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<1>
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

<2>
Accession Number
2035931588
Title
Comparison between thoracic epidural analgesia VS patient controlled
analgesia on chronic postoperative pain after video-assisted thoracoscopic
surgery: A prospective randomized controlled study.
Source
Journal of Clinical Anesthesia. 100 (no pagination), 2025. Article Number:
111685. Date of Publication: February 2025.
Author
Jiang L.; Wang C.; Tong J.; Han X.; Miao C.; Liang C.
Institution
(Jiang, Wang, Tong, Han, Miao, Liang) Department of Anesthesiology,
Zhongshan Hospital, Fudan University, Shanghai, China
(Miao, Liang) Department of Anesthesiology, Zhongshan Hospital (Xiamen),
Fudan University, Xiamen, China
Publisher
Elsevier Inc.
Abstract
Study objective: To test the hypothesis that thoracic epidural anesthesia
and analgesia (TEA) reduces the incidence of chronic postoperative pain
(CPSP) after video-assisted thoracoscopic surgery (VATS). Design(s):
A single-center, single-blind, randomized controlled trial was conducted.
 Setting(s): The study was conducted in the operating room, with
follow-up assessments performed in the ward. Telephone was used to follow
the long-term outcomes. Patient(s): 231 patients >=18 years of age
and scheduled for VATS. Intervention(s): Patients were randomized
into two groups, including an epidural block (EPI) group (general
anesthesia with patient-controlled epidural analgesia) and a general
anesthesia with patient-controlled intravenous analgesia (PCIA) group.
Measurements: The primary endpoint was the incidence of CPSP at 3 months
postoperatively. CPSP data, including acute pain, neuropathic pain,
depression, and side effects, were collected at 3 and 6 months
postoperatively through telephone follow-up. Main Result(s): A total
of 231 patients were analyzed, including 114 in the PCIA group and 117 in
the EPI group. Sixty-six patients (56.4 %) in the PCIA group and 33
patients (28.9 %) in the EPI group experienced chronic pain at 3 months
postoperatively. The odds ratio (OR) was 0.31 (95 % confidence interval
[CI], 0.18 to 0.54; P < 0.0001). After adjusting for confounding factors,
the adjusted OR was 0.28 (95 % CI, 0.16 to 0.50, P < 0.001). Six months
postoperatively, 50 (42.7 %) and 17 (14.9 %) patients in the PCIA and EPI
groups, respectively, were diagnosed with CPSP (P < 0.0001). Copyright
© 2024 Elsevier Inc.

<3>
Accession Number
2032419364
Title
Evolution of Thoracic Disc Herniation Surgery: Future Perspectives from a
Systematic Review and Meta-Analysis.
Source
Brain Sciences. 14(11) (no pagination), 2024. Article Number: 1062. Date
of Publication: November 2024.
Author
Corazzelli G.; Corvino S.; Di Noto G.; Di Domenico C.; Russo F.;
Mariniello G.; Elefante A.; Bocchetti A.; Paolini S.; Esposito V.;
Innocenzi G.; de Falco R.; de Divitiis O.
Institution
(Corazzelli, Corvino, Di Domenico, Russo, Mariniello, de Divitiis)
Department of Neurosciences and Reproductive and Odontostomatological
Sciences, Neurosurgical Clinic, University of Naples "Federico II", Naples
80131, Italy
(Corazzelli, Bocchetti, de Falco) Neurosurgery Department, Santa Maria
delle Grazie Hospital, ASL Napoli 2 Nord, Naples 80078, Italy
(Di Noto) Division of Neurosurgery, Universita degli Studi di
Messina-Policlinico "G. Martino", Messina 98124, Italy
(Elefante) Department of Advanced Biomedical Sciences, University of
Naples "Federico II", Naples 80138, Italy
(Paolini, Esposito, Innocenzi) Department of Neurosurgery, IRCCS Neuromed,
Pozzilli 86077, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: The neurosurgical treatment of thoracic disc herniation (TDH)
has undergone dramatic changes over the years in terms of surgical
approaches and intraoperative technological tools. There is still no
unanimous consent on the criteria for approach selection, and the choice
varies among Institutions. The aim of this study is to compare anterior
and posterolateral approaches for TDH in terms of functional and surgical
outcomes. Method(s): A systematic literature review and meta-analysis
according to PRISMA guidelines from EMBASE, PubMed, Cochrane Library, Web
of Science, and Google Scholar online databases up to May 2024
incorporated studies that reported outcomes of thoracic disc herniation
surgeries. Analyzed factors included major peri- and postoperative
complications, intraoperative blood loss, hospital stay, neurological
improvement, and complete hernia resection. Random-effect models were used
to calculate pooled odds ratios and mean differences. Result(s): The
posterolateral approach was associated with significantly lower rates of
major medical (OR 0.14, 95% CI: 0.07 to 0.27) and surgical complications
(OR 0.61, 95% CI: 0.38 to 0.99) compared to the anterior approach.
Additionally, posterolateral approaches reduced intraoperative blood loss
and shorter hospital stays. Posterolateral techniques were linked to
higher odds of neurological improvement (OR 0.65, 95% CI: 0.43 to 0.99)
and higher rates of complete hernia resection (OR 0.38, 95% CI: 0.21 to
0.71). Conclusion(s): Posterolateral approaches offer advantages in
terms of safety, recovery, neurological improvement, and complete hernia
resection. More extensive prospective studies are needed to confirm these
findings and refine surgical strategies. Emerging technologies, such as
the exoscope and 45degree endoscopy, may further enhance surgical
outcomes. Copyright © 2024 by the authors.

