen L.X.; Van
Geuns R.J.; Van Garsse L.A.F.M.; Geuzebroek G.S.C.; Verkroost M.W.A.;
Cetinyurek-Yavuz A.; Heijmen R.H.; Ten Berg J.M.; Tonino P.A.L.; Delewi
R.; Van Royen N.
Institution
(Versteeg, Rooijakkers, Van Wely, Van Nunen, Van Geuns, Van Royen)
Department of Cardiology, Radboud University Medical Center, Nijmegen,
Netherlands
(Hemelrijk, Aarts, Delewi) Department of Cardiology, Amsterdam UMC,
Amsterdam, Netherlands
(Vlaar, Tonino) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(Overduin, Van Ginkel, Ten Berg) Department of Cardiology, St Antonius
Hospital, Nieuwegein, Netherlands
(Van Garsse, Geuzebroek, Verkroost, Heijmen) Department of Cardiothoracic
Surgery, Radboud University Medical Center, Nijmegen, Netherlands
(Cetinyurek-Yavuz) Department of IQ Health, Section of Biostatistics,
Radboud University Medical Center, Nijmegen, Netherlands
(Ten Berg) Cardiovascular Research Institute Maastricht, Maastricht,
Netherlands
Publisher
American Medical Association
Abstract
Importance: An upper-extremity approach for secondary access during
transfemoral transcatheter aortic valve implantation (TAVI) may reduce
clinically relevant secondary access site-related bleeding.
 Objective(s): To investigate the safety and efficacy of an
upper-extremity approach compared with a lower-extremity approach in
patients undergoing TAVI. Design, Setting, and Participant(s): The
TAVI XS trial was a randomized clinical trial performed between November
28, 2022, and November 15, 2023, with a 30-day follow-up, in 4 TAVI
centers in the Netherlands. Eligibility was determined first, and only
those patients with severe aortic stenosis and no contraindication for
upper- or lower-extremity secondary access were informed about the study
and asked to participate. Intervention(s): Participants were
randomized 1:1 between the upper-extremity approach (radial artery
diagnostic access and upper-arm vein for temporary pacing lead placement)
and lower-extremity approach (femoral artery diagnostic access and femoral
vein for temporary pacing lead placement) for secondary access during
TAVI. Main Outcomes and Measures: Primary end point was clinically
relevant bleeding (Bleeding Academic Research Consortium type 2, 3, or 5)
of the randomized secondary access. Secondary end points included any
clinically relevant bleeding, time to mobilization, duration of
hospitalization, secondary access failure, and procedural time.
 Result(s): Of a total of 324 eligible patients, 238 patients
undergoing transfemoral TAVI (mean [SD] age, 79.4 [6.5] years; 150 male
[63.0%]; median European System for Cardiac Operative Risk Evaluation II
score, 2.2% [IQR, 1.5%-3.5%]) were included. The primary end point
occurred in 5 of 119 patients (4.2%) in the upper-extremity group and 16
of 119 (13.4%) in the lower-extremity group (odds ratio [OR], 0.28 [95%
CI, 0.10-0.80]; P =.01). Incidence of any clinically relevant bleeding was
decreased in the upper-extremity group (25 of 119 [21.0%] vs 41 of 119
[34.5%] patients; OR, 0.51 [95% CI, 0.28-0.91]; P =.02). There was no
difference in time to mobilization or duration of hospitalization.
Secondary access failure (14 of 119 [11.8%] vs 1 of 119 [0.8%] patients;
OR, 15.73 [95% CI, 2.03-121.69]; P =.001) and procedural time (60.0 [IQR,
39.0-88.0; 95% CI, 53.0-70.0] vs 48.0 [IQR, 34.0-64.0; 95% CI, 40.0-55.0]
minutes; P =.002) were higher in the upper-extremity cohort. Conclusion
and Relevance: In this randomized clinical trial of patients undergoing
transfemoral TAVI, the upper-extremity approach for secondary access was
associated with less clinically relevant access site-related bleeding
compared with the conventional lower-extremity approach and should be
considered to reduce periprocedural bleeding complications. Copyright
© 2024 Versteeg GAA et al.

<64>
Accession Number
2035612124
Title
Extracorporeal Blood Purification and Acute Kidney Injury in Cardiac
Surgery: The SIRAKI02 Randomized Clinical Trial.
Source
JAMA. 332(17) (pp 1446-1454), 2024. Date of Publication: 05 Nov 2024.
Author
Perez-Fernandez X.; Ulsamer A.; Camara-Rosell M.; Sbraga F.;
Boza-Hernandez E.; Moret-Ruiz E.; Plata-Menchaca E.; Santiago-Bautista D.;
Boronat-Garcia P.; Gumucio-Sanguino V.; Penafiel-Munoz J.; Camacho-Perez
M.; Betbese-Roig A.; Forni L.; Campos-Gomez A.; Sabater-Riera J.
Institution
(Perez-Fernandez) Facultat de Medicina Campus, De Bellvitge Universitat de
Barcelona l'Hospitalet, de Llobregat, Barcelona, Spain
(Perez-Fernandez, Ulsamer, Plata-Menchaca, Gumucio-Sanguino,
Penafiel-Munoz, Sabater-Riera) Institut de Investigacio Biomedica de
Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
(Perez-Fernandez, Sbraga, Boza-Hernandez, Gumucio-Sanguino, Sabater-Riera)
Hospital Universitari, De Bellvitge l'Hospitalet de LLobregat, Barcelona,
Spain
(Camara-Rosell, Moret-Ruiz, Santiago-Bautista, Boronat-Garcia,
Campos-Gomez) Hospital Universitari Germans Trias i Pujol Badalona,
Barcelona, Spain
(Camacho-Perez, Betbese-Roig) Hospital Universitari Santa Creu i Sant Pau,
Barcelona, Spain
(Forni) Royal Surrey NHS Foundation Trust and School of Medicine,
University of Surrey, Guildford, United Kingdom
Publisher
American Medical Association
Abstract
Importance: Cardiac surgery-Associated acute kidney injury (CSA-AKI)
remains a significant problem following cardiopulmonary bypass (CPB).
Various strategies are proposed to attenuate CSA-AKI, including
extracorporeal blood purification (EBP), but little is known about the
effect of EBP through an acrylonitrile-sodium
methallylsulfonate/polyethyleneimine membrane during CPB.
 Objective(s): To determine whether the use of an EBP device in a
nonemergent cardiac surgery population reduces CSA-AKI after CPB.
 Design, Setting, and Participant(s): This double-blind, randomized
clinical trial was conducted in 2 tertiary hospitals in Spain. Patients 18
years or older undergoing nonemergent cardiac surgery who were at high
risk for CSA-AKI were enrolled from June 15, 2016, through November 5,
2021, with follow-up data through February 5, 2022. Of 1156 patients
assessed, 343 patients were randomized (1:1) to either receive EBP or
standard care. Intervention(s): Nonselective EBP device connected to
the CPB circuit. Main Outcomes and Measures: The primary outcome was
the rate of CSA-AKI in the 7 days after randomization. Result(s):
Among 343 patients randomized (169 to receive EBP and 174 to receive usual
care), the mean (SD) age was 69 (9) years and 119 were females. The rate
of CSA-AKI was 28.4% (95% CI, 21.7%-35.8%) in the EBP group vs 39.7% (95%
CI, 32.3%-47.3%) in the standard care group (P =.03), with an adjusted
difference of 10.4% (95% CI, 2.3%-18.5%) using a log-binomial model (P
=.01). No significant differences (P >.05) were observed in most of the
predefined clinical secondary end points or post hoc exploratory end
points. In a sensitivity analysis, EBP was found to be more effective in
terms of CSA-AKI reduction in patients with chronic kidney disease,
diabetes, hypertension, low left ventricular ejection fraction (<40%), and
lower body mass index (<30). No differences were observed between the
groups in adverse events tracking. Conclusions and Relevance: The use
of a nonselective EBP device connected to the CPB circuit in a nonemergent
population of patients undergoing cardiac surgery was associated with a
significant reduction of CSA-AKI in the first 7 days after
surgery. Copyright © 2024 American Medical Association. All
rights reserved.

<65>
Accession Number
2035610735
Title
Anemia Acuity Effect on Transfusion Strategies in Acute Myocardial
Infarction: A Secondary Analysis of the MINT Trial.
Source
JAMA Network Open. 7(11) (pp e2442361), 2024. Date of Publication: 01 Nov
2024.
Author
Carrier F.M.; Cooper H.A.; Portela G.T.; Bertolet M.; Lemesle G.;
Prochaska M.; Kim S.; Alexander J.H.; Crozier I.; Ducrocq G.; Quadros
A.S.; Bagai A.; Dracoulakis M.; Madan M.; Brooks M.M.; Carson J.L.; Hebert
P.C.
Institution
(Carrier) Department of Anesthesiology and Department of Medicine,
Critical Care Division, Centre Hospitalier de l'Universite de Montreal,
Montreal, QC, Canada
(Carrier) Department of Anesthesiology and Pain Medicine, Universite de
Montreal, Montreal, QC, Canada
(Cooper) Department of Cardiology, Westchester Medical Center, Valhalla,
NY, United States
(Portela, Bertolet) Department of Epidemiology, University of Pittsburgh,
Pittsburgh, PA, United States
(Lemesle) Heart and Lung Institute, University Hospital of Lille, CHU
Lille, Lille, France
(Lemesle) Universite de Lille, Lille F-59000, France
(Lemesle) French Alliance for Cardiovascular Trials, Paris, France
(Lemesle) Institut Pasteur of Lille, Inserm U1011-EGID, Lille, France
(Prochaska) Department of Medicine, University of Chicago, Chicago, IL,
United States
(Kim, Carson) Department of Medicine, Rutgers Robert Wood Johnson Medical
School, New Brunswick, NJ, United States
(Alexander) Duke Clinical Research Institute, Division of Cardiology, Duke
University, Durham, NC, United States
(Crozier) Department of Cardiology, Christchurch Hospital, Christchurch,
New Zealand
(Ducrocq) Universite de Paris, Assistance Publique-Hopitaux de Paris,
French Alliance for Cardiovascular Trials, INSERM U1148, Paris, France
(Quadros) Department of Interventional Cardiology, Instituto de
Cardiologia Do Rio Grande Dosul, Porto Alegre, Brazil
(Bagai) Terrence Donnelly Heart Center, St Michael's Hospital, University
of Toronto, Toronto, ON, Canada
(Dracoulakis) Clinical Center Research-Hospital da Bahia, Dasa, Brazil
(Madan) Division of Cardiology, Schulich Heart Program, Sunnybrook Health
Sciences Centre, Toronto, ON, Canada
(Madan) Temerty Faculty of Medicine, University of Toronto, Toronto, ON,
Canada
(Brooks) Epidemiology Data Center, Faculty in Epidemiology and
Biostatistics, School of Public Health, University of Pittsburgh,
Pittsburgh, PA, United States
(Hebert) Innovation and Health Evaluation Hub, Centre de Recherche du
CHUM, Montreal, QC, Canada
(Hebert) Department of Medicine, Universite de Montreal, Montreal, QC,
Canada
Publisher
American Medical Association
Abstract
Importance: In patients with acute myocardial infarction (MI), limited
physiologic adaptation to acute anemia might lead to greater benefit from
a liberal red blood cell (RBC) transfusion strategy. Data on such a
possible benefit are lacking. Objective(s): To compare acute anemia
with chronic anemia and post-MI outcomes and estimate the differential
effect of a restrictive RBC transfusion strategy compared with a liberal
strategy on post-MI outcomes according to anemia acuity. Design,
Setting, and Participant(s): A prespecified subgroup analysis of the
Myocardial Ischemia and Transfusion (MINT) multicenter randomized clinical
trial was conducted in 126 hospitals in 6 countries between April 26,
2017, and April 14, 2023, with 30-day follow-up and blinded adjudication
of the primary outcome. The analysis included 3144 of 3504 MINT
participants (89.7%) with acute MI, a hemoglobin (Hb) level less than 10
g/dL at randomization, and a first Hb measurement available on the day of
or the day following hospital admission. Intervention(s): The MINT
trial randomized participants to a restrictive (Hb <7-8 g/dL) or liberal
(Hb <10 g/dL) RBC transfusion strategy. Acute anemia was defined as having
a first Hb value greater than 13 g/dL (men) or 12 g/dL (women), or as
having a decrease greater than or equal to 2 g/dL between the first Hb
measurement and measurement at randomization. Other Hb levels were
categorized as chronic anemia. Main Outcomes and Measures: The
primary outcome was a composite of death or recurrent MI up to 30 days
after randomization. Secondary outcomes were death, recurrent MI, cardiac
death, heart failure, pulmonary complications, and major bleeding events.
Intention-To-Treat analysis was performed. Result(s): Among 3144
included participants (mean [SD] age, 72.3 [11.6] years; 1715 [54.5%]
male; 1307 [41.6%] with type 1 MI), 1078 [34.3%]) had acute anemia. Acute
anemia was associated with an increased risk of death or recurrent MI
(adjusted risk ratio, 1.25; 95% CI, 1.05-1.48). The effect of a
restrictive RBC transfusion strategy compared with a liberal strategy was
similar for participants with either acute or chronic anemia for all
outcomes. Conclusions and Relevance: In this secondary analysis of
the MINT trial, acute anemia was associated with less favorable post-MI
outcomes than chronic anemia but did not modify the effects of the
randomized transfusion strategy. In patients with anemia and MI, the
acuity of anemia should not influence the choice of transfusion
trigger. Copyright © 2024 Carrier FM et al.

<66>
Accession Number
2035601995
Title
Postdilatation after stent deployment during primary percutaneous coronary
intervention: a systematic review and meta-analysis.
Source
Postgraduate Medical Journal. 100(1189) (pp 827-835), 2024. Date of
Publication: 01 Nov 2024.
Author
Putra T.M.H.; Widodo W.A.; Putra B.E.; Soerianata S.; Yahya A.F.; Tan
J.W.C.
Institution
(Putra, Widodo) Jakarta Heart Center, Department of Cardiology and
Vascular Medicine, Jakarta 13140, Indonesia
(Putra) RSUD Berkah Pandeglang, Department of Cardiology and Vascular
Medicine, Pandeglang 42253, Indonesia
(Soerianata) Faculty of Medicine, National Cardiovascular Center Harapan
Kita, Department of Cardiology and Vascular Medicine, Universitas
Indonesia, Jakarta 11420, Indonesia
(Yahya) Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin
General Hospital, Department of Cardiology and Vascular Medicine, Bandung
40161, Indonesia
(Tan) National Heart Center, Department of Cardiology, Singapore 169609,
Singapore
Publisher
Oxford University Press
Abstract
Background: The utilization of postdilatation in primary percutaneous
coronary intervention (PCI) is feared to induce suboptimal coronary blood
flow and compromise the outcome of the patients. This meta-analysis sought
to verify whether postdilatation during primary PCI is associated with
worse angiographic or long-term clinical outcomes. Method(s):
Systematic literature searches were conducted on PubMed, The Cochrane
Library, ClinicalTrials.gov, EBSCO, and Europe PMC on 10 March 2024.
Eligible studies reporting the outcomes of postdilatation among ST-segment
elevation myocardial infarction patients were included. The primary
outcome was no-reflow condition during primary PCI based on angiographic
finding. The secondary clinical outcome was major adverse cardiovascular
events (MACEs) comprising all-cause death, myocardial infarction, target
vessel revascularization (TVR), and stent thrombosis. Result(s): Ten
studies were finally included in this meta-analysis encompassing 3280
patients, which was predominantly male (76.6%). Postdilatation was
performed in 40.7% cases. Postdilatation was associated with increased
risk of no-reflow during primary PCI [Odd Ratio (OR) = 1.33, 95%
Confidence Interval (CI): 1.12-1.58; P = .001)]. Conversely,
postdilatation had a tendency to reduce MACE (OR = 0.70, 95% CI:
0.51-0.97; P = .03) specifically in terms of TVR (OR = 0.41, 95% CI:
0.22-0.74; P = .003). No significant differences between both groups in
relation to mortality (OR = 0.58, 95% CI: 0.32-1.05; P = .07) and
myocardial infarction (OR = 1.5, 95% CI: 0.78-2.89; P = .22).
 Conclusion(s): Postdilatation after stent deployment during primary
PCI appears to be associated with an increased risk of no-reflow
phenomenon after the procedure. Nevertheless, postdilatation strategy has
demonstrated a significant reduction in MACE over the course of long-term
follow-up. Specifically, postdilatation significantly decreased the
occurrence of TVR. Copyright © The Author(s) 2024. Published by
Oxford University Press on behalf of Fellowship of Postgraduate Medicine.
All rights reserved.

<67>
Accession Number
2034775872
Title
Relative Perioperative Analgesic Efficacy of Superficial Versus Deep
Approach of Serratus Anterior Plane Block for Anterior Chest Wall Surgery
A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Source
Clinical Journal of Pain. 40(12) (pp 726-733), 2024. Date of Publication:
24 Sep 2024.
Author
Singh N.P.; Makkar J.K.; Dhawan I.; Singh N.; Singh P.M.; Siddiqui N.
Institution
(Singh, Siddiqui) Department of Anesthesia and Pain Medicine, Mount Sinai
Hospital, University of Toronto, Toronto, ON, Canada
(Makkar, Dhawan) Department of Anaesthesia and Intensive Care, Post
Graduate Institute of Medical Education and Research, Chandigarh, India
(Singh) Department of Anaesthesia and Critical Care, All India Institute
of Medical Sciences, Sijua, Patrapada, OR, Bhubaneswar, India
(Singh) Department of Anesthesia, Washington University, Saint Louis, MO,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: Both superficial and deep serratus anterior plane (SAP) blocks
are effective for anterior chest wall surgeries, but there is little
clarity on which is more effective. Hence, we conducted a systematic
review and meta-analysis of randomized controlled trials (RCTs) to
evaluate the comparative efficacy of the 2 approaches for SAP block after
anterior chest wall surgery. Material(s) and Method(s): A systematic
literature search was performed using PubMed, Embase, Scopus, and Cochrane
Central Registers of Controlled Trials for eligible RCTs from inception
until August 2023. The primary outcome was opioid consumption during the
first 24 hours of the postoperative period. The secondary outcomes
included pain scores at various intervals, intraoperative opioid
consumption, time to first analgesic request, block-related complications,
opioid-related side effects, and patient satisfaction scores. Statistical
analysis of the pooled data was performed using Review Manager Version
5.3. Result(s): We identified 7 RCTs published between 2020 and 2022,
enrolling 371 patients (186 in the superficial SAP block and 187 in the
deep SAP block). Moderate certainty of evidence suggests that both the
approaches (deep and superficial) of SAP block were comparable for 24-hour
oral morphine equivalent consumption with a mean difference (MD) of 3.78
mg (95% CI: -1.70 to 9.29; P = 0.18; I2 = 87%). The results of
other secondary outcomes were comparable, including resting pain scores
with an MD of 0.08 (95% CI: -0.27 to 0.43; P = 0.67; I2 = 87%)
for early pain and MD of 0.63 (95% CI: -1.28 to 0.01; P = 0.05;
I2 = 95%) for late pain scores, time to first analgesic request
with MD of -0.41 hour (95% CI: -1.40 to 0.59; P = 0.42; I2 =
90%), and incidence of postoperative nausea and vomiting (odds ratio: 1.45
(95% CI: 0.72 to 2.90; P = 0.30; I2 = 0%). Conclusion(s):
Current evidence does not support the preference for one approach of SAP
block over the other for postoperative pain. Based on the available data,
we recommend further future trials to determine any differences between
these interventions. Copyright © 2024 Wolters Kluwer Health, Inc.
All rights reserved.

<68>
Accession Number
2034202402
Title
Dexamethasone for Cardiac Surgery: A Practice Preference-Randomized
Consent Comparative Effectiveness Trial.
Source
Anesthesiology. 141(5) (pp 859-869), 2024. Date of Publication: November
2024.
Author
Myles P.S.; Dieleman J.M.; Munting K.E.; Forbes A.; Martin C.A.; Smith
J.A.; McGiffin D.; Verheijen L.P.J.; Wallace S.
Institution
(Myles, Wallace) Department of Anaesthesiology and Perioperative Medicine,
Alfred Hospital, Monash University, Melbourne, Australia
(Dieleman) Department of Anaesthesia, Westmead Hospital, Western Sydney
University, Penrith, Australia
(Munting, Verheijen) Department of Anaesthesia, University Medical Center,
Utrecht, Netherlands
(Forbes, Martin) Biostatistics Unit, School of Public Health and
Preventive Medicine, Monash University, Melbourne, Australia
(Smith) Department of Cardiothoracic Surgery, Department of Surgery,
School of Clinical Sciences at Monash Health, Monash University, Clayton,
Australia
(McGiffin) Department of Cardiothoracic Surgery, Alfred Hospital,
Melbourne, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: High-dose corticosteroids have been used to attenuate the
inflammatory response to cardiac surgery and cardiopulmonary bypass, but
patient outcome benefits remain unclear. The primary aim was to determine
whether using dexamethasone was superior to not using dexamethasone to
increase the number of home days in the first 30 days after cardiac
surgery. The secondary aim was to evaluate efficiency, value, and impact
of the novel trial design. Method(s): This pragmatic, international
trial incorporating a prerandomized consent design favoring local practice
enrolled patients undergoing cardiac surgery across seven hospitals in
Australia and The Netherlands. Patients were randomly assigned to
dexamethasone 1 mg/kg or not (control). The primary outcome was the number
of days alive and at home up to 30 days after surgery ("home days").
Secondary outcomes included prolonged mechanical ventilation (more than 48
h), sepsis, renal failure, myocardial infarction, stroke, and death.
 Result(s): Of 2,562 patients assessed for eligibility, 1,951 were
randomized (median age, 63 yr; 80% male). The median number of home days
was 23.0 (interquartile range, 20.1 to 24.1) in the no dexamethasone group
and 23.1 (interquartile range, 20.1 to 24.6) in the dexamethasone group
(median difference, 0.1; 95% CI, -0.3 to 0.5; P = 0.66). The rates of
prolonged mechanical ventilation (risk ratio, 0.72; 95% CI, 0.48 to 1.08),
sepsis (risk ratio, 1.02; 95% CI, 0.57 to 1.82), renal failure (risk
ratio, 0.94; 95% CI, 0.80 to 1.12), myocardial infarction (risk ratio,
1.20; 95% CI, 0.30 to 4.82), stroke (risk ratio, 1.06; 95% CI, 0.54 to
2.08), and death (risk ratio, 0.72; 95% CI, 0.22 to 2.35) were comparable
between groups (all P > 0.10). Dexamethasone reduced intensive care unit
stay (median, 29 h; interquartile range, 22 to 50 h vs. median, 43 h;
interquartile range, 24 to 72 h; P = 0.004). The authors' novel trial
design was highly efficient (89.3% enrollment). Conclusion(s): Among
patients undergoing cardiac surgery, high-dose dexamethasone decreased
intensive care unit stay but did not increase the number of home days
after surgery. Copyright © 2024 American Society of
Anesthesiologists. All Rights Reserved.

<69>
Accession Number
645624714
Title
Ozaki aortic valve reconstruction could be the best availableoption for
aortic valve replacement in children: results of meta-analysis of 32
studies.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S572-S573), 2024. Date of Publication: May 2024.
Author
Kandil O.A.; Awad A.; Said S.M.
Institution
(Kandil, Awad, Said) Alexandria Faculty of Medicine, Alexandria, Egypt
Publisher
Cambridge University Press
Abstract
Background: Aortic valve replacement (AVR) in children remains to be
palliative with no ideal prosthesis. We sought to analyze outcomes related
to different AVR options in the pediatric age group. Method(s):
Studies yielded from searching in four databases were used to perform a
meta-analysis using metaprop and metafor package in R software version
4.2. Result(s): A total of 3,446 pts from 32 studies underwent AVR,
were analyzed. Mechanical prostheses were implanted in 1,603 pts. Ozaki
was the technique used in 1,154, while homografts and bioprostheses were
used in 485 and 204 patients respectively. Homografts were associated with
higher early mortality, while Ozaki had the lowest mortality with effect
estimates (EE) of early death of 0.1 [95%CI: 0.07-0.14], and 0.02 [95%CI:
0.01-0.03] respectively. This effect persisted also with late mortality EE
of 0.07 [95%CI: 0.03-0.12], 0.06 [95%CI: 0.02-0.19], 0.05 [95% CI:
0.03-0.09], and 0.04 [95%CI: 0.02-0.09] for homografts, bioprostheses,
mechanical valves and Ozaki respectively. Bioprostheses had higher
endocarditis EE of 0.17 [95%CI: 0.07-0.34] , followed by the homografts
and Ozaki groups EE of 0.02 [95%CI: 0.01-0.05] . In regards to
reintervention, homografts had the highest EE (0.2 [95%CI: 0.10-0.34]),
followed by bioprosthesis (EE of 0.16 [ 95%CI: 0.03-0.54] , and mechanical
valves EE of 0.07 [ 95%CI: 0.04-0.10] . Ozaki had the lowest
reintervention rates with an EE of 0.06 [95%CI 0.03-0.13].
 Conclusion(s): While there is no ideal substitute for the aortic
valve in children, Ozaki valve reconstruction is associated with better
early and late survival and lower reoperation rate.

<70>
Accession Number
645624238
Title
Mesenchymal stromal cell delivery through cardiopulmonary bypass can
minimize extensive systemic and neuroinflammation reactions in a juvenile
porcine model.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S649), 2024. Date of Publication: May 2024.
Author
Kobayashi K.; Maeda T.; Sarkislali K.; Somaa F.; Zurakowski D.; Hanley P.;
Jonas R.; Ishibashi N.
Institution
(Kobayashi, Maeda, Sarkislali, Somaa, Zurakowski, Hanley, Jonas,
Ishibashi) Children's National Hospital, Washington, DC, United States
Publisher
Cambridge University Press
Abstract
Background: Cardiopulmonary bypass (CPB) can cause systemic inflammation
and microglia activation. We have previously shown that mesenchymal
stromal cell (MSC) delivery through CPB inhibits microglial activation.
Various factors can affect CPBinduced stresses. The present studies
assessed neuroprotective capacity of MSC treatment on inflammatory
responses resulting from an extensive period of CPB. Method(s):
Two-week old piglets (n=20) were randomly assigned to one of three
CPB-induced insults: i) Control; ii) CPB (150min CPB with 60min
deep-hypothermic circulatory-arrest (DHCA)); and iii) CPB-L (CPB with DHCA
followed by 3hrs extra-perfusion). CPB-induced inflammatory/oxidative
stresses were amplified in extra-perfusion. MSCs (1x107/kg) or saline were
administered through CPB. Microglial number/activation were measured by
immunohistochemistry. Multiplex assays determined circulating
cytokines/chemokines. Result(s): The numbers of microglia and
activated microglia after CPB were significantly increased compared to
control (P<0.001). Extended CPB period further increased the number and
activation of white matter microglia (P<0.05). Notably, MSC delivery via
CPB normalized the extensive microglia expansion/ activation resulting
from prolonged CPB (P<0.001). In addition to reduced IFN-g and increased
IL-10, MSC treatment increased IL-1b and IL-8, suggestive of a tumor-like
environment resulting from CPB. While there was a positive correlation
between IFN-g and microglia expansion/activation, IL-10 was inversely
correlated with the numbers. Consistent with immunosuppressive roles in
the tumor environment, we found inverse Spearman correlations between
IL-1b and IL-8 versus CPBinduced microglia activation (P<0.01).
 Conclusion(s): MSC administration via CPB have the potential to
improve extensive inflammatory stress in infants undergoing cardiac
surgery. Further investigation is needed to assess mechanistic insights of
MSC's anti-inflammatory responses during CPB.

<71>
Accession Number
645623773
Title
Expanding robotic congenital cardiac surgery practice worldwide: a
systematic review.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S583), 2024. Date of Publication: May 2024.
Author
Lee M.; Amabile A.; Hameed I.; Antonios J.; Awad A.K.; Brackett A.; Krane
M.; Gruber P.J.; Geirsson A.
Institution
(Lee, Amabile, Hameed, Antonios, Awad, Brackett, Krane, Gruber, Geirsson)
Yale School of Medicine, New Haven, CT, United States
Publisher
Cambridge University Press
Abstract
Background: With increasing adoption of robotic technology to adult
cardiac surgery patients, improved surgeon experience and wider
utilization have been reported. However, interpreting trends in practices
offering robotic congenital surgery is more challenging. By performing a
systematic review, the authors aim to evaluate the currently available
literature on robotic congenital operations. Method(s): The protocol
was registered with PROSPERO. The inclusion and exclusion were established
based on the Population, Intervention, Comparison, and Outcome (PICO)
framework. A comprehensive literature search was conducted in electronic
databases from January 1998 to December 2021. Studies involving patients
undergoing congenital cardiac surgery operations performed with robotic
assistance were included. Two independent reviewers screened
titles/abstracts and then full-text of eligible studies. Discrepancies
were resolved by a third reviewer. The Newcastle Ottawa Scale was applied
to quantify quality assessment for non-randomized observational studies.
 Result(s): One hundred twenty-eight publications underwent fulltext
review and 66 studies were included. Overwhelmingly, the majority of
papers are from single-institutions, observational, and retrospective. The
population was mostly adults with only 10.6% (7/66) studies solely
reporting pediatric patients. About 50% were case reports (28/66). Most
studies were conducted in developed countries with the majority in the
U.S. (21/66). The most common robotic congenital diagnosis reported was
secundum atrial septal defect (31.8%). Interestingly, only 10 institutions
worldwide have published more than one paper. Conclusion(s): Through
this systematic review, we gain a better understanding of recent worldwide
trends, e.g., most common congenital lesions with utilization of the
robotic approach, complication rates, and analyze practice patterns. This
information will allow us to identify potential barriers to increased
application of this advanced technology to congenital cardiac surgery
patients.

<72>
Accession Number
645623659
Title
Hybrid strategy as an alternative to norwood surgery for hypoplastic left
heart syndrome: an updated systematic review and meta-analysis.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S541-S542), 2024. Date of Publication: May 2024.
Author
Montana-Jimenez L.P.; Mejia-Quinones V.; Pizarro A.B.; Gempeler A.
Institution
(Montana-Jimenez, Mejia-Quinones, Pizarro, Gempeler) Fundacion Valle del
Lili/ Universidad Icesi, Cali, Valle del Cauca, Colombia
Publisher
Cambridge University Press
Abstract
Background: The hybrid procedure (HP) emerged as an alternative for
palliation in patients with hypoplastic left heart syndrome (HLHS) with
high risk for the Norwood procedure (NP). Existing metanalyses showed
better outcomes for NP but did not consider differences in baseline risk
in study populations. Studies comparing the two should be synthesized
considering baseline confounding and other aspects that determine the
certainty of the evidence. Method(s): We performed a systematic
review that followed Cochrane guidelines and PRISMA recommendations
(PROSPERO registration CRD42021281510). We searched MEDLINE, EMBASE,
LILACS, and Central in October 2021 for randomized controlled trials and
observational studies comparing NS and HP for HLHS palliation. Outcomes of
interest were mortality (in-hospital, stage 1, late), 1-,3-, and 5-year
survival. ROBINS-1 tool was used to assess the risk of bias. We followed
the GRADE approach for rating the quality of evidence. Result(s): We
identified 444 articles; 55 were reviewed in full-text. 30 fulfilled
selection criteria and were included for quantitative (25 studies included
in metanalyses) or narrative synthesis (five studies). All were
observational studies. They had overall low risk of bias and metanalyses
had no inconsistency or imprecision, but their observational nature
determined moderate certainty on the results. Comparison of HP and NP for
hospital mortality (RR=1.19 [0.83-1.71], 8 studies, n=486), stage I
mortality (RR=0.97[0.78 - 1.22], 9 studies, n=1014 patients), late death
(RR=0.37 [0.11 - 1.28], 4 studies, n=205), 1-year survival (RR=0.99,
[0.92- 1.06], 17 studies, n=1828), 3-year survival (RR=1.00 [0.93- 1.09],
12 studies, n=1495) and 5-year survival (RR=0.96 [0.85- 1.08], 6 studies,
n=630) yielded estimates suggesting no clinically-important differences
between the two procedures. Conclusion(s): HP and NP may be
comparable for initial palliation in patients with HLHS regarding
intermediate and long-term survival. Certainty is limited by the
observational nature although low risk of bias and sufficient precision
suggests that clinically important differences in survival are unlikely.
Differences in secondary outcomes and additional advantages are to be
studied further as they are currently not reported by most of the studies.

