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<1>
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

<2>
Accession Number
2035766517
Title
Efficacy and safety of yangxinshi versus trimetazidine on exercise
tolerance in patients with coronary heart disease after percutaneous
coronary intervention: Multicenter, double-blind clinical trial.
Source
Phytomedicine. 135 (no pagination), 2024. Article Number: 156198. Date of
Publication: December 2024.
Author
Li Y.; Zhang Z.; Zhang J.; Chen H.; Yu H.; Meng X.; Yuan H.; Shao L.; Lu
Y.; Liu B.; Xu J.; Zhang Y.; Li J.; Han Y.
Institution
(Li, Li, Zhang, Zhang, Li, Han) State Key Laboratory of Frigid Zone
Cardiovascular Disease, Cardiovascular Research Institute and Department
of Cardiology, General Hospital of Northern Theater Command, Liaoning,
Shenyang, China
(Zhang, Xu) Department of Epidemiology and Health Statistics, School of
Public Health, Fudan University, Shanghai, China
(Chen) Department of Cardiology, Peking University People's Hospital,
Beijing, China
(Yu) Department of Cardiology, The Affiliated Hospital of Qingdao
University, Shandong, Qingdao, China
(Meng) Department of Cardiovascular Medicine, Affiliated Hospital of
Changchun University of Chinese Medicine, Jilin, Changchun, China
(Yuan) Department of Cardiology, Shandong Provincial Hospital Affiliated
to Shandong First Medical University, Shandong, Jinan, China
(Shao) Department of Cardiology, The First Hospital of Handan of Hebei
Province, Hebei, Handan, China
(Lu) Department of Cardiovascular Medicine, First Hospital of Shanxi
Medical University, Shanxi, Taiyuan, China
(Liu) Department of Cardiovascular Medicine, The Second Norman Bethune
Hospital of Jilin University, Jilin, Changchun, China
Publisher
Elsevier GmbH
Abstract
Background: Optimizing medication to improve exercise tolerance in
patients with coronary heart disease (CHD) after percutaneous coronary
intervention (PCI) is limited. Yangxinshi tablets, an herbal-based oral
medicine, relieve symptoms of angina might be that they can improve energy
metabolism of the ischemic myocardium. We conducted a randomized trial to
assess the efficacy and safety of Yangxinshi vs. trimetazidine in
improving exercise tolerance in patients with CHD after PCI.
 Method(s): This prospective, randomized, double-blind, double-dummy,
multicenter, non-inferiority study enrolled patients aged 18-75 years with
CHD who underwent their first PCI within 2 months of diagnosis. Patients
were randomized to Yangxinshi plus trimetazidine-placebo or trimetazidine
plus Yangxinshi-placebo for 24 weeks. The primary endpoint was the change
in metabolic equivalents (METs) assessed by cardiopulmonary exercise test
(CPET) between 0 and 24 weeks. Secondary endpoints were comprehensive
variables of the CPET, health status and adverse events. This study has
been registered at ClinicalTrials. gov (NCT03809273). Result(s):
Between August 1, 2019, and March 31, 2022, a total of 681 patients were
randomized to Yangxinshi (n = 341) or trimetazidine (n = 340). After 24
weeks, the exercise tolerance of patients increased by 0.77+/-1.25 METs in
the Yangxinshi group and 0.76+/-1.00 METs in the trimetazidine group
(difference, 0.01; 95 % confidence interval [CI], -0.17 to 0.19), meeting
the predefined non-inferiority threshold. Better outcomes were observed in
the Yangxinshi group compared with the trimetazidine group for
patient-reported depression (PHQ-9; -1.88+/-3.32 vs. -0.93+/-3.68; p <
0.001) and anxiety (GAD-7; -1.70+/-3.26 vs. -0.39+/-3.29; p < 0.001).
Adverse events were similar in both groups. Conclusion(s): In
patients with CHD after PCI, Yangxinshi was non-inferior to trimetazidine
in improving exercise tolerance during the 24-week treatment period.
Notably, patients in the Yangxinshi group showed a better mental health
profile compared with trimetazidine recipients. Copyright © 2024
The Authors

<3>
Accession Number
2035736136
Title
Left Atrial Appendage Occlusion vs Standard of Care after Ischemic Stroke
Despite Anticoagulation.
Source
JAMA Neurology. 81(11) (no pagination), 2024. Date of Publication: 11 Nov
2024.
Author
Maarse M.; Seiffge D.J.; Werring D.J.; Boersma L.V.A.; Aarnink E.W.;
Fierro N.; Mazzone P.; Beneduce A.; Tondo C.; Gasperetti A.; Pracon R.;
Demkow, M.; Zielinski K.; De Backer O.; Korsholm K.; Nielsen-Kudsk J.E.;
Estevez-Loureiro R.; Caneiro-Queija B.; Benito-Gonzalez T.; De Prado A.P.;
Nombela-Franco L.; Salinas P.; Holmes D.; Almakadma A.H.; Berti S.; Romeo
M.R.; Alvarez X.M.; Arzamendi D.; Alla V.M.; Agarwal H.; Eitel I.;
Paitazoglou C.; Freixa X.; Cepas-Guillen P.; Chothia R.; Badejoko S.O.;
Bergmann M.W.; Spoon D.B.; Maddux J.T.; El-Chami M.; Ram P.; Branca L.;
Adamo M.; Suradi H.S.; Van Dijk V.F.; Rensing B.J.W.M.; Zietz A.;
Paciaroni M.; Caso V.; Koga M.; Toyoda K.; Kallmunzer B.; Cappellari M.;
Wilson D.; Engelter S.; Swaans M.J.
Institution
(Maarse, Boersma, Aarnink, Van Dijk, Rensing, Swaans) Department of
Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
(Maarse, Boersma, Aarnink) Department of Cardiology, Amsterdam UMC,
Location AMC, Amsterdam, Netherlands
(Seiffge) Department of Neurology, Inselspital University Hospital Bern,
Bern, Switzerland
(Fierro) De Gasperis Cardio Center, Interventional Cardiology Unit,
Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano
Niguarda, Milan, Italy
(Mazzone) Arrhythmia Unit and Electrophysiology Laboratories, Azienda
Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda,
Milan, Italy
(Beneduce) IRCCS, San Raffaele Scientific Institute, Milan, Italy
(Tondo, Gasperetti) Department of Clinical Electrophysiology & Cardiac
Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Tondo) Department of Biomedical Surgical and Dental Sciences, University
of Milan, Milan, Italy
(Gasperetti) Department of Cardiology, Johns Hopkins University,
Baltimore, MD, United States
(Pracon, Demkow, Zielinski) Department of Coronary and Structural Heart
Diseases, National Institute of Cardiology, Warsaw, Poland
(De Backer) Heart Center, Rigshospitalet, Copenhagen, Denmark
(Korsholm, Nielsen-Kudsk) Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark
(Estevez-Loureiro, Caneiro-Queija) Interventional Cardiology Unit,
University Hospital Alvaro Cunqueiro, Vigo, Spain
(Benito-Gonzalez, De Prado) Department of Cardiology, University Hospital
of Leon, Leon, Spain
(Nombela-Franco, Salinas) Cardiovascular Institute, Hospital Clinico San
Carlos, IdISSC, Madrid, Spain
(Holmes, Almakadma) Department of Cardiology, Mayo Clinic, Rochester, MN,
United States
(Berti, Romeo) Fondazione Toscana G. Monasterio, Massa, Italy
(Alvarez, Arzamendi) Cardiology Department, Sant Pau Research Institute
(IIB Sant Pau), Barcelona, Spain
(Alla, Agarwal) Creighton University, School of Medicine, Omaha, NE,
United States
(Eitel, Paitazoglou) Medical Clinic II, University Heart Center Lubeck,
Lubeck, Germany
(Eitel, Paitazoglou) German Center for Cardiovascular Research (DZHK),
Partner Site Hamburg - Kiel Lubeck, Lubeck, Germany
(Freixa, Cepas-Guillen) Department of Cardiology, Institut Clinic
Cardiovascular, Hospital Clinic of Barcelona, Barcelona, Spain
(Chothia, Badejoko) St Joseph's Medical Center, Stockton, CA, United
States
(Bergmann) Department of Cardiology, AK Altona, Hamburg, Germany
(Spoon, Maddux) Department of Cardiology, Providence Heart Institute,
Missoula, MT, United States
(El-Chami, Ram) Department of Cardiology, Emory University Hospital,
Atlanta, GA, United States
(Branca, Adamo) Cardiology and Cardiac Catheterization Laboratory, ASST
Spedali Civili di Brescia, Department of Medical and Surgical Specialties,
Radiological Sciences, and Public Health, University of Brescia, Brescia,
Italy
(Suradi) Division of Cardiovascular Medicine, Rush University, Medical
Center, Chicago, IL, United States
(Zietz, Engelter) Department of Neurology, University Hospital Basel,
Switzerland
(Paciaroni, Caso) Stroke Unit - Internal Vascular and Emergency Medicine,
Santa Maria della Misericordia Hospital, University of Perugia, Perugia,
Italy
(Koga, Toyoda) Department of Cerebrovascular Medicine, National Cerebral
and Cardiovascular Center, Osaka, Japan
(Kallmunzer) Stroke Unit, Department of Neuroscience, Azienda Ospedaliera
Universitaria Integrata, Verona, Italy
(Cappellari) Department of Neurology, University Hospital Erlangen,
Friedrich-Alexander-University Erlangen - Nuremberg (FAU), Erlangen,
Germany
(Wilson) Department of Neurology, Christchurch Hospital, Christchurch, New
Zealand
(Wilson) New Zealand Brain Research Institute, Christchurch, New Zealand
(Engelter) Neurology and Neurorehabilitation, University Department of
Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
(Werring) UCL Queen Square Institute of Neurology, UCL, London, United
Kingdom
Publisher
American Medical Association
Abstract
Importance: Patients with atrial fibrillation (AF) who have ischemic
stroke despite taking oral anticoagulation therapy (OAT) have a very high
risk of recurrence. Left atrial appendage occlusion (LAAO) is a mechanical
stroke prevention strategy that may provide additional protection in
patients with thromboembolic events under OAT. Objective(s): To
compare percutaneous LAAO with continuing OAT alone regarding stroke
prevention in patients with AF who had a thromboembolic event despite
taking OAT. Design, Setting, and Participant(s): This cohort study
was a propensity score-matched comparison of the STR-OAC LAAO cohort, an
international collaboration of 21 sites combining patients from multiple
prospective registries of patients who underwent LAAO between 2010 and
2022. STR-OAC LAAO cohort patients who had follow-up longer than 3 months
were propensity score-matched to a previously published control cohort
comprising patients from an established international collaboration of
investigator-initiated prospective studies. This control cohort included
patients with nonvalvular AF, recent ischemic stroke or transient ischemic
attack, and follow-up longer than 3 months who were taking OAT before the
index event. Analyses were adjusted for imbalances in gender, age,
hypertension, diabetes, and CHA2 DS2-VASc score. Exposure: Left atrial
appendage occlusion vs continuation of oral anticoagulation therapy alone
(control group). Main Outcomes and Measures: The primary outcome was
time to first ischemic stroke. Result(s): Four hundred thirty-three
patients from the STR-OAC LAAO cohort (mean [SD] age, 72 [9] years; 171
[39%] females and 262 [61%] males; mean [SD] CHA2 DS2-VASc score, 5.0
[1.6]) were matched to 433 of 1140 patients (38%) from the control group.
During 2-year follow-up, 50 patients experienced ischemic stroke: an
annualized event rate of 2.8% per patient-year in the STR-OAC LAAO group
vs 8.9% per patient-year in the control group. Left atrial appendage
occlusion was associated with a lower risk of ischemic stroke (hazard
ratio, 0.33; 95% CI, 0.19-0.58; P <.001) compared with the control group.
After LAAO, OAT was discontinued in 290 patients (67%), and the remaining
143 patients (33%) continued OAT after LAAO as an adjunctive therapy.
 Conclusions and Relevance: In patients with nonvalvular AF and a
prior thromboembolic event despite taking OAT, LAAO was associated with a
lower risk of ischemic stroke compared with continued OAT alone.
Randomized clinical trial data are needed to confirm that LAAO may be a
promising treatment option for this population with a very high risk of
stroke.. Copyright © 2024 American Medical Association. All
rights reserved.

<4>
Accession Number
2034839857
Title
Efficacy of Therapeutic Plasma Exchange or Cangrelor as an Adjunctive
Strategy to Facilitate Cardiopulmonary Bypass in Patients with
Heparin-Induced Thrombocytopenia: A Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 38(12) (pp 2915-2924),
2024. Date of Publication: December 2024.
Author
Del Vecchio A.; Pham L.-P.; McNeil J.; Singh K.; Tanaka K.; Eaton M.;
Mazzeffi M.
Institution
(Del Vecchio, Pham) University of Virginia School of Medicine,
Charlottesville, VA, United States
(Tanaka) Oklahoma University College of Medicine, Department of
Anesthesiology, Oklahoma City, OK, United States
(Eaton) University of Rochester School of Medicine, Department of
Anesthesiology, Rochester, NY, United States
(McNeil, Singh, Mazzeffi) University of Virginia School of Medicine,
Department of Anesthesiology, Charlottesville, VA, United States
Publisher
W.B. Saunders
Abstract
Objective: Conduct a systematic review and meta-analysis of the efficacy
of therapeutic plasma exchange (TPE) or intravenous cangrelor to prevent
thromboembolism in patients with heparin-induced thrombocytopenia (HIT)
who undergo cardiopulmonary bypass (CPB) with heparin. Design(s):
Systematic review and meta-analysis. Setting(s): N/A.
 Participant(s): Adults having cardiac surgery with a history of HIT
who received preoperative or intraoperative TPE or intravenous cangrelor
as an adjunct to CPB with heparin. Intervention(s): None
 Measurements and Main Results: A systematic review was performed
using MEDLINE, PubMed, and Google Scholar. The primary outcome was
avoidance of thromboembolism (venous or arterial) during or after CPB.
Proportional meta-analysis with a random effects model was used to
calculate a weighted-pooled proportion/efficacy for the study's primary
outcome. Fifty-seven patients in 17 reports received TPE as an adjunctive
treatment to prevent HIT-related thrombosis related to heparinization
during CPB and 3 (5.3%) experienced thrombosis. Proportional meta-analysis
suggested a weighted-pooled freedom from perioperative thromboembolism
rate of 91.0% (95% CI 82.6%-96.9%). Fifteen patients in 6 reports received
intravenous cangrelor as an adjunctive treatment to prevent HIT-related
thrombosis related to heparinization during CPB and 2 (13.3%) experienced
thrombosis. Proportional meta-analysis suggested a weighted-pooled freedom
from perioperative thromboembolism rate of 83.0% (95% CI 61.2%- 97.6%).
 Conclusion(s): TPE and cangrelor are feasible strategies to prevent
thromboembolism in adults with HIT who require CPB with heparin. Given the
relatively small number of cases in the published literature and a high
likelihood for publication and detection biases, prudence remains
warranted when using these strategies. Copyright © 2024 Elsevier
Inc.

<5>
Accession Number
2034640079
Title
Effect of Adding Integrated Core and Graduated Upper Limb Exercises to
Inpatient Cardiac Rehabilitation on Sternal Instability After Coronary
Artery Bypass Grafting: A Randomized Controlled Trial.
Source
Archives of Physical Medicine and Rehabilitation. 105(12) (pp 2245-2252),
2024. Date of Publication: December 2024.
Author
Mehani S.H.M.; Helmy Z.M.; Ali H.M.; Mohamed Mahmoud M.I.
Institution
(Mehani, Ali, Mohamed Mahmoud) Physical Therapy Department for
Cardiovascular / Respiratory Disorders and Geriatrics, Faculty of Physical
Therapy, Beni-Suef University
(Helmy) Physical Therapy Department for Cardiovascular / Respiratory
Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University,
Cairo, Egypt
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the effect of adding integrated core and graduated
resistance upper limb exercises to an inpatient cardiac rehabilitation
program in patients with acute sternal instability after coronary artery
bypass grafting (CABG). Design(s): This was a single-center,
randomized, controlled, parallel-group intervention study.
 Setting(s): This study was conducted at the National Heart Institute.
 Participant(s): Forty patients with post-CABG with sternal
instability aged 50-60 years completed this study and were randomized into
2 groups: an intervention group (n=20) and an active control group (n=20).
 Intervention(s): The intervention group (A) received a routine
inpatient rehabilitation program from the first postoperative day plus
integrated core and graduated resistance upper limb exercises, which
started from the seventh postoperative day for approximately 4 weeks,
whereas the control group (B) received only the routine inpatient
rehabilitation program. Main Outcome Measure(s): Sternal separation
measured by ultrasonography, visual analog scale for measuring pain, and
activities of daily living (ADL) index were main outcome measures.
 Result(s): Patients in the intervention group (A) showed a
significant reduction in sternal separation from the supine and long
sitting positions, whereas those in the control group (B) showed a
significant increase in sternal separation (P=.0001). Both groups showed a
reduction in pain, and an increase in the ADL score was observed in group
A. There was a significant interaction between the time and group effects
(P=.0001). Conclusion(s): Adding integrated core and graduated upper
limb exercises to inpatient cardiac rehabilitation for patients with
sternal instability after coronary artery bypass grafting significantly
improved sternal healing, pain, and ADL. Copyright © 2024
American Congress of Rehabilitation Medicine

<6>
Accession Number
2030436227
Title
Left versus right ventricular pacing during TAVR and balloon aortic
valvuloplasty: A systematic review and meta-analysis.
Source
PACE - Pacing and Clinical Electrophysiology. 47(9) (pp 1141-1156), 2024.
Date of Publication: September 2024.
Author
Khalefa B.B.; Ayyad M.; Albandak M.; Ayyad A.; Yassin M.N.A.; Awad A.K.
Institution
(Khalefa, Awad) Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Ayyad, Albandak, Ayyad) Faculty of Medicine, Al-Quds University,
Jerusalem, Palestine
(Yassin) Faculty of Medicine, Cairo University, Cairo, Egypt
Publisher
John Wiley and Sons Inc
Abstract
Introduction: While right ventricular pacing (RVP) is the conventional
temporary pacing modality used for transcatheter aortic valve replacement
(TAVR), this approach possesses inherent risks and procedural challenges.
We aim to assess and compare the safety and efficacy of left ventricular
pacing (LVP) and RVP during TAVR and balloon aortic valvuloplasty (BAV).
 Method(s): Following PRISMA guidelines, a comprehensive literature
search was conducted in four databases from inception to December 15th,
2023. We included observational studies and clinical trials comparing LVP
with RVP during TAVR and BAV procedures. Primary outcomes included
short-term mortality, mortality due to cardiac tamponade, and procedural
complications including bleeding, vascular complications, and cardiac
tamponade. Secondary outcomes comprised procedure duration and length of
hospital stay. Result(s): Five studies involving 830 patients with
RVP and 1577 with LVP were included. Short-term mortality was
significantly higher in the RVP group (RR 2.32, 95% CI: [1.37-3.93], P
=.002), as was the incidence of cardiac tamponade (RR 2.19, 95% CI:
[1.11-4.32], P =.02). LVP demonstrated shorter hospital stays (MD = 1.34
d, 95% CI: [0.90, 1.78], P <.001) and reduced procedure duration (MD =
7.75 min, 95% CI: [5.08, 10.41], P <.00001) compared to RVP. New pacemaker
implantation was higher in the RVP group (RR 2.23, 95% CI: [1.14, 4.39], P
=.02). Conclusion(s): LVP during TAVR and BAV emerges a safer
alternative to RVP, offering reduced mortality, hospital stays, and
procedure durations. Copyright © 2024 Wiley Periodicals LLC.

<7>
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

<8>
Accession Number
2031983035
Title
The Effects of Albumin 20% and Hydroxyethyl Starch 6% on Bleeding and
Interleukin-6 Levels as Priming Solutions for Cardiopulmonary Bypass: A
Randomized Controlled Trial.
Source
Journal of Tehran University Heart Center. 19(3) (pp 162-169), 2024. Date
of Publication: 2024.
Author
Hosseini A.; Shahzamani M.; Hashemabadi A.; Andalib A.
Institution
(Hosseini, Shahzamani) Department of Surgery, Chamran Hospital, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Hashemabadi) Department of Blood Circulation Technology, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Andalib) Department of Immunology, School of Medicine, Isfahan University
of Medical Sciences, Isfahan, Iran, Islamic Republic of
Publisher
Tehran Heart Center
Abstract
Background: Cardiopulmonary bypass (CPB) can adversely affect coagulation
and systemic inflammatory response. Given that the optimal strategy for
priming CPB in cardiac surgery remains a matter of debate, this study
aimed to investigate the effects of albumin 20% and hydroxyethyl starch 6%
as priming solutions on bleeding and interleukin-6 (IL-6) levels during
CPB. Method(s): This randomized clinical trial involved 40 patients
undergoing coronary artery bypass surgery at Shahid Chamran Hospital
between July 2021 and July 2022. Participants were assigned to 2 groups:
the first group received 50 mL of albumin 20% as the priming solution for
the CPB circuit, while the second group received 500 mL of hydroxyethyl
starch 6%. Bleeding and IL-6 levels were assessed before and after the
intervention. Result(s): The albumin group comprised 80.0% men and
20.0% women, with a mean age of 66.45+/-5.84 years. The hydroxyethyl
starch 6% group consisted of 85.0% men and 15.0% women, with a mean age of
63.05+/-5.92 years (P>0.05). The findings revealed that 12 hours after
CPB, the IL-6 level in the hydroxyethyl starch 6% group (mean:
171.6+/-77.71 pg/ mL) was significantly higher than that in the albumin
group (mean: 105.8+/-36.45 pg/mL; P=0.002). At 48 hours after CPB, the
mean bleeding was not significantly different between the groups
(P=0.950). Conclusion(s): Albumin 20% was more effective than
hydroxyethyl starch 6% concerning IL-6 levels. However, no significant
differences in bleeding were observed between the groups at 48 hours
post-CPB. Copyright © 2024 Tehran University of Medical Sciences.

<9>
Accession Number
2031983025
Title
The Effect of Traditional Iranian Music on Anxiety and Physiological
Parameters of Patients before Coronary Artery Bypass Graft (CABG): A
Randomized Controlled Trial.
Source
Journal of Tehran University Heart Center. 19(3) (pp 184-191), 2024. Date
of Publication: 2024.
Author
Rasoli S.; Nasiri-Formi E.; Dadkhah-Tirani H.; Esmaeilpour-Bandboni M.;
Asaolahpour A.
Institution
(Rasoli) Department of Anesthesiology and Operating Room, School of Allied
Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran,
Islamic Republic of
(Nasiri-Formi) Department of Anesthesiology and Operating Room, School of
Allied Medical Sciences, Traditional and Complementary Medicine Research
Center, Addiction Institute, Mazandaran University of Medical Sciences,
Sari, Iran, Islamic Republic of
(Dadkhah-Tirani) Department of Cardiac Surgery, School of Medicine,
Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran,
Islamic Republic of
(Esmaeilpour-Bandboni) Department of Medical-Surgical Nursing, Faculty of
Nursing, Guilan University of Medical Sciences, Rasht, Iran, Islamic
Republic of
(Asaolahpour) Department of Medical Surgical Nursing, Heshmat Hospital,
Guilan University of Medical Sciences, Rasht, Iran, Islamic Republic of
Publisher
Tehran Heart Center
Abstract
Background: Coronary artery bypass graft (CABG) surgery is a primary
treatment for coronary artery occlusion. Anxiety is a common preoperative
concern among patients undergoing this procedure. This study aimed to
investigate the effect of listening to traditional Iranian music on
anxiety in patients before CABG surgery. Method(s): This randomized
controlled trial involved 66 patients scheduled for CABG surgery. Patients
were randomly assigned to either the control or intervention group, with
33 patients in each group. The intervention group listened to traditional
music on an MP3 player for 20 minutes, while the control group received an
MP3 player without music. Anxiety levels were measured using the
Spielberger Anxiety Questionnaire before and after the intervention. Data
were analyzed using the Student's t-test, the paired t-test, and the
Mann-Whitney U-test with SPSS software version 21. Result(s): There
was no significant difference in anxiety severity between the 2 groups
before the intervention (music group: 106.45+/-10.67 and control group:
116.36+/-9.78; P=0.798). However, after the intervention, there was a
significant difference between the groups (music group: 65.82+/-7.54 vs
control group: 113.72+/-13.04; P=0.001). There were no significant
differences in physiological parameters (blood pressure, heart rate, and
respiration rate) between the groups before the intervention (P<0.078).
Following the intervention, systolic (P<0.013) and diastolic (P<0.003)
blood pressure significantly decreased in the intervention group compared
with the control group. Conclusion(s): Traditional Iranian music
therapy can be a noninvasive, low-cost, and accessible tool to reduce
anxiety in patients undergoing CABG surgery. Copyright © 2024
Tehran University of Medical Sciences.

<10>
Accession Number
2035874042
Title
Effect of Narrow Chest on Minimally Invasive Mitral Valve Surgery via
Right Minithoracotomy.
Source
Circulation Journal. 88(12) (pp 1973-1979), 2024. Date of Publication:
December 2024.
Author
Sawa S.; Nakamura Y.; Nakayama T.; Kuroda M.; Nakamae K.; Niitsuma K.;
Ushijima M.; Yasumoto Y.; Yoshiyama D.; Furutachi A.; Ito Y.; Tsuruta R.
Institution
(Sawa, Nakamura, Nakayama, Kuroda, Nakamae, Niitsuma, Ushijima, Yasumoto,
Yoshiyama, Furutachi, Ito, Tsuruta) Department of Cardiovascular Surgery,
Chibanishi General Hospital, Matsudo, Japan
Publisher
Japanese Circulation Society
Abstract
Background: The effect of a narrow chest on minimally invasive mitral
valve surgery (MIMVS) is unclear. Methods and Results: We enrolled
206 MIMVS patients and measured anteroposterior diameter (APD) between the
sternum and vertebra, transverse thoracic diameter (TD), right and left
APD of the hemithorax (RD and LD, respectively), and the Haller index (HI;
TD/APD ratio) on computed tomography. Preoperative characteristics and
operative outcomes were compared between patients with a narrow chest
(Group N; HI >2.5; n=53) and those with a normal chest (control [C]; HI
<=2.5; n=153), and the correlations of these measurements with operation
time were evaluated in 133 patients undergoing an isolated mitral
procedure. Groups N and C differed significantly in APD (89.4 vs. 114.3mm,
respectively; P<0.001), TD (251.5 vs. 240.3mm, respectively; P=0.002), RD
(152.5 vs. 172.5mm, respectively; P<0.001), LD (155.0 vs. 172.4mm,
respectively; P<0.001), and HI (2.84 vs. 2.12, respectively; P<0.001).
Procedural characteristics were comparable, except for a longer aortic
cross-clamp time (ACCT) in Group N (118.7 vs. 105.8min; P=0.047). Rates of
surgical death, re-exploration, cerebral infarction, and prolonged
ventilation were comparable between the 2 groups. TD was significantly
correlated with ACCT (R2=0.037, P=0.028) in patients undergoing
an isolated mitral procedure. Conclusion(s): Early MIMVS outcomes in
patients with narrow chests are satisfactory. TD prolongs ACCT during
MIMVS. Copyright © 2024 Japanese Circulation Society. All rights
reserved.

<11>
Accession Number
645832707
Title
Colchicine in Acute Myocardial Infarction.
Source
The New England journal of medicine. (no pagination), 2024. Date of
Publication: 17 Nov 2024.
Author
Jolly S.S.; d'Entremont M.-A.; Lee S.F.; Mian R.; Tyrwhitt J.; Kedev S.;
Montalescot G.; Cornel J.H.; Stankovic G.; Moreno R.; Storey R.F.; Henry
T.D.; Mehta S.R.; Bossard M.; Kala P.; Layland J.; Zafirovska B.;
Devereaux P.J.; Eikelboom J.; Cairns J.A.; Shah B.; Sheth T.; Sharma S.K.;
Tarhuni W.; Conen D.; Tawadros S.; Lavi S.; Yusuf S.
Institution
(Jolly, d'Entremont, Lee, Mian, Tyrwhitt, Kedev, Montalescot, Cornel,
Stankovic, Moreno, Storey, Henry, Mehta, Bossard, Kala, Layland,
Zafirovska, Devereaux, Eikelboom, Cairns, Shah, Sheth, Sharma, Tarhuni,
Conen, Tawadros, Lavi, Yusuf) From the Population Health Research
Institute, McMaster University (S.S.J., M.-A.E., S.F.L., R. Mian, J.T.,
S.R.M., P.J.D., J.E., T.S., D.C., S.T., S.Y.), and Hamilton Health
Sciences (S.S.J., M.-A.E., S.F.L., R. Mian, S.R.M., P.J.D., J.E., T.S.,
D.C.), Hamilton, Centre Hospitalier Universitaire de Sherbrooke,
Sherbrooke (M.-A.E.), the University of British Columbia and Centre for
Cardiovascular Innovation, Vancouver Coastal Health, Vancouver (J.A.C.),
the Department of Medicine, University of Saskatchewan, Saskatoon (W.T.),
and London Health Sciences, University of Western Ontario, London (S.L.) -
all in Canada; the University Clinic of Cardiology, Medical Faculty,
University Ss. Cyril and Methodius, Skopje, North Macedonia (S.K., B.Z.);
Sorbonne University, ACTION Study Group, Centre Hospitalier Universitaire
Pitie-Salpetriere Assistance Publique-Hopitaux de Paris, Paris (G.M.); the
Dutch Network for Cardiovascular Research, Utrecht, Radboud University
Medical Center, Nijmegen, and Northwest Clinics, Alkmaar - all in the
Netherlands (J.H.C.); the University Clinical Center of Serbia and the
Faculty of Medicine, University of Belgrade, Belgrade (G.S.); the
Cardiology Department, University Hospital La Paz, Universidad Autonoma de
Madrid, Madrid (R. Moreno)
Abstract
BACKGROUND: Inflammation is associated with adverse cardiovascular events.
Data from recent trials suggest that colchicine reduces the risk of
cardiovascular events. METHOD(S): In this multicenter trial with a
2-by-2 factorial design, we randomly assigned patients who had myocardial
infarction to receive either colchicine or placebo and either
spironolactone or placebo. The results of the colchicine trial are
reported here. The primary efficacy outcome was a composite of death from
cardiovascular causes, recurrent myocardial infarction, stroke, or
unplanned ischemia-driven coronary revascularization, evaluated in a
time-to-event analysis. C-reactive protein was measured at 3 months in a
subgroup of patients, and safety was also assessed. RESULT(S): A
total of 7062 patients at 104 centers in 14 countries underwent
randomization; at the time of analysis, the vital status was unknown for
45 patients (0.6%), and this information was most likely missing at
random. A primary-outcome event occurred in 322 of 3528 patients (9.1%) in
the colchicine group and 327 of 3534 patients (9.3%) in the placebo group
over a median follow-up period of 3 years (hazard ratio, 0.99; 95%
confidence interval [CI], 0.85 to 1.16; P=0.93). The incidence of
individual components of the primary outcome appeared to be similar in the
two groups. The least-squares mean difference in C-reactive protein levels
between the colchicine group and the placebo group at 3 months, adjusted
according to the baseline values, was -1.28 mg per liter (95% CI, -1.81 to
-0.75). Diarrhea occurred in a higher percentage of patients with
colchicine than with placebo (10.2% vs. 6.6%; P<0.001), but the incidence
of serious infections did not differ between groups. CONCLUSION(S):
Among patients who had myocardial infarction, treatment with colchicine,
when started soon after myocardial infarction and continued for a median
of 3 years, did not reduce the incidence of the composite primary outcome
(death from cardiovascular causes, recurrent myocardial infarction,
stroke, or unplanned ischemia-driven coronary revascularization). (Funded
by the Canadian Institutes of Health Research and others; CLEAR
ClinicalTrials.gov number, NCT03048825.). Copyright © 2024
Massachusetts Medical Society.

<12>
Accession Number
645830057
Title
Left Atrial Appendage Closure after Ablation for Atrial Fibrillation.
Source
The New England journal of medicine. (no pagination), 2024. Date of
Publication: 16 Nov 2024.
Author
Wazni O.M.; Saliba W.I.; Nair D.G.; Marijon E.; Schmidt B.; Hounshell T.;
Ebelt H.; Skurk C.; Oza S.; Patel C.; Kanagasundram A.; Sadhu A.; Sundaram
S.; Osorio J.; Mark G.; Gupta M.; DeLurgio D.B.; Olson J.; Nielsen-Kudsk
J.E.; Boersma L.V.A.; Healey J.S.; Phillips K.P.; Asch F.M.; Wolski K.;
Roy K.; Christen T.; Sutton B.S.; Stein K.M.; Reddy V.Y.
Institution
(Wazni, Saliba, Nair, Marijon, Schmidt, Hounshell, Ebelt, Skurk, Oza,
Patel, Kanagasundram, Sadhu, Sundaram, Osorio, Mark, Gupta, DeLurgio,
Olson, Nielsen-Kudsk, Boersma, Healey, Phillips, Asch, Wolski, Roy,
Christen, Sutton, Stein, Reddy) From Cleveland Clinic, Cleveland (O.M.W.,
W.I.S., K.W.); St. Bernards Medical Center and Arrhythmia Research Group,
Jonesboro, AR (D.G.N.); the Cardiology Department, European Georges
Pompidou Hospital, Paris (E.M.); Cardioangiologisches Centrum Bethanien,
Agaplesion Markus Krankenhaus, Frankfurt am Main (B.S.), Catholic
Hospital, Sankt Johann Nepomuk, Erfurt (H.E.), and Deutsches Herzzentrum
der Charite (DHZC), Campus Benjamin Franklin, Berlin (C.S.) - all in
Germany; Iowa Heart Center, West Des Moines (T.H.); Ascension St.
Vincent's Medical Center, Jacksonville, FL (S.O.); UPMC Pinnacle,
Harrisburg, PA (C.P.); Vanderbilt University, Nashville (A.K.); Phoenix
Cardiovascular Research Group, Phoenix AZ (A.S.); South Denver Cardiology,
Littleton, CO (S.S.); Grandview Medical Center, Birmingham, AL (J.
Osorio); Heart House-Cooper University, Camden, NJ (G.M.); Lindner Center
for Research and Education at Christ Hospital, Cincinnati (M.G.); Emory
University, Medicine, Atlanta (D.B.D.); St. Vincent Heart Center of
Indiana, Indianapolis (J. Olson); the Department of Cardiology, Aarhus
University Hospital, Aarhus, Denmark (J.E.N.-K.); St. Antonius Hospital,
Nieuwegein, the Netherlands (L.V.A.B.); the Population Health Research
Institute, Hamilton, ON, Canada (J.S.H.); Brisbane AF Clinic, Greenslopes
Private Hospital, Brisbane, QLD, Australia (K.P.P.); Medstar Health
Research Institute, Medstar Washington Hospital Center, Washington, DC
(F.M.A.); Boston Scientific, Marlborough, MA (K.R., T.C., B.S.S., K.M.S.);
and Cardiac Electrophysiology, Mount Sinai Fuster Heart Hospital School of
Medicine, New York (V.Y.R.)
Abstract
BACKGROUND: Oral anticoagulation is recommended after ablation for atrial
fibrillation among patients at high risk for stroke. Left atrial appendage
closure is a mechanical alternative to anticoagulation, but data regarding
its use after atrial fibrillation ablation are lacking. METHOD(S): We
conducted an international randomized trial involving 1600 patients with
atrial fibrillation who had an elevated score (>=2 in men and >=3 in
women) on the CHA2DS2-VASc scale (range, 0 to 9, with higher scores
indicating a greater risk of stroke) and who underwent catheter ablation.
Patients were randomly assigned in a 1:1 ratio to undergo left atrial
appendage closure or receive oral anticoagulation. The primary safety end
point, tested for superiority, was non-procedure-related major bleeding or
clinically relevant nonmajor bleeding. The primary efficacy end point,
tested for noninferiority, was a composite of death from any cause,
stroke, or systemic embolism at 36 months. The secondary end point, tested
for noninferiority, was major bleeding, including procedure-related
bleeding, through 36 months. RESULT(S): A total of 803 patients were
assigned to undergo left atrial appendage closure, and 797 to receive
anticoagulant therapy. The mean (+/-SD) age of the patients was 69.6+/-7.7
years, 34.1% of the patients were women, and the mean CHA2DS2-VASc score
was 3.5+/-1.3. At 36 months, a primary safety end-point event had occurred
in 65 patients (8.5%) in the left atrial appendage closure group (device
group) and in 137 patients (18.1%) in the anticoagulation group (P<0.001
for superiority); a primary efficacy end-point event had occurred in 41
patients (5.3%) and 44 patients (5.8%), respectively (P<0.001 for
noninferiority); and a secondary end-point event had occurred in 3.9% and
5.0% (P<0.001 for noninferiority). Complications related to the appendage
closure device or procedure occurred in 23 patients. CONCLUSION(S):
Among patients who underwent catheter-based atrial fibrillation ablation,
left atrial appendage closure was associated with a lower risk of
non-procedure-related major or clinically relevant nonmajor bleeding than
oral anticoagulation and was noninferior to oral anticoagulation with
respect to a composite of death from any cause, stroke, or systemic
embolism at 36 months. (Funded by Boston Scientific; OPTION
ClinicalTrials.gov number, NCT03795298.). Copyright © 2024
Massachusetts Medical Society.

<13>
Accession Number
2034294565
Title
Efficacy of Single-port Thoracoscopic Resection of Benign Lung Tumors and
Its Impacts on Respiratory Function and Inflammatory Factors: A Randomized
Controlled Study.
Source
Iranian Journal of Allergy, Asthma and Immunology. 23(4) (pp 403-411),
2024. Date of Publication: 2024.
Author
Wang Q.; Deng M.; Wang B.
Institution
(Wang, Deng, Wang) Department of Cardiothoracic Surgery, Renmin Hospital,
Hubei University of Medicine, Shiyan, China
Publisher
Tehran University of Medical Sciences
Abstract
Peripheral benign lung tumors are often asymptomatic and incidentally
detected on chest radiographs. Surgical intervention is recommended when
feasible. Single-port thoracoscopic resection has emerged as a promising
technique for treating various chest diseases, including lung tumors. This
study aimed to assess the clinical efficacy of single-port thoracoscopic
resection for benign lung tumors and its impact on respiratory function
and inflammatory factors. A total of 128 eligible patients diagnosed with
benign lung tumors were randomly assigned to either the observation group
(undergoing single-port thoracoscopic resection) or the control group
(undergoing conventional thoracic surgery). Surgical outcomes,
complications, pulmonary and respiratory function, and inflammatory
factors were compared between the two groups. The observation group showed
significantly lower intraoperative bleeding, shorter hospitalization time,
and lower complication rates compared to the control group. Patients in
the observation group exhibited higher vital capacity (VC), forced vital
capacity (FVC), and total lung capacity (TLC) levels at 1/2 week and 1
month after surgery. Additionally, forced expiratory volume in one second
(FEV1) and maximum ventilation volume per minute (MVV) levels were higher
in the observation group post-surgery, with a lower Borg score. Levels of
C-reactive protein (CRP), precalcitonin (PCT), and tumor necrosis factor
(TNF-alpha) were lower in the observation group post-surgery. Single-port
thoracoscopic resection demonstrates favorable clinical efficacy for
treating benign lung tumors, reducing bleeding, and shortening hospital
stays. Furthermore, it improves lung and respiratory function while
reducing inflammatory factors. This technique is safe, effective, and
holds promise for wider application in managing benign lung
tumors. Copyright © 2024 Wang et al.

<14>
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.

<15>
Accession Number
2035832312
Title
Transcatheter aortic-valve implantation with or without on-site cardiac
surgery: The TRACS trial.
Source
American Heart Journal. 280 (pp 7-17), 2025. Date of Publication: February
2025.
Author
Iannopollo G.; Cocco M.; Leone A.; Sacca S.; Mangino D.; Picchi A.; Reccia
M.R.; Fineschi M.; Meliga E.; Audo A.; Nobile G.; Tumscitz C.; Penzo C.;
Saia F.; Rubboli A.; Moretti C.; Vignali L.; Niccoli G.; Cimaglia P.;
Rognoni A.; Aschieri D.; Iaccarino D.; Ottani F.; Cavazza C.; Varbella F.;
Secco G.G.; Bolognese L.; Limbruno U.; Guiducci V.; Campo G.; Casella G.
Institution
(Iannopollo, Nobile, Casella) Cardiology Unit, Ospedale Maggiore, Bologna,
Italy
(Cocco, Tumscitz, Penzo, Cimaglia, Campo) Cardiovascular Institute,
Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
(Leone) Cardiac Surgery Department, S. Orsola Hospital, University of
Bologna, Bologna, Italy
(Sacca) Department of Cardiology, Ospedale Civile di Mirano, Venice,
Mirano, Italy
(Mangino) Cardiac Surgery Unit, Ospedale dell'Angelo, Venice-Mestre, Italy
(Picchi, Limbruno) Cardiovascular Department, Azienda USL Toscana Sud-Est,
Misericordia Hospital, Grosseto, Italy
(Reccia, Bolognese) Cardiovascular Department, San Donato Hospital,
Arezzo, Italy
(Fineschi) Interventional Cardiology UOSA, Azienda Ospedaliera
Universitaria Senese, Siena, Italy
(Meliga) Department of Cardiology, Cardinal Massaia Hospital, Asti, Italy
(Audo) Department of Cardiac Surgery, AO SS Antonio e Biagio e Cesare
Arrigo, Alessandria, Italy
(Saia) Division of Interventional Cardiology, IRCCS University Hospital of
Bologna, Policlinico Sant'Orsola, Bologna, Italy
(Rubboli, Moretti) Division of Cardiology, S.Maria delle Croci Hospital,
Ravenna, Italy
(Vignali, Niccoli) Division of Cardiology, Parma University Hospital,
Parma, Italy
(Rognoni) Division of Cardiology, Ospedale degli Infermi, Azienda
Sanitaria Locale di Biella, Biella, Italy
(Aschieri) Cardiology Unit of Emergency Department, Guglielmo da Saliceto
Hospital, Piacenza, Italy
(Iaccarino) Cardiology Department, Nuovo Ospedale S. Agostino Estense,
Modena, Italy
(Ottani, Cavazza) Cardiovascular Department, Infermi Hospital, Rimini,
Italy
(Varbella) Rivoli Infermi Hospital, Turin, Rivoli, Italy
(Secco) Department of Cardiology, AO SS Antonio e Biagio e Cesare Arrigo,
Alessandria, Italy
(Guiducci) Cardiology Unit, Azienda USL-IRCCS Reggio Emilia, S. Maria
Nuova Hospital, Reggio Emilia, Italy
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has emerged as
an effective and safe treatment for patients with symptomatic aortic
stenosis. The indication to TAVI should be agreed upon by a Heart Team,
and the procedure should be performed in centers with on-site cardiac
surgery. However, TAVI complications requiring emergent cardiac surgery
(ECS) have become very rare. Concurrently, access disparities and
prolonged waiting times are pressing issues due to increasing clinical
demand of TAVI. Many solutions have been proposed and one of them is the
possibility of performing TAVI in centers without on-site cardiac surgery.
Methods and Design: The Transcatheter Aortic-Valve Implantation with or
without on-site Cardiac Surgery (TRACS) trial is a prospective,
randomized, multicenter, open-label study with blinded adjudicated
evaluation of outcomes. Patients with symptomatic severe aortic stenosis
and deemed inoperable, at high surgical risk, or presenting with at least
1 clinical factor compromising the benefit/risk ratio for ECS, will be
randomized to undergo TAVI either in centers with or without on-site
cardiac surgery. The primary endpoint will be the composite occurrence of
all-cause death, stroke, and hospital readmission for cardiovascular
causes at one year. The safety endpoint will include death attributable to
periprocedural complications actionable by ECS. The study aims to enroll
566 patients. Implications: The TRACS trial aims to address critical gaps
in knowledge regarding the safety and efficacy of TAVI procedures
performed in centers without on-site cardiac surgery, potentially
improving access and outcomes for high-risk patients. Trial Registration:
ClinicalTrials.gov NCT05751577 Copyright © 2024 The Author(s)

<16>
Accession Number
2035803082
Title
Late gadolinium enhancement on cardiac MRI: A systematic review and
meta-analysis of prognosis across cardiomyopathies.
Source
International Journal of Cardiology. 419 (no pagination), 2025. Article
Number: 132711. Date of Publication: 15 Jan 2025.
Author
Helali J.; Ramesh K.; Brown J.; Preciado-Ruiz C.; Nguyen T.; Silva L.T.;
Ficara A.; Wesbey G.; Gonzalez J.A.; Bilchick K.C.; Salerno M.; Robinson
A.A.
Institution
(Helali, Preciado-Ruiz, Silva, Ficara, Wesbey, Gonzalez, Robinson)
Division of Cardiology, Scripps Clinic, La Jolla, CA, United States
(Ramesh) University of California San Diego School of Medicine, La Jolla,
CA, United States
(Brown) Northwestern University Feinberg School of Medicine, Chicago, IL,
United States
(Nguyen) University of California Riverside, Riverside, CA, United States
(Silva) University of California San Diego, La Jolla, CA, United States
(Bilchick) Department of Cardiovascular Medicine, University of Virginia
Health System, Charlottesville, VA, United States
(Salerno) Department of Medicine, Division of Cardiovascular Medicine,
Stanford University School of Medicine, Stanford, CA, United States
(Wesbey, Gonzalez) Department of Radiology, Scripps Clinic, La Jolla, CA,
United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Late gadolinium enhancement (LGE) on cardiac MRI has been
shown to predict adverse outcomes in a range of cardiac diseases. However,
no study has systematically reviewed and analyzed the literature across
all cardiac pathologies including rare diseases. Method(s): PubMed,
EMBASE and Web of Science were searched for studies evaluating the
relationship between LGE burden and cardiovascular outcomes. Outcomes
included all-cause mortality, MACE, sudden cardiac death, sustained VT or
VF, appropriate ICD shock, heart transplant, and heart failure
hospitalization. Only studies reporting hazards ratios with LGE as a
continuous variable were included. Result(s): Of the initial 8928
studies, 95 studies (23,313 patients) were included across 19 clinical
entities. The studies included ischemic cardiomyopathy (7182 patients, 33
studies), hypertrophic cardiomyopathy (5080 patients, 17 studies),
non-ischemic cardiomyopathy not otherwise specified (2627 patients, 11
studies), and dilated cardiomyopathy (2345 patients, 14 studies). Among 42
studies that quantified LGE by percent myocardium, a 1 % increase in LGE
burden was associated with life-threatening ventricular arrhythmias (LTVA)
with a pooled hazard ratio of 1.04 (CI 1.02-1.05), and MACE with a pooled
hazard ratio of 1.06 (CI 1.04-1.07). The risk of these events was similar
across disease types, with minimal heterogeneity. Conclusion(s):
Despite mechanistic differences in myocardial injury, LGE appears to have
a fairly consistent, dose-dependent effect on risk of LTVA, MACE, and
mortality. These data can be applied to derive a patient's absolute risk
of LTVA, and therefore can be clinically useful in informing decisions on
primary prevention ICD implantation irrespective of the disease
etiology. Copyright © 2024 Elsevier B.V.