<4>
Accession Number
2032390419
Title
Dynamic coronary roadmap in percutaneous coronary intervention: a
systematic review and meta-analysis.
Source
BMC Cardiovascular Disorders. 24(1) (no pagination), 2024. Article Number:
681. Date of Publication: December 2024.
Author
Behnoush A.H.; Ramandi A.; Mahajan S.; Altibi A.; Samavarchitehrani A.;
Gupta R.
Institution
(Behnoush, Ramandi) School of Medicine, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Behnoush) Endocrinology and Metabolism Population Sciences Institute,
Non-Communicable Diseases Research Center, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Mahajan) Ri Jayadeva Institute of Cardiovascular Sciences and Research,
Karnataka, Bengaluru, India
(Altibi, Gupta) Yale University School of Medicine, New Haven, CT, United
States
(Samavarchitehrani) Faculty of Medicine, Tehran Medical Sciences, Islamic
Azad University, Tehran, Iran, Islamic Republic of
Publisher
BioMed Central Ltd
Abstract
Background: Contrast-induced acute kidney injury (CI-AKI) is one of the
complications of percutaneous coronary intervention (PCI) with high
financial burden and poor outcomes. Dynamic coronary roadmap (DCR) is one
of the augmentation tools that can provide a dynamic clear coronary
mapping with the potential to reduce contrast use and CI-AKI incidence.
Herein, we aim to systematically investigate the studies that have
assessed the effect of DCR on PCI outcomes. Method(s): Four online
databases including PubMed, Scopus, Embase, and the Web of Science were
systematically searched for relevant studies. Studies that compared the
DCR group with the non-DCR group were included while the outcomes were AKI
incidence, contrast volume, fluoroscopy time, dose area product, air
kerma, intravascular ultrasonography (IVUS) use, and procedural success.
Random-effect meta-analysis was conducted to calculate the standardized
mean difference (SMD) or odds ratio (OR) and 95% confidence interval (CI)
for comparison of DCR and non-DCR groups. Result(s): A total of six
studies were included in the final analysis comprised of 447 patients in
the DCR group and 527 in the non-DCR group. The mean age was 68.7 +/- 10.6
years while 78.9% of the DCR group and 75.6% of the non-DCR group were
males. There was no difference between the groups in terms of the rates of
hypertension, diabetes, hyperlipidemia, prior myocardial infarction (MI),
prior coronary artery bypass grafting (CABG), and atrial fibrillation.
Meta-analysis revealed that patients in the DCR group had a significantly
lower rate of AKI (OR 0.50, 95% CI 0.27 to 0.93, p-value = 0.028), and
contrast volume used (SMD -1.16, 95% CI -2.15 to -0.18, p-value = 0.021).
However, there was no difference in fluoroscopy time (SMD -0.64, 95% CI
-1.43 to 0.16, p-value = 0.116), air kerma (SMD -1.81, 95% CI -4.61 to
0.99, p-value = 0.206), IVUS use (OR 1.21, 95% CI 0.85 to 1.73, p-value =
0.285), and procedural success (OR 1.05, 95% CI 1.15 to 7.26, p-value =
0.957). Conclusion(s): These findings show that DCR use is associated
with a lower rate of AKI and lower contrast use, compared to conventional
PCI. This is of particular importance since many patients undergoing PCI
have limited renal function and hence will benefit from the use of DCR.
Further studies are needed to confirm these findings and to pave the way
for the routine use of DCR in clinical settings. Copyright © The
Author(s) 2024.