<73>
Accession Number
645623633
Title
Qualitative quantification and evidence-based dosing regimen of fresh
frozen plasma during cardiopulmonary bypass in neonates and infants.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S624), 2024. Date of Publication: May 2024.
Author
Chinnappan I.
Institution
(Chinnappan) Johns Hopkins Children's Center, Baltimore, MD, United States
Publisher
Cambridge University Press
Abstract
Background: Cardiopulmonary Bypass (CPB) intervention alters fluid
dynamics in neonates and infants. Addition of Fresh Frozen Plasma (FFP) in
the prime and its usage during CPB is a traditional practice. It is
evident that there is a huge variation in our clinical practice regarding
FFP dosing in the prime and during CPB. Different preferences, opinions
and thoughts regarding the clinical relevance of FFP usage during CPB
impacts wide variation in clinical practice. The objective of this study
is to assess the required quantity of FFP in the prime and clinical
justification its usage for neonates and infants during CPB.
 Method(s): Protocolized information regarding FFP dosing in the prime
and during CPB in neonates and infants population were collected from 25
pediatric cardiac surgical facilities. Patients from 84% (21/25) of
participated facilities received FFP in the prime. The pro-coagulant and
anti-coagulant impact of FFP and its osmotic effect with reference to
priming volume and total circulating blood volume, Estimation of possible
increase in Fibrinogen and Antithrombin-III (AT-III) due to volume-dose
response of FFP addition, Quantification of supplemental dosing of FFP
during CPB and Isotonic FFP-Hypertonic albumin features were analyzed.
 Result(s): The empirical dosing of FFP in the prime does not have any
significant clinical benefit. Adding FFP in the prime and during CPB
probably helps to increase the circulating AT-III concentration. The
estimated volume-dose response of FFP addition have significant clinical
benefit to increase post-dilutional fibrinogen level. Both FFP and
hypertonic albumin has unique features and will not compensate each other.
Quantification of FFP dosing in the prime and during CPB is optional to
treat hypofibrinogenemia. Conclusion(s): Recommendations and
variations in our current CPB clinical practice of FFP dosing should have
scientific reasoning with evidence-based quantification. Further relevant
studies are required to estimate the dosage of FFP in the prime and to-use
or not-to use during CPB. FFP is not an alternative to maintain or to
integrate or to regulate colloid osmotic pressure (COP) during CPB in
neonates and infants. Estimation of FFP dosage is very crucial to treat
deficiency of coagulation factors and/or AT-III deficiency in neonates and
infants during CPB.

<74>
Accession Number
645623387
Title
Feeding recovery model post-surgery for infants with CHD.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S1427), 2024. Date of Publication: May 2024.
Author
Cooper B.M.; Preminger T.
Institution
(Cooper, Preminger) Children's Hospital of Philadelphia, Philadelphia, PA,
United States
Publisher
Cambridge University Press
Abstract
Background: Safe oral feeding is a particular challenge for infants born
with complex congenital heart disease. These infants are likely to require
tube assisted feeding at the initiation of enteral feeding and struggle to
transition to full oral feeding. However, there is no quantitative means
to measure adequate maturation of feeding skills that assess infant
feeding progress or recovery in infants who have undergone cardiac surgery
during the first month of life. The Neoneur Feeding System (Neoneur
LLC)*tracks feeding and respiratory patterns from the initiation of oral
feeding post-surgery. The purpose of this pilot study is to validate a
post-surgical feeding recovery model as a clinical useful tool for
clinical decision making Design and Methods: In this pilot study 25 full
term infants with complex congenital heart disease were recruited from the
Children's Hospital of Philadelphia in a non-randomized clinical trial All
infant underwent surgery during the first two weeks of life. Families were
approached for consent at the initiation of infant oral feeding. Infants
were fed with the Neoneur feeding system after clearance by the clinical
speech pathologist. The Neoneur feeding system was used during routine
feedings 2-3 times a week until discharge. Result(s): Of the 25
infants enrolled in the study. 56% of the infants were males, 60% white,
21% Black, 19% other. All but two infants were diagnosed prenatally. Forty
three percent of the infants had palliative surgery vs. 57% corrective
surgery. Post-surgical feeding was initiated with naso-gastric tube (NG)
placement. Thirty percent of the infants achieved full oral feeding before
discharge. For those infants who achieved full oral feeding during
hospitalization, feeding organization improved over days of measurement as
demonstrated in the feeding traces. Conclusion(s): The Neoneur
feeding system provides an objective measure of feeding progression of
infants transition from NG to oral feedings. Progression of oral feeding
can serve as an indicator of an infant's recovery status post-surgery.
Further investigation is needed to determine the role of this device in
augmenting oral feeding in this high-risk population.

<75>
Accession Number
645623160
Title
Ready, set, go: efficient launch of the multicenter titre trial of
indication-based transfusion of red blood cells in pediatric ecmo.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S1277), 2024. Date of Publication: May 2024.
Author
Sleeper L.A.; Alexander P.; Kelly D.P.; Bembea M.; Bellinger D.C.;
Sadhwani A.; Sun L.; Shrivastava M.; Boggs K.; Klein G.L.; Newburger J.W.;
Thiagarajan R.R.
Institution
(Sleeper, Alexander, Kelly, Bembea, Bellinger, Sadhwani, Sun, Shrivastava,
Boggs, Klein, Newburger, Thiagarajan) Boston Children's Hospital, Boston,
MA, United States
Publisher
Cambridge University Press
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) support for
critically ill children can be a life-saving therapy. RBC transfusion
during ECMO can improve oxygen delivery to tissues and manage bleeding;
however, it is associated with increased morbidity and mortality, and the
hemoglobin (Hb) level needed for optimal tissue oxygen delivery is
unknown, exposing ECMO patients to excess RBC volume. The TITRE Trial is
designed to determine whether indication-basedRBCtransfusion, compared
with RBC transfusion based on institutional-specific Hb thresholds can: 1)
reduce organ dysfunction by the time of decannulation, and 2) improve
1-year neurodevelopment in children receiving ECMO. Method(s):
Multicenter randomized trials (RCT) face numerous challenges that can
preclude a timely and successful launch. The challenges are even greater
in the setting of ECMO, a landscape characterized by heterogeneity in
standard of care (SOC) and patient care stakeholders from multiple
disciplines and specialties. We describe an integrated successful approach
to the timely launch of TITRE. Result(s): The pragmatic TITRE Trial
is comprised of over 18 North American sites. At the start of trial
development, we identified important challenges of equipoise and secular
changes in practice. Rapid changes in SOC towards an indication-based
transfusion strategy and adoption of lower Hb thresholds jeopardize the
separation of treatments necessary to test TITRE's hypothesis. The elusive
nature of equipoise and its threat to protocol compliance are further
compounded by the multiple ECMO delivery teams, i.e., cardiac,
medical/surgical, and neonatal intensive care programs. We implemented an
intensive team-building, communications and educational approach to ensure
trial launch and active enrollment in under 10 months, which will be
detailed along with TITRE cohort characteristics to date.
 Conclusion(s): Execution of a pragmatic multicenter RCT with SOC as
the comparator in pediatric ECMO presents unique challenges that we have
successfully addressed to launch the TITRE Trial. TITRE will have
important implications for optimal management of those supported with
ECMO.

<76>
Accession Number
645623142
Title
The impact of oral versus nasal intubation on feeding outcomes in neonates
requiring cardiac surgery.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S1360), 2024. Date of Publication: May 2024.
Author
Yildirim M.; Spaeder M.; Frank D.
Institution
(Yildirim, Spaeder, Frank) Cleveland Clinic Foundation, Cleveland, OH,
United States
Publisher
Cambridge University Press
Abstract
Background: Patients who require cardiac surgery in the neonatal period
frequently encounter difficulties reaching full volume oral feeds. These
difficulties are related to developmental features, perioperative events,
and post-operative oral aversion symptoms. Patients who struggle with oral
feeding require longer hospitalizations and frequently require feeding
tubes for stable nutrition at discharge. Method(s): This is a
single-center, prospective randomized control trial of patients less than
2 weeks of age who undergo endotracheal intubation at the time of cardiac
surgery. We exclude patients who were <37 weeks corrected gestational age
(GA) at surgery, had orofacial or gastrointestinal anomalies, required >5
days of intubation before surgery, or required ECMO or >5 minutes of CPR
at any time during the hospitalization. Patients are randomized to nasal
(NI) or oral intubation (OI). Result(s): 62 subjects were enrolled
(25 NI, 37 OI). NI failure occurred in three patients who are analyzed as
treated in the OI group. Clinical characteristics between the NI and OI
groups are similar: GA at birth (39 weeks vs 39 weeks, p = 0.04),
birthweight (3530 vs 3100 grams, p = 0.02), STAT score distribution (p =
0.50), systemic to pulmonary shunt placement (32% vs 41%, p = 0.50),
bypass time (181 vs 177 minutes, p = 0.77), and cross clamp time (111 vs
105 minutes, p = 0.79). With respect to feeding milestones, nasally
intubated infants more quickly progressed to NG tube removal (3 vs 6 days,
p = 0.02). 4% of subjects in the NI group and 22% in the OI group were
discharged with a feeding tube (p = 0.05). Postoperative (16 vs 20 days, p
= 0.13) and total hospital length of stay (22 vs 24 days, p = 0.19) were
similar in the two groups. Conclusion(s): In this cohort, nasally
intubated patients reach full oral feeds more quickly and are less likely
to require supplemental tube feeding at hospital discharge in comparison
to the orally intubated patients. This may be due to less oral aversion in
the nasally intubated group. The limitations of this study include the
relatively small sample size and single-center nature. In the future, a
large multi-center trial may be beneficial to establish recommendations
for intubation route in neonates requiring cardiac surgery.

<77>
Accession Number
645622800
Title
Relationship between triiodothyronine supplementation and clinical
outcomes among children undergoing cardiac surgery utilizing
cardiopulmonary bypass: a meta-analysis.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S559), 2024. Date of Publication: May 2024.
Author
Radman M.; Slee A.; Marwali E.M.; Portman M.
Institution
(Radman, Slee, Marwali, Portman) Seattle Children's Hospital, Seattle, WA,
United States
Publisher
Cambridge University Press
Abstract
Background: Multiple trials of triiodothyronine (T3) treatment in children
undergoing cardiopulmonary bypass (CPB) have suggested benefit. Larger,
well-powered pediatric studies of T3 treatment are lacking, making
meta-analysis useful to determine the effects of T3 repletion on clinical
outcomes. Method(s): Utilizing PRISMA guidelines, we performed a
systematic review and meta-analysis of randomized controlled trials (RCT)
evaluating the effects of T3 supplementation in children with congenital
heart disease ages 0-3 years undergoing CPB. We searched Medline for RCTs
published between 1/1/2000 and 1/31/2022. Time to extubation (TTE) was the
primary outcome. We calculated Hazard ratios (HR) and Kaplan-Meier curves
for TTE, time to ICU (TICU) and hospital (THOSP) discharge. PROSPERO no.
CRD42022324162. Result(s): 7/53 studies met inclusion criteria with
patient-level data available in 5; 2 in USA and 3 in Indonesia with 767
total subjects (range 29-220). Median (IQR) age 4.1 (1.6, 8.0) months;
female 43%; RACHS-1 scores: 1-1%; 2-55%; 3-27%; 4-13%; 5-0.1%; 6- 3.9%;
54% of subjects in US vs 46% in Indonesia. There was no significant
difference in TTE between the T3- vs. placebo-treated patients overall [HR
1.09 (CI, 0.94-1.26)]. TTE numerically favored T3-treated patients ages
1-5 months [HR 1.24 (CI, 0.97-1.60)] though not significant. There was no
treatment difference by age (<1 month, 1-5 months, >5 months) on TTE
(p=0.270). For patients in Indonesia, the TTE HR for the T3 group was 1.31
(CI, 1.04-1.65) vs. 0.95 (CI, 0.78-1.15) in the US. The TICU HR for the T3
group in Indonesia was 1.19 vs. 0.89 in the US (p=0.046). In Indonesia,
there was a significant effect of T3 on THOSP [HR 1.30 (CI, 1.01-1.67)]
but not in US [HR 0.99 (CI, 0.78-1.23)]. Conclusion(s): Though we
found no significant effect in the total combined US cohort, this simple
and inexpensive intervention has important impact on outcomes in
resource-limited settings, likely related to the differences in age,
nutritional status and accompanying morbidities between the US and
Indonesian cohorts. Furthermore, each individual study found no adverse
effects of T3 treatment supporting safety .

<78>
Accession Number
645622518
Title
Posterior annulus elevation technique in reducing residual regurgitation
during mitral valve repair in children.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S596), 2024. Date of Publication: May 2024.
Author
Rahmat B.
Institution
(Rahmat) National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia
Publisher
Cambridge University Press
Abstract
Background: The current technique used in severe mitral regurgitation in
children can occasionally lead to residual regurgitation. The posterior
annulus elevation technique was developed to enhance coaptation and reduce
residual lesions. This study aims to evaluate the effectiveness of the
posterior annulus elevation technique in reducing residual regurgitation
during mitral valve repair in children. Method(s): A randomized
controlled trial was conducted at NCCHarapan Kita, Indonesia, July 2020 -
June 2022. Pediatric mitral regurgitation patients aged 1 day to 18 years
undergoing mitral valve repair surgery were included. They divided into
two groups: the intervention group, which received the posterior annulus
elevation technique, and the control group. Various parameters, including
coaptation area, residual mitral regurgitation, clinical outcomes, and
metabolic markers, were measured on day 0, 5, 2 weeks and 3 months after
surgery. A bivariate analysis using independent Student's
t-test/Mann-Whitney test was done for numerical data and Chi-square for
nominal data. Repeated-measures Anova was done to compare the difference
of coaptation length and index on each time of evaluation. Result(s):
The study included 64 subjects with a mean age of 12.32 +/- 4.1 years. The
intervention group showed a significant reduction in residual mitral
regurgitation compared to the control group consistently at postoperative
evaluation times. At 3 months after surgery, we found that the use of this
technique could be a protective factor that reduce the chance of residual
regurgitation compared to control (RR= 0,31; CI: 0,18 - 0,54; p = <0.001).
Coaptation length and index were also found to be significantly higher in
the intervention group (p = <0.001). Clinical outcomes, metabolic markers,
and hemolysis marker did not show any significant differences between the
two groups. Conclusion(s): The posterior annulus elevation technique
(Buram Stitch) demonstrated effectiveness in reducing residual mitral
regurgitation and improving coaptation area in pediatric mitral valve
repair. This technique shows potential for improving the long-term
surgical outcomes in children with mitral regurgitation.

<79>
Accession Number
645622327
Title
Tricuspid valve repair can restore the prognosis of patients with
hypoplastic left heart syndrome and tricuspid valve regurgitation: a
meta-analysis.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S594-S595), 2024. Date of Publication: May 2024.
Author
Ponzoni M.; Azzolina D.; Vedovelli L.; Gregori D.; Vida V.; Padalino M.
Institution
(Ponzoni, Azzolina, Vedovelli, Gregori, Vida, Padalino) University of
Padua, Padua, Italy
Publisher
Cambridge University Press
Abstract
Background: To date, evidence supporting the efficacy of tricuspid valve
(TV) repair in interrupting the progression of systemic right ventricular
(RV) adverse remodeling in hypoplastic left heart syndrome (HLHS) is
unclear. We performed a systematic review and meta-analysis of scientific
literature to assess the impact of TV repair in effectively modifying the
prognosis of HLHS patients. Method(s): We conducted a systematic
review of PubMed, Web of Science, and Scopus databases. A random-effect
meta-analysis was performed and transplant-free survival, freedom from TV
regurgitation, and TV reoperation data were reconstructed from published
Kaplan-Meier curves. Result(s): Nine studies were included, for a
total of 203 HLHS patients undergoing TV repair and 323 HLHS controls.
Pooled transplant-free survival at 1, 5, and 10 years of follow-up was
75.5%[67.6-84.3%], 63.6%[54.6-73.9%], and 61.9%[52.7- 72.6%],
respectively, and it was comparable to HLHS peers without TV regurgitation
(p=0.59, Figure). Five-year freedom from TV regurgitation recurrence and
freedom from TV reoperation was 57%[46.7-69.7%] and 63.6% [54.5-74.3%],
respectively (Figure). Younger age and TV repair at the time of Norwood
operation increased the risk of TV regurgitation recurrence and TV
reoperation. Conclusion(s): Our meta-analysis supports the efficacy
of TV repair in modifying favorably the prognosis of patients with HLHS
and TV regurgitation, reestablishing a survival which is comparable to
HLHS peers. However, durability of surgery and long-term fate of TV and RV
performance are still unclear.

<80>
Accession Number
645622247
Title
The effects of medication strategies on cardiovascular outcomes in
patients with marfan syndrome: a consistency model analysis.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S1129-S1130), 2024. Date of Publication: May 2024.
Author
Chiu H.-H.; Kang Y.-N.; Huang S.-H.; Lin C.-Y.; Wu M.-H.
Institution
(Chiu, Kang, Huang, Lin, Wu) Taipei Tzu Chi Hospital, Buddhist Tzu Chi
Medical Foundation, New Taipei City, Taiwan (Republic of China)
Publisher
Cambridge University Press
Abstract
Background: Drug options for the treatment of Marfan syndrome (MFS) still
warrant further investigation. Beta-blockers (BB) have long been
considered the standard treatment, though several medications other than
BB and angiotensin receptor blockers (ARB) have entered clinical practice
and trials. However, no synthesis gathers evidence on medications other
than BB or ARB. Therefore, this study aimed to investigate the effects and
safety of medication strategies in managing MFS by synthesizing relevant
randomized controlled trials (RCT). Method(s): Three databases were
searched for potential evidence using relevant keywords in both free-text
and medical subject headings. Outcomes of interests were aortic root
growth, aortic root Z score, aortic surgery, moderate-to-severe adverse
events, cardiovascular and all-cause mortality. Quantitative data were
pooled using frequentist-approach network meta-analysis in random-effects
model. Result(s): Sixteen reports derived from 13 RCTs contributed to
a seven-node consistency model including no treatment, BB, ARB, ARB+BB,
calcium channel blockers (CCB), angiotensin converting enzyme inhibitor
(ACEI), and combination of BB and renin inhibitor (RI). As compared with
no treatment, RI +BB showed significant protection of aortic root growth
(standardized mean difference [SMD]= -1.90, 95% confidence interval [CI]:
-2.91, -0.89), followed by ARB+BB (SMD= -1.75, 95%CI: -2.40, -1.10).
Nevertheless, no significant findings were seen in other clinical
outcomes. Conclusion(s): RI or ARB added on BB appear to be the
optimal medication strategies to slow the progression of aortic root
growth in MFS patients. However, we found no statistically significant
difference in the risk of aortic surgeries, adverse effects,
cardiovascular and all-cause mortality among medications. More RCTs with
longer follow-up periods or bigger populations are needed to draw stronger
evidence for clinical practices.

<81>
Accession Number
645622207
Title
Impact of perfusion modalities on cerebral hemodynamics, organ injury, and
clinical outcomes in acyanotic and cyanotic congenital heart surgery
Patients.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S532), 2024. Date of Publication: May 2024.
Author
Undar A.; Patel K.; Lin T.; Clark J.; Ceneviva G.; Imundo J.; Spear D.;
Kunselman A.; Thomas N.; Myers J.
Institution
(Undar, Patel, Lin, Clark, Ceneviva, Imundo, Spear, Kunselman, Thomas,
Myers) Penn State College of Medicine, Hershey, PA, United States
Publisher
Cambridge University Press
Abstract
Background: Acyanotic and cyanotic congenital heart disease (CHD) patients
are known to have distinct operative risk profiles. However, little is
known about whether pulsatile and non-pulsatile cardiopulmonary bypass
(CPB) have differential effects on cerebral hemodynamics or outcomes in
these two patient groups. Method(s): 159 pediatric cardiac surgery
patients were randomized to pulsatile or non-pulsatile CPB. Patients were
stratified by type of CHD: acyanotic versus cyanotic. Postoperative organ
injury was quantified by Pediatric-Logistic-Organ-Dysfunction (PELOD-2)
score at 24, 48, and 72 hours. Additional outcomes included Pediatric
Risk-of-Mortality 3 (PRISM 3) score, vasoactive-inotropic score, duration
of mechanical ventilation, intensive care and hospital length-of-stay, and
mortality within 180 days. Result(s): Pulsatility index at the right
middle cerebral artery was consistently higher in the pulsatile group for
both acyanotic and cyanotic patients at all aortic cross-clamping time
points (Figure 1A). Regional-cerebral-oxygen-saturation (Figure 1B),
gaseous microemboli counts, mean arterial pressure, and CPB
characteristics were similar between groups. PELOD-2 scores decreased over
time, with similar scores between perfusion modalities in either group
(Figure 1C). Analysis of additional postoperative outcomes revealed no
significant differences between non-pulsatile and pulsatile perfusion in
either acyanotic or cyanotic groups. Conclusion(s): Despite patients
undergoing pulsatile CBP demonstrating a more physiologic pulsatility
index in both acyanotic and cyanotic groups, no clinically significant
differences in cerebral hemodynamics or clinical outcomes were
appreciated.

<82>
Accession Number
645622142
Title
Childhood opportunity index and exercise capacity, endothelial function,
muscle mass and strength in pediatric fontan patients.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S1028-S1029), 2024. Date of Publication: May 2024.
Author
Lui M.; Bernstein D.; Palaniappan L.; Leonard M.; Long J.; Desai M.;
Davila T.; Cooke J.P.; Olson I.; Chen S.; Myers J.; Chih-Wang H.J.; Kameny
R.J.; Tierney S.
Institution
(Lui, Bernstein, Palaniappan, Leonard, Long, Desai, Davila, Cooke, Olson,
Chen, Myers, Chih-Wang, Kameny, Tierney) Stanford University, Palo Alto,
CA, United States
Publisher
Cambridge University Press
Abstract
Background: 50% of Fontan patients will have died or undergone heart
transplantation by age 40. Little is known of how environmental factors
influence disease progression. Here, we present baseline data of pediatric
Fontan patients prior to entering an exercise intervention (RE-ENERGIZE
FONTAN) and how their health measures relate to their Child Opportunity
Index (COI) score, a new composite index that captures neighborhood
resources and conditions that might impact children's health.
 Method(s): This randomized controlled trial in Fontan patients
utilizes live-video conferencing to deliver a supervised exercise
intervention. We include patients 8-19 years of age with exercise
clearance and exclude patients with NYHA Class IV, recent acute illness,
active protein losing enteropathy, pacemaker, and/or cognitive delay. At
baseline, patients undergo a cardiopulmonary exercise test (peak VO2),
endothelial pulse amplitude testing (reactive hyperemia index, RHI), blood
work (NOx), DXA scan (muscle mass), and isokinetic dynamometry (handgrip
and leg strength). COI scores are determined based on their residential
zip codes. Result(s): 86 Fontan patients (median age 13.1 years; IQR,
10.6, 15.6) completed the baseline visit. Median time from Fontan
operation was 9.2 years [IQR, 7.0, 12.0]. 40 (47%) had a single right
ventricle. Percent predicted peak VO2 was 68.1+/-16.4 and indexed peak VO2
was 27.9+/-6.71 mL/kg/min. RHI and lnRHI were 1.42+/-0.51 and 0.31+/-0.32,
respectively. NOx level was 16.1+/-5.81 umol/L. Leg lean mass z-score was
-0.90+/-1.4. Lean handgrip strength was 18.0 +/-7.90 kg. Leg strength
extension and flexion were 54.9 +/-32.2 and 25.8+/-14.9 ft/lbs,
respectively. Median COI score was 71.5 [IQR, 40.0, 88.0] with 9 patients
classified as very low (0-20), 14 low (20-40), 13 moderate (40-60), 21
high (60-80), 29 very high (80-100). Indexed peak VO2 was lower in very
low vs. very high COI group (23.1 vs. 30.0 mL/kg/min, p=0.05).
 Conclusion(s): In this cohort of pediatric Fontan patients, patients
with low COI scores had worse exercise capacity compared to patients with
higher COI scores. Our exercise intervention is designed to demonstrate
the impact of aerobic activity and strength training and will be able to
provide further information if the impact of the intervention will differ
among patients with different opportunities.

<83>
Accession Number
645622050
Title
Effect of home-based physical training in patients with congenital heart
disease: partial results of a randomized controlled clinical trial.
Source
Cardiology in the Young. Conference: 8th World Congress of Pediatric
Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States.
34(Supplement 1) (pp S1126), 2024. Date of Publication: May 2024.
Author
Agostinho D.R.; Turquetto A.L.L.R.; Oliveira P.A.; Tanaka A.C.; Jatene
M.B.
Institution
(Agostinho, Turquetto, Oliveira, Tanaka, Jatene) Heart Institute, Sao
Paulo, Brazil
Publisher
Cambridge University Press
Abstract
Background: Congenital heart disease (CHD) patients who had cardiac
surgery are aging and at higher risk of metabolic diseases like
overweight, obesity, and sedentary lifestyles. This study aimed to assess
the impact of home-based physical training on functional capacity, body
composition, and metabolic markers in CHD patients. Method(s): In a
randomized controlled trial, 16 adults with CHD were divided into physical
training (TG) and control (CG) groups. Assessments included
cardiopulmonary exercise tests, bioimpedance analysis, metabolic
laboratory tests, and venous occlusion plethysmography. TG underwent
home-based physical training four times a week for 45 minutes, including
aerobic and strength exercises. CG maintained regular activities. After
three months, both groups were evaluated. Result(s): No significant
differences were observed between the groups in terms of gender, age, BMI,
and left ventricular function. Table 1 presents the data collected before
and after the three-month period for both groups Conclusion(s):
Home-based physical training improves functional capacity, body
composition, and metabolic parameters, leading to a better quality of life
for CHD patient. (Figure Presented).

<84>
Accession Number
643013871
Title
Intravenous infusion of potassium/magnesium solution for the treatment of
postoperative atrial fibrillation after coronary artery bypass graft: a
randomized, double-blinded, parallel controlled trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Masoudkabir F.; Mohammadi Z.; Jameie M.; Jalali A.; Salarifar M.; Bagheri
J.; Mansourian S.; Ahmadi Tafti H.
Institution
(Masoudkabir, Mohammadi, Jameie, Jalali, Salarifar, Bagheri, Mansourian,
Ahmadi Tafti) Cardiovascular Diseases Research Institute, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Oxford University Press
Abstract
Background: Postoperative atrial fibrillation (POAF) afflicts 18% of
patients following coronary artery bypass graft (CABG), increasing the
risk of cerebrovascular events and all-cause mortality by more than three
folds. POAF prevention and treatment have remained challenging. Correcting
the hydroelectric imbalance before initiating antiarrhythmics (especially
potassium and magnesium) is imperative for POAF prevention and management.
Nevertheless, the implications of electrolyte infusion among patients with
normal electrolyte levels have remained debatable. Method(s): This
randomized, double-arm, double-blind, and parallel clinical trial assessed
all patients who developed POAF following isolated CABG for eligibility.
Patients were included according to inclusion and exclusion criteria
(Figure 1). Permuted block stratified randomization (1:1 ratio) was
adopted for randomization. The intervention group received oral metoprolol
47.5 mg combined with the infusion of 10cc potassium (15%) and 4cc
magnesium sulfate (50%) diluted in 250cc half-saline serum during 60
minutes. The control group received oral metoprolol 47.5 mg (the standard
treatment) and 250 cc half-saline infusion as the placebo. Hemodynamic
status and cardiac rhythm were monitored continuously following treatment.
Those whose POAF persisted for 6 hours after treatment were administered
intravenous amiodarone according to guideline-adherent protocols. Primary
outcomes were AF persistence (during the first six hours) and AF
recurrence (during 48 hours after cardioversion). Intention-to-treat (ITT)
analysis was used to assess the intervention effects. Secondary outcomes
included time to cardioversion (in the first six hours), rate control
achievement (rate<110 beats/min achieved in the first three hours), and
time to cardioversion after amiodarone administration. Result(s):
Seventy-two patients were enrolled in the study, with 38 (65.05+/-7.65
years, 73.7% men) in the intervention and 34 patients (65.24 +/-7.35
years, 67.6% men) in the control group. The two groups were comparable
regarding demographics, medical history, electrolyte levels, and intra-
and postoperative characteristics. In the intervention and control groups,
16 (42.1%) and 16 (47.1%) patients had AF persistence, respectively
(P-value:0.67). Respective figures for AF recurrence were 10 (26.3%) and
13 (38.2%) patients (P-value: 0.28). ITT analysis indicated that
potassium/magnesium infusion did not significantly reduce AF persistence
(relative-risk (RR): 0.89, 95% confidence interval (CI): 0.53-1.49) or AF
recurrence (RR: 0.68, 95%CI: 0.35-1.36). Likewise, secondary outcomes did
not differ significantly between the intervention and control groups (all
Ps>0.2) (Figure 1). Conclusion(s): Among patients with normal
electrolyte levels, potassium and magnesium infusion did not reduce the
risk of AF persistence or recurrence compared to the standard treatment
(beta blockers).

<85>
Accession Number
643013130
Title
Heart failure after left atrial appendage occlusion: insights from the
LAAOS-III randomized trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Krisai P.; Belley-Cote E.P.; Mcintyre W.F.; Tsiplova K.; Paparella D.;
Whitlock R.P.; Healey J.S.
Institution
(Krisai) University Hospital Basel, Basel, Switzerland
(Belley-Cote, Mcintyre, Tsiplova, Whitlock, Healey) Population Health
Research Institute, Hamilton, Canada
(Paparella) University of Foggia, Foggia, Italy
Publisher
Oxford University Press
Abstract
Background: Left atrial appendage removal or occlusion (LAAO) might
increase the risk for heart failure (HF) due to the loss of the LAA's
reservoir function, active contraction and neuroendocrine function.
 Purpose(s): To investigate the incidence of HF hospitalizations
and/or HF related death after LAAO in the Left Atrial Appendage Occlusion
Study (LAAOS III). Method(s): In LAAOS III, 4811 patients with atrial
fibrillation (AF) and a CHA2DS2-VASc score >=2 were randomized to undergo
or not undergo surgical LAAO during cardiac surgery for another
indication. We compared the incidence of a composite endpoint of HF
hospitalizations and HF related death between the two randomized groups
(LAAO vs no-LAAO). We also pre-specified subgroups including: sex, age,
BMI, surgery type, concomitant AF ablation, prior history of HF, history
of hypertension, diabetes, prior myocardial infarction, left ventricular
ejection fraction, sinus rhythm and occlusion method. Result(s): We
included 2379 patients in the LAAO and 2391 patients in the no-LAAO group.
Overall, mean age was 71 years, 67% were male and 57% had prior HF.
Baseline characteristics including drug treatment were balanced between
the groups. Over a mean follow-up of 3.8 years, 395 (8.3%) patients met
the primary HF endpoint: 209 (8.8%) in the LAAO group and 186 (7.8%) in
the no-LAAO group. We did not find a significant difference for the
primary endpoint between the randomized groups (Hazard ratio [95%
confidence intervals] 1.13 [0.93-1.37], p=0.233) (Figure). The only
significant subgroup interaction was for concomitant AF ablation (p for
interaction = 0.004). Patients in the LAAO group without concomitant AF
ablation had a higher risk for the primary endpoint (HR [95% CI] 1.37
[1.08-1.74], p=0.009) than patients with ablation (HR [95% CI] 0.74
[0.51-1.06], p=0.097). Conclusion(s): LAAO did not increase the risk
for a combined endpoint of HF hospitalizations and HF related death in
patients with AF. Patients with concomitant AF ablation might have lower
risk for the combined endpoint.

<86>
Accession Number
643013042
Title
Right ventricular dysfunction after coronary artery bypass grafting.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Weiss T.; Jensen J.K.; Vase H.O.; James S.; Thelin S.; Modrau I.S.
Institution
(Weiss, Modrau) Aarhus University Hospital, Department of Cardiothoracic
and Vascular Surgery, Aarhus, Denmark
(Jensen, Vase) Aarhus University Hospital, Department of Cardiology,
Aarhus, Denmark
(James, Thelin) Uppsala Clinical Research Center, Uppsala, Sweden
Publisher
Oxford University Press
Abstract
Background: Impaired right ventricular (RV) function is a frequent
echocardiographic finding following coronary artery bypass grafting
(CABG). It is subject of debate whether this finding reflects actual RV
dysfunction with clinical impact, or rather limitations of the applied
echocardiographic measurements. Purpose(s): We aimed to investigate
prevalence of RV dysfunction using currently available echocardiographic
measurements, and self-reported physical capacity more than two years
after CABG. Material(s) and Method(s): This pre-specified
cross-sectional substudy of the SWEDEGRAFT trial included patients
scheduled for follow-up more than two years after elective CABG at our
institution. The SWEDEGRAFT trial is an ongoing multicenter, randomized
clinical trial comparing patency of saphenous vein grafts harvested with
'no-touch' and open skeletonized technique. We prospectively assessed RV
function with multivariable transthoracic echocardiography. Self-reported
physical capacity was assessed using the three items for physical
limitation of the Seattle Angina Questionnaire (SAQ-7) (3 denotes the
worst and 15 the best possible physical capacity), as well as NYHA-class.
Baseline and procedural data were retrieved from the SWEDEGRAFT trial.
Preoperative echocardiographies were systematically reexamined.
 Result(s): We enrolled 207 patients into our substudy at a median
follow-up after CABG of 31.0 (range 24.2-39.9) months. RV function
assessed by tricuspid annular plane systolic excursion (TAPSE) was
significantly reduced compared to the preoperative assessment. In
contrast, postoperative RV function as assessed by RV fractional area
change (FAC) was preserved. Similarly, assessment of three-dimensional RV
ejection fraction (3D-RVEF) indicated preserved RV function (mean 49.4 +/-
6.3 %). Mean RV global longitudinal strain was -19.7 (+/-3.6), and mean RV
free wall strain was -22.7 (+/-4.9). At follow-up, assessments of 3D-RVEF
and strain modalities were obtainable in 51.7% and 72.4% of patients,
respectively. Patient-reported functional capacity was excellent (median
score 15, interquartile range 1.5). NYHA-class improved significantly
(NYHA-class I preoperative 49.4% vs. postoperative 61.4%, p=0.032).
Postoperative median pro-Brain Natiuretic Peptide levels were 163
(interquartile range 195) ng/L. Conclusion(s): RV systolic function
was preserved more than two years after CABG when assessed by RV FAC and
3D-RVEF despite significant reduction in TAPSE. These findings likely
reflect the increased sphericity of the RV following opening the
pericardium during surgery. Our study supports that measurements of
longitudinal systolic parameters likely underestimate RV systolic function
after CABG.