<17>
Accession Number
2035772202
Title
Cardiac rehabilitation and frailty: a systematic review and meta-analysis.
Source
European Journal of Preventive Cardiology. 31(16) (pp 1960-1976), 2024.
Date of Publication: 01 Nov 2024.
Author
Maceachern E.; Quach J.; Giacomantonio N.; Theou O.; Hillier T.;
Abel-Adegbite I.; Gonzalez-Lara M.; Kehler D.S.
Institution
(Maceachern, Theou, Kehler) School of Physiotherapy, Dalhousie University,
5869 University Ave, Forrest Building, PO Box 15000, Halifax, NS B3H 4R2,
Canada
(Quach, Theou, Abel-Adegbite, Gonzalez-Lara, Kehler) Faculty of Health,
Dalhousie University, 5868 College Street, PO Box 15000, Halifax, NS B3H
4R2, Canada
(Giacomantonio) Department of Cardiology, Dalhousie University, Halifax,
NS, Canada
(Theou) Division of Geriatric Medicine, Dalhousie University, Halifax, NS,
Canada
(Hillier) Department of Surgery, Dalhousie University, Halifax, NS, Canada
Publisher
Oxford University Press
Abstract
Aims: Frailty among cardiac rehabilitation (CR) participants is associated
with worse health outcomes. However, no literature synthesis has
quantified the relationship between frailty and CR outcomes. The purpose
of this study was to examine frailty prevalence at CR admission, frailty
changes during CR, and whether frailty is associated with adverse outcomes
following CR. Methods and Results: We searched CINAHL, EMBASE, and
MEDLINE for studies published from 2000 to 2023. Eligible studies included
a validated frailty measure, published in English. Two reviewers
independently screened articles and abstracted data. Outcome measures
included admission frailty prevalence, frailty and physical function
changes, and post-CR hospitalization and mortality. Observational and
randomized trials were meta-analysed separately using inverse variance
random-effects models. In total, 34 peer reviewed articles (26
observational, 8 randomized trials; 19 360 participants) were included.
Admission frailty prevalence was 46% [95% CI 29-62%] and 40% [95% CI
28-52%] as measured by Frailty Index and Kihon Checklist (14 studies) and
Frailty Phenotype (11 studies), respectively. Frailty improved following
CR participation (standardized mean difference (SMD): 0.68, 95% CI
0.37-0.99; P < 0.0001; six studies). Meta-analysis of observational
studies revealed higher admission frailty and increased participants' risk
of all-cause mortality (hazard ratio: 9.24, 95% CI 2.93-29.16; P = 0.0001;
four studies). Frailer participants at admission had worse physical health
outcomes, but improved over the course of CR. Conclusion(s): High
variability in frailty tools and CR designs was observed, and randomized
controlled trial contributions were limited. The prevalence of frailty is
high in CR and is associated with greater mortality risk; however, CR
improves frailty and physical health outcomes. Copyright © 2024
The Author(s).

<18>
[Use Link to view the full text]
Accession Number
2035651920
Title
Invasive Treatment Strategy for Older Patients with Myocardial Infarction.
Source
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) The Translational and Clinical Research Institute, Newcastle
University, Faculty of Medical Sciences, Newcastle upon Tyne, United
Kingdom
(Mossop, Teare) The Population Health Sciences Institute, Newcastle
University, Newcastle upon Tyne, United Kingdom
(Shields, Bardgett, Watts, Teare, Pritchard) The Newcastle Clinical Trials
Unit, Newcastle University, Newcastle upon Tyne, United Kingdom
(Kunadian, Haq) The Cardiothoracic Centre, Newcastle Upon Tyne Hospitals
Nhs Foundation Trust, Freeman Hospital, Newcastle upon Tyne, United
Kingdom
(Runnett, Ripley) Northumbria Healthcare Nhs Foundation Trust,
Cramlington, United Kingdom
(Ripley) The Faculty of Health Sciences and Wellbeing, School of Medicine,
Sunderland, United Kingdom
(Carter, Quigley) North Tees and Hartlepool Nhs Foundation Trust,
Stockton-on-Tees, United Kingdom
(Cooke) Chesterfield Royal Hospital, Chesterfield, United Kingdom
(Austin) South Tees Nhs Foundation Trust, Middlesbrough, United Kingdom
(Murphy) County Darlington and Durham Nhs Foundation Trust, Darlington,
United Kingdom
(Kelly) Royal Derby Hospital, Derby, United Kingdom
(Adams-Hall) University Hospital Ayr, Ayr, United Kingdom
(Veerasamy) Leeds Teaching Hospital Nhs Trust, Leeds, United Kingdom
(Felmeden) Torbay and South Devon Nhs Foundation Trust, Torquay, United
Kingdom
(Contractor) Manchester University Nhs Foundation Trust, Manchester,
United Kingdom
(Mutgi) Epsom and St. Helier University Hospitals, Epsom, United Kingdom
(Irving) Ninewells Hospital, Dundee, United Kingdom
(Lindsay) Bradford Royal Infirmary, Bradford, United Kingdom
(Galasko) Blackpool Victoria Hospital, Blackpool, United Kingdom
(Lee) United Lincolnshire Hospitals Nhs Trust, Lincoln, United Kingdom
(Sultan) Wrightington Wigan and Leigh Teaching Hospitals Nhs Foundation
Trust, Wigan, United Kingdom
(Dastidar) North Bristol Nhs Trust, Bristol, United Kingdom
(Hussain) University Hospital of Leicester Nhs Trust, Leicester, United
Kingdom
(McGowan) Barts Health Nhs Trust, London, United Kingdom
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(De Belder, Denvir, Newby, Fox) The Centre for Cardiovascular Science,
University of Edinburgh, Edinburgh, United Kingdom
(Flather) Norwich Medical School, University of East Anglia, Norwich,
United Kingdom
(Storey) Sheffield Teaching Hospital, Sheffield, United Kingdom
Publisher
Massachussetts Medical Society
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. Methods 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.
Results 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. Conclusions 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. Copyright © 2024 Massachusetts Medical Society.

<19>
Accession Number
2034348329
Title
Correlation Between Tissue Doppler Imaging Method (E/e') and Invasive
Measurements of Left Ventricular Filling Pressures: A Systematic Review,
Meta-Analysis, and Meta-Regression.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 38(12) (pp 3200-3214),
2024. Date of Publication: December 2024.
Author
Orso D.; Sabbadin M.; Bacchetti G.; Simeoni G.; Bove T.
Institution
(Orso, Simeoni, Bove) Department of Anesthesia and Intensive Care, ASUFC
University Hospital of Udine, Udine, Italy
(Sabbadin, Bacchetti, Bove) Department of Medicine (DAME), University of
Udine, Udine, Italy
Publisher
W.B. Saunders
Abstract
Objectives: Evaluation of pulmonary capillary wedge pressure (PCWP)
through right heart catheterization can indirectly provide an estimation
of the filling pressure of the left ventricle. Echocardiography can
estimate left ventricular compliance using mitral annular tissue Doppler
imaging (TDI). The E/e' ratio refers to the correlation between the peak
mitral inflow (E-wave) velocity and early diastolic tissue Doppler mitral
annular velocity (e'). The main purpose of this systematic review was to
establish the correlation between echocardiographic E/e' ratio and PCWP.
The correlation between E/e' and left ventricular end-diastolic pressure
(LVEDP) was evaluated as a secondary objective. Design(s): A
systematic review and meta-analysis of observational studies was
conducted. The search was based on Medline (PubMed), Scopus, and Web of
Science. Setting(s): Intensive care unit or cardiac intensive care
unit. Participant(s): Adult patients. Intervention(s): Any study
comparing the left ventricular filling pressure obtained by cardiac
catheterization (reference) and echocardiographic evaluation, in
particular TDI analysis (intervention), were included. Measurements
and Main Results: The pooled analysis included 94 studies from the
initially identified 7,304 records. The correlation was 0.48 (95% CI
0.42-0.54, Q = 420.52, I2 = 84.8%) for PCWP and 0.50 (95% CI
0.38-0.60, Q = 210.91, I2 = 89.1%) for LVEDP.
 Conclusion(s): The E/e' ratio moderately correlated with PCWP/LVEDP.
The correlation was stable irrespective of the sites where e' was
measured, but each site has its own limitations for specific patient
subpopulations. The correlation was weak in patients with heart failure
with a preserved ejection fraction. Copyright © 2024 Elsevier
Inc.

<20>
Accession Number
2031321509
Title
Efficacy and safety of ticagrelor monotherapy following a brief DAPT vs.
prolonged 12-month DAPT in ACS patients post-PCI: a meta-analysis of RCTs.
Source
European Journal of Clinical Pharmacology. 80(12) (pp 1871-1882), 2024.
Date of Publication: December 2024.
Author
Qamar U.; Naeem F.; Maqsood M.T.; Khan M.Z.; Imtiaz Z.; Saeed F.; Gupta
N.; Brohi F.Z.; Mkpozi C.; Sattar Y.
Institution
(Qamar, Naeem, Maqsood, Khan, Imtiaz) Department of Internal Medicine,
King Edward Medical University, Lahore, Pakistan
(Saeed) Department of Rheumatology, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, United States
(Gupta) Department of Cardiology, Kirk Kerkorian School of Medicine at
the, University of Nevada, Las Vegas, United States
(Brohi) Department of Cardiology, Western Michigan University, Kalamazoo,
MI, United States
(Mkpozi, Sattar) Department of Internal Medicine and Department of
Cardiology, West Virginia University, 1 Medical Ctr Dr., Morgantown, WV
26506, United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: As per current guidelines, acute coronary syndrome (ACS)
patients who undergo percutaneous coronary intervention (PCI) should be
started on dual antiplatelet therapy (DAPT) for a period of 12 months.
 Objective(s): To assess the efficacy and safety of brief DAPT (up to
3 months) succeeded by ticagrelor monotherapy compared with a 12-month
DAPT in ACS patients following PCI. Method(s): We systematically
searched Cochrane, Embase, and PubMed to find relevant randomized clinical
trials. Examined outcomes included the incidence of major adverse
cerebrovascular and cardiovascular events (MACCE), bleeding events, and
the composite incidence of net adverse clinical events (NACE).
 Result(s): Our primary analysis included 21,927 ACS patients from six
RCTs. Our pooled results indicate that following PCI in individuals with
ACS, brief DAPT followed by ticagrelor did not increase the risk of MACCE
(OR 0.92, 95% CI 0.79-1.07) but significantly reduced the risk of minor or
major bleeding (OR 0.52, 95% CI 0.44-0.62) and NACE (OR 0.71, 95% CI
0.59-0.86) compared with a long-term DAPT within a follow-up of 12 months.
 Conclusion(s): Brief DAPT followed by ticagrelor monotherapy is
superior to a 12-month DAPT in offering a net clinical advantage in ACS
patients following PCI. Copyright © The Author(s), under
exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature
2024.

<21>
Accession Number
2030170387
Title
Feasibility of airway replacement using stented aortic matrices: Bench to
TRITON-01 study.
Source
Surgical Practice. 28(3) (pp 129-131), 2024. Date of Publication: August
2024.
Author
Wei S.; Zhang Y.; Fang L.
Institution
(Wei, Zhang) Department of Hepatobiliary and Pancreatic Surgery, General
Surgery Center, The First Hospital of Jilin University, Changchun, China
(Wei, Zhang, Fang) Department of Thoracic Surgery, The First Hospital of
Jilin University, Changchun, China
(Fang) Department of General Surgery, Liaoyuan People's Hospital,
Liaoyuan, China
Publisher
John Wiley and Sons Inc
Abstract
Patients with long-segment tracheal defects, deemed technically
inoperable, constitute a population in critical need of airway
replacement. Regardless of the underlying cause-be it benign or malignant
processes-this patient category requires either a tracheal transplant or
admission to a palliative care facility. Despite over 50 years of
exploration in thoracic surgery and regenerative medicine, airway
transplantation remains a significant challenge. Various tracheobronchial
substitutes, such as synthetic prostheses, bioprostheses, allografts,
autografts, and bioengineered conduits, have been experimentally tested,
yet none have provided a standardized method for airway replacement.
Aortic grafts were suggested by Aortic grafts have been suggested as a
biological matrix for extensive airway reconstruction as a biological
matrix for extensive airway reconstruction. Cryopreserved aortic
allografts, because of their availability in tissue banks and the lack of
need for immunosuppressive therapy, were first used in clinical
applications. The TRITON-01 study (NCT04263129) focuses on patients who
received airway replacement to determine the routine applicability of this
novel approach. The primary objective of this review is to provide
information on advancements in the use of aortic allografts as tracheal
replacements. Copyright © 2024 College of Surgeons of Hong Kong.

<22>
Accession Number
2035284661
Title
Discontinuation or continuation of renin-angiotensin system inhibitors
prior to non-cardiac surgery: Results of the STOP-or-NOT trial.
Source
Praticien en Anesthesie Reanimation. 28(6) (pp 359-363), 2024. Date of
Publication: December 2024.
Author
Legrand M.; Gayat E.
Institution
(Legrand) Department of Anesthesia and Perioperative Care, Division of
Critical Care Medicine, University of California, San Francisco (UCSF),
San Francisco, CA, United States
(Legrand, Gayat) INI-CRCT Network, Nancy, France
(Gayat) DMU PARABOL, service d'anesthesie-reanimation-CTB, hopital
Lariboisiere, universite Paris-Cite, AP-HP, Paris, France
(Gayat) Inserm, UMR-942 << MASCOT >>, Paris, France
Publisher
Elsevier Masson s.r.l.
Abstract
Many patients undergoing major surgery have a medical history of
hypertension, diabetes and/or heart failure. Often, these conditions
involve chronic use of an inhibitor of the renin-angiotensin system
(iSRA), including angiotensin-converting enzyme (ACE) inhibitors or
angiotensin receptor blockers (ARBs). Observational studies have suggested
that continuation of ARBs prior to major non-cardiac surgery may increase
the risk of intraoperative hypotension, which could lead to postoperative
complications such as acute renal failure, myocardial infarction (MI) or
cerebrovascular accident (CVA). However, firm recommendations on the
management of RASi prior to surgery are lacking due to the absence of
solid evidence, mainly limited to data from observational studies. The
STOP-OR-NOT trial was a large-scale multicenter randomized trial designed
to answer the question of whether chronic iSRA should be continued or
stopped before major non-cardiac surgery. The trial results showed that
there was no difference in the primary endpoint of all-cause mortality and
major postoperative complications within 28 days of surgery between the
treatment continuation and discontinuation groups, with a rate of death
and major postoperative complications of 22% in both groups. Patients in
the continuation group had a higher incidence of intraoperative
hypotension (54% vs. 41% in the discontinuation group). However, the
duration of mean arterial pressure below 60 mmHg was only slightly higher
in the treatment continuation group, with a mean absolute difference of
3.7 minutes (95% CI: 1.4-6.0). The results of the STOP-or-NOT trial
suggest that continuing iSRA is a safe option for patients undergoing
major non-cardiac surgery, provided that particular attention is paid to
the rapid correction of the risk of peroperative arterial
hypotension. Copyright © 2024 Elsevier Masson SAS

<23>
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.

<24>
Accession Number
2031898020
Title
The prognostic utility of galectin-3 in patients undergoing cardiac
surgery: a scoping review.
Source
Biomarkers. 29(7) (pp 485-493), 2024. Date of Publication: 2024.
Author
Shah A.; Ding Y.; Walji D.; Rabinovich G.A.; Pelletier M.; El-Diasty M.
Institution
(Shah) School of Medicine, Queen's University, Kingston, ON, Canada
(Ding) Institute of Biomedical Engineering, Faculty of Applied Science and
Engineering, University of Toronto, Toronto, ON, Canada
(Walji, El-Diasty) Faculty of Health Sciences, Queen's University,
Kingston, ON, Canada
(Rabinovich) Laboratorio de Glicomedicina, Instituto de Biologia y
Medicina Experimental, Consejo Nacional de Investigaciones Cientificas y
Tecnicas (CONICET) and Facultad de Ciencias Exactas y Naturales,
Universidad de Buenos Aires, Buenos Aires, Argentina
(Pelletier, El-Diasty) Cardiac Surgery Department, University Hospitals
Cleveland Medical Center, Cleveland, OH, United States
Publisher
Taylor and Francis Ltd.
Abstract
Objective: To review the utility of galectin-3 (Gal-3) as a biomarker for
postoperative adverse outcomes in patients undergoing cardiac surgery.
 Method(s): This review was conducted in compliance with the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines. Electronic database search was conducted in October 2023.
Studies that measured pre- and/or postoperative plasma Gal-3 levels in
adult patients undergoing cardiac surgery were included. Primary outcomes
included postoperative morbidity and mortality. Result(s): Out of 391
studies screened, eight studies met the inclusion criteria. Two of the
three studies showed that preoperative plasma levels of Gal-3 were
associated with acute kidney injury (AKI) after cardiac surgery. Two of
the three studies reported a significant increase in preoperative Gal-3
levels in patients who developed postoperative atrial fibrillation (POAF).
The addition of Gal-3 to the EuroSCORE II model was found to statistically
improve the prediction of both AKI and POAF. Three of the five studies
suggested that Gal-3 levels can predict postoperative mortality. Finally,
one study suggested that lower preoperative Gal-3 levels was associated
with a higher likelihood of achieving left ventricular reverse remodeling
(LVRR) after surgery. Conclusion(s): Gal-3 may play a promising role
in predicting adverse outcomes in patients undergoing cardiac surgery. The
addition of Gal-3 to clinical risk prediction scores may improve their
discriminatory power in this group of patients. Future studies are
warranted to justify its incorporation into routine clinical
practice. Copyright © 2024 Informa UK Limited, trading as Taylor
& Francis Group.

<25>
Accession Number
2031304394
Title
Routine beta-blocker therapy after acute coronary syndromes: The end of an
era?.
Source
European Journal of Clinical Investigation. 54(12) (no pagination), 2024.
Article Number: e14309. Date of Publication: December 2024.
Author
Johner N.; Gencer B.; Roffi M.
Institution
(Johner, Gencer, Roffi) Cardiology Division, Geneva University Hospitals,
Geneva, Switzerland
(Gencer) Institute of Primary Healthcare (BIHAM), University of Bern,
Bern, Switzerland
(Gencer) Department of Cardiology, Lausanne University Hospital, Lausanne,
Switzerland
Publisher
John Wiley and Sons Inc
Abstract
Background: Beta-blocker therapy, a treatment burdened by side effects
including fatigue, erectile dysfunction and depression, was shown to
reduce mortality and cardiovascular events after acute coronary syndromes
(ACS) in the pre-coronary reperfusion era. Potential mechanisms include
protection from ventricular arrhythmias, increased ischaemia threshold and
prevention of left ventricular (LV) adverse remodelling. With the advent
of early mechanical reperfusion and contemporary pharmacologic secondary
prevention, the benefit of beta-blockers after ACS in the absence of LV
dysfunction has been challenged. Method(s): The present narrative
review discusses the contemporary evidence based on searching the PubMed
database and references in identified articles. Result(s): Recently,
the REDUCE-AMI trial-the first adequately powered randomized trial in the
reperfusion era to test beta-blocker therapy after myocardial infarction
with preserved left ventricular ejection fraction (LVEF)-showed no benefit
on the composite of all-cause death or myocardial infarction over a median
3.5-year follow-up. While the benefit of beta-blockers in patients with
reduced LVEF remains undisputed, their value in post-ACS patients with
mildly reduced systolic function (LVEF 41%-49%) has not been studied in
contemporary randomized trials; in this setting, observational studies
have suggested a reduction in cardiovascular events with these agents. The
adequate duration of beta-blocker therapy remains unknown, but
observational data suggests that any mortality benefit may be lost beyond
1-12 months after ACS in patients with LVEF >40%. Conclusion(s): We
believe that there is sufficient evidence to abandon routine beta-blocker
prescription in post-ACS patients with preserved LV systolic
function. 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.

<26>
Accession Number
2031032043
Title
Percutaneous coronary revascularization versus medical therapy in chronic
coronary syndromes: An updated meta-analysis of randomized controlled
trials.
Source
European Journal of Clinical Investigation. 54(12) (no pagination), 2024.
Article Number: e14303. Date of Publication: December 2024.
Author
Panuccio G.; Carabetta N.; Torella D.; DeRosa S.
Institution
(Panuccio, Torella) Department of Experimental and Clinical Medicine,
Magna Graecia University, Catanzaro, Italy
(Panuccio) Department of Cardiology, Angiology and Intensive Care
Medicine, Deutsches Herzzentrum der Charite, Berlin, Berlin, Germany
(Carabetta, De Rosa) Department of Medical and Surgical Sciences, Magna
Graecia University, Catanzaro, Italy
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Coronary artery disease (CAD) is a main cause of morbidity
and mortality. The effectiveness of coronary revascularization in chronic
coronary syndromes (CCS) is still debated. Our recent study showed the
superiority of coronary revascularization over optimal medical therapy
(OMT) in reducing cardiovascular (CV) mortality and myocardial infarction
(MI). The recent publication of the ORBITA-2 trial suggested superiority
of percutaneous coronary revascularization (PCI) in reducing angina and
improving quality of life. Therefore, we aimed to provide an updated
meta-analysis evaluating the impact of PCI on both clinical outcomes and
angina in CCS. Method(s): Relevant studies were screened in
PubMed/Medline until 08/01/2024. Randomized controlled trials (RCTs)
comparing PCI to OMT in CCS were selected. The primary outcome was CV
death. Secondary outcomes were MI, all-cause mortality, stroke, major
bleeding and angina severity. Result(s): Nineteen RCTs involving 8616
patients were included. Median follow-up duration was 3.3 years.
Revascularization significantly reduced CV death (4.2% vs. 5.5%; OR =.77;
95% CI.62-.96, p =.02). Subgroup analyses favoured revascularization in
patients without chronic total occlusions (CTOs) (p =.052) and those aged
<65 years (p =.02). Finally, a follow-up duration beyond 3 years showed
increased benefit of coronary revascularization (p =.04). Secondary
outcomes analyses showed no significant differences, except for a lower
angina severity in the revascularization group according to the Seattle
Angina Questionnaire (SAQ) (p =.04) and to the Canadian Cardiovascular
Society (CCS) classification (p =.005). Conclusion(s): PCI compared
to OMT significantly reduces CV mortality and angina severity, improving
quality of life in CCS patients. This benefit was larger without CTOs, in
patients aged <65 years and with follow-up duration beyond 3
years. Copyright © 2024 The Author(s). European Journal of
Clinical Investigation published by John Wiley & Sons Ltd on behalf of
Stichting European Society for Clinical Investigation Journal Foundation.

<27>
Accession Number
2035895676
Title
Heart transplantation in adults with congenital heart diseases: A
comprehensive meta-analysis on waiting times, operative, and survival
outcomes.
Source
Transplantation Reviews. 39(1) (no pagination), 2025. Article Number:
100886. Date of Publication: January 2025.
Author
Banaja A.A.; Bulescu N.C.; Martin-Bonnet C.; Lilot M.; Henaine R.
Institution
(Banaja, Bulescu, Henaine) Congenital Cardiac Surgery, Louis Pradel
Hospital, 59 boulevard Pinel, Lyon, Bron 69500, France
(Martin-Bonnet) Congenital and Pediatric Cardiology, Louis Pradel
Hospital, 59 boulevard Pinel, Lyon, Bron 69500, France
(Lilot) Pediatric Cardiac, Thoracic and Vascular Anesthesia and Intensive
Care Unit, Louis Pradel Hospital, 59 boulevard Pinel, Lyon, Bron 69500,
France
(Lilot, Henaine) Faculte de Medecine Lyon Est, Universite Claude Bernard
Lyon 1, 8 avenue Rockefeller, Lyon 69003, France
Publisher
Elsevier Inc.
Abstract
The rising prevalence of congenital heart disease (CHD) among adults has
led to increased heart transplantation (HT) procedures in this population.
However, CHD patients face significant challenges including longer waiting
times, higher early mortality rates, and increased risks of complications
such as renal dysfunction. This systematic review and meta-analysis
examined 50 studies to assess waiting times, postoperative outcomes, and
survival rates in CHD patients undergoing HT compared to non-CHD patients.
Results revealed that CHD patients experience longer HT waiting times
(mean difference [MD]: 53.86 days, 95 % CI: [22.00, 85.72], P = 0.0009)
and increased ischemic times (MD: 20.01 min, 95 % CI: [10.51, 29.51], P <
0.0001), which may increase waitlist and early postoperative mortality.
Regarding complications, renal dysfunction is more prevalent in CHD
patients than in non-CHD patients (RR: 2.05, 95 % CI: [1.61, 2.61], P <
0.00001). Despite these challenges, long-term survival rates for CHD
patients are comparable to those of non-CHD recipients, with significant
improvements noted in recent allocation systems. Our findings emphasize
the need for ongoing refinements in HT allocation systems to improve
outcomes for CHD patients, particularly in reducing waiting times and
managing post-transplant complications. Copyright © 2024 The
Authors

<28>
Accession Number
2032322238
Title
Prescriber perceptions of the safety and efficacy of unfractionated
heparin versus low molecular weight heparin in the acute treatment phase:
a qualitative study.
Source
Journal of Pharmaceutical Policy and Practice. 17(1) (no pagination),
2024. Article Number: 2418367. Date of Publication: 2024.
Author
Green D.; Edmunds C.; Rose'Meyer R.; Singh I.; Hattingh H.L.
Institution
(Green, Edmunds) Pharmacy Department, Gold Coast Hospital and Health
Service, Southport, Australia
(Rose'Meyer, Singh, Hattingh) School of Pharmacy and Medical Sciences,
Griffith University, Southport, Australia
(Hattingh) Allied Health Research, Gold Coast Health, Southport, Australia
(Hattingh) School of Pharmacy, The University of Queensland, St Lucia,
Australia
Publisher
Taylor and Francis Ltd.
Abstract
Background: Intravenous unfractionated heparin (IVUFH) and low molecular
weight heparins (LMWH) are first line anticoagulants for the management of
acutely unwell patients. The decision to prescribe either IVUFH or an LMWH
is complex with minimal direction from clinical guidelines. The aim of
this study was to explore individual prescribers' perceptions on
prescribing IVUFH or LMWH in patients' acute management. Method(s):
Semi-structured interviews were conducted with purposively selected senior
medical officers who were from specialities including cardiology,
cardiothoracic surgery, respiratory, emergency, vascular surgery,
nephrology, neurology and general medicine, identified as those that
routinely prescribe IVUFH or LMWH. An interview tool with seven questions
and four hypothetical case scenarios guided interview discussions.
Interviews were audio recorded, transcribed and inductively coded for
thematic analysis. Result(s): Twelve doctors participated in
interviews between February and October 2022. Mean interview duration was
24 min; data saturation was achieved. Most were senior doctors: one was a
registrar and others were staff specialists. Three key themes emerged: (1)
rationale for the choice of heparinoid, (2) patient safety considerations
and (3) resources required. The themes and subthemes identified the
complexity of issues to consider when choosing between IVUFH and LMWH.
Multiple factors were considered by participants which were based on
previous experiences and institutional capabilities rather than
evidence-based medicine. Conclusion(s): Future interventions should
focus on highlighting LMWH as the preferred heparinoid in most clinical
scenarios. The use of IVUFH should be reserved for specific patient
cohorts where the benefit of IVUFH outweighs the additional
risks. Copyright © 2024 The Author(s). Published by Informa UK
Limited, trading as Taylor & Francis Group.

<29>
Accession Number
2031992683
Title
Comparative Efficacy of Drug-Eluting Stents vs Bare-Metal Stents in
Peripheral Arterial Diseases.
Source
Vascular and Endovascular Review. 7(2) (no pagination), 2024. Article
Number: e02. Date of Publication: 2024.
Author
Ramirez M.
Institution
(Ramirez) Universidad Politecnica de Valencia, Spain
Publisher
SCARLET PUBLISHING SOLUTIONS
Abstract
There is currently no demonstrated patency advantage of a drug-eluting
stent (DES) over bare metal stents (BMSs) for the treatment of marginal
pathway disease of the femoropopliteal the component. In order to compare
the patency of BMSs for the treatment of femoropopliteal artery wounds to
the Eluvia DES (Boston Scientific, Marlborough, MA), a polymer-coated
paclitaxel-eluting stent, the EMINENT study (Trial Comparing Eluvia Versus
Bare Metal Stent in Treatment of Superficial Femoral and/or Proximal
Popliteal Artery) was conducted. Blinded participation and outcome
evaluation are features of the prospective, randomized trials, controlled,
multicenter European study EMINENT. For measuring the research study used
smart PLS software and generate result included descriptive statistic,
correlation also that smart PLS Algorithm model between them. A decrease
in Rutherford classification of >=1 categories from baseline without
repeat target lesion revascularization was considered sustained clinical
improvement. Walking capacity and health-related quality of life were
assessed. Since important meta-analyses of randomized controlled trials in
interventional cardiology suggested that drug-eluting stents might reduce
the rates of restenosis and reintervention, the use of active protecting
technology in peripheral arterial interventions is one of the next steps
in the treatment of arterial occlusive disease complying with coronary
artery stenting. Overall result found that direct and significant relation
in between Drug eluting stents and bare-metal stents in peripheral
arterial diseases. Examining the literature on the current uses of
drug-eluting stents in peripheral (lower limb, renal, and supra-aortic)
settings, examining the financial ramifications, and offering
recommendations for future therapeutic approaches in this area of research
are our goals. Copyright © The Author(s) 2024.

<30>
Accession Number
2035783674
Title
Transcatheter aortic valve implantation with SAPIEN 3 versus surgical
aortic valve replacement in patients with symptomatic severe aortic
stenosis at low risk of surgical mortality: a cost-utility analysis for
Switzerland.
Source
Swiss Medical Weekly. 154(10) (no pagination), 2024. Article Number: 3558.
Date of Publication: 01 Oct 2024.
Author
Wyss C.A.; Corti R.; Nestelberger T.; Candolfi P.; Delbaere A.; Fischer
B.; Schwenkglenks M.; Telser H.
Institution
(Wyss, Corti) University of Zurich, HerzKlinik Hirslanden, Zurich,
Switzerland
(Nestelberger) University of Basel, Basel, Switzerland
(Candolfi, Delbaere) Edwards Lifesciences, Nyon, Switzerland
(Fischer, Telser) Polynomics AG, Olten, Switzerland
(Schwenkglenks) Health Economics Facility, Department of Public Health,
University of Basel, Basel, Switzerland
(Telser) Center for Health, Policy and Economics, University of Lucerne,
Lucerne, Switzerland
Publisher
SMW supporting association
Abstract
AIMS OF THE STUDY: The 2021 European Society of Cardiology Guidelines on
valvular heart disease recommend transcatheter aortic valve implantation
(TAVI) for patients with symptomatic severe aortic stenosis at low
surgical risk and age >=75 years who are suitable for a transfemoral
approach (recommendation class IA) based on two large randomised
controlled trials (PARTNER 3 and Evolut Low Risk) comparing transcatheter
aortic valve implantation with surgical aortic valve replacement (SAVR).
Whether such an approach is cost-effective in Switzerland remains unclear.
The aim of this cost-utility analysis was to compare transcatheter aortic
valve implantation with SAPIEN 3 versus surgical aortic valve replacement
in symptomatic severe aortic stenosis patients at low risk of surgical
mortality from the perspective of Swiss compulsory health insurance using
data from the PARTNER 3 trial (reflecting specifically the safety and
efficacy of the SAPIEN 3 TAVI device). METHOD(S): A previously
published two-stage Markov-based model that captured clinical outcomes
from the PARTNER 3 trial was adapted from the perspective of the Swiss
compulsory health insurance system, using local or geographically close
general population mortality and utility data, unit costs and medical
resource use from publicly available sources and based on expert opinion.
The model had a lifetime horizon with a 3% yearly discounting factor. The
cost-utility analysis estimated changes in both direct healthcare costs
and health-related quality-adjusted life years for transcatheter aortic
valve implantation compared with surgical aortic valve replacement in
patients with symptomatic severe aortic stenosis at low risk of surgical
mortality. RESULT(S): Overall, transcatheter aortic valve
implantation with SAPIEN 3 resulted in lifetime costs per patient of CHF
79,534 and quality-adjusted life years per patient of 9.64, compared with
surgical aortic valve replacement lifetime costs and quality-adjusted life
years per patient of CHF 76,891 and 8.96, respectively. Compared with
surgical aortic valve replacement, transcatheter aortic valve implantation
was estimated to offer an incremental improvement of +0.68
quality-adjusted life years per patient at an increased cost of +CHF 2643
per patient over a lifetime horizon. The incremental cost-effectiveness
ratio was CHF 3866 per quality-adjusted life year gained and remained
below CHF 50,000 per quality-adjusted life year gained across several
sensitivity analyses. CONCLUSION(S): This analysis suggests that
transcatheter aortic valve implantation using the SAPIEN 3 device is
likely to be a highly cost-effective alternative for symptomatic severe
aortic stenosis patients at a low risk of surgical mortality, treated in
the contemporary Swiss setting. These findings may help to inform a
holistic approach when making policy decisions for the management of this
patient group. Copyright © 2024 SMW supporting association. All
rights reserved.

<31>
Accession Number
2035782032
Title
Recommendations for fast-track extubation in adult cardiac surgery
patients: a consensus statement.
Source
Minerva Anestesiologica. 90(11) (pp 957-968), 2024. Date of Publication:
November 2024.
Author
Silvetti S.; Pateraternoster G.; Abelardo D.; Ajello V.; Aloisio T.;
Baiocchi M.; Puano P.; Caruso A.; Del Sarto Sartosarto P.A.; Guarracino
F.; Landoni G.; Marianello D.; Munch C.M.; Pieri M.; Sanfilippo F.;
Sepolvere G.; Torraccatorracca L.; Toscatoscano A.; Zaccarelli M.; Ranucci
M.; Scolletta S.
Institution
(Silvetti) Department of Cardiac Anesthesia and Intensive Care,
Cardiovascular Network, IRCCS Policlinico San Martino Hospital, Genoa,
Italy
(Pateraternoster) Department of Health Science, Anesthesia and ICU, School
of Medicine, San Carlo Hospital, University of Basilicata, Potenza, Italy
(Abelardo) Department of Medical and Surgical Sciences, Magna Graecia
University of Catanzaro, Catanzaro, Italy
(Abelardo) Regional Epilepsy Center, Great Metropolitan
Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
(Ajello) Department of Cardio-Thoracic Anesthesia, University Hospital Tor
Vergata, Rome, Italy
(Aloisio, Ranucci) Department of Cardio-Thoraco-Vascular Anesthesia and
Intensive Therapy, IRCCS Policlinico San Donato, San Donato Milanese,
Milan, Italy
(Baiocchi) Unit of Anesthesiology and Intensive Care, Cardiothoracic and
Vascular Department, IRCCS University Hospital, Bologna, Italy
(Puano) Department of Anesthesia and Intensive Care, Istituto Mediterraneo
per i Trapiantie Terapie ad alta Specializzazione IRCCS -IS METT, UPMCI
University of Pittsburgh Medical Center Italy, Palermo, Italy
(Caruso) Department of Anesthesia and Intensive Care Medicine III,
CAST-A.O.U. Policlinico-San Marco, Policlinico G. Rodolico, Catania, Italy
(Del Sarto Sartosarto) Department of Anesthesia and Critical Care,
Ospedale del Cuore Fondazione Toscana Gabriele Monasterio, Massa e
Carrara, Italy
(Guarracino) Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
(Landoni, Pieri) IRCCS San Raffaele Scientific Institute, Milan, Italy
(Marianello) Department of Medical Science, Surgery, and Neurosciences,
Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, University
Hospital of Siena, Siena, Italy
(Munch) Department of Cardiac Anesthesia and Intensive Care, Azienda
Ospedaliero Universitaria delle Marche, Ancona, Italy
(Sanfilippo) Department of General Surgery and Medico-Surgical
Specialties, School of Anesthesia and Intensive Care, University of
Catania, Catania, Italy
(Sepolvere) Intensive Care Unit, Department of Anesthesia and Cardiac
Surgery, San Michele Hospital, Maddaloni, Caserta, Italy
(Torraccatorracca) Department of Cardiac Surgery, Humanitas Research
Hospital IRCCS, Milan, Italy
(Toscatoscano) Department of Anesthesia, Critical Care, and Emergency,
Citta della Salute e della Scienza, Turin, Italy
(Zaccarelli) Department of Surgical Sciences and Integrated Diagnostics,
University of Genoa, Genoa, Italy
(Scolletta) Department of Medicine, Surgery, and Neurosciences, Anesthesia
and Intensive Care Unit, University Hospital of Siena, Siena, Italy
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: Enhanced recovery after cardiac surgery in selected low-risk
patients, has the potential to improve outcomes and reduce the burden of
healthcare costs. Anesthesia-related challenges play a major role in the
successful implementation of Enhanced Recovery After Surgery (ERAS )
protocols, with particular emphasis placed on fast-track extubation.
Acknowledging the importance of this practice, the Italian Association of
Cardiac Anesthesiologists and InMinerva tensive Care (ITACTAIC ITACTAIC
ITACTAIC ) has advocated for an initiative to establish a consensus
offering practical recommendations for fast-track extubation after adult
cardiac surgery. E VIDENCE AC QUISITIO N: After conducting a systematic
review, all randomised control trials (RCT s) published between 2013 and
2023 were meticulously selected and analysed during a consensus meeting
that involved statement voting. EVIDENCE SYNTHESIS: Out of the 2268
publications identified using the search string, 60 RCTs were selected and
classified into six groups, each evaluating specific interventions
associated with extubation within 6 hours post-surgery. The authors
examined 20 RCT s pertaining to loco-regional anesthesia, 19 analysing
elements of general anesthesia, 12 focused on surgery-related aspects and
techniques, three examining ventilation, two exploring anesthesia depth
monitoring, and four addressing miscellaneous aspects. The expert panel
approved 16 statements with 15 achieving high agreement and one obtaining
moderate agreement. Finally a total of eight interventions were considered
associated with fast-track extubation: parasternal block, erector spinae
plane block, alpha agonist in the operating room (OR ), opioids in the OR
, dexmedetomidine in the intensive care unit (IC U), minimal invasive
surgical access, anesthesia depth monitoring, adaptative support
ventilation. CONCLUSION(S): In the first consensus document ever
published by a scientific society addressing practical recommendations for
fast-track extubation post-cardiac surgery, the authors identified sixteen
interventions commonly associated with fast-track extubation in selected
adult cardiac surgery patients. Copyright © 2024 THEAUTHORS.