<87>
Accession Number
643013006
Title
Association of late-gadolinium enhancement on cardiac magnetic resonance
with cardiovascular outcomes and mortality in patients with aortic
stenosis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Tao M.; Moussa S.; Sheng S.; Dhaliwal S.; Tam E.; Goldschmidt M.; Mann N.
Institution
(Tao, Moussa, Sheng, Dhaliwal, Tam, Goldschmidt, Mann) Stony Brook
University Hospital, Stony Brook, United States
Publisher
Oxford University Press
Abstract
Background: Late-gadolinium enhancement (LGE) on cardiac magnetic
resonance has been associated with increased risk of adverse events in
various clinical settings. This association in patients with aortic
stenosis is not well established. Purpose(s): This meta-analysis
assessed the association between LGE on CMR with all-cause moratlity,
cardiovascular (CV) mortality, and major adverse cardiovascular events
(MACE) in patients with aortic stenosis. Method(s): A literature
search was conducted for studies reporting the association between LGE in
aortic stenosis and the primary endpoint of all-cause mortality. Secondary
endpoints included CV mortality and MACE. The search included the
following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google
Scholar. The search was not restricted to time or publication status. The
minimum duration of follow-up was 12 months. Result(s): A total of 11
studies and 2527 patients (1279 with LGE vs 1248 without LGE) were
included; mean follow up was 30 months (ranging between 12 to 52 months).
LGE is associated with increased risk of all-cause mortality on long-term
follow-up (odds ratio 2.87, 95% confidence interval 2.03-4.04; P<0.01).
Heterogeneity was low-moderate: Chi2= 12.28, df8, I2 =35%. Subgroup
analysis of only patients who underwent aortic valve replacement
demonstrated that LGE is associated with increased risk of all-cause
mortality on long-term follow-up (OR 2.49, 95% CI 1.94-3.20; P<0.01). For
secondary endpoints, LGE was not associated with a statistically
significant increase in risk of CV mortality or MACE, however there is a
trend toward increased risk (OR 2.43, 95% CI 0.95-6.23; P = 0.06; OR 2.33,
95% CI 0.86-6.28; P=0.09). Conclusion(s): Our results suggest that
LGE is associated with increased risk of all-cause mortality in patients
with aortic stenosis regardless of whether aortic valve replacement is
performed. LGE was not associated with a statistically significant
increased risk of CV mortality or MACE, however additional high quality
prospective studies are needed to further evaluate these endpoints.

<88>
Accession Number
643012924
Title
Effectiveness and safety of bempedoic acid in routine clinical practice:
1-year follow-up snapshot of the MILOS German cohort.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Gouni-Berthold I.; Koskinas K.; Averna M.; Stulnig T.; Vanassche T.;
Blackburn C.; Smolnik R.; Soronen J.; Wenz-Poschl K.; Pinto X.; Parhofer
K.
Institution
(Gouni-Berthold) University of Cologne, Faculty of Medicine, University
Hospital Cologne, Cologne, Germany
(Koskinas) Bern University Hospital, Bern, Switzerland
(Averna) University of Palermo, Department of Health Promotion, Mother and
Child Care, Internal Medicine and Medical Specialties, Palermo, Italy
(Stulnig) Hietzing Hospital, Department of Medicine III, Karl Landsteiner
Institute for Metabolic Diseases and Nephrology, Vienna, Austria
(Vanassche) University Hospitals Leuven, Department of Cardiovascular
Medicine, Leuven, Belgium
(Blackburn, Smolnik, Soronen, Wenz-Poschl) Daiichi Sankyo Europe GmbH,
Munich, Germany
(Pinto) Hospital Universitari de Bellvitge-Idibell-UB-CiberObn, Department
of Internal Medicine, Barcelona, Spain
(Parhofer) Ludwig-Maximilians University, LMU-Klinikum Medical Department
4 - Grosshadern, Munich, Germany
Publisher
Oxford University Press
Abstract
Background: Low-density lipoprotein cholesterol (LDL-C) has an established
role in the development of atherosclerotic cardiovascular disease. The
2019 ESC/EAS dyslipidaemia guidelines recommended more intensive treatment
goals, however, many patients do not reach them. Bempedoic acid (BA) is a
first-in-class ATP citrate lyase inhibitor that lowers LDL-C levels. There
is limited data on the use of BA and BA + ezetimibe (EZE) fixed-dose
combination (FDC) in clinical practice. Purpose(s): The purpose of
this snapshot of 1-year follow-up data from the MILOS study is to evaluate
the effectiveness and safety of BA and its FDC in routine clinical
practice in Germany. Method(s): MILOS is a European, prospective,
observational, non-interventional study in adult patients with primary
hypercholesterolaemia or mixed dyslipidaemia. Patients were recruited from
126 sites in Germany between January 2021 and January 2022, and are
followed up for 1-2 years after baseline measurements. Here, we summarise
1-year follow-up data from a snapshot taken on January 13th, 2023.
 Result(s): Of 992 patients enrolled in Germany, 714 had either
completed their 1-year follow-up or discontinued the study prematurely,
and 524 of these 714 patients attended their 1-year follow-up visit. For
this snapshot, 714 patients are used when determining cardiovascular (CV)
outcomes and safety endpoints, and 524 patients are used when reporting
efficacy data. The overall mean (SD) age of the population (n=524) was
64.7 (10.0) years, and 60.7% were male. Patients treated with BA/BA+EZE
FDC had an overall mean LDL-C level of 2.18 mmol/L (84.1 mg/dL) at 1 year
compared with 3.20 mmol/L (123.6 mg/dL) pre-treatment, representing a mean
relative LDL-C reduction of 27.3%. Overall, 25.8% (135/524) of patients
had reached their LDL-C goal after 1 year of treatment compared with 4.0%
(21/524) pre-treatment (Figure 1A and 1B). The overall incidence rate of
the composite endpoint of major adverse cardiovascular event (4-component
MACE) including CV death, non-fatal myocardial infarction, non-fatal
stroke, and coronary revascularisation (n=714) was 3.36%. At 1-year
follow-up, 19% (136/714) of patients had an adverse drug reaction (ADR)
suspected to be related to BA/BA+EZE FDC, and 0.8% (6/714) had serious
ADRs, as deemed by the investigator. Conclusion(s): This snapshot
analysis of 1-year follow-up data suggests that the addition of BA to
other lipid-lowering therapies increases the proportion of patients at
LDL-C goal by ~6-fold in the observed cohort. The safety and tolerability
profile of bempedoic acid are in line with data from randomised controlled
trials.

<89>
Accession Number
643012793
Title
Longer-term impact of PCSK9 inhibitors on major adverse cardiovascular
events and all-cause mortality: a systematic review and meta-analysis of
randomised controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Grover J.; Yao W.X.; Amarasekera A.T.; Leung A.N.W.; Sekhar P.; Tan T.C.
Institution
(Grover, Yao, Leung, Sekhar, Tan) Blacktown Hospital, Sydney, Australia
(Amarasekera) University of Sydney, Westmead Heart Rhythm Institute,
Sydney, Australia
Publisher
Oxford University Press
Abstract
Background: The development of proprotein convertase subtilisin/kexin type
9 (PCSK9) inhibitors offers a novel treatment option for lowering
cardiovascular risk profiles through significant reductions in low-density
lipoprotein cholesterol. Whilst their effect on improving patients' lipid
profiles has been well-established in clinical trials, their impact on
major adverse cardiovascular events (MACE) and all-cause mortality in the
longer-term is of interest since PCSK9 inhibitors are becoming an
important addition to the current armament of lipid-lowering therapies.
 Purpose(s): This systematic review and meta-analysis seeks to
evaluate the longer-term effect (>= 12 months) of PCSK9 inhibitors on MACE
and all-cause mortality, compared to placebo, in patients with
dyslipidaemia or atherosclerotic cardiovascular disease. Method(s): A
systematic search of databases including PubMed, Ovid, and Cochrane
Central Register of Controlled Trials was conducted in accordance with the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines in January 2023. Two reviewers screened for phase 3
randomised-controlled trials (RCTs) comparing the anti-PCSK9 monoclonal
antibodies currently in use (alirocumab and evolocumab) to placebo in
adult patients. Trials were included if they had a follow-up of at least
12 months from initiation of treatment and reported on MACE or all-cause
mortality. Demographic data, clinical characteristics, MACE outcomes such
as rates of myocardial infarction, coronary revascularisation,
cardiovascular death, hospitalisation for heart failure, hospitalisation
for unstable angina, stroke and all-cause mortality outcomes were
extracted. A random effects model was used for meta-analysis with
dichotomous outcomes reported as odds ratio (OR), 95% confidence intervals
(CI) and I2 metric to assess heterogeneity. Result(s): The incidence
of myocardial infarction and coronary revascularisation was reported in
ten studies (encompassing 57,890 participants) out of the eleven RCTs that
met our inclusion criteria. Meta-analysis demonstrated statistically
significant reduction in myocardial infarction (OR -0.27, 95% CI -0.40 to
-0.15, p <0.01, I2 = 25.5%) and coronary revascularisation (OR -0.20, 95%
CI -0.28 to -0.11, p <0.01, I2 =12.4%) for patients on PCSK9 inhibitors
compared to placebo. Heterogeneity was considered moderate and low
respectively for these outcomes. No statistically significant effect was
observed for other MACE or all-cause mortality. Conclusion(s): The
results of this study suggest that PCSK9 inhibitors can significantly
reduce rates of myocardial infarction and coronary revascularisation in
patients over the long-term (>= 12 months). Further studies with
longer-term follow-up are needed to fully evaluate the impact of PCSK9
inhibitors across MACE outcomes, and to inform clinical decision-making.

<90>
Accession Number
643012076
Title
Long-term recurrence of new-onset post-operative AF in cardiac surgery
patients as detected by an implantable loop recorder: a systematic review
and individual participant data meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Kaur H.; Healey J.S.; Belley-Cote E.P.; Bidar E.; Kawczynski M.;
Ayala-Paredes F.A.; Ayala-Valani L.; Sandgren E.; El-Chami M.F.; Jorgensen
T.H.; Thyregod H.G.H.; Sabbag A.; Mcintyre W.F.
Institution
(Kaur, Healey, Belley-Cote, Mcintyre) Population Health Research
Institute, Hamilton, Canada
(Bidar, Kawczynski) Maastricht University Medical Centre (MUMC),
Maastricht, Netherlands
(Ayala-Paredes, Ayala-Valani) Sherbrooke University, Sherbrooke, Canada
(Sandgren) Karolinska Institutet Danderyd Hospital, Department of Clinical
Sciences, Stockholm, Sweden
(El-Chami) Emory University, School of Medicine, Department of Medicine,
Atlanta, United States
(Jorgensen, Thyregod) Copenhagen University Hospital, Department of
Cardiology, Copenhagen, Denmark
(Sabbag) Sheba Medical Center, Davidai Arrhythmia Center, Ramat Gan,
Israel
Publisher
Oxford University Press
Abstract
Introduction: New-onset atrial fibrillation (AF) occurs in 25-50% of
patients after cardiac surgery. For some patients, post-operative AF
(POAF) is thought to be a transient entity, while in others it represents
a first presentation of paroxysmal or persistent AF. The long-term rate of
AF recurrence in patients with POAF is not well defined.
 Objective(s): To estimate the recurrence of AF in patients who had
new-onset POAF following cardiac surgery as evaluated with an implantable
loop recorder (ILR). Method(s): We searched MEDLINE, Embase and
Cochrane CENTRAL to August 18, 2022 for studies of adult patients without
a history of AF, who had POAF detected following cardiac surgery and
received an ILR. We defined AF occurring in the first 30 days after
surgery as POAF. We defined AF occurring beyond 30 days after surgery as
AF recurrence. We contacted authors of eligible studies with a request to
contribute individual participant time-to-event data on AF recurrence and
participant demographics at the study level. When individual data were not
available, we estimated events from figures in published study records. We
constructed a Kaplan-Meier curve illustrating the time to first AF
recurrence, with 95% confidence intervals (CIs). Result(s): From 8111
screened records, we identified 8 eligible studies (Table 1). All studies
were single-centre cohorts from 7 countries including the United States of
America (2), Canada, Denmark, Israel, The Netherlands, Russia and Sweden.
Two studies defined AF recurrence as lasting 30 seconds, four defined AF
recurrence as lasting at least 2 minutes, one defined AF recurrence as
lasting at least 5 minutes and one defined AF recurrence as lasting at
least 6 minutes. We received data for 6 studies and estimated events for
one study; data were not available from one study. We pooled data from a
total of 186 participants, with a median follow-up of 1.7 (interquartile
range (IQR): 1.3 - 2.8) years. Overall, 19.7% of participants were female,
79.8% of participants had isolated CABG, and the median (IQR) CHA2DS2-VASc
was 3 (1 - 6). Rates of AF recurrence beginning after the 30-day
post-operative period were: 15.1% (95% CI 10.5% - 21.2%) at 3 months,
23.9% (95% CI 18.1% - 31.0%) at 6 months, 30.7% (95% CI 24.1% - 38.1%) at
12 months and 39.2% (95% CI 32.0% - 47.0%) at 18 months (Figure 1, wherein
the shaded area indicates the 95% CI). Conclusion(s): For patients
with new-onset POAF following cardiac surgery, AF recurrence, as detected
by an ILR, is common, with approximately 1 in 3 experiencing recurrence in
the first year after surgery. The optimal strategy for monitoring for AF
recurrence and its clinical sequelae in this population remains uncertain.

<91>
Accession Number
643012059
Title
Machine learning to predict myocardial injury and death after non-cardiac
surgery.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Nolde J.; Schlaich M.P.; Sessler D.I.; Mian A.; Corcoran T.B.; Chow C.K.;
Chan M.T.V.; Borges F.K.; Mcgillion M.H.; Myles P.S.; Mills N.L.;
Devereaux P.J.; Hillis G.S.
Institution
(Nolde) University of Western Australia, Perth, Australia
(Schlaich, Mian) University of Western Australia, School of Medicine,
Perth, Australia
(Sessler) Cleveland Clinic, Anesthesiology, Cleveland, United States
(Corcoran, Hillis) Royal Perth Hospital, Perth, Australia
(Chow) Westmead Hospital, Sydney, Australia
(Chan) Chinese University of Hong Kong, Hong Kong, Hong Kong
(Borges, Mcgillion, Devereaux) McMaster University, Hamilton, Canada
(Myles) Nil, Melbourne, Australia
(Mills) University of Edinburgh, Edinburgh, United Kingdom
Publisher
Oxford University Press
Abstract
Background/Introduction: Myocardial injury after non-cardiac surgery
(MINS) is defined as prognostically relevant myocardial injury due to
ischaemia that occurs within 30-days of non-cardiac surgery.
 Purpose(s): The aim of this study was to test whether machine
learning, using neural networks, can accurately predict this frequent and
important complication. Method(s): Using data from 24,589
participants in the Vascular Events in Noncardiac Surgery Patients Cohort
Evaluation (VISION) study, who had non-cardiac surgery and post-operative
high-sensitivity troponin T (hs-TnT) levels measured, a deep neural
network was trained to predict the primary outcome of MINS and the
secondary outcome of death within 30-days. Validation was performed on a
separate, randomly selected, subset of the study population with model
discrimination and accuracy (number of correct predictions) determined.
 Result(s): Using only data available pre-operatively, the deep neural
network predicted MINS with an area under the receiver operating
characteristic curve (AUROC) of 0.75 (95% confidence interval [95% CI]
0.74-0.76) and death at 30-days with an AUROC of 0.83 (95% CI 0.79-0.86).
Addition of basic intra-operative and early post-operative data increased
the AUROC for MINS to 0.77 (95% CI 0.76-0.78) and death to 0.87 (95% CI
0.85-0.90). The deep neural network trained on the full dataset
(pre-operative, intra-operative and early post-operative) predicted MINS
with an accuracy of 70% and death within 30-days with an accuracy of 89%.
 Conclusion(s): Neural networks can be trained to predict MINS and
death within 30-days of non-cardiac surgery and the inclusion of
intra-operative and early post-operative data improves predictive
accuracy. These techniques may be useful clinically to predict adverse
outcomes after non-cardiac surgery.

<92>
Accession Number
643011949
Title
Clinical presentation and cardiovascular risk factors in patients with
STEMI due to spontaneous coronary artery dissection (SCAD).
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Malleier S.; Troebs M.; Achenbach S.
Institution
(Malleier, Troebs, Achenbach) Friedrich Alexander University Erlangen
Nuernberg, Department of Cardiology, Erlangen, Germany
Publisher
Oxford University Press
Abstract
Background: Spontaneous coronary artery dissection (SCAD) may occur in the
absence of atherosclerotic and traumatic etiology and can lead to severe
clinical manifestations such as ST-segment elevation myocardial infarction
(STEMI). Compared to atherosclerotic STEMI, younger patients and females
are predominantly affected. Hence, underdiagnosis is an important concern.
We therefore systematically analyzed the prevalence of SCAD among a large
cohort of young patients presenting with STEMI, as well as risk factors
and presenting symptoms. Method(s): We retrospectively identified a
consecutive cohort of 631 patients younger than 55 years who underwent
coronary angiography due to STEMI between 01/2005 and 10/2022. Systematic
review of coronary angiograms allowed identification of all STEMI caused
by SCAD (n=20, 3.2%), including patients previously misdiagnosed as
atherosclerotic STEMI. By reviewing medical records, we identified
symptoms at presentation and cardiovascular risk factors in patients with
SCAD-STEMI. Result(s): Out of the 20 patients <55 years presenting
with SCAD-STEMI, 16 (80%) were female, and the mean age was 49.5 years. By
far the most common presentation was typical angina (75%, n=15), being
reported by all 4 male and 11/16 female patients (100% vs. 69%,
respectively). Importantly, three patients presented with cardiac arrest
due to malignant ventricular arrhythmia (15%). In 6 patients, symptoms
were mild and atypical (nausea/vomiting, n = 3, 15%; atypical chest pain,
n = 2, 10%; and diaphoresis, n = 1, 5%). There was no significant
difference of symptoms between men and women. 11 patients (55%) were
treated by primary PCI, none received emergency coronary artery bypass
grafting (CABG). The mean maximum serum creatin kinase (CK) level was 1410
U/l (range 139-86144 U/l). Mean left ventricular ejection fraction (LVEF)
was 50% (range 30-60%). Symptoms at presentation did not correlate with
maximum CK levels, nor with LVEF. In this caucasian cohort, the most
common cardiovascular risk factor was arterial hypertension (n = 12, 60%),
followed by smoking (n = 9, 45%). Six patients had hyperlipidemia (30%),
and three (15%) were obese. Diabetes and a positive family history for
cardiovascular events were rare (n = 2, 10% vs. n = 1, 5%, respectively).
 Conclusion(s): In this large caucasian cohort of young patients with
STEMI, SCAD accounted for 3.2 % of cases. Typical angina was the most
common symptom at presentation, but cardiac arrest due to ventricular
fibrillation was frequent. Symptoms in men and women were similar and did
not correlate with LVEF, nor with maximum CK levels.

<93>
Accession Number
643011650
Title
Baseline high sensitivity C-Reactive Protein predicts incident
cardiovascular events and all-cause mortality in the ASCOT Study at
20-years.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Hartley A.; Rostamian S.; Kaura A.; Chrysostomou P.; Welsh P.; Sattar N.;
Sever P.; Khamis R.
Institution
(Hartley, Rostamian, Kaura, Chrysostomou, Sever, Khamis) Imperial College
London, London, United Kingdom
(Welsh, Sattar) BHF Glasgow Cardiovascular Research Centre, Glasgow,
United Kingdom
Publisher
Oxford University Press
Abstract
Introduction: The prediction of future cardiovascular events in those at
greatest risk is essential to optimise preventative therapies
appropriately and effectively. The value of high sensitivity C-reactive
Protein (hsCRP) has been questioned in this regard, and recent studies
have suggested the utility of this widely assessed biomarker for
predicting future mortality in those presenting with suspected myocardial
infarction (MI), however the relationship in stable patients is still
debated. Purpose(s): To investigate the role of baseline hsCRP for
predicting long-term incident cardiovascular events in hypertensive
patients in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), with
follow-up extending to 20-years. Method(s): This ASCOT legacy study
reports events after 20-years of the UK participants in the original ASCOT
trial. ASCOT was a multicentre randomised trial, randomising patients with
hypertension into amlodipine-based or atenolol-based blood
pressure-lowering (BPL) treatment. In addition, those with total
cholesterol <6.5 mmol/L and no previous lipid-lowering treatment underwent
further randomisation to either atorvastatin or placebo as part of the
lipid-lowering (LL) arm of ASCOT. We examined outcomes related to hsCRP
levels in the LL arm, dichotomously (< or > 2mg/L), in tertiles or
continuously, adjusting in Model 1 (age, sex, socio-economic status [years
of education] and ethnicity) and Model 2 (Model 1 plus current smoker,
body mass index, baseline systolic blood pressure, creatinine, diabetes,
history of vascular diseases, history of antihypertensive medication and
allocation to BPL and LL). All-cause mortality, non-fatal and fatal MI,
total coronary events and procedures and total cardiovascular events were
assessed. Result(s): 5,294 participants were included in the final
cohort, after exclusion of 3,286 participants in the LL arm (n=8,580)
without hsCRP data. There were no substantial differences in baseline
characteristics between treatment allocation arms (non-randomised, placebo
or atorvastatin). The highest tertile of hsCRP (median [IQR], 6.41
[4.81-10.44]) strongly related to all-cause mortality, withstanding
adjustment in both Model 1 (HR 95% CI, 1.38 [1.27-1.53]; p<0.001; p<0.001
for interaction) and Model 2 (HR 1.25 [1.10-1.42]; p<0.001; p<0.001 for
interaction). Moreover, the highest hsCRP tertile also related to fatal
and non-fatal MI (Model 2 - HR 1.32 [1.05-1.67]; p=0.020; p=0.019 for
interaction); total coronary events and procedures (Model 2 - HR 1.27
[1.09-1.47]; p=0.002; p=0.003 for interaction); and total cardiovascular
events (Model 2 - HR 1.22 [1.08-1.37]; p=0.001; p=0.001 for interaction).
 Conclusion(s): This study demonstrates that one hsCRP reading at
baseline independently predicts cardiovascular events and all-cause
mortality at very long-term follow-up in patients at high-risk for these
events, and may help stratify patients into higher risk categories for
intensive preventative strategies.

<94>
Accession Number
643011634
Title
Direct oral anticoagulants versus vitamin k antagonists in patients with
atrial fibrillation and bioprosthesis: a systematic review and
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Guardia Martinez P.; Aviles Toscano A.L.; Martinez Mayoral M.A.; Molto
Miralles J.
Institution
(Guardia Martinez) Hospital Costa del Sol, Marbella, Spain
(Aviles Toscano) Hospital de la Serrania de Ronda, Ronda, Spain
(Martinez Mayoral, Molto Miralles) University Miguel Hernandez, Dpto.
Estadistica, Matematicas e Informatica, Elche, Spain
Publisher
Oxford University Press
Abstract
Background/Introduction: The large randomized clinical trials published to
date have shown that direct oral anticoagulants (DOACs) are as or more
effective than vitamin K antagonists (VKAs) in the prevention of
thromboembolic events in atrial fibrillation (AF) and generally show a
better bleeding risk profile. However, patients with bioprosthetic valves
have been underrepresented in RCTs. The aim of this study was to assess
the safety and efficacy of DOAC in patients with AF and bioprosthetic
valves through a systematic review and meta-analysis including recent
evidence from comparative cohort studies and real-world results.
 Method(s): A systematic review of the scientific literature and a
subsequent meta-analysis were carried out. We included RCTs or comparative
observational studies, published from January 2017 to January 2022
comparing DOACs versus vitamin K antagonists in patients with AF or atrial
flutter and bioprostheses. We collected data of all-cause mortality, major
bleeding, and systemic embolism. The primary outcome of interest was
all-cause mortality. Secondary outcomes were systemic embolism or stroke.
The primary safety outcome was major bleeding. Result(s): Our
analysis included 12 studies, 4 RCTs and 8 observational studies that
enrolled a total of 30.283 patients. All-cause mortality 6 observational
and 3 RCT were combined. A 9% reduction was found for all-cause mortality
in patients treated with DOACs (HR,0.91; P=.0068;95%CI,0.85-0.97;I2=8%).
Stroke and systemic embolism 4 RCT and 8 observational studies were
combined. No evidence showing a significant effect of DOAC therapy on risk
reduction for stroke and embolism was obtained (HR, 0.87; P =.29; 95%CI,
0.67-1.14; I2=45%). Major bleeding The results of the 12 studies were
combined. A robustness analysis was performed, and the ENVISAGE RCT was
identified as atypical. We therefore proceeded to re-run the meta-analysis
without this study's results. The overall effect size was HR, 0.79 (P =
.0001; 95%CI, 0.73-0.85; I2 = 0%), with a 21.1% reduction of major
bleeding with DOAC therapy compared with VKA. The present study has
several limitations. It has the inherent limitations of the studies
included and the combination of findings from comparative observational
cohort studies and ad hoc studies from RCTs, which entails a potential
source of bias. Second, individual risks for each type of bioprosthesis
were not studied. Finally, the four currently marketed DOACs were included
in our meta-analysis, but their efficacy and safety were not evaluated
separately. Conclusion(s): Our study found that DOAC therapy is
associated with a significant reduction of all-cause mortality with no
significant increase in the risk of systemic embolism or stroke. This
reduction could be attributed to a decrease in major bleeding. Our results
therefore suggest that DOACs could be a safer alternative than VKAs in
this group of patients.

<95>
Accession Number
643011527
Title
Association of liver dysfunction with outcomes after percutaneous coronary
intervention - a systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Caldonazo T.; Kirov H.; Pompeu Sa M.; Tasoudis P.; Shanaah A.; Haji D.;
Doenst T.
Institution
(Caldonazo, Kirov, Shanaah, Haji, Doenst) Friedrich-Schiller-Universitat,
Jena, Germany
(Pompeu Sa) Lankenau Heart Institute, Department of Cardiothoracic
Surgery, Wynnewood, United States
(Tasoudis) Surgery Working Group, Society of Junior Doctors, Athens,
Greece
Publisher
Oxford University Press
Abstract
Background: Liver dysfunction is currently receiving renewed attention as
a major risk factor in patients undergoing cardiac surgery, including
surgical treatment of coronary artery disease (CAD). Since percutaneous
coronary intervention (PCI) for CAD treatment is much less invasive, the
influence of liver dysfunction on outcomes after PCI may not be relevant.
 Purpose(s): To assess the association of liver dysfunction with PCI
outcomes. Method(s): We systematically searched three libraries
(MEDLINE, Web of Science and The Cochrane Library) selecting all studies
including patients with liver dysfunction who underwent PCI. A
meta-analysis of studies comparing outcomes in patients with and without
liver dysfunction who underwent PCI was performed. Primary outcome was
short-term mortality. Secondary outcomes were major adverse cardiovascular
events (MACE), bleeding and acute kidney injury. Random-effects model was
performed. Result(s): Five studies were selected and the data from
10,710,317 patients were included in the final analysis. Included studies
were published between 2015 and 2021, all were observational risk-adjusted
cohort studies, and two were national databases. In comparison with the
absence of liver dysfunction, patients with liver dysfunction were
associated with higher short-term mortality (OR, odds ratio: 2.97, 95% CI,
confidence interval: 1.23-7.18, p=0.02), higher MACE (OR 1.42, 95%CI
1.08-1.87, p=0.01), and higher bleeding rates (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 is a major risk factor in patients
undergoing PCI. It is independently associated with higher risk of
short-term mortality and also with an increased occurrence of MACE and
bleeding, without significantly affecting renal function.

<96>
Accession Number
643011342
Title
Cardiac rehabilitation reduces risk of overall mortality within 12 months
after a heart failure hospitalization: data linkage analysis of 9,023
patients in Australia.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Beleigoli A.; Gebremichael L.G.; Bulamu N.B.; Nesbitt K.; Ramos J.S.;
Foote J.; Clark R.A.
Institution
(Beleigoli, Gebremichael, Bulamu, Nesbitt, Ramos, Foote, Clark) Flinders
University, Adelaide, Australia
Publisher
Oxford University Press
Abstract
Background: Meta-analyses of randomized trials show that cardiac
rehabilitation (CR) prevents cardiovascular (CV) and heart failure
(HF)-specific hospitalizations. However, globally only 30-50% of eligible
patients participate in CR which might affect CR effectiveness.
 Purpose(s): To investigate CR utilization and clinical outcomes after
an admission for HF. Method(s): This is a retrospective cohort study
of patients >=18 years old discharged from public hospitals in South
Australia with a diagnosis of HF from 2016-2021. We linked the statewide
clinical CR database to hospital administrative and death databases to
assess CR utilization (non-attendance vs attendance without completion vs
completion of >= 70% of the sessions), the composite primary outcome (CV
re-admission or CV death within 12 months after the index hospitalization)
and the secondary outcome (all-cause death within 12 months after the
index hospitalization). To investigate factors associated with not
attending CR, we adjusted a logistic model by age, sex, Index of Relative
Socioeconomic Advantage and Disadvantage (IRSAD), remoteness; admission
during the COVID pandemic, acute myocardial infarction (MI), procedures,
arrhythmias, Charlson comorbidities index, history of diabetes,
hypertension, obesity, prior stroke, and peripheral vascular disease. To
investigate the association of the primary and secondary outcomes with CR
utilization, we adjusted Cox survival models by age; sex; IRSAD;
remoteness; ACS; revascularization, valve and implantable devices
procedures; AF; other arrhythmias; Charlson comorbidities index; history
of diabetes, hypertension, obesity, prior stroke and peripheral vascular
disease; remoteness. Result(s): Of the 9023 eligible separations
(52.0% male with mean age 77, SD 13.8 years), 8572 (95%) did not attend
CR. Among the 451 patients commencing CR, 352 (78.0%) completed it. CABG
(118; 1.3%), PCI (252; 2.8%), diabetes (3031; 33.6%), hypertension (1332;
14.8%) and MI (607; 6.7%) were common diagnoses. Women (OR1.62; 95%CI
1.31-2.02); and older age (OR1.03; 95%CI 1.02-1.04) were associated with a
higher risk of not attending CR. Within 12 months of the index
hospitalization, there were 4056 (45.0%) CV readmissions/CV deaths and
3486 (38.6%) deaths. After adjustment for demographic, clinical and social
factors, CR attendance without completion (p=0.60) or completion (p=0.43)
was not associated with CV readmission/CV death. The risk of all-cause
death was lower in the groups attending without completing (HR 0.57; 95%CI
0.36-0.91; p=0.02) and completing CR (HR 0.52; 95%CI 0.39-0.71; p=0.02)
compared to those not attending CR (Figure 1). Conclusion(s): CR
attendance and completion reduces the risk of death within 12 months after
a HF hospitalization. Strategies focusing on increasing CR participation
should target women and older people who are less likely to attend. A
limitation of this study is that we could not control for the utilization
of HF-specialist clinics.

<97>
Accession Number
643011266
Title
PCSK9 inhibitors and small interfering RNA therapy for cardiovascular risk
reduction: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Khan A.; Has P.; Jacobson A.; Bogin S.; Khalid M.; Kim S.; Erqou S.; Aspry
K.; Wu W.; Imran T.F.
Institution
(Khan, Has, Jacobson, Bogin, Erqou, Aspry, Wu, Imran) Brown University,
Providence, United States
(Khalid) Rhode Island and Miriam Hospitals, Lifespan Cardiovascular
Institute, Providence, United States
(Kim) Weill Cornell Medical College, New York, United States
Publisher
Oxford University Press
Abstract
Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading
cause of morbidity and mortality globally. Despite Class IA indications
for high intensity statin therapies in those with ASCVD or at risk, they
are underutilized and/or insufficient, and large proportions remain above
LDL-C thresholds with residual risk. As monotherapy or on a background of
statin therapy, Proprotein convertase subtilisn/kexin type 9 (PCSK9)
inhibitors (Evolocumab, Alirocumab) or small interfering RNA (siRNA)
therapy (Inclisiran) have been demonstrated to lower LDL-C and ASCVD
events, but meta-analyses of these therapies and their individual outcomes
are lacking. Purpose(s): The purpose of this study was to perform a
systematic review and meta-analysis of the effects of PCSK9 inhibitors and
small interfering RNA (siRNA) therapy on LDL-C reduction and major adverse
cardiac events (MACE). Method(s): Using Pubmed, Embase, Cochrane
Library and clinicaltrials.gov until Jan 2023, we extracted randomized
controlled trials (RCTs) of PCSK9 inhibitors (Evolocumab, Alirocumab) and
siRNA therapy (Inclisiran) for primary or secondary prevention of MACE.
Using random-effects models, we pooled the relative risks (RR) and 95%
confidence intervals (CI) and weighted least-squares mean difference in
LDL-C levels. We estimated odds ratios with 95% CIs among MACE subtypes
and all-cause mortality. Fixed-effect model was used, and heterogeneity
was assessed using the I2 statistic. Result(s): LDL-C percentage
change was reported in 47 (RCTs) (n = 267,900) evaluating two PCSK9
inhibitors and one siRNA therapy. Of those, 21 studies (n = 211,058)
included treatment with Evolocumab (140mg), 22 (n = 47,320) included
Alirocumab (75mg), and 4 studies (n = 9,522) included Inclisiran (284mg
and 300mg). Compared with placebo, after a median of 24 weeks, Evolocumab
reduced LDL-C by -61.09% (95% CI: -64.81, -57.38, p<0.01) and Alirocumab
reduced LDL-C by -46.35% (95% CI: -51.75, -41.13, p<0.01). Inclisiran
284mg reduced LDL-C by -54.83% (95% CI: -59.04, -50.62, p = 0.05) and
Inclisiran 300mg reduced LDL-C by -43.11% (95% CI: -52.42, -33.80, p =
0.01). After a median of 26 months, Evolocumab reduced the risk of
myocardial infarction (MI), OR 0.72 (95% CI: 0.64, 0.81, p<0.01), coronary
revascularization, OR 0.77 (95% CI: 0.70, 0.84, p<0.01), stroke, OR 0.79
(95% CI: 0.66, 0.94, p = 0.01) and overall MACE, OR 0.85 (95% CI: 0.80,
0.89, p<0.01). Alirocumab reduced MI, OR 0.57 (0.38, 0.86, p = 0.01),
cardiovascular mortality OR 0.35 (95% CI: 0.16, 0.77, p = 0.01), all-cause
mortality OR 0.60 (95% CI: 0.43, 0.84, p<0.01), and overall MACE OR 0.35
(0.16, 0.77, p = 0.01). Insufficient MACE data has been reported for
Inclisiran. Conclusion(s): PCSK9 inhibitors (Evolocumab, Alirocumab)
and siRNA therapy (Inclisiran) significantly reduce LDL-C by >40% in
high-risk individuals. Additionally, Alirocumab and Evolocumab reduce the
risk of MACE, and Alirocumab reduced cardiovascular and all-cause
mortality.