<32>
Accession Number
2035829836
Title
Transcatheter Aortic Valve Replacement in Patients With Systolic Heart
Failure and Moderate Aortic Stenosis: TAVR UNLOAD.
Source
Journal of the American College of Cardiology. (no pagination), 2024.
Date of Publication: 2024.
Author
Van Mieghem N.M.; Elmariah S.; Spitzer E.; Pibarot P.; Nazif T.M.; Bax
J.J.; Hahn R.T.; Popma A.; Ben-Yehuda O.; Kallel F.; Redfors B.; Chuang
M.L.; Alu M.C.; Lindeboom W.; Kolte D.; Zahr F.E.; Kodali S.K.; Strote
J.A.; Hermanides R.S.; Cohen D.J.; Tijssen J.G.P.; Leon M.B.
Institution
(Van Mieghem, Spitzer) Department of Cardiology, Thoraxcenter,
Cardiovascular Institute, Erasmus University Medical Center, Rotterdam,
Netherlands
(Elmariah) Division of Cardiology, University of San Francisco, San
Francisco, CA, United States
(Spitzer, Lindeboom, Tijssen) Cardialysis, Rotterdam, Netherlands
(Pibarot) Department of Medicine, Quebec Heart and Lung Institute, Laval
University, Quebec City, QC, Canada
(Nazif, Hahn, Alu, Kodali, Leon) Division of Cardiology,
NewYork-Presbyterian Hospital/Columbia University Irving Medical Center,
New York, NY, United States
(Bax) Department of Cardiology, Leiden University Medical Center, Leiden,
Netherlands
(Hahn, Popma, Redfors, Chuang, Alu, Cohen, Leon) Cardiovascular Research
Foundation, New York, NY, United States
(Ben-Yehuda) Division of Cardiovascular Medicine, University of California
San Diego, San Diego, CA, United States
(Kallel) Edwards Lifesciences, Irvine, CA, United States
(Redfors) Department of Population Health Sciences, Weill Cornell
Medicine, New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Redfors) Wallenberg Laboratory, Institute of Medicine, University of
Gothenburg, Gothenburg, Sweden
(Kolte) Cardiology Division, Massachusetts General Hospital, Boston, MA,
United States
(Kolte) Harvard Medical School, Boston, MA, United States
(Zahr) Oregon Health and Science University, Portland, OR, United States
(Strote) Medical Center of the Rockies, Loveland, CO, United States
(Hermanides) Department of Cardiology, Isala Heart Center, Zwolle,
Netherlands
(Cohen) St Francis Hospital, Roslyn, NY, United States
(Tijssen) Department of Cardiology, Amsterdam UMC, University of
Amsterdam, Amsterdam, Netherlands
Publisher
Elsevier Inc.
Abstract
Background: Neurohormonal modulation and afterload reduction are key for
treatment of heart failure with reduced ejection fraction (HFrEF). In
HFrEF patients with concomitant moderate aortic stenosis (AS), treatment
with transcatheter aortic valve replacement (TAVR) may be complementary to
guideline-directed medical therapy (GDMT). Objective(s): This study
sought to determine whether TAVR for moderate AS provides clinical benefit
in patients with HFrEF on top of GDMT. Method(s): We performed an
investigator-initiated, international, randomized controlled trial in
patients with HFrEF on GDMT with moderate AS who were suitable for
transfemoral TAVR with a balloon-expandable valve. Patients were
randomized 1:1 to TAVR or clinical aortic stenosis surveillance (CASS)
with aortic valve replacement upon progression to severe AS. The primary
endpoint was the hierarchical occurrence of: 1) all-cause death; 2)
disabling stroke; 3) disease-related hospitalizations and heart failure
equivalents; and 4) change from baseline in the Kansas City Cardiomyopathy
Questionnaire Overall Summary Score analyzed using the win ratio.
 Result(s): From January 2017 to December 2022, 178 patients were
randomized to TAVR (n = 89) or AS surveillance (n = 89). The mean age was
77 years, 20.8% were female, and 55.6% were in NYHA functional class III
or IV. The median follow-up duration was 23 months (Q1-Q3: 12-33 months).
A total of 38 (43%) patients in the CASS group (of whom 35 had progressed
to severe AS) underwent TAVR at a median of 12 months postrandomization.
TAVR was associated with wins in 47.6% of pairs, compared with 36.6% in
the CASS group, resulting in a win ratio of 1.31 (95% CI: 0.91-1.88; P =
0.14). At 1 year, TAVR resulted in a greater improvement in the Kansas
City Cardiomyopathy Questionnaire Overall Summary Score compared with the
CASS group (12.8 +/- 21.9 points vs 3.2 +/- 22.8 points; P = 0.018).
 Conclusion(s): TAVR was not superior to AS surveillance for the
primary hierarchical composite endpoint in patients with moderate AS and
HFrEF on GDMT. Preemptive TAVR for moderate AS was safe and may provide
clinically meaningful quality-of-life benefits. Copyright © 2024
American College of Cardiology Foundation

<33>
Accession Number
2035736964
Title
Tranexamic Acid during Radical Cystectomy: A Randomized Clinical Trial.
Source
JAMA Surgery. (no pagination), 2024. Date of Publication: 2024.
Author
Breau R.H.; Lavallee L.T.; Cagiannos I.; Momoli F.; Bryson G.L.; Kanji S.;
Morash C.; Turgeon A.F.; Zarychanski R.; Houston B.L.; McIsaac D.I.;
Mallick R.; Knoll G.A.; Kulkarni G.; Izawa J.; Saad F.; Kassouf W.; Fradet
V.; Rendon R.; Shayegan B.; Fairey A.; Drachenberg D.E.; Fergusson D.
Institution
(Breau, Lavallee, Kanji, McIsaac, Mallick, Fergusson) Ottawa Hospital
Research Institute, Ottawa, ON, Canada
(Cagiannos, Morash) Ottawa Hospital, Ottawa, ON, Canada
(Momoli) School of Epidemiology and Public Health, University of Ottawa,
Ottawa, ON, Canada
(Bryson, McIsaac) Departments of Anesthesiology and Pain Medicine,
University of Ottawa, Ottawa, ON, Canada
(Turgeon) Department of Anesthesiology and Critical Care Medicine,
Division of Critical Care Medicine, Universite Laval, Quebec City, QC,
Canada
(Turgeon) Population Health and Optimal Health Practices Research Unit,
CHU de Quebec - Universite Laval Research Center, Quebec City, QC, Canada
(Zarychanski, Houston) Department of Internal Medicine, University of
Manitoba, Winnipeg, MB, Canada
(Zarychanski, Houston) Department of Medical Oncology and Haematology,
Cancercare Manitoba, Winnipeg, MB, Canada
(Knoll) Department of Medicine (Nephrology), The Ottawa Hospital, Ottawa,
ON, Canada
(Kulkarni) Division of Urology, Department of Surgery, University of
Toronto, Toronto, ON, Canada
(Izawa) Department of Surgery & Oncology, Division of Urology, Western
University, London, ON, Canada
(Saad) University of Montreal Hospital Center (CHUM), Montreal Cancer
Institute/CRCHUM, Montreal, QC, Canada
(Kassouf) Department of Surgery (Urology), McGill University Health
Center, Montreal, QC, Canada
(Fradet) Department of Surgery (Urology), CHU de Quebec - Universite
Laval, Quebec City, QC, Canada
(Rendon) Department of Urology, Dalhousie University and Nova Scotia
Health Authority, Halifax, Nova Scotia, Canada, Canada
(Shayegan) Division of Urology, McMaster University, Hamilton, ON, Canada
(Fairey) Division of Urology, University of Alberta, Edmonton, AB, Canada
(Drachenberg) Urologic Oncologist, Section of Urology, Department of
Surgery, University of Manitoba, Winnipeg, MB, Canada
Publisher
American Medical Association
Abstract
Importance: Among cancer surgeries, patients requiring open radical
cystectomy have the highest risk of red blood cell (RBC) transfusion.
Prophylactic tranexamic acid (TXA) reduces blood loss during cardiac and
orthopedic surgery, and it is possible that similar effects of TXA would
be observed during radical cystectomy. Objective(s): To determine
whether TXA, administered before incision and for the duration of radical
cystectomy, reduced the number of RBC transfusions received by patients up
to 30 days after surgery. Design, Setting, and Participant(s): The
Tranexamic Acid During Cystectomy Trial (TACT) was a double-blind,
placebo-controlled, randomized clinical trial with enrollment between June
2013 and January 2021. This multicenter trial was conducted in 10 academic
centers. A consecutive sample of patients was eligible if the patients had
a planned open radical cystectomy for the treatment of bladder cancer.
 Intervention(s): Before incision, patients in the intervention arm
received a loading dose of intravenous TXA, 10 mg/kg, followed by a
maintenance infusion of 5 mg/kg per hour for the duration of the surgery.
In the control arm, patients received indistinguishable matching placebo.
 Main Outcomes and Measures: The primary outcome was receipt of RBC
transfusion up to 30 days after surgery. Result(s): A total of 386
patients were assessed for eligibility, and 33 did not meet eligibility.
Of 353 randomized patients (median [IQR] age, 69 [62-75] years; 263 male
[74.5%]), 344 were included in the intention-to-treat analysis. RBC
transfusion up to 30 days occurred in 64 of 173 patients (37.0%) in the
TXA group and 64 of 171 patients (37.4%) in the placebo group (relative
risk, 0.99; 95% CI, 0.83-1.18). There were no differences in secondary
outcomes among the TXA group vs placebo group including mean (SD) number
of RBC units transfused (0.9 [1.5] U vs 1.1 [1.8] U; P =.43), estimated
blood loss (927 [733] mL vs 963 [624] mL; P =.52), intraoperative
transfusion (28.3% [49 of 173] vs 24.0% [41 of 171]; P =.08), or venous
thromboembolic events (3.5% [6 of 173] vs 2.9% [5 of 171]; P =.57).
Non-transfusion-related adverse events were similar between groups.
 Conclusions and Relevance: Results of this randomized clinical trial
reveal that TXA did not reduce blood transfusion in patients undergoing
open radical cystectomy for bladder cancer. Based on this trial, routine
use of TXA during open radical cystectomy is not recommended. Trial
Registration: ClinicalTrials.gov Identifier: NCT01869413. 2024 American
Medical Association. All rights reserved. Copyright © 2024
American Medical Association. All rights reserved.

<34>
Accession Number
2035556472
Title
Is the Use of a Buprenorphine Transdermal Patch More Effective Than Oral
Medications for Postoperative Analgesia after Arthroscopic Rotator Cuff
Repair? A Randomized Clinical Trial.
Source
Clinical Orthopaedics and Related Research. (no pagination), 2024.
Article Number: 10.1097/CORR.0000000000003303. Date of Publication: 2024.
Author
Liu W.; Qin J.; Fang X.; Jiang G.; Wang P.; Ding M.; Xu R.
Institution
(Liu) Department of Pharmacy, Nanjing Drum Tower Hospital, Drum Tower
Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing,
China
(Qin, Jiang, Wang, Xu) Division of Sports Medicine and Adult
Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum
Tower Hospital, Affiliated Hospital of Medical School, Nanjing University,
Nanjing, China
(Fang, Ding) Department of Pharmacy, Nanjing Drum Tower Hospital, School
of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University,
Nanjing, China
(Xu) Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated
Hospital of Medical School, Nanjing University, Nanjing, China
Publisher
Wolters Kluwer Health Inc
Abstract
BackgroundAppropriate analgesic protocols for patients following
arthroscopic rotator cuff repair remain controversial. Although
transdermal buprenorphine patches might potentially provide better pain
control and fewer side effects, it is worth noting that there is limited
evidence for this given a lack of direct comparisons with oral pain
regimens.Questions/purposesAmong patients undergoing arthroscopic rotator
cuff repair, and compared with an analgesic approach using oral tramadol
plus celecoxib: (1) Does perioperative use of buprenorphine patches
provide better pain relief by a clinically important margin? (2) Does
perioperative use of buprenorphine patches improve shoulder joint function
recovery? (3) Does perioperative use of buprenorphine patches have a lower
frequency of adverse reactions?MethodsThis was a prospective,
single-center, randomized controlled trial. We included patients who
underwent arthroscopic rotator cuff repair for partial- or full-thickness
rotator cuff tears < 3 cm in size in the anterior to posterior direction
as estimated by preoperative MRI and excluded those who had obesity, were
pregnant, had opioid dependence, had history of cardiac bypass surgery or
ipsilateral rotator cuff repair, had allergies to trial medications, were
taking anticoagulants or antidepressants, were being treated with other
postsurgical pain management methods, or had severe liver or kidney
dysfunction. Based on these criteria, 64% (72 of 112) of patients were
eligible. The patients were randomly assigned into either the control
group (oral tramadol and celecoxib) or the experimental group
(buprenorphine patches). The control group received 100 mg of tramadol and
200 mg of celecoxib every 12 hours for 2 weeks after surgery. The
experimental group received buprenorphine patches about 48 hours before
surgery without any oral medication. A medication journal was given to the
patients to self-report their compliance in taking the drugs. The dosage
regimen adhered strictly to protocol. After enrollment, 11% (4 of 36) of
patients in the control group and 17% (6 of 36) of patients in the
experimental group could not be fully analyzed because of loss to
follow-up or missing data. The surveillance period was 3 months, and there
was no crossover between groups. The groups did not differ at baseline in
terms of demographic parameters and relevant clinical characteristics,
including age, gender, BMI, American Society of Anesthesiologists
classification, tear size, concomitant procedures, and number of anchors.
The outcomes were (1) numeric rating scale (NRS) for pain score at rest or
with movement, which ranges from 0 to 10, where 0 indicates no pain, and
10 indicates the worst pain; (2) the American Shoulder and Elbow Surgeons
(ASES) score for joint function, which ranges from 0 to 100, with higher
scores indicating better shoulder joint function; and (3) the incidence of
postoperative adverse reactions. We defined the minimum clinically
important difference on the NRS as 2 of 10 points and on the ASES score as
15 of 100 points, based on anchor-based approaches reported in other
studies.ResultsWe found no clinically important between-group differences
in NRS pain scores at any time point, either at rest or with movement.
Likewise, we found no clinically important between-group differences in
ASES scores at any time point. Postoperative dizziness or drowsiness (20%
[6 of 30 patients] versus 44% [14 of 32 patients]; p = 0.04) and nausea
(10% [3 of 30 patients] versus 34% [11 of 32 patients]; p = 0.02) during
the hospital stay were slightly lower in the experimental group compared
with the control group.ConclusionIn this randomized trial, we found no
clinically important advantages in pain or function to the use of
buprenorphine patches after arthroscopic rotator cuff repair, and
insufficient evidence exists to confirm whether the minor differences in
transient side effects could justify the use of a new and largely untested
analgesic approach in this context. That being so, we recommend against
the routine use of buprenorphine patches for this indication. In general,
we found that pain levels were low after the procedure in both groups.
Future studies, therefore, should focus on the efficacy of buprenorphine
patches for more invasive or more painful procedures. Copyright
© 2024 by the Association of Bone and Joint Surgeons.

<35>
Accession Number
2035556467
Title
Robotic Versus Thoracoscopic Minimally Invasive Mitral Valve Surgery: A
Systematic Review and Meta-Analysis of Matched Studies.
Source
Cardiology in Review. (no pagination), 2024. Article Number:
10.1097/CRD.0000000000000814. Date of Publication: 2024.
Author
De Jesus J.; Estrella J.; Jesse J.; Binny V.; Sri Radhakrishnan
Parthasarathy P.; Kabir Y.; Nallamotu S.; Guntupalli S.V.; Cai L.Y.;
Al-Tawil M.
Institution
(De Jesus) Accident and Emergency Department, Queen Alexandra Hospital,
Portsmouth, United Kingdom
(Estrella) Acute Medicine Department, Queen Alexandra Hospital,
Portsmouth, United Kingdom
(Jesse) Department of Cardiology, Universidad de Montemorelos, Nuevo Leon,
Mexico
(Binny) Department of Cardiology, Gretchen Whitney High School, Cerritos,
CA, United States
(Sri Radhakrishnan Parthasarathy) Department of Cardiology, Tbilisi State
Medical University, GA, Tbilisi, Georgia
(Kabir) Department of Cardiology, Hywel Dda University Health Board,
United Kingdom
(Nallamotu) Department of Cardiology, Kasturba Medical College, Manipal,
India
(Guntupalli) Department of Cardiology, Guntur Medical College, Guntur,
India
(Cai) Department of Cardiology, Caribbean Medical University, Willemstad,
Curacao
(Al-Tawil) Department of Cardiovascular Surgery, Trier Heart Centre,
Trier, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
Mitral regurgitation is the most prevalent form of valvular heart disease,
impacting over 24 million people globally. Robotic and thoracoscopic
minimally invasive mitral valve repair (MIMR) techniques have emerged as
viable alternatives to traditional open-heart surgery. However, the
comparative effectiveness and safety of these 2 approaches remain
underexplored. This systematic review and meta-analysis, conducted
according to Preferred Reporting Items for Systematic Review and
Meta-Analysis (PRISMA) guidelines, aimed to compare robotic and
thoracoscopic MIMR outcomes. A literature search was performed across
PubMed, Scopus, and Embase databases to identify studies comparing these 2
surgical techniques. Eligible studies included randomized controlled
trials and cohort studies. Six propensity score-matched studies and 1
retrospective cohort study, involving 11,823 patients, were included, with
5851 undergoing robotic mitral valve repair and 5972 receiving
thoracoscopic MIMR. No significant differences were found in perioperative
mortality [risk ratio (RR): 0.97, 95% confidence interval (CI): 0.65-1.45]
or pump/clamp times. Robotic surgery was associated with longer operative
times (mean difference: 33.01 minutes) and higher intraoperative
transfusion rates (RR: 1.53, 95% CI: 1.07-2.18), but a lower risk of
atrial fibrillation (RR: 0.89, 95% CI: 0.83-0.95). In conclusion, robotic
and thoracoscopic MIMR show comparable mortality and overall safety
profiles. However, robotic surgery may require longer operative times and
increased transfusion needs, while reducing the risk of atrial
fibrillation. Further high-quality, randomized studies are warranted to
validate these findings. Copyright © 2024 Wolters Kluwer Health,
Inc. All rights reserved.

<36>
Accession Number
2032346546
Title
Life-threatening complications in ophthalmic surgery: a systematic review.
Source
Eye (Basingstoke). (no pagination), 2024. Date of Publication: 2024.
Author
Ferrara M.; Romano V.; Longo L.; Rovati M.; Raimondi R.; Semeraro F.;
Aliberti S.; Romano M.R.
Institution
(Ferrara, Romano, Rovati, Semeraro) Department of Medical and Surgical
Specialties, Radiological Sciences, and Public Health, University of
Brescia, Brescia, Italy
(Ferrara, Romano, Semeraro) Eye Unit, ASST Spedali Civili di Brescia,
Brescia, Italy
(Ferrara) School of Medicine, University of Malaga, Malaga, Spain
(Longo, Aliberti, Romano) Department of Biomedical Sciences, Humanitas
University, Milan, Italy
(Raimondi) Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle Upon
Tyne, United Kingdom
(Aliberti) IRCCS Humanitas Research Hospital, Respiratory Unit, Milan,
Italy
(Romano) Department of Ophthalmology, Humanitas Gavazzeni-Castelli,
Bergamo, Italy
Publisher
Springer Nature
Abstract
Ophthalmic surgical procedures are widely acknowledged for their safety
and efficacy. Undoubtedly, advances in ophthalmic surgery, along with the
improvement of anaesthetic techniques, have contributed to the reduction
in the occurrence of these events. However, although uncommon, systemic
severe and life-threatening adverse events can still occur and it is
imperative for an ophthalmologic surgeon to have a comprehensive
understanding of them to act in terms of proactive prevention, prompt
recognition, and optimal treatment, thus maximizing patients' outcomes.
Among life-threatening complication following ophthalmic surgery,
cardiovascular events represent the most common ones, including a range of
different clinical entities: the oculocardiac reflex, potentially leading
to haemodynamic instability and asystole; iatrogenic vascular air
embolism, in form of venous air embolism or "pefluorocarbon syndrome",
which can lead to obstruction of the pulmonary circulation, respiratory
distress and cardiovascular collapse; postoperative venous
thromboembolism, in the context of which the management of perioperative
antiplatelet and anticoagulant therapy has a crucial role. Furthermore,
among infectious complications, that are more commonly limited to the
ocular tissues, necrotizing fasciitis represents a potentially lethal
infection. This review aims to provide an up-to-date, evidence-based
overview of potential life-threatening complications associated with
ophthalmic surgery, exploring pathogenesis, risk factors, signs, symptoms,
and, briefly, management strategies. Copyright © The Author(s),
under exclusive licence to The Royal College of Ophthalmologists 2024.

<37>
Accession Number
645812997
Title
Partial Cardiac Denervation to Prevent Postoperative Atrial Fibrillation
After Coronary Artery Bypass Grafting: The pCAD-POAF Randomized Clinical
Trial.
Source
JAMA cardiology. (no pagination), 2024. Date of Publication: 17 Nov 2024.
Author
Yang Z.; Tiemuerniyazi X.; Xu F.; Wang Y.; Sun Y.; Yan P.; Tian L.; Han
C.; Zhang Y.; Pan S.; Hu Z.; Li X.; Zhao W.; Feng W.
Institution
(Yang, Tiemuerniyazi, Xu, Yan, Tian, Han, Zhang, Pan, Hu, Zhao, Feng)
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for
Cardiovascular Diseases, National Clinical Research Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
(Wang) Department of Medical Research and Biometrics Center, State Key
Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
(Sun) Department of Pathology Diagnostic Laboratory Service, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China
(Li) State Key Laboratory of Cardiovascular Disease, Fuwai Hospital,
National Center for Cardiovascular Diseases, National Clinical Research
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China
Abstract
Importance: Efficient approaches to prevent postoperative atrial
fibrillation (POAF) after coronary artery bypass grafting (CABG) are still
needed. Objective(s): To investigate whether partial cardiac
denervation, achieved by cutting off the ligament of Marshall (LOM) and
resecting the fat pad along the Waterston groove, can reduce the risk of
POAF following CABG. Design, Setting and Participants: This single-center,
randomized clinical trial enrolled adult patients scheduled for isolated
CABG in China. Enrollment was from August 15, 2022, to December 13, 2023;
follow-up visits were 30 days after discharge. Intervention(s):
Participants were randomized into the intervention group (CABG plus
partial cardiac denervation) and the control group (CABG only) in a 1:1
pattern. All participants were continuously monitored for the incidence of
POAF until day 6 after the operation. Main outcome and Measures: The
primary end point was the incidence of POAF in 6 days, defined as a
supraventricular arrhythmia lasting for more than 30 seconds.
 Result(s): The trial enrolled 430 patients (79 [18.4%] female; mean
[SD] age, 61.9 [7.8] years). Compared with the control group, the 6-day
incidence of POAF was significantly lower in the intervention group (18.1%
vs 31.6%; P=.001; risk ratio, 0.57 [95% CI, 0.41-0.81]). To further
support these results, a sensitivity analysis performed with Kaplan-Meier
survival curves also showed a significant reduction in the occurrence of
POAF in the intervention group (hazard ratio, 0.53 [95% CI, 0.36-0.79];
P=.002). Safety assessments showed no difference between the 2 groups,
while postoperative medical cost was reduced in the intervention group.
 Conclusions and Relevance: This randomized clinical trial found that
partial cardiac denervation was an effective procedure to reduce the
occurrence of POAF after isolated CABG without additional postoperative
complications. These results suggest that partial cardiac denervation may
be a good option for cardiac surgeons to consider for preventing POAF
after CABG. Trial Registration: ClinicalTrials.gov Identifier:
NCT05009914.

<38>
Accession Number
645811645
Title
Contemporary review of the evolution of various treatment modalities for
mitral regurgitation.
Source
Expert review of cardiovascular therapy. (no pagination), 2024. Date of
Publication: 16 Nov 2024.
Author
Sengodan P.; Younes A.; Shah N.; Maraey A.; Chitwood W.R.; Movahed A.
Institution
(Sengodan, Shah, Chitwood, Movahed) Department of Cardiovascular sciences,
East Carolina University, Greenville, NC, United States
(Younes) Department of Internal Medicine, East Carolina University,
Greenville, NC, United States
(Maraey) Department of Internal Medicine, University of Toledo, United
States
Abstract
INTRODUCTION: Mitral regurgitation is one of the commonest valvular heart
diseases for which there have been several innovative treatment strategies
that have developed over the last several decades. We describe the various
treatment modalities that have been used for the last several decades. All
articles in PubMed, Cochran and Embase were screened from inception to
August 2024 for the following - 'Mitral valve regurgitation' 'Mitral valve
repair' 'Mitral valve replacement' 'Robotic mitral surgery' 'Transcatheter
mitral valve repair.' AREAS COVERED: Mitral regurgitation (MR) is
classified into primary and secondary MR. Causes of primary MR include
degenerative disease, rheumatic heart disease, and infective endocarditis.
Secondary MR is observed in the setting of left ventricle (LV) pathology,
including ischemic or dilated cardiomyopathy. In secondary MR, annular
dilation, papillary muscle displacement, tethering of chordae tendineae
and/or mitral valve (MV) leaflets result in leaflet restriction and
malcoaptation. EXPERT OPINION: In this review, we discuss various
modalities for treatment of mitral regurgitation, as well as newer
treatment options for MR including robotic MV repair and other minimally
invasive procedures. Several ongoing randomized controlled trials in this
topic will help shed more light and provide guidance to deliver the
optimal care for our patients.

<39>
Accession Number
2035125122
Title
2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative
Cardiovascular Management for Noncardiac Surgery: A Report of the American
College of Cardiology/American Heart Association Joint Committee on
Clinical Practice Guidelines.
Source
Journal of the American College of Cardiology. 84(19) (pp 1869-1969),
2024. Date of Publication: 05 Nov 2024.
Author
Thompson A.; Fleischmann K.E.; Smilowitz N.R.; de las Fuentes L.;
Mukherjee D.; Aggarwal N.R.; Ahmad F.S.; Allen R.B.; Altin S.E.; Auerbach
A.; Berger J.S.; Chow B.; Dakik H.A.; Eisenstein E.L.; Gerhard-Herman M.;
Ghadimi K.; Kachulis B.; Leclerc J.; Lee C.S.; Macaulay T.E.; Mates G.;
Merli G.J.; Parwani P.; Poole J.E.; Rich M.W.; Ruetzler K.; Stain S.C.;
Sweitzer B.; Talbot A.W.; Vallabhajosyula S.; Whittle J.; Williams K.A.
Publisher
Elsevier Inc.
Abstract
Aim: The "2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for
Perioperative Cardiovascular Management for Noncardiac Surgery" provides
recommendations to guide clinicians in the perioperative cardiovascular
evaluation and management of adult patients undergoing noncardiac surgery.
 Method(s): A comprehensive literature search was conducted from
August 2022 to March 2023 to identify clinical studies, reviews, and other
evidence conducted on human subjects that were published in English from
MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for
Healthcare Research and Quality, and other selected databases relevant to
this guideline. Structure: Recommendations from the "2014 ACC/AHA
Guideline on Perioperative Cardiovascular Evaluation and Management of
Patients Undergoing Noncardiac Surgery" have been updated with new
evidence consolidated to guide clinicians; clinicians should be advised
this guideline supersedes the previously published 2014 guideline. In
addition, evidence-based management strategies, including pharmacological
therapies, perioperative monitoring, and devices, for cardiovascular
disease and associated medical conditions, have been
developed. Copyright © 2024

<40>
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)

<41>
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)

<42>
Accession Number
2035810828
Title
Major Bleeding and Mortality After Revascularization of Left Main Disease.
Source
Journal of the American College of Cardiology. 84(24) (pp 2335-2346),
2024. Date of Publication: 10 Dec 2024.
Author
Giustino G.; Sabik J.F.; Serruys P.W.; Puskas J.D.; Karmpaliotis D.;
Kandzari D.E.; Morice M.-C.; Ragosta M.; Zhang Z.; Dressler O.; Redfors
B.; Ben-Yehuda O.; Sharma S.K.; Kappetein A.P.; Stone G.W.
Institution
(Giustino, Karmpaliotis) Gagnon Cardiovascular Institute, Atlantic Health
System, Morristown, NJ, United States
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Puskas) Mount Sinai Morningside, New York, NY, United States
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Morice) Ramsay Generale de Sante, Hopital Prive Jacques Cartier, Massy,
France
(Ragosta) Division of Cardiovascular Medicine, University of Virginia
Health System, Charlottesville, VA, United States
(Zhang, Dressler, Redfors) Cardiovascular Research Foundation, New York,
NY, United States
(Ben-Yehuda) University of California-San Diego, San Diego, CA, United
States
(Sharma, Stone) The Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Kappetein) Erasmus University Medical Center, Rotterdam, Netherlands
Publisher
Elsevier Inc.
Abstract
Background: The incidence and prognostic impact of major bleeding (MB)
after percutaneous coronary intervention (PCI) and coronary artery bypass
grafting (CABG) for left main coronary artery disease (LMCAD) are unknown.
 Objective(s): The goal of this study was to investigate the rates and
outcomes of MB after LMCAD revascularization. Method(s): In the EXCEL
(Evaluation of XIENCE versus Coronary Artery Bypass Surgery for
Effectiveness of Left Main Revascularization) trial, 1,905 patients with
unprotected LMCAD were randomized to undergo PCI (n = 948) or CABG (n =
957) and followed up for 5 years. MB was defined as TIMI major or minor
bleeding, BARC (Bleeding Academic Research Consortium) types 3 to 5
bleeding, or any overt bleeding requiring blood transfusion. The
association between MB and subsequent mortality was assessed in
time-adjusted Cox regression models. Result(s): At 5 years, 217
patients (11.4%) had at least 1 MB event. Rates of 5-year MB were 7.9%
after PCI vs 14.8% after CABG (OR: 0.48; 95% CI: 0.36-0.65; P < 0.0001).
However, in-hospital MB was lower after PCI (3.8% vs 13.5%; OR: 0.25; 95%
CI: 0.17-0.37), whereas postdischarge MB was lower after CABG (4.5% vs
2.0%; OR: 2.33; 95% CI: 1.33-3.09; P<inf>interaction</inf> < 0.0001). All
41 postdischarge MB events after PCI occurred in patients receiving dual
antiplatelet therapy. MB events within 5 years were associated with a
higher subsequent risk of all-cause mortality (adjusted HR: 2.71; 95% CI:
1.95-3.77; P < 0.0001), whether in-hospital or postdischarge
(P<inf>interaction</inf> = 1.00) and after both PCI and CABG
(P<inf>interaction</inf> = 0.95), driven both by increased cardiovascular
and non-cardiovascular mortality. Conclusion(s): In the EXCEL trial,
CABG resulted in higher 5-year rates of all MB and in-hospital MB,
although postdischarge MB was more frequent after PCI. MB after both
procedures was associated with increased cardiovascular and
noncardiovascular mortality within 5 years. (Evaluation of XIENCE versus
Coronary Artery Bypass Surgery for Effectiveness of Left Main
Revascularization [EXCEL]; NCT01205776) Copyright © 2024 American
College of Cardiology Foundation

<43>
Accession Number
2035725000
Title
Coronary Revascularization Guided with Fractional Flow Reserve or
Instantaneous Wave-Free Ratio: A 5-Year Follow-Up of the DEFINE FLAIR
Randomized Clinical Trial.
Source
JAMA Cardiology. 9(12) (no pagination), 2024. Article Number: 3314. Date
of Publication: 11 Dec 2024.
Author
Escaned J.; Travieso A.; Dehbi H.-M.; Nijjer S.S.; Sen S.; Petraco R.;
Patel M.; Serruys P.W.; Davies J.
Institution
(Escaned, Travieso) Hospital Clinico San Carlos IDISSC, Complutense
University of Madrid and CIBERCV, Madrid, Spain
(Escaned, Travieso) Comprehensive Clinical Trials Unit at UCL, University
College London, London, United Kingdom
(Dehbi) Imperial College Healthcare NHS Trust, Hammersmith Hospital,
London, United Kingdom
(Nijjer, Sen, Petraco, Davies) Duke Clinical Research Institute, Duke
University School of Medicine, Durham, NC, United States
(Patel) Department of Cardiology, University of Galway, Galway, Ireland
(Serruys) College of Medicine Nursing and Health Sciences, University of
Galway, Galway, Ireland
Publisher
American Medical Association
Abstract
Importance: The differences between the use of fractional flow reserve
(FFR) or instantaneous wave-free ratio (iFR) in the long term are unknown.
 Objective(s): To compare long-Term outcomes of iFR-and FFR-based
strategies to guide revascularization. Design, Setting, and
Participant(s): The DEFINE-FLAIR multicenter study randomized patients
with coronary artery disease to use either iFR or FFR as a pressure index
to guide revascularization. Patients from 5 continents with coronary
artery disease and angiographically intermediate severity stenoses who
underwent hemodynamic interrogation with pressure wires were included.
These data were analyzed from March, 13, 2014, through April, 27, 2021.
MAIN OUTCOME MEASURES: Five-year major adverse cardiac events (MACE) (a
composite of all-cause death, nonfatal myocardial infarction, and
unplanned revascularization), as well as the individual components of the
combined end point. Result(s): At 5 years of follow-up, no
significant differences were found between the iFR (mean age [SD], 65.5
[10.8] years; 962 male [77.5%]) and FFR (mean age [SD], 65.2 [10.6] years;
929 male [74.3%]) groups in terms of MACE (21.1% vs 18.4%, respectively;
hazard ratio [HR], 1.18; 95% CI, 0.99-1.42; P =.06). While all-cause death
was higher among patients randomized to iFR, it was not driven by
myocardial infarction (6.3% vs 6.2% in the FFR study arm; HR, 1.01; 95%
CI, 0.74-1.38; P =.94) or unplanned revascularization (11.9% vs 12.2% in
the FFR group; HR, 0.98; 95% CI, 0.78-1.23; P =.87). Furthermore, patients
in whom revascularization was deferred on the basis of iFR or FFR had
similar MACE in both study arms (17.9% in the iFR group vs 17.5% in the
FFR group; HR, 1.03; 95% CI, 0.79-1.35; P =.80) with similar rates of the
components of MACE, including all-cause death. On the contrary, in
patients who underwent revascularization after physiologic interrogation,
the incidence of MACE was higher in the iFR group (24.6%) compared with
the FFR group (19.2%) (HR, 1.36; 95% CI, 1.07-1.72; P =.01). Conclusions
and relevance: At 5-year follow up, an iFR based-strategy was not
statistically different than an FFR strategy to guide revascularization in
terms of MACE, nonfatal myocardial infarction, and unplanned
revascularization. Trial Registration: ClinicalTrials.gov Identifier:
NCT02053038. Copyright © 2024 American Medical Association. All
rights reserved.

<44>
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.

<45>
Accession Number
2035775273
Title
Family caregivers: an essential link in achieving health information
equity.
Source
The Lancet Global Health. 12(12) (pp e1934), 2024. Date of Publication:
December 2024.
Author
Alam S.; Bharmal N.; Elliott E.
Institution
(Alam, Elliott) Noora Health, San Francisco, CA 94115, United States
(Bharmal) Stanford Medicine, Palo Alto, CA, United States
Publisher
Elsevier Ltd

<46>
Accession Number
2032261652
Title
Personalized risk prediction of mortality and rehospitalization for heart
failure in patients undergoing mitral valve repair surgery.
Source
Frontiers in Cardiovascular Medicine. 11 (no pagination), 2024. Article
Number: 1470987. Date of Publication: 2024.
Author
Zhou N.; Zhang K.; Qiao B.; Chen C.; Guo X.; Fu W.; Zheng J.; Du J.; Dong
R.
Institution
(Zhou, Zhang, Qiao, Chen, Guo, Fu, Zheng, Du, Dong) Coronary Artery
Disease Surgical Center, Beijing Anzhen Hospital, Capital Medical
University, Chaoyang District, China
(Zhou, Zhang, Chen, Guo, Fu, Zheng, Dong) Department of Cardiac Surgery,
Beijing Anzhen Hopital, Capital Medical University, Beijing, China
(Qiao, Du) Precision Medicine Center, Beijing Institute of Heart, Lung and
Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
Publisher
Frontiers Media SA
Abstract
Background: Accurately assessing the postoperative mortality and
rehospitalization for heart failure risks in patients undergoing mitral
valve repair surgery is of significant importance for individualized
medical strategies. Objective(s): We sought to develop and validate a
risk assessment system for the prediction of mortality and
rehospitalization for heart failure. Method(s): Personalized risk
prediction system of mortality and rehospitalization for heart failure was
developed. For developing a prediction system with death as the outcome,
there were 965 patients (70%) and 413 patients (30%) were included in the
the derivation cohort and the validation cohort. For developing a
prediction system with rehospitalization for heart failure as the outcome,
there were 927 patients (70%) and 398 patients (30%) were included in the
derivation cohort and the validation cohort. There were 42 routine
clinical variables used to develop the models. The performance evaluation
of the model is based on the area under the curve (AUC). Evaluate the
improvement with Euro Score II according to NRI and IDI net
reclassification improvement (NRI) and integrated discrimination
improvement (IDI). Result(s): The median follow-up time was 685 days,
the incidence of death was 3.85% (n = 53), and the incidence of
rehospitalization for heart failure was 10.01% (n = 138). The AUC values
of the mortality prediction model in the derivation and validation cohorts
were 0.825 (0.764-0.886) and 0.808 (0.699-0.917), respectively. The AUC
values of the rehospitalization for heart failure prediction model in the
derivation and validation cohorts were 0.794 (0.756-0.832) and 0.812
(0.758-0.866), respectively. NRI and IDI showed that the mortality
prediction model exhibited superior performance than the Euro Score II.
The mortality and rehospitalization for heart failure risk prediction
models effectively stratified patients into different risk subgroups.
 Conclusion(s): The developed and validated models exhibit
satisfactory performance in prediction of all-cause mortality and
rehospitalization for heart failure after mitral valve repair surgery.
Clinical Trial Registration: http://www.clinicaltrials.gov, Unique
identifier: (NCT05141292). Copyright 2024 Zhou, Zhang, Qiao, Chen,
Guo, Fu, Zheng, Du and Dong.

<47>
Accession Number
2035621047
Title
Smoking cessation and prognosis during long-term follow-up after stroke,
TIA, and acute coronary syndrome-results from the randomized controlled
NAILED trial.
Source
PLoS ONE. 19(11 November) (no pagination), 2024. Article Number: e0311955.
Date of Publication: November 2024.
Author
Anna-Lotta I.; Aslund L.; Ogren J.; Mooe T.
Institution
(Anna-Lotta, Aslund, Ogren, Mooe) Department of Public Health and Clinical
Medicine, Umea University, Ostersund, Sweden
Publisher
Public Library of Science
Abstract
Background and aims About 50% of patients continue to smoke after stroke
and myocardial infarction. We aimed to assess the effect of a multiple
risk factor intervention on long-term smoking cessation and to explore a
possible association between early smoking cessation and long-term
prognosis. Material and methods Consecutive patients with stroke/TIA/acute
coronary syndrome (ACS) at Ostersund Hospital during 2010-2014 were
included, randomized to intervention or usual care (1:1), and followed
through 2017. This substudy included participants that reported current
smoking during hospitalization and were alive at 1 month post discharge
when the intervention began (n = 321). The smoking cessation intervention
was part of a telephone-based, multiple risk factor intervention delivered
by a nurse and consisted of brief advice delivered annually. Smoking
cessation at the last follow-up was analyzed as the primary outcome.
Smoking cessation at other time points and association between early
smoking cessation and prognosis (CV events, survival) were secondary
outcomes. Result After a mean follow-up of 4.2 years, 171 participants
reported nonsmoking, with no significant difference between the
intervention and control group (50.3% vs. 56.3%, absolute difference 5.9%,
95% CI -5.0 to 16.7, p = 0.286). Of these, 80.7% had stopped smoking
within 1 month after discharge. The intervention did not improve smoking
cessation proportions in the long or short term, and there was no apparent
effect on smoking cessation attempts or sustained abstinence. Smoking
cessation within 1 month was associated with lower all-cause mortality (HR
0.52, 95% CI 0.32-0.87), and there was a nonsignificant trend towards a
lower incidence of CV events (HR 0.71, 95% CI 0.45-1.12).
Conclusion Annual brief advice by a nurse as part of a multiple risk
factor follow-up did not improve long-term smoking cessation after
stroke/TIA/ACS. Continued smoking past 1 month was associated with worse
prognosis. Copyright © 2024 Irewall et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<48>
Accession Number
2035618439
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: 01 Oct 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) Universite Paris-Cite, 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
Publisher
Oxford University Press
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 © 2024 The Author(s).

<49>
Accession Number
2034347727
Title
Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors
before Major Noncardiac Surgery: The Stop-or-Not Randomized Clinical
Trial.
Source
JAMA. 332(12) (pp 970-978), 2024. Date of Publication: 24 Sep 2024.
Author
Legrand M.; Falcone J.; Cholley B.; Charbonneau H.; Delaporte A.; Lemoine
A.; Garot M.; Joosten A.; Meistelman C.; Cheron-Leroy D.; Rives J.-P.;
Pastene B.; Dewitte A.; Sigaut S.; Danguy Des Deserts M.; Truc C.; Boisson
M.; Lasocki S.; Cuvillon P.; Schiff U.; Jaber S.; Le Guen M.; Caillard A.;
Bar S.; Pereira De Souza Neto E.; Colas V.; Dimache F.; Girardot T.;
Jozefowicz E.; Viquesnel S.; Berthier F.; Vicaut E.; Gayat E.
Institution
(Legrand) Department of Anesthesiology and Perioperative Care, Division of
Critical Care Medicine, University of California, San Francisco, United
States
(Legrand, Gayat) French Clinical Research Infrastructure Network
Initiative-Cardio Renal Clinical Trialists Network, Nancy, France
(Falcone, Garot) Centre Hospitalier Universitaire de Lille, Hopital
Huriez, Lille, France
(Cholley) Department of Anesthesiology and Intensive Care, Hopital
Europeen Georges Pompidou, AP-HP, Paris, France
(Charbonneau) Department of Anesthesiology and Intensive Care Unit,
Clinique Pasteur, Toulouse, France
(Delaporte) Hopital Marie Lannelongue, Le Plessis-Robinson, France
(Lemoine) Service d'Anesthesie-Reanimation et Medecine Peri-Operatoire,
Hopital Tenon, APHP, Sorbonne Universite, Paris, France
(Joosten) Department of Anesthesiology and Perioperative Medicine, David
Geffen School of Medicine, University of California, Los Angeles, United
States
(Meistelman) Department of Anesthesiology, CHU de Nancy Brabois, Hopital
Saint Charles, Saint Die des Vosges, France
(Cheron-Leroy) Universite Paris Cite, AP-HP, Hopital Saint-Louis, DMU
PARABOL, Service d'Anesthesie-Reanimation-Centre de Traitment des Brules,
Paris, France
(Rives) Service d'Anesthesie, Departement d'Anesthesie, de Chirurgie et
Interventionnel, Hopital Gustave Roussy, Villejuif, France
(Pastene) Aix Marseille Universite, APHM, Service d'Anesthesie et de
Reanimation, Hopital Nord, Marseille, France
(Dewitte) Service d'Anesthesie-Reanimation, Centre Hospitalier
Universitaire de Bordeaux, Pessac, France
(Dewitte) Universite de Bordeaux, CNRS, Inserm, Immuno ConcEpT, UMR 5164,
Bordeaux, France
(Sigaut) Department of Anesthesiology and Intensive Care, AP-HP, Hopital
Beaujon, Clichy, France
(Danguy Des Deserts) Department of Anesthesia and Intensive Care,
Clermont-Tonnerre Military Hospital, Univ Brest, Inserm, UMR 1304-GETBO,
Brest, France
(Truc) Hospices Civils de Lyon, Hopital Edouard Herriot, Lyon, France
(Boisson) Universite de Poitiers, INSERM U1070 PHAR2, CHU de Poitiers,
Service d'Anesthesie-Reanimation et Medecine Peri-Operatoire, Poitiers,
France
(Lasocki) Departement Anesthesie Reanimation, CHU d'Angers, Angers, France
(Cuvillon) Departement Anesthesie, Centre Hospitalier Universitaire
Caremeau, Nimes et Universite Montpellier 1, Montpellier, France
(Schiff) Centre Hospitalier Universitaire de Clermont Ferrand, Hopital
Estaing, Clermont Ferrand, France
(Jaber) Anesthesia and Critical Care Department, Saint Eloi, University of
Montpellier, Research Unit: PhyMedExp, INSERM U-1046, CNRS, Montpellier,
France
(Le Guen) Hopital Foch, Suresnes, France
(Caillard) Departement Anesthesie Reanimation, Centre Hospitalier
Universitaire Brest, Brest, France
(Bar) Department of Anaesthesiology and Critical Care Medicine, Amiens
University Hospital, Rond-Point du Professeur Christian Cabrol, Amiens,
France
(Pereira De Souza Neto) Centre Hospitalier de Montauban, Montauban, France
(Colas) Hopital Saint Philibert-Groupement des Hopitaux de l'Institut
Catholique de Lille, Lille, France
(Dimache) Centre Hospitalier Universitaire de Strasbourg, Strasbourg,
France
(Girardot) Centre Hospitalier de Valence, Valence, France
(Jozefowicz) Departement d'Anesthesie-Reanimation, Centre Hospitalier
Universitaire de Lille, Hopital Roger Salengro, Lille, France
(Viquesnel) Anesthesia and Intensive Care Department, Universite de
Rennes, CHU Rennes, Rennes, France
(Berthier) Departement d'Anesthesie Reanimation Chirurgicale, Universite
de Franche-Comte, Centre Hospitalier Universitaire Besancon, INSERM CIC
1431, SINERGIES, Besancon, France
(Vicaut) Unite de Recherche Clinique, GH St-Louis-Lariboisere-Fernand
Widal, Universite Paris Diderot, Paris, France
(Gayat) Universite Paris Cite, AP-HP, Hopital Lariboisiere, DMU PARABOL,
Service d'Anesthesie-Reanimation-CTB, Paris, France
(Gayat) Inserm U942 MASCOT, Paris, France
Publisher
American Medical Association
Abstract
Importance: Before surgery, the best strategy for managing patients who
are taking renin-angiotensin system inhibitors (RASIs)
(angiotensin-converting enzyme inhibitors or angiotensin receptor
blockers) is unknown. The lack of evidence leads to conflicting
guidelines. Objective(s): To evaluate whether a continuation strategy
vs a discontinuation strategy of RASIs before major noncardiac surgery
results in decreased complications at 28 days after surgery. Design,
Setting, and Participant(s): Randomized clinical trial that included
patients who were being treated with a RASI for at least 3 months and were
scheduled to undergo a major noncardiac surgery between January 2018 and
April 2023 at 40 hospitals in France. Intervention(s): Patients were
randomized to continue use of RASIs (n = 1107) until the day of surgery or
to discontinue use of RASIs 48 hours prior to surgery (ie, they would take
the last dose 3 days before surgery) (n = 1115). Main Outcomes and
Measures: The primary outcome was a composite of all-cause mortality and
major postoperative complications within 28 days after surgery. The key
secondary outcomes were episodes of hypotension during surgery, acute
kidney injury, postoperative organ failure, and length of stay in the
hospital and intensive care unit during the 28 days after surgery.
 Result(s): Of the 2222 patients (mean age, 67 years [SD, 10 years];
65% were male), 46% were being treated with angiotensin-converting enzyme
inhibitors at baseline and 54% were being treated with angiotensin
receptor blockers. The rate of all-cause mortality and major postoperative
complications was 22% (245 of 1115 patients) in the RASI discontinuation
group and 22% (247 of 1107 patients) in the RASI continuation group (risk
ratio, 1.02 [95% CI, 0.87-1.19]; P =.85). Episodes of hypotension during
surgery occurred in 41% of the patients in the RASI discontinuation group
and in 54% of the patients in the RASI continuation group (risk ratio,
1.31 [95% CI, 1.19-1.44]). There were no other differences in the trial
outcomes. Conclusions and Relevance: Among patients who underwent
major noncardiac surgery, a continuation strategy of RASIs before surgery
was not associated with a higher rate of postoperative complications than
a discontinuation strategy. Trial Registration: ClinicalTrials.gov
Identifier: NCT03374449. Copyright © 2024 American Medical
Association. All rights reserved.