<98>
Accession Number
643011180
Title
Incidence and pattern of repeat coronary revascularizations in patients
with acute coronary syndromes treated with ticagrelor or prasugrel.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Aytekin A.; Scalamogna M.; Coughlan J.J.; Lahu S.; Ndrepepa G.; Menichelli
M.; Mayer K.; Joner M.; Xhepa E.; Kufner S.; Laugwitz K.L.; Neumann F.J.;
Schunkert H.; Kastrati A.; Cassese S.
Institution
(Aytekin, Scalamogna, Lahu, Ndrepepa, Mayer, Joner, Xhepa, Kufner,
Schunkert, Kastrati, Cassese) German Heart Center Muenchen Technical
University of Munich, Munich, Germany
(Coughlan) Cardiovascular Research Institute, Mater Private Network,
Dublin, Ireland
(Menichelli) Hospital Fabrizio Spaziani, Department of Cardiology,
Frosinone, Italy
(Laugwitz) Klinikum rechts der Isar, Medizinische Klinik und Poliklinik
Innere Medizin I (Kardiologie, Angiologie, Pneumologie), Munich, Germany
(Neumann) University Heart Center Freiburg-Bad Krozingen, Department of
Cardiology and Angiology II, Bad Krozingen, Germany
Publisher
Oxford University Press
Abstract
Background: The ISAR-REACT 5 randomized trial compared the efficacy and
safety of ticagrelor and prasugrel in patients with acute coronary
syndromes (ACS) managed invasively. Data are missing with regard to the
effect of these antiplatelet agents on the repeat revascularization
procedures. Purpose(s): We sought to investigate the impact of
ticagrelor and prasugrel on the incidence and pattern of repeat coronary
revascularizations in patients with ACS undergoing percutaneous coronary
intervention (PCI). Method(s): This post-hoc analysis of the
ISAR-REACT 5 trial included all ACS patients who underwent PCI. Patients
were divided into two groups as per assigned antiplatelet treatment. The
primary outcome for this analysis was the incidence of repeat coronary
revascularization (percutaneous or surgical) up to 12-month follow-up.
Secondary outcomes were target vessel revascularization (TVR) and
non-target vessel revascularization (NTVR). We also studied whether repeat
revascularization procedures were urgent in nature. Result(s): Among
3,377 ACS patients, 1,676 were assigned to ticagrelor and 1,701 to
prasugrel group before receiving PCI. Compared with prasugrel, the
incidence of repeat coronary revascularization at 12 months was
significantly higher in patients treated with ticagrelor (hazard ratio
[HR]=1.14; 95% confidence interval [CI] 1.01-1.29), mostly attributable to
significantly more NTVR (HR=1.15 [1.01-1.32]) in this latter group. There
were numerically more urgent repeat revascularizations in patients
receiving ticagrelor compared with prasugrel (HR=1.32 [1.00-1.75]), mostly
due to urgent NTVR (HR=1.62 [1.09-2.41]). The risk of TVR was not
significantly different between treatment groups (HR=1.04 [0.76-1.44]).
 Conclusion(s): In patients with ACS treated with PCI, ticagrelor is
associated with significantly more repeat coronary revascularizations
compared to prasugrel after 12 months, predominantly in remote coronary
vessels.

<99>
Accession Number
643011092
Title
Association of revascularization with mortality in ischemic left
ventricular dysfunction.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Tao M.; Liu Y.; Radakrishnan A.; Al-Sadawi M.; Masson R.; Rahman T.; Mann
N.; Pyo R.
Institution
(Tao, Liu, Radakrishnan, Al-Sadawi, Masson, Rahman, Mann, Pyo) Stony Brook
University Hospital, Stony Brook, United States
Publisher
Oxford University Press
Abstract
Background: Revascularization in patients with left ventricular (LV)
dysfunction has been a subject of ongoing uncertainty and conflicting
results. This is further complicated by factors including viability,
severity of LV dysfunction, and method of revascularization using
percutaneous coronary intervention (PCI) versus coronary-artery bypass
grafting (CABG). The purpose of this meta-analysis is to evaluate the
association of coronary revascularization with mortality in patients with
ischemic LV dysfunction. Method(s): A literature search was conducted
for studies reporting on all-cause mortality after revascularization with
PCI or CABG compared to optimal medical therapy (OMT) in patients with
ischemic LV dysfunction. The search included the following databases: Ovid
MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not
restricted to time or publication status. Result(s): A total of 21
studies with 6062 participants (2838 revascularized, 3224 on OMT) met
inclusion criteria. Mean follow-up was 37 months (11-68 months), mean LV
ejection fraction (EF) was 29%, mean age was 61, 85% of patients were
male. Revascularization was significantly associated with lower all-cause
mortality compared to patients on OMT (OR 0.57, 95% CI 0.46-0.71; p<0.01).
The association was statistically significant regardless of severity of LV
dysfunction or method of revascularization. Heterogeneity between
subgroups was low and test for subgroup difference was not statistically
significant by EF cutoff of 35% or by revascularization method (p=0.43,
I2=0%; p=0.12, I2=59.7%). Subgroup analysis by viability demonstrated that
revascularization was significantly associated with lower all-cause
mortality compared to OMT for patients with viability and mixed cohorts
with or without viability, but not patients without viability (OR 0.47,
95% CI 0.33-0.66; p<0.01; OR 0.57, 95% CI 0.38-0.84; p<0.01; OR 0.73, 95%
CI 0.51-1.02; p=0.07). The effect size was larger in the subgroup with
viable myocardium compared to mixed patients with viable or non-viable
myocardium (Z=4.33 vs 2.79). Conclusion(s): Revascularization in
patients with ischemic LV dysfunction is associated with lower risk of
all-cause mortality independent of severity of LV dysfunction or method of
revascularization. Revascularization is not associated with lower risk of
all-cause mortality in patients without evidence of viable myocardium.

<100>
Accession Number
643011041
Title
Reticulated platelets predict cardiovascular death and adverse events in
coronary artery disease.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Bongiovanni D.; Novelli L.; Condello F.; Laugwitz K.L.; Raake P.; Kastrati
A.; Chiarito M.; Bernlochner I.
Institution
(Bongiovanni, Raake) University Hospital Augsburg, Augsburg, Germany
(Novelli, Condello, Chiarito) Clinical Institute Humanitas IRCCS,
Department of Cardiovascular Medicine, Rozzano, Italy
(Laugwitz, Bernlochner) Hospital Rechts der Isar, I. Medizinische Klinik
und Poliklinik, Munich, Germany
(Kastrati) Deutsches Herzzentrum Muenchen Technical University of Munich,
Munich, Germany
Publisher
Oxford University Press
Abstract
Background/Introduction: The pro-thrombotic immature or reticulated
platelets (RPs) are known to be elevated in high risk patients and in
different pathological settings. Several studies have shown that RPs
correlate with an insufficient antiplatelet response to antiplatelet
agents. In addition, RPs are emerging novel biomarkers for the prediction
of adverse cardiovascular events in cardiovascular disease.
 Purpose(s): The current study, using the totality of existing
evidence, evaluated the prognostic role of RPs in patients with coronary
artery disease. Method(s): We performed a systematic review and
meta-analysis including trials of acute and chronic coronary syndrome
reporting clinical outcomes according to RPs levels in the peripheral
blood. Patients with elevated RPs were defined as RPshigh according to the
single study definitions and compared to patients without elevated RPs
(RPslow). Odds ratios (ORs) and 95% CIs were used as metric of choice for
treatment effects with random-effects models. The primary endpoint was
major adverse cardiovascular and cerebrovascular events (MACCE). Secondary
endpoints were cardiovascular death, myocardial infarction, ischemic
stroke, urgent coronary revascularization and any bleeding. Prospero
Registration number: CRD42022381282. Result(s): A total of 7 studies,
including 2213 patients, were included. The risk for MACCE was
significantly higher in RPshigh compared to RPslow patients (OR 2.67
[1.87; 3.81], I2=43.8%, Figure 1). RPshigh were significantly associated
with cardiovascular death (OR 2.09 [1.36; 3.22], I2=40.4%). No significant
associations for RPshigh were detected with the other singular components
of MACCE: myocardial infarction (OR 1.73 [0.89; 3.38] I2=60.5%) and stroke
(OR 1.72 [0.59; 4.96] I2=21%). Urgent revascularization was not
significantly associated with elevated RPs (OR 2.09 [0.90; 4.86]
I2=55.5%). The risk of bleeding did not significantly differ between
groups(OR 0.58 [0.15; 2.22] I2=86.1%). Conclusion(s): Elevated RPs
are significantly associated with increased risk of cardiovascular events
and cardiovascular death in patients with coronary artery disease and
should be considered a useful prognostic biomarker in this setting. Figure
1.

<101>
Accession Number
643010969
Title
Course of the effects of LDL-cholesterol reduction on cardiovascular risk
over time: a meta-analysis of 59 trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no
pagination), 2023. Date of Publication: November 2023.
Author
Burger P.M.; Dorresteijn J.A.N.; Koudstaal S.; Mosterd A.; Visseren F.L.J.
Institution
(Burger, Dorresteijn, Visseren) University Medical Center Utrecht,
Utrecht, Netherlands
(Koudstaal) Green Heart Hospital, Gouda, Netherlands
(Mosterd) Meander Medical Center, Amersfoort, Netherlands
Publisher
Oxford University Press
Abstract
Background: Therapies lowering low-density lipoprotein cholesterol (LDL-c)
are widely used to reduce cardiovascular disease (CVD) risk in patients
with or at high risk of CVD. Therapy is usually continued lifelong, but
whether the effects of LDL-c reduction remain stable over time is
uncertain. This study aimed to establish the course of the relative
treatment effects of LDL-c reduction on cardiovascular risk over time,
i.e. treatment duration and age. Method(s): Randomized controlled
trials (RCTs) of LDL-c lowering therapies were identified through a search
in MEDLINE and EMBASE (1966-January 2023). RCTs of guideline-recommended
therapies (i.e. statins, ezetimibe, and proprotein convertase
subtilisin-kexin type 9 inhibitors [PCSK9i]) were selected for the primary
analyses, with RCTs of other therapies included in sensitivity analyses.
Random-effects meta-analyses were performed to establish the average
relative risk (RR) for major vascular events (cardiovascular death,
myocardial infarction or other acute coronary syndrome, coronary
revascularization, or stroke) per 1 mmol/L LDL-c reduction. Course of the
effects over time was assessed using random-effects meta-regression
analyses for the association between follow-up duration, age, and the RR
for major vascular events per 1 mmol/L LDL-c reduction. Analyses were also
stratified for primary and secondary prevention. Result(s): A total
of 59 trials (26 statin trials, 2 ezetimibe trials, 3 statin/ezetimibe
combination trials, 7 PCSK9i trials, and 21 other trials) were selected,
including 394,989 participants and 49,642 major vascular events. Mean
follow-up was 3.9 years (range 0.9-9.7), and age was 63.8 years (range
48.0-77.0). The average RR for major vascular events per 1 mmol/L LDL-c
reduction was 0.78 (95% confidence interval [CI] 0.75-0.81), with slightly
larger risk reductions in primary (RR 0.74; 95% CI 0.68-0.81) as compared
to secondary prevention (RR 0.80; 95% CI 0.77-0.83). Follow-up duration
was not associated with the RR for major vascular events (p = 0.615), with
the meta-regression line showing a stable RR over follow-up time (RR for
change per year 0.994; 95% CI 0.971-1.017). The RR for major vascular
events increased (i.e. risk reduction decreased) with age in primary
prevention (RR for change per 5 years 1.094; 95% CI 1.028-1.165; p =
0.018), but remained largely unchanged in secondary prevention (RR for
change per 5 years 0.986; 95% CI 0.943-1.031; p = 0.533). Consistent
results were found for statin trials only, and all trials combined.
 Conclusion(s): The relative treatment effects of LDL-c reduction are
stable over time in secondary prevention, but may decrease with age in
primary prevention.

<102>
Accession Number
2035550661
Title
Three-Year Outcomes Following TAVR in Younger (<75 Years)
Low-Surgical-Risk Severe Aortic Stenosis Patients.
Source
Circulation: Cardiovascular Interventions. (no pagination), 2024. Article
Number: e014018. Date of Publication: 2024.
Author
Modine T.; Tchetche D.; Van Mieghem N.M.; Deeb G.M.; Chetcuti S.J.;
Yakubov S.J.; Sorajja P.; Gada H.; Mumtaz M.; Ramlawi B.; Bajwa T.; Crouch
J.; Teirstein P.S.; Kleiman N.S.; Iskander A.; Bagur R.; Chu M.W.A.;
Berthoumieu P.; Sudre A.; Adrichem R.; Ito S.; Huang J.; Popma J.J.;
Forrest J.K.; Reardon M.J.
Institution
(Modine) Centre Hospitalier Universitaire de Bordeaux, L'Unite
Medico-Chirurgicale des Valvulopathies, Chirurgie Cardiaque, Universite de
Bordeaux, France
(Tchetche, Berthoumieu) Clinique Pasteur, Toulouse, France
(Van Mieghem, Adrichem) Department of Interventional Cardiology,
Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Deeb) Department of Cardiac Surgery, Division of Interventional
Cardiology, University Hospital, Ann Arbor, MI, United States
(Chetcuti) Department of Internal Medicine, Division of Cardiovascular
Medicine, University Hospital, Ann Arbor, MI, United States
(Yakubov, Sorajja) Michigan Medicine Health Systems, University Hospital,
Ann Arbor, MI, United States
(Gada) Department of Cardiology, Ohio Health Riverside Methodist Hospital,
Columbus, United States
(Sorajja) Minneapolis Heart Institute Foundation, Abbott Northwestern
Hospital, Mongolia
(Gada, Mumtaz) Department of Interventional Cardiology and Cardiothoracic
Surgery, University of Pittsburgh Medical Center, Moffitt Heart/Pinnacle
Health, Harrisburg, PA, United States
(Ramlawi) Cardiothoracic Surgery, Lankenau Heart Institute, Wynnewood, PA,
United States
(Bajwa, Crouch) Department of Interventional Cardiology and Cardiothoracic
Surgery, Aurora Health Care, Aurora St. Luke's Medical Center, Milwaukee,
WI, United States
(Teirstein) Department of Interventional Cardiology, Scripps Clinic,
Scripps Prebys Cardiovascular Institute, La Jolla, CA, United States
(Kleiman) Department of Interventional Cardiology and Cardiothoracic
Surgery, Methodist DeBakey Heart and Vascular Center, Houston Methodist
Hospital, TX, United States
(Iskander) Saint Joseph's Hospital Health Center, Syracuse, NY, United
States
(Bagur) London Health Sciences Centre, University Campus, ON, Canada
(Chu, Sudre) Centre Hospitalier Regional Universitaire, Lille, France
(Ito) Echocardiography Core Laboratory, Mayo Clinic, Rochester, MN, United
States
(Huang, Popma) Medtronic, Mounds View, MN, United States
(Forrest, Reardon) Department of Internal Medicine (Cardiology), Yale
University School of Medicine, New Haven, CT, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an
alternative to surgery in patients with severe aortic stenosis, but data
are limited on younger, low-risk patients. This analysis compares outcomes
in low-surgical-risk patients aged <75 years receiving TAVR versus
surgery. METHOD(S): The Evolut Low Risk Trial randomized 1414
low-risk patients to treatment with a supra-annular, self-expanding TAVR
or surgery. We compared rates of all-cause mortality or disabling stroke,
associated clinical outcomes, and bioprosthetic valve performance at 3
years between TAVR and surgery patients aged <75 years. RESULT(S): In
patients <75 years, 352 were randomized to TAVR and 351 to surgery. Mean
age was 69.1+/-4.0 years (minimum 51 and maximum 74); Society of Thoracic
Surgeons Predicted Risk of Mortality was 1.7+/-0.6%. At 3 years, all-cause
mortality or disabling stroke for TAVR was 5.7% and 8.0% for surgery
(P=0.241). Although there was no difference between TAVR and surgery in
all-cause mortality, the incidence of disabling stroke was lower with TAVR
(0.6%) than surgery (2.9%; P=0.019), while surgery was associated with a
lower incidence of pacemaker implantation (7.1%) compared with TAVR
(21.0%; P<0.001). Valve reintervention rates (TAVR 1.5%, surgery 1.5%,
P=0.962) were low in both groups. Valve performance was significantly
better with TAVR than surgery with lower mean aortic gradients (P<0.001)
and lower rates of severe prosthesis-patient mismatch (P<0.001). Rates of
valve thrombosis and endocarditis were similar between groups. There were
no significant differences in rates of residual >=moderate paravalvular
regurgitation. CONCLUSION(S): Low-risk patients <75 years treated
with supra-annular, self-expanding TAVR had comparable 3-year all-cause
mortality and lower disabling stroke compared with patients treated with
surgery. There was significantly better valve performance in patients
treated with TAVR. Copyright © 2024 The Authors.

<103>
Accession Number
2032295062
Title
A Network Meta-Analysis of Vasodilator Therapies in Pulmonary Hypertension
Patients Undergoing Mitral Valve Replacement Surgery: Insights for
Optimizing Hemodynamics.
Source
Clinical Drug Investigation. (no pagination), 2024. Date of Publication:
2024.
Author
Elrosasy A.; Maher A.; Ramadan A.; Hamam N.G.; Soliman M.; Kamal S.K.;
Milik B.E.; Shahat A.A.; Kamel M.N.; Ali A.A.; Hassan L.A.; Zabady A.;
Zeid M.A.; Abdelmottaleb W.; Nassar S.
Institution
(Elrosasy, Ramadan, Hamam, Soliman, Kamal, Milik, Shahat, Kamel, Hassan)
Faculty of Medicine, Kasr Al-Ainy, Cairo University, Al-Saray Street, El
Manial, Cairo 11562, Egypt
(Maher) Faculty of Medicine, Al-Azhar University, New-Damietta, Egypt
(Ali) Faculty of Medicine, Merit University, Sohag, Egypt
(Zabady) Faculty of Science, Damanhour University, Damanhour, Egypt
(Zeid) Faculty of Medicine, Tanta University, Tanta, Egypt
(Abdelmottaleb) Department of Medicine, New York Medical
College/Metropolitan Hospital, New York, NY, United States
(Nassar) Department of Cardiology, West Virginia University, Morgantown,
WV, United States
Publisher
Adis
Abstract
Background and Objective: Pulmonary hypertension (PH) is a progressive
hemodynamic condition associated with significant morbidity and mortality,
especially in patients undergoing cardiac surgery. Therefore, the
objective of this network meta-analysis (NMA) is to compare the efficacy
of various pulmonary vasodilators in perioperative control of PH among
patients undergoing mitral valve replacement surgery (MVRS), aiming to
address the existing knowledge gap and improve perioperative outcomes.
 Method(s): Electronic databases including PubMed, Cochrane Central
Registry of Controlled Trials, Scopus, Embase, and Web of Science (WOS)
from inception to 17 September 2024. Only randomized controlled trials
(RCTs) evaluating vasodilators in PH patients undergoing MVRS were
included. We used netmeta package in RStudio to analyze the outcome data
with their corresponding mean difference (MD) and confidence intervals
(CI). Result(s): Seventeen RCTs including 862 patients were analyzed.
Prostacyclin, nitric oxide (NO), and sodium nitroprusside (SN)
significantly reduced mean pulmonary arterial pressure with effect sizes
[MD, 95% confidence interval (CI)] of (11.77, - 18.78; - 4.76; - 8.3, -
15.9; - 0.6; - 11.02, - 20.1; - 3.8, respectively). While no treatment
showed significant efficacy on pulmonary capillary wedge pressure,
systolic pulmonary arterial pressure, or heart rate, nitroglycerin, NO,
and prostacyclin, showed significant increases in cardiac index with
effect sizes (MD, 95% CI) of (1, 0.3; 1.7; 1.2 0.8; 1.6; 1.2 0.8; 1.6,
respectively). Additionally, NO, prostacyclin, SN, and nitroglycerin
demonstrated significant reductions in systemic vascular resistance (SVR),
with effect sizes of. (- 0.54, - 0.82; - 0.26, - 0.37, - 0.65; - 0.09; -
0.47, - 0.77; - 0.16; - 0.14, - 0.24; - 0.03, respectively).
 Conclusion(s): This NMA highlights prostacyclin, nitroglycerin, NO,
and SN as consistently effective in improving hemodynamics for patients
with PH undergoing MVRS, and provides valuable insights for surgeons to
choose the suitable vasodilator for these surgeries. However, limitations
and the need for further RCTs are acknowledged. Copyright © The
Author(s) 2024.

<104>
Accession Number
2032293413
Title
Intracerebral haemorrhage - mechanisms, diagnosis and prospects for
treatment and prevention.
Source
Nature Reviews Neurology. (no pagination), 2024. Date of Publication:
2024.
Author
Seiffge D.J.; Fandler-Hofler S.; Du Y.; Goeldlin M.B.; Jolink W.M.T.;
Klijn C.J.M.; Werring D.J.
Institution
(Seiffge, Goeldlin) Department of Neurology, Inselspital University
Hospital Bern and University of Bern, Bern, Switzerland
(Fandler-Hofler, Du, Werring) Stroke Research Centre, Department of Brain
Repair and Rehabilitation, UCL Queen Square Institute of Neurology,
University College London, London, United Kingdom
(Fandler-Hofler) Department of Neurology, Medical University of Graz,
Graz, Austria
(Du) Department of Neurology, Xiangya Hospital of Central South
University, Hunan, Changsha, China
(Jolink) Department of Neurology, Isala Hospital, Zwolle, Netherlands
(Klijn) Department of Neurology, Donders Institute of Brain, Cognition and
Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
Publisher
Nature Research
Abstract
Intracerebral haemorrhage (ICH) is a devastating condition associated with
high mortality and substantial residual disability among survivors.
Effective treatments for the acute stages of ICH are limited. However,
promising findings from randomized trials of therapeutic strategies,
including acute care bundles that target anticoagulation therapies, blood
pressure control and other physiological parameters, and trials of
minimally invasive neurosurgical procedures have led to renewed optimism
that patient outcomes can be improved. Currently ongoing areas of research
for acute treatment include anti-inflammatory and haemostatic treatments.
The implementation of effective secondary prevention strategies requires
an understanding of the aetiology of ICH, which involves vascular and
brain parenchymal imaging; the use of neuroimaging markers of cerebral
small vessel disease improves classification with prognostic relevance.
Other data underline the importance of preventing not only recurrent ICH
but also ischaemic stroke and cardiovascular events in survivors of ICH.
Ongoing and planned randomized controlled trials will assess the efficacy
of prevention strategies, including antiplatelet agents, oral
anticoagulants or left atrial appendage occlusion (in patients with
concomitant atrial fibrillation), and optimal management of long-term
blood pressure and statin use. Together, these advances herald a new era
of improved understanding and effective interventions to reduce the burden
of ICH. Copyright © Springer Nature Limited 2024.

<105>
Accession Number
2034152699
Title
Low-Dose Direct Oral Anticoagulation vs Dual Antiplatelet Therapy after
Left Atrial Appendage Occlusion: The ADALA Randomized Clinical Trial.
Source
JAMA Cardiology. 9(10) (pp 922-926), 2024. Date of Publication: 09 Oct
2024.
Author
Freixa X.; Cruz-Gonzalez I.; Cepas-Guillen P.; Millan X.; Antunez-Muinos
P.; Flores-Umanzor E.; Asmarats L.; Regueiro A.; Lopez-Tejero S.; Li
C.-H.P.; Sanchis L.; Rodes-Cabau J.; Arzamendi D.
Institution
(Freixa, Cepas-Guillen, Antunez-Muinos, Flores-Umanzor, Regueiro,
Lopez-Tejero, Sanchis, Rodes-Cabau) Department of Cardiology, Institut
Cardiovascular, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain
(Cruz-Gonzalez) Department of Cardiology, Hospital Universitario of
Salamanca, Salamanca, Spain
(Millan, Asmarats, Li, Arzamendi) Department of Cardiology, Hospital
Universitari de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
(Rodes-Cabau) Quebec Heart and Lung Institute, Laval University, Quebec
City, QC, Canada
Publisher
American Medical Association
Abstract
Importance: Optimal antithrombotic therapy after percutaneous left atrial
appendage occlusion (LAAO) is not well established as no randomized
evaluation has been performed to date. Objective(s): To compare the
efficacy and safety of low-dose direct oral anticoagulation (low-dose
DOAC) vs dual antiplatelet therapy (DAPT) for 3 months after LAAO.
 Design, Setting, and Participant(s): The ADALA (Low-Dose Direct Oral
Anticoagulation vs Dual Antiplatelet Therapy After Left Atrial Appendage
Occlusion) study was an investigator-initiated, multicenter, prospective,
open-label, randomized clinical trial enrolling participants from June 12,
2019, to August 28, 2022 from 3 European sites. Patients who underwent
successful LAAO were randomly assigned 1:1 to low-dose DOAC vs DAPT for 3
months after LAAO. The study was prematurely terminated when only 60% of
the estimated sample size had been included due to lower recruitment rate
than anticipated due to the COVID-19 pandemic. Intervention(s): The
low-dose DOAC group received apixaban, 2.5 mg every 12 hours, and the DAPT
group received aspirin, 100 mg per day, plus clopidogrel, 75 mg per day,
for the first 3 months after LAAO. Main Outcomes and Measures: The
primary end point was a composite of safety (major bleeding) and efficacy
(thromboembolic events including stroke, systemic embolism, and
device-related thrombosis [DRT]) within the first 3 months after
successful LAAO. Secondary end points included individual components of
the primary outcome and all-bleeding events. Result(s): A total of 90
patients (mean [SD] age, 76.6 [8.1] years; 60 male [66.7%]; mean [SD]
CHADS-VASc score, 4.0 [1.5]) were included in the analysis (44 and 46
patients in the low-dose DOAC and DAPT groups, respectively). A total of
53 patients (58.8%) presented with previous major bleeding events (60
gastrointestinal [66.7%] and 16 intracranial [17.8%]). At 3 months,
low-dose DOAC was associated with a reduction of the primary end point
compared with DAPT (2 [4.5%] vs 10 [21.7%]; hazard ratio, 0.19; 95% CI,
0.04-0.88; P =.02). Patients in the low-dose DOAC group exhibited a lower
rate of DRT (0% vs 6 [8.7%]; P =.04) and tended to have a lower incidence
of major bleeding events (2 [4.6%] vs 6 [13.0%]; P =.17), with no
differences in thromboembolic events such as stroke and systemic embolism
between groups (none in the overall population). Conclusions and
Relevance: This was a small, randomized clinical trial comparing different
antithrombotic strategies after LAAO. Results show that use of low-dose
DOAC for 3 months after LAAO was associated with a better balance between
efficacy and safety compared with DAPT. However, the results of the study
should be interpreted with caution due to the limited sample size and will
need to be confirmed in future larger randomized trials. Trial
Registration: ClinicalTrials.gov Identifier: NCT05632445. Copyright
© 2024 American Medical Association. All rights reserved.

<106>
Accession Number
2033552589
Title
Comparing clinical and echocardiographic outcomes following valve-sparing
versus transannular patch repair of tetralogy of Fallot: a systematic
review and meta-analysis.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. 39(1) (no
pagination), 2024. Article Number: ivae124. Date of Publication: 01 Jul
2024.
Author
Martins R.S.; Fatimi A.S.; Mahmud O.; Qureshi S.; Nasim M.T.; Virani S.S.;
Tameezuddin A.; Yasin F.; Malik M.A.
Institution
(Martins) Division of Thoracic Surgery, Department of Surgery, Hackensack
Meridian School of Medicine, Hackensack Meridian Health Network, Edison,
NJ, United States
(Fatimi, Mahmud, Qureshi, Nasim, Yasin) Medical College, Aga Khan
University, Karachi, Pakistan
(Virani) Department of Surgery, Aga Khan University, Karachi, Pakistan
(Tameezuddin) Medical College, Ziauddin University, Karachi, Pakistan
(Malik) Department of Cardiac Surgery, Rawalpindi Institute of Cardiology,
Rawalpindi, Pakistan
Publisher
Oxford University Press
Abstract
OBJECTIVES: Transannular patch (TAP) repair of tetralogy of Fallot
(ToF)relieves right ventricular tract obstruction but may lead to
pulmonary regurgitation. Valve-sparing (VS) procedures can avoid this
situation, but there is a potential for residual pulmonary stenosis. Our
goal was to evaluate clinical and echocardiographic outcomes of TAP and VS
repair for ToF. METHOD(S): A systematic search of the PubMed, Embase,
Scopus, Cochrane Central Register of Controlled Trials and Web of Science
databases was carried out to identify articles comparing conventional TAP
repair and VS repair for ToF. Random-effects models were used to perform
meta-analyses of the clinical and echocardiographic outcomes.
 RESULT(S): Forty studies were included in this meta-analysis with
data on 11 723 participants (TAP: 6171; VS: 5045). Participants who
underwent a VS procedure experienced a significantly lower cardiopulmonary
bypass time [mean difference (MD): -14.97; 95% confidence interval (CI):
-22.54, -7.41], shorter ventilation duration (MD: -15.33; 95% CI: -30.20,
-0.46) and shorter lengths of both intensive care unit (ICU) (MD: -0.67;
95% CI: -1.29, -0.06) and hospital stays (MD: -2.30; 95% CI: [-4.08,
-0.52). There was also a lower risk of mortality [risk ratio: 0.40; 95%
CI: (0.27, 0.60) and pulmonary regurgitation [risk ratio: 0.35; 95% CI:
(0.26, 0.46)] associated with the VS group. Most other clinical and
echocardiographic outcomes were comparable in the 2 groups.
 CONCLUSION(S): This meta-analysis confirms the well-established
increased risk of pulmonary insufficiency following TAP repair while also
demonstrating that VS repairs are associated with several improved
clinical outcomes. Continued research can identify the criteria for
adopting a VS approach as opposed to a traditional TAP
repair. Copyright © The Author(s) 2024.

<107>
Accession Number
2033405345
Title
Pulmonary artery catheter use and in-hospital outcomes in cardiac surgery:
a systematic review and meta-analysis.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. 39(1) (no
pagination), 2024. Article Number: ivae129. Date of Publication: 01 Jul
2024.
Author
Rong L.Q.; Luhmann G.; Franco A.D.; Dimagli A.; Perry L.A.; Martinez A.P.;
Demetres M.; Mazer C.D.; Bellomo R.; Gaudino M.
Institution
(Rong, Luhmann, Martinez) Department of Anesthesiology, Weill Cornell
Medicine, New York, NY, United States
(Franco, Dimagli, Gaudino) Department of Cardiothoracic Surgery, Weill
Cornell Medicine, New York, NY, United States
(Perry) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Perry, Bellomo) Department of Critical Care, University of Melbourne,
Melbourne, VIC, Australia
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Centre, Weill Cornell Medicine, New York, NY, United States
(Mazer) Departments of Anaesthesia and Critical Care, Keenan Research
Centre for Biomedical Science, Li Ka Shing Knowledge Institute of St
Michael's Hospital, Toronto, ON, Canada
(Mazer) Department of Anesthesia, University of Toronto, Toronto, ON,
Canada
(Bellomo) Department of Intensive Care, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Monash University, Melbourne, VIC, Australia
Publisher
Oxford University Press
Abstract
OBJECTIVES: To determine the association of intraoperative pulmonary
artery catheter (PAC) use with in-hospital outcomes in cardiac surgical
patients. METHOD(S): MEDLINE, Embase, and Cochrane Library (Wiley)
databases were screened for studies that compared cardiac surgical
patients receiving intraoperative PAC with controls and reporting
in-hospital mortality. Secondary outcomes included intensive care unit
length of stay, cost of hospitalization, fluid volume administered,
intubation time, inotropes use, acute kidney injury (AKI), stroke,
myocardial infarction (MI), and infections. RESULT(S): Seven studies
(25 853 patients, 88.6% undergoing coronary artery bypass graft surgery)
were included. In-hospital mortality was significantly increased with PAC
use [odds ratio (OR) 1.57; 95% confidence interval (CI) 1.12-2.20, P 1/4
0.04]; PAC use was also associated with greater intraoperative inotrope
use (OR 2.61; 95% CI 1.54-4.41) and costs [standardized mean difference
(SMD) 1/4 0.20; 95% CI 0.16-0.23], longer intensive care unit stay (SMD
1/4 0.29; 95% CI 0.25-0.33), and longer intubation time (SMD 1/4 0.44; 95%
CI 0.12-0.76). CONCLUSION(S): PAC use is associated with
significantly increased odds of in-hospital mortality, but the amount and
quality of the available evidence is limited. Prospective randomized
trials testing the effect of PAC on the outcomes of cardiac surgical
patients are urgently needed. Copyright © The Author(s) 2024.