<50>
[Use Link to view the full text]
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.

<51>
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.

<52>
Accession Number
2031523178
Title
Assessing the cost-effectiveness of replacing antimetabolites with mTOR
inhibitors in heart transplant immunosuppression in China: a network
meta-analysis-based economic evaluation.
Source
International Journal of Clinical Pharmacy. 46(6) (pp 1472-1481), 2024.
Date of Publication: December 2024.
Author
Gu Y.; Liu B.; Lin X.; Chen J.; Chen X.; Jiang Y.; Zhu Y.; Li X.; Lou S.;
Zhu J.
Institution
(Gu, Liu, Lin, Chen, Lou, Zhu) Department of Pharmacy, Nanjing First
Hospital, China Pharmaceutical University, Nanjing 210006, China
(Gu, Liu, Lin, Chen, Lou, Zhu) Department of Pharmacy, Nanjing First
Hospital, Nanjing Hospital Afiliated to Nanjing Medical University,
Nanjing 210006, China
(Chen, Jiang, Zhu) Department of Cardiothoracic Surgery, Nanjing First
Hospital, Nanjing Hospital Affiliated to Nanjing Medical University,
Nanjing 210006, China
(Li) School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
(Li) Center for Global Health, School of Public Health, Nanjing Medical
University, Nanjing, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Although several pharmacoeconomic studies have assessed the
cost-effectiveness of maintenance immunosuppressive regimens for heart
transplant recipients, economic comparisons between various combination
drug therapies remain sparse. Aim(s): This study used an economic
evaluation based on network meta-analysis to assess the cost-effectiveness
of four immunosuppressive regimens for adult heart transplant recipients
in China. Method(s): We conducted a systematic search for clinical
trials in PubMed, Embase, Cochrane Library, Web of Science, China National
Knowledge Infrastructure (CNKI), Wanfang Data, and VIP database. A
validated Markov model was adapted to reflect the Chinese medical
landscape. Four maintenance immunosuppression regimens were considered:
tacrolimus/mycophenolate mofetil (TAC/MMF), cyclosporine/mycophenolate
mofetil (CSA/MMF), everolimus/cyclosporine (EVL/CSA), and
sirolimus/tacrolimus (SRL/TAC). The probabilities of health events were
derived from a comprehensive literature review. Direct medical costs,
adjusted for 2022 values, were from public documents and websites, while
utilities for quality-adjusted life-years (QALYs) were taken from previous
studies. Primary outcomes were mean lifetime cost, QALYs, and
cost-effectiveness, with a willingness-to-pay (WTP) threshold set at three
times China's GDP per capita in 2022. Sensitivity analyses were conducted
to test the robustness of the results. Result(s): The base case
analysis identified TAC/MMF as the most cost-effective regimen, producing
a mean of 6.31 QALYs per patient at a cost of Chinese Yuan (CNY)
534,182.89. Sensitivity analyses consistently reinforced TAC/MMF as the
most cost-effective and robust choice. Conclusion(s): TAC/MMF is the
most cost-effective maintenance immunosuppressive regimen for heart
transplant recipients within the Chinese health system. The study findings
are reinforced by sensitivity analyses, affirming their robustness amid
various uncertainties. Copyright © The Author(s), under exclusive
licence to Springer Nature Switzerland AG 2024.

<53>
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

<54>
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.

<55>
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.

<56>
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.

<57>
Accession Number
2031028164
Title
Characteristics and Outcomes of Fetal Cardiac Rhabdomyoma With or Without
mTOR Inhibitors, a Systematic Review and Meta-Analysis.
Source
Prenatal Diagnosis. 44(10) (pp 1251-1267), 2024. Date of Publication:
September 2024.
Author
Mustafa H.J.; Javinani A.; Morning M.L.; D'Antonio F.; Pagani G.; Puranik
P.M.; Khalil A.; Shamshirsaz A.A.
Institution
(Mustafa) The Fetal Center at Riley Children's and Indiana University
Health, Division of Maternal-Fetal Medicine, Indiana University School of
Medicine, Indianapolis, IN, United States
(Javinani, Shamshirsaz) Maternal Fetal Care Center, Division of Fetal
Medicine and Surgery, Boston Children's Hospital, Harvard Medical School,
Boston, MA, United States
(Morning) Department of Obstetric and Gynecology, Indiana University
School of Medicine, Indianapolis, IN, United States
(D'Antonio) Center for Fetal Care and High-Risk Pregnancy, Department of
Obstetrics and Gynecology, University Hospital of Chieti, Chieti, Italy
(Pagani) Maternal Fetal Medicine Unit, Department of Obstetrics and
Gynecology, ASST-Papa Giovanni XXIII, Bergamo, Italy
(Puranik) Pediatric Cardiology, Riley Hospital for Children and Indiana
University School of Medicine, Indianapolis, IN, United States
(Khalil) Fetal Medicine Unit, St George's Hospital, St George's University
of London, London, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Objectives: To investigate the characteristics and outcomes of fetal
cardiac rhabdomyoma with or without prenatal use of mammalian target of
rapamycin inhibitor (mTORi). Search Strategy: We systematically searched
PubMed, Scopus, and Web of Science until June 2023. Selection
Criteria: Studies reporting on pregnancies with fetal cardiac rhabdomyoma
were included. Data Collection and Analysis: A meta-analysis of
proportions was conducted only on studies that included three or more
cases. Result(s): A systematic review included 61 studies reporting
on 400 fetuses with cardiac rhabdomyoma, of which 52 studies (389 fetuses)
had expectant management and 9 studies (11 fetuses) were managed with
mTORi. The meta-analysis included 26 studies reporting on 354 fetuses.
Prenatally, 14% (95% CI 4-36) had pericardial effusion, 13% (95% CI 6-27)
had arrhythmia, 16% (95% CI 7-31) had outflow tract obstruction, and 10%
(95% CI 4-21) had hydrops. Fetal demise occurred in 12% (95% CI 5-30).
Before delivery, tumor size reduction was noted in 13%, and after birth in
58%. Following birth, 8% (95% CI 3-14) had neonatal death and 9% (95%
4-17) required cardiac surgery. 60% (95% CI 41-79) of cases were diagnosed
with tuberous sclerosis. Seizures were reported only in cases with a
tuberous sclerosis diagnosis (41/71 infants). For the 9 studies reporting
all together on 11 fetuses with tuberous sclerosis receiving prenatal
mTORi, they showed improvement in the size of cardiac rhabdomyoma as well
as outflow obstruction and none had fetal demise or neonatal death, and
none required postnatal cardiac surgery. Conclusion(s): We report on
the natural history of prenatal cardiac rhabdomyoma, including
characteristics, progression, and survival. We report 11 fetuses with
tuberous sclerosis and cardiac rhabdomyoma receiving prenatal mTORi,
showing promising results. Copyright © 2024 The Author(s).
Prenatal Diagnosis published by John Wiley & Sons Ltd.

<58>
Accession Number
2030463495
Title
Evaluation of the effect of empagliflozin on prevention of atrial
fibrillation after coronary artery bypass grafting: a double-blind,
randomized, placebo-controlled trial.
Source
Naunyn-Schmiedeberg's Archives of Pharmacology. 397(12) (pp 9935-9946),
2024. Date of Publication: December 2024.
Author
Zarei B.; Fazli B.; Tayyebi M.; Abbasi Teshnizi M.; Moeinipour A.;
Javedanfar O.; Javidi Dasht Bayaz R.; Rahmati M.; Ghavami V.; Amini S.;
Mohammadpour A.H.
Institution
(Zarei, Mohammadpour) Department of Clinical Pharmacy, School of Pharmacy,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Fazli) Department of Anesthesiology, Mashhad University of Medical
Sciences, Mashhad, Iran, Islamic Republic of
(Tayyebi) Interventional Cardiac Electrophysiologist, Department of
Cardiovascular Diseases, Faculty of Medicine, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Abbasi Teshnizi, Moeinipour, Javedanfar) Department of Cardiac Surgery,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Javidi Dasht Bayaz, Rahmati) Vascular and Endovascular Surgery Research
Center, Faculty of Medicine, Mashhad University of Medical Sciences,
Mashhad, Iran, Islamic Republic of
(Ghavami) Department of Biostatistics, Social Determinants of Health
Research Center, Mashhad University of Medical Sciences, Mashhad, Iran,
Islamic Republic of
(Amini) Department of Anesthesia, School of Medicine, Mashhad University
of Medical Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
This study is aimed at evaluating the effect of empagliflozin in
preventing atrial fibrillation after coronary artery bypass grafting
(CABG). Eighty-two patients who fulfilled the inclusion criteria were
allocated to the empagliflozin group (n = 43) or placebo group (n = 39).
In two groups, patients received empagliflozin or placebo tablets 3 days
before surgery and on the first three postoperative days (for 6 days) in
addition to the standard regimen during hospitalization. During the first
3 days after surgery, types of arrhythmias after cardiac surgery,
including supraventricular arrhythmias, especially postoperative atrial
fibrillation (POAF), ventricular arrhythmias, and heart blocks, were
assessed by electrocardiogram monitoring. C-reactive protein (CRP) levels
were evaluated pre-operatively and postoperative on the third day. The
incidence of POAF in the treatment group was lower compared to the control
group; however, this reduction was statistically non-significant (p =
0.09). The frequency of ventricular tachycardia was reduced significantly
in the treatment group versus patients in the control (p = 0.02). Also, a
significant reduction in the frequency of premature ventricular
contractions (PVCs) was seen in the treatment group in comparison with the
control group (p = 0.001). After the intervention, CRP levels were
significantly less in the empagliflozin group compared to the control
group in the third postoperative day (p = 0.04). The prophylactic use of
empagliflozin effectively reduced the incidence of ventricular arrhythmia
in patients undergoing CABG surgery. Copyright © The Author(s),
under exclusive licence to Springer-Verlag GmbH Germany, part of Springer
Nature 2024.

<59>
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.

<60>
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.

<61>
Accession Number
2035206293
Title
Hydroxocobalamin Versus Methylene Blue for Treatment of Vasoplegic Shock
Following Cardiopulmonary Bypass: A Systematic Review and Meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 38(12) (pp 3188-3199),
2024. Date of Publication: December 2024.
Author
Cadd M.; Watson U.; Kilpatrick T.; Hardy B.; Gallop L.; Gerard A.; Cabaret
C.
Institution
(Cadd, Kilpatrick, Gerard, Cabaret) Anaesthetics Department, Royal Sussex
County Hospital, University Hospitals Sussex, United Kingdom
(Watson, Gallop) Anaesthetics Department, Worthing Hospital, University
Hospitals Sussex, United Kingdom
(Hardy) Department of Cardiothoracic Anesthesia and the Cardiovascular
Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
Publisher
W.B. Saunders
Abstract
Objectives: To summarize the evidence of the hemodynamic effects and
vasopressor requirements of adult cardiac surgery patients with vasoplegic
shock treated with hydroxocobalamin or methylene blue. Design(s):
Systematic review and meta-analysis. Setting(s): Multi-institutional.
 Participant(s): Adult cardiac surgery patients with vasoplegic shock.
 Intervention(s): Administration of hydroxocobalamin or methylene
blue. Measurements and Main Results: A total of 263 patients in four
retrospective observational studies were included in a pooled analysis.
There was no significant difference in the primary outcome, vasopressor
requirement at 1 hour (mean difference [MD]: 0.00 mcg/kg/min
norepinephrine equivalent [NEE], 95% confidence interval [CI]: -0.09 to
0.08). Hydroxocobalamin was associated with a significant improvement in
mean arterial pressure at 1 hour (MD: 5.30 mmHg, 95% CI: 2.98 to 7.62),
total vasopressor dose at 1 hour (MD: -0.13 mcg/kg/min NEE, 95% CI: -0.25
to -0.01), total vasopressor at 6 hours (MD: -0.15 mcg/kg/min NEE, 95% CI:
-0.21 to -0.08). No differences were observed in systemic vascular
resistance or mortality between groups. Three studies were deemed at
moderate risk of bias and one at serious risk. Conclusion(s):
Hydroxocobalamin has been shown to have a beneficial effect on
hemodynamics and vasopressor requirements in vasoplegic cardiac surgery
patients compared with methylene blue, although evidence is limited, and
further well-powered randomized controlled trials are
required. Copyright © 2024 Elsevier Inc.

<62>
Accession Number
2034698245
Title
The Impact of Preoperative Combined Pectoserratus and/or Interpectoral
Plane (Pectoralis Type II) Blocks on Opioid Consumption, Pain, and Overall
Benefit of Analgesia in Patients Undergoing Minimally Invasive Cardiac
Surgery: A Prospective, Randomized, Controlled, and Triple-blinded Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 38(12) (pp 2973-2981),
2024. Date of Publication: December 2024.
Author
Gasteiger L.; Fiala A.; Naegele F.; Gasteiger E.; Seisl A.; Bonaros N.;
Mair P.; Velik-Salchner C.; Holfeld J.; Hofer D.; Stundner O.
Institution
(Gasteiger, Fiala, Gasteiger, Seisl, Mair, Velik-Salchner, Stundner)
Department of Anaesthesiology and Intensive Care Medicine, Medical
University of Innsbruck, Innsbruck, Austria
(Naegele, Bonaros, Holfeld, Hofer) Department of Cardiac Surgery, Medical
University of Innsbruck, Innsbruck, Austria
Publisher
W.B. Saunders
Abstract
Objective: Acute postoperative pain remains a major obstacle in minimally
invasive cardiac surgery (MICS). Evidence of the analgesic benefit of
chest wall blocks is limited. This study was designed to assess the
influence of combined pectoserratus plane block plus interpectoral plane
block (PSPB + IPPB) on postoperative pain and the overall benefit of
analgesia compared with placebo. Design(s): A prospective,
randomized, triple-blinded study was conducted. Setting(s): The
setting was the operating room and intensive care unit of a university
hospital. Participant(s): A total of 60 patients undergoing elective
right-lateral MICS were enrolled. Intervention(s): Patients were
randomly assigned to preoperative PSPB + IPPB with 30 mL of ropivacaine
0.5% or saline. Measurements and Main Results: The primary endpoint
was total intravenous morphine milligram equivalents administered in the
first 24 hours after extubation. Secondary endpoints included the Overall
Benefit of Analgesia Score (OBAS) at 24 hours after extubation and
repeated Visual Analogue Scale (VAS). Values for intravenous morphine
milligram equivalents administered in the first 24 hours after extubation
were significantly lower (median [interquartile range]: 4.2 mg [2.1 - 7.9]
v 8.3 mg [4.2 - 15.7], p = 0.025; mean difference: 6.7 mg [0.94 - 12 mg],
p = 0.024, Cohen's d: 0.64 [0.09 - 1.2]). Moreover, OBAS at 24 hours and
VAS after extubation were significantly lower (4.0 [3.0 - 6.0] v 7.0 [3.0
- 9.0], p = 0.043; 0.0 cm [0.0 - 2.0] v 1.5 cm [0.3 - 3.0], p = 0.030).
VAS did not differ between groups at later points. Conclusion(s):
Preoperative PSPB + IPPB reduced 24-hour postextubation opioid
consumption, pain at extubation, and OBAS. Given its low risk and
expedient placement, it could be a helpful addition to MICS protocols.
Future studies should evaluate these findings in multicenter settings and
further elucidate the optimal timing of block placement. Copyright
© 2024

<63>
Accession Number
2034350898
Title
Remimazolam Use in Cardiac Anesthesia: A Narrative Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 38(12) (pp 3179-3187),
2024. Date of Publication: December 2024.
Author
Muncan B.; Bennett-Guerrero E.
Institution
(Muncan) Department of Anesthesiology, Perioperative and Pain Medicine,
Stanford Medicine, Stanford, CA, United States
(Bennett-Guerrero) Professor and Vice-Chair, Department of Anesthesiology,
Stony Brook Medicine, Stony Brook, NY, United States
Publisher
W.B. Saunders
Abstract
Remimazolam, a novel ultra-short-acting intravenous benzodiazepine, has
garnered recent attention for its use as a general anesthetic. This
narrative review aims to summarize and analyze the available literature on
the effects of remimazolam use in cardiac surgical patients, including its
effects on hemodynamics, safety in patients with baseline myocardial
dysfunction, and impact on postoperative management including time to
emergence and extubation. Finally, there is discussion regarding potential
drawbacks of adopting remimazolam as a routine anesthetic for cardiac
surgery. Copyright © 2024 Elsevier Inc.

<64>
Accession Number
643015506
Title
Cerebral Embolic Protection Device protects against stroke during
Transcatheter Aortic Valve Replacement (TAVR): An Updated 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
Basit J.; Fatima M.; Zaheer Z.; Ebad Ur Rehman M.; Ahmed N.; Lee Q.; Saeed
S.; Leung C.; Maqbool S.; Malik J.; Tse G.
Institution
(Basit, Ebad Ur Rehman, Saeed, Maqbool) Rawalpindi Medical University,
Rawalpindi, Pakistan
(Fatima, Zaheer, Ahmed) King Edward Medical University, Lahore, Pakistan
(Lee) University of Aberdeen, Aberdeen, United Kingdom
(Leung) Chinese University of Hong Kong, Hong Kong, Hong Kong
(Malik) Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
(Tse) Tianjin Medical University, Tianjin, China
Publisher
Oxford University Press
Abstract
Background: Cerebral Embolic Protection Device (CEPD) is used to capture
emboli during Transcatheter Aortic Valve Replacement (TAVR). Previous
meta-analyses have yielded conflicting results regarding efficacy and
safety of CEPD in TAVR. With recently published pivotal trial and multiple
Cohort studies reporting new data, there is a need of re-calibration of
available statistical evidence. Aim(s): The aim of our study was to
explore the effects of using CEPD on TAVR outcomes. Method(s): A
systematic literature search was conducted across Pubmed, Cochrane,
Embase, and clinicaltrials.gov from inception till February 2023.
Dichotomous outcomes were pooled using Odds Ratio (OR) while continuous
outcomes were pooled using Standardized Mean Difference (SMD). Revman 5.4
was used to pool the data using random effects model With Mantel-Haenszel
method. Subgroup analysis for study type (RCT vs NRS) was conducted.
Sensitivity analysis using leave one out method and multiple exit method
was conducted to find out, if unadjusted cohort studies had an impact on
the pooled outcomes. Result(s): The initial search revealed 870
articles. After primary and secondary screening, data was included from 17
studies (6 RCTs, 11 cohorts, n= 180187). Use of CEPD was associated with
50% reduced odds of stroke (OR=0.50, 95% CI=0.03-0.75, p=<0.01, I2=32%).
There was no significant difference in 30 days mortality between the two
groups (OR=0.76, 95% CI=0.44-1.31, p=0.33, I2=18%). On Diffusion Weighted
Magnetic Resonance Imaging (DW-MRI), the two groups did not have any
significant differences in volume per lesion (SMD=-0.07, CI=-0.28-0.14,
p=0.52,I2=71%), Total volume of lesions (SMD=-0.08, p=0.73, CI=-0.53,0.17,
I2=84%) and Number of lesions per patient (SMD=-0.15, p=0.45,
CI=-0.23,0.10, I2=84%). On subgroup analysis, RCTs were found to have high
heterogeneity while NRS had zero heterogeneity. The pooled analysis
revealed no significant association with either of the group regarding
Acute Kidney Injury (OR=0.84, p=0.43, I2=0%), risk of pacemaker
implantation (OR=1.17,p=0.35,I2=0%), major bleed (OR=0.97,p=0.94,I2=62%),
Worsening National Institute of Health Stroke Scale (NIHSS)
(OR=0.46,p=0.36,I2=76%), and Vascular complications VC
(OR=0.85,p=0.35,I2=0%). The results remained insignificant for subgroup
analysis for study type and sensitivity analysis using leave one out and
exit multiple methods for unadjusted cohort studies. Conclusion(s):
The use of CEPD during TAVR was found to be associated with reduced risk
of stroke, however, there was no significant association with mortality,
DW-MRI findings, AKI, major bleed, minor bleed, risk of pacemaker
implantation, worsening NIHSS score and vascular complications. Further,
large scale prospective trials are needed to provide definitive evidence
(Figure Presented).

<65>
Accession Number
643015448
Title
Impaired myocardial flow reserve from 82-rubidium positron emission
tomography predicts survival benefit from revascularization: a multicenter
registry study.
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
Toftholm M.; Kim Wadt Hansen K.W.H.; Signe Hoejstrup S.H.; Louise Hougesen
Bjerking L.H.B.; Soeren Galatius S.G.; Kirsten Bouchelouche K.B.; Lars
Jakobsen L.J.; Evald Hoej Christiansen E.H.C.; Lisbeth Marner L.M.; Ulrik
Talleruphuus U.T.; Eva Irene Bossano Prescott E.I.B.P.
Institution
(Toftholm, Kim Wadt Hansen, Signe Hoejstrup, Louise Hougesen Bjerking,
Soeren Galatius, Lisbeth Marner, Ulrik Talleruphuus, Eva Irene Bossano
Prescott) Bispebjerg University Hospital, Copenhagen, Denmark
(Kirsten Bouchelouche) Skejby University Hospital, Department of Nuclear
Medicine and PET-Centre, Aarhus, Denmark
(Lars Jakobsen, Evald Hoej Christiansen) Skejby University Hospital,
Department of cardiology, Aarhus, Denmark
Publisher
Oxford University Press
Abstract
Background: The identification of patients that may accrue prognostic
benefit from revascularization is complex. Myocardial perfusion imaging
(MPI) using 82-rubidium positron emission tomography (82Rb-PET) provides
information on myocardial perfusion defects, calcium-score, left
ventricular ejection fraction (LVEF), and myocardial flow reserve (MFR).
 Purpose(s): To examine if MFR assessed by 82-Rb PET MPI identifies
subgroups that benefit from revascularization. Method(s): We included
7462 all-comers suspected of coronary artery disease undergoing 82-Rb-PET
MPI at three high-volume nuclear centers in Denmark between January 1,
2018, and August 20, 2020. Patients with reversible perfusion defects <5%,
eGFR <30 mL/min/1.73m2, receiving dialysis, left ventricular ejection
fraction <35%, and those that died within 90 days of their index 82Rb-PET
MPI were excluded. Revascularization was defined as percutaneous coronary
intervention (PCI) or coronary artery bypass-graft surgery (CABG) within
90 days of MPI. Patients were followed for major adverse cardiac events
(MACE), a composite of all-cause death, acute coronary syndromes, ischemic
stroke, or heart failure, and all-cause mortality until July 9, 2022. We
analyzed each outcome according to revascularization and MFR (<2 vs. >=2)
using the Kaplan-Meier estimator and proportional hazards Cox regressions
adjusted for patient and 82Rb-PET characteristics, including any perfusion
defects, using inverse probability weighting. Result(s): A total of
1805 patients were included (mean age 69 (SD 10.6), 29.8% females, 27%
diabetes), of whom 902 (50%) had MFR <2. The median follow-up was 35.9
months. A total of 480 were revascularized. 58 experienced a MACE; 36
died. Revascularization was associated with a significantly lower risk of
all-cause mortality and MACE among patients with MFR<2, whereas there was
no survival benefit from revascularization among those with normal MFR
(figure 1). After adjustment, HR for revascularization for MACE in the
MFR<2 group was 0.51 (95%CI 0.33-0.78) versus 1.19 (95%CI 0.64-2.20) in
the MFR>=2 group (p for interaction 0.042) and for All-cause mortality
0.48 (95%CI 0.30-0.77) in the MFR<2 group versus 1.01 (95%CI 0.43-2.39) in
the MFR>=2 group (p for interaction 0.28). Results were independent of the
extent of reversible perfusion defect, consistent across several
subgroups, and independent of the mode of revascularization (CABG or PCI),
figure 2. Conclusion(s): In this observational study,
revascularization was associated with improved prognosis, specifically
among patients with impaired MFR, whereas among patients with normal MFR,
there was no prognostic benefit. Impaired MFR may identify patients with
prognostic benefit from revascularization. This novel hypothesis should be
tested in a randomized controlled trial.

<66>
Accession Number
643015297
Title
Impact of in-hospital initiation of sodium-glucose cotransporter-2
inhibitors in patients with heart failure and reduced ejection fraction.
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
Burgos L.; Ballari F.; Spaccavento A.; Ricciardi B.; Suarez L.; Baro Vila
R.; Campos Cevera L.; Chicote F.; Fasan M.; Fescina J.; Arias R.; Santos
Gallego C.; Diez M.
Institution
(Burgos, Ballari, Spaccavento, Ricciardi, Suarez, Baro Vila, Campos
Cevera, Chicote, Fasan, Fescina, Arias, Diez) Instituto Cardiovascular De
Buenos Aires, Buenos Aires, Argentina
(Santos Gallego) Mount Sinai Hospital, New York, United States
Publisher
Oxford University Press
Abstract
Introduction: Safety and early clinical benefit make sodium-glucose
cotransporter-2 inhibitor (SGLT-2i) therapy suitable for in-hospital
initiation in patients with heart failure and reduced ejection fraction
(HFrEF). Despite randomized controlled trials and guideline
recommendations, they are underused and clinical inertia may play a role.
 Objective(s): Primary: To assess the impact of initiating SGLT-2i at
discharge on 90-day prescription rates in patients with HFrEF during
hospitalization for acute heart failure (AHF). Secondary: To evaluate the
presence of contraindications at discharge and the independent factors
associated with in-hospital prescription, and to assess clinical outcomes
at 90 days. Method(s): Retrospective analysis of a consecutive
prospective single-center cohort. Adult patients hospitalized between
January 2021 and October 2022 with a primary diagnosis of AHF and left
ventricular ejection fraction (LVEF) <40% were included. Patients who
underwent heart transplantation during hospitalization, used SGLT2i before
admission, died or were referred during the index hospitalization were
excluded. Those who started SGLT-2i before or at discharge were compared
with those who did not. The primary outcome was SGLT-2i prescription rate
at 90 days, and the exploratory secondary endpoints was the composite of
hospitalization or urgent visit for AHF or all-cause mortality at 90 days.
Independent factors associated with inpatient SGLT-2i prescription were
analyzed using a logistic regression model. Result(s): Among 378
patients with documented HFrEF, 240 (64%) met the inclusion criteria. Mean
age was 76+/-11 years, 75.4% were male and the mean LVEF was 25+/-13%.
SGLT-2i was indicated during hospitalization in 31.6% of patients. A total
of 86% of the cohort had a 90-day follow-up, and the SGLT2i prescription
rate was 94.2% in those with in-hospital initiation and 14.4% in those
without (p<0.001). Among those without contraindications at discharge
(n=141), the independent factor associated with inpatient prescription was
lower age, OR 0.96 (0.93-0.99) for each year. There were no statistically
significant differences between the two groups for the combined endpoint
of all-cause death, HF rehospitalisation or unplanned HF visit at 90 days
(p=0.3). Conclusion(s): In-hospital initiation of SGLT-2-i was
associated with significantly higher prescription rates 90 days after
discharge, without differences in death from all causes and
hospitalization or urgent visit for AHF at 90 days. This study reflects
the presence of medical inertia, particularly in older patients. It also
highlights the hospitalization period as an optimal time to start SGLT-2i
and achieve the proven clinical benefits that accumulate rapidly over
weeks, with solid safety and tolerability.

<67>
Accession Number
643015235
Title
Randomized study for the optimal treatment of symptomatic patients with
low gradient severe aortic valve stenosis and preserved left ventricular
ejection fraction (ROTAS 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
Galli E.; Coisne A.; Le Ven F.; Sportouch C.; Lairez O.; Bernard A.; Oger
E.; Le Pabic E.; Donal E.
Institution
(Galli, Donal) Hospital Pontchaillou of Rennes, Cardiology and vascular
disease, Rennes, France
(Coisne) Chru De Lille - Institut Coeur-Poumons, Lille, France
(Le Ven) Hospital Cavale Blanche, Brest, France
(Sportouch) Clinique du Millenaire, Montpellier, France
(Lairez) Toulouse Rangueil University Hospital (CHU), Toulouse, France
(Bernard) University Hospital of Tours, Tours, France
(Oger, Le Pabic) Hospital Pontchaillou of Rennes, Rennes, France
Publisher
Oxford University Press
Abstract
Background: the best management of symptomatic patients with low gradient
(LG) severe aortic stenosis (AS) and preserved left ventricular ejection
fraction (LVEF) has not been established in randomized controlled trials.
The ROTAS trial aimed to assess the superiority of aortic valve
replacement (AVR) versus optimized medical therapy (OMT) in symptomatic
patients with LG severe AS and preserved LVEF. Methods and Results:
Fifty-two patients (age 79+/-7 years; males 46%, mean aortic gradient:
31+/-5 mmHg; aortic surface: 0.8+/-0.1 cm2, LVEF 61+/-8%) were
randomized 1:1 to AVR or OMT. The stroke volume index (SVi, cut-off 35
ml/m2) was considered for randomisation so that the same
percentage of patients with reduced SVi was present in the two groups. The
follow-up lasted 14+/-7 months. An early interruption of the study
occurred in 2021 because of the extremely low inclusion rate during the
COVID-2019 pandemic and the large tendency to already implant TAVI in
patients with severe LG AS with preserved LVEF. In all patients, a
multimodality approach, including dobutamine stress echocardiography
and/or aortic calcium score was applied to confirm AS severity. The
primary end-point (a composite of overall death and heart failure
hospitalisation) occurred in 13 (25%) patients. Patients receiving OMT did
not experience worse survival compared to patients receiving AVR (HR=1.57,
95% CI:0.51-4.83, p=0.4275). Kaplan-Meier curves showed similar event-free
survival (log-rank p=0.4236) among the 2 groups (Figure 1).
 Conclusion(s): In the randomized ROTAS trial, AVR was not associated
with a better prognosis in symptomatic patients with LG severe AS and
preserved LVEF.

<68>
Accession Number
643015226
Title
A novel approach to determine the optimal annual case volume for
cardiovascular interventions in need of centralization.
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
Heuts S.; Kawczynski M.J.; Van Kuijk S.M.J.; Olsthoorn J.R.; Kats S.;
Bidar E.; Maessen J.G.
Institution
(Heuts, Kawczynski, Van Kuijk, Kats, Bidar, Maessen) Maastricht University
Medical Centre (MUMC), Maastricht, Netherlands
(Olsthoorn) Catharina Hospital, Cardiothoracic Surgery, Eindhoven,
Netherlands
Publisher
Oxford University Press
Abstract
Background: There is an incentive to centralize specialized health care,
which particularly applies to high-risk surgical and trans-catheter
cardiovascular procedures. In health care policy, annual hospital case
volume is the main criterion to define expertise and determine
centralization. Purpose(s): We propose a novel methodology to
evaluate the volume-outcome relation for high-risk and infrequent
cardiovascular procedures, by use of a meta-analytical approach, and aim
to determine a specific annual case volume threshold, using surgery for
acute type A aortic dissection (ATAAD) as an example. Method(s): This
study was designed as a systematic review and meta-analysis (PROSPERO;
registration number CRD42022345024). We included studies reporting on (i)
consecutive ATAAD patients, (ii) years of inclusion and (iii) early
mortality. The primary outcome was early mortality in relation to annual
hospital case volume. Secondary outcome was long-term survival. Data were
presented and compared in volume quartiles (Q's, Q1 1-12, Q2 12-17, Q3
17-28, and Q4 28-241 cases/year). Restricted cubic spline analysis was
used to demonstrate the volume-outcome relation. Derived from optimization
statistics, we introduce the concept of the 'elbow-method' to determine
the optimal annual case volume (see Figure 1). For long-term survival,
individual patient data derived from Kaplan-Meier curves were integrated.
For clinical interpretation, numbers needed to treat (NNT) were
calculated. Result(s): 125 studies from 125 unique centers were
included (25 countries, 5 continents, see Figure 1), comprising 33 027
patients. A significant between-quartile difference for early mortality
was observed (10.5% [Q4] vs. 16.8% [Q1], p<0.001, I2=72%), which persisted
after correction for age, sex, and dissection type (p<0.001). Furthermore,
a significant non-linear volume-outcome association was observed as well
(p<0.001, Figure 1). The optimal annual case volume after which results
did not improve any further, was determined at 41 cases/year (95% CI
39-45, relative risk reduction 37.1%, NNT 16.1, compared to 10 cases/year,
Figure 1). Even more pronounced between-quartile survival differences were
observed for long-term survival (43 studies, n=11 704, 10-year survival Q4
69% vs Q1 56%, p<0.001, HR=0.87, 95%CI=0.84-0.90, p<0.001, NNT 6.7, Figure
2). This notable long-term survival difference persisted after correction
for age, sex, and dissection type (Figure 2). Conclusion(s): High
volume centers exhibit superior results in surgery for ATAAD, compared to
lower volume centers. Using a novel approach, the optimal annual hospital
ATAAD case volume threshold was statistically determined at 41 cases/year,
with a high degree of certainty. Despite its acute character, rerouting of
patients and centralization of ATAAD care in high-volume centers may lead
to improved outcomes. This novel method has the potential to be applied to
various other cardiovascular procedures requiring centralization. (Figure
Presented).

<69>
Accession Number
643015128
Title
Meta-analysis of the performances of contemporary risk models in cardiac
surgery for infective endocarditis.
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
Wang T.K.M.; Agrawal A.; Arockiam A.D.; El Dahdah J.; Honnekeri B.;
Shekhar S.; Unai S.; Griffin B.
Institution
(Wang, Agrawal, Arockiam, El Dahdah, Honnekeri, Shekhar, Unai, Griffin)
Cleveland Clinic, Cleveland, United States
Publisher
Oxford University Press
Abstract
Background: Risk scores play important roles in the decision-making for
cardiac surgery, but remain under-studied in the setting of infective
endocarditis (IE) when there is often a high risk of adverse outcomes.
Several IE-specific risk scores have been developed recently, but there is
a paucity of external validation studies. We aimed to pool the performance
of current risk models applied to IE surgery. Method(s): Ovid
Medline, Ovid Embase and Cochrane Library were comprehensively searched
following PRISMA guidelines for eligible studies. Standard meta-analysis
techniques using random effects models were used to pool the
discriminative and calibration performance of risk scores for predicting
operative mortality after IE surgery. Result(s): Amongst 620 studies
and 50 full-text articles screened, 17 studies reporting 12 risk scores
and totaling 6337 patients were included. Amongst traditional risk scores,
EuroSCORE I, EuroSCORE II, and STS IE score had pooled areas under curve
(95%CI) of 0.727 (0.700.754), 0.753 (0.731-0.775), and 0.695 (0.645-0.746)
(Table1). However, EuroSCORE II significantly over-estimated operative
mortality while EuroSCORE I had good calibration with pooled Peto's odds
ratio (95%CI) of 2.47 (1.22-5.01) and 1.00 (0.74-1.36) respectively.
Amongst IE-specific scores, areas under curve (95%CI) was highest for the
ANCLA score 0.838 (0.803-0.873) and lowest for the COSTA score 0.641
(0.573-0.710). Conclusion(s): Most contemporary risk score had
moderate discriminative ability for operative mortality after IE surgery,
with the IE-specific ANCLA score performing the best. However, there is
room for improving the performance of current risk models, along with need
for further external validation studies and calibration assessment,
especially for IE-specific scores.

<70>
Accession Number
643015095
Title
The impact of resting heart rate on adverse outcomes and haemodynamic
progression of 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
Courtney W.; Budgeon C.; Giudicatti L.; Strange G.; Playford D.; Ihdayhid
A.; Schultz C.; Hillis G.S.
Institution
(Courtney) University of Western Australia, School of Medicine, Perth,
Australia
(Budgeon) University of Western Australia, School of Population and Global
Health, Perth, Australia
(Giudicatti, Ihdayhid) Fiona Stanley Hospital, Perth, Australia
(Strange) Royal Prince Alfred Hospital, Sydney, Australia
(Playford) University of Notre Dame, School of Medicine, Fremantle,
Australia
(Schultz, Hillis) Royal Perth Hospital, Perth, Australia
Publisher
Oxford University Press
Abstract
Introduction: A high resting heart rate (RHR) is an established risk
factor for cardiovascular disease, adverse cardiac events, accelerated
calcification in coronary artery disease and carotid stenosis, and
increased aortic valve calcification in patients with and without a
confirmed diagnosis of aortic stenosis (AS). Aortic valve calcification is
the most common precursor to AS and is associated with significantly
faster disease progression. There are few studies exploring the effects of
RHR on the progression of AS, the development of severe stenosis, and the
risk of complications and death. Purpose(s): We hypothesised that an
elevated RHR would be associated with poorer outcomes and more rapid
haemodynamic disease progression in patients with AS and tested this in a
large cohort of patients without severe disease. Method(s): Using the
National Echocardiography Database of Australia (NEDA) we undertook a
retrospective observational study on patients without severe AS, a
bicuspid aortic valve or prior aortic valve replacement. The association
between baseline RHR and time to the composite primary endpoint of severe
AS, aortic valve replacement or cardiovascular death was tested using Cox
proportional hazards regression. In addition, the relationship between
baseline RHR and the components of this composite was investigated.
Subsequently, the relationship between annualised AS progression rate,
defined as change in standard indices of AS severity (maximal jet velocity
[Vmax], mean pressure gradient [MPG], and aortic valve area [AVA]), and
RHR were analysed using general linear models. Result(s): The initial
study cohort comprised 55 585 individuals: 54% male, mean age 63 years and
median baseline RHR 70 bpm. The composite primary endpoint, reached by 7
434 patients, was independently associated with RHR (hazard ratio [per
10bpm increase], 1.04; 95% CI, 1.02-1.05; p < 0.001). RHR was also
independently associated with time to developing severe AS (hazard ratio
[per 10bpm increase], 1.06; 95% CI, 1.01-1.12; p = 0.017) and
cardiovascular death (hazard ratio [per 10bpm increase], 1.04; 95% CI,
1.02-1.06; p < 0.001). The event rate was significantly higher in patients
with a RHR of at least 70 bpm (the median RHR) compared to those with an
RHR less than 70 bpm. In addition, RHR was independently associated with
rate of change of each individual measurement index of AS severity
including Vmax (beta = 0.65 cm/s/year [per 10 bpm increase]; p < 0.001),
MPG (beta = 0.05 mmHg/ year [per 10 bpm increase]; p<0.001), and AVA (beta
= -0.01 cm2/year [per 10 bpm increase]; p < 0.001). Conclusion(s):
RHR is independently associated with adverse clinical outcomes and
haemodynamic progression of AS in patients without severe disease. Future
randomised controlled trials should investigate the effect of lowering RHR
on clinical endpoints and progression of AS.

<71>
Accession Number
643015034
Title
Risk of thromboembolic and bleeding events in patients with atrial
fibrillation after valvular intervention in either aortic or mitral
position.
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
Skogseid E.L.; Batra G.; Westerbergh J.; Held C.; Christersson C.
Institution
(Skogseid, Christersson) Uppsala University, Uppsala, Sweden
(Batra, Held) Uppsala University Hospital, Uppsala Clinical Research
Center, Uppsala, Sweden
(Westerbergh) Uppsala Clinical Research Center, Uppsala, Sweden
Publisher
Oxford University Press
Abstract
Background: The optimal oral anticoagulant treatment (OAC) for patients
with atrial fibrillation (AF) undergoing valvular intervention is
uncertain. Mitral valve prostheses are believed to be more thrombogenic
than the aortic due to lower flow velocity across the valves. The only
randomized controlled trial of AF patients with biological valve
prostheses included only patients receiving mitral valve prostheses (1).
It is unclear if these findings could be extrapolated to patients
receiving aortic valve prostheses. Purpose(s): To describe baseline
characteristics and comorbidities of patients receiving biological valve
prostheses in aortic or mitral valve position and to investigate possible
associations between valve position and the incidence of cardiovascular
(CV) death, ischemic stroke or systemic embolism and major bleeding.
 Method(s): All patients in Sweden undergoing open heart surgery with
aortic or mitral valve replacement with biological prostheses between
2010-2016 with known AF were included. The study cohort was identified in
the SWEDEHEART registry. Information on comorbidities, drug exposure and
occurrence of outcome events was collected from SWEDEHEART and other
national registries. Association between the position of valve prosthesis
(mitral and aortic) and incidence of outcome events was investigated using
Cox regression analysis. Multivariable adjustments were made for
comorbidities. Result(s): In total, 2359 patients with AF underwent
aortic (n=2103) or mitral (n=256) valve replacement. The median age was 75
and 73 years, respectively. Hypertension, diabetes mellitus and previous
TIA were more common in the aortic valve group, whereas heart failure and
previous major bleeding was more frequently observed in the mitral group.
In both groups, about 50% of the patients were not on OAC treatment at
time of discharge from valve intervention, despite that the mean
CHA2DS-VASc score was 3.3 and 3.2, respectively. Mitral valve prostheses
were associated with similar risk of CV death (hazard ratio (HR) 1.09; 95%
confidence interval (CI), 0.77 - 1.56), ischemic stroke and systemic
embolism (HR 1.27; 95% CI, 0.85-1.92) compared to aortic valve prostheses.
In contrast, receiving mitral valve prosthesis was associated with lower
risk of major bleeding compared to aortic prosthesis (HR 0.58; 95% CI 0.38
- 0.88). Conclusion(s): The study indicated similar risk of CV death,
ischemic stroke and systemic embolism among patients with AF undergoing
valve replacement with biological prostheses in either aortic or mitral
position. Mitral valve replacement was associated with lower risk of major
bleeding.