<108>
Accession Number
2032559937
Title
How to harvest the left internal mammary artery-a randomized controlled
trial.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. 38(5) (no
pagination), 2024. Article Number: ivae102. Date of Publication: 01 May
2024.
Author
Laugesen S.; Krasniqi L.; Benhassen L.L.; Mortensen P.E.; Pallesen P.A.;
Bak S.; Kjelsen B.J.; Riber L.P.
Institution
(Laugesen, Krasniqi, Mortensen, Pallesen, Bak, Kjelsen, Riber) Department
of Cardio, Vascular and Thoracic Surgery, Odense University Hospital,
Odense, Denmark
(Laugesen, Krasniqi, Riber) Department of Clinical Medicine, Faculty of
Health, Odense University, Odense, Denmark
(Benhassen) Department of Clinical Medicine, Faculty of Health, Aarhus
University, Aarhus, Denmark
(Benhassen) Department of Cardiothoracic and Vascular Surgery, Aarhus
University Hospital, Aarhus, Denmark
Publisher
Oxford University Press
Abstract
OBJECTIVES: It is uncertain whether Thunderbeat has a place in harvesting
the left internal mammary artery (LIMA) and whether skeletonization is
superior to pedicle-harvested LIMA. Some investigations have shown
improved flowrates in the skeletonized graft. The aim of this study was to
compare 3 groups of harvesting techniques: Pedicled, surgical skeletonized
and skeletonized with Thunderbeat in terms of flow rates in the LIMA and
postoperative in-hospital outcomes. METHOD(S): Patients undergoing
coronary artery bypass grafting with the LIMA to the anterior descending
artery were randomized to pedicled (n 1/4 56), surgical skeletonized (n
1/4 55) and skeletonized with Thunderbeat (n 1/4 54). Main outcomes were
blood flow and pulsatility index in the graft. RESULT(S): No
statistical difference between groups regarding flow in LIMA or
pulsatility index. Similarly, no difference in postoperative bleeding or
days of hospitalization. The duration of harvesting was faster for the
pedicled technique compared with surgical skeletonized and skeletonized
with Thunderbeat [mean total min: pedicled 20.2 min standard deviation
(SD) +/- 5.4; surgical skeletonized 28.6 min SD +/- 8.7; skeletonized with
Thunderbeat 28.3 min SD +/- 9.11, P < 0.001]. No grafts discarded due to
faulty harvesting and there was no graft failure within hospital stay.
 CONCLUSION(S): We found no difference between the harvesting methods
except for a significantly faster harvesting time with the pedicled
technique. However, non-touch skeletonized LIMA harvesting with
Thunderbeat seems to be an effective alternative to traditional surgical
skeletonized LIMA. The future will reveal whether patency is harvesting
dependent. Copyright # The Author(s) 2024. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<109>
Accession Number
2032408935
Title
Postoperative quality of life and pain after upper hemisternotomy and
conventional median sternotomy for aortic valve replacement: results of a
randomized clinical trial.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. 38(5) (no
pagination), 2024. Article Number: ivae083. Date of Publication: 01 May
2024.
Author
Klop I.D.G.; Van Putte B.P.; Kloppenburg G.T.L.; Klautz R.J.M.; Sprangers
M.A.G.; Nieuwkerk P.T.; Klein P.
Institution
(Klop, Van Putte, Kloppenburg, Klein) Department of Cardiothoracic
Surgery, St Antonius Hospital, Nieuwegein, Netherlands
(Van Putte, Klautz) Department of Cardiothoracic Surgery, AMC Heart
Centre, Amsterdam University Medical Center, Amsterdam, Netherlands
(Sprangers, Nieuwkerk) Department of Medical Psychology, Amsterdam UMC
Location University of Amsterdam, Amsterdam, Netherlands
(Sprangers) Department of Mental Health, Amsterdam Public Health,
Amsterdam, Netherlands
Publisher
Oxford University Press
Abstract
OBJECTIVES: Surgical aortic valve replacement through conventional
sternotomy yields excellent results. Minimally invasive techniques are
deemed equally safe and serve as a viable and less traumatic alternative.
However, it is unclear how both surgical techniques affect
patient-reported outcomes. The objective of this trial is to compare
postoperative cardiac-related quality of life and postoperative pain after
upper hemisternotomy and conventional surgical aortic valve replacement.
 METHOD(S): In this single-centre, open-label, investigator-initiated
randomized clinical trial, patients were randomized to upper
hemisternotomy or conventional full median sternotomy. Patients unable to
undergo randomization were monitored prospectively (registry group).
Primary outcome was cardiac-specific quality of life, measured with the
Kansas City Cardiomyopathy Questionnaire up to 1 year postoperatively.
 RESULT(S): Patients undergoing upper hemisternotomy had a
significantly higher physical limitation domain score across all
postoperative time points than patients undergoing conventional surgical
aortic valve replacement (estimated mean difference 2.12 points; P 1/4
0.014). Patients undergoing upper hemisternotomy were more likely to have
a pain score <30 the first 2 days postoperatively than patients undergoing
conventional surgical aortic valve replacement (odds ratio 2.63; P 1/4
0.007). This was associated with reduced opioid analgesic intake.
Postoperative surgical outcome did not differ between both groups.
 CONCLUSION(S): Surgical aortic valve replacement through both
conventional sternotomy and upper hemisternotomy resulted in clinically
similar and important improvements in quality of life, with a small
advantage for upper hemisternotomy, while there was no compromise in
safety. Copyright © The Author(s) 2024.

<110>
Accession Number
2031822137
Title
Thorax support vest to prevent sternal wound infections in cardiac surgery
patients-a systematic review and meta-analysis.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. 38(4) (no
pagination), 2024. Article Number: ivae055. Date of Publication: 01 Apr
2024.
Author
Caldonazo T.; Dell'Aquila M.; Cancelli G.; Harik L.; Soletti G.; Fischer
J.; Kirov H.; Rahouma M.; Ibrahim M.; Demetres M.; An K.R.; Girardi L.;
Doenst T.; Gaudino M.
Institution
(Caldonazo, Fischer, Kirov, Doenst) Department of Cardiothoracic Surgery,
Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
(Caldonazo, Dell'Aquila, Cancelli, Harik, Soletti, Rahouma, An, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New
York, NY, United States
(Ibrahim) Department of General Surgery, Maimonides Medical Center,
Brooklyn, NY, United States
(Ibrahim) Nuffield Department of Surgical Sciences, University of Oxford,
Oxford, United Kingdom
(Demetres) Samuel J. Wood Library & CV Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(An) Division of Cardiac Surgery, Department of Surgery, University of
Toronto, Toronto, ON, Canada
Publisher
Oxford University Press
Abstract
OBJECTIVES: Midline sternotomy is the main surgical access for cardiac
surgeries. The most prominent complication of sternotomy is sternal wound
infection (SWI). The use of a thorax support vest (TSV) that limits thorax
movement and ensures sternal stability has been suggested to prevent
postoperative SWI. METHOD(S): We performed a meta-analysis to
evaluate differences in clinical outcomes with and without the use of TSV
after cardiac surgery in randomized trials. The primary outcome was deep
SWI (DSWI). Secondary outcomes were superficial SWI, sternal wound
dehiscence, and hospital length of stay (LOS). A trial sequential analysis
was performed. Fixed (F) and random effects (R) models were calculated.
 RESULT(S): A total of 4 studies (3820 patients) were included.
Patients who wore the TSV had lower incidence of DSWI [odds ratio (OR) 1/4
F: 0.24, 95% confidence interval (CI), 0.13-0.43, P < 0.01; R: 0.24,
0.04-1.59, P 1/4 0.08], sternal wound dehiscence (OR 1/4 F: 0.08, 95% CI,
0.02-0.27, P < 0.01; R: 0.10, 0.00-2.20, P 1/4 0.08) and shorter hospital
LOS (standardized mean difference 1/4 F: -0.30, -0.37 to -0.24, P < 0.01;
R: -0.63, -1.29 to 0.02, P 1/4 0.15). There was no difference regarding
the incidence of superficial SWI (OR 1/4 F: 0.71, 95% CI, 0.34-1.47, P 1/4
0.35; R: 0.64, 0.10, 4.26, P 1/4 0.42). The trial sequential analysis,
however, showed that the observed decrease in DSWI in the TSV arm cannot
be considered conclusive based on the existing evidence.
 CONCLUSION(S): This meta-analysis suggests that the use of a TSV
after cardiac surgery could potentially be associated with a reduction in
sternal wound complications. However, despite the significant treatment
effect in the available studies, the evidence is not solid enough to
provide strong practice recommendations. Copyright © The
Author(s) 2024. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery.

<111>
Accession Number
2031335657
Title
Randomized comparison of oblique and perpendicular stabilizers for
minimally invasive repair of pectus excavatum.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. 38(3) (no
pagination), 2024. Article Number: ivae040. Date of Publication: 01 Mar
2024.
Author
Tedde M.L.; De Carvalho R.L.C.; De Campos J.R.M.; Da Silva D.A.G.; Okumura
E.M.; Guilherme G.F.; Marchesi A.C.; Petrizzo P.; Maior B.S.S.;
Pego-Fernandes P.M.
Institution
(Tedde, De Carvalho, De Campos, Da Silva, Okumura, Guilherme, Marchesi,
Petrizzo, Maior, Pego-Fernandes) Divisao Cirurgia Toracica, Instituto do
Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,
Universidade de Sao Paulo, SP, Sao Paulo, Brazil
(Tedde) Thoracic Surgery Division, Hospital Infantil Sabara, Sao Paulo,
Brazil
Publisher
Oxford University Press
Abstract
OBJECTIVES: Bar dislocation is one of the most feared complications of the
minimally invasive repair of pectus excavatum. METHOD(S): Prospective
randomized parallel-group clinical trial intending to assess whether
oblique stabilizers can reduce bar displacement in comparison with regular
stabilizers used in minimally invasive repair of pectus excavatum.
Additionally, we evaluated pain, quality of life and other postoperative
complications. Participants were randomly assigned to surgery with
perpendicular (n = 16) or oblique stabilizers (n = 14) between October
2017 and September 2018 and followed for 3 years. Bar displacements were
evaluated with the bar displacement index. Pain scores were evaluated
through visual analogue scale and quality of life through the Pectus
Excavatum Evaluation Questionnaire. RESULT(S): Control group average
displacement index was 17.7 (+/-26.7) and intervention group average
displacement index was 8.2 (+/- 10.9). There was 1 reoperation in each
group that required correction with 2 bars. Bar displacement was similar
among groups (P = 0.12). No other complications were recorded. There was
no statistically significant difference on pain score. There was a
significant difference between pre- and postoperative composite scores of
the participants' body image domain and psycho-social aspects in both
groups. The difference between the pre- and postoperative participants'
perception of physical difficulties was greater and statistically
significant in the intervention group. CONCLUSION(S): There was no
statistical difference in the use of perpendicular or oblique stabilizers,
but the availability of different models of stabilizers during the study
suggested that this can be advantageous. The trial is registered at
ClinicalTrials.gov, number NCT03087734. Copyright # The Author(s)
2024.

<112>
Accession Number
2029649264
Title
The impact of perioperative non-steroidal anti-inflammatory drugs use on
pleurodesis following thoracic surgery.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. 37(5) (no
pagination), 2023. Article Number: ivad107. Date of Publication: 01 Nov
2023.
Author
Kutywayo K.; Habib A.A.; Caruana E.J.
Institution
(Kutywayo, Habib, Caruana) Department of Thoracic Surgery, Glenfield
Hospital, University Hospitals Leicester, Leicester, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: in patients who have had
{visceral and parietal pleural symphysis}, {do NSAIDs reduce} {the
efficacy of pleurodesis}? Sixteen papers were discovered in the search. Of
these, 3 human studies were included in the analysis. None showed a
significantly higher rate of pleurodesis failure in patients given
perioperative NSAIDs. The results from the largest study met criteria for
noninferiority. Within the constraints of the study, the results suggest
that systemic administration of nonsteroidal anti-inflammatory medication
in the perioperative period does not necessarily attenuate effective
pleurodesis. However, further study is needed as there is a clear paucity
of human-based studies. Copyright © 2023 The Author(s).

<113>
Accession Number
2026748415
Title
Impact of Complete Revascularization in the ISCHEMIA Trial.
Source
Journal of the American College of Cardiology. 82(12) (pp 1175-1188),
2023. Date of Publication: 19 Sep 2023.
Author
Stone G.W.; Ali Z.A.; O'Brien S.M.; Rhodes G.; Genereux P.; Bangalore S.;
Mavromatis K.; Horst J.; Dressler O.; Poh K.K.; Nath R.K.; Moorthy N.;
Witkowski A.; Dwivedi S.K.; Bockeria O.; Chen J.; Smanio P.E.P.; Picard
M.H.; Chaitman B.R.; Berman D.S.; Shaw L.J.; Boden W.E.; White H.D.;
Fremes S.E.; Rosenberg Y.; Reynolds H.R.; Spertus J.A.; Hochman J.S.;
Maron D.J.; Boden W.; Harrington R.; Williams D.; Alexander K.P.; Berger
J.; Mark D.; Ballantyne C.; Beyar R.; Bhargava B.; Buller C.; Carvalho
A.T.; Diaz R.; Doerr R.; Dzavik V.; Goodman S.; Gosselin G.; Hachamovitch
R.; Hamm C.; Held C.; Helm M.; Huber K.; Jiang L.; Keltai M.; Kohsaka S.;
Lang I.; Lopes R.; Maggioni A.; Mancini J.; Bairey Merz C.N.; Min J.;
Peterson E.; Ruzyllo W.; Selvanayagam J.; Senior R.; Sharir T.; Steg G.;
Szwed H.; Van de Werf F.; Weintraub W.; White H.; Calfas K.; Champagne
M.A.; Davidson M.; Fleg J.; McCullough P.A.; Newman J.; Stone P.; Menasche
P.; Fremes S.; Guyton R.; Mack M.; Mohr F.; Rao A.; Sabik J.; Shapira O.;
Taggart D.; Tatoulis J.; Blankenship J.; Brener S.; Colombo A.; de Bruyne
B.; Kereiakes D.; Lefevre T.; Moses J.; Mahaffey K.; Cruz-Flores S.;
Danchin N.; Feen E.; Garcia M.J.; Hauptman P.; Laddu A.A.; Passamani E.;
Pina I.L.; Simoons M.; Skali H.; Thygesen K.; Waters D.; Endsley P.;
Esposito G.; Kanters J.; Pownall J.; Stournaras D.; Friedrich M.; Kwong
R.; Oliver D.; Harrell F.; Blume J.; Lee K.; Kullo I.; McManus B.; Newby
K.; Cohen D.; Bugiardini R.; Celutkiene J.; Escobedo J.; Hoye A.;
Lyubarova R.; Mattina D.; Peteiro J.; Smanio P.; Berman D.; Leipsic J.;
Mathew R.; Sidhu M.; Friedman L.; Anderson J.; Berg J.; DeMets D.; Gibson
C.M.; Lamas G.; Deming N.; Himmelfarb J.; Ouyang P.; Woodard P.; Nwosu S.;
Kirby R.; Jeffries N.; Denaro J.E.; Mavromichalis S.; Chan K.; Cobb G.;
Contreras A.; Cukali D.; Ferket S.; Gabriel A.; Hansen A.; Roberts A.;
Naumova A.; Chang M.; Islam S.; Wayser G.; Yakubov S.; Yee M.; Callison
C.; Hogan I.; Qelaj A.; Pirro C.; Van Loo K.; Wisniewski B.; Gilsenan M.;
Lang B.; Mohamed S.; Esquenazi-Karonika S.; Mathews P.; Setang V.; Xavier
M.; Bagai A.; Broderick S.; Crowder M.; Cyr D.; Garg J.; Gu X.; Hatch L.;
Heath A.; Huang Z.; Leimberger J.; Marcus J.; Page C.; Parker W.; Pennachi
W.; Rockhold F.; Stevens S.; Stone A.; Thompson O.; Ussery S.; White J.;
Williams M.K.; Xing W.; Zhu S.; Anstrom K.; Baloch K.; Blount J.; Cowper
P.; Davidson-Ray L.; Drew L.; Harding T.; Knight J.D.; Minshall Liu D.;
O'Neal B.; Redick T.; Jones P.; Nugent K.; Jingyan Wang G.; Phillips L.;
Goyal A.; Hetrick H.; Hayes S.W.; Friedman J.D.; Gerlach R.J.; Hyun M.;
Miranda-Peats R.; Slomka P.; Thomson L.; Mongeon F.P.; Michael S.; Hung
J.; Scherrer-Crosbie M.; Zeng X.; Eckstein J.; Guruge B.; Streif M.;
Alfonso M.A.; Corral M.P.; Garcia J.J.; Jankovic I.; Konigstein M.; Lustre
M.B.; Peralta Y.; Sanchez R.; Arsanjani R.; Budoff M.; Elmore K.; Gomez
M.; Hague C.; Hindoyan N.; Mancini G.J.; Nakanishi R.; Srichai-Parsia
M.B.; Yeoh E.; Youn T.; Maggioni A.P.; Bianchini F.; Ceseri M.; Lorimer
A.; Magnoni M.; Orso F.; Sarti L.; Tricoli M.; Carvalho A.; Barbosa L.M.;
Bello Duarte T.; Colaiacovo Soares T.; de Aveiro Morata J.; Carvalho P.;
de Carvalho Maffei N.; Egydio F.; Kawakami A.; Oliveira J.; Restelli
Piloto E.; Pozzibon J.; Camara D.; Mowafy N.; Spindler C.; Dai H.; Feng
F.; Li J.; Li L.; Liu J.; Xie Q.; Zhang H.; Zhang J.; Zhang L.; Zhang N.;
Zhong H.; Escobar C.; Martin M.E.; Pascual A.; Lopez-Sendon J.; Moraga P.;
Hernandez V.; Castro A.; Posada M.; Fernandez S.; Narro Villanueva J.L.;
Selgas R.; Abergel H.; Juliard J.M.; Alsweiler C.; Claes K.; Goetschalckx
K.; Luyten A.; Robesyn V.; Murphy D.; Garcevic N.; Stojkovic J.; Ahmed A.;
Bhatt R.; Chadha N.; Kumar V.; Lubna S.; Naik P.; Pandey S.; Ramasamy K.;
Saleem M.; Sharma P.; Siddaram H.
Institution
(Stone, Shaw) The Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Ali) St Francis Hospital, Roslyn, NY, United States
(Ali, Horst, Dressler) Cardiovascular Research Foundation, New York, NY,
United States
(O'Brien, Rhodes) Duke Clinical Research Institute, Durham, NC, United
States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Bangalore, Reynolds, Hochman) NYU Grossman School of Medicine, New York,
NY, United States
(Mavromatis) Emory University School of Medicine, Atlanta, GA, United
States
(Poh) National University Heart Center Singapore and the Yong Loo Lin
School of Medicine, National University of Singapore, Singapore
(Nath) Dr Ram Manohar Lohia Hospital, New Delhi, India
(Moorthy) Sri Jayadeva Institute of Cardiovascular Sciences and Research,
Karnataka, Bangalore-Karnataka, India
(Witkowski) National Institute of Cardiology, Warsaw, Poland
(Dwivedi) King George Medical University, Lucknow Up, India
(Bockeria) National Research Center for Cardiovascular Surgery, Moscow,
Russian Federation
(Chen) Guangdong Provincial People's Hospital, Guangdong, China
(Smanio) Instituto Dante Pazzanese de Cardiologia e Fleury Medicina e
Saude, Sao Paulo, Brazil
(Picard) Massachusetts General Hospital and Harvard Medical School,
Boston, MA, United States
(Chaitman) St Louis University School of Medicine Center for Comprehensive
Cardiovascular Care, St Louis, MO, United States
(Berman) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Boden) Boston University School of Medicine, Boston, MA, United States
(White) Auckland City Hospital Green Lane Cardiovascular Services and
University of Auckland, Auckland, New Zealand
(Fremes) University of Toronto, Sunnybrook Health Sciences Centre,
Toronto, ON, Canada
(Rosenberg) National Heart, Lung, and Blood Institute, Washington, DC,
United States
(Spertus) Saint Luke's Mid America Heart Institute and the University of
Missouri, Kansas City, Kansas City, MO, United States
(Maron) Department of Medicine, Stanford School of Medicine, Stanford, CA,
United States
Publisher
Elsevier Inc.
Abstract
Background: Anatomic complete revascularization (ACR) and functional
complete revascularization (FCR) have been associated with reduced death
and myocardial infarction (MI) in some prior studies. The impact of
complete revascularization (CR) in patients undergoing an invasive (INV)
compared with a conservative (CON) management strategy has not been
reported. Objective(s): Among patients with chronic coronary disease
without prior coronary artery bypass grafting randomized to INV vs CON
management in the ISCHEMIA (International Study of Comparative Health
Effectiveness with Medical and Invasive Approaches) trial, we examined the
following: 1) the outcomes of ACR and FCR compared with incomplete
revascularization; and 2) the potential impact of achieving CR in all INV
patients compared with CON management. Method(s): ACR and FCR in the
INV group were assessed at an independent core laboratory.
Multivariable-adjusted outcomes of CR were examined in INV patients.
Inverse probability weighted modeling was then performed to estimate the
treatment effect had CR been achieved in all INV patients compared with
CON management. Result(s): ACR and FCR were achieved in 43.4% and
58.4% of 1,824 INV patients. ACR was associated with reduced 4-year rates
of cardiovascular death or MI compared with incomplete revascularization.
By inverse probability weighted modeling, ACR in all 2,296 INV patients
compared with 2,498 CON patients was associated with a lower 4-year rate
of cardiovascular death or MI (difference -3.5; 95% CI: -7.2% to 0.0%). In
comparison, the event rate difference of cardiovascular death or MI for
INV minus CON in the overall ISCHEMIA trial was -2.4%. Results were
similar but less pronounced with FCR. Conclusion(s): The outcomes of
an INV strategy may be improved if CR (especially ACR) is achieved.
(International Study of Comparative Health Effectiveness With Medical and
Invasive Approaches [ISCHEMIA]; NCT01471522) Copyright © 2023
American College of Cardiology Foundation

<114>
Accession Number
2035610186
Title
Continuation versus discontinuation of renin-angiotensin aldosterone
system inhibitors before non-cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of Clinical Anesthesia. 99 (no pagination), 2024. Article Number:
111679. Date of Publication: December 2024.
Author
Ahmed M.; Fatima E.; Shafiq A.; Ahsan A.; Zulfiqar E.; Masood F.; Ahmed
R.; Yasmin F.; Asghar M.S.
Institution
(Ahmed) Department of Medicine, Rawalpindi Medical University, Rawalpindi,
Pakistan
(Fatima) Department of Medicine, Services Institute of Medical Sciences,
Lahore, Pakistan
(Shafiq, Zulfiqar) Department of Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Ahsan) Department of Medicine, Foundation University Medical College,
Islamabad, Pakistan
(Masood) Department of Anesthesia, King Abdulaziz Medical City, Riyadh,
Saudi Arabia
(Ahmed) Department of Cardiology, Royal Brompton Hospital, London, United
Kingdom
(Ahmed) Department of Cardiology, National Heart and Lung Institute,
Imperial College London, United Kingdom
(Yasmin) Department of Internal Medicine, Yale University School of
Medicine, New Haven, CT, United States
(Asghar) Division of Nephrology and Hypertension, Mayo Clinic, Rochester,
MN, United States
(Asghar) Department of Internal Medicine, AdventHealth, Sebring, FL,
United States
Publisher
Elsevier Inc.
Abstract
Background: A large number of patients undergoing noncardiac surgeries are
on long-term use of angiotensin-converting enzyme inhibitors (ACEi) or
angiotensin receptor blockers (ARBs). The current guidelines regarding the
continuation or discontinuation of renin-angiotensin-aldosterone system
inhibitors (RAAS) inhibitors before noncardiac surgery are conflicting.
This meta-analysis aims to evaluate whether continuing or withholding RAAS
inhibitors before noncardiac surgery influences perioperative mortality
and complications. Method(s): A thorough literature search was
performed across PubMed/MEDLINE, Embase, and the Cochrane Library from
their inception up to August 30, 2024 to identify eligible randomized
controlled trials (RCTs) and cohort studies. Clinical outcomes were
evaluated using a random-effects model to pool odds ratios (ORs) with 95 %
confidence intervals (CIs). Result(s): The analysis included 16
studies with a total of 59,105 patients on RAAS inhibitors before
noncardiac surgery. Withholding RAAS inhibitors was associated with a
significantly lower incidence of intraoperative hypotension (OR = 0.49; 95
% CI = 0.29 to 0.83) and acute kidney injury (AKI) (OR = 0.88; 95 % CI =
0.82 to 0.95) than continuing the therapy. However, there was no
statistically significant difference in reducing mortality (OR = 1.10; 95
% CI = 0.86 to 1.40), major adverse cardiovascular events (MACE) (OR =
1.27; 95 % CI = 0.75 to 2.16), myocardial infarction (OR = 0.83; 95 % CI =
0.27 to 2.59) or stroke events (OR = 0.70; 95 % CI = 0.36 to 1.36) between
the two groups. Conclusion(s): Withholding RAAS inhibitors before
noncardiac surgery reduces intraoperative hypotension and AKI with
nonsignificant effects on mortality and MACE. Copyright © 2024

<115>
Accession Number
2032194146
Title
Transcatheter Repair of Tricuspid Valve Regurgitation: A Systematic
Review.
Source
Journal of Clinical Medicine. 13(21) (no pagination), 2024. Article
Number: 6531. Date of Publication: November 2024.
Author
Srinivasan A.; Brown J.; Rhodes A.; Khan S.; Chinta V.; Loyalka P.; Kumar
A.
Institution
(Srinivasan, Brown, Rhodes) Department of Cardiology, HCA Houston
Healthcare Medical Center, Tilman J. Fertitta Family College of Medicine,
The University of Houston, Houston, TX 77004, United States
(Khan) Department of Internal Medicine, HCA Houston Healthcare Clear Lake,
Tilman J. Fertitta Family College of Medicine, The University of Houston,
Houston, TX 77004, United States
(Chinta, Loyalka, Kumar) Structural Heart & Valve Center, Houston Heart,
HCA Houston Healthcare Medical Center, Tilman J. Fertitta Family College
of Medicine, The University of Houston, Houston, TX 77004, United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Introduction: Clinically significant severe tricuspid regurgitation (TR)
is a common untreated pathology associated with increased mortality. Even
though surgical valve replacement has been the mainstay option,
transcatheter intervention is a novel and potentially effective tool. To
the best of our knowledge, this is the first systematic review that
assessed and compared clinical and echocardiographic outcomes of
coaptation and annuloplasty devices in patients with clinically
significant TR. Method(s): PubMed, the Cochrane Central Register of
Controlled Trials, and EMBASE were searched for articles published from
August 2016 until February 2023. Primary endpoints were technical and
procedural successes. Secondary endpoints were TR grade, NYHA, change in 6
min walk distance (6MWD), and echocardiographic parameters at 30-day
follow-up. Result(s): We included thirty-eight studies consisting of
2273 patients with severe symptomatic TR (NYHA III-IV 77% and
severe/massive/torrential TR 83.3%) and high surgical risk (mean EUROSCORE
of 7.54). The technical success for the annuloplasty devices was 96.7% and
for the coaptation device was 94.8%. The procedural success for the
annuloplasty devices was 64.6% and for the coaptation device was 81.4%.
The 6MWD increased by 17 m for the coaptation devices and increased by 44
m after 30 days for the annuloplasty devices. A reduction in TR grade to
<2 was seen in 70% of patients with coaptation and 59% of patients with
annuloplasty devices. Conclusion(s): Transcatheter tricuspid valve
intervention appears to be feasible and is associated with favorable
outcomes. Copyright © 2024 by the authors.

<116>
Accession Number
2032189489
Title
Efficacy and Safety of Cardioband in Patients with Tricuspid
Regurgitation: Systematic Review and Meta-Analysis of Single-Arm Trials
and Observational Studies.
Source
Journal of Clinical Medicine. 13(21) (no pagination), 2024. Article
Number: 6393. Date of Publication: November 2024.
Author
Piragine E.; Veneziano S.; Trippoli S.; Messori A.; Calderone V.
Institution
(Piragine, Veneziano, Calderone) Department of Pharmacy, University of
Pisa, Pisa 56126, Italy
(Piragine) Specialization School in Hospital Pharmacy, University of Pisa,
Pisa 56126, Italy
(Trippoli, Messori) HTA Unit, Centro Operativo, Regione Toscana, Firenze
50136, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: The incidence and prevalence of tricuspid
regurgitation (TR) are increasing worldwide. "Traditional" drug therapy
with diuretics is often ineffective and the identification of new
strategies, including non-pharmacological ones, is an urgent need. The aim
of this study was to summarize the results on the efficacy and safety of
Cardioband, one of the few approved transcatheter tricuspid valve repair
systems, in patients with TR. Method(s): Three databases (Medline,
Scopus, and CENTRAL) were searched to identify clinical trials and
observational studies on the efficacy (primary outcome) and safety
(secondary outcome) of Cardioband. A random-effects meta-analysis was
performed with R software (version 4.3.3). Survival and freedom from heart
failure (HF) hospitalization were estimated with the method of
reconstructing individual patient data from Kaplan-Meier curves
(IPDfromKM). Result(s): Eleven studies were included in this
systematic review and meta-analysis. Cardioband significantly reduced
annulus diameter (-9.31 mm [95% Confidence Interval, CI: -11.47; -7.15]),
vena contracta (-6.41 mm [95% CI: -8.34; -4.49]), and effective
regurgitant orifice area (EROA) (-0.50 cm2 [95% CI: -0.72;
-0.28]) in patients with TR. Cardioband reduced the severity of TR and the
extent of heart failure in 91% [95% CI: 85; 97] and 63% [95% CI: 52-75] of
patients, respectively. Finally, Cardioband implantation was associated
with prolonged survival and freedom from HF hospitalization (80.1% and
57.8% at 24 months, respectively). Conclusion(s): This study
demonstrates that Cardioband implantation leads to cardiac remodeling and
mechanical improvements, reduces the severity of TR, and improves quality
of life. Therefore, Cardioband is an effective option for the
non-pharmacological treatment of TR. Copyright © 2024 by the
authors.

<117>
Accession Number
2032188910
Title
Brainstem Anesthesia and Cardiac Arrest Following Peribulbar Block: A Case
Report and Systematic Review of the Literature.
Source
Journal of Clinical Medicine. 13(21) (no pagination), 2024. Article
Number: 6572. Date of Publication: November 2024.
Author
Ripa M.; Schipa C.; Aceto P.; Kanikaram G.; Shah N.A.
Institution
(Ripa, Kanikaram, Shah) Department of Ophthalmology, Sankara Eye Hospital,
Rajasthan, Jaipur 302039, India
(Schipa, Aceto) Catholic University "Sacro Cuore", Lazio, Rome 00168,
Italy
(Schipa, Aceto) Department of Emergency, Anesthesiological and Reanimation
Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Lazio,
Rome 00168, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: We report a case of brainstem anesthesia (BSA) and subsequent
cardiac arrest following a routinary peribulbar block (PB) in a patient
scheduled for cataract extraction and intraocular lens (IOL) implantation,
thus providing a reference for further analysis of this potentially
catastrophic life-threatening complication and to evaluate the current
knowledge in terms of incidence, physiopathology management, and treatment
of the BSA following PB. Method(s): Three databases (PubMed, Embase,
and Scopus) were checked to perform a systematic review of all available
studies in the English Language following the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate
relevant studies that clearly described BSA following BSA. Result(s):
Our literature search identified 15 cases. All the patients experienced
BSA-related symptoms, including respiratory arrest, seizure, heart rate,
and blood pressure abnormalities. All the patients with respiratory arrest
required assisted ventilation with intubation, whereas patients with
seizures were administered intravenous midazolam. Only one patient
experienced cardiac arrest and underwent cardiac resuscitation. Surgery
was aborted and deferred in 5 out of 15 patients, whereas 4 out of 15
underwent surgery after extubation. Conclusion(s): Despite the BSA
incidence after the PB being very low, this possible life-threatening rare
event should be considered in patients losing their consciousness and
becoming apneic after the block. Therefore, prompt recognition and
immediate treatment are paramount to cope with this potentially
catastrophic scenario and save the patient's life. Copyright ©
2024 by the authors.