<72>
Accession Number
643014776
Title
Clinical outcomes in patients receiving oral anticoagulation stratified by
the presence of dose reduction criteria and older age: a subanalysis of
ENVISAGE-TAVI AF.
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
Van Mieghem N.; Chen C.; Hengstenberg C.; Jin J.; Kimura T.; Lang I.;
Mehran R.; Nicolas J.; Unverdorben M.; Zamorano J.; Dangas G.
Institution
(Van Mieghem) Erasmus University Medical Centre, Rotterdam, Netherlands
(Chen, Jin, Unverdorben) Daiichi Sankyo, Basking Ridge, United States
(Hengstenberg, Lang) General hospital vienna, Division of Cardiology,
Vienna, Austria
(Kimura) Daiichi Sankyo, Tokyo, Japan
(Mehran, Dangas) Mount Sinai Hospital, New York, United States
(Nicolas) Icahn School of Medicine at Mount Sinai, New York, United States
(Zamorano) University Hospital Ramon y Cajal, Madrid, Spain
Publisher
Oxford University Press
Abstract
Background/Introduction: In the ENVISAGE-TAVI AF (Edoxaban vs Standard of
Care and Their Effects on Clinical Outcomes in Patients Having Undergone
Transcatheter Aortic Valve Implantation-Atrial Fibrillation) trial,
edoxaban (EDX) was noninferior to vitamin K antagonists (VKAs) for
preventing most adverse clinical events but was associated with increased
major bleeding (MB). Presence of EDX dose reduction criteria applied in
the trial (DRC; body weight <=60 kg, CrCL 15-50 mL/min, concomitant use of
selected P-glycoprotein-inhibitors) indicates a more vulnerable patient
phenotype. Purpose(s): Compare clinical outcomes after TAVI for AF
patients with and without DRC stratified by anticoagulation strategy and
age. Method(s): ENVISAGE-TAVI AF (NCT02943785) was a multicentre,
open-label, randomised, controlled trial comparing EDX vs VKA in patients
with AF as the indication for oral anticoagulation (OAC) after successful
TAVI. In this analysis, outcomes which included net adverse clinical
events (NACE; composite all-cause death, myocardial infarction, ischaemic
stroke, systemic thromboembolic event, valve thrombosis, or MB),
intracranial haemorrhage, ischaemic stroke, all-cause death,
cardiovascular (CV) death, non-CV death, MB bleeding, fatal MB bleeding,
and major gastrointestinal bleeding (MGIB) were compared in patients with
vs without DRC, further stratified by OAC use, and age (< or >=80 years
[y]). Result(s): Patients meeting DRC (n=637) were older, more often
female, and had lower baseline CrCL than those without (n=740). In
addition, these patients had significantly higher rates of NACE (P=0.0375)
and all-cause death (P=0.0136). There were no differences in MB or MGIB
rates between patients with vs without DRC. EDX resulted in more MB
(hazard ratio [95% CI], 1.6 [1.1-2.5] and MGIB (2.6 [1.2-5.8]) than VKA
only in patients without DRC. In patients aged <80 y meeting DRC, rates of
all-cause death (P=0.0366) and CV death (P=0.0042) were significantly
higher than those without DRC. Among patients aged <80 y, there were no
differences in rates of clinical outcomes between EDX and VKA regardless
of the presence or absence of DRC; Figure 1). In patients aged >=80 y,
there were no differences in rates of all-cause death, MB, or MGIB in
those with or without DRC; Figure 2). Additionally in this age group,
there was no difference in MB between patients on EDX and VKA both with
and without DRC. However, there was more MGIB with EDX when there were no
DRC. In patients aged >=80 y with DRC, all-cause death was lower with EDX.
 Conclusion(s): In this subanalysis of ENVISAGE-TAVI AF, the presence
of DRC indicates a more vulnerable patient phenotype at higher risk for
all-cause death after TAVI and in whom a lower EDX dose may have
substantial benefits in terms of outcomes, including bleeding events,
particularly in patients >=80 y.

<73>
Accession Number
643014562
Title
Patient-reported functional and symptomatic outcomes in patients with mild
cognitive disorder undergoing transcatheter aortic valve implantation - A
secondary analysis of a randomized 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
Thevathasan T.; Hornig C.; Leistner D.M.; Suendermann S.; Unbehaun A.;
Sherif M.; Haghikia A.; Stangl K.; Falk V.; Landmesser U.; Dreger H.;
Stangl V.; Brand A.
Institution
(Thevathasan, Hornig, Unbehaun, Sherif, Haghikia, Stangl, Landmesser,
Dreger, Stangl, Brand) Charite - Universitatsmedizin Berlin, Department of
Cardiology,Angiology and Intensive Care Medicine, Berlin, Germany
(Leistner) University Hospital Frankfurt, Medizinische Klinik 3 -
Kardiologie und Angiologie, Frankfurt, Germany
(Suendermann, Falk) Charite - Universitatsmedizin Berlin, Department of
Cardiothoracic Surgery, Berlin, Germany
Publisher
Oxford University Press
Abstract
Background: The impact of pre-existing mild cognitive disorder (MCD) on
patient-reported outcome measures (PROMs) after transcatheter aortic valve
implantation (TAVI) remains unclear. Purpose(s): To investigate
functional and symptomatic outcomes after TAVI in patients with or without
MCD at two German tertiary care centers as part of a randomised controlled
trial (TAVI-COMIC study). Method(s): Adult patients undergoing
elective TAVI were enrolled. MCD was defined by the Montreal Cognitive
Assessment (MoCA) <26 points. PROMs were assessed at 90 days after TAVI.
 Result(s): Of 199 patients, 109 (54.8%) showed MCD. Female patients
had significantly more often MCD (49.5% vs. 34.4%, p=0.046). Prior to
TAVI, 21.6% reported dyspnea (NYHA class III-IV), 35.1% angina (CCS class
II-IV), 41.2% dizziness and 12.6% syncope. Both patient groups reported
similar improvements in general health status after TAVI: 'marginally or
significantly better' health status in 73.5% with MCD vs. 68.9% without
MCD (p=n.s.). In multivariable logistic regression models, the number of
patients reporting a 'good, very good or excellent' general health status
after TAVI was similar in both patient groups (p=n.s.) (Table). Similarly,
post-TAVI symptoms of dyspnea, angina, dizziness or syncope were similar
between both groups (each p=n.s.). Procuration and walking ability without
difficulties as well as functional independence were 54% [95% Confidence
Interval (CI) 0.23-0.92] (p=0.028), 55% [95% CI 0.22-0.89] (p=0.023) and
52% [95% CI 0.24-0.94] (p=0.035) less frequently reported by patients with
MCD compared to patients without MCD, respectively. Of note, delirium was
more frequently observed in patients with MCD within 3 days after TAVI
(8.3% vs. 1.1%, p=0.049). Conclusion(s): TAVI appeared to result in
similar improvements in general health status and symptomatic PROMs in
patients with and without MCD. Though, patients with MCD reported impaired
functional PROMs after TAVI. More careful post-procedural care should be
taken for patients with MCD to enhance functional independence in this
vulnerable patient group.

<74>
Accession Number
643014385
Title
Ten-year mortality after percutaneous coronary intervention, off-pump and
on-pump surgery for complex coronary artery disease - who is the winner?.
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
Kageyama S.; Serruys P.W.; Ninomiya K.; Colombo A.; Van Genus R.J.;
Milojevic M.; Mack M.J.; Soo A.; Onuma Y.; Davierwala P.
Institution
(Kageyama, Serruys, Ninomiya, Onuma) National University of Ireland,
Galway, Ireland
(Colombo) Clinical Institute Humanitas IRCCS, Rozzano, Italy
(Van Genus) Radboud University Medical Centre, Nijmegen, Netherlands
(Milojevic) Erasmus University Medical Centre, Cardiothoracic Surgery,
Rotterdam, Netherlands
(Mack) Baylor University Medical Center, Cardiothoracic Surgery, Dallas,
United States
(Soo) Galway University Hospital, Galway, Ireland
(Davierwala) Peter Munk Cardiac Centre, Toronto, Canada
Publisher
Oxford University Press
Abstract
Aim: The very long-term mortality of off-pump and on-pump CABG versus PCI
in a randomized complex coronary artery disease (CAD) population is
unknown. This study aims to investigate the impact of on-pump and off-pump
coronary artery bypass grafting (CABG) versus percutaneous coronary
intervention (PCI) on 10-year all-cause mortality. Methods and
Results: The SYNTAXES trial randomized 1800 patients with three-vessel
and/or left main CAD to PCI or CABG and assessed their survival at 10
years. In this sub-study, the hazard of mortality over 10 years was
compared according to the technique of revascularization: on-pump CABG
(n=725), off-pump CABG (n=128), and PCI (n=903). There was substantial
inter-site variation in the use of off-pump CABG despite baseline
characteristics being largely homogeneous amongst the three groups. The
crude rate of mortality was significantly lower following on-pump CABG
versus PCI (25.6% vs 28.4%, Hazard Ratio [HR] 0.79, 95% Confidence
Interval [CI] 0.65-0.96), whilst it was comparable between off-pump CABG
and PCI (28.5% vs 28.4%, HR 0.98, 95%CI 0.69-1.40). After adjusting for
the nine variables included in the SYNTAX score II 2020, 10-year mortality
remained significantly lower with on-pump CABG than PCI (HR 0.75 against
PCI, p=0.009) (central figure). Conclusion(s): In the SYNTAXES trial,
10-year mortality adjusted for major confounders was significantly lower
following on-pump CABG compared to PCI, whilst off-pump CABG offered no
prognostic survival benefit over PCI. Site heterogeneity in the technique
used in bypass surgery has had measurable effects on treatment
performance. Given its impact on outcomes, it should be pre-stratified in
future studies. (Table Presented).

<75>
Accession Number
643014351
Title
Predictors of permanent pacemaker implantation after transcatheter aortic
valve implantation - Results from the SOLVE-TAVI 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
Feistritzer H.; Stachel G.; Kurz T.; Eitel I.; Marquetand C.H.;
Abdel-Wahab M.; Desch S.; Thiele H.
Institution
(Feistritzer, Abdel-Wahab, Desch, Thiele) Heart Center Leipzig, University
of Leipzig, Leipzig, Germany
(Stachel) Leipzig University Hospital, Klinik and Poliklinik fur
Kardiologie, Leipzig, Germany
(Kurz, Eitel, Marquetand) Medical University, Department of
Cardiology,Angiology and Intensive Care Medicine, University Heart Centre
Lubeck, Lubeck, Germany
Publisher
Oxford University Press
Abstract
Background: Permanent pacemaker implantation (PPI) is frequently required
following transcatheter aortic valve implantation (TAVI). However, the
predisposing parameters increasing the likelihood of severe conduction
abnormalities are still not fully understood. Purpose(s): To analyze
predictors of PPI 30 days after TAVI. Method(s): The SOLVE-TAVI trial
randomized 447 patients to TAVI using either the balloon-expandable
Edwards Sapien 3 valve or the self-expanding Medtronic Evolut R valve.
Pacemaker rates at 30 days were relatively high, but comparable between
both transcatheter heart valve (THV) types (19% vs. 23%). Computed
tomography (CT) scans were analyzed semi-automatically to determine aortic
annulus size and subannular calcification. The percentage of THV
oversizing was calculated using the formula (nominal THV
circumference/annular circumference - 1) x 100). Result(s): From all
patients treated with either the Sapien 3 or Evolut R valve, 47 patients
were excluded because of prior pacemaker implantation. Rates of new PPI at
30 days were similar in patients with and without pre-existing left bundle
branch block (7/36 patients vs. 53/342 patients, p=0.48) and right bundle
branch block (11/51 patients vs. 48/327 patients, p=0.22), without
significant differences according to valve type. Patients with new PPI
showed a significantly higher degree of THV oversizing compared to
patients without PPI (median 15%, interquartile range [IQR] 9-20% vs.
median 12%, IQR 7-17%; p=0.03). Moderate/severe compared to no/mild
subannular calcification did not result in higher PPI rates (17/121
patients vs. 40/245 patients; p=65). Conclusion(s): THV oversizing
but not pre-existing left and right bundle branch block and subannular
calcification is associated with PPI after TAVI.

<76>
Accession Number
643014257
Title
Aortic valve reconstruction in nonelderly adults: a systematic review,
meta-analysis and microsimulation study.
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
Notenboom M.; Rhellab R.; Veen K.M.; Etnel J.R.G.; Taverne Y.H.J.H.; Van
De Woestijne P.C.; Roos-Hesselink J.W.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Notenboom, Rhellab, Veen, Etnel, Taverne, Van De Woestijne,
Roos-Hesselink, Bogers, Takkenberg) Erasmus University Medical Centre,
Rotterdam, Netherlands
Publisher
Oxford University Press
Abstract
Background: Aortic valve disease (AVD) calls for careful planning of
treatment strategies that adheres to a patient-tailored lifetime
perspective, especially in younger patients. Aortic valve reconstruction
(AVr) provides an attractive option in patients with aortic valve
regurgitation (AR). Purpose(s): This study aims to provide a
comprehensive overview of published outcome after AVr in nonelderly adults
and to use microsimulation to obtain age-specific estimates of outcomes.
 Method(s): A systematic review of published literature reporting
clinical outcome after AVr in nonelderly adults (mean age >=18y and <=55y)
published between 1/1/1990 and 17/10/2022 was conducted. Publications
reporting outcome after AVr were considered for inclusion, including
publications on valve-sparing root surgery. Studies that included patients
without AVD as the primary indication for AVr were excluded. Early risks
(<30d), late event rates (>30d) and time-to-event data were pooled and
entered into a microsimulation model. Subgroup analyses were performed for
AVr for isolated AR and AVr for bicuspid aortic valves (BAV).
 Result(s): Thirty-seven studies, all retrospective cohort studies,
were included, yielding a total of 4,573 patients with 16,524
patient-years of follow-up (median follow-up: 4.0y; range 0.6-10.5y).
Pooled mean age for all repairs, AVr for AR and AVr for BAV was
48.1+/-13.8, 48.3+/-13.8, and 42.4+/-12.5 years, respectively. Pooled
early mortality for all repairs, AVr for AR and AVr for BAV, respectively,
was 1.7% (95%CI: 1.2-2.3%), 1.5% (1.0-2.1%), and 1.0% (0.6-1.9%), and late
pooled mortality rate was 1.0%/y (0.7-1.5%/y), 1.3%/y (0.8-2.1%/y), and
0.8%/y (0.5-1.4%/y), respectively. Microsimulation-based life-expectancy
relative to the general population 20 years postoperatively was 92.6% (95%
Credible Interval: 90.1-95.3%) after all repairs, 89.0% (85.0-93.0%) after
AVr for isolated AR and 94.9% (92.0-97.4%) after AVr for BAV.
Microsimulation-based 20-year risk of aortic valve reintervention for all
repairs, isolated AR and BAV, respectively, was 25.0%(23.8-26.2%),
25.1%(23.5-26.9%) and 49.9%(48.2-52.0%). The main cause for reintervention
was repaired valve dysfunction for all three groups, followed by
endocarditis. Estimates of other late complications are shown in Figure 2.
 Conclusion(s): Aortic valve reconstruction for aortic valve
regurgitation effectively postpones valve replacement in nonelderly with
satisfactory long-term outcomes but reintervention risks are still
considerable, especially in BAV patients. Reconstructive valve surgery is
associated with low risks of bleeding and thrombo-embolic events and
should be considered in nonelderly adults with aortic regurgitation and
carefully weighed against hazards of primary aortic valve replacement.
(Table Presented).

<77>
Accession Number
643014226
Title
Dapaglifozin in adults with a systemic right ventricle:initial results
from the DAPA-SERVE 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
Abbate M.; Fusco F.; Scognamiglio G.; Merola A.; Palma M.; Grimaldi N.;
Barracano R.; Borrelli N.; Ppaccioli G.; Sorice D.; Roma A.S.; Colonna D.;
Correra A.; Romeo E.; Sarubbi B.
Institution
(Abbate, Fusco, Scognamiglio, Merola, Palma, Grimaldi, Barracano,
Borrelli, Ppaccioli, Sorice, Roma, Colonna, Correra, Romeo, Sarubbi)
Monaldi Hospital, Naples, Italy
Publisher
Oxford University Press
Abstract
Background: Sodium-glucose Cotransporter-2(SGLT2) inhibitors are currently
recommended as first line therapy for all patients with heart failure with
reduced ejection fraction (HFrEF).Adults with a systemic right ventricle
(sRV) may develop progressive systolic dysfunction during follow-up.
Optimal medical therapy for HFrEF remains still to be determined in this
complex population. Purpose(s): We aimed to assess safety and
evaluate potential clinical benefit of dapagliflozin in patients with a
sRV compared to standard medical treatment for HF. Method(s):
Inclusion criteria were:age >= 18 years; transposition of the great
arteries (TGA) following Senning/Mustard repair or congenitally corrected
TGA, sRV EF <= 40%, already on optimized medical therapy including
sacubitril/valsartan for at least 3 months. Exclusion criteria were:
systolic blood pressure (SBP) <90 mmHg, glomerular filtration rate
(GFR)<30ml/min and univentricular physiology. All eligible patients
attending our tertiary center for adult congenital heart disease were
randomly assigned to the treatment or control group. Patients in the
treatment arm were prescribed 10 mg dapagliflozin o.d. on top of their
medical therapy, while control group continued standard therapy. Patients
were scheduled for a structured follow-up including clinical evaluation,
blood test, echocardiography, and 6 minute-walking at 6 months from study
inclusion for both groups. Result(s): Fifty patients (41+/-11 years,
54% male, 64% TGA) met the inclusion criteria: 25(50%) were started on 10
mg dapagliflozin. There was no significant difference in terms of age
(p=0.4), sex(p=0.1), anatomy(p=0.2) and baseline sRV EF (p=0.2). Up to
February 2023, 14 patients in the treatment group and 13 controls
completed the 6-month follow-up. Clinical and echocardiographic findings
at baseline and at 6-month in the treatment group are summarized in
Table1: dapagliflozin was well tolerated and no major adverse events were
reported. Treatment did not impact on the systolic blood pressure and
renal function. However a significant improvement in the sRV freewall
global longitudinal strain(GLS) was found (-15.8+/-3 Vs -18.3+/-3;
p=0.03). Differences in main echocardiographic indices of sRV systolic
function between baseline and follow-up in the two arms are shown in
Table2: treatment resulted in significant positive changes of sRV FAC,
GLS, and free wall GLS compared to the group on standard therapy.
 Conclusion(s): Initial results from the ongoing single-centre
DAPA-SERVE trial provided reassuring data on the safety profile of
dapagliflozin in patients with a sRV. Furthermore, significant improvement
of echocardiographic indices of sRV function in patients on dapagliflozin
compared to those on standard medical therapy was demonstrated at 6-month.
Longer follow-up is warranted to determine the clinical impact of those
positive changes and to shed light on the potential benefit of SGLT2
inhibitors use on top of standard therapy in this complex population.

<78>
Accession Number
643014199
Title
The efficacy and safety of novel oral anticoagulants versus vitamin k
antagonist in transcatheter aortic valve replacement patients with
indications for anticoagulation.
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
Abella J.; Vestal M.
Institution
(Abella, Vestal) Perpetual Succour Hospital, Cebu City, Philippines
Publisher
Oxford University Press
Abstract
Introduction: Thrombotic events from atrial fibrillation, clinical and
subclinical leaflet thromboses continue to be a major concern in
Transcatheter Aortic Valve Replacement (TAVR) patients despite
technological advancement and operator expertise. The proportion of TAVR
patients who have or eventually develop indications for anticoagulation is
not negligible and thus may warrant oral anticoagulants. However, the
choice of anticoagulation is this select patients remained debatable.
Thus, this study was conducted to determine whether current collective
data support the efficacy and safety of novel oral anticoagulants (NOACS)
versus vitamin K antagonists (VKAs). Purpose(s): Oral anticoagulation
(OAC) is necessary but the patients who needed it the most have baseline
high bleeding risks. Anticoagulation carries a high bleeding risk
especially among majority of a typical post TAVR patients with indications
for anticoagulation. The paucity of data among asian TAVR patients were
propensity to bleed are prevailing issues with anticoagulation owing
perhaps to genetic or race predisposition and lower body weights or BMI
compared to non-Asian counterparts. Currently the high court is still out
to settle the optimum choice of anti-thrombotic therapy after TAVR. With
TAVR now being performed in our local setting, we find this a relevant
issue, hence we conducted a meta-analysis. Method(s): A literature
search from Pubmed, Embase, and Cochrane databases for relevant RCTs and
observational studies published until February 2022 were conducted. The
pooled estimates of all-cause mortality, stroke and major bleeding events
were measured using RevMan version 5.4.1 software. Result(s): Eleven
eligible studies (9 observational studies and 2 RCTs) allocated 29,156
TAVR patients with indications for anticoagulation either to receive NOACS
(n = 11,718) or VKAs (n = 17,468). The effect estimate using random
effects model showed no significant differences in all-cause mortality (RR
0.79, 95% CI 0.42-2.25, p = 0.07), stroke (RR 0.96, 95% CI 0.54-2.79, p =
0.70), and major bleeding events (RR 0.82, 95% CI 0.48-1.44, p = 0.08)
between the NOACs and VKAs treatment arms. Conclusion(s): NOACs
demonstrated non-inferiority over VKA in reducing all-cause mortality,
stroke and major or life-threatening bleeding events in TAVR patients with
indications for anticoagulation.

<79>
Accession Number
643014135
Title
Efficacy of aortic valve replacement on Heyde syndrome-related acquired
von Willebrand syndrome and gastrointestinal bleeding: 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
Rooijakkers M.J.P.; Goltstein L.C.M.J.; Hoeks M.; Li W.W.L.; Van Wely
M.H.; Rodwell L.; Van Royen N.; Drenth J.P.H.; Van Geenen E.M.
Institution
(Rooijakkers, Goltstein, Hoeks, Li, Van Wely, Rodwell, Van Royen, Drenth,
Van Geenen) Radboud University Medical Centre, Nijmegen, Netherlands
Publisher
Oxford University Press
Abstract
Background: Heyde syndrome is the co-occurrence of aortic stenosis,
acquired von Willebrand syndrome, and gastrointestinal bleeding. Aortic
valve replacement has been shown to resolve all three associated
disorders. Purpose(s): To assess the efficacy of aortic valve
replacement (both surgical aortic valve replacement and transcatheter
aortic valve implantation) on acquired von Willebrand syndrome recovery
and gastrointestinal bleeding cessation. Method(s): A systematic
review and meta-analysis using MEDLINE, Embase, and the Cochrane Library
was performed to identify articles on Heyde syndrome and aortic valve
replacement. Primary outcomes were the proportion of patients with
recovery of acquired von Willebrand syndrome within 24 hours (T1), 24 to
72 hours (T2), 3 to 21 days (T3), and 4 weeks to 2 years (T4) after aortic
valve replacement, and the proportion of patients with cessation of
gastrointestinal bleeding. Pooled proportions and risk ratios (RR) were
calculated using random-effects models. Result(s): We identified 33
studies (32 observational studies and one randomized controlled trial) on
acquired von Willebrand syndrome (n = 1,054), and 11 observational studies
on gastrointestinal bleeding (n = 300). One study reported on both
associated disorders (n = 6). The pooled proportion of Heyde patients with
acquired von Willebrand syndrome recovery was 86% (95% CI, 79-91%) at T1,
90% (74-96%) at T2, 92% (84-96%) at T3, and 87% (67-96%) at T4. The pooled
proportion of Heyde patients with cessation of gastrointestinal bleeding
was 73% (62-81%). Residual aortic valve disease was associated with lower
recovery rates of both acquired von Willebrand syndrome (RR 0.20;
0.05-0.72; p = 0.014) and gastrointestinal bleeding (RR 0.57; 0.40-0.81; p
= 0.002). Conclusion(s): Aortic valve replacement is associated with
a rapid recovery of the bleeding diathesis in Heyde syndrome and cessation
of gastrointestinal bleeding. Residual aortic valve disease negatively
impacts clinical benefits of aortic valve replacement.

<80>
Accession Number
643014126
Title
A systematic review of the evidence supporting the use of surgical aortic
and mitral valves: an update from the CORE MD consortium.
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
Mcgovern L.; Coughlan J.J.; Siontis G.; Frenk A.; Melvin T.; Mcgauran G.;
Geertsma R.; Schnell-Inderst P.; Fraser A.G.; Windecker S.; Byrne R.A.
Institution
(Mcgovern) Cardiovascular Research Institute (CVRI), Royal College of
Surgeons in Ireland (RCSI), Dublin, Ireland
(Coughlan) Cardiovascular Research Institute (CVRI)/Mater Private, Dublin,
Ireland
(Siontis, Frenk, Windecker) Bern University Hospital, Bern, Switzerland
(Melvin) Trinity College Dublin, Dublin, Ireland
(Mcgauran) Health Products Regulatory Authority (HPRA), Dublin, Ireland
(Geertsma) RIVM: National Institute for Public Health and the Environment,
Utrecht, Netherlands
(Schnell-Inderst) UMIT TIROL, Tirol, Austria
(Fraser) University Hospital for Wales, Cardiff, United Kingdom
(Byrne) Cardiovascular Research Institute (CVRI), Royal College of
Surgeons in Ireland (RCSI)/Mater Private, Dublin, Ireland
Publisher
Oxford University Press
Abstract
Introduction: The European Union (EU) Medical Device Regulation (MDR)
2017/745 challenges the medical community to engage with regulators,
notified bodies and industry to develop transparent, rigorous and
proportionate methods to evaluate the clinical safety and efficacy of
medical devices and to monitor their performance. As part of the EU
Horizon 2020 funded CORE-MD project, we performed a systematic review of
the published scientific evidence available for surgical heart valve
replacements for native aortic and mitral valve pathologies.
 Purpose(s): The aim of this analysis is to review the scientific
evidence available which supports the use of currently available surgical
aortic and mitral valves. Method(s): A systematic literature review
was conducted using Ovid, MEDLINE, Embase, and the Cochrane Central
Register of Controlled Trials (CENTRAL). We included only surgical aortic
and mitral valves that received CE Mark approval from the year 2000
onwards. We included any study of prospective design (randomised or
non-randomised clinical trials of any design) in humans, published between
2000 and 2021. We excluded retrospective studies, case reports, reviews,
systematic reviews, meta-analyses, and expert opinion documents. Title and
abstract screening, full-text review, risk of bias evaluation and data
collection were performed by two authors independently, with disagreements
resolved by discussion with a third author. Result(s): A total of 17
surgical aortic valves and 4 surgical mitral valves were identified based
on the CE mark criterion (Figure 1). The initial literature search
identified 4901 and 3696 potentially eligible papers in the aortic and
mitral valve categories, respectively. Finally, 39 aortic and 3 mitral
valve studies were included (Figure 2). The majority of included studies
(90%) had a non-randomised, prospective, observational design, with 68%
receiving industry funding. The median number of patients included was 295
[interquartile range (IQR): 153, 689] with a median maximum follow up of
24 months [IQR: 12, 60]. Only 50% of the identified studies had a
pre-specified registered study protocol and only 5% included a power
calculation to estimate the required study size. No study reported patient
involvement in the study design and only 15% of studies had a comparator
group. Using the ROBINS I AND II assessment tools, 90% of the included
studies were classified as having a high or serious risk of bias.
 Conclusion(s): The evidence available for currently used surgical
aortic and mitral replacement heart valves is largely from small, industry
funded, non-randomised controlled trials. The median duration of maximum
follow up was only 24 months, the majority of studies were classed as
having a high/serious risk of bias and only half had a pre-registered
study protocol. These results highlight the limitations of the available
scientific evidence supporting the surgical aortic and mitral valves used
in current clinical practice. (Table Presented).

<81>
Accession Number
643013987
Title
The effectiveness of virtual reality on cardiac procedure related anxiety:
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
Bashir Z.; Misquith C.; Has P.; Bukhari S.
Institution
(Bashir, Misquith) Brown University, Providence, United States
(Has) Rhode Island Hospital, Lifespan Biostatistics,Epidemiology and
Research Design, Providence, United States
(Bukhari) Temple University Hospital, Philadelphia, United States
Publisher
Oxford University Press
Abstract
Introduction: Cardiac procedures are associated with anxiety which can
lead to worse outcomes1 2. However, virtual reality (VR) may offer an
innovative approach of a more informative experience enhancing procedural
understanding and reducing procedure-related anxiety. Previous studies
have shown benefits of VR related therapies in improving anxiety related
to cardiac rehabilitation and different surgical procedures3 4.
 Purpose(s): To evaluate the effectiveness of VR in improving cardiac
procedure related anxiety compared to standard of care in patients
undergoing any type of cardiac procedure. PROSPERO ID CRD 42023395395
Methods: A comprehensive search strategy was used to search the online
databases (MEDLINE, EMBASE, CINAHL, Web of Sciences, and COCHRANE) for
randomized controlled trials (RCTs) on VR, cardiac procedures, and
anxiety. Risk of bias was analyzed using revised Cochrane risk of bias
tool for RCTs5. Effect estimate was reported as standardized mean
difference (SMD) with a 95% confidence interval. Random effect model was
used to generate effect estimate if heterogeneity was significant
(I2>60%), otherwise fixed effect model was used. Sensitivity analysis was
performed based on the type of anxiety questionnaire used and p-value of
<0.05 was taken as statistically significant. Statistical analysis was
conducted using Stata SE version 17.0 (College Station, TX, USA) and
RevMan5. Result(s): A total of 171 study participants were part of
four studies included in the meta-analysis. Three studies were part of
narrative synthesis. Mean age was between 44+/-11 years and 83+/-6.4
years. VR group did not show significant improvement in anxiety compared
to standard of care (SMD 0.11, 95% CI -0.90, 1.11). However, significant
improvement in anxiety was seen in VR group on sensitivity analysis after
including studies that utilized validated anxiety assessment State-Trait
Anxiety Inventory (STAI) questionnaire6 only ( (SMD -0.39, 95% CI -0.74,
-0.05). Egger's regression test did not identify any significant
publication bias (p=0.64). Conclusion(s): Our findings suggest that
VR significantly improves anxiety related to cardiac procedures when
assessed using validated anxiety questionnaire. Two out of three studies
included in the narrative synthesis also showed improvement in anxiety
levels, despite using non-standardized questionnaires. However, further
studies are needed to investigate the effectiveness of novel VR technology
in reducing cardiac procedure-related anxiety while comparing the use of
standardized and non-standardized anxiety assessment tools. (Figure
Presented).

<82>
Accession Number
643013920
Title
Protecting the vulnerable during a crisis - TAVR during the COVID-19
pandemic.
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
Zaka A.; Mridha N.; Abtahi J.; Anderson S.; Murdoch D.
Institution
(Zaka, Abtahi, Anderson) Gold Coast Hospital And Health Service, Gold
Coast, Australia
(Mridha) University Of Queensland, Brisbane, Australia
(Murdoch) Prince Charles Hospital, Brisbane, Australia
Publisher
Oxford University Press
Abstract
Introduction: The coronavirus (COVID-19) pandemic has been challenging for
healthcare systems globally. Patients with symptomatic severe aortic
stenosis awaiting transcatheter aortic valve replacement (TAVR) are a
vulnerable, elderly subset of patients often with multiple comorbidities.
Untreated severe aortic stenosis (AS) is associated with a poor prognosis.
It is uncertain if population-based strategies to mitigate COVID-19 spread
such as delaying elective procedures and virtual consultations have
resulted in increased morbidity or mortality in this subset of patients.
Position statements guiding TAVR during the COVID-19 pandemic have
suggested fewer and shorter hospital admissions. We evaluated the
available literature and performed a systematic review and meta-analysis
assessing the impact of the COVID-19 pandemic on referral times, hospital
stays and mortality in patients awaiting TAVR. Method(s): This
systematic review and meta-analysis (CRD42022379840) is reported according
to PRISMA guidelines. A comprehensive search strategy with computer- based
search was performed using PubMed, Ovid MEDLINE, EMBASE and Cochrane
databases. No time limit to start date was applied, and the search was
conducted up to 28 November 2022. Only studies with available comparative
data to pre-COVID 19 cohorts were included. Result(s): Eleven studies
satisfied our inclusion criteria, with a pooled analysis of 79785 TAVR
patients. Patients undergoing TAVR in the COVID-19 era were associated
with a modest risk of all-cause mortality (unadjusted RR: 1.41, 95% CI
0.97-2.06) however this was not statistically significant (Figure 1) and
substantial heterogeneity was observed (p<0.01 and i2 = 84%). Patients
undergoing TAVR in the COVID-19 cohort trended towards shorter average
lengths of stay and time from referral to procedure than TAVR patients
prior to the pandemic (mean difference -0.37, 95% CI -0.93 - 0.19 and mean
difference -25.43, 95% CI -52.31 to 1.44 respectively), however this was
not significant. Conclusion(s): This systematic review suggested a
trend towards increased all-cause mortality in TAVR patients in the
COVID-19 era. Furthermore, the available data trended towards shorter
times from referral to TAVR and a shorter average length of stay,
consistent with published recommendations from European and Asian expert
consensus papers. Our data did not reach statistical significance and
showed significant heterogeneity, likely reflecting widespread
institutional variations during the pandemic. As the COVID-19 dynamic
changes, further data is required to help characterise and optimise
patient care in this vulnerable patient group.

<83>
Accession Number
643013513
Title
Perioperative aspirin and coronary artery bypass graft surgery: a
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
Zaka A.; Gupta A.; Lombardo A.; Kovoor J.; Bacchi S.; Smith J.; Bennetts
J.; Maddern G.
Institution
(Zaka, Lombardo) Gold Coast Hospital And Health Service, Gold Coast,
Australia
(Gupta, Kovoor, Bacchi, Maddern) University of Adelaide, Adelaide,
Australia
(Smith) Monash University, Melbourne, Australia
(Bennetts) Flinders University, Adelaide, Australia
Publisher
Oxford University Press
Abstract
Background: Although consensus guidelines demonstrate clear benefit for
the continuation of aspirin in patients awaiting coronary artery bypass
grafting (CABG) following an acute coronary syndrome where risk of
re-infarction outweighs bleeding risk, the evidence remains unclear in the
case of elective CABG. We performed the largest to date systematic review
and meta-analysis to compare outcomes between CABG patients who stopped
and continued aspirin perioperatively. Method(s): A thorough search
of PubMed, MEDLINE and CENTRAL databases was conducted to 25th July 2022
for randomized control trials that evaluated patients undergoing CABG.
Summary odds ratios were calculated using a random effects model for
dichotomous and continuous variables. Subgroup and sensitivity analyses
were conducted in order to explore sources of heterogeneity.
 Result(s): 16 eligible studies were included with a total of 6188
patients who underwent CABG. Patients who continued Aspirin
perioperatively demonstrated an increased risk of all cause mortality [OR
1.37 (0.81-2.33)] and reduced risk of perioperative myocardial infarction
[OR 0.81 (0.55-1.18)], however neither were statistically significant. No
significant difference was observed between low-dose and higher doses of
Aspirin. There was minimal heterogeneity amongst included studies (i2 =
0%, p=0.97 and i2=33%, p=0.13 respectively). Continuing aspirin produced a
modest increase in postoperative blood loss [mean difference 66.12mL
(-1.45-133.69)], as was a dose greater than 100mg [216.87(-152.99-586.72),
p=0.60], however this was not statistically significant.
 Conclusion(s): Continuing Aspirin before CABG is not associated with
a significantly increased risk of all-cause mortality, of perioperative
myocardial infarction, and of postoperative bleeding. Future trials with
more robust methodology should be aimed at further evaluating this patient
cohort to guide perioperative Aspirin use.

<84>
Accession Number
643013511
Title
Impact of carotid artery stenosis on outcomes of transcatheter aortic
valve replacement: 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
Gibicoski T.B.; Caetano L.; Silva E.P.; Rodriguez F.A.; Scabello I.;
Iplinski B.
Institution
(Gibicoski, Rodriguez) Federal University of Health Sciences of Porto
Alegre, Porto Alegre, Brazil
(Caetano) Federal University of Paraiba, Joao Pessoa, Brazil
(Silva) Santo Amaro Hospital, Recife, Brazil
(Scabello) Joao Pessoa University Center, Joao Pessoa, Brazil
(Iplinski) Santa Casa de Misericordia Hospital, Porto Alegre, Brazil
Publisher
Oxford University Press
Abstract
Background/Introduction: Carotid Artery Stenosis (CAS) is common in
elderly patients undergoing Transcatheter Aortic Valve Replacement (TAVR).
However, the impact of CAS on the outcomes of TAVR is unclear.
 Purpose(s): This systematic review and meta-analysis aimed to compare
the clinical and periprocedural outcomes in patients with and without CAS
undergoing TAVR. Method(s): PubMed, Embase, and Cochrane databases
were searched up to February 2023. We included studies that performed a
direct comparison of outcomes of TAVR in CAS versus non-CAS patients. Data
were extracted from published reports and the ROBINS-I tool was utilised
for quality assessment. Review Manager 5.1 was adopted for statistical
analysis. A random-effects model was used to calculate a pooled effect
size and 95% confidence interval. Result(s): Five observational
studies and 111,915 patients were included. Follow-up ranged from 30 days
to 1 year. The mean age was 80.7 +/- 8.2 years and 46.3% were female. The
risk of stroke or transient ischaemic attack was elevated in the group of
patients with CAS (OR 1.44; 95% CI 1.05-1.99; p=0.02; Figure 1A).
Similarly, there was an increased risk of myocardial infarction in the CAS
group (OR 1.25; 95% CI 1.06-1.47; p= 0.008; Figure 1B). In contrast,
all-cause mortality (OR 0.99; 95% CI 0.71-1.37; p=0.94; Figure 2A) and
major bleeding (OR 1.14; 95% CI 0.98-1.32; p=0.08; Figure 2B) were not
significantly different between CAS and non-CAS groups. There was also no
significant difference in acute kidney injury (OR 0.99; 95% CI 0.79-1.23;
p=0.99) and new pacemaker implantation (OR 0.95; 95% CI 0.70-1.30; p=0.76)
between patients with and without CAS. Conclusion(s): Our findings
suggest that CAS is significantly associated with cerebrovascular events
and myocardial infarction in patients who undergo TAVR, without a
significant impact on all-cause mortality. Further prospective studies are
needed for a more granular assessment of additional determinants of this
association, such as unilateral vs. bilateral involvement and whether
there is a threshold of CAS severity for increased risk.

<85>
Accession Number
643013446
Title
The FRAGILE clinical trial: the impact of the coronary artery bypass graft
in frailty.
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
Mejia O.A.V.; Meneghini B.; Freitas F.L.; Hoeflinger L.C.F.; Guerrieri
M.L.J.; Hueb A.C.; Cosentino F.; Segalote R.; Ribas F.F.; Oliveira M.A.P.;
Deininger M.O.; Dallan L.R.; Lisboa L.A.F.; Dallan L.A.O.; Jatene F.B.
Institution
(Mejia, Meneghini, Freitas, Hoeflinger, Dallan, Lisboa, Dallan, Jatene)
Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
(Guerrieri, Hueb, Cosentino, Segalote) Federal University of Minas Gerais,
Belo Horizonte, Brazil
(Ribas, Oliveira) Hospital Beneficencia Portuguesa, Sao Paulo, Brazil
(Deininger) Hospital Unimed - Cardiocenter, Joao Pessoa, Brazil
Publisher
Oxford University Press
Abstract
Background: The exponential increase in the elderly population has been
observed worldwide, and it implies a higher incidence of coronary artery
disease and, consequently the need for coronary artery bypass graft
(CABG). The growing number of elderlies is also related to frailty, a
syndrome that affects at least 10% of the elderly population and is an
exceedingly effective parameter for correlating with the adverse effects
of aging. The impact of frailty concerning mortality and morbidity is well
established however, there are no studies regarding the outcomes of CABG
and its techniques in frail patients. Purpose(s): To evaluate the
impact of coronary artery bypass graft surgery in patient's frailty and
compare the differences in the frailty index after a 6-month follow-up
between the groups off-pump and on-pump. Method(s): This was a
subanalysis of the FRAGILE trial, a brazilian multicenter, randomized,
controlled clinical trial that analyzed 169 patients aged 60 years or
older undergoing coronary artery bypass graft surgery with (on-pump) and
without (off-pump) cardiopulmonary bypass. Using the Fried's Frailty
Criteria, we classifed the patients into frail, pre-frail, and non-frail
and also evaluated the five paramenters of this criteria. The patients
were divided into two groups: the off-pump CABG group (n=87) and the
on-pump CABG group (n=82), and compared unintentional weight loss,
self-reported fatigue, physical activity level, grip strength, and gait
speed before and after surgery, and between groups. The study was approved
by the local Ethics Committee and all patients signed the informed
consent. Result(s): We observed an improvement in the frailty of
patients undergoing CABG. Overall, over 50% of frail patients became
pre-frail after CABG, and only 3% of the total patients were classified as
frail after 6 months of surgery (Fig 1A). No patient was classified as
non-frail preoperatively in both groups because it was one of the
exclusion criteria. There is no difference between the groups off-pump and
on-pump (Fig 1B). The total time of physical activity, the gait speed, and
the self-reported fatigue were positively impacted regardless of surgical
technique. However, grip strength and unintentional weight loss were
improved only in the group that underwent off-pump CABG surgery. Patients
reported practicing an average more time of exercises, improved gait
speed, and claimed to be less fatigated compared to the before-surgery
measurements. However, grip strength and unintentional weight loss were
improved only in the group that underwent off-pump CABG surgery (Table 1).
 Conclusion(s): CABG positively impacts patients' frailty after six
months of surgery. Both techniques, on-pump and off-pump, showed positive
results when comparing frailty features before and after CABG surgery.
Nevertheless, the off-pump CABG was the only technique that played a role
in improving grip strength and unintentional weight loss of patients after
6 months of surgery. (Table Presented).