<118>
Accession Number
2032072970
Title
3D vs. 2D-4 K: Performance and self-perception of laparoscopic novices in
a randomized prospective teaching intervention using standard tasks and
box trainers.
Source
Langenbeck's Archives of Surgery. 409(1) (no pagination), 2024. Article
Number: 330. Date of Publication: December 2024.
Author
Kolbel B.; Ragnitz J.; Schale K.; Witzenhausen M.; Axt S.; Beltzer C.
Institution
(Kolbel, Witzenhausen, Beltzer) Department of General, Visceral and
Thoracic Surgery, German Armed Forces Hospital Ulm, Oberer Eselsberg 40,
Ulm 89081, Germany
(Ragnitz) School of Medicine, HMU Health and Medical University,
Olympischer Weg 1, Potsdam 14471, Germany
(Schale) Department for Trauma Surgery and Orthopedics, Reconstructive and
Septic Surgery, Sportstraumatology, German Armed Forces Hospital Ulm,
Oberer Eselsberg, 40, Ulm 89081, Germany
(Axt) Department of General, Visceral and Transplant Surgery, Tubingen
University Hospital, Hoppe-Seyler-Str. 3, Tubingen 72076, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objective: The use of three-dimensional (3D) laparoscopy in surgical
practice and training has been an area of research and discussion. Studies
have suggested that 3D vision can improve speed and precision compared to
traditional two-dimensional (2D) displays, while other authors found no
benefits on the learning curves of laparoscopic novices. Modern
two-dimensional laparoscopy with a resolution of 3840 x 2160 pixels (2D-4
K) seems to improve laparoscopic view and helps learners orient without
stereopsis. However, evidence comparing these systems for laparoscopic
training is limited. Therefore, the impact of viewing mode (2D-4 K vs. 3D)
on learning and task proficiency remains unclear. Design(s): We
performed a two-hour teaching intervention on basic laparoscopic skills
for novices. In this parallel group randomized study, we randomly assigned
learners to 2D-4 K or 3D teaching and performed tasks of increasing
difficulty and complexity using standard laparoscopy box trainers. Before
the last and most challenging task, learners had to crossover to the other
laparoscopy setup. Our hypothesis was that learners would be faster and
more precise when using a 3D setup. The primary endpoint was task
proficiency measured by speed and failure rate. Secondary outcomes were
performance using the viewing mode of the other group without
familiarization, self-perception, and career aspirations before and after
the teaching intervention, expressed on a Likert scale. Setting(s):
The study was performed by the Department of General, Visceral and
Thoracic Surgery at the German Armed Forces Hospital Ulm, which is an
academic teaching hospital of the University of Ulm. Participant(s):
Thirty-eight laparoscopic novices, including medical students and junior
residents, participated voluntarily in this teaching intervention. Group
allocation was performed via the virtual coin flip method. Apparently,
participants and tutors were not blinded to group assignment. No formal
approval by the ethics committee was needed for this noninvasive study in
compliance with the World Medical Association Declaration of Helsinki as
discussed with the ethics committee of the University of Ulm.
 Result(s): Thirty-eight laparoscopy novices were randomized in the
study. The 3D group (n = 19) was significantly faster than the 2D-4 K
group (n = 19) (p =.008) in a standard box trainer model, with 134.45 +/-
41.45 s vs. 174.99 +/- 54.03 s for task 1 and 195.97 +/- 49.78 s vs.
276.56 +/- 139.20 s for task 2, and the effect was consistent throughout
the learning curve. The failure rate was not significantly affected by the
viewing mode. After crossover to the other laparoscopy system, precision
and time were not significantly different between the groups. Learners
rated the difficulty of laparoscopy lower on a Likert scale after having
two hours of basic laparoscopy training. The study was funded by the
hospital's teaching budget. Conclusion(s): Laparoscopic novices can
benefit from a 3D laparoscopy training setup. Exclusive 3D training prior
to a complex task on a 2D-4 K setup does not negatively affect the
learner's performance. Copyright © The Author(s) 2024.

<119>
Accession Number
2031762753
Title
Identification of Psychosocial Issues in Pediatric Patients Undergoing or
Waiting for Organ Transplant: A Systematic Review.
Source
Experimental and Clinical Transplantation. 22(10 Supplement 5) (pp
132-138), 2024. Date of Publication: October 2024.
Author
Ucgun T.; Koyuncu I.E.; Koc E.; Kilinc B.S.; Saridag K.N.K.
Institution
(Ucgun, Saridag) Psychiatric and Mental Health Nursing Department, the
Baskent University, Faculty of Health Sciences, Ankara, Turkey
(Koyuncu) Pediatric Nursing Department, the Baskent University, Faculty of
Health Sciences, Ankara, Turkey
(Koc) Public Health Nursing Department, the Baskent University, Faculty of
Health Sciences, Ankara, Turkey
(Kilinc) Fundamentals of Nursing Department, Baskent University, Faculty
of Health Sciences, Ankara, Turkey
Publisher
Baskent University
Abstract
Objectives: Despite increased rates of survival, pediatric organ
transplant is characterized by clinical complexities and psychosocial
challenges. Understanding and addressing the psychosocial issues inherent
in this population are crucial for optimizing their overall well-being and
transplant outcomes. In this systematic review, we thus aimed to provide a
comprehensive analysis of the psychosocial issues encountered by pediatric
patients undergoing or awaiting organ transplant. Material(s) and
Method(s): This systematic review was conducted by retrospectively
searching PubMed, Scopus, ScienceDirect, and Cochrane electronic databases
using the keywords "pediatric kidney transplantation" or "pediatric liver
transplantation" or "pediatric heart transplantation" and "psychosocial
problems" or "psychosocial issues" or "psychosocial outcomes" or
"psychosocial needs." The literature review resulted in 3746 initial
studies, with 6 studies included in this systematic review.
 Result(s): Examination of psychosocial problems experienced by
pediatric organ transplant recipients in included studies showed factors
such as depression, anxiety, quality of life, medication adherence,
psychological distress, children's psychosocial characteristics, healthy
behaviors, mental and somatic well-being, fear of rejection, fear of
recurrence, fear of secondary diseases, sleep problems, sadness, and
exhaustion. Conclusion(s): Pediatric organ transplant intertwines
complex medical procedures with intricate psychosocial dynamics, placing
nurses at the forefront of care delivery for pediatric transplant
recipients and their families. In embracing a holistic approach to care,
nurses advocate for the integration of psychosocial support into standard
practice protocols, recognizing that optimal health outcomes extend beyond
physiological parameters. Copyright © Baskent University 2024
Printed in Turkey. All Rights Reserved.

<120>
Accession Number
2031275600
Title
The Impact of Different Regional Anesthesia Techniques on the Incidence of
Chronic Post-surgical Pain in Patients Undergoing Video-Assisted
Thoracoscopic Surgery: A Network Meta-analysis.
Source
Pain and Therapy. 13(6) (pp 1335-1350), 2024. Date of Publication:
December 2024.
Author
Zhao Y.; Guo Y.; Pan X.; Zhang X.; Yu F.; Cao X.
Institution
(Zhao, Pan, Zhang, Yu, Cao) Department of Anesthesiology, The First
Hospital of China Medical University, Shenyang 110001, China
(Guo) Department of General Surgery, Hepatobiliary and Splenic Surgery
Ward, Shengjing Hospital of China Medical University, Shenyang, China
Publisher
Adis
Abstract
Introduction: Chronic post-surgical pain (CPSP) remains a prevalent issue
following video-assisted thoracic surgery (VATS), despite advancements in
surgical techniques. Various regional anesthesia techniques, including
thoracic paravertebral block (PVB), intercostal nerve block (ICNB),
serratus anterior plane block (SAPB), erector spinae plane block (ESPB),
and thoracic epidural anesthesia (TEA), have been employed in VATS
procedures to mitigate this issue. This study aims to compare the efficacy
of these analgesia methods in reducing the incidence of CPSP in VATS
patients through a network meta-analysis. Method(s): A systematic
search was conducted in PubMed, the Cochrane Library, and EMBASE for
randomized controlled trials (RCTs) comparing the incidence of CPSP
associated with PVB, ICNB, SAPB, ESPB, and TEA. The occurrence of CPSP was
evaluated at both 2-3 months and 6 months post-surgery. Result(s):
Six RCTs, involving 652 patients, were included in the analysis of CPSP
incidence at 2-3 months, while seven RCTs, involving 715 patients, were
included for 6 months analysis. PVB, ICNB, or TEA reduced CPSP incidence
compared with control group (without regional anesthesia techniques) at
both 2-3 months and 6 months post-surgery. However, SAPB was found less
effective in reducing CPSP incidence at 2-3 months post-VATS compared to
PVB, ICNB, or TEA. Conclusion(s): PVB, ICNB, and TEA exhibit
significant effects on reducing CPSP incidence following VATS. Conversely,
SAPB is not recommended for reducing CPSP incidence post-VATS.
Nonetheless, considering the limitation of a small sample size in this
network meta-analysis, additional RCTs are necessary to validate these
conclusions and enhance the management of CPSP after VATS. Copyright
© The Author(s) 2024.

<121>
Accession Number
2035525063
Title
Heart failure with preserved ejection fraction management: a systematic
review of clinical practice guidelines and recommendations.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 10(7) (pp
571-589), 2024. Date of Publication: 01 Nov 2024.
Author
Mahmood A.; Dhall E.; Primus C.P.; Gallagher A.; Zakeri R.; Mohammed S.F.;
Chahal A.A.; Ricci F.; Aung N.; Khanji M.Y.
Institution
(Mahmood, Chahal, Aung, Khanji) William Harvey Research Institute, NIHR
Barts Biomedical Research Centre, Queen Mary University of London,
Charterhouse Square, London EC1M 6BQ, United Kingdom
(Mahmood, Dhall, Gallagher, Khanji) Newham University Hospital, Barts
Health NHS Trust, Glen Road, London E13 8SL, United Kingdom
(Primus, Gallagher, Chahal, Aung, Khanji) Barts Heart Centre, St
Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London
EC1A 7BE, United Kingdom
(Zakeri) School of Cardiovascular Medicine & Sciences, James Black Centre,
King's College London, 125 Coldharbour Lane, London SE5 9NU, United
Kingdom
(Mohammed) Department of Cardiology, Creighton University School of
Medicine, Omaha, NE 68124, United States
(Chahal) Department of Cardiovascular Medicine, Mayo Clinic, 200 First
Str, SW, Rochester, MN 55905, United States
(Chahal) Center for Inherited Cardiovascular Diseases, Department of
Cardiology, WellSpan Health, 30 Monument Rd, York, PA 17403, United States
(Ricci) Department of Neuroscience, Imaging and Clinical Sciences, "G.
d'Annunzio" University of Chieti-Pescara, Via dei Vestini 33, Chieti
66100, Italy
(Ricci) University Cardiology Division, SS Annunziata Polyclinic
University Hospital, Via dei Vestini 5, Chieti 66100, Italy
(Ricci) Department of Clinical Sciences, Lund University, Jan Waldenstroms
Gata 35, Malmo 21428, Sweden
Publisher
Oxford University Press
Abstract
Multiple guidelines exist for the diagnosis and management of heart
failure with preserved ejection fraction (HFpEF). We systematically
reviewed current guidelines and recommendations, developed by national and
international medical organizations, on the management of HFpEF in adults
to aid clinical decision-making. We searched MEDLINE and EMBASE on 28
February 2024 for publications over the last 10 years as well as websites
of organizations relevant to guideline development. Of the 10 guidelines
and recommendations retrieved, 7 showed considerable rigour of development
and were subsequently retained for analysis. There was consensus on the
definition of HFpEF and the diagnostic role of serum natriuretic peptides
and resting transthoracic echocardiography. Discrepancies were identified
in the thresholds of serum natriuretic peptides and transthoracic
echocardiography parameters used to diagnose HFpEF. There was agreement on
the general pharmacological and supportive management of acute and chronic
HFpEF. However, differences exist in strategies to identify and address
specific phenotypes. Contemporary guidelines for HFpEF management agree on
measures to avoid its development and the consideration of cardiac
transplantation in advanced diseases. There were discrepancies in
recommended frequency of surveillance for patients with HFpEF and sparse
recommendations on screening for HFpEF in the general population, use of
diagnostic scoring systems, and the role of newly emerging
therapies. Copyright © The Author(s) 2024. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<122>
Accession Number
2035525061
Title
Catheter ablation as an adjunctive therapy to ICD implantation in Brugada
Syndrome.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 10(7) (pp
590-601), 2024. Date of Publication: 01 Nov 2024.
Author
Doundoulakis I.; Chiotis S.; Pannone L.; Della Rocca D.G.; Sorgente A.;
Kordalis A.; Scacciavillani R.; Zafeiropoulos S.; Marcon L.; Vetta G.;
Pagkalidou E.; Bala G.; Almorad A.; Stroker E.; Sieira J.; La Meir M.;
Brugada P.; Tsiachris D.; Sarkozy A.; Chierchia G.B.; de Asmundis C.
Institution
(Doundoulakis, Chiotis, Pannone, Della Rocca, Sorgente, Scacciavillani,
Marcon, Vetta, Bala, Almorad, Stroker, Sieira, Brugada, Sarkozy,
Chierchia, de Asmundis) Heart Rhythm Management Centre, Postgraduate
Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis
Brussel, Vrije Universiteit Brussel, European Reference Networks
Guard-Heart, Brussels 1090, Belgium
(Kordalis, Tsiachris) First University Department of Cardiology, National
and Kapodistrian University of Athens, "Hippokration" General Hospital,
Athens 11527, Greece
(Scacciavillani) Department of Cardiovascular & Pulmonary Sciences,
Catholic University of the Sacred Heart, Rome 00168, Italy
(Zafeiropoulos) Department of Cardiology, University Hospital of Zurich,
Zurich 8091, Switzerland
(Pagkalidou) Department of Hygiene, Social-Preventive Medicine & Medical
Statistics, School of Medicine, Aristotle University of Thessaloniki,
Thessaloniki 54124, Greece
(La Meir) Cardiac Surgery Department, Universitair Ziekenhuis Brussel,
Vrije Universiteit Brussel, Brussels 1090, Belgium
Publisher
Oxford University Press
Abstract
Background Brugada Syndrome (BrS) is a life-threatening cardiac arrhythmia
disorder associated with an increased risk of ventricular arrhythmias
(VAs) and sudden cardiac death. Current management primarily relies on
implantable cardioverter-defibrillators (ICDs), but patients may
experience ICD shocks. Catheter ablation (CA) has emerged as a potential
intervention to target the arrhythmogenic substrate. This systematic
review aims to evaluate the safety and efficacy of CA in BrS patients.
Methods and Studies with BrS patients undergoing CA for VAs were included.
Fourteen studies that involved a total population of results 709 BrS
patients, with CA performed in 528 of them, were included. CA resulted in
the non-inducibility of VAs in 91% (95% CI: 83-99, I2 = 76%)
and resolution of type 1 ECG Brugada pattern in 88% (95% CI: 81-96.2,
I2 = 91%) of the patients. After a mean follow-up of 30.7
months, 87% (95% CI: 80-94, I2 = 82%) of patients remained free
from VAs. The incidence of VAs during follow-up was significantly lower in
the ablation cohort in comparison to the group receiving only ICD therapy
(OR = 0.03, 95% CI: 0.01-0.12, I2 = 0%). Conclusion CA shows
potential as a therapeutic approach to reduce VAs and improve outcomes in
BrS patients. While further research with a long follow-up period is
required to confirm these findings, it represents a valuable tool as an
add-on intervention to ICD implantation in BrS patients with a high burden
of VAs. Copyright © The Author(s) 2024. Published by Oxford
University Press on behalf of the European Society of Cardiology. All
rights reserved.

<123>
[Use Link to view the full text]
Accession Number
2035500459
Title
Effects of cognitive training on cognitive function in patients after
cardiac surgery A systematic review and meta-analysis of randomized
controlled trials.
Source
Medicine (United States). 103(44) (no pagination), 2024. Article Number:
e40324. Date of Publication: 01 Nov 2024.
Author
Zhang R.; Zhu C.; Chen S.; Tian F.; Huang P.; Chen Y.
Institution
(Zhang, Tian, Huang, Chen) Xiamen Cardiovascular Hospital, Xiamen
University, Xiamen, China
(Zhang, Zhu, Chen, Tian, Chen) School of Nursing, Fujian University of
Traditional Chinese Medicine, Fuzhou, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative cognitive deficits frequently occur in patients
undergoing cardiac surgery, leaving them with reduced cognitive function.
Cognitive training has been shown to improve cognitive function, however,
the role in patients after cardiac surgery is unclear. In this study, we
aimed to evaluate the effectiveness and safety of cognitive training in
patients undergoing cardiac surgery. Method(s): A systematic search
of PubMed, Embase, Cochrane Library, CINAHL, Ovid Medline, Web of Science,
CNKI, and Wanfang was conducted until March 2024. The risk of bias was
assessed using the Cochrane Risk of Bias Tool. Data were meta-analyzed
using RevMan 5.4 software. Potential bias and reliability of evidence were
fairly assessed by using the Cochrane risk of bias method and the GRADE
evidence grading method. Result(s): A total of 16 studies involving
1335 cardiac surgery patients were included in this study. Compared with
the control group, the cognitive training group had a significantly lower
incidence of postoperative cognitive dysfunction (RR 0.35, 95% CI
0.18-0.65, P = .001), significantly improved cognitive function (MD 2.54,
95% CI 1.27-3.81, P < .001), and a significantly higher quality of
life-mental component (MD 5.22, 95% CI 2.32-8.13, P < .001), anxiety (MD
-6.05, 95% CI -10.96 to -1.15, P = .02) and depression (MD -3.97, 95% CI
-7.15 to -0.80, P = .01) were significantly improved between groups.
However, the differences were not statistically significant for
postoperative delirium (RR 1, 95% CI 0.38-2.65, P = 1.00) and
postoperative hospitalization (MD -0.95, 95% CI -2.90 to 1.00, P = .34).
 Conclusion(s): The present study, based on a low to moderate quality
of evidence, suggests that cognitive training improves cognitive
functioning, reduces the incidence of postoperative cognitive dysfunction,
and has a positive impact on anxiety and depression in patients undergoing
cardiac surgery. However, current evidence does not allow for the
determination of effects on quality of life, postoperative delirium, and
postoperative length of stay. Copyright © 2024 the Author(s).
Published by Wolters Kluwer Health, Inc.

<124>
Accession Number
2035467074
Title
Effects of Cardiac Rehabilitation on Patients Undergoing Heart Valve
Surgery: A Systematic Review and Meta-Analysis.
Source
Heart Surgery Forum. 27(10) (pp E1228-E1236), 2024. Date of Publication:
2024.
Author
Kong X.; Zhu J.; Chang J.; Meng X.
Institution
(Kong, Zhu) Nursing Department, The 964th Hospital of the Joint Logistics
Support Force of the People's Liberation Army of China, Jilin, Changchun
130000, China
(Chang, Meng) Cardiothoracic Surgery, The 964th Hospital of the Joint
Logistics Support Force of the People's Liberation Army of China, Jilin,
Changchun 130000, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Objective: This study assessed the effects of cardiac rehabilitation (CR)
on patients undergoing heart valve surgery by collecting literature for
meta-analysis. Method(s): PubMed, ScienceDirect, Embase, Cochrane
Library, CNKI, and Web of Science databases were systematically searched
from the time of construction to December 2023. Primary outcomes were
improvements in the 6 min walking distance (6-MWD) and Barthel index (BI)
after CR. Secondary outcomes included short form (SF)-12/36 scale,
depression, anxiety, and Morse Fall Scale (MFS) scores. All statistical
analyses were performed by using standard statistical procedures provided
in Review Manager 5.2 (The Nordic Cochrane Centre, Copenhagen, Denmark).
 Result(s): A total of 14 studies involving 1687 subjects were
included. Pooled data showed that CR care significantly improved 6-MWD
(mean difference (MD) = 47.60, 95% confidence interval (CI): [33.70,
61.50], p < 0.00001) and BI (MD = 10.88, 95% CI: [7.72, 14.05], p <
0.00001). In addition, patients showed no difference in mental component
scores (MD = 1.27, 95% CI: [-0.10, 2.64], p = 0.07) and significant
difference in physical component scores (MD = 1.65, 95% CI: [0.24, 3.06],
p = 0.02) at CR discharge compared with those at admission. Similar
results were observed for depression (MD = -0.13, 95% CI: [-0.60, 0.34], p
= 0.59) and anxiety scores (MD = -0.44, 95% CI: [-0.88, -0.01], p = 0.04).
Results also showed that CR significantly improved the MFS score of
patients (MD = -5.82, 95% CI: [-9.38, -2.27], p = 0.001).
 Conclusion(s): Our analysis suggested that CR contributes to
enhancing exercise tolerance and self-care and improving psychological
status in patients undergoing heart valve surgery. Copyright ©
2024 The Author(s).

<125>
Accession Number
2034982457
Title
Hemodynamic management of acute kidney injury.
Source
Current Opinion in Critical Care. 30(6) (pp 542-547), 2024. Date of
Publication: 01 Dec 2024.
Author
De Backer D.; Rimachi R.; Duranteau J.
Institution
(De Backer, Rimachi) Department of Intensive Care, CHIREC Hospitals,
Universite Libre de Bruxelles, 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 postHoc
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.

<126>
Accession Number
2029649283
Title
Bayesian interpretation of non-inferiority in transcatheter versus
surgical aortic valve replacement trials: a systematic review and
meta-analysis.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. 37(5) (no
pagination), 2023. Article Number: ivad185. Date of Publication: 01 Nov
2023.
Author
Heuts S.; Kawczynski M.J.; Sardari Nia P.; Maessen J.G.; Biondi-Zoccai G.;
Gabrio A.
Institution
(Heuts, Kawczynski, Sardari Nia, Maessen) Department of Cardiothoracic
Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
(Heuts, Kawczynski, Sardari Nia, Maessen) Cardiovascular Research
Institute Maastricht (CARIM), Maastricht University, Maastricht,
Netherlands
(Biondi-Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Rome, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Napoli, Italy
(Gabrio) Department of Methodology and Statistics, Maastricht University,
Maastricht, Netherlands
Publisher
Oxford University Press
Abstract
Objectives: The concept of non-inferiority is widely adopted in randomized
trials comparing transcatheter aortic valve replacement (TAVR) and
surgical aortic valve replacement (SAVR). However, uncertainty exists
regarding the long-term outcomes of TAVR, and non-inferiority may be
difficult to assess. We performed a systematic review and meta-analysis of
randomized trials comparing TAVR and SAVR, with a specific emphasis on the
non-inferiority margin for 5-year all-cause mortality. Method(s): A
systematic search was applied to 3 electronic databases. Randomized trials
comparing TAVR and SAVR were included. Bayesian methods were implemented
to evaluate the posterior probability of non-inferiority at different
trial non-inferiority margins under either a vague, Cauchy, or a
literature-based prior. Primary outcomes were 5-year actuarial all-cause
mortality, and the probability of non-inferiority at various transformed
trial non-inferiority margins. Secondary outcomes were long-term survival
and 1- and 2-year actuarial survival. Result(s): Eight trials (n =
8698 patients) were included. Kaplan-Meier-derived 5-year survival was
61.6% (95% CI 59.8-63.5%) for TAVR, and 63.7% (95% CI 61.9-65.6%) for
SAVR. Six trials (n = 6370 patients) reported all-cause mortality at
5-year follow-up. Under a vague prior, the posterior median relative risk
for all-cause mortality of TAVR was 1.14, compared to SAVR (95% credible
interval 1.06-1.22, probability of relative risk <1.00 = 0.01%,
I2 = 0%). Similar results in terms of point estimate and
uncertainty measures were obtained using frequentist methods. Based on the
various trial non-inferiority margins, the results of the analysis suggest
that non-inferiority at 5 years is no longer likely. Conclusion(s):
It is unlikely that TAVR is still non-inferior to SAVR at 5 years in terms
of all-cause mortality. Copyright © 2023 The Author(s).

<127>
Accession Number
2029649214
Title
Simulation-based training in cardiac surgery: A systematic review.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. 37(2) (no
pagination), 2023. Article Number: ivad079. Date of Publication: 01 Aug
2023.
Author
Arjomandi Rad A.; Hajzamani D.; Sardari Nia P.
Institution
(Arjomandi Rad) Medical Sciences Division, University of Oxford, Oxford,
United Kingdom
(Arjomandi Rad, Hajzamani, Sardari Nia) Department of Cardiothoracic
Surgery, Maastricht University Medical Center, Maastricht, Netherlands
Publisher
Oxford University Press
Abstract
OBJECTIVES: The increase in the complexity of operations, the rising quest
for improved outcomes and the scrutiny of surgical practice and its
associated complications have led to a decreased educational value of
in-patient surgical training within cardiac surgery. Simulation-based
training has emerged as an adjunct to the apprenticeship model. In the
following review, we aimed to evaluate the currently available evidence
regarding simulation-based training in cardiac surgery. METHOD(S): A
systematic database search was conducted as per PRISMA guidelines, of
original articles that explored the use of simulation-based training in
adult cardiac surgery programs in EMBASE, MEDLINE, Cochrane database and
Google Scholar, from inception to 2022. Data extraction covered the study
characteristics, simulation modality, main methodology and main outcomes.
 RESULT(S): Our search yielded 341 articles, of which 28 studies were
included in this review. Three main areas of focus were identified: (i)
validity testing of the models; (ii) impact on surgeons' skills; and (iii)
impact on clinical practice. Fouteen studies reported animal-based models
and 14 reported on non-Tissue-based models covering a wide spectrum of
surgical operations. The results of the included studies suggest that
validity assessment is scarce within the field, being carried out for only
4 of the models. Nonetheless, all studies reported improvement in
trainees' confidence, clinical knowledge and surgical skills (including
accuracy, speed, dexterity) of trainees both at senior and junior levels.
The direct clinical impact included initiation of minimally invasive
programmes and improved board exam pass rates, and creating positive
behavioural changes to minimize further cardiovascular risk.
 CONCLUSION(S): Surgical simulation has been shown to provide
substantial benefits to trainees. Further evidence is needed to explore
its direct impact on clinical practice. Copyright © 2023 The
Author(s). Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery.

<128>
Accession Number
645737222
Title
SHORT-TERM EFFECTS OF BLOOD PRESSURE LOWERING DRUGS ON CARDIOVASCULAR
EVENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED,
PLACEBO-CONTROLLED DOUBLED-BLIND TRIALS.
Source
Journal of Hypertension. Conference: International Society of Hypertension
Congress, ISH 2024. Cartagena Colombia. 42(Supplement 3) (pp e99), 2024.
Date of Publication: September 2024.
Author
Gnanenthiran S.; Kaistha P.; Pant R.; Dhurjati R.; Kumar A.; Haghdoost F.;
Kota V.; Wang N.; Rodgers A.; Salam A.
Institution
(Gnanenthiran, Kaistha, Pant, Dhurjati, Kumar, Haghdoost, Kota, Wang,
Rodgers, Salam) George Institute for Global Health, Sydney, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Objective: There remains uncertainty about the short-term
effects of blood pressure (BP) lowering drugs on cardiovascular events.
This metaanalysis of double-blind, short-term randomised trials, evaluated
the effect of BPlowering drugs on cardiovascular events compared to
placebo. Method(s): A systematic search was performed in the
following databases: MEDLINE, Cochrane Central Register of Controlled
Trials, and Epistemonikos. Trials satisfying the following criteria were
included: (i) randomized, double-blind placebo- controlled trials of 2-26
weeks published in English language; (ii) adults (age >=18 years) with
hypertension (BP >=140/90 mmHg) or taking BP-lowering drugs; (iii)
intervention: oral fixed dose of BP-lowering drug(s) as either monotherapy
or combination therapy from five major classes (angiotensin converting
enzyme, angiotensin-II receptor blockers, calcium channel blockers,
beta-blockers, and diuretics); (iv) placebo comparator; (v) reported data
on cardiovascular events; (vi). The primary outcome was major adverse
cardiovascular events (MACE), defined as stroke, transient ischaemic
attack (TIA), myocardial infarction, heart failure, angina or coronary
revascularisation. Result(s): 451 trials (93121 participants [mean
age 54yrs, 56% males, mean follow- up 8 weeks] were included. There was no
effect of the intervention compared to placebo on MACE (0.19% versus
0.43%; relative risk [RR] 0.89, 95% CI 0.69-1.14, p=0.35). There was a
significant reduction in stroke (0.01% versus 0.05%; RR 0.37 [0.19-0.72];
p<0.001) and TIA (0.001% versus 0.01%; RR 0.26 [0.08-0.82]; p=0.02).
Subgroup analysis suggested combination therapy provided the most benefit
in stroke reduction (RR 0.21 [0.04-1.01], p=0.05), but benefits were
observed across all anti-hypertensive groups for TIA outcomes. There were
no between group differences in all-cause or cardiovascular mortality,
myocardial infarction, heart failure hospitalization, angina or coronary
secularization. Conclusion(s): This meta-analysis of
placebo-controlled RCTs demonstrated reduced stroke and TIA events with
BP-lowering drugs even at short-term follow up. These findings suggest BP
lowering treatment should be initiated as soon as possible in at risk
individuals because even 8 weeks of treatment can significantly reduce the
risk of stroke/TIA..

<129>
Accession Number
2035515435
Title
The Impact of Autologous Platelet Rich Plasma in the Prevention of
Hypertrophic Scar on the Site of Sternotomy: A Pilot Clinical Trial.
Source
International Journal of Surgery Open. (no pagination), 2024. Date of
Publication: 2024.
Author
Aval Z.A.; Monfared M.B.; Roohbakhsh P.; Fani K.; Askarpour H.; Ebrahimi
H.; Ashrafi S.
Institution
(Aval, Askarpour) Cardiovascular Research Center, Department of
Cardiovascular Surgery, Shahid Beheshti University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Monfared, Ebrahimi, Ashrafi) Clinical Research Development Center, Shahid
Modarres Educational hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Roohbakhsh) School of medicine, Guilan university of Medical Sciences,
Rasht, Iran, Islamic Republic of
(Fani) Anesthesiology and Critical Care Department, School of Medicine,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Ashrafi) Ophthalmic Research Center, Research Institute for Ophthalmology
and Vision Science, Shahid Beheshti University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Platelet-rich plasma (PRP) has shown a good effect in healing
different types of wounds in the studies. This study was conducted with
the aim of investigating the impact of Autologous PRP in the prevention of
hypertrophic scar on the site of sternotomy in adults. Method(s):
This pilot clinical trial study was conducted on 28 patients undergoing
open heart surgery. Before the surgery and the injection of anesthetic
drugs, a certain volume of blood was taken from the patient through the
CVP line by the anesthesiologist, and the PRP solution was prepared with
the help of a standard kit. The hypertrophic scars were evaluated by the
Vancouver Scar Scale at 2, 12 and 24 weeks after surgery. Data analysis
was done by SPSS version 16 software. P<0.05 was considered significant.
 Result(s): The GEE test, comparing the Vancouver Scar Scale score
between the intervention group and the control group over time shows that
there is no significant difference between the intervention and control
groups (P>0.05). This means that the lower part of the CABG surgical
incision, where the PRP was injected, did not show any difference in the
incidence of hypertrophic scars compared to the upper part, considered as
control group during the investigation. Conclusion(s): PRP injection
cannot be effective on the scar of the sternotomy surgical site in
patients. Since this study was conducted as a pilot, it is suggested to
conduct a study with a large sample size in line with the purpose of this
study. Copyright © 2024 The Authors.

<130>
Accession Number
2035513246
Title
Comparison of Ultrasound-Guided Single-Injection Erector Spinae Plane
Block, Retrolaminar Block and Paravertebral Block for Postoperative
Analgesia in Single-Incision Video-Assisted Thoracoscopic Surgery: A
Three-Arm, Double-Blind, Randomized Controlled Non-Inferiority Trial.
Source
Clinical Journal of Pain. (no pagination), 2024. Date of Publication:
2024.
Author
Zhu Y.; Yang Y.; Zhang Q.; Li X.; Xue W.; Liu Y.; Zhao Y.; Xu W.; Yan P.;
Li S.; Fang Y.; Huang J.
Institution
(Zhu, Yang, Zhang, Li, Xue, Liu, Zhao, Xu, Yan, Li, Fang, Huang)
Department of Anesthesiology, First Affiliated Hospital of Kunming Medical
University, Yunnan, Kunming, China
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Effective postoperative analgesia is critical for thoracic
surgery. This study compares the analgesic efficacy of the erector spinae
plane block (ESPB), retrolaminar block (RLB), and paravertebral block
(TPVB) in single-incision video-assisted thoracoscopic surgery (SITS).
Methods:Seventy-six patients underwent general anesthesia followed by
ultrasound-guided nerve blocks with 20 ml of 0.5% ropivacaine. Primary
outcomes included the area under the curve (AUC) of Numeric Rating Scale
(NRS) scores during rest and coughing over 24 hours. Secondary outcomes
included perioperative opioid use, plasma biomarkers, and postoperative
recovery measures. Result(s): The AUC for NRS was 107.8+/-10.53 in
the ESPB group, 104.8+/-8.05 in the RLB group, and 103.6+/-10.42 in the
TPVB group, demonstrating non-inferiority for ESPB (difference: 4.2+/-3.0,
95% CI -1.82 to 10.22) and RLB (difference: 1.2+/-2.6, 95% CI -3.97 to
6.37) compared to TPVB. No significant differences were observed in opioid
use, plasma biomarkers, QoR-15 scores, or adverse events.
 Discussion(s): ESPB and RLB provide non-inferior analgesia compared
to TPVB in SITS patients and are effective alternatives that enhance
safety. Copyright © 2024 Wolters Kluwer Health, Inc. All rights
reserved.

<131>
Accession Number
2035507555
Title
Culprit vessel revascularization prior to complete angiography as a
strategy to minimize delays in primary percutaneous coronary intervention
for patients with ST-elevation myocardial infarction: a systematic review
and meta-analysis.
Source
Coronary Artery Disease. (no pagination), 2024. Article Number: e01450.
Date of Publication: 2024.
Author
Bulhoes E.; Antunes V.L.J.; Defante M.L.R.; Mazetto R.; Garcia A.C.;
Garcia T.C.C.; Guida C.
Institution
(Bulhoes) Medicine Department, College of Higher Education of the United
Amazon, Redencao, Para, Brazil
(Antunes) Medicine Department, Federal University of Health Sciences of
Porto Alegre, Porto Alegre, Brazil
(Defante) Medicine Department, Redentor University Center, Itaperuna,
Brazil
(Mazetto) Medicine Department, Amazonas State University, Manaus, Brazil
(Garcia) Division of Cardiology, Goias Military Police Hospital, Goias,
Brazil
(Garcia, Guida) Division of Cardiology, Dante Pazzanese Institute of
Cardiology, Sao Paulo, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
The rapid restoration of blood flow in patients with acute myocardial
infarction with ST elevation through percutaneous coronary intervention
(PCI) is crucial for the survival of this population. Attempts to decrease
the time from diagnosis of ST-segment elevation myocardial infarction
(STEMI) to arrival at the catheterization laboratory have been extensively
investigated. However, strategies during the procedure aiming to reduce
the time to reperfusion are lacking. We conducted a meta-analysis to
evaluate culprit vessel revascularization prior to complete angiography as
a strategy to minimize delays in primary PCI for patients with STEMI. We
searched PubMed, Embase, and Cochrane Central. Outcome(s): vascular
access-to-balloon, door-to-balloon, and first medical contact-to-balloon
times; death, reinfarction in 30 days, Bleeding Academic Research
Consortium >=3 type, coronary artery bypass grafting referral, and left
ventricular ejection fraction %. Statistical analysis was performed using
the R program (version 4.3.2). Heterogeneity was assessed with
I2 statistics. We included 2050 patients from six studies, of
which two were randomized controlled trials and four were observational
studies. Culprit vessel revascularization prior to complete angiography
was associated with a statistically significant decrease of times:
vascular access-to-balloon time (mean difference -6.79 min; 95% CI: -8.00
to -5.58; P < 0.01; I2 = 82%) and door-to-balloon time (mean
difference -9.02 min; 95% CI: -12.83 to -5.22; P < 0.01; I2 =
93%). In this meta-analysis, performing PCI on the culprit lesion prior to
complete coronary angiography led to significantly shorter reperfusion
times, with no discernible differences in complication rates.
 Copyright © 2024 Wolters Kluwer Health, Inc. All rights
reserved.

<132>
Accession Number
2032226865
Title
Chlorhexidine-alcohol compared with povidone-iodine-alcohol skin
antisepsis protocols in major cardiac surgery: a randomized clinical
trial.
Source
Intensive Care Medicine. (no pagination), 2024. Date of Publication:
2024.
Author
Boisson M.; Allain G.; Roussel J.-C.; d'Ostrevy N.; Burbassi S.; Demondion
P.; Mertes P.-M.; Labaste F.; Kerforne T.; Rozec B.; Eljezi V.; Zannis K.;
Leprince P.; Oulehri W.; Minville V.; Seguin S.; Loiodice A.; Ruckly S.;
Lucet J.-C.; Timsit J.-F.; Mimoz O.
Institution
(Boisson) INSERM U1070 PHAR2, CHU de Poitiers, Service
d'Anesthesie-Reanimation et Medecine Peri-Operatoire, Universite de
Poitiers, Poitiers Cedex, France
(Allain) INSERM U1313 IRMETIST, CHU de Poitiers, Service de Chirurgie
Cardio-Thoracique et Vasculaire, Universite de Poitiers, Poitiers, France
(Roussel) Service de chirurgie cardio-thoracique, Hopital G et R Laennec,
CHU Nantes, Nantes Universite, Nantes, France
(d'Ostrevy) Service de Chirurgie Cardio-Vasculaire, CHU de
Clermont-Ferrand, Clermont-Ferrand, France
(Burbassi) Unite de Recherche Clinique, Institut Mutualiste Montsouris,
Paris, France
(Demondion, Leprince) INSERM, UMRS_1166-ICAN, Institute of
Cardiometabolism and Nutrition, Department of Thoracic and Cardiovascular
Surgery, Cardiology Institute, AP-HP, Sorbonne Universite, Paris, France
(Mertes) Pole d'Anesthesie Reanimation et Medecine Perioperatoire,
Hopitaux Universitaires de Strasbourg, Universite de Strasbourg,
Strasbourg, France
(Labaste, Minville) INSERM RESTAURE UMR 1301-5070 CNRS, Service
d'Anesthesie-Reanimation et Medecine Peri-Operatoire, CHU de Toulouse,
Universite de Toulouse 3, Toulouse, France
(Kerforne) INSERM U1313 IRMETIST, CHU de Poitiers, Service
d'Anesthesie-Reanimation et Medecine Peri-Operatoire, Universite de
Poitiers, Poitiers, France
(Rozec) CNRS, INSERM, l'institut du thorax, Service d'Anesthesie et de
Reanimation, Hopital G et R Laennec, CHU Nantes, Nantes Universite,
Nantes, France
(Eljezi) Universite Clermont Auvergne, CHU Gabriel Montpied, Pole Medecine
Peri-Operatoire, Clermont Ferrand, France
(Zannis) Service de chirurgie cardiaque, Institut Mutualiste Montsouris,
Paris, France
(Oulehri) Pole d'Anesthesie Reanimation et Medecine Perioperatoire,
Hopitaux Universitaires de Strasbourg, Strasbourg, France
(Seguin) Service d'Anesthesie-Reanimation et Medecine Peri-Operatoire, CHU
de Poitiers, Poitiers, France
(Loiodice) ICURESEARCH, Fontaine, France
(Ruckly) Department of Biostatistics, OUTCOME REA Research Network,
Drancy, France
(Lucet) INSERM, IAME, U1137, Team DeSCID, Infection Control Unit, Bichat
Claude Bernard Hospital, AP-HP, Paris, France
(Timsit) INSERM, IAME, U1137, Team DeSCID, Medical and infectious diseases
ICU (MI2), Bichat Claude Bernard Hospital, AP-HP, Universite Paris-Cite,
Paris, France
(Timsit) OUTCOME REA Research Network, Drancy, France
(Mimoz) INSERM U1070 PHAR2, CHU de Poitiers, Universite de Poitiers,
Service des Urgences Adultes-SAMU 86 Centre 15, Poitiers, France
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Whether skin disinfection of the surgical site using
chlorhexidine-alcohol is superior to povidone-iodine-alcohol in reducing
reoperation and surgical site infection rates after major cardiac surgery
remains unclear. Method(s): CLEAN 2 was a multicenter, open-label,
randomized, two-arm, assessor-blind, superiority trial conducted in eight
French hospitals. We randomly assigned adult patients undergoing major
heart or aortic surgery via sternotomy, with or without saphenous vein or
radial artery harvesting, to have all surgical sites disinfected with
either 2% chlorhexidine-alcohol or 5% povidone-iodine-alcohol. The primary
outcome was any resternotomy by day 90 or any reoperation at the
peripheral surgical site by day 30. Result(s): Of 3242 patients (1621
in the chlorhexidine-alcohol group [median age, 69 years; 1276 (78.7%)
men] and 1621 in the povidone-iodine-alcohol group [median age, 69 years;
1247 (76.9%) men], the percentage required reoperation within 90 days was
similar (7.7% [125/1621] in the chlorhexidine-alcohol group vs 7.5%
[121/1621] in the povidone-iodine-alcohol group; risk difference, 0.25
[95% confidence interval (CI), - 1.58-2.07], P = 0.79). The incidence of
surgical site infections at the sternum or peripheral sites was similar
(4% [65/1621] in the chlorhexidine-alcohol group vs 3.3% [53/1621] in the
povidone-iodine-alcohol group; risk difference, 0.74 [95% CI - 0.55-2.03],
P = 0.26). Length of hospital stay, intensive care unit or hospital
readmission, mortality and surgical site adverse events were similar
between the two groups. Conclusion(s): Among patients requiring
sternotomy for major heart or aortic surgery, skin disinfection at the
surgical site using chlorhexidine-alcohol was not superior to
povidone-iodine-alcohol for reducing reoperation and surgical site
infection rates. Copyright © The Author(s) 2024.

<133>
Accession Number
2032213094
Title
Prophylactic 24 versus 48 h cephalosporins in cardiac surgery: A
randomized trial.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2024. Date of
Publication: 2024.
Author
Koudieh M.; Al Saif S.; Oueida F.; Baradai A.; Alkhamees K.; Otabi A.; Al
Tahir H.; Younis H.; Al Qudaihi G.; Essa M.; Maharem T.; Fadel M.; Al
Balwai D.; Eskander K.
Institution
(Koudieh, Oueida, Baradai, Alkhamees, Otabi, Essa, Eskander) Cardiac
Surgery Department, Saud Al Babtain Cardiac Center, Dammam, Saudi Arabia
(Al Saif) Cardiology Department, Saud Al Babtain Cardiac Center, Dammam,
Saudi Arabia
(Baradai) Cardiac Surgery Department, King Salman Heart Center, Riyadh,
Saudi Arabia
(Al Tahir, Maharem, Fadel) Anesthesia Department, Saud Al Babtain Cardiac
Center, Dammam, Saudi Arabia
(Younis) Intensive Care Unit, Saud Al Babtain Cardiac Center, Dammam,
Saudi Arabia
(Al Qudaihi) Epidemiology Department, Qatif Central Hospital, Dammam,
Saudi Arabia
(Al Balwai) Research Unit, Saud al Babtain Cardiac Center, Dammam, Saudi
Arabia
Publisher
SAGE Publications Inc.
Abstract
Background: Recommendations for cardiac surgery advocate for antibiotic
prophylaxis for up to 48 hour after surgery. However, recent reports found
a significant reduction in surgical site infection with extended duration.
We evaluated the effect of the type of prophylactic antibiotics and
administration durations on the postoperative surgical site infection rate
following cardiac surgery in adults. Method(s): An
investigator-initiated randomized controlled trial was conducted from 2018
to 2022 on adult patients undergoing cardiac surgery. Patients were
randomized into four groups based on antibiotic treatment type and
duration: 24 h cefazolin, 24 h cefuroxime, 48 h cefazolin, and 48 h
cefuroxime. The primary outcome was the rate of surgical site infections
within 90 days of surgery. Result(s): A total of 568 patients were
included in this study. The four groups had similar baseline
characteristics, including age, sex, EuroSCORE II, and baseline HbA1c. A
total of 75 patients developed infection within 90 days postoperative. The
overall infection rate was not statistically different across the four
groups (p = 0.193). The efficacy of cefazolin and cefuroxime in reducing
infection was comparable (p = 0.901). Extended prophylaxis was associated
with a significantly reduced overall infection rate within 90 days
postoperatively compared to 24-h prophylaxis (10.2% vs. 16.3%; risk ratio
= 0.62, 95% confidence interval: 0.40-0.96, p = 0.032).
 Conclusion(s): Using cefazolin or cefuroxime for 48 h instead of 24 h
was more effective in reducing the overall surgical site infections rate
up to 90 days after surgery. Copyright © The Author(s) 2024.

<134>
Accession Number
2035502617
Title
The effects of thoracic epidural blockade on ventilation-perfusion
matching during one-lung ventilation: An exploratory study.
Source
Journal of Clinical Anesthesia. 99 (no pagination), 2024. Article Number:
111678. Date of Publication: December 2024.
Author
Wang Y.; Wei Y.; Chen G.; Wang Z.; Fan Y.; Wang J.; Yang Y.; Zhou D.;
Zhong M.
Institution
(Wang, Chen, Yang, Zhong) Department of Critical Care Medicine, Zhongshan
Hospital, Fudan University, Shanghai, China
(Wei, Zhong) Shanghai Institute of Infectious Disease and Biosecurity,
School of Public Health, Fudan University, Shanghai, China
(Wang, Fan, Wang, Zhou) Department of Anesthesiology, Zhongshan Hospital,
Fudan University, Shanghai, China
(Zhong) Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai,
China
Publisher
Elsevier Inc.
Abstract
Objective: Electrical impedance tomography (EIT) enables continuous image
acquisition, facilitating real-time measurements of ventilation and
perfusion at the clinical bedside. Experimental and clinical studies on
controversial effects of thoracic epidural blockade (TEB) with local
anesthetics on ventilation-perfusion(V/Q) matching and hypoxia during one
lung ventilation (OLV) are rare. The aim of this study was to use EIT to
investigate the effects of TEB combined with general anesthesia on
pulmonary perfusion distribution and V/Q matching during one-lung
ventilation. Design(s): Single-centered, prospective, unblinded,
randomized, parallel-group clinical trial. Setting(s): Surgical suite
of a university-affiliated teaching hospital. Patient(s): Thirty
patients prepared for thoracic surgery were randomly assigned to either
the control group or the TEB group, which received a combination of
thoracic epidural blockade and general anesthesia. Measurements: EIT
measurements and blood gas analysis were conducted in the lateral position
during two-lung ventilation(T<inf>0</inf>), 15 min after
OLV(T<inf>1</inf>), and 15 min after administration of 0.25 % ropivacaine
or 0.9 % saline via epidural delivery during OLV(T<inf>2</inf>).
Hemodynamic and respiratory parameters were recorded, and Dead Space%,
Shunt%, and V/Q Match% were calculated based on blood gas analysis and EIT
images. Result(s): Mean arterial pressure (p < 0.05) significantly
decreased 15 min after TEB, while there were no significant changes in
heart rate among the 30 patients (p = 0.547). OLV resulted in a
significant decrease in arterial oxygen partial pressure/inspired oxygen
fraction (PaO<inf>2</inf>/FiO<inf>2</inf>) from T<inf>0</inf> to
T<inf>1</inf> in both groups. The PaO<inf>2</inf>/FiO<inf>2</inf> in the
TEB group was significantly lower after epidural administration of the
local anesthetic (p < 0.05). Shunt- ABG (%) was significantly higher in
the TEB group compared to the control group at T<inf>2</inf> (p < 0.05).
TEB increased non-ventilated perfusion distribution(p < 0.05), and
Shunt-EIT % (p < 0.05) and reduced Matched Region % (p < 0.05), while Dead
Space-EIT % remained (p = 0.499). Conclusion(s): Based on the
contrast-enhanced EIT evaluation of pulmonary perfusion and ventilation,
TEB appears to induce a V/Q mismatch in patients undergoing OLV in the
lateral position for thoracic surgery. Trial registration:
ClinicalTrials.gov, NCT04730089. Registration on January 25th,
2021. Copyright © 2024

<135>
Accession Number
2030956243
Title
P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy after Deployment
of a Drug-Eluting Stent: The SHARE Randomized Clinical Trial.
Source
JAMA Network Open. 7(3) (pp E240877), 2024. Date of Publication: 07 Mar
2024.
Author
Min P.-K.; Kang T.S.; Cho Y.-H.; Cheong S.-S.; Kim B.-K.; Kwon S.W.; Park
W.J.; Lee J.-H.; Kim W.; Lee W.-S.; Yoon Y.W.; Lee B.K.; Kwon H.M.; Hong
B.-K.
Institution
(Min, Yoon, Lee, Kwon, Hong) Cardiology Division, Department of Internal
Medicine, Gangnam Severance Hospital, Yonsei University, College of
Medicine, Seoul, South Korea
(Kang) Division of Cardiology, Dankook University Hospital, Cheonan, South
Korea
(Cho) Division of Cardiology, Myongji Hospital, Hanyang University,
College of Medicine, Goyang, South Korea
(Cheong) Department of Cardiology, Gangneung Asan Hospital, University of
Ulsan, College of Medicine, Gangneung, South Korea
(Kim) Division of Cardiology, Severance Cardiovascular Hospital, Yonsei
University, College of Medicine, Seoul, South Korea
(Kwon) Division of Cardiology, Inha University Hospital, Incheon, South
Korea
(Park) Division of Cardiology, Hallym University Sacred Heart Hospital,
Anyang, South Korea
(Lee) Division of Cardiology, Yeungnam University Medical Center, Daegu,
South Korea
(Kim) Eulji University, School of Medicine, Daejeon, South Korea
(Lee) Heart Research Institute, Chung-Ang University Hospital, Seoul,
South Korea
Publisher
American Medical Association
Abstract
Importance: P2Y12 inhibitor monotherapy after dual antiplatelet therapy
(DAPT; a P2Y12 inhibitor plus aspirin) for a brief duration has recently
emerged as an attractive alternative for patients undergoing percutaneous
coronary intervention (PCI) with a drug-eluting stent. Objective(s):
To investigate whether P2Y12 inhibitor monotherapy after 3 months of DAPT
was noninferior to 12 months of DAPT following PCI with a drug-eluting
stent. Design, Setting, and Participant(s): The Short-Term Dual
Antiplatelet Therapy After Deployment of Bioabsorbable Polymer
Everolimus-Eluting Stent (SHARE) open-label, noninferiority randomized
clinical trial was conducted from December 15, 2017, through December 14,
2020. Final 1-year clinical follow-up was completed in January 2022. This
study was a multicenter trial that was conducted at 20 hospitals in South
Korea. Patients who underwent successful PCI with bioabsorbable polymer
everolimus-eluting stents were enrolled. Intervention(s): Patients
were randomly assigned to receive P2Y12 inhibitor monotherapy after 3
months of DAPT (n = 694) or 12 months of DAPT (n = 693). Main
Outcomes and Measures: The primary outcome was a net adverse clinical
event, a composite of major bleeding (based on Bleeding Academic Research
Consortium type 3 or type 5 bleeding) and major adverse cardiac and
cerebrovascular events (cardiac death, myocardial infarction, stent
thrombosis, stroke, or ischemia-driven target lesion revascularization)
between 3 and 12 months after the index PCI. The major secondary outcomes
were major adverse cardiac and cerebrovascular events and major bleeding.
The noninferiority margin was 3.0%. Result(s): Of the total 1452
eligible patients, 65 patients were excluded before the 3-month follow-up,
and 1387 patients (mean [SD] age, 63.0 [10.7] years; 1055 men [76.1%])
were assigned to P2Y12 inhibitor monotherapy (n = 694) or DAPT (n = 693).
Between 3 and 12 months of follow-up, the primary outcome (using
Kaplan-Meier estimates) occurred in 9 patients (1.7%) in the P2Y12
inhibitor monotherapy group and in 16 patients (2.6%) in the DAPT group
(absolute difference, -0.93 [1-sided 95% CI, -2.64 to 0.77] percentage
points; P <.001 for noninferiority). For the major secondary outcomes
(using Kaplan-Meier estimates), major adverse cardiac and cerebrovascular
events occurred in 8 patients (1.5%) in the P2Y12 inhibitor monotherapy
group and in 12 patients (2.0%) in the DAPT group (absolute difference,
-0.49 [95% CI, -2.07 to 1.09] percentage points; P =.54). Major bleeding
occurred in 1 patient (0.2%) in the P2Y12 inhibitor monotherapy group and
in 5 patients (0.8%) in the DAPT group (absolute difference, -0.60 [95%
CI, -1.33 to 0.12] percentage points; P =.10). Conclusions and
Relevance: In patients with coronary artery disease undergoing PCI with
the latest generation of drug-eluting stents, P2Y12 inhibitor monotherapy
after 3-month DAPT was not inferior to 12-month DAPT for net adverse
clinical events. Considering the study population and lower-than-expected
event rates, further research is required in other populations. Trial
Registration: ClinicalTrials.gov Identifier: NCT03447379. Copyright
© 2024 American Medical Association. All rights reserved.

<136>
Accession Number
2032189450
Title
Dual-Energy CT as a Well-Established CT Modality to Reduce Contrast Media
Amount: A Systematic Review from the Computed Tomography Subspecialty
Section of the Italian Society of Radiology.
Source
Journal of Clinical Medicine. 13(21) (no pagination), 2024. Article
Number: 6345. Date of Publication: November 2024.
Author
Guerrini S.; Zanoni M.; Sica C.; Bagnacci G.; Mancianti N.; Galzerano G.;
Garosi G.; Cacioppa L.M.; Cellina M.; Zamboni G.A.; Minetti G.; Floridi
C.; Mazzei M.A.
Institution
(Guerrini) Unit of Diagnostic Imaging, Department of Medical Sciences,
University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena
53100, Italy
(Guerrini, Bagnacci, Cacioppa, Cellina, Zamboni, Minetti, Floridi, Mazzei)
Italian Society of Medical and Interventional Radiology (SIRM), Italian
College of Computed Tomography, Italian Society of Medical and
Interventional Radiology, Milano 20122, Italy
(Zanoni, Sica, Bagnacci, Mazzei) Unit of Diagnostic Imaging, Department of
Medical, Surgical and Neuro Sciences and of Radiological Sciences,
University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena
53100, Italy
(Mancianti, Garosi) Unit of Nephrology, Dialysis and Transplantation,
Department of Emergency and Transplantation, Azienda
Ospedaliero-Universitaria Senese, Siena 53100, Italy
(Galzerano) Unit of Vascular Surgery, Department of Heart, Thorax and
Vessels, University of Siena, Azienda Ospedaliero-Universitaria Senese,
Siena 53100, Italy
(Cacioppa, Floridi) Department of Clinical, Special and Dental Sciences,
University Politecnica Delle Marche, Ancona 60126, Italy
(Cellina) Radiology Department, Fatebenefratelli Hospital, ASST
Fatebenefratelli Sacco, Principessa Clotilde 3, Milan 20121, Italy
(Zamboni) Institute of Radiology, Department of Diagnostics and Public
Health, Policlinico GB Rossi, University of Verona, Verona 37134, Italy
(Minetti) Radiology Unit, Ospedale Santo Spirito, ASL AL, Alessandria,
Casale Monferrato 15121, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Our study aims to provide an overview of existing evidence
regarding the image quality of dual-energy CT (DECT) employing reduced
contrast media (CM) volumes, in comparison to single-energy CT (SECT) with
standard CM loads. The advantages, indications, and possible applications
of DECT were investigated from the perspective of providing better patient
care, minimizing CM volume and managing CM shortage. Method(s): In
this systematic review (PRISMA methodology), PubMed and WOS were searched
from January 2010 to January 2023 by two independent reviewers. The scan
and CM characteristics, radiation dose, and results of quantitative
(contrast to noise ratio, CNR, and signal to noise ratio, SNR) and
qualitative assessment of image quality were collected. Sixty
non-duplicated records eligible for full-text screening were examined.
 Result(s): Finally, 22 articles (1818 patients) were included. The
average CM reduction with DECT ranged between 43.4 +/- 11%. Despite the
wide variability in CT scan protocols, no differences were found in
radiation doses between DECT and SECT. Conclusion(s): DECT scanners
allow the employment of lower CM volumes with equal or better image
quality evaluated by quantitative and qualitative analyses and similar
dose radiation compared to SECT. Using image reconstructions at low
monochromatic energy levels, DECT increases iodine conspicuity and
attenuation contributing to CM containment measures. Copyright ©
2024 by the authors.

<137>
Accession Number
2032188923
Title
Ultrasound-Guided Intranodal Lipiodol Lymphangiography for the Assessment
and Treatment of Chylous Leaks: A Retrospective Case Series from a Single
Center in Switzerland and a Systematic Review of the Literature.
Source
Journal of Clinical Medicine. 13(21) (no pagination), 2024. Article
Number: 6432. Date of Publication: November 2024.
Author
Schulz S.N.; Miftaroski A.; Rouiller B.; Egger B.; Lutz J.A.; Widmer L.
Institution
(Schulz) Department of Reconstructive, Esthetic, and Plastic Surgery,
Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, Geneve 1205,
Switzerland
(Miftaroski) Department of General Surgery, Geneva University Hospital,
Rue Gabrielle-Perret-Gentil 4, Geneve 1205, Switzerland
(Rouiller, Lutz) Department of Thoracic Surgery, Fribourg Cantonal
Hospital, Chem. des Pensionnats 2/6, Villars-sur-Glane 1752, Switzerland
(Egger) Department of General Surgery, Fribourg Cantonal Hospital, Chem.
des Pensionnats 2/6, Villars-sur-Glane 1752, Switzerland
(Widmer) Department of Diagnostic and Interventional Radiology, Fribourg
Cantonal Hospital, Chem. des Pensionnats 2/6, Villars-sur-Glane 1752,
Switzerland
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Lymphatic leaks are well-known complications of major thoracic
or abdominal surgeries, which significantly heighten morbidity and
mortality rates. While the existing literature provides insights into
managing these post-operative leaks, with a step-up approach from
conservative measures (CMs) to surgical intervention, there are no
standardized treatment guidelines. The purpose of this paper is to offer a
management algorithm of post-operative lymphatic leaks based on a
systematic literature review (SLR) of the therapeutic effect of Lipiodol
lymphangiography (LL), completed by a case series of five patients who
underwent LL in our department. Method(s): In this IRB-approved
study, we conducted an SLR following the PRISMA guidelines, using a PICOS.
A quality assessment was performed for each study. The case series
consisted of consecutive patients who underwent LL for diagnostic and
therapeutic purposes at our institution between September 2018 and
December 2020. Result(s): A total of 39 observational studies were
included in the SLR comprising 11 retrospective case reviews (Group 1),
and 3 case series as well as 25 case reports (Group 2). In total, these
studies report cases of 557 patients (51.52% presenting oncological
diagnoses; 43.98% having benefited from lymphadenectomy). Lymphatic or
chylous fistulas were the most encountered complication, followed by
chylothorax. The median volume of Lipiodol injected during lymphography
was 11.7 mL (range: 9.8-75 mL). Overall, LL was technically successful in
77.7% (366/471) of patients. The clinical success of all technically
successful LLs was 80.6% (295/366). Time-to-leak resolution after
lymphography varied between 1 and 31 days. The factors associated with
treatment failure were a high leak output (>500 mL/day) and Lipiodol
extravasation on post-LL imaging. Our case series consisted of five
patients (mean age: 62 +/- 9.24 years; 20% female; 100% oncological
diagnoses; 60% having beneficiated from lymphadenectomy). Technical and
clinical successes were 80% (4/5) and 75% (3/4), respectively.
Time-to-leak resolution varied between 1 and 4 days. The volume and
technique of LL was not different from that identified in the SLR.
 Conclusion(s): LL is a safe procedure with high technical and
clinical success rates that could be proposed as both a diagnostic and
therapeutic solution for patients with post-operative central lymphatic
lesions. Copyright © 2024 by the authors.

<138>
Accession Number
2032188581
Title
Prothrombotic Rebound After Discontinuation of Direct Oral Anticoagulants
Therapy: A Systematic Review.
Source
Journal of Clinical Medicine. 13(21) (no pagination), 2024. Article
Number: 6606. Date of Publication: November 2024.
Author
Frydrych M.; Janeczek M.; Malyszek A.; Nelke K.; Dobrzynski M.;
Lukaszewski M.
Institution
(Frydrych, Lukaszewski) Anaesthesiology and Intensive Care Unit,
Sokolowski Specialist Hospital in Walbrzych, Sokolowski 4, Walbrzych
58-309, Poland
(Janeczek, Malyszek) Department of Biostructure and Animal Physiology,
Wroclaw University of Environmental and Life Sciences, Kozuchowska 1,
Wroclaw 51-631, Poland
(Nelke) Maxillo-Facial Surgery Ward, EMC Hospital, Pilczycka 144, Wroclaw
54-144, Poland
(Nelke) Academy of Applied Sciences Angelus Silesius in Walbrzych, Health
Department, Zamkowa 4, Walbrzych 58-300, Poland
(Dobrzynski) Department of Pediatric Dentistry and Preclinical Dentistry,
Wroclaw Medical University, Krakowska 26, Wroclaw 50-425, Poland
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: The practice of holding anticoagulation is a
relatively common approach, with the aim of either preventing excessive
bleeding in preparation for surgical procedures or managing acute bleeding
episodes. Method(s): To assess the relationship between the
discontinuation of direct oral anticoagulants (DOACs) therapy and the
condition of hypercoagulability, a systematic review of the literature was
conducted, following PRISMA guidelines, in PubMed/MEDLINE, Cochrane, and
Google Scholar. These databases were searched for all publications that
described a rebound phenomenon or hypercoagulability state after DOACs
discontinuation. Result(s): A total of 1494 articles were selected
from searched databases, and 29 were eligible. A final total of 16 case
reports and 14 original research articles were subjected to analysis.
 Conclusion(s): The results of this study indicate that the cessation
of DOAC therapy may be associated with an increased risk of thrombotic
events. More studies are required to ascertain whether DOACs treatment
cessation can be linked to rebound phenomena associated with
thromboembolic events. This will provide the data needed to determine the
incidence and risk of this phenomenon. Copyright © 2024 by the
authors.

<139>
Accession Number
2032169192
Title
Cardioprotection in coronary artery bypass graft surgery: the impact of
remote ischemic preconditioning on modulating LOX-1 and SOD-1 to
counteract oxidative stress.
Source
Frontiers in Cardiovascular Medicine. 11 (no pagination), 2024. Article
Number: 1502326. Date of Publication: 2024.
Author
Luca C.-D.; Boieriu A.; Neculoiu D.; Tint D.
Institution
(Luca, Boieriu, Neculoiu, Tint) Faculty of Medicine, "Transilvania"
University, Brasov, Romania
(Luca) Cardiology Department, Cardiovascular Rehabilitation Hospital, "Dr.
Benedek Geza", Covasna, Romania
(Boieriu) Cardiology Department, Emergency Clinical County Hospital,
Brasov, Romania
(Neculoiu) Clinical Laboratory Department, Emergency Clinical County
Hospital, Brasov, Romania
(Tint) Cardiology Department, Clinicco Hospital, Brasov, Romania
Publisher
Frontiers Media SA
Abstract
Background: Coronary artery bypass grafting (CABG) is frequently used to
treat severe coronary artery disease (CAD), but it can lead to increased
oxidative stress and inflammation, worsening patient outcomes. Remote
ischemic preconditioning (RIPC) has been suggested as a potential strategy
to protect against these effects by modulating oxidative stress and
inflammatory responses, though its impact on specific biomarkers requires
further investigation. This study aims to assess the effects of remote
ischemic preconditioning on inflammation markers and oxidative stress in
patients with severe CAD undergoing coronary artery bypass grafting.
 Method(s): We conducted a case-control study involving 80 patients
with severe coronary artery disease (CAD) scheduled for coronary artery
bypass grafting (CABG). Fifty percent of these patients received ischemic
preconditioning prior to surgery. Plasma levels of Lectin-like oxidized
low-density lipoprotein receptor-1 (LOX-1) and Superoxide dismutase-1
(SOD-1) levels were measured in all individuals using the ELISA method at
three important time points: before surgery (visit 1 or V1), immediately
post-operatively (visit 2 or V2), and one week post-operatively (visit 3
or V3). Result(s): We enrolled 80 patients, of which 40 were assigned
to the studied group receiving remote ischemic preconditioning (RIPC) and
40 to the control group. There were no statistically significant
differences between the groups regarding baseline, clinical, or operative
characteristics. RIPC treatment significantly reduced plasma levels of
Lectin-like oxidized low-density lipoprotein (LDL) receptor-1 (LOX-1) (p <
0.05) as well as significantly increasing total values of Superoxide
dismutase-1 (SOD-1) (p < 0.05, respectively). There were notable
differences between the studied and control groups at V2 and V3. The
studied group had higher SOD-1 levels (p < 0.05) and significantly lower
LOX-1 levels at both time points (p < 0.05). Conclusion(s): The
significant changes in plasma levels of both LOX-1 and SOD-1 observed in
this study strongly suggest that remote ischemic preconditioning (RIPC)
plays an important role in reducing oxidative stress and enhancing the
antioxidative status of patients. This is evidenced by the marked decrease
in LOX-1 levels, alongside a corresponding increase in SOD-1 levels,
indicating that RIPC may contribute to improved cardioprotection through
these mechanisms. Copyright 2024 Luca, Boieriu, Neculoiu and Tint.

<140>
Accession Number
2032100835
Title
Biomarkers of glucose-insulin homeostasis and incident type 2 diabetes and
cardiovascular disease: results from the Vitamin D and Omega-3 trial.
Source
Cardiovascular Diabetology. 23(1) (no pagination), 2024. Article Number:
393. Date of Publication: December 2024.
Author
Qian F.; Guo Y.; Li C.; Liu Y.; Luttmann-Gibson H.; Gomelskaya N.; Demler
O.V.; Cook N.R.; Lee I.-M.; Buring J.E.; Larsen J.; Boring J.; McPhaul
M.J.; Manson J.E.; Pradhan A.D.; Mora S.
Institution
(Qian, Guo, Li, Liu, Luttmann-Gibson, Gomelskaya, Demler, Cook, Lee,
Buring, Manson, Pradhan, Mora) Division of Preventive Medicine, Center for
Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School,
Boston, MA, United States
(Qian) Department of Nutrition, Harvard T.H. Chan School of Public Health,
Boston, MA, United States
(Qian) Section of Cardiovascular Medicine, Boston Medical Center, Boston
University Chobanian and Avedisian School of Medicine, Boston, MA, United
States
(Luttmann-Gibson) Department of Environmental Health, Harvard T.H. Chan
School of Public Health, Boston, MA, United States
(Cook, Lee, Buring, Manson) Department of Epidemiology, Harvard T.H. Chan
School of Public Health, Boston, MA, United States
(Larsen, Boring, McPhaul) Quest Diagnostics Nichols Institute, San Juan
Capistrano, CA, United States
(Pradhan) Bristol Myers Squibb, Cambridge, MA, United States
(Mora) Division of Cardiovascular Medicine, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Mora) Divisions of Preventive and Cardiovascular Medicine, Center for
Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School,
900 Commonwealth Avenue, Boston, MA 02215, United States
Publisher
BioMed Central Ltd
Abstract
Background: Dysglycemia and insulin resistance increase type 2 diabetes
(T2D) and cardiovascular disease (CVD) risk, yet associations with
specific glucose-insulin homeostatic biomarkers have been inconsistent.
Vitamin D and marine omega-3 fatty acids (n-3 FA) may improve insulin
resistance. We sought to examine the association between baseline levels
of insulin, C-peptide, HbA1c, and a novel insulin resistance score (IRS)
with incident cardiometabolic diseases, and whether randomized vitamin D
or n-3 FA modify these associations. Method(s): VITamin D and OmegA-3
TriaL (NCT01169259) was a randomized clinical trial testing vitamin D and
n-3 FA for the prevention of CVD and cancer over a median of 5.3 years.
Incident cases of T2D and CVD (including cardiovascular death, myocardial
infarction, stroke, and coronary revascularization) were matched 1:1 on
age, sex, and fasting status to controls. Conditional logistic regressions
adjusted for demographic, clinical, and adiposity-related factors were
used to assess the adjusted odds ratio (aOR) per-standard deviation (SD)
and 95%CI of baseline insulin, C-peptide, HbA1c, and IRS (Insulinx0.0295 +
C-peptidex0.00372) with risk of T2D, CVD, and coronary heart disease
(CHD). Result(s): We identified 218 T2D case-control pairs and 715
CVD case-control pairs including 423 with incident CHD. Each of the four
biomarkers at baseline was separately associated with incident T2D, aOR
(95%CI) per SD increment: insulin 1.46 (1.03, 2.06), C-peptide 2.04 (1.35,
3.09), IRS 1.72 (1.28, 2.31) and HbA1c 7.00 (3.76, 13.02), though only
HbA1c remained statistically significant with mutual adjustments. For
cardiovascular diseases, we only observed significant associations of
HbA1c with CVD (1.19 [1.02, 1.39]), and IRS with CHD (1.25 [1.04, 1.50]),
which persisted after mutual adjustment. Randomization to vitamin D and/or
n-3 FA did not modify the association of these biomarkers with the
endpoints. Conclusion(s): Each of insulin, C-peptide, IRS, and HbA1c
were associated with incident T2D with the strongest association noted for
HbA1c. While HbA1c was significantly associated with CVD risk, a novel IRS
appears to be associated with CHD risk. Neither vitamin D nor n-3 FA
modified the associations between these biomarkers and cardiometabolic
outcomes. Copyright © The Author(s) 2024.