<86>
Accession Number
643013389
Title
Repetitive LevosimenDan infusions fOR patients with advanced chronic heart
failure in the vulnerable post-discharge period: the multinational
randomized LeoDOR 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
Polzl G.; Altenberger J.; Comin-Colet J.; Delgado J.; Fedele F.;
Garcia-Gonzales M.J.; Gustafsson F.; Masip J.; Papp Z.; Stoerk S.; Ulmer
H.; Vrtovec B.; Wikstrom G.; Zima E.; Bauer A.
Institution
(Polzl) Innsbruck Medical University, Innsbruck, Austria
(Altenberger) Centre for Cardiac Rehabilitation Grossgmain, Grossgmain,
Austria
(Comin-Colet) University Hospital Bellvitge, Barcelona, Spain
(Delgado) University Hospital 12 de Octubre, Madrid, Spain
(Fedele) Sapienza University of Rome, Rome, Italy
(Garcia-Gonzales) University of La Laguna, Tenerife, Spain
(Gustafsson) Copenhagen University Hospital, Copenhagen, Denmark
(Masip) University of Barcelona, Barcelona, Spain
(Papp, Ulmer) University of Debrecen, Faculty of Medicine, Debrecen,
Hungary
(Stoerk) University Hospital Wurzburg, Wurzburg, Germany
(Vrtovec) University Medical Centre Ljubljana, Ljubljana, Slovenia
(Wikstrom) Uppsala University Hospital, Uppsala, Sweden
(Zima) Semmelweis University Heart and Vascular Center, Budapest, Hungary
(Bauer) Department of Internal Medicine III - Cardiology, Innsbruck,
Austria
Publisher
Oxford University Press
Abstract
Background: Studies of the repetitive use of intravenous levosimendan
suggested a beneficial effect in patients with advanced heart failure
(HF). It was the aim of the LeoDOR trial to test the efficacy and safety
of intermittent levosimendan therapy in the vulnerable phase following a
hospitalization for acute HF. Method(s): In this multicenter,
double-blind, three-armed trial with an enrolment period from 3-2018 to
6-2021, patients with advanced HF were randomized 2:1 at the end of an
index hospitalization for acute HF to intermittent levosimendan therapy or
placebo for a period of 12 weeks. Levosimendan was administered according
to center preference either as 6-hour infusion at a rate of 0.2 mcg/kg/min
every 2 weeks, or as 24-hour infusion at a rate of 0.1 mcg/kg/min every 3
weeks. The primary efficacy assessment after 14 weeks was based on a
global rank endpoint consisting of three hierarchical groups: Tier 1 =
time to death or urgent heart transplantation or implantation of a
ventricular assist device; Tier 2 = time to non-fatal HF requiring i.v.
vasoactive therapy; Tier 3 = time-averaged proportional change in NTproBNP
from baseline to week 14. Result(s): Due to a forced interim
interruption of the study as a result of the COVID-19 pandemic, the
planned number of patients could not be recruited. The final modified
intention-to-treat (mITT) analysis included 145 patients (93 in the
combined levosimendan arm, 52 in the placebo arm). Patient characteristics
were well balanced between treatment and placebo arms (mean age 69.3+/-9.7
vs 67.9+/-10.1, proportion of women 22.6% vs 21.2%, HF-hospitalizations in
previous 12 months 1.9+/-1.4 vs. 1.7+/-1.1, NTproBNP at baseline 4740 ng/L
(IQR 2235 - 9016) vs 5380 ng/L (IQR 2287 - 8204). There were no marked
differences regarding HF medication and implanted devices. Compared with
placebo, intermittent levosimendan had no significant effect on the
primary endpoint (mean rank score 71.8 for the levosimendan group vs 75.1
for the placebo group; p = 0.65). However, there was a strong signal
towards a higher incidence of the individual clinical components of the
primary endpoint (tier 1 plus tier 2) in the levosimendan group vs the
placebo group both after 14 weeks (HR 2.94, 95%CI 1.13-7.70; p = 0.028)
and 26 weeks (HR 1.65 95%CI 0.87 - 3.12; p = 0.123). The number of
investigator-reported adverse events during and immediately after drug
application was 12.4% in the levosimendan group vs 11.8% in the placebo
group (p = 0.905). Conclusion(s): Our findings do not support the use
of intermittent levosimendan to improve post-hospitalization clinical
stability in patients who were recently hospitalized with HF and reduced
LVEF. Further studies are warranted to find the correct use of
levosimendan in advanced heart failure patients.

<87>
Accession Number
643013288
Title
Validation of the developed ASGARD risk score for safe monitoring of
asymptomatic patients with non-severe aortic valve 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
Hadziselimovic E.; Greve A.M.G.; Sajadieh A.S.; Olsen M.H.O.; Kesaniemi
Y.A.K.; Nienaber C.A.N.; Ray S.G.R.; Rosseboe A.B.R.; Wachtell K.W.;
Dominguez H.D.; Koeber N.V.K.; Carstensen H.G.C.; Nielsen O.W.N.
Institution
(Hadziselimovic, Sajadieh, Dominguez, Koeber, Carstensen, Nielsen)
Bispebjerg University Hospital, Copenhagen, Denmark
(Greve) Rigshospitalet - Copenhagen University Hospital, Department of
Clinical Biochemistry 3011, Copenhagen, Denmark
(Olsen) Holbaek Hospital, Department of Internal Medicine 1, Holbaek,
Denmark
(Kesaniemi) University of Oulu, Research Unit of Internal Medicine,
Medical Research Center Oulu, Oulu, Finland
(Nienaber) Imperial College London, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
(Ray) Manchester University Hospitals, Manchester, United Kingdom
(Rosseboe) Oslo University Hospital Ulleval, Department of Cardiology,
Oslo, Norway
(Wachtell) Weill Cornell Medicine, Division of Cardiology, New York,
United States
Publisher
Oxford University Press
Abstract
Background: The recommended standard monitoring of patients with
non-severe aortic valve stenosis (AS) involves echocardiography
surveillance at 1-2 year intervals. Since many of these costly routine
echocardiograms yield no clinical consequences during a prolonged watchful
waiting period, we propose to replace them with a risk stratification
approach. Purpose(s): The primary aim was to validate the ability of
ASGARD risk score to a) identify low-risk AS patients who do not need new
echocardiography for safe monitoring, and b) estimate optimal follow-up
intervals. Method(s): We have developed the ASGARD risk score using
data from 1196/1739 (69%) asymptomatic AS-patients with mild-to-moderate
AS who were enrolled in the randomized, multicentre Simvastatin and
Ezetimibe in Aortic Stenosis (SEAS) trial. The primary outcome was a
composite of AS-related outcomes, aortic valve replacement, or
hospitalization with heart failure during a clinically relevant 2-year
follow-up. From multivariable Cox proportional hazards regression
analyses, we chose the best prognostic model with the lowest Akaike
information criterion (AIC) values and p-values <0.05. The risk score
included five predictors: age, sex, systolic blood pressure, N-terminal
pro-brain natriuretic peptide (NT-proBNP), and last year's measurement of
transaortic maximal velocity (Vmax). Kaplan-Meier plot visualized event
rates stratified by quartiles of risk score. We validated the ASGARD risk
score in an internal validation cohort of 543 patients (31% hold-out from
SEAS-population) and an external validation cohort of 69 asymptomatic
out-clinic patients with Vmax <=4 m/s from six hospitals from capital
city. Result(s): Patients from the external validation cohort
significantly differed from those in the development cohort in terms of
higher age (mean [SD], 71.7 [8.5] vs. 67.4 [9.8] years, p<0.001), less
prevalent left ventricular hypertrophy (13.0% vs. 37.5%, p<0.001), and
higher event-rates (12.5 [95% CI, 7.6-20.8] vs. 4.5 [3.7-5.4] events per
100 patient-years of follow-up, p<0.001). The ASGARD risk score showed
consistent predictive performance across the validation cohorts (external
validation: area under the curve: 0.82 [95% CI, 0.73-0.91];
calibration-in-the-large, p=0.24; calibration slope, p=0.15; Brier score,
0.18). The score performed just as well or better than a new Vmax
measurement (Figure 1A-1B). In the three upper ASGARD score quartiles, 95%
of patients had less than 5% risk of AVR or heart failure until 7.5, 16.5,
and 22.5 months, respectively (Figure 1C). Conclusion(s): Without a
new echocardiogram, the ASGARD risk score identifies patients at low risk
for AS-related events among asymptomatic patients with non-severe AS. The
ASGARD risk score also estimates the safe watchful-waiting period of 6,
15, 21, and 24 months for the four ASGARD risk score quartiles in
decreasing order.

<88>
Accession Number
643013139
Title
Cerebral embolic protection in transcatheter aortic valve replacement with
bicuspid 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
Gupta A.; Koren O.; Patel V.; Nagasaka T.; Patel D.; Golwala K.;
Chakravarty T.; Al-Jilaihawi H.; Nakamura M.; Makkar R.
Institution
(Gupta, Koren, Patel, Nagasaka, Patel, Golwala, Chakravarty, Al-Jilaihawi,
Nakamura, Makkar) Cedars-Sinai Smidt Heart Institute, Los Angeles, United
States
Publisher
Oxford University Press
Abstract
Background: In the PROTECTED-TAVR randomized controlled trial, use of
cerebral embolic protection device (CEPD) during transcatheter aortic
valve replacement (TAVR) did not reduce procedural stroke. It is, however,
not clear whether certain high-risk subgroups like young patients with
bicuspid aortic stenosis may derive benefit from CEPD. Purpose(s):
This study aimed to determine the effectiveness of CEPD in preventing
cerebrovascular events during TAVR in patients with severe bicuspid aortic
stenosis. Method(s): We retrospectively analyzed 3505 patients who
underwent transfemoral TAVR at a single center between 2016-2020 and
identified 257 patients with bicuspid aortic valve stenosis. Baseline
demographic, clinical, and procedural characteristics were stratified by
CEPD use. We performed Cox Proportional Hazards regression analysis to
examine whether the use of CEPD in patients was associated with a lower
rate of cerebrovascular events (stroke or transient ischemic attack) after
adjusting for baseline characteristics. Result(s): Among 257 patients
receiving TAVR for bicuspid aortic stenosis, median age was 74.7 years
(IQR 66.9 - 83.2 years) and 62.6% were men. There were no significant
differences in the baseline demographic and clinical characteristics
between patients with (n=94) and without CEPD (n=163) (Figure 1a). In
univariate analysis, there was no significant difference in rates of
stroke or transient ischemic attack in-hospital or at 30-days (Figure 1b).
In adjusted analysis, CEPD use (HR 1.55 [95% CI, 0.1-3.8)] was not
associated with a decreased rate of stroke or transient ischemic attack.
 Conclusion(s): These findings indicate that CEPD use is not
associated with lower rates of cerebrovascular events in patients with
bicuspid aortic stenosis and add to the growing body of evidence that
questions the utility of CEPD during TAVR. (Table Presented).

<89>
Accession Number
643013077
Title
Effectiveness of Cerebral Embolic Protection in Transcatheter Aortic Valve
Replacement with High Aortic Valve Calcium Burden.
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
Gupta A.; Koren O.; Patel V.; Nagasaki T.; Patel D.; Golwala K.;
Chakravarty T.; Al-Jilaihawi H.; Nakamura M.; Makkar R.
Institution
(Gupta, Koren, Patel, Nagasaki, Patel, Golwala, Chakravarty, Al-Jilaihawi,
Nakamura, Makkar) Cedars-Sinai Smidt Heart Institute, Los Angeles, United
States
Publisher
Oxford University Press
Abstract
Background: The use of a cerebral embolic protection device (CEPD) during
transcatheter aortic valve replacement (TAVR) has not been shown to be
effective in preventing stroke in the PROTECTED-TAVR randomized controlled
trial. However, whether CEPD may specifically benefit patients with high
aortic valve calcium burden has not been studied. Purpose(s): This
study aimed to determine the effectiveness of CEPD in preventing
cerebrovascular events during TAVR in patients with high aortic valve
calcium scores (AVCS) (>2000 AU in men and >1300 AU in women) detected on
baseline computed tomography. Method(s): We retrospectively analyzed
3505 patients who underwent transfemoral TAVR at a single center between
2016-2020 (Figure 1a). Baseline demographic, clinical, and procedural
characteristics were stratified by CEPD use and AVCS (high vs. low). We
performed Cox Proportional Hazards regression analysis to examine whether
the use of CEPD in patients with high AVCS was associated with a lower
rate of cerebrovascular events (stroke or transient ischemic attack)
within 30 days (primary outcome) after adjusting for baseline
characteristics. Result(s): We stratified our study cohort into four
subgroups: low AVCS without CEPD (n=1163), low AVCS with CEPD (n=633),
high AVCS without CEPD (n=1081), and high AVCS with CEPD (n=628). Patients
for whom CEPD was used in high AVCS group had lower prevalence of
peripheral arterial disease compared with no CEPD use. Otherwise, there
were no significant differences in the baseline characteristics between
patients with and without CEPD in either the low or high AVCS subgroups
(Table). In adjusted analysis, CEPD use (HR 1.30 [95% CI, 0.64-2.65)] or
high AVCS (HR 1.16 [95% CI, 0.64-2.02)] were not associated with a
decreased rate of primary outcome (Figure 1b). Conclusion(s): This
study indicates that CEPD use is not associated with lower cerebrovascular
events after TAVR, even in patients with a high aortic valve calcium
burden. Further research is needed to identify effective stroke prevention
strategies for this patient population. (Table Presented).

<90>
Accession Number
643012721
Title
Fractional-flow reserve use in coronary artery revascularization: a 78.897
patients 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
Martinez Sole J.; Sorolla-Romero J.A.; Farjat-Pasos J.; Hussain B.; Garg
M.; Chiarito M.; Diez-Gil J.L.; Waksman R.; Garcia-Garcia H.; Sanz-Sanchez
J.
Institution
(Martinez Sole, Sorolla-Romero, Diez-Gil, Sanz-Sanchez) University
Hospital Y Politecnico La Fe, Valencia, Spain
(Farjat-Pasos) Centre de Recherche de lInstitut, Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec, Canada
(Hussain) Brookdale University Hospital and Medical Center, Brooklyn,
United States
(Garg, Waksman, Garcia-Garcia) MedStar Washington Hospital Centre,
Washington, United States
(Chiarito) Humanitas Research Hospital, Milan, Italy
Publisher
Oxford University Press
Abstract
Background: Fractional flow reserve (FFR)-guided percutaneous coronary
intervention (PCI) is recommended in the guidelines of revascularization
for patients presenting with coronary artery disease (CAD) with
intermediate lesion severity. However, recently published studies
comparing FFR-guided PCI with non-physiology guided revascularization
strategies have reported conflicting result. Method(s): The PubMed
and Embase databases were searched for randomized clinical trials and
observational studies comparing FFR-guided PCI with non-physiology-guided
revascularization strategies (angiography-guided, intracoronary
imaging-guided, coronary artery bypass grafting) in patients with CAD.
Data were pooled by meta-analysis using a random-effects model.
 Result(s): 26 studies enrolling 78,897 patients were included.
Patients undergoing FFR-guided PCI as compared to those undergoing
non-physiology guided coronary revascularization had a lower risk of
all-cause mortality (OR 0.79 95% CI 0.64-0.99, I2=53%) and myocardial
infarction (OR 0.74 95% CI 0.59-0.93, I2=44.7%). However, no differences
between groups were found in terms of MACE (OR 0.86 95% CI 0.72-1.03,
I2=72.3%) and repeat revascularization (OR 1 95% CI 0.82-1.20, I2=43.2%).
 Conclusion(s): Among patients with CAD, FFR-guided PCI as compared to
non-physiology-guided revascularization was associated with a lower risk
of all-cause mortality and MI. (Figure Presented).

<91>
Accession Number
643012544
Title
Sutureless and rapid-deployment versus conventional bioprosthetic aortic
valve replacement in patients with aortic stenosis: 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
Yadee J.; Chotnoppharatphatthara P.; Permsuwan U.
Institution
(Yadee) Chiang Mai University, Ph.D. Degree Program in Pharmacy, Faculty
of Pharmacy, Chiang Mai, Thailand
(Chotnoppharatphatthara) Chiang Mai University, Chiang Mai University
Pharmacy, Faculty of Pharmacy, Chiang Mai, Thailand
(Permsuwan) Chiang Mai University, Department of Pharmaceutical Care,
Faculty of Pharmacy, Chiang Mai, Thailand
Publisher
Oxford University Press
Abstract
Background: Sutureless aortic valve replacement (SUAVR) has become an
alternative to conventional bioprosthetic aortic valve replacement (CAVR)
for the treatment of aortic stenosis. This procedure was designed to
shorten surgery time, enable optimal valve insertion, and improve surgical
outcomes. Purpose(s): This study aimed to compare the clinical
outcomes between SUAVR and CAVR for treating patients with aortic
stenosis. Method(s): Systematic searches were conducted from the
inception to December 2022, using 4 databases: PubMed, Scopus, Embase, and
Web of Sciences. Randomised controlled trials comparing SUAVR versus CAVR
were included for analyses. Data were extracted and analysed using
predefined clinical outcomes. The revised Cochrane risk-of-bias tool for
randomized trials version 2.0 was used to assess the quality of included
RCTs. A meta-analysis with risk ratio (RR) or mean difference (MD) was
performed to compare clinical outcomes such as aortic cross-clamp (ACC)
time, cardiopulmonary bypass (CPB) time, mortality, and complications at
30 days and 1 year. Result(s): The study included 4 articles with a
total of 478 SUAVR and 485 CAVR patients. Compared to CAVR, SUAVR had a
significantly shorter ACC time (MD -25.1 minutes, 95%CI -44.5 to -5.8, I2
=97%, p 0.01) and CPB time (MD -22.8 minutes, 95% CI -42.4 to -3.2, I2
=93%, p 0.02). There was no significant difference in mortality at 30-day
(RR 1.04, 95%CI 0.34-3.15, I2 =0%, p 0.952) and 1-year follow-up (RR 1.08,
95%CI 0.56-2.06, I2 =0%, p 0.822). Complications including myocardial
infarction, stroke, major bleeding, renal failure, and endocarditis, did
not significantly differ between the two groups. However, permanent
pacemaker implantation was significantly higher after SUAVR at 30 days (RR
3.25, 95%CI 1.81-5.84, I2 =0%, p <0.01) and 1 year (RR 2.97, 95%CI
1.71-5.16, I2 =0%, p <0.01). Conclusion(s): SUAVR had significantly
shorter ACC and CPB times than CAVR. SUAVR required more permanent
pacemaker implantation than CAVR. Mortality and other complications were
comparable between the two groups.

<92>
Accession Number
643012507
Title
Efficacy of Intravascular Lithotripsy (IVL) in peripheral lesions with
severe calcification and its use in TAVI procedure: 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
Sagris M.; Dimitriadis K.; Soulaidopoulos S.; Beneki E.; Ktenopoulos N.;
Papanikolaou A.; Tzoumas A.; Lichtenberg M.; Korosoglou G.; Iliakis P.;
Tsioufis P.; Aznaouridis K.; Toutouzas K.; Tousoulis D.; Tsioufis K.
Institution
(Sagris, Dimitriadis, Soulaidopoulos, Beneki, Ktenopoulos, Papanikolaou,
Iliakis, Tsioufis, Aznaouridis, Toutouzas, Tousoulis, Tsioufis)
Hippokration General Hospital, Athens, Greece
(Tzoumas) University of Cincinnati Medical Center, Cincinnati, United
States
(Lichtenberg) Department of Cardiology,Vascular Medicine and Pneumology,
GRN Hospital, Weinheim, Germany
(Korosoglou) Vascular Center Arnsberg, Arnsberg, Germany
Publisher
Oxford University Press
Abstract
Background: Heavily calcified peripheral artery lesions increase the risk
of vascular complications, constituting a severe challenge for the
operator. Intravascular Lithotripsy (IVL) technology disrupts
subendothelial calcification by using localized pulsative sonic pressure
waves and is a promising technique for patients with severe calcification
in peripheral arteries. Purpose(s): Our aim was to systematically
review and summarize available data regarding the safety and efficacy of
IVL in preparing severely calcified plaques in peripheral arteries and its
use in Transcatheter Aortic Valve Implantation (TAVI). Method(s):
This study was conducted according to the PRISMA guidelines. We
systematically searched PubMed, SCOPUS, and Cochrane databases from their
inception to February 23, 2023, for studies assessing the characteristics
and outcomes of patients undergoing IVL in peripheral vasculature. The
diameter of the vessel lumen before and after IVL was estimated. The
occurrence peri-procedural complications were assessed using a
random-effects model. Result(s): 20 studies with a total of 1,223
patients with heavily calcified peripheral lesions were analyzed. The mean
age of the cohort was 73.8 +/- 8.9 years. Successful IVL delivery achieved
in 100% (95% CI: 100%-100%, I2=0%), with an increase in the luminal
diameter (SMD: 4.66, 95% CI: 3.41-5.92, I2=90.8%) and reduction in
diameter stenosis (SMD: -4.15, 95% CI: -4.75 to -3.55, I2=92.8%), and a
described low rate of complications. There was not observed any dissection
in 97% (95% CI: 91%-100%, I2=81.4%), while dissections of any type (A, B,
C, or D) were observed in 6% (95% CI: 2%-10%, I2=85.3%) of the patients.
Several rare cases of abrupt closure, no-reflow phenomenon, perforation,
thrombus formation, and distal embolization were recorded. Finally, the
subgroup analysis of patients who underwent a TAVI with IVL assistance
presented successful implantation in 100% (95% CI: 100%-100%, I2=0%) of
the cases, with only 4% (95% CI: 0%-12%, I2=68.96%) presented dissections
of any sort. Conclusion(s): IVL seems to be an effective and safe
technique for preparing severely calcified lesions in peripheral vessels
during TAVI interventions. These results support the use of IVL for
amelioration of overall outcome in high vascular risk TAVI settings.

<93>
Accession Number
643012470
Title
Impact of age versus comorbidities on outcomes after transcatheter aortic
valve implantation: validating the guideline-recommended age cut-off.
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
Hannen L.; Ludwig S.; Kellner C.; Grundmann D.; Demal T.; Waldschmidt L.;
Voigtlaender-Buschmann L.; Linder M.; Kirchhof P.; Conradi L.;
Reichenspurner H.; Blankenberg S.; Schaefer A.; Seiffert M.; Schofer N.
Institution
(Hannen, Ludwig, Kellner, Grundmann, Demal, Waldschmidt,
Voigtlaender-Buschmann, Linder, Kirchhof, Conradi, Reichenspurner,
Blankenberg, Schaefer, Seiffert, Schofer) University Heart and Vascular
Center Hamburg, Hamburg, Germany
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has become the
most common treatment for patients with severe aortic stenosis (AS) in
Europe and North America. Current European guidelines recommend
transfemoral TAVI for patients with severe, symptomatic AS aged >=75
years. However, this cut-off is based solely on coincidentally existing
patient cohort mean age of randomized controlled trials and individual
risk factors might have a greater impact on outcomes after TAVI compared
to age alone. Purpose(s): This study aimed to validate the
guideline-recommended age cut-off of 75 years compared to a comorbidity
focused approach. Method(s): Using long-term prospective
single-centre data, we analysed 4,278 patients with severe, symptomatic AS
undergoing transfemoral TAVI between 2008-2022. A multivariable Cox
regression model was fitted to assess predictors of all-cause mortality.
Based on this model, a comorbid profile was defined as at least one
prevalent comorbidity from the final model. Kaplan-Meier estimates were
calculated for all-cause mortality after 3 years for young (<75 years) and
elderly (>=75 years), and comorbid and non-comorbid patients.
 Result(s): A total of 1,620 patients were included in the final
analysis (<75 years: N=302 [18.6%], 70.8 [IQR 67.4-73.3] years; >=75
years: N=1,318 [81.4%], 82.6 [IQR 79.5-85.6] years). In multivariable
analysis, male gender (hazard ratio [HR] 1.37, 95%-confidence interval
[CI] 1.06-1.77), atrial fibrillation (AF) (HR 1.78, 95%-CI 1.35-2.33),
chronic obstructive pulmonary disease (COPD) (HR 1.44, 95%-CI 1.07-1.93)
and chronic kidney disease (CKD) (eGFR <60ml/min/1.72m2) (HR 0.99, 95%-CI
0.98-0.99) were identified as predictors independently associated with
all-cause mortality. Overall, 64% of patients were defined as comorbid by
at least one risk factor emerging as an independent predictor: AF/
COPD/CKD. While there was no difference in all-cause mortality between
patients aged < or >=75 years (27.5% vs. 23.9%, p=0.62) (Figure 1A),
3-year mortality rates were significantly higher in comorbid (30.4%)
compared to non-comorbid subjects (14.5%, p<0.001) (Figure 1B). No
difference was found comparing non-comorbid young to non-comorbid elderly
(16.2% vs. 14.1%, p=0.69), but comorbid young showed higher mortality than
non-comorbid elderly patients (34.0% vs. 14.1%, p<0.001) (Figure 1C).
According to age-adjusted multivariable analysis, a comorbid risk profile
was independently associated with all-cause mortality (HR 2.09, 95%-CI
1.49-2.93), whereas age was not predictive. Conclusion(s): In a large
all-comer TAVI patient cohort age was not predictive for mortality within
a 3-year follow-up. This finding was true for both, non-comorbid as well
as comorbid patients. Thus, outcome of patients with AS undergoing
transfemoral TAVI depends on patients' comorbidities rather than age. Our
findings do not confirm the guideline recommended binary age cut-off
currently recommended for patients with severe symptomatic AS. (Figure
Presented).

<94>
Accession Number
643012423
Title
Cerebral embolic protection devices during transcatheter aortic valve
implantation: a 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
Reddy R.K.; Ahmad Y.; Arnold A.D.; Howard J.P.
Institution
(Reddy, Arnold, Howard) National Heart and Lung Institute Imperial
College, London, United Kingdom
(Ahmad) Yale School of Medicine, Section of Cardiovascular Medicine, New
Haven, United States
Publisher
Oxford University Press
Abstract
Background: Stroke is a feared complication of transcatheter aortic valve
implantation (TAVI), which may be mitigated by embolic protection devices
(EPDs). Purpose(s): We performed a systematic review and
meta-analysis of randomised controlled trials (RCTs) to test the effect of
EPDs in TAVI. Method(s): All RCTs comparing EPDs with control during
TAVI were systematically identified. Pre-specified primary endpoints were
all stroke, disabling stroke, non-disabling stroke and all-cause
mortality. Safety and neuroimaging parameters were assessed. Sensitivity
analyses were stratified by EPD type. This study was prospectively
registered. Result(s): Eight trials randomising 4043 patients were
included. There was no significant difference between EPDs and control for
all stroke [RR 0.88, 95%CI 0.65-1.18, p=0.386, I2=0%], disabling stroke
[RR 0.59, 95%CI 0.31-1.14, p=0.117, I2=0%], non-disabling stroke [RR 0.99,
95% CI 0.71-1.40, p=0.967, I2=0%] or all-cause mortality [RR 0.88, 95%CI
0.44-1.78, p=0.727, I2=0%]. There were no differences in safety endpoints
of bleeding, vascular complications, or acute kidney injury. EPDs resulted
in reduced cerebral lesion volume [SMD -0.55, 95%CI -0.91- -0.18, p=0.003,
I2=63.6%], but no difference in number of patients with new lesions. The
Sentinel EPD significantly reduced risk of disabling stroke [RR 0.42,
95%CI 0.20-0.88, p=0.022, I2=0%] but did not impact all stroke,
non-disabling stroke or all-cause mortality. Conclusion(s): The
totality of randomised data for EPDs during TAVI demonstrated no safety
concerns or significant differences in clinical endpoints, although total
cerebral lesion volume was reduced. Analyses restricted to the Sentinel
EPD demonstrated large, clinically meaningful reductions in disabling
stroke. Ongoing RCTs may help validate these results. (Table Presented).

<95>
Accession Number
643012221
Title
C-reactive protein levels and coronary in-stent restenosis: 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
Rai H.; Reddi Bathuni R.; Fitzgerald S.; Coughlan J.J.; Spence M.;
Hanratty C.; Colleran R.; Blake G.J.; Byrne R.A.
Institution
(Rai, Fitzgerald, Coughlan, Spence, Hanratty, Colleran, Byrne)
Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network
Dublin, Dublin, Ireland
(Reddi Bathuni) Royal College of Surgeons in Ireland, Dublin, Ireland
(Blake) Mater Private Network Dublin, Dublin, Ireland
Publisher
Oxford University Press
Abstract
Background: C-reactive protein (CRP) is an inflammatory biomarker and has
been implicated in the pathogenesis of atherosclerotic lesion formation,
plaque rupture, and coronary thrombosis. Its relationship to adverse
angiographic outcomes after coronary stenting however remains uncertain.
 Purpose(s): We aimed to test the association of baseline CRP levels
with the incidence of coronary in-stent restenosis (ISR) using a
systematic review and meta-analysis. Method(s): Relevant published
studies were identified following a US National Institutes of Health
(PubMed), EMBASE, MEDLINE, Scopus and Web of Knowledge databases search,
until 31st October 2022. Selected studies had to be/have (i) original
research with an angiographically determined ISR and an angiographically
or clinically determined no-ISR group, and (ii) CRP levels measured before
index stenting for both groups. Mean difference in CRP levels with its
95%CI between ISR and no-ISR was ascertained for each included study.
Pooled standard mean difference (SMD) and its 95%CI was derived after
pooling study level results using random effects employing a Z test.
Begg's funnel plots and Egger's test were used for publication bias
assessment. Result(s): Amongst total of 1,009 unique results, 497
full-text articles were assessed for eligibility, 461 were excluded for a
variety of reasons, which left 36 articles with 37 different studies (Nst=
37), with a total sample of 10,577 (2,122 ISR cases / 8,455 controls), to
be included for quantitative synthesis. Complete study flow is depicted in
Figure 1. ISR group had higher pooled CRP levels (Nst= 37, SMD= 0.50, 95%
CI= 0.33, 0.67 mg/L, p< 0.00001) as compared to no-ISR group. Sensitivity
analysis found no instance of significant alteration from the original
results. No evidence of publication bias was detected either visually by
the Begg's funnel plots or the Egger's test (p= 0.07). Analysis was
repeated after subgroup stratification of the included studies according
to study design, stent type, assay type, ancestry, presentation diagnosis,
and data type. Important findings identified by the subgroup analysis were
the significant differences in CRP levels between ISR and no-ISR, amongst
Middle Easterners (Nst= 10, SMD 0.63, 95%CI 0.33, 0.93 mg/L, p< 0.0001)
and Asians (Nst= 18, SMD 0.71, 95%CI 0.46, 0.96 mg/L, p= 0.00001), however
not amongst Europeans (Nst= 9, SMD -0.11, 95%CI -0.43, 0.21 mg/L, p=
0.50). Results obtained for other subgroups however remained consistent
and showed significant positive associations. (Figure 2.)
 Conclusion(s): The present systematic review and meta-analysis
indicates a positive association of higher baseline CRP values with the
incidence of angiographically confirmed ISR. In subgroup analysis there
was no evidence of association amongst Europeans, in contrast to
significant associations seen amongst rest of the ancestries. These
results warrant further validation in dedicated large cohorts, ideally in
a prospective setting. (Figure Presented).

<96>
Accession Number
643012174
Title
Antiplatelet effect of acetylsalicylic acid in patients early after
cardiac valve surgery: comparative investigation of the impairment of
platelet inhibition by dipyrone versus acetaminophen.
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
Trenk D.; Hainke B.; Lehane C.; Niebergall-Joos E.; Leggewie S.; Twarock
S.; Hohlfeld T.; Schroer K.; Siepe M.; Keyl C.
Institution
(Trenk, Leggewie, Siepe) University of Freiburg, Faculty of Medicine,
Heart Center Freiburg University, Bad Krozingen, Germany
(Hainke, Lehane, Niebergall-Joos, Keyl) University of Freiburg, Faculty of
Medicine, Anaesthesiology and Intensive Care Medicine, Bad Krozingen,
Germany
(Twarock, Hohlfeld, Schroer) University Hospital Duesseldorf, Institute of
Pharmacology and Clinical Pharmacology, Duesseldorf, Germany
Publisher
Oxford University Press
Abstract
Background: Low-dose acetylsalicylic acid (ASA) is recommended in current
guidelines for a period of 3 months after surgical implantation of a
bioprosthesis in aortic position or after surgical repair of the mitral
valve. Dipyrone (D; metamizole) and acetaminophen (A; paracetamol) are
frequently used non-opioid analgesics after surgery. The active metabolite
of dipyrone (4-methylaminoantipyrine) is a reversible inhibitor of
cyclooxygenase-1 and an interaction with the antiplatelet effect of ASA in
more than 50 % of patients has been reported. Material(s) and
Method(s): We enrolled 162 patients scheduled for cardiac surgery in this
prospective investigator-initiated clinical study. Patients were
randomized at day 1 after surgery to either 4 x 1g dipyrone iv/day or 4 x
1g acetaminophen iv/day. All patients were on ASA 100 mg daily (200 mg at
day 1). The primary endpoint was the proportion of patients with adequate
antiplatelet response to ASA assessed via determination of thromboxane B2
in platelet rich plasma after stimulation with arachidonic acid (AA) at
day 4/5 after surgery (cutpoint <=209.8 ng/ml thromboxane B2). Key
secondary endpoints comprised platelet reactivity assessed by light
transmission aggregometry [LTA] and by multiple electrode impedance
aggregometry [MEIA]. Result(s): 15 patients dropped out of the study.
Thus, data from 71 patients randomized to dipyrone and 76 patients
randomized to acetaminophen were available for data analysis. Patients had
a mean age of 66.5+/-7.6 years and 97 were male and 50 female. Aortic
valve was replaced in 92 patients, 54 underwent mitral valve
reconstruction and combined surgery was performed in a single patient. The
primary endpoint analyzed at day 4/5 after surgery is shown in the Figure.
The proportion of non-responders was 12.5% (D) and 3.0% (A), respectively.
Platelet reactivity at day 4/5 after surgery was assessed after
stimulation with arachidonic acid by LTA or MEIA. No statistically
significant difference between the treatment strata was determined in both
assays: Maximum aggregation in LTA was 5.0% (median; 95% confidence
interval [95% CI]: 4.0 - 8.0%) in D+ASA and 6.0% (95% CI: 5.0 - 11.0%) in
A+ASA (p=0.528) and MEIA AUC was 345.5 AU*min (95% CI: 268.0 - 419.0) in D
+ASA and 276.5 AU*min (95% CI: 241.0 - 330.0) in A+ASA (p=0.098). Plasma
concentrations of MAA in patients treated with dipyrone were higher in
patients identified as responders to ASA (86.6 muM; 95% CI: 67.9 - 102.4
muM) compared to non-responders (31.0 muM; 95% CI: 2.9 - 146.7 muM;
p=0.0147). Summary and conclusion: The proportion of non-responders to ASA
is higher in patients treated with dipyrone compared to acetaminophen. The
proportion of non-responders in the dipyrone-treated group in our study is
substantially lower than reported in previous studies. High plasma
concentrations of MAA in responders may contribute to enhanced inhibition
of COX-1 in patients treated with dipyrone.

<97>
Accession Number
643012102
Title
Temporal trends in characteristics and outcomes in patients undergoing
percutaneous mitral valve repair for secondary mitral regurgitation.
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
Kaddoura R.; Al-Badriyeh D.; Abushanab D.; Al-Hijji M.
Institution
(Kaddoura, Abushanab, Al-Hijji) Hamad Medical Corporation Heart Hospital,
Doha, Qatar
(Al-Badriyeh) Qatar University, Doha, Qatar
Publisher
Oxford University Press
Abstract
Background and purpose: Several studies have investigated the procedural
and clinical outcomes of patients with secondary mitral regurgitation (MR)
who underwent percutaneous mitral valve repair. However, temporal trend of
patients' characteristics and outcomes has not been studied in comparison
with landmark studies. Thus, this systematic review investigated the
temporal trend in patient characteristics and outcomes from observational
studies over years in comparison with landmark studies in secondary MR.
 Method(s): The identified observational studies were grouped into two
5-year periods. The first 5-year period included 36 studies that started
recruiting patients at any year between 2008 and 2012, whereas 25 studies
in the second 5-year period started recruitment between 2012 and 2018.
Pooled data of two every 5-year period were compared with the landmark
studies. Multicenter studies with potential overlap in term of recruitment
periods were excluded. Variables from observational studies were compared
with those of landmark trials using a random-effects model for each
variable. R software was used for non-comparative pooling of variables,
and the RevMan software was used for the comparative meta-analysis.
 Result(s): EVEREST versus observational studies: In first 5-year
period, patients in EVERST program were more likely to have non-ischemic
MR aetiology and less likely to be symptomatic at presentation (i.e., NYHA
III/IV) or getting implanted cardiac device. They were less likely to have
MR grade <=2+ (OR 0.58, 95% CI:0.44-0.78) post procedure but maintained
NYHA class I/II at 12-month follow-up (OR 1.74, 95% CI: 1.38-2.19) with no
difference in mortality. In the subsequent 5-year period, there was no
change from the former comparisons. COAPT versus observational studies: In
the first period, COAPT patients were more likely to have renal
insufficiency and receive beta-blockers and implanted device. They were
less likely to present with severe heart failure symptoms or severe MR.
There was no difference in post procedure outcomes, but they were more
likely to maintain MR grade <=2+ at follow-up (OR 3.98, 95% CI:
2.15-7.37). In the following period, COAPT patients were more likely to
present with MR grade 3+ without a difference in procedural or clinical
outcomes except for more chance to maintain procedural success at 12-mont
follow-up (i.e., MR grade <=2+; OR 2.41, 95% CI: 1.27-4.58). MITRA-FR
versus observational studies: In the first period, MITRA-FR patients were
less likely to have atrial fibrillation, renal insufficiency, or NYHA
class III/IV. They were more likely receive beta-blockers and implanted
device. However, there was no difference in post procedure and clinical
outcomes. In the second period, there was no major change from the
previous comparisons. Conclusion(s): Although patients from landmark
studies, namely COAPT and MITRA-FR, may have favourable characteristics,
this did not translate into better outcome over time.

<98>
Accession Number
643012014
Title
Repeat coronary revascularization in high-risk patients treated with
ticagrelor monotherapy after PCI: Insights from the randomized TWILIGHT
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
Spirito A.; Baber U.; Sartori S.; Moliterno D.J.; Kastrati A.; Collier T.;
Gibson C.M.; Vogel B.; Angiolillo D.J.; Pocock S.; Cohen D.J.; Escaned J.;
Sardella G.; Dangas G.; Mehran R.
Institution
(Spirito, Sartori, Vogel, Dangas, Mehran) Icahn School of Medicine at
Mount Sinai, New York, United States
(Baber) University of Oklahoma Health Sciences Center, Oklahoma City,
United States
(Moliterno) University of Kentucky, Lexington, United States
(Kastrati) Technical University of Munich, Deutsches Herzzentrum Munchen,
Munich, Germany
(Collier, Pocock) London School of Hygiene and Tropical Medicine,
Department of Medical Statistics, London, United Kingdom
(Gibson) Beth Israel Deaconess Medical Center, Division of Cardiovascular
Medicine, Boston, United States
(Angiolillo) University of Florida, College of Medicine, Division of
Cardiology, Jacksonville, United States
(Cohen) Cardiovascular Research Foundation, New York, United States
(Escaned) Hospital Clinico San Carlos, Madrid, Spain
(Sardella) Polyclinic Umberto I, Rome, Italy
Publisher
Oxford University Press
Abstract
Background: Repeat revascularization after percutaneous coronary
intervention (PCI) remains a major concern, even though its impact on
mortality is limited. The effect of ticagrelor monotherapy vs. standard
dual antiplatelet therapy (DAPT) on this outcome is unclear. Aim(s):
To assess the impact of ticagrelor monotherapy vs. DAPT on repeat
revascularization after PCI. Method(s): In the TWILIGHT trial,
high-risk patients who were event-free and adherent to a ticagrelor-based
DAPT for 3 months after PCI were randomized to ticagrelor plus aspirin or
ticagrelor plus placebo for 12 additional months. In this post-hoc
analysis, the primary endpoint was repeat revascularization due to
recurrent or persistent symptomatic myocardial ischemia. Secondary
endpoints included target lesion revascularization (TLR), target vessel
revascularization (TVR) and major adverse cardiac and cerebrovascular
events (MACCE) and net adverse clinical events (NACE) (Figure). All
endpoints were adjudicated and assessed at 12 months after randomization
in the per-protocol population. Result(s): Among 6,759 patients,
ticagrelor monotherapy and ticagrelor plus aspirin were associated with a
similar risk of repeat revascularization (7.1% vs 6.7%, HR 1.07, 95% CI
0.89-1.29), TLR, TVR and MACCE (Figure), while NACE was lower with
ticagrelor monotherapy. Conclusion(s): In high-risk patients
undergoing PCI, ticagrelor monotherapy after 3 months of ticagrelor plus
aspirin was associated with similar rates of recurrent coronary
revascularization and MACCE and a lower risk of NACE compared with
continued DAPT.

<99>
Accession Number
643011831
Title
Revascularization of coronary chronic total occlusions in the elderly:
what results? - The insights of a multicentre national registry.
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
Cabral M.; Goncalves C.; Vinhas H.; Teles R.C.; Duarte J.A.A.; Fernandes
R.; Costa M.; Silveira J.B.; Pereira H.; Braga P.; Ferreira P.C.; Machado
F.P.; Abreu P.F.; Guardado J.; Cardoso P.P.
Institution
(Cabral, Goncalves, Guardado) Leiria Hospital Centre, Leiria, Portugal
(Vinhas) Algarve University Hospital Center, Faro, Portugal
(Teles) Hospital Santa Cruz, Lisbon, Portugal
(Duarte) Hospital De Santa Maria, Lisbon, Portugal
(Fernandes) Hospital Espirito Santo de Evora, Evora, Portugal
(Costa) Coimbra Hospital and University Center, Coimbra, Portugal
(Silveira) Hospital Center of Porto, Porto, Portugal
(Pereira) Hospital Garcia de Orta, Almada, Portugal
(Braga) Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia,
Portugal
(Ferreira) Hospital Center Tondela Viseu, Viseu, Portugal
(Machado) Hospital Luz, Lisbon, Portugal
(Abreu) Hospital Prof Fernando da Fonseca EPE, Amadora, Portugal
(Cardoso) Hospital dos Lusiadas, Lisbon, Portugal
Publisher
Oxford University Press
Abstract
Lately, the remarkable progress in knowledge and treatment of
cardiovascular diseases has been significantly impacting society's
morbidity and mortality. However, the burden of coronary artery disease
(CAD) remains non-negligible. In addition, as a consequence of demographic
changes, age, as a non-modifiable cardiovascular risk factor, makes it
increasingly important to focus on the elderly. Up to one-fifth of
patients with CAD have a chronic total occlusion (CTO) of a coronary
artery, defined as a lesion with 100% stenosis and Thrombolysis In
Myocardial Infarction (TIMI) flow grade 0 that exists for more than 3
months. There is current evidence that successful CTO-percutaneous
coronary intervention (PCI) is associated with clinical benefits. However,
elderly patients are currently underrepresented in CTO-PCI randomized
controlled trials and registries, and its clinical impact and safety in
this group of patients are still debated. This study aims to characterise
patients submitted to CTO-PCI and compare the baseline characteristics,
coronary intervention features, intraprocedural complications and
in-hospital mortality between patients younger and older than 75. The
authors performed a retrospective analysis of adult patients submitted to
a CTO-PCI, included in the Portuguese Registry on Interventional
Cardiology between January 2019 and December 2022. Comparison tests
between groups for parametric and non-parametric variables were performed.
A p-value less than 0.05 was considered statistically significant. A total
of 353 patients who underwent CTO-PCI were analysed, 271 (76.8%) with 18
to 74 years old (group 1) and 82 (23.2%) with 75 or more years old (group
2). Table 1 shows the most important baseline characteristics, with
similar features for both groups except body mass index and smoking
habits. Table 2 demonstrates the differences between the groups regarding
PCI, with the left main and left anterior descending arteries being more
treated among older patients and the right coronary artery in younger
patients. Complete coronary revascularization and procedure success rate
did not differ significantly between groups (p-value=0.19 and
p-value=0.59, respectively). Finally, table 3 presents the main
intra-procedural and in-hospital complications, with a significant
difference only for occlusion of the side branch, occurring in 2 patients
aged over 75 years (p-value=0.01). In conclusion, in our registry, the
elderly presents a high success rate in the complete recanalization of CTO
lesions, comparable to the group under 75 years of age. However, the
presence of side branch occlusion was higher in older patients, without
other significant differences in intraprocedural and in-hospital
complications, including mortality. Further studies including a large
sample and follow-up analysis would be essential to better understand the
rate of risks related to PCI-CTO potentially associated with the
complexity and comorbidities of the elderly. (Table Presented).