<141>
Accession Number
2032079028
Title
Comparing surgical outcomes of powered versus manual surgical staplers: a
systematic review and meta-analysis.
Source
Langenbeck's Archives of Surgery. 409(1) (no pagination), 2024. Article
Number: 331. Date of Publication: December 2024.
Author
Ho S.Y.A.; Muthiah V.K.; Tay K.V.
Institution
(Ho, Muthiah, Tay) Lee Kong Chian School of Medicine, Nanyang
Technological University, Singapore, Singapore
(Tay) Department of Surgery, Woodlands Health, Singapore, Singapore
(Tay) Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: The growing use of staplers, manual and powered, especially in
minimally invasive surgeries, necessitates evaluating their efficacy in
gastrointestinal and thoracic surgeries. Parameters analysed include
anastomotic and air leakage rates, bleeding, infection, cost, and
operative duration. Method(s): We searched Cochrane Library, CINAHL,
EMBASE, PubMed, and Web of Science using terms like "surgical staplers,"
"manual staplers," "automatic staplers," and "powered staplers." We
assessed study quality using the Joanna Briggs Institute (JBI) Critical
Appraisal tools and conducted meta-analysis using Review Manager software.
 Result(s): A total of 43,104 patients with a mean age of 60.8 were
involved in the studies. The meta-analysis revealed a significant
reduction in anastomotic leaks in GI surgery patients (OR 0.31, p =
0.0001) and a significant decrease in postoperative air leakage in
thoracic surgery patients (OR 0.65, p = 0.05) when powered staplers were
employed. Additionally, we observed a significant decline in
hemostasis-related complications for both thoracic and GI surgeries (OR
0.48, p = 0.002) with the use of powered staplers. Although individually
costlier than manual staplers, powered staplers significantly decreased
total hospitalisation costs (MD -1725.82, p < 0.00001) amoungst the
thoracic surgeries, due to the cost saved on remedying the lower rate of
complications compared to manual staplers. It also decreased the average
operative times in thoracic and GI surgeries, although not significant (p
= 0.06, p = 0.07 respectively). Conclusion(s): Powered staplers
surpass manual staplers by reducing operative duration, total hospital
costs, and complications like anastomotic leaks and bleeding. Hence, they
are poised to become the preferred alternative in future
surgeries. Copyright © The Author(s), under exclusive licence to
Springer-Verlag GmbH Germany, part of Springer Nature 2024.

<142>
Accession Number
2032072639
Title
Outcome of Solid Organ Transplantation in Patients With Intellectual
Disability: A Systematic Literature Review.
Source
Transplant International. 37 (no pagination), 2024. Article Number: 11872.
Date of Publication: 2024.
Author
de Rover I.; Orlandini L.; Darwish Murad S.; Polak W.G.; Hartley J.;
Sharif K.; Sneiders D.; Hartog H.
Institution
(de Rover, Orlandini, Polak, Sneiders, Hartog) Erasmus Medical Center (MC)
Transplant Institute, Department of Surgery, Erasmus Medical Center (MC),
Rotterdam, Netherlands
(Darwish Murad) Erasmus Medical Center (MC) Transplant Institute,
Department of Gastroenterology and Hepatology, Erasmus Medical Center
(MC), Rotterdam, Netherlands
(Hartley, Sharif, Hartog) Liver Unit, Birmingham Children's Hospital,
Birmingham Women's and Children's National Health Service (NHS) Foundation
Trust, Birmingham, United Kingdom
(Hartog) Centre for Liver and Gastrointestinal Research, Institute of
Immunology and Immunotherapy, University of Birmingham, Birmingham, United
Kingdom
Publisher
Frontiers Media SA
Abstract
Access to solid organ transplantation in patients with intellectual
disability is associated with health inequities due to concerns about
treatment adherence, survival rates, and post-transplant quality of life.
This systematic literature review aims to compare outcomes after organ
transplantation in patients with intellectual disability compared to
patients without intellectual disability. Embase, Medline Ovid, PsycINFO,
Web of Science, Cochrane Central Register of Trials, and Google Scholar
databases were systematically searched for studies concerning pediatric or
adult solid organ transplantation in recipients with a diagnosis of
intellectual disability prior to transplantation. Primary outcomes were
patient and graft survival rates. Secondary outcomes were acute rejection
rate, adherence rates, and quality of life. Nine studies were included,
describing kidney (n = 6), heart (n = 4) and liver (n = 1)
transplantation. Reported graft survival rates were non-inferior or better
compared to patients without intellectual disability, while patient
survival was reportedly slightly lower in two studies reporting on kidney
transplantation. Although current evidence has a potential selection bias
based on including patients with a sufficient support network,
intellectual disability alone should not be regarded a relative or
absolute contra-indication for solid organ transplantation. Copyright
© 2024 de Rover, Orlandini, Darwish Murad, Polak, Hartley, Sharif,
Sneiders and Hartog.

<143>
Accession Number
2031757775
Title
Randomized Control Study to Evaluate the Effect of Rajyoga Meditation on
Metabolic and Psychological Correlates of Health in Patients of Surgical
Repair for Congenital Heart Disease.
Source
Journal of Cardiac Critical Care. 8(4) (pp 217-222), 2024. Date of
Publication: October-December 2024.
Author
Naswa R.; Makhija N.; Rajashekar P.; Kalra S.; Kiran U.
Institution
(Naswa, Makhija, Rajashekar) Department of Cardiac Anaesthesia and
Critical Care, All India Institutes of Medical Sciences, India
(Kalra) School of Physiotherapy, Delhi Pharmaceutical Sciences and
Research University, New Delhi, India
(Kiran) Department of Cardiac Anesthesia, Cardio Thoracic Centre, All
India Institute of Medical Sciences, New Delhi, India
Publisher
Scientific Scholar LLC
Abstract
Objectives: Congenital heart diseases (CHDs) and their operative
management are a source of emotional and financial stress to the patient
and family. Rajyoga meditation (RYM) is a specific art and science of
meditation that encompasses but is not limited to mind-body medicine
theories, inculcation of values in life, and development of life skills
for complete physical, mental, and spiritual well-being. The role of RYM
has never been studied in CHD patients, especially children. This study
aimed to evaluate the efficacy of the RYM program on resting metabolic
rate (RMR) and post-hospitalization behavior questionnaire (PHBQ)
immediately after the program and after 1 and 3 months. Material(s)
and Method(s): It was a single-blind, randomized controlled study.
Subjects operated for CHD, in the age group of 8-19 years, were included
in the study. Subjects in Group A received cardiac rehabilitation and RYM
(Experimental group), whereas subjects in Group B received conventional
cardiac rehabilitation (Control group). Result(s): At one-month
follow-up, the experimental group showed a 14.18% reduction in RMR
compared to baseline, whereas Group B showed 8.96% elevated RMR from
baseline. Group A showed a more significant reduction in RMR at one-month
follow-up from baseline as compared to group B (P < 0.05). The patients
who underwent RYM training had higher PHBQ (-9.0 [-15.6, -2.5], P < 0.05)
in comparison to the control group. Conclusion(s): The result of this
study suggests that the inclusion of RYM along with conventionally given
cardiac rehabilitation enhanced metabolic resilience with lowered resting
metabolism and enhanced recovery post-surgery in children operated on for
CHD. There was an improvement in the psychological adjustment and behavior
of adolescents. Copyright © 2024 Published by Scientific Scholar
on behalf of Journal of Cardiac Critical Care TSS.

<144>
Accession Number
2031757774
Title
Prospective Interventional Cohort Study using AIIMS Simplified POC
Algorithm for Restricted Blood Transfusion in Cyanotic Children.
Source
Journal of Cardiac Critical Care. 8(4) (pp 195-204), 2024. Date of
Publication: October-December 2024.
Author
Chakraborty S.; Kapoor P.M.; Rajashekar P.; Devagourou V.; Patidar G.;
Mathiyalagen P.
Institution
(Chakraborty, Rajashekar, Devagourou) Department of Cardio-Thoracic and
Vascular Surgery, All India Institute of Medical Sciences, New Delhi,
India
(Kapoor) Department of Cardiac Anaesthesia and Critical Care, CNC, All
India Institute of Medical Sciences, New Delhi, India
(Patidar) Department of Transfusion Medicine, All India Institute of
Medical Sciences, New Delhi, India
(Mathiyalagen) Department of Community Medicine, Indira Gandhi Medical
College and Research Institute, Puducherry, India
Publisher
Scientific Scholar LLC
Abstract
Objectives: The coagulation parameters are known to be deranged in
cyanotic congenital heart diseases (CCHDs). Perioperative hemorrhage, as
well as massive blood and components transfusion, can cause hemodynamic
and metabolic instability, which may lead to multi-organ damage and
adversely affect the outcome of a well-performed surgical correction. In
recent years, there are a number of studies shown that zero transfusion
cardiac surgery, even with cardiopulmonary bypass (CPB), in adult as well
as pediatric cardiac surgery is possible. This study yields a newer
strategy to reduce over-ordering and transfusion of blood and blood
products in cardiac surgeries, and in turn, this will also improve the
outcome of cardiac surgeries, especially for CCHDs. Saved blood can save
other lives, too. Material(s) and Method(s): Total 150 patients of
either sex, with cyanotic congenital heart defect (CCHD) undergoing
corrective surgery on CPB were used in this randomized controlled
interventional cohort study. Written and informed consent was taken. Blood
samples for ROTEM (Group A) and standard laboratory coagulation profile
(Group B) were collected twice (T1: at aortic declaiming and T2: 10-15
minutes after protamine reversal). Blood and components were transfused
according to ROTEM algorithm or non POC algorithm (as per proposed
algorithms) when indicated and outcomes recorded. Result(s): Despite
a significant longer cardiopulmonary bypass time (140 vs. 128.5 min;
P=0.019) in the POC group (ROTEM based algorithm), we found a significant
reduction in total drain output (357 vs. 426 mL; P=0.002), blood
components transfusion (packed red blood cells, 3.0 vs. 6.0 U, P>0.001;
plasma, 1 vs. 2 U, P<0.001; and platelets, 1 vs. 4 U, P<0.001), incidence
of postoperative complications(42.5% vs. 65.7%, P=0.004), as well as
duration of ICU stay (5 vs. 9 days, P=0.003). The reduction of in-hospital
mortality was not significant (6.25% vs. 14.29%, P=0.102).
 Conclusion(s): ROTEM based POC algorithm will guide us for rational
blood components utilization and also help to reduce transfusion-related
complications and duration of ICU stay.. Risk awareness and our easily
interpretable algorithm will be helpful in this regard. Copyright
© 2024 Published by Scientific Scholar on behalf of Journal of
Cardiac Critical Care TSS.

<145>
Accession Number
2031729030
Title
Comparison of combined deep and superficial serratus anterior block with
thoracic paravertebral block for postoperative pain in patients undergoing
video-assisted thoracoscopic surgery.
Source
Turkish Journal of Medical Sciences. 54(5) (pp 1021-1032), 2024. Date of
Publication: 2024.
Author
Ulger G.; Zengin M.; Kucuk O.; Baldemir R.; Kaybal O.; Tunc M.; Sazak H.;
Alagoz A.
Institution
(Ulger, Kucuk, Baldemir, Kaybal, Tunc, Sazak, Alagoz) Department of
Anesthesiology and Reanimation, Ankara Ataturk Sanatoryum Training and
Research Hospital, University of Health Sciences, Ankara, Turkey
(Zengin) Department of Anesthesiology and Reanimation, Ankara Etlik City
Hospital, University of Health Sciences, Ankara, Turkey
Publisher
TUBITAK
Abstract
Background/aim: Thoracic paravertebral block (TPVB) is a well-established
procedure for the management of postoperative pain in patients undergoing
video-assisted thoracic surgery (VATS). In recent years, there have been
studies suggesting that fascial plane blocks may be an alternative to
TPVB. The objective of our study was to determine the efficacy of combined
deep and superficial serratus anterior block (C-SAPB) as an alternative to
TPVB in the management of postoperative analgesia in VATS.
 Material(s) and Method(s): The patients were divided into two groups:
the TPVB group and the C-SAPB group. Both groups were administered the
same dose of local anesthetics. Multimodal analgesia was achieved for the
groups. The primary outcome measure was visual analog scale (VAS) pain
scores recorded within the first 48 h of the postoperative period in each
group. The secondary outcomes were analgesic requirement, rescue
analgesics, complications rate, and postoperative patient satisfaction.
 Result(s): Thirty patients with C-SAPB and 30 patients with TPVB were
analysed. VAS rest and VAS coughing scores were similar between the groups
(p > 0.05). Demographic and side effect conditions, total morphine use,
additional analgesic needs, vital parameters, block procedure time, and
patient satisfaction were also similar between the groups (p > 0.05).
Additionally, although block application times were comparable, the time
was slightly shorter in C-SAPB. Conclusion(s): Similar analgesic
efficacy was observed between C-SAPB and TPVB. TPVB maintains its place
among the first choices in VATS. The efficacy of C-SAPB is comparable to
that of TPVB. While the duration of C-SAPB application is not a
significant factor, the brief nature of the procedure and its
straightforward administration suggest that it may be an effective
method. Copyright © TUBITAK.

<146>
Accession Number
2035606163
Title
Continuous vital sign monitoring on surgical wards: The COSMOS pilot.
Source
Journal of Clinical Anesthesia. 99 (no pagination), 2024. Article Number:
111661. Date of Publication: December 2024.
Author
Anusic N.; Gulluoglu A.; Ekrami E.; Mascha E.J.; Li S.; Coffeng R.; Turan
A.; Clemens A.; Perez C.; Beard J.W.; Sessler D.I.; Rodriguez F.;
Mueller-Wirtz L.; Mueller C.M.; Slife M.; Mosqueda M.; Gatt R.; Nikoo
M.Z.; Cekmecelioglu B.T.; Kopac O.; Singh S.; Corrales Martinez M.J.;
Karki D.; Medellin S.; Erazo V.L.; Brooker J.; Rossler J.; Mukhia R.; Pu
X.
Institution
(Anusic, Gulluoglu, Ekrami) Research Fellow, OUTCOMES RESEARCH Consortium,
Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, United
States
(Mascha) Staff Biostatistician, Department of Quantitative Health
Sciences, OUTCOMES RESEARCH Consortium, Department of Anesthesiology,
Cleveland Clinic, Cleveland, OH, United States
(Li) Statistical Programmer, Department of Quantitative Health Sciences,
OUTCOMES RESEARCH Consortium, Department of Anesthesiology, Cleveland
Clinic, Cleveland, OH, United States
(Coffeng) GE HealthCare - Patient Care Solutions, Helsinki, Finland
(Turan) Director, Outcomes Research Consortium, Professor of
Anesthesiology, Department of Anesthesiology and Center for OUTCOMES
RESEARCH, University of Texas Health Science Center, Houston, TX, United
States
(Clemens, Perez) Nurse Manager, Office of Nursing Research and Innovation,
Zielony Nursing Institute, Cleveland Clinic, Cleveland, OH, United States
(Beard) Chief Medical Officer, GE HealthCare - Patient Care Solutions,
Chicago, IL, United States
(Sessler) Vice-President for Clinical and Outcomes Research, Professor of
Anesthesiology, Department of Anesthesiology and Center for OUTCOMES
RESEARCH, University of Texas Health Science Center, Houston, TX, United
States
(Rodriguez, Mueller-Wirtz, Mueller, Slife, Mosqueda, Gatt, Nikoo,
Cekmecelioglu, Kopac, Singh, Corrales Martinez, Karki, Medellin, Erazo,
Brooker, Rossler, Mukhia, Pu) Outcomes Research Consortium, Department of
Anesthesiology, Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Study objectives: Alerts for vital sign abnormalities seek to identify
meaningful patient instability while limiting alarm fatigue. Optimal vital
sign alarm settings for postoperative patients remain unknown, as is
whether alerts lead to effective clinical responses reducing vital sign
disturbances. We conducted a 2-phase pilot study to identify thresholds
and delays and test the hypothesis that alerts from continuous monitoring
reduce the duration of vital sign abnormalities. Design(s): Two-phase
pilot. Patient(s): 250 adults having major non-cardiac surgery.
 Setting(s): Surgical wards. Intervention(s): All patients had
routine vital sign monitoring by nurses at 4-h intervals. We initially
continuously recorded clinician-blinded saturation, heart rate, and
respiratory rate in 100 patients. In the second phase, we randomized 150
patients to blinded versus unblinded continuous vital sign monitoring. In
unblinded patients, nurses were verbally alerted to abnormal vital signs.
Measurements: In the first phase, we modeled expected alarm counts using
6082 h of continuous oxygen saturation, heart rate, and respiratory rate
data. Thresholds and delays targeting ~3 alarms per patient per day were
selected for phase two. Primary analysis assessed the effect of unblinded
monitoring across a 5-component primary composite of cumulative durations
of vital sign abnormalities. Secondary outcomes included fraction of
alerts deemed meaningful by nurses and number of clinical interventions.
 Result(s): In phase one, we identified alarm settings that yielded an
average of 2.3 alerts per patient per day. In phase two, the average
relative effect ratio of geometric duration means for vital signs
exceeding thresholds was 0.75 [95 % CI: 0.51, 1.1], P = 0.17. Sixty alarms
(82 %) were deemed useful in unblinded patients, leading to 60 % more
interventions in unblinded patients. Conclusion(s): We were able to
select continuous saturation, heart rate, and respiratory rate thresholds
that generated about 2 alerts per patient per day, nearly all of which
were considered useful by nurses. Unblinded monitoring and nursing alerts
led to interventions (mostly increasing oxygen delivery) that
non-significantly reduced vital sign abnormalities by 25 %.
ClinicalTrials.gov registration: NCT05280574. Copyright © 2024

<147>
Accession Number
2035473521
Title
The Effect of Yoga Intervention on Psychological Symptoms, Health-Related
Quality of Life, and Cardiovascular Risk Factors in People with Coronary
Artery Disease: A Systematic Review and Meta-Analysis.
Source
Heart and Mind. 8(4) (pp 300-309), 2024. Date of Publication: 2024.
Author
Neto M.G.; Saquetto M.B.; Roever L.; Carvalho V.O.
Institution
(Neto, Saquetto) Department of Physical Therapy, Federal University of
Bahia - Ufba, Bahia, Salvador, Brazil
(Neto, Saquetto) Department of Physical Therapy, Physiotherapy Research
Group, Ufba, Bahia, Salvador, Brazil
(Roever) Department of Clinical Research, Federal University of
Uberlandia, Uberlandia, Brazil
(Roever) Department of Evidence Based Health, Brazilian Network of
Research in Meta-Analysis, Uberlandia, Brazil
(Carvalho) Department of Evidence Based Health, Federal University of
Sergipe, Universidade Federal de Sergipe, Sao Cristovao Sergipe, Brazil
(Carvalho) The Great Group (GRupo de Estudos em ATividade Fisica), Brazil
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Whether yoga is effective in the cardiac rehabilitation of
people with coronary artery disease (CAD) remains controversial.
 Objective(s): The aim of this study was to investigate the effects of
yoga intervention on psychological symptoms, health-related quality of
life (HRQoL), and major cardiovascular risk factors in people with CAD.
 Method(s): We searched MEDLINE/PubMed, Cochrane, EMBASE, and
Physiotherapy Evidence Database (from the earliest date available to July
2023). Mean difference (MD), standardized MD (SMD), and 95% confidence
interval (CI) were calculated. Result(s): Seventeen studies, with
5,698 patients, met the study criteria. Compared to control (no exercise),
yoga resulted in improved depression MD -0.83 (95% CI: -1.35 to -0.31),
stress MD -3.83 (95% CI: -4.8 to 2.86), HRQoL SMD 1.48 (95% CI: 0.55 to
2.4), major cardiovascular risk factors (peak VO 2 MD 1.7 mL/kg/min [95%
CI: 0.2 to 3.3], systolic blood pressure MD -3.2 mmHg [95% CI: -5.9 to
-0.5], and diastolic blood pressure MD -2.42 mmHg [95% CI: -4.08 to
-0.76]). Conclusion(s): Yoga was effective in the improvement of
psychological symptoms, HRQoL, and cardiovascular risk factors. ©
2024 Copyright:

<148>
Accession Number
644512091
Title
Effects of omega-3 fatty acids on coronary revascularization and
cardiovascular events: a meta-analysis.
Source
European journal of preventive cardiology. 31(15) (pp 1863-1875), 2024.
Date of Publication: 11 Nov 2024.
Author
Dinu M.; Sofi F.; Lotti S.; Colombini B.; Mattioli A.V.; Catapano A.L.;
Casula M.; Baragetti A.; Wong N.D.; Steg P.G.; Ambrosio G.
Institution
(Dinu, Sofi, Lotti, Colombini) Department of Experimental and Clinical
Medicine, University of Florence, Florence, Italy
(Sofi) Unit of Clinical Nutrition, Careggi University Hospital, Florence,
Italy
(Mattioli) Department of Medical and Surgical Sciences, University of
Modena and Reggio Emilia, Modena, Italy
(Catapano, Casula, Baragetti) IRCCS MultiMedica, Milan, Italy
(Catapano, Casula, Baragetti) Department of Pharmacological and
Biomolecular Sciences, University of Milan, Milan, Italy
(Wong) Division of Cardiology, University of California, Irvine, United
States
(Steg) INSERM U1148, FACT French Alliance for Cardiovascular Trials, AP-HP
Hopital Bichat, Paris, France
(Ambrosio) Division of Cardiology, Center for Clinical and Translational
Research-CERICLET, University of Perugia School of Medicine, Ospedale S.
Maria della Misericordia, Via S. Andrea delle Fratte, Perugia 06156, Italy
Abstract
AIMS: Benefits of pharmacologic omega-3 fatty acid administration in
cardiovascular prevention are controversial. Particularly, effects on
coronary revascularization are unclear; also debated are specific benefits
of eicosapentaenoic acid (EPA). We investigated incident coronary
revascularizations, myocardial infarction (MI), stroke, heart failure
(HF), unstable angina, and cardiovascular death, in subjects randomized to
receive EPA or EPA + docosahexaenoic acid (EPA + DHA) vs. control. METHODS
AND RESULTS: Meta-analysis of randomized controlled trials (RCTs) was
conducted after MEDLINE, Embase, Scopus, Web of Science, and Cochrane
Library search. Preferred Reporting Items for Systematic Reviews and
Meta-analysis guidelines were followed for abstracting data and assessing
data quality and validity. Data were pooled using a random effects model.
Eighteen RCTs with 134 144 participants (primary and secondary
cardiovascular prevention) receiving DHA + EPA (n = 52 498), EPA alone (n
= 14 640), or control/placebo (n = 67 006) were included. Follow-up ranged
from 4.5 months to 7.4 years. Overall, compared with controls, omega-3
supplementation reduced the risk of revascularization [0.90, 95%
confidence interval (CI) 0.84-0.98; P = 0.001; P-heterogeneity = 0.0002;
I2 = 68%], MI (0.89, 95% CI 0.81-0.98; P = 0.02; P-heterogeneity = 0.06;
I2 = 41%), and cardiovascular death (0.92, 95% CI 0.85-0.99; P = 0.02;
P-heterogeneity = 0.13; I2 = 33%). Lower risk was still observed in trials
where most participants (>=60%) were on statin therapy. Compared with DHA
+ EPA, EPA alone showed a further significant risk reduction of
revascularizations (0.76, 95% CI 0.65-0.88; P = 0.0002; P-interaction =
0.005) and all outcomes except HF. CONCLUSION(S): Omega-3 fatty acid
supplementation reduced the risk of cardiovascular events and coronary
revascularization, regardless of background statin use. Eicosapentaenoic
acid alone produced greater benefits. The role of specific omega-3
molecules in primary vs. secondary prevention and the potential benefits
of reduced revascularizations on overall health status and cost savings
warrant further research. Copyright © The Author(s) 2024.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<149>
Accession Number
645175714
Title
Invasive Treatment Strategy for Older Patients with Myocardial Infarction.
Source
The New England journal of medicine. 391(18) (pp 1673-1684), 2024. Date of
Publication: 07 Nov 2024.
Author
Kunadian V.; Mossop H.; Shields C.; Bardgett M.; Watts P.; Teare M.D.;
Pritchard J.; Adams-Hall J.; Runnett C.; Ripley D.P.; Carter J.; Quigley
J.; Cooke J.; Austin D.; Murphy J.; Kelly D.; McGowan J.; Veerasamy M.;
Felmeden D.; Contractor H.; Mutgi S.; Irving J.; Lindsay S.; Galasko G.;
Lee K.; Sultan A.; Dastidar A.G.; Hussain S.; Haq I.U.; de Belder M.;
Denvir M.; Flather M.; Storey R.F.; Newby D.E.; Pocock S.J.; Fox K.A.A.
Institution
(Kunadian, Mossop, Shields, Bardgett, Watts, Teare, Pritchard, Adams-Hall,
Runnett, Ripley, Carter, Quigley, Cooke, Austin, Murphy, Kelly, McGowan,
Veerasamy, Felmeden, Contractor, Mutgi, Irving, Lindsay, Galasko, Lee,
Sultan, Dastidar, Hussain, Haq, de Belder, Denvir, Flather, Storey, Newby,
Pocock, Fox) From the Translational and Clinical Research Institute,
Faculty of Medical Sciences (V.K.), the Population Health Sciences
Institute (H.M., M.D.T.), and the Newcastle Clinical Trials Unit (C.S., M.
Bardgett, P.W., M.D.T., J.P.), Newcastle University, and the
Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS
Foundation Trust (V.K., J.A.H., I.U.H.), Newcastle upon Tyne; Northumbria
Healthcare NHS Foundation Trust, Cramlington (C.R., D.P.R.); the Faculty
of Health Sciences and Wellbeing, School of Medicine, University of
Sunderland Medical School, Sunderland (D.P.R.); North Tees and Hartlepool
NHS Foundation Trust, Stockton-on-Tees (J. Carter, J.Q.); Chesterfield
Royal Hospital, Chesterfield (J. Cooke); South Tees NHS Foundation Trust,
Middlesbrough (D.A.); County Darlington and Durham NHS Foundation Trust,
Darlington (J. Murphy); Royal Derby Hospital, Derby (D.K.); University
Hospital Ayr, Ayr (J. McGowan); Leeds Teaching Hospital NHS Trust, Leeds
(M.V.); Torbay and South Devon NHS Foundation Trust, Torquay (D.F.);
Manchester University NHS Foundation Trust, Manchester (H.C.); Epsom and
St. Helier University Hospitals, Epsom (S.M.); Ninewells Hospital, Dundee
(J.I.); Bradford Royal Infirmary, Bradford (S.L.); Blackpool Victoria
Hospital, Blackpool (G.G.); United Lincolnshire Hospitals NHS Trust,
Lincoln (K.L.); Wrightington Wigan and Leigh Teaching Hospitals NHS
Foundation Trust, Wigan (A.S.); North Bristol NHS Trust, Bristol (A.G.D.);
University Hospital of Leicester NHS Trust, Leicester (S.H.); Barts Health
NHS Trust (M. Belder) and London School of Hygiene and Tropical Medicine
(S.J.P.), London; the Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh (M.D., D.E.N., K.A.A.F.); Norwich Medical School,
University of East Anglia, Norwich (M.F.); and Sheffield Teaching
Hospital, Sheffield (R.F.S.) - all in the United Kingdom
Abstract
BACKGROUND: Whether a conservative strategy of medical therapy alone or a
strategy of medical therapy plus invasive treatment is more beneficial in
older adults with non-ST-segment elevation myocardial infarction (NSTEMI)
remains unclear. METHOD(S): We conducted a prospective, multicenter,
randomized trial involving patients 75 years of age or older with NSTEMI
at 48 sites in the United Kingdom. The patients were assigned in a 1:1
ratio to a conservative strategy of the best available medical therapy or
an invasive strategy of coronary angiography and revascularization plus
the best available medical therapy. Patients who were frail or had a high
burden of coexisting conditions were eligible. The primary outcome was a
composite of death from cardiovascular causes (cardiovascular death) or
nonfatal myocardial infarction assessed in a time-to-event analysis.
 RESULT(S): A total of 1518 patients underwent randomization; 753
patients were assigned to the invasive-strategy group and 765 to the
conservative-strategy group. The mean age of the patients was 82 years,
45% were women, and 32% were frail. A primary-outcome event occurred in
193 patients (25.6%) in the invasive-strategy group and 201 patients
(26.3%) in the conservative-strategy group (hazard ratio, 0.94; 95%
confidence interval [CI], 0.77 to 1.14; P=0.53) over a median follow-up of
4.1 years. Cardiovascular death occurred in 15.8% of the patients in the
invasive-strategy group and 14.2% of the patients in the
conservative-strategy group (hazard ratio, 1.11; 95% CI, 0.86 to 1.44).
Nonfatal myocardial infarction occurred in 11.7% in the invasive-strategy
group and 15.0% in the conservative-strategy group (hazard ratio, 0.75;
95% CI, 0.57 to 0.99). Procedural complications occurred in less than 1%
of the patients. CONCLUSION(S): In older adults with NSTEMI, an
invasive strategy did not result in a significantly lower risk of
cardiovascular death or nonfatal myocardial infarction (the composite
primary outcome) than a conservative strategy over a median follow-up of
4.1 years. (Funded by the British Heart Foundation; BHF SENIOR-RITA ISRCTN
Registry number, ISRCTN11343602.). Copyright © 2024 Massachusetts
Medical Society.

<150>
Accession Number
2034916689
Title
Benefits and Harms of Coronary Revascularization in Non-Dialysis-Dependent
CKD and Ischemic Heart Disease: A Systematic Review and Meta-Analysis.
Source
Clinical Journal of the American Society of Nephrology. (no pagination),
2024. Date of Publication: 2024.
Author
Patel D.M.; Wilson L.M.; Wilson R.F.; Yang X.; Gharibani T.; Robinson K.A.
Institution
(Patel) Division of Nephrology, Department of Medicine, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
(Wilson, Wilson, Yang, Gharibani, Robinson) Department of Health Policy
and Management, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, United States
(Robinson) Department of Medicine, Johns Hopkins University, Baltimore,
MD, United States
(Robinson) Department of Epidemiology, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Cardiovascular disease is the leading cause of death in people
with chronic kidney disease (CKD). Coronary revascularization can improve
cardiac function and prognosis in people with ischemic heart disease;
however, in people with CKD, there is concern that potential harms could
outweigh benefits of revascularization. Evidence on the balance of these
risks and benefits, specifically in people with non-dialysis-dependent
CKD, is lacking. Method(s): We conducted a systematic review of
randomized controlled trials (RCTs) to assess the risks and benefits of
revascularization, compared to medical management, among adults or
children with ischemic heart disease and CKD not requiring kidney
replacement therapy (dialysis or transplantation). We searched PubMed,
Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL)
through December 12th, 2023. Two people independently screened
titles and abstracts followed by full-text review, serially extracted data
using standardized forms, independently assessed risk of bias, and graded
the certainty of evidence (COE). Result(s): Evaluating data from nine
RCTs, we found that people with CKD and ischemic heart disease treated
with revascularization may experience lower all-cause mortality compared
to people receiving medical management (RR 0.80, 95% CI 0.64-0.98; COE,
low). Revascularization may reduce incidence of myocardial infarction (RR
0.81, 95% CI 0.64-1.04; COE, low) and heart failure (RR 0.80, 95% CI
0.52-1.23; COE, low). The effect on cardiovascular mortality is uncertain
(HR 0.67, 95% CI 0.37-1.20; COE, very low). Evidence was insufficient for
patient-reported outcomes and adverse kidney events. Data were limited by
heterogeneity of patient populations and the limited number of trials.
 Conclusion(s): In people with non-dialysis-dependent CKD,
revascularization may be associated with lower all-cause mortality
compared to medical management and may also lower the risk of
cardiovascular events. Additional data surrounding kidney and
patient-reported outcomes are needed to comprehensively engage in shared
decision making and determine optimal treatment strategies for people with
CKD and ischemic heart disease. Copyright © 2024 by the American
Society of Nephrology.

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