<100>
Accession Number
643011593
Title
Comparison of Antithrombotic Regimens after Left Atrial Appendage
Occlusion: A Systematic Review and Network 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
Carvalho P.E.P.; Gewehr D.M.; Miyawaki I.A.; Nogueira A.; Felix N.;
Nascimento B.R.; Garot P.; Darmon A.; Mazzone P.; Preda A.; Kubrusly L.F.;
Cardoso R.
Institution
(Carvalho) Federal University of Minas Gerais, Belo Horizonte, Brazil
(Gewehr, Kubrusly) Curitiba Heart Institute, Curitiba, Brazil
(Miyawaki) Federal University of Parana, Curitiba, Brazil
(Nogueira) Bahiana School of Medicine and Public Health, Salvador, Brazil
(Felix) Federal University of Campina Grande, Department of Medicine,
Campina Grande, Brazil
(Nascimento) Federal University of Minas Gerais, Department of Internal
Medicine, Belo Horizonte, Brazil
(Garot, Darmon) Cardiovascular Institute Paris-Sud (ICPS), Massy, France
(Mazzone, Preda) San Raffaele Hospital, Milan, Italy
(Cardoso) Brigham and Women's Hospital, Harvard Medical School, Boston,
United States
Publisher
Oxford University Press
Abstract
Background: The optimal antithrombotic therapy following left atrial
appendage occlusion (LAAO) in patients with non-valvular atrial
fibrillation (AF) remains uncertain. Purpose(s): This network
meta-analysis aimed to compare the efficacy and safety of various
antithrombotic strategies after LAAO. Method(s): We conducted a
comprehensive search of MEDLINE, Cochrane, Embase, and ClinicalTrials.gov
databases for studies that reported outcomes after LAAO, stratified by the
antithrombotic therapies administered at discharge. Direct oral
anticoagulants (DOACs), vitamin-K antagonists (VKAs), single antiplatelet
therapy (SAPT), dual antiplatelet therapy (DAPT), DOAC plus SAPT, VKA plus
SAPT, and no antithrombotic therapy were analyzed. We performed a
frequentist random-effects model network meta-analysis to estimate the
odds ratio (OR) with 95% confidence intervals (CI) for each strategy. The
surface under the cumulative ranking curve (SUCRA) P-scores provided a
ranking of treatments. Quality assessment and risk of bias were conducted
in accordance with Cochrane recommendations. Result(s): We included
39 studies comprising 10,573 patients with non-valvular AF. As shown in
Figure 1, in the network comparison, DAPT (OR 0.33; 95% CI 0.14-0.73),
DOAC (OR 0.31; 95% CI 0.11-0.84), DOAC plus SAPT (OR 0.15; 95% CI
0.03-0.68), and VKA (OR 0.29; 95% CI 0.10-0.87) were superior to no
therapy in preventing device-related thrombosis (DRT). There was no
significant difference between the therapies analyzed in terms of major
bleeding (Figure 2). In the SUCRA analysis, DOAC plus SAPT had the highest
probability of being the best strategy for preventing DRT, followed by VKA
and DOAC monotherapies, respectively. DOAC monotherapy was associated with
the lowest probability of major bleeding, followed by DOAC plus SAPT and
VKA as monotherapy, respectively. Conclusion(s): In patients with
non-valvular AF undergoing LAAO, post-discharge therapy with DOAC as
monotherapy reduces the incidence of DRT compared with no therapy and is
associated with a lower probability of major bleeding compared with other
therapies. (Figure Presented).

<101>
Accession Number
643011575
Title
Using natural language processing to generate a large-scale database of
aortic stenosis with long-term follow-up: the CASPER (cogstack aortic
stenosis patient electronic registry) database.
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
Wu J.; Biswas D.; Seale T.; Bean D.; Fairhurst N.; Kaye G.; Dobson R.;
Chowienczyk P.; Shah A.; O'Gallagher K.
Institution
(Wu, Biswas, Seale, Bean, Dobson, Chowienczyk, Shah, O'Gallagher) King's
College London, London, United Kingdom
(Fairhurst, Kaye) King's College Hospital NHS Foundation Trust, London,
United Kingdom
Publisher
Oxford University Press
Abstract
Background: Aortic stenosis (AS) is one of the most common heart valve
diseases in the Western World, with a prevalence of approximately 4% in
patients over 70 years old. High quality observational data can provide
insight into characteristics that define patient trajectories and inform
the design of appropriately powered randomised trials. Objective(s):
The aim of this study is to develop a data pipeline to generate a large
database containing information of an AS cohort in a hospital by analysing
both structured and unstructured (free text) data in routinely collected
electronic heath records (EHR). The unstructured data are processed using
natural language processing (NLP, an artificial intelligence technique
that allows machines to recognize clinical concepts in EHR with
contextualisation and linked to SNOMED ontology). Method(s): The
open-source CogStack retrieval system is used to collect clinical notes of
AS patients. The natural language processing toolkit, MedCAT, is used to
identify clinical concepts in the form of SNOMED terms in clinical notes.
In addition to patient demographic data (including ethnicity and markers
of social deprivation), a range of clinical characteristics,
co-morbidities, medications and procedural interventions are extracted.
Validation of the dataset was performed using 3 existing, independent data
sources (structured echocardiogram reports, surgical aortic valve
replacement (AVR) operation notes, transcatheter intervention (TAVI)
reports). Result(s): We identified 7,451 patients with AS from our
EHR, of whom 5,754 had an echocardiogram at our centre. The mean duration
of follow up was 5 years. Of those with an echocardiogram at our centre,
we were able to extract data on AS severity in 91% and left ventricular
function in 89%. Manual validation of procedural data suggests a
sensitivity of 98% to detect TAVI and 97% to detect AVR procedures.
Kaplan-Meier curves for automated detection of patient mortality are
consistent with the known survival data for patients with AS.
 Conclusion(s): We developed and validated an automated NLP-enabled
data pipeline to identify and characterise a single retrospective centre
cohort of AS patients from routinely collected EHR across the spectrum of
severity, with long term mortality data. This resource has the potential
to provide insights toward several outstanding questions relating to
progression of AS, and the influence of ethnicity and social deprivation
without the need for conventional dedicated databases. The EHR-based
database also has the potential to guide the design of future randomised
control trials. (Figure Presented).

<102>
Accession Number
643011534
Title
Outcomes of chronic total occlussion recanalization in patients with prior
bypass-surgery: an updated systematic review and meta-analysis of real
world registries.
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
Romeo F.; Moroni F.; Del Buono M.G.; Damonte J.I.; Chiabrando J.G.;
Azzalini L.
Institution
(Romeo) Icahn School of Medicine at Mount Sinai, New York, United States
(Moroni) University of Virginia, Charlottesville, United States
(Del Buono) Catholic University of the Sacred Heart, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
(Damonte, Chiabrando) Hospital Italiano de Buenos Aires, Buenos Aires,
Argentina
(Azzalini) University of Washington Medical Center, Seattle, United States
Publisher
Oxford University Press
Abstract
Background: Recanalization of chronic total occlusion (CTO) coronary
lesions by percutaneous coronary intervention (PCI) in patients with prior
coronary artery bypass grafting (CABG) is still considered a challenging
scenario due to the complexity of coronary lesions as well as the
requirement of CTO PCI advanced techniques. The aim of this study is to
compare clinical outcomes of patients undergoing CTO PCI with and without
CABG surgery. Method(s): We conducted a systematic review and
meta-analysis of observational studies that compared in-hospital outcomes
of CTO PCI in patients with vs. without prior CABG published in Medline
from inception until December 2022. The results are synthesized in a
quantitative manner with random effects models. Categorical variables were
compared using the chi-square test, whereas continuous variables were
compared using a 2-sample Student's t-test. Statistical heterogeneity was
assessed by I2 statistics: I2 statistic >50% was considered substantial,
and I2 >75% was considered considerable. The Review Manager Software
version 5.3.5. (The Cochrane Collaboration, 2014) was used to calculate
summary statistics (odds ratios [ORs] with 95% confidence intervals
[CIs]). Result(s): Eleven observational studies with a total of
35,666 patients were included, of whom 7,005 patients had a history of
CABG. Prior CABG patients were older, (68.1 +/- 9.0 vs. 64.1 +/- 10.7
years; p < 0.001), and had more complex coronary lesions (J-CTO score: 3.2
+/- 1.4 vs. 2.5 +/- 1.4; p < 0.001). Prior CABG was associated with lower
technical success (66.6% vs. 78.5%; OR 0.53 [95% CI: 0.43 to 0.65]; p <
0.00001, I2 = 84%) as well as lower procedural success (OR 0.64 [95% CI:
0.57 to 0.71]; p < 0.00001, I2 = 0%) as compared with patients with no
prior CABG (Figure 1A and Figure 1B). Prior CABG patients had a higher
incidence of in-hospital mortality (0.7% vs. 0.4%; OR: 2.00 [95% CI: 1.32
to 3.05]; p = 0.001, I2 = 9%, Figure 2A), coronary perforation (3.7% vs.
2.3%; OR: 1.64 [95% CI: 1.15 to 2.33]; p < 0.006, I2 = 74%, Figure 2B),
and myocardial infarction (1.7% vs. 0.7%; OR: 2.57 [95% CI: 1.73 to 3.81];
p < 0.00001, I2 = 12%), but a lower incidence of cardiac tamponade (0.2%
vs. 0.9%; OR: 0.36 [95% CI: 0.17 to 0.77]; p = 0.09, I2 = 0%, Figure 2C)
compared with those without prior CABG. Both groups had a similar
incidence of acute cerebrovascular events (0.2% vs. 0.1%; OR: 1.70 [95%
CI: 0.75 to 3.88]; p = 0.21, I2 = 0%), major bleeding (1.4% vs. 1.2%; OR:
1.24 [95% CI: 0.96 to 1.61]; p = 0.09, I2 = 0%) and vascular complications
(1.4% vs. 0.9%; OR: 1.50 [95% CI: 0.93 to 2.41]; p = 0.10, I2 = 0%).
 Conclusion(s): Prior CABG patients undergoing CTO PCI presented a
higher risk of in-hospital mortality and perioperative procedural
complications although the risk of tamponade was lower. (Figure
Presented).

<103>
Accession Number
645798553
Title
INTEGRATIVE INTERVENTION PALETTE DEVELOPMENT FOR THE THORACIC
PERIOPERATIVE INTEGRATIVE SURGICAL CARE EVALUATION (POISE) TRIAL.
Source
Journal of Integrative and Complementary Medicine. Conference:
International Congress on Integrative Medicine and Health, ICIMH. Las
Vegas, NV United States. 22(6) (pp A135-A136), 2016. Date of Publication:
2016.
Author
Seely D.; Chamberland P.; Herrington C.; Spooner C.; Threader J.; Ennis
J.; Fazekas A.; Zhao L.; Seely A.
Institution
(Seely, Herrington, Zhao) Ottawa Integrative Cancer Centre, Ottawa, ON,
Canada
(Chamberland) Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Spooner) Paradigm Naturopathic Medicine, Vernon, BC, Canada
(Threader) Royal Melbourne Hospital, Melbourne, Australia
(Ennis, Fazekas, Seely) Ottawa Hospital, Ottawa, ON, Canada
Publisher
Mary Ann Liebert Inc.
Abstract
Purpose: The Thoracic POISE Trial is the first randomized pragmatic trial
to explore the impact of an integrative program of care for patients with
thoracic cancer on surgical adverse events, survival, recurrence and
quality of life. The first stage of this three-stage trial will involve
the development and refinement of an integrative intervention palette that
will be applied peri-operatively for people with lung or gastro-esophageal
cancer. The palette of therapies is driven by both practice and evidence
and requires a truly collaborative multidisciplinary group to agree on and
implement a whole-person program of care. Method(s): The intervention
development process is guided by three main principles: 1 evidence of
benefit and safety from scientific investigation; 2) holism across pre-
and post-operative treatment goals and therapeutic approaches; and 3)
consensus among doctors of naturopathic and conventional medicine. To
assess for utilization and rationale of use, all members of the Oncology
Association of Naturopathic Physicians were surveyed for their
recommendations. All recommendations made by more than 40% of respondents
went through systematic review to collect relevant literature related to
the intervention in question, thoracic cancer, and/or surgery. Additional
therapies brought forward outside the survey were considered based on
evidence for efficacy, safety and feasibility. Result(s): A total of
14 pre-operative treatment recommendations were considered and reviewed
across four domains including: 1 natural health products, 2) physical
therapies, 3) mental-emotional treatments, and 4) nutritional approaches.
For post-operative care, 21 recommendations were reviewed across the same
domains. Of the recommendations a handful of core therapies will be
selected for application in the clinical trial. Conclusion(s): The
intervention development process using welldefined and transparent
principles has fostered an effective collaboration of naturopathic
doctors, thoracic surgeons, oncologists, pharmacists, and epidemiologists.
This collaboration and consensus for treatment in a large multicentre and
multidisciplinary randomized trial is essential to its success and
conduct..

<104>
Accession Number
2035806427
Title
A PROSPECTIVE COMPARATIVE STUDY OF PEDIATRIC CARDIAC CATHETERIZATION
PROCEDURE UNDER GENERAL ANESTHESIA WITH OR WITHOUT FEMORAL NERVE BLOCK.
Source
Journal of Cardiovascular Disease Research. 15(9) (pp 2339-2345), 2024.
Date of Publication: 2024.
Author
Shishir K.R.; Vasudev M.L.
Institution
(Shishir, Vasudev) Department of Anaesthesiology, Vydehi Institute of
Medical Sciences & Research Centre, Bangalore, India
Publisher
EManuscript Technologies
Abstract
Introduction: Pediatric cardiac catheterization interventions become an
established way of care for selected patients with congenital heart
diseases (CHD). Interventional procedures in small infants become more
feasible with reduced morbidity and mortality. This is related to the
current availability of a wide range of choices of catheters, wires,
balloons, sheaths, and flexible, low-profile coronary stents as well as
the improvements in pediatric anesthesia and ICU care. The current
balloons and coronary stents can be delivered through a 4 to 5 Frech
sheaths. Material(s) and Method(s): This study was a prospective,
observational clinical study for the use of femoral nerve block in
paediatric patients undergoing diagnostic or interventional cardiac
catheterization in the cath lab at Department of Anaesthesiology, Vydehi
Institute of Medical Sciences & Research Centre, Bangalore, India.
Enrolled patient's parents gave written informed consent. Study included a
total number of patients-50, aged between 2-10 years and weighed between
6-25 kg. They were randomly divided into two groups- group A (n=50) and
group B (n-50), Group A patients received femoral nerve block along with
IV sedation and analgesia, while group B patients received only IV
sedation and analgesia. Procedures included in the study were diagnostic
procedure and interventional cardiac procedures. Result(s): Group A
patients required IV ketamine 3.24mg/kg (+/-0.31SD) as compared to
5.58mg/kg (+/-1.6SD) in group B, which suggests significantly reduced
requirement of IV anesthetic agents in group where femoral nerve block has
been given. Hemodynamic parameters remained stable and comparable (no
statistically significant variation) Pain score was less in group A
patients than group B. Conclusion(s): Femoral nerve block is safe and
effective as an adjuvant to sedative and analgesics in paediatric patients
undergoing diagnostic or interventional cardiac catheterization
procedures. The success rate is very high with minimal or no complications
if performed properly. Some older paediatric patients may not require any
intravenous sedation or analgesia, and can be managed with only femoral
nerve block. Copyright © 2024 EManuscript Technologies. All
rights reserved.

<105>
Accession Number
2035693467
Title
Postoperative Cognitive Dysfunction following General Anaesthesia in
Patients Undergoing Elective Non-cardiac Surgery.
Source
Journal of the College of Physicians and Surgeons Pakistan. 30(4) (pp
417-419), 2020. Date of Publication: April 2020.
Author
Yousuf M.S.; Samad K.; Ullah H.
Institution
(Yousuf, Samad, Ullah) Department of Anaesthesiology, The Aga Khan
University Hospital, Karachi, Pakistan
Publisher
College of Physicians and Surgeons Pakistan
Abstract
Objective: To determine frequency of early postoperative cognitive
dysfunction (POCD) in patients aged 40 to 60 years, following general
anaesthesia in patients undergoing elective, non-cardiac surgery.
 Study Design: Descriptive study. Place and Duration of Study:
Department of Anaesthesiology, The Aga Khan University Hospital (AKUH),
Karachi, from December 2015 to May 2016. Methodology: After obtaining
approval from Ethical Review Committee of AKUH and informed consent, ASA I
and II patients, aged between 40 to 60 years of either gender, undergoing
general anaesthesia for elective non-cardiac surgical procedures, were
recruited. Patients were assessed preoperatively by using mini-mental
state examination (MMSE); and patients having a score equal to or greater
than 23 (maximum 30) were included in the study. All patients were
reassessed at 24 hours postoperatively by MMSE. Both the MMSE evaluations
were performed by primary investigator on predesigned data collection
form. Result(s): A total of 150 patients were enrolled in the study.
Preoperative MMSE score ranged from 24 to 30 while postoperative MMSE
score (at 24 hours) was between 25 and 30. Thus, no patient developed POCD
following general anaesthesia for elective, non- cardiac surgery in this
study. Conclusion(s): Early POCD was not found in the presently
studied population of middle aged patients having elective non-cardiac
surgery under general anaesthesia. Copyright © 2020 College of
Physicians and Surgeons Pakistan. All rights reserved.

<106>
[Use Link to view the full text]
Accession Number
2035548071
Title
Quality of life in patients with advanced heart failure and an implanted
left ventricular assist device: An umbrella review protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 17(10) (pp
2115-2121), 2019. Date of Publication: 29 Jul 2019.
Author
Abrams D.; McNair M.
Institution
(Abrams, McNair) School of Nursing, University of Mississippi Medical
Center, Jackson, United States
(Abrams, McNair) Mississippi Centre for Evidence Based Practice: A Joanna
Briggs Institute Centre of Excellence, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objective:This review aims to evaluate the effectiveness of implanted left
ventricular assist devices on quality of life in patients with advanced
heart failure.Introduction:Approximately 500,000 patients worldwide are
diagnosed with advanced heart failure. The preferred treatment for
patients who remain symptomatic after standard medical treatment is heart
transplantation. However, due to the shortage of donor organs, left
ventricular assist devices are increasingly used as an alternative. This
umbrella review is necessary to advise clinicians so they may provide
patients and families with clear information on standard medical
treatment, implanted left ventricular assist devices and heart
transplantation.Inclusion criteria:This umbrella review will consider
research syntheses that include patients 16 years or over with advanced
heart failure and an implanted left ventricular assist device. The primary
outcome is quality of life, and secondary outcomes include patient
survival rates and the New York Heart Association functional
classification changes. Method(s):An initial search of PubMed and
CINAHL has been undertaken to identify articles and create a search
strategy. Retrieved articles will be screened against the inclusion
criteria. Included studies will be critically appraised for methodological
quality according to JBI umbrella review methodology, and data will be
extracted using the standardized JBI data extraction tool. The results
will be presented in a Summary of Evidence, and a GRADE Summary of
Findings will be produced for grading the quality of the evidence.
 Copyright © 2019 Joanna Briggs Institute.

<107>
Accession Number
2035473749
Title
Amino acids and the kidney; friends or foes?.
Source
Current Opinion in Clinical Nutrition and Metabolic Care. (no
pagination), 2024. Article Number: 10.1097/MCO.0000000000001083. Date of
Publication: 2024.
Author
Baiardo Redaelli M.; Landoni G.; Monti G.; Bellomo R.
Institution
(Baiardo Redaelli, Landoni, Monti) Department of Anesthesia and Intensive
Care, IRCCS San Raffaele Scientific Institute, Italy
(Landoni, Monti) Vita-Salute San Raffaele University, Milan, Italy
(Bellomo) Department of Critical Care, University of Melbourne, Australia
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Monash University, Melbourne, Australia
(Bellomo) Department of Intensive Care, Austin Hospital, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of review Acute kidney injury (AKI) is common in hospitalized
patients and is independently associated with morbidity and mortality.
Moreover, AKI increases the risk of chronic kidney disease, which is a
major healthcare problem. Currently, no single therapy has been proven to
be effective in preventing AKI. The role of amino acids in the context of
kidney function and AKI prevention has been controversial and most of the
evidence is available from nutritional studies. However, knowledge of
amino acids in recruiting renal functional reserve and their potential
role to protect renal function under stress has recently expanded. Recent
findings The nephroprotective effects of amino acids were first postulated
in 1973. Recently, this strategy gained renewed interest and has been more
extensively studied, reintroducing their use in clinical situations
characterized by a high incidence of AKI. Intravenous amino acids
administration for kidney protection is now supported by a large
multinational randomized double-blind controlled trial in cardiac surgery
and by experimental and observational data. All such data support the
rationale for a biologically and clinically important nephroprotective
effect. Summary The infusion of amino acids was recently found to reduce
the incidence of AKI in cardiac surgery patients and surgical patients.
This strategy for the protection of renal function is supported by a
multicenter, international, double-blind randomized trial, with a huge
potential for additional application in several clinical fields. Several
mechanisms of action support the robustness of these findings and are
summarized in this manuscript. Copyright © 2024 Wolters Kluwer
Health, Inc.

<108>
Accession Number
2032328558
Title
Clinical Outcomes of Transcatheter Mitral Valve-In-Valve and Valve-In-Ring
Implantation: A Systematic Review and Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2024.
Date of Publication: 2024.
Author
Fong K.Y.; Koh J.M.Y.; Saw L.W.; Anggreni D.; Ng E.Z.X.; Chan Y.H.; Poon
K.; Stub D.; Sung S.-H.; Chandavimol M.; Lee M.K.-Y.; Chui A.S.F.;
Gopalamurugan A.B.; Nair R.; Guo Y.; Amanullah M.R.; Chao V.T.T.; Ewe
S.H.; Ho K.W.; Yap J.
Institution
(Fong, Koh, Saw, Anggreni, Ng) Yong Loo Lin School of Medicine, National
University of Singapore, Singapore, Singapore
(Fong) Department of Cardiology, Changi General Hospital, Singapore,
Singapore
(Chan) Biostatistics Unit, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore, Singapore
(Poon) Department of Cardiology, The Prince Charles Hospital, Brisbane,
QLD, Australia
(Stub) Department of Cardiology, Alfred Hospital, Melbourne, VIC,
Australia
(Sung) Division of Cardiology, Taipei Veterans General Hospital, Taipei,
Taiwan (Republic of China)
(Chandavimol) Department of Cardiology, Ramathibodi Hospital, Bangkok,
Thailand
(Lee, Chui) Division of Cardiology, Queen Elizabeth Hospital, King's Park,
Hong Kong
(Gopalamurugan) The Heart Valve Centre, HeartTeam India, Chennai, India
(Nair) Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
(Guo) Department of Cardiovascular Surgery and Cardiovascular Surgery
Research Laboratory, West China Hospital, Sichuan University, Sichuan,
China
(Amanullah, Ewe, Ho, Yap) Department of Cardiology, National Heart Centre
Singapore, Singapore, Singapore
(Amanullah, Chao, Ewe, Ho, Yap) Duke-NUS Medical School, Singapore,
Singapore
(Chao) Department of Cardiothoracic Surgery, National Heart Centre
Singapore, Singapore, Singapore
Publisher
John Wiley and Sons Inc
Abstract
Background: Transcatheter valve-in-valve (VIV) or valve-in-ring (VIR)
therapies for degenerated mitral bioprosthetic valves and rings are still
evolving. We aimed to characterize short- and long-term outcomes of these
procedures. Method(s): An electronic literature search was conducted
to retrieve articles describing mitral VIV or VIR implantation with at
least 10 patients. Meta-analysis of proportions was carried out for 30-day
or in-hospital outcomes of mortality, stroke, major bleeding, transfusion,
acute kidney injury, procedural success, valve embolization, paravalvular
leak, pacemaker implantation, and hospital stay. Individual patient data
meta-analysis using Kaplan-Meier curve reconstruction was used to estimate
long-term mortality of VIV, VIR and redo surgical mitral valve replacement
(SMVR). Result(s): We analyzed 34 studies (7047 patients). Pooled
procedural success was 94.8% in VIV and 80.5% in VIR. Pooled short-term
mortality and stroke risk was 6.4% and 1.9% respectively in VIV, 9.1% and
1.6% respectively in VIR, and 8.4% and 5.5% respectively in SMVR.
 Conclusion(s): This study provides prognostic information on clinical
outcomes for redo SMVR and transcatheter mitral VIV and VIR
implantation. Copyright © 2024 Wiley Periodicals LLC.

<109>
Accession Number
2032322415
Title
Transcatheter Aortic Valve Replacement in Patients With Severe Rheumatic
Aortic Stenosis: A Proportional Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2024.
Date of Publication: 2024.
Author
Ahsan M.J.; Ahmad S.; Ghumman G.M.; Dvalishvili M.; Malik S.A.; Islam
A.M.; Goldsweig A.M.
Institution
(Ahsan) Department of Cardiology, Baylor University Medical Center,
Dallas, TX, United States
(Ahmad, Malik, Goldsweig) Department of Cardiology, University of Nebraska
Medical Center, Omaha, NE, United States
(Ghumman) Department of Cardiology, St. Vincent Mercy Medical Center,
Toledo, OH, United States
(Dvalishvili) Department of Cardiology, East Carolina University,
Greenville, NC, United States
(Islam, Goldsweig) Department of Cardiology, Baystate Medical Center/UMass
Chan Medical School, Springfield, MA, United States
Publisher
John Wiley and Sons Inc

<110>
Accession Number
645808529
Title
Practice Changing Updates in Perioperative Medicine Literature 2023. A
Systematic Review.
Source
The American journal of medicine. (no pagination), 2024. Date of
Publication: 13 Nov 2024.
Author
Silbert R.E.; Khambaty M.; Devalapalli A.P.; Kashiwagi D.T.; Stephenson
C.R.; Bartlett M.A.; Regan D.W.; Sundsted K.K.; Mauck K.F.
Institution
(Silbert, Stephenson, Bartlett, Mauck) Division of General Internal
Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of
Medicine, Rochester, MN, United States
(Khambaty, Devalapalli, Kashiwagi, Regan, Sundsted) Division of Hospital
Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic
College of Medicine, Rochester, MN, United States
Abstract
Perioperative medicine is an evolving field with important publications
each year across multiple disciplines. Staying up to date in the field is
complicated due to the wide range of journals that publish relevant
articles. This review summarizes the most noteworthy perioperative
publications in 2023. We conducted a multi-database search of the
literature from January to December 2023 and included all original
research articles, meta-analyses, systematic reviews, and guidelines.
Abstracts, case reports, letters, protocols, pediatric and obstetric
articles, and cardiac surgery publications were excluded. Two authors
reviewed each reference using the Distiller SR systematic review software
(Evidence Partners Inc., Ottawa, Ontario, Canada). A modified Delphi
technique was used to identify eight practice-changing articles as well as
another eight articles for table-based summary. Copyright © 2024.
Published by Elsevier Inc.

<111>
Accession Number
645806463
Title
Definitions of clinical study outcome measures for cardiovascular
diseases: the European Unified Registries for Heart Care Evaluation and
Randomized Trials (EuroHeart).
Source
European heart journal. (no pagination), 2024. Date of Publication: 15
Nov 2024.
Author
Wilkinson C.; Bhatty A.; Batra G.; Aktaa S.; Smith A.B.; Dwight J.;
Rucinski M.; Chappell S.; Alfredsson J.; Erlinge D.; Ferreira J.;
Gudmundsdottir I.J.; Hrafnkelsdottir ThJ.; Ingimarsdottir I.J.; Irs A.;
Janosi A.; Jarai Z.; Oliveira-Santos M.; Popescu B.A.; Vasko P.; Vinereanu
D.; Yap J.; Bugiardini R.; Cenko E.; Nadarajah R.; Sydes M.R.; James S.;
Maggioni A.P.; Wallentin L.; Casadei B.; Gale C.P.
Institution
(Wilkinson) Hull York Medical School, University of York, York YO10 5DD,
United Kingdom
(Wilkinson) Academic Cardiovascular Unit, South Tees NHS Foundation Trust,
James Cook University Hospital, Middlesbrough, United Kingdom
(Bhatty, Aktaa, Smith, Chappell, Nadarajah, Gale) Leeds Institute of
Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United
Kingdom
(Bhatty, Aktaa, Smith, Chappell, Nadarajah, Gale) Leeds Institute for Data
Analytics, University of Leeds, Leeds, United Kingdom
(Bhatty, Aktaa, Nadarajah, Gale) Department of Cardiology, Leeds Teaching
Hospitals NHS Trust, Leeds, United Kingdom
(Batra, James, Wallentin) Department of Medical Sciences, Cardiology and
Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
(Dwight, Rucinski) European Society of Cardiology Patient Forum
(Alfredsson, Vasko) Department of Cardiology, Linkoping University
Hospital, Linkoping, Sweden
(Erlinge) Department of Clinical Sciences, Lund University, Lund, Sweden
(Ferreira) Department of Cardiology, Hospital de Santa Cruz, Centro
Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
(Gumundsdottir, Hrafnkelsdottir, Ingimarsdottir) Department of Cardiology,
Landspitali University Hospital, Reykjavik, Iceland
(Ingimarsdottir) Department of Health Sciences, Faculty of Medicine,
University of Iceland, Reykjavik, Iceland
(Irs) Heart Clinic, Tartu University Hospital, Tartu, Estonia
(Janosi) Gyorgy Gottsegen National Cardiovascular Institute, Budapest,
Hungary
(Jarai) Department of Cardiology, Szent Imre Teaching Hospital, South Buda
Center Hospital, Budapest, Hungary
(Oliveira-Santos, Vinereanu) Cardiology Department, Unidade Local de Saude
de Coimbra, Coimbra, Portugal
(Popescu) Cardiology Clinic, University of Medicine and Pharmacy Carol
Davila, Emergency Institute for Cardiovascular Diseases Prof Dr C C
Iliescu, Bucharest, Romania
(Vinereanu) Cardiology and Cardiovascular Surgery, University and
Emergency Hospital, Bucharest, Romania
(Yap) Department of Cardiology, National Heart Centre Singapore, Singapore
(Bugiardini, Cenko) Department of Experimental, Diagnostic and Specialty
Medicine, Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy
(Sydes) BHF Data Science Centre, London, United Kingdom
(Sydes) MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and
Methodology, UCL, London, United Kingdom
(Maggioni) ANMCO Research Centre, Heart Care Foundation, Florence 50121,
Italy
(Casadei) Division of Cardiovascular Medicine, NIHR Oxford Biomedical
Research Centre, University of Oxford, Oxford, United Kingdom
Abstract
BACKGROUND AND AIMS: Standardized definitions for outcome measures in
randomized clinical trials and observational studies are essential for
robust and valid evaluation of medical products, interventions, care, and
outcomes. The European Unified Registries for Heart Care Evaluation and
Randomised Trials (EuroHeart) project of the European Society of
Cardiology aimed to create international data standards for cardiovascular
clinical study outcome measures. METHOD(S): The EuroHeart methods for
data standard development were used. From a Global Cardiovascular Outcomes
Consortium of 82 experts, five Working Groups were formed to identify and
define key outcome measures for: cardiovascular disease (generic
outcomes), acute coronary syndrome and percutaneous coronary intervention
(ACS/PCI), atrial fibrillation (AF), heart failure (HF) and transcatheter
aortic valve implantation (TAVI). A systematic review of the literature
informed a modified Delphi method to reach consensus on a final set of
variables. For each variable, the Working Group provided a definition and
categorized the variable as mandatory (Level 1) or optional (Level 2)
based on its clinical importance and feasibility. RESULT(S): Across
the five domains, 24 Level 1 (generic: 5, ACS/PCI: 8, AF: 2; HF: 5, TAVI:
4) and 48 Level 2 (generic: 18, ACS-PCI: 7, AF: 6, HF: 2, TAVI: 15)
outcome measures were defined. CONCLUSION(S): Internationally derived
and endorsed definitions for outcome measures for a range of common
cardiovascular diseases and interventions are presented. These may be used
for data alignment to enable high-quality observational and randomized
clinical research, audit, and quality improvement for patient
benefit. Copyright © The Author(s) 2024. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<112>
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

<113>
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

<114>
Accession Number
372108942
Title
Dynamics in medical treatment of ischemic heart disease in clinical
practice.
Source
Rational Pharmacotherapy in Cardiology. 9(6) (pp 611-618), 2013. Date of
Publication: 2013.
Author
Shalnova S.A.; Deev A.D.; Boytsov A.S.
Institution
(Shalnova, Deev, Boytsov) State Research Center for Preventive Medicine,
Petroverigsky per. 10, Moscow, 101990, Russian Federation
Publisher
Stolichnaya Izdatelskaya Kompaniya
Abstract
At the present time ischemic heart disease (IHD) continues to be the
leading cause of cardiovascular mortality. Improvement of treatment
methods is an important aspect in reduction of IHD fatal complications.
Aim. To carry out a meta-analysis of several clinical and epidemiological
studies with research on the use of drugs with established prognostic
effect in patients with IHD. Material and methods. Analysis of dynamics in
drug prescription in IHD was conducted based on Russian clinical and
epidemiological trials, performed from 2004 to 2009 years. Results. The
total amount of patients was 17345. Majority of them suffered from
arterial hypertension (81.6%), one third had a history of myocardial
infarction, more than a half revealed heart failure (59.8%). At that
history of diabetes mellitus was only registered in 10.5% of the patients
varying from 8% to 17.6%. Lipid metabolism disorders were present in more
than a half of the patients. On the average one in four patients was
obese. At drug therapy analysis it was found out that 6.4% of the IHD
patients received no medications. Statins intake increased from 5.3% to
85.7% in men and from 9.6% to 69.3% in women in last 5 years. Incidence of
the renin-angiotensin-aldosterone system blockers intake increased by 13%
in the both genders. Men with IHD received antiplatelet agents more often
than women. So, only 45.9% of women received these drugs in 2004 and 57.9%
- in 2009, while men increased antiplatelet agents use from 58.5% in 2004
to 63.5% in 2009. Men received beta-blockers by 14% more often in 2009
(74.6%) than in 2004 and women - by 30% (82.4%). Conclusion. The incidence
of the prescription of the drugs with established prognostic value has
increased recently. At that rate of IHD mortality in cardiovascular
mortality structure continues to be high probably due to inadequate
treatment. First, the number of coronary surgical interventions in our
patients is significantly lower than in the other countries. Second,
despite considerable increase in the drug use, doses and adherence to
treatment remain insufficient. Representative trials with participation of
different-level healthcare institutions are reasonable.

<115>
Accession Number
2035712520
Title
Electronic Nudges to Increase Influenza Vaccination in Patients with
Chronic Diseases: A Randomized Clinical Trial.
Source
JAMA. 332(22) (no pagination), 2024. Date of Publication: 10 Dec 2024.
Author
Johansen N.D.; Vaduganathan M.; Bhatt A.S.; Modin D.; Chatur S.; Claggett
B.L.; Janstrup K.H.; Larsen C.S.; Larsen L.; Wiese L.; Dalager-Pedersen
M.; Kober L.; Solomon S.D.; Sivapalan P.; Jensen J.U.S.; Martel C.J.-M.;
Krause T.G.; Biering-Sorensen T.
Institution
(Johansen, Modin, Janstrup, Biering-Sorensen) Department of Cardiology,
Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
(Johansen, Modin, Janstrup, Biering-Sorensen) Center for Translational
Cardiology and Pragmatic Randomized Trials, Department of Biomedical
Sciences, Faculty of Health and Medical Sciences, University of
Copenhagen, Denmark
(Johansen, Vaduganathan, Chatur, Claggett, Solomon) Cardiovascular
Division, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Vaduganathan, Solomon) Center for Cardiometabolic Implementation Science,
Brigham and Women's Hospital, Boston, MA, United States
(Bhatt) Kaiser Permanente San Francisco Medical Center, Division of
Research, San Francisco, CA, United States
(Bhatt) Stanford University School of Medicine, Palo Alto, CA, United
States
(Larsen) Department of Clinical Medicine, Department of Infectious
Diseases, Aarhus University Hospital, Aarhus, Denmark
(Larsen) Research Unit for Infectious Diseases, Odense University
Hospital, Odense, Denmark
(Wiese) Department of Infectious Diseases, Zealand University Hospital,
Roskilde, Denmark
(Dalager-Pedersen) Department of Infectious Diseases, Aalborg University
Hospital, Aalborg, Denmark
(Dalager-Pedersen) Department of Clinical Medicine, Aalborg University
Hospital, Aalborg, Denmark
(Kober, Sivapalan, Jensen) Department of Clinical Medicine, Faculty of
Health and Medical Sciences, University of Copenhagen, Denmark
(Kober) Department of Cardiology, Copenhagen University
Hospital-Rigshospitalet, Copenhagen, Denmark
(Sivapalan, Jensen) Respiratory Medicine Section, Department of Medicine,
Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
(Martel, Krause) Epidemiological Infectious Disease Preparedness, Statens
Serum Institut, Copenhagen, Denmark
(Biering-Sorensen) Steno Diabetes Center Copenhagen, Copenhagen, Denmark
Publisher
American Medical Association
Abstract
Importance: Despite strong worldwide guideline recommendations, influenza
vaccination rates remain suboptimal among young and middle-aged patients
with chronic diseases. Effective scalable strategies to increase
vaccination are needed. Objective(s): To investigate whether
electronically delivered letter-based nudges informed by behavioral
science could increase influenza vaccination uptake among patients aged 18
to 64 years with chronic diseases. Design, Setting, and
Participant(s): Nationwide pragmatic registry-based randomized clinical
implementation trial conducted between September 24, 2023, and May 31,
2024, enrolling all Danish citizens aged 18 to 64 years who met criteria
for free-of-charge influenza vaccination in light of preexisting chronic
disease. All trial data were sourced from nationwide administrative health
registries. Intervention(s): Randomized in 2.45:1:1:1:1:1:1 ratio to
no letter (usual care) or 6 different behaviorally informed electronic
letters. Main Outcomes and Measures: The primary end point was
receipt of influenza vaccination on or before January 1, 2024, assessed in
7 prespecified coprimary comparisons (all intervention groups pooled vs
usual care and each individual intervention group vs usual care). Absolute
risk difference in proportions and a crude relative risk were calculated
for each comparison. Result(s): A total of 299881 participants (53.2%
[159454] female, median age, 52.0 [IQR, 39.8-59.0] years) were randomized.
Compared with usual care, influenza vaccination rates were higher among
those receiving any intervention letter (any intervention letter, 39.6% vs
usual care, 27.9%; difference, 11.7 percentage points; 99.29% CI,
11.2-12.2 percentage points; P <.001). Each individual letter type
significantly increased influenza vaccination with the largest effect
sizes observed with a repeated letter sent 10 days after the initial
letter (repeated letter, 41.8% vs usual care, 27.9%; difference, 13.9
percentage points; 99.29% CI, 13.1-14.7 percentage points; P <.001) and a
letter emphasizing potential cardiovascular benefits of vaccination
(cardiovascular gain, 39.8% vs usual care, 27.9%; difference, 11.9
percentage points; 99.29% CI, 11.1-12.7 percentage points; P <.001).
Vaccination rates were improved across major subgroups. Conclusions
and Relevance: In a nationwide randomized clinical implementation trial,
electronically delivered letter-based nudges markedly increased influenza
vaccination compared with usual care among young and middle-aged patients
with chronic diseases. The results of this study suggest that simple,
scalable, and cost-efficient electronic letter strategies may have
substantial public health implications. Copyright © 2024 American
Medical Association.

<116>
Accession Number
2035712357
Title
Assessment of Antitachycardia Pacing in Primary Prevention Patients: The
APPRAISE ATP Randomized Clinical Trial.
Source
JAMA. 332(20) (no pagination), 2024. Date of Publication: 26 Nov 2024.
Author
Schuger C.; Joung B.; Ando K.; Mont L.; Lambiase P.D.; O'Hara G.E.;
Jennings J.M.; Yung D.; Boriani G.; Piccini J.P.; Wold N.; Stein K.M.;
Daubert J.P.
Institution
(Schuger) Clinical Cardiac Research Center, University of Rochester,
Rochester, NY, United States
(Joung) Yonsei University, Severance Hospital, Seoul, South Korea
(Ando) Department of Cardiology, Kokura Memorial Hospital, Kitakyushu,
Japan
(Mont) Universitat de Barcelona, Hospital Clinic, Barcelona, Spain
(Lambiase) Bart's Heart Centre, St Bartholomew's Hospital, London, United
Kingdom
(O'Hara) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec, QC, Canada
(Jennings) Heart Center Research, Huntsville, AL, United States
(Yung) Scarborough Health Network, Scarborough, ON, Canada
(Boriani) Cardiology Division, Department of Biomedical, Metabolic and
Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
(Piccini, Daubert) Duke Clinical Research Institute, Division of
Cardiology, Duke University, Durham, NC, United States
(Wold, Stein) Boston Scientific Corporation, Saint Paul, MN, United States
Publisher
American Medical Association
Abstract
Importance: The emergence of novel programming guidelines that reduce
premature and inappropriate therapies along with the availability of new
implantable cardioverter-defibrillator (ICD) technologies lacking
traditional endocardial antitachycardia pacing (ATP) capabilities requires
the reevaluation of ATP as a first strategy in terminating fast
ventricular tachycardias (VTs) in primary prevention ICD recipients.
 Objective(s): To assess the role of ATP in terminating fast VTs in
primary prevention ICD recipients with contemporary programming.
 Design, Setting, and Participant(s): This global, prospective,
double-blind, randomized clinical trial had an equivalence design with a
relative margin of 35%. Superiority tests were performed at interim
analyses and the final analysis if equivalence was not proven. Patients
were enrolled between September 2016 and April 2021 at 134 sites in 8
countries, with the last date of follow-up on July 6, 2023. Patients were
required to have an indication for a primary prevention ICD, including
left ventricular ejection fraction less than or equal to 35%.
 Intervention(s): Patients were randomized in a 1:1 ratio to receive
ATP plus shock vs shock only. Main Outcomes and Measures: The primary
end point was time to first all-cause shock. Secondary end points included
time to first appropriate shock, time to first inappropriate shock,
all-cause mortality, and the composite of time to first all-cause shock
plus all-cause mortality. Result(s): A total of 2595 patients were
randomized (mean age, 63.9 years; 22.4% were females). At a mean follow-up
of 38 months, first all-cause shock occurred in 129 participants in the
ATP plus shock group and 178 participants in the shock only group. The
hazard ratio (HR) for the primary end point was 0.72 (95.9% CI,
0.57-0.92), with P =.005 for superiority of the ATP plus shock group over
the shock only group. During follow-up in an intention-to-treat analysis,
the total shock burden per 100 patient-years was not statistically
different, at 12.3 and 14.9, respectively (P =.70). Conclusions and
Relevance: The use of a single burst of ATP prior to shock in primary
prevention ICD recipients with modern ICD detection programming prolonged
the time to first all-cause ICD shock. Trial Registration:
ClinicalTrials.gov Identifier: NCT02923726. Copyright © 2024
American Medical Association. All rights reserved.

<117>
Accession Number
2034993724
Title
Preoperative Identification of Adamkiewicz Artery in Pediatric Posterior
Thoracic Tumors: Fact or Fiction? A Systematic Review from the
International Society of Pediatric Surgical Oncology (IPSO).
Source
Journal of Pediatric Surgery. 59(12) (no pagination), 2024. Article
Number: 161985. Date of Publication: December 2024.
Author
Zarfati A.; Guerin F.; Dioguardi Burgio M.; Fuchs J.; Sarnacki S.; Losty
P.D.; Pio L.
Institution
(Zarfati) University of Rome Tor Vergata, Italy
(Zarfati, Guerin, Pio) Department of Pediatric Surgery, Bicetre Hospital,
Assistance Publique - Hopitaux de Paris (APHP), France
(Zarfati, Guerin, Pio) Universite Paris Saclay, France
(Dioguardi Burgio) Department of Radiology, Beaujon Hospital, Assistance
Publique - Hopitaux de Paris (APHP), France
(Dioguardi Burgio) Universite Paris Cite, Inserm, Centre de recherche sur
l'inflammation, Paris F-75018, France
(Fuchs) Department of Pediatric Surgery and Pediatric Urology, University
Children's Hospital Tuebingen, Germany
(Sarnacki) Department of Pediatric Surgery, Necker Enfants Malade
Hospital, Assistance Publique - Hopitaux de Paris (APHP), France
(Sarnacki) Universite Paris-Cite, France
(Losty) Institute of Systems Molecular and Integrative Biology University
of Liverpool, United Kingdom
(Losty) Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
Publisher
W.B. Saunders
Abstract
Background and aims: We aimed to review current literature on the impact
of Preoperative Identification (POI) of the Adamkiewicz Artery (AKA) in
solid pediatric Posterior Thoracic Tumors (PTT), comprising a spectrum of
neuroblastic tumors and neuroblastoma, with particular focus on Complete
Macroscopic Excision (CME) and Neurologic Complications/Sequelae (NCS).
 Method(s): A systematic review in accordance with PRISMA guidelines
was undertaken. The study included reports on pediatric patients providing
available data on POI of the AKA in PTT. Result(s): Among 838 records
screened, 33 full-texts underwent evaluation, and 8 papers were included.
Among 49 tumors (N = 49 patients), 30 were neuroectodermic tumors. Spinal
angiography (SA) was undertaken in four studies for 32 (65%) patients. No
SA-related morbidity was recorded. Otherwise, a combination of CT and/or
MRI imaging was described. The lack of detailed reporting on CT/MRI
imaging, hindered a feasible detailed comparative analysis among non-SA
imaging modality techniques. The overall success rate of AKA POI was 65%,
71% with SA and 33% with non-SA studies. CME was achieved in 73% of SA and
80% non-SA groups. Overall, 5 children experienced NCS, 60% of those who
had dumbbell tumors. All NCS occurred in patients without successful POI
of the AKA. Furthermore, no SA patient had NCS, while 33% of the non-SA
sustained NCS. Conclusion(s): Successful POI of the AKA may play a
key role in prevention of NCS. SA showed the utility of deploying POI,
without added morbidity. Furthermore, SA appeared to have a preventive
impact on NCS. SA may have a key role on CME which may also be operator
dependent. Copyright © 2024 The Author(s)

<118>
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.

<119>
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.

<120>
Accession Number
645727645
Title
Tranexamic acid for preventing postpartum haemorrhage after caesarean
section.
Source
Cochrane Database of Systematic Reviews. 2024(11) (no pagination), 2024.
Article Number: CD016278. Date of Publication: 13 Nov 2024.
Author
Rohwer C.; Rohwer A.; Cluver C.; Ker K.; Hofmeyr G.J.
Institution
(Rohwer, Cluver) Department of Obstetrics and Gynaecology, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape Town, South
Africa
(Rohwer) Centre for Evidence-based Health Care, Division Epidemiology and
Biostatistics, Department of Global Health, Faculty of Medicine and Health
Sciences, Stellenbosch University, Cape Town, South Africa
(Ker) Clinical Trials Unit, London School of Hygiene & Tropical Medicine,
London, United Kingdom
(Hofmeyr) Effective Care Research Unit, University of the Witwatersrand
and Walter Sisulu University, Johannesburg and Easst London, South Africa
(Hofmeyr) Department of Obstetrics and Gynaecology, University of
Botswana, Gabarone, Botswana
Publisher
John Wiley and Sons Ltd
Abstract
Rationale: Postpartum haemorrhage (PPH) is common and potentially
life-threatening. The antifibrinolytic drug tranexamic acid (TXA) is
recommended for treating PPH; it reduces the risk of death from
haemorrhage by one-third when given soon after bleeding onset, but not
overall risk of death. Interest in whether TXA may be effective in
preventing PPH is growing. Evidence indicates that TXA given more than
three hours after injury to bleeding trauma patients increases mortality.
Potential harm becomes critical in prophylactic use of TXA. Reliable
evidence of the effect and safety profile of TXA is required before
widespread prophylactic use can be considered. Objective(s): To
assess the effects of TXA for preventing PPH compared to placebo or no
treatment (with or without uterotonic co-treatment) in women during
caesarean birth. Search Method(s): We searched CENTRAL, MEDLINE,
Embase, and WHO ICTRP to 20 February 2024 and searched reference lists of
retrieved studies. Eligibility criteria: We included randomised controlled
trials (RCTs) evaluating the use of TXA alone or plus uterotonics during
caesarean birth for preventing PPH. Trials needed to be prospectively
registered (i.e. before starting recruitment). We applied a
trustworthiness checklist. Outcome(s): The critical outcome was blood
loss >= 1000 mL, measured using estimated or calculated methods. Important
outcomes included maternal death, severe morbidity, blood transfusion, the
use of additional surgical interventions to control PPH, thromboembolic
events, use of additional uterotonics, hysterectomy, maternal
satisfaction, and breastfeeding at discharge. Risk of Bias: We
assessed risk of bias in the included studies using Cochrane's RoB 1 tool.
Synthesis methods: Two review authors independently selected trials,
extracted data, and assessed risk of bias and trial trustworthiness. We
pooled data using random-effects meta-analysis. We assessed the certainty
of the evidence using GRADE. Included studies: We included six RCTs with
15,981 participants. All 12 trials in the previous version of this review
were not included after review of trial registrations and trustworthiness
checklists. Most included studies involved women at low risk of PPH and
were conducted in high-resource settings. Synthesis of results:
Prophylactic TXA in addition to standard care compared to placebo in
addition to standard care or standard care alone. TXA results in little to
no difference in estimated blood loss >= 1000 mL (risk ratio (RR) 0.94,
95% confidence interval (CI) 0.79 to 1.11; 4 RCTs; n = 13,042; high
certainty evidence), resulting in 8 fewer per 1000 women having estimated
blood loss >= 1000 mL (from 30 fewer to 16 more). TXA likely results in a
slight reduction in calculated blood loss >= 1000 mL (RR 0.83, 95% CI 0.76
to 0.92; 2 RCTs; n = 4327; moderate certainty evidence), resulting in 53
fewer per 1000 having calculated blood loss >= 1000 mL (from 75 fewer to
25 fewer). The evidence is very uncertain about the effect of TXA on
maternal death (one event in placebo group, none in TXA group). No trials
measured severe morbidity. TXA likely results in little to no difference
in blood transfusion (RR 0.88, 95% CI 0.72 to 1.08; 5 RCTs; n = 15,740;
moderate certainty evidence), resulting in 4 fewer per 1000 women
requiring a blood transfusion (from 10 fewer to 3 more). TXA results in
little to no difference in additional surgical interventions to control
PPH (RR 1.02, 95% CI 0.86 to 1.22; 4 RCTs; n = 15,631; high certainty
evidence), resulting in 1 more per 1000 women requiring additional
surgical intervention (from 4 fewer to 7 more). The evidence is very
uncertain about the effect of TXA on thromboembolic events (RR 1.40, 95%
CI 0.22 to 8.90; 4 RCTs; n = 14,480; very low certainty evidence),
resulting in 1 more per 1000 women having a thromboembolic event (from 2
fewer to 17 more). TXA results in little to no difference in the need for
additional uterotonics (RR 0.88, 95% CI 0.78 to 1.00; 4 RCTs; n = 15,728;
high certainty evidence), resulting in 15 fewer per 1000 women requiring
additional uterotonics (from 27 fewer to 0 fewer). The evidence is very
uncertain about the effect of TXA on hysterectomy (RR 0.80, 95% CI 0.20 to
3.29; 2 RCTs; n = 4546; very low certainty evidence), resulting in 3 fewer
per 10,000 women requiring a hysterectomy (from 11 fewer to 31 more). One
trial measuring maternal satisfaction reported no difference between
groups at day two postpartum. No data were available on breastfeeding.
Overall, studies had low risk of bias. We downgraded the certainty of
evidence mainly for imprecision. Authors' conclusions: Prophylactic TXA in
addition to standard care during caesarean birth results in little to no
difference in estimated blood loss >= 1000 mL and likely results in a
slight reduction in calculated blood loss >= 1000 mL compared to placebo.
There were no data for severe morbidity due to PPH. Event rates for
further interventions to control PPH were low and similar across groups.
Prophylactic TXA thus results in little to no difference between groups
for additional surgical interventions (32 versus 31 per 1000), and likely
results in little to no difference between groups for blood transfusions
(31 versus 36 per 1000) and use of additional uterotonics (107 versus 121
per 1000). There were very few events for the outcomes maternal death (1
in placebo group), thromboembolic events (2 versus 3 per 1000), and
hysterectomy (1 per 1000 in each group). Evidence for these serious
adverse events is therefore very uncertain. Decisions about implementing
routine prophylactic TXA during caesarean birth should not only consider
outcomes related to blood loss, but also the relatively low rates of PPH
morbidity and uncertainty of serious adverse events. Most studies included
women at low risk of PPH, thereby precluding any conclusions about women
at high risk of PPH. Cost associated with routine use of an additional
drug for all caesarean births needs to be considered. Registration: The
published protocol and updates to the review can be accessed:. Protocol
(2009) DOI: 10.1002/14651858.CD007872. Original Review (2010) DOI:
10.1002/14651858.CD007872.pub2. Review Update (2015) DOI:
10.1002/14651858.CD007872.pub3. Copyright © 2024 The Authors.
Cochrane Database of Systematic Reviews published by John Wiley & Sons,
Ltd. on behalf of The Cochrane Collaboration.

<121>
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.

<122>
Accession Number
2035625734
Title
Risk Stratification in Nonischemic Dilated Cardiomyopathy Using CMR
Imaging: A Systematic Review and Meta-Analysis.
Source
JAMA. 332(18) (pp 1535-1550), 2024. Date of Publication: 12 Nov 2024.
Author
Eichhorn C.; Koeckerling D.; Reddy R.K.; Ardissino M.; Rogowski M.; Coles
B.; Hunziker L.; Greulich S.; Shiri I.; Frey N.; Eckstein J.; Windecker
S.; Kwong R.Y.; Siontis G.C.M.; Grani C.
Institution
(Eichhorn, Eckstein) Division of Acute Medicine, University Hospital
Basel, Basel, Switzerland
(Eichhorn, Rogowski) Private University in the Principality of
Liechtenstein, Triesen, Liechtenstein
(Eichhorn) Department of Internal Medicine, See-Spital, Horgen,
Switzerland
(Koeckerling, Frey) Department of Cardiology Angiology and Respiratory
Medicine, University Hospital Heidelberg, Heidelberg, Germany
(Reddy, Ardissino) National Heart and Lung Institute, Imperial College
London, London, United Kingdom
(Reddy, Ardissino) Nuffield Department of Population Health, University of
Oxford, Oxford, United Kingdom
(Ardissino) British Heart Foundation Cardiovascular Epidemiology Unit,
Department of Public Health and Primary Care, University of Cambridge,
Cambridge, United Kingdom
(Rogowski) Agaplesion General Hospital, Hagen, Germany
(Hunziker, Shiri, Windecker, Siontis, Grani) Department of Cardiology,
Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
(Coles) Velindre University NHS Trust Library and Knowledge Service,
Cardiff University, Wales, Cardiff, United Kingdom
(Greulich) Department of Cardiology and Angiology, University of Tubingen,
Tubingen, Germany
(Kwong) Cardiovascular Division, Department of Medicine, Brigham and
Women's Hospital, Boston, MA, United States
Publisher
American Medical Association
Abstract
Importance: Accurate risk stratification of nonischemic dilated
cardiomyopathy (NIDCM) remains challenging. Objective(s): To evaluate
the association of cardiac magnetic resonance (CMR) imaging-derived
measurements with clinical outcomes in NIDCM. Data Sources: MEDLINE,
Embase, Cochrane Library, and Web of Science Core Collection databases
were systematically searched for articles from January 2005 to April 2023.
Study Selection: Prospective and retrospective nonrandomized diagnostic
studies reporting on the association between CMR imaging-derived
measurements and adverse clinical outcomes in NIDCM were deemed eligible.
Data Extraction and Synthesis: Prespecified items related to patient
population, CMR imaging measurements, and clinical outcomes were extracted
at the study level by 2 independent reviewers. Random-effects models were
fitted using restricted maximum likelihood estimation and the method of
Hartung, Knapp, Sidik, and Jonkman. Main Outcomes and Measures:
All-cause mortality, cardiovascular mortality, arrhythmic events, heart
failure events, and major adverse cardiac events (MACE). Result(s): A
total of 103 studies including 29687 patients with NIDCM were analyzed.
Late gadolinium enhancement (LGE) presence and extent (per 1%) were
associated with higher all-cause mortality (hazard ratio [HR], 1.81 [95%
CI, 1.60-2.04]; P <.001 and HR, 1.07 [95% CI, 1.02-1.12]; P =.02,
respectively), cardiovascular mortality (HR, 2.43 [95% CI, 2.13-2.78]; P
<.001 and HR, 1.15 [95% CI, 1.07-1.24]; P =.01), arrhythmic events (HR,
2.69 [95% CI, 2.20-3.30]; P <.001 and HR, 1.07 [95% CI, 1.03-1.12]; P
=.004) and heart failure events (HR, 1.98 [95% CI, 1.73-2.27]; P <.001 and
HR, 1.06 [95% CI, 1.01-1.10]; P =.02). Left ventricular ejection fraction
(LVEF) (per 1%) was not associated with all-cause mortality (HR, 0.99 [95%
CI, 0.97-1.02]; P =.47), cardiovascular mortality (HR, 0.97 [95% CI,
0.94-1.00]; P =.05), or arrhythmic outcomes (HR, 0.99 [95% CI, 0.97-1.01];
P =.34). Lower risks for heart failure events (HR, 0.97 [95% CI,
0.95-0.98]; P =.002) and MACE (HR, 0.98 [95% CI, 0.96-0.99]; P <.001) were
observed with higher LVEF. Higher native T1 relaxation times (per 10 ms)
were associated with arrhythmic events (HR, 1.07 [95% CI, 1.01-1.14]; P
=.04) and MACE (HR, 1.06 [95% CI, 1.01-1.11]; P =.03). Global longitudinal
strain (GLS) (per 1%) was not associated with heart failure events (HR,
1.06 [95% CI, 0.95-1.18]; P =.15) or MACE (HR, 1.03 [95% CI, 0.94-1.14]; P
=.43). Limited data precluded definitive analysis for native T1 relaxation
times, GLS, and extracellular volume fraction (ECV) with respect to
mortality outcomes. Conclusion(s): The presence and extent of LGE
were associated with various adverse clinical outcomes, whereas LVEF was
not significantly associated with mortality and arrhythmic end points in
NIDCM. Risk stratification using native T1 relaxation times, extracellular
volume fraction, and global longitudinal strain requires further
evaluation. Copyright © 2024 American Medical Association. All
rights reserved.

<123>
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.

<124>
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.

<125>
Accession Number
2035605185
Title
Comparison of Inhalational and Intravenous Anesthesia Induction on
Electroencephalogram and Cerebral Perfusion in Children With Congenital
Heart Disease: A Secondary Analysis of a Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2024.
Date of Publication: 2024.
Author
Han D.; Xie S.; Pan S.; Ou Y.
Institution
(Han, Xie, Pan, Ou) Anesthesia Department, Children's Hospital affiliated
to Capital Institute of Pediatrics, Beijing, China
(Ou) Anesthesia Center, Beijing Anzhen Hospital affiliated to Capital
Medical University, Beijing, China
Publisher
W.B. Saunders
Abstract
Objectives: The effects of anesthetics on electroencephalograms and
cerebral perfusion remain understudied in children with congenital heart
disease. With regard to this, we compared inhalational anesthesia
induction and intravenous anesthesia induction. Design(s): A
randomized controlled trial. Setting(s): Operating room in 2 tertiary
hospitals. Participant(s): A cohort of 116 pediatrics patients
undergoing cardiac surgery. Measurements and Main Results: The
patients were randomly assigned to either the intravenous group (n = 58)
or the inhalational group (n = 58). The inhalational group received
anesthesia induction with 4% to 6% sevoflurane and a bolus of pipecuronium
0.2 mg/kg, whereas the intravenous group received anesthesia induction
with intravenous midazolam 0.2 mg/kg, pipecuronium 0.2 mg/kg, and
sufentanil 1 mug/kg. Ten minutes after tracheal intubation, the following
parameters were measured: spectral edge frequency, burst suppression
event, patient state index, middle cerebral artery blood flow velocity,
cerebral oxygen saturation, and hemodynamic parameters. In comparison with
the intravenous group, the inhalational group exhibited significant
increases in 95% spectral edge frequency, ratio of burst suppression
event, blood flow velocity in the middle cerebral artery, and cerebral
oxygen saturation (p < 0.05 for all), as well as decreases in systolic
pressure, diastolic pressure, cardiac index, and the maximal slope of
systolic upstroke (p < 0.05 for all). Conclusion(s): The
administration of sevoflurane for anesthesia induction results in more
burst suppression, while also demonstrating superior cerebral perfusion
when compared with the use of intravenous medications for anesthesia
induction. Trial registration: Chinese Clinical Trial Registry
(ChiCTR1800015946). Copyright © 2024 Elsevier Inc.

<126>
Accession Number
645778408
Title
A systematic review of the effect of massage therapy and reflexology on
vital signs.
Source
Traditional and Integrative Medicine. Conference: 1st National Congress of
PERSIAN MEDICINE. Tehran Iran, Islamic Republic of. 9(Supplement 1) (pp
146), 2024. Date of Publication: October 2024.
Author
Ghanbari M.; Momenian M.
Institution
(Ghanbari, Momenian) Department of Nursing, School of Nursing and
Midwifery, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Tehran University of Medical Sciences
Abstract
Background and Aim: Vital signs include temperature, pulse, blood
pressure, and breathing rate. Measuring and evaluating vital signs is the
first step in clinical examination. One of the approaches to changing
vital signs is the use of complementary medicine. The purpose of this
article is to review the effects of massage and reflexology on vital
signs. Method(s): A systematic search of relevant controlled
experimental studies was conducted in major databases such as PubMed,
Science Direct and Google Scholar search engine in the period 2013-2023.
The search strategy includes key words massage therapy, reflexology vital
signs, pressure, heart rate, respiratory rate. Repetitive and unrelated
articles, studies published in non-English languages, studies conducted on
non-patients are exclusion criteria. Finally, 17 articles out of 26 were
selected. Result(s): According to 17 studies reviewed in patients
with heart problems, after surgery, as well as patients admitted to the
ICU with a reduced level of consciousness, it was shown that massage
therapy and reflexology have reduced blood pressure and improved the blood
circulation of these patients, with This has variable effects on other
vital signs such as heart rate, breathing and temperature.
 Conclusion(s): The reviewed studies showed that massage therapy and
reflexology can be used to improve vital signs, especially lowering blood
pressure.

<127>
Accession Number
645778402
Title
Effect of reflexology on the sleep quality of patients undergoing coronary
artery bypass surgery: a review article.
Source
Traditional and Integrative Medicine. Conference: 1st National Congress of
PERSIAN MEDICINE. Tehran Iran, Islamic Republic of. 9(Supplement 1) (pp
144), 2024. Date of Publication: October 2024.
Author
Asgari F.; Aghajani M.
Institution
(Asgari, Aghajani) Trauma Center Research, Kashan University of Medical
Science, Kashan, Iran; Infectious Diseases Center, Kashan University of
Medical Science, Kashan, Iran
Publisher
Tehran University of Medical Sciences
Abstract
Background and Aim: Cardiovascular diseases account for the highest number
of deaths and are still the primary cause of death in the world. Many
patients with coronary artery diseases who do not respond to drug therapy
undergo coronary artery bypass surgery. After heart surgery, one of the
main problems of patients is sleep related problems. Massage therapy is
one of the non-pharmacological methods to solve sleep problems. Among
complementary treatments, massage ranks third in terms of prevalence of
use for patients. Therefore, the aim of this study is to determine the
effect of reflexology on the sleep quality of patients undergoing coronary
artery bypass surgery. Method(s): This study was systematic review.
The search of Persian and English database was done in IranMedex, SID,
Magiran, science direct, PubMed, Ovide, Elsevier, ProQuest respectively
from 2010-2022. Keywords was massage therapy, heart, heart surgery, sleep
quality, sleep disorder, reflexology. The inclusion criteria were
interventional studies related to reflexology. Result(s): From 8
reviewed articles, four were Persian and four were English. All studies
measure the effect of reflexology on the sleep quality of cardiac
patients. The sample size in the studies was minimum and maximum 30 to 90
people. In various studies, reflexology with kinds of oils had a
significantly effect on the overall sleep quality of patients.
 Conclusion(s): The findings showed the effectiveness of reflexology
in improving the sleep quality of patients undergoing coronary artery
bypass surgery. The studies had limitations such as the small number of
samples, defects in sampling, random allocation and follow-up, as well as
the difference in the duration of massage use, the type of oils and
measurement tools. Overall, a significant improvement observed in the
sleep quality of these patients. Therefore, reflexology can used as a
complementary approach to other therapeutic interventions in improving the
sleep quality of these patients.

<128>
Accession Number
645778304
Title
The effect of aromatherapy with lavender on vital signs and pain.
Source
Traditional and Integrative Medicine. Conference: 1st National Congress of
PERSIAN MEDICINE. Tehran Iran, Islamic Republic of. 9(Supplement 1) (pp
118), 2024. Date of Publication: October 2024.
Author
Momenian M.; Ghanbari M.
Institution
(Momenian, Ghanbari) Iran University of Medical Sciences, Tehran, Iran;
Department of Medical Surgical Nursing, Iran University of Medical
Sciences, Tehran, Iran
Publisher
Tehran University of Medical Sciences
Abstract
Background and Aim: Vital signs include temperature, pulse, blood pressure
and respiration rate, in the United States, they added pain as the fifth
vital sign. Their measurement and clinical evaluation are the first step
for clinical examination. One of the approaches used to change the vital
signs is the use of aromatherapy. The effects of lavender scent observed
in controlling pain, reducing depression and other beneficial .This
article aims to evaluate and summarize the results of clinical trials
conducted on the effect of lavender aromatherapy on Vital signs and pain.
 Method(s): A systematic search of related controlled experimental
studies was conducted in the main databases such as PubMed, Scopus,
Science Direct and search machine Google Scholar in a period 2014-2024.
The search strategy includes keywords Lavender, vital sign, blood
pressure, pain, heart rate/ Aromatherapy. Repetitive and unrelated
articles, studies published non-English languages, studies conducted on
non-patients such as nurses are among the exit criteria. Result(s):
In general, a total of 18 reviewed articles have shown that Aromatherapy
with lavender generally reduces vital signs in patients after oral
surgery, before rhinoplasty, ERCP, and BPH, and in patients undergoing
mechanical ventilation, as well as significantly reducing pain in
osteoarthritis patients and after gynecological surgeries and caesarean
section, before ERCP and during drain evacuation. According to the trials
conducted, aromatherapy with lavender in palliative care and cardiac
rehabilitation patients could not affect vital signs. The effect of this
in ACS patients and after CABG are variable. Conclusion(s): In
general, it can be concluded that lavender aromatherapy in patients with
acute problems has more effects on the control of vital signs and it can
be used as a non-medicinal treatment with less side effects in improving
vital signs.

<129>
Accession Number
2035748325
Title
Post-cardiac Surgery Chylopericardium.
Source
Journal of the College of Physicians and Surgeons Pakistan. 30(6) (pp
627-632), 2020. Date of Publication: June 2020.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, The First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Fujian Province, Putian,
China
Publisher
College of Physicians and Surgeons Pakistan
Abstract
Post-cardiac surgery chylopericardium is a rare complication. This
systematic review included 87 articles with 119 patients of post-cardiac
surgery chylopericardium. Chylopericardium developed after operations for
congenital heart defect more than those for acquired heart disease, and
more patients in whom post-cardiac surgery chylopericardium developed were
with complex than with simple congenital heart defects. Cardiac tamponade
occurred in 35 (29.4%) patients. The onset time of chylopericardium was
18.2 days earlier in patients operated for acquired than in those for
congenital heart defects. Post-cardiac surgery chylopericardium were
curable to conservative treatment in most patients. The recurrence of
post-cardiac surgery chylopericardium was on day 13.2 +/-18.2 after the
initial treatment. The overall early and late mortality rates were 1.7%
(2/119) and 1.7% (2/117), respectively. Most patients with post-cardiac
surgery chylopericardium were diagnosed by laboratory analysis of chylous
fluid. Patients with mild chylopericardium usually show good response to
conservative treatment. Whereas, patients with massive chylopericardium
and rapid accumulation, incurable to conservative treatment and recurrent
to either conservative or surgical treatment, warrant further surgical
treatment. Copyright © 2020 College of Physicians and Surgeons
Pakistan. All rights reserved.

<130>
Accession Number
645793020
Title
Outcomes of Endovascular Repair for Ascending Aortic Diseases: A
Systematic Review and Meta-analysis.
Source
European journal of vascular and endovascular surgery : the official
journal of the European Society for Vascular Surgery. (no pagination),
2024. Date of Publication: 08 Nov 2024.
Author
de Kort J.F.; Mandigers T.J.; Bissacco D.; Domanin M.; Piffaretti G.;
Twine C.P.; Wanhainen A.; van Herwaarden J.A.; Trimarchi S.; de Vincentiis
C.
Institution
(de Kort) Cardio Thoracic Vascular Department, Section of Vascular
Surgery, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan,
Italy; Department of Vascular Surgery, University Medical Centre Utrecht,
Utrecht, the Netherlands. Electronic address: jasperdkort@gmail.com
(Mandigers) Cardio Thoracic Vascular Department, Section of Vascular
Surgery, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan,
Italy; Department of Vascular Surgery, University Medical Centre Utrecht,
Utrecht, the Netherlands
(Bissacco) Department of Clinical Sciences and Community Health,
Universita degli Studi di Milano, Milan, Italy
(Domanin, Trimarchi) Cardio Thoracic Vascular Department, Section of
Vascular Surgery, Fondazione IRCCS Ca Granda Ospedale Maggiore
Policlinico, Milan, Italy; Department of Clinical Sciences and Community
Health, Universita degli Studi di Milano, Milan, Italy
(Piffaretti) Department of Medicine and Surgery, Vascular Surgery,
University of Insubria School of Medicine, Varese University Hospital,
Varese, Italy
(Twine) Southmead Hospital, University of Bristol Medical School, North
Bristol NHS Trust, Bristol, United Kingdom
(Wanhainen) Section of Vascular Surgery, Department of Surgical Sciences,
Uppsala University, Uppsala, Sweden; Department of Surgical and
Perioperative Sciences, Surgery, Umea University, Umea, Sweden
(van Herwaarden) Department of Vascular Surgery, University Medical Centre
Utrecht, Utrecht, Netherlands
(de Vincentiis) Cardiac Surgery Unit, Cardiac Surgery Division, Department
of Cardiovascular Disease "E. Malan", IRCCS Policlinico S. Donato, Milan,
Italy
Abstract
OBJECTIVE: High risk, inoperable patients with ascending aortic disease
are increasingly managed with thoracic endovascular aortic repair (TEVAR).
The aim of this study was to assess the available literature on TEVAR
confined to the ascending aorta (aTEVAR), describing study and patient
characteristics, procedural and stent graft details, and outcomes. DATA
SOURCES: This was a systematic review and meta-analysis. MEDLINE, Web of
Science, and Scopus were systematically searched for eligible studies
reporting on outcomes after aTEVAR (PROSPERO ID: CRD42023440826). Eligible
studies reported outcomes after aTEVAR without adjunctive supra-aortic
vessel treatment. REVIEW METHODS: The Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. The
ROBINS-I and Joanna Briggs Institute Critical Appraisal Checklist were
used as quality assessment tools. A Grading of Recommendations Assessment,
Development, and Evaluation (GRADE) evidence certainty analysis was
performed for the main outcomes. The main outcome was death. A
proportional meta-analysis was performed with a mean and 95% confidence
interval (CI) for the main outcomes. All articles were included up until 1
January 2024. RESULT(S): Ninety four studies were included (19 cohort
studies, 75 case reports or series), reporting on 259 patients (57.8%
male). Mean age was 69.1 (95% CI 65.0 - 73.1) years and mean follow up was
19.6 (95% CI 14.5 - 24.6) months. The most common comorbidity was prior
cardiac/thoracic surgery (n = 191). The most frequent indications for
aTEVAR (52.1% urgent aTEVAR) were type A aortic dissection (43.8%) and
pseudoaneurysm (38.8%). The most commonly deployed stent grafts were Gore
(44.5%), Cook (23.5%), and Medtronic (17.0%). In hospital mortality rate
was 7.3% (95% CI 4.7 - 11.2%), 30 day mortality rate was 7.7% (95% CI 5.1
- 11.6%), and overall mortality rate was 17.0% (95% CI 12.9 - 22.0%)
during follow up. GRADE showed very low evidence certainty for all
outcomes. Eighty eight complications were reported and there was a
re-operation rate of 13.1% (95% CI 9.5 - 17.8%). In hospital mortality and
30 day mortality rates for type A dissection were 12.4% (95% CI 7.5 -
19.7%) (n = 14) and 13.3% (95% CI 8.2 - 20.8%) (n = 15), respectively, and
for pseudoaneurysm were 4.0% (95% CI 1.6 - 9.8%) (n = 4), and 4.0% (95% CI
1.6 - 9.8) (n = 4), respectively. CONCLUSION(S): Despite
heterogeneous literature and very low GRADE evidence certainty, aTEVAR
seems technically feasible in high risk patients. In addition, there is
need for a consensus on when and how to use aTEVAR and a need for a
specific endograft for use in the ascending aorta. Copyright ©
2024 European Society for Vascular Surgery. Published by Elsevier B.V. All
rights reserved.

<131>
Accession Number
645791894
Title
A Systematic Review of Reporting and Handling of Missing Data in
Observational Studies Using the UNOS Database.
Source
The Journal of heart and lung transplantation : the official publication
of the International Society for Heart Transplantation. (no pagination),
2024. Date of Publication: 07 Nov 2024.
Author
Baker W.L.; Moore T.; Baron E.; Kittleson M.; Parker W.F.; Jaiswal A.
Institution
(Baker) Department of Pharmacy Practice, University of Connecticut School
of Pharmacy, Storrs, CT, United States
(Moore) Statistical Consulting Services (Center for Open Research
Resources & Equipment), University of Connecticut, Storrs, CT, United
States
(Baron) Servier Pharmaceuticals, Boston, MA, United States
(Kittleson) Division of Cardiology, Cedars-Sinai Medical Center, Los
Angeles, CA, United States
(Parker) University of Chicago Medicine, Chicago, IL, United States
(Jaiswal) Hartford HealthCare Heart and Vascular Institute, Hartford
Hospital, Hartford, CT, United States
Abstract
BACKGROUND: Missing data can undermine a registry's ability to draw valid
inferences by decreasing study power and introducing bias. We evaluated
how missing data are reported and addressed in observational studies of
adult heart transplantation (HT) recipients using the United Network for
Organ Sharing (UNOS) database. METHOD(S): We conducted a systematic
literature search of Medline from January 1st, 2018 through August 22nd,
2023 and included studies that used the UNOS database to evaluate adult
(>=18 years) de novo HT recipients. We collected details on the study
population, timeframe, primary endpoint, use of missing data, and whether
and what methods were used to handle missing data. Approaches were
classified as variable selection, complete case analysis (CCA), missing
indicator method, single imputation, or multiple imputation.
 RESULT(S): 229 studies were included from 2018-2023. 67 (29.3%)
studies limited their cohorts to those without missing data for the
outcome or key variables and 93 (40.6%) reported missing data in their
final cohort. 78 (34.1%) studies reported how they handled missing data in
their statistical modeling. Of these, CCA was most used (n=41, 52.6%)
followed by multiple imputation (n=22, 28.2%), and other methods (n=15,
19.2%) including a combination of missing indicator method (for binary
variables) and single imputation. Thirty-one (13.5%) studies reported
removing covariates from their analysis because of missing data. Only four
(5.1%) studies reported sensitivity analysis to evaluate different missing
data approaches. CONCLUSION(S): Merely a third of the identified UNOS
database studies reported how they handled missing data in their analysis,
with strategies varying. Although no singular approach to handling missing
data exists, methods are available that can improve upon the most used
approaches by, for example, reducing bias and increasing statistical
power. Though these improvements are contingent on the missing data
mechanism and the goals of the analysis. Future best practices should
include explicit reporting of missingness, detailed methods, and
sensitivity checks to maximize the credibility of UNOS database
analyses. Copyright © 2024 International Society for the Heart
and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

<132>
Accession Number
645791120
Title
Multisensory stimulation to reduce procedural pain in retinopathy of
prematurity: A randomized controlled trial.
Source
Nursing in critical care. (no pagination), 2024. Date of Publication: 10
Nov 2024.
Author
Tasdemir H.I.
Institution
(Tasdemir) Burdur Health Services Vocational School, Burdur Mehmet Akif
Ersoy University, Burdur, Turkey
Abstract
BACKGROUND: Retinopathy is frequently seen in the neonatal intensive care
unit (NICU), and its examination is a painful procedure for infants. AIM:
This randomized active-controlled trial aimed to investigate the impact of
multisensory stimulation (MSS) on neonatal pain during retinopathy of
prematurity (ROP) examinations, in comparison with a white noise (WN) and
control group receiving standard care. STUDY DESIGN: Conducted as a
three-arm, randomized controlled trial, the study was implemented in the
NICU of a local university hospital. Recruitment spanned from July 2023 to
November 2023, with preterm infants (gestational age<37weeks) randomly
assigned to either a MSS, WN or a control group. MSS components included
visual, auditory, tactile, olfactory and gustatory stimuli, all designed
to create a synergistic, comforting environment for the infant during the
procedure. Procedural pain, heart rate and oxygen saturation were assessed
at various stages before and after ROP examinations. RESULT(S):
Analysis of 90 participants revealed that the MSS group exhibited lower
Premature Infant Pain Profile (PIPP) scores than the WN and control groups
(mean difference: -2.12, 95% confidence interval [CI]: -2.62 to -1.62;
odds ratio [OR]: 0.004, 95% CI [0.001, 0.012], p<0.001). Additionally,
heart rates were significantly lower in the MSS group (mean difference:
-15.3 beats/min, 95% CI: -20.5 to -10.1; OR: 0.025, 95% CI [0.008, 0.073],
p<.001) and oxygen saturation levels were higher (mean difference: 3.2%,
95% CI: 1.8% to 4.6%; OR: 1.12, 95% CI [1.05, 1.20], p<.001) than in the
other groups. CONCLUSION(S): MSS emerges as a favourable, safe and
non-pharmacological intervention for pain management in ROP and similar
procedures. RELEVANCE TO CLINICAL PRACTICE: Multisensory stimulation can
be effectively integrated into the routine care provided by critical care
nurses during retinopathy of prematurity examinations in preterm infants.
This non-pharmacological intervention offers a practical approach for
critical care nurses to reduce procedural pain and improve physiological
stability in this vulnerable population. Copyright © 2024 British
Association of Critical Care Nurses.

<133>
Accession Number
645788745
Title
Combined left atrial appendage occlusion and catheter ablation for atrial
fibrillation versus isolated left atrial appendage occlusion: A systematic
review and meta-analysis.
Source
International journal of cardiology. (pp 132597), 2024. Date of
Publication: 01 Oct 2024.
Author
Clemente M.R.C.; Navalha D.D.P.; Bittar V.; Costa T.A.; Fernandes G.P.;
Silva L.T.M.
Institution
(Clemente) Petropolis School of Medicine, Petropolis, Brazil
(Navalha) Department of Medicine, University of Nebraska Medical Center,
Omaha, NE, United States
(Bittar) University Centre of Associated Colleges for Education, Sao Joao
da Boa Vista, Brazil
(Costa) Department of Medicine, University of Colorado School of Medicine,
Aurora, CO, United States
(Fernandes) University Center of the State of Para, Para, Brazil
(Silva) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
Abstract
BACKGROUND: Data on the effects of combined left atrial appendage
occlusion (LAAO) and catheter ablation (CA) for atrial fibrillation (AF)
remain limited. We aimed to perform a systematic review and meta-analysis
comparing LAAO and CA versus isolated LAAO. METHOD(S): We
systematically searched PubMed, Embase, and Cochrane Library for studies
comparing combined LAAO and CA versus isolated LAAO in patients with
atrial fibrillation. Statistical analyses were performed using R software
version 4.3.1. We pooled odds ratios (OR) with 95 % confidence intervals
(CI) for binary outcomes. RESULT(S): We included eight studies
comprising 51,802 patients, of whom 1375 (2.6 %) underwent combined LAAO
and CA. There were no significant differences between combined LAAO and CA
versus isolated LAAO in terms of major bleeding (OR 0.55; 95 % CI 0.09,
3.41; p = 0.52; I2 = 0 %), major adverse cardiovascular events (OR 0.88;
95 % CI 0.40, 1.93; p = 0.74; I2 = 0 %), stroke (OR 1.03; 95 % CI 0.35,
3.00; p = 0.96; I2 = 0 %), thromboembolism (OR 0.60; 95 % CI 0.18, 1.98; p
= 0.40; I2 = 0 %), minor bleeding (OR 1.32; 95 % CI 0.63, 2.80; p = 0.46;
I2 = 0 %), or pericardial effusion (OR 1.18; 95 % CI 0.60, 2.33; p = 0.63;
I2 = 24 %). CONCLUSION(S): In this meta-analysis of observational
studies, combined LAAO and CA for AF was similar to isolated LAAO in terms
of efficacy and safety. Further large randomized controlled trials are
needed to explore the long-term effects of combining these
procedures. Copyright © 2024 Elsevier B.V. All rights reserved.

<134>
Accession Number
645786842
Title
Perioperative Management of Takayasu Arteritis for Cardiac Surgery- Review
and Single-Center Experience.
Source
Circulation journal : official journal of the Japanese Circulation
Society. (no pagination), 2024. Date of Publication: 09 Nov 2024.
Author
Arita Y.; Asano R.; Ueda J.; Seike Y.; Inoue Y.; Ogo T.; Fukushima S.;
Matsuda H.; Nakaoka Y.
Institution
(Arita, Asano, Nakaoka) Department of Vascular Physiology, National
Cerebral and Cardiovascular Center Research Institute
(Arita) Department of Cardiology, Japan Community Healthcare Organization
Osaka Hospital, Japan
(Asano, Ueda, Ogo, Nakaoka) Department of Cardiovascular Medicine,
National Cerebral and Cardiovascular Center
(Seike, Inoue, Fukushima, Matsuda) Department of Cardiovascular Surgery,
National Cerebral and Cardiovascular Center
(Nakaoka) Department of Cardiovascular Medicine, Osaka University Graduate
School of Medicine
Abstract
Takayasu arteritis (TAK) is classified as a large vessel vasculitis and
often causes vascular stenosis, occlusion, and aneurysm formation.
Although the principal treatment for TAK involves suppressing inflammation
with glucocorticoids, the emergence of biological disease-modifying
antirheumatic drugs has considerably changed the treatment landscape of
TAK in recent years. Several biological disease-modifying antirheumatic
drugs, such as tocilizumab (TCZ), have shown promising effects on TAK in
clinical studies. Cardiologists and cardiovascular surgeons encounter
patients receiving these drugs who require catheterization, endovascular
treatment, or cardiovascular surgery. However, in patients treated with
glucocorticoids and TCZ, there needs to be greater awareness of more
complications than usual after surgery, such as delayed wound healing,
systemic infection, and surgical site infection. In addition, in patients
receiving TCZ, inflammatory markers, such as C-reactive protein, may not
increase when complications arise from infection. Unfortunately, there are
no guidelines or solid evidence that have clearly defined the optimal
perioperative treatment strategy for patients with TAK who require
cardiovascular surgery. This article reviews the evidence and our recent
experience supporting the perioperative use of TCZ, and proposes a
protocol that can reduce complications in patients with TAK undergoing
invasive cardiovascular treatment.

<135>
Accession Number
645786468
Title
A Randomized Study of Cryoablation of Intercostal Nerves in Patients
Undergoing Minimally Invasive Thoracic Surgery.
Source
The Journal of thoracic and cardiovascular surgery. (no pagination),
2024. Date of Publication: 08 Nov 2024.
Author
Weksler B.; Maxwell C.; Drake L.; Crist L.; Specht K.; Kuchta P.; DeHaven
K.; Weksler I.; Williams B.A.; Fernando H.C.
Institution
(Weksler, Maxwell, Drake, Crist, Specht, Kuchta, DeHaven, Weksler,
Williams, Fernando) Division of Thoracic and Esophageal Surgery,
Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA, United
States
Abstract
OBJECTIVES: Minimally invasive thoracic surgery can cause significant
pain, and optimizing pain control after surgery is highly desirable. We
examined pain control after intercostal nerve block with or without
cryo-ablation of the intercostal nerves. METHOD(S): This was a
randomized study (NCT05348447) of adults scheduled for a minimally
invasive thoracic procedure. Each intercostal space near the incision site
was injected with lidocaine and bupivacaine with epinephrine
(standard-of-care). The cryo-analgesia group also had 5-6 intercostal
nerves ablated. The primary outcome was the amount of narcotics (in
morphine mg equivalent, MME) taken during the postoperative hospital stay
and the first two weeks post-discharge. Secondary outcomes were incentive
spirometry (IS) volume and pain scores in the hospital and pain and
neuropathy scores at two weeks. RESULT(S): Our final cohort contained
103 patients (52 standard-of-care; 51 cryo-analgesia). There were no
differences between the treatment groups in MMEs administered during the
hospital stay (44.9 mg standard of care vs. 38.4 mg cryo-analgesia), total
MME at two weeks (108.8 vs. 95.2 mg), or pain assessed on postoperative
day (POD) 1 (3.8 and 3.3), POD2 (2 and 3.5), or two weeks (2 and 3.5). The
decrease in IS in the postoperative period was not significantly different
between the two groups. Patients in the cryo-analgesia group had higher
neuropathy scores (8 vs. 13, p=0.019) two weeks after surgery.
 CONCLUSION(S): In this randomized study, cryo-analgesia did not
decrease postoperative pain or narcotic requirements. Cryo-analgesia
increased neuropathic pain two weeks after surgery. Copyright ©
2024. Published by Elsevier Inc.

<136>
Accession Number
645780570
Title
The effects of virtual reality on pain, anxiety, and comfort during the
chest tube removal procedure: A randomized clinical trial.
Source
Complementary therapies in clinical practice. 58 (pp 101931), 2024. Date
of Publication: 08 Nov 2024.
Author
Secer H.; Yayla A.
Institution
(Secer) Department of Surgical Nursing, Erzurum Research Hospital,
Erzurum, Turkey
(Yayla) Department of Surgical Nursing, Faculty of Nursing, Ataturk
University, Erzurum, Turkey
Abstract
PURPOSE: The purpose of the current study is to determine the effects of
virtual reality on pain, anxiety, and comfort during chest tube removal.
MATERIALS AND METHODS: The research was conducted in the Cardiovascular
Surgery Department of Ataturk University Health Practice and Research
Hospital between January 2023 and April 2024. The study was performed as a
randomized controlled experimental trial with a pretest-posttest control
group. Eighty-two patients (41 in the intervention group and 41 in the
control group) were included in the research. Patients in the intervention
group watched a video with virtual reality glasses during chest tube
removal. The "Descriptive Information Form," "Visual Analog Scale,"
"Verbal Pain Scale," "State Anxiety Inventory," and "Comfort Scale" were
used to collect data. Number, percentage, mean, standard deviation,
chi-square, paired sample t-test, independent sample t-test, Mann-Whitney
U test, Wilcoxon test, and linear regression analysis were used in data
evaluation. Our study was recorded in the Clinical Trials database with
protocol number "NCT06550323." RESULTS: The groups had similar descriptive
characteristics (p > 0.05). The pre-procedural mean pain, anxiety, and
comfort scores were similar in the two groups (p > 0.05). The
post-procedural mean VAS and verbal pain scores, mean anxiety, and comfort
scores of the intervention group were lower in comparison with the control
group (p < 0.05). CONCLUSION(S): The research findings showed that
virtual reality significantly reduced pain and anxiety while increasing
comfort levels during chest tube removal. Therefore, it is recommended
that virtual reality be used during chest tube removal. Copyright
© 2024 Elsevier Ltd. All rights reserved.

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