<5>
Accession Number
2035826788
Title
Integrated, person-centred care for patients with complex cardiovascular
disease, diabetes mellitus and chronic kidney disease: a randomized trial.
Source
Clinical Kidney Journal. 17(11) (no pagination), 2024. Article Number:
sfae331. Date of Publication: 01 Nov 2024.
Author
Even G.; Stenfors T.; Jacobson S.H.; Jernberg T.; Franzen-Dahlin A.;
Jaghult S.; Kahan T.; Spaak J.
Institution
(Even, Jacobson, Jernberg, Franzen-Dahlin, Jaghult, Kahan, Spaak)
Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital,
Stockholm, Sweden
(Stenfors) Karolinska Institutet, Department of Learning, Informatics,
Management and Ethics - LIME, Sweden
(Jaghult) Department of Clinical Science and Education, Sodersjukhuset,
Sweden
Publisher
Oxford University Press
Abstract
Background. Patients with cardiovascular disease (CVD), diabetes mellitus
(DM) and chronic kidney disease (CKD) often experience fragmented care,
which negatively impacts outcomes and health-related quality of life
(HRQoL). This study assessed whether multidisciplinary, person-centred
care at an integrated clinic improves clinical outcomes and HRQoL.
Methods. This prospective, open, blinded-endpoint trial (CareHND;
NCT03362983) included 131 patients with CVD, DM and CKD stages 3-4, most
of whom were enrolled during or shortly after acute hospitalization. The
intervention group received person-centred care from cardiologists,
nephrologists, endocrinologists and specialist nurses at an integrated
clinic; the control group received traditional care from separate
specialists. Primary disease progression outcome was the composite of
major adverse renal and cardiovascular events (MARCE) including death,
heart failure (HF) readmission, myocardial infarction, percutaneous
coronary intervention/coronary artery bypass graft, acute or end-stage
kidney failure, or transient ischaemic attack/stroke at 2 years.
Co-primary person-centred outcomes was self-reported HRQoL by RAND-36.
Results. In a pre-specified interim analysis, patients randomized to
integrated care had lower estimated glomerular filtration rate and higher
NT-proBNP (N-terminal pro brain natriuretic peptide) than traditional
care. Follow-up ranged from 2.0 to 5.7 years. Kaplan-Meier analysis showed
no difference in MARCE between groups. Cox-regression adjusting for
baseline differences, indicated a trend towards reduced HF
hospitalizations for integrated care (hazard ratio 0.53; confidence
interval 0.28-1.01; P = .054). Integrated care improved role physical and
social function scores, and self-rated health (P = .021, P = .019 and P =
.011, respectively). Conclusions. Integrated care improved several
dimensions of HRQoL but did not improve MARCE compared with traditional
care in this small trial. We observed a trend towards reduced HF
hospitalizations. Overall, integrated care presents a promising
alternative. Copyright © The Author(s) 2024. Published by Oxford
University Press on behalf of the ERA.

<6>
Accession Number
2034782203
Title
Sacubitril/Valsartan in Pediatric Heart Failure (PANORAMA-HF): A
Randomized, Multicenter, Double-Blind Trial.
Source
Circulation. 150(22) (pp 1756-1766), 2024. Date of Publication: 26 Nov
2024.
Author
Shaddy R.; Burch M.; Kantor P.F.; Solar-Yohay S.; Garito T.; Zhang S.;
Kocun M.; Mao C.; Cilliers A.; Wang X.; Canter C.; Rossano J.; Wallis G.;
Menteer J.; Daou L.; Kusa J.; Tokel K.; Dilber D.; Xu Z.; Xiao T.; Halnon
N.; Daly K.P.; Bock M.J.; Zuckerman W.; Singh T.P.; Chakrabarti M.;
Levitas A.; Senni M.; Grutter G.; Kim G.B.; Song J.; Lee H.D.; Chen C.K.;
Sanchez-De-Toledo J.; Law Y.; Wanitkun S.; Cui Y.; Anjos R.; Mese T.;
Bonnet D.; Ablonczy L.; Aggarwal N.; Agnoletti G.; Alhabdan M.; Amedro P.;
Ameduri R.; Alberto Annoni G.; Asante-Korang A.; Audi N.; Ballweg J.;
Berger F.; Bosaleh M.; Boyle G.; Castaldi B.; Chag M.; Chaloupecky V.;
Chehab G.; Conway J.; Daehnert I.; Di Bernardo S.; Dittrich S.; Dogan E.;
Donti A.; Durongpisitkul K.; Favilli S.; Feingold B.; Garcia-Guereta L.;
Gil-Villanueva N.; Glass L.; Gomez-Guzman E.; Gorenflo M.; Gran F.; Hirata
Y.; Hirono K.; Hoshino K.; Hsieh K.-S.; Hussain M.; Inuzuka R.; Ishido M.;
Jeewa A.; Johnson J.; Jokinen E.; Won Jung J.; Kaneva-Nencheva A.; Kaufman
B.; Kochilas L.; Kumar S.; Lal A.; Viktorovna Leontyeva I.; Lin I.-C.;
Lytrivi I.; Malcic I.; Marinho Da Silva A.; Medrano Lopez C.; Milanesi O.;
Deanne Miyamoto S.; Motomura H.; Odri Komazec I.; Ono H.; Pacileo G.; Mark
Payne R.; Ramakrishnan S.; Riggi C.; Rusconi P.; Sabiniewicz R.; Salaymeh
K.; Schumacher K.; Schweigmann U.; Seguela P.-E.; Shih R.; Singh R.;
Yurievna Sitnikova M.; Spicer R.; Stiller B.; Sugiyama H.; Sundararaghavan
S.; Takeda A.; Thambo J.-B.; Trigo Pereira C.; Ulger Tutar Z.; Vaughn G.;
Velez H.; Vignati G.; Wang J.-N.; Wang J.-K.; Yasuda K.; Ziolkowska L.;
Zuhlke L.
Institution
(Shaddy, Kantor, Menteer) Children's Hospital Los Angeles, The Keck School
of Medicine, The University of Southern California, Los Angeles, United
States
(Burch) Great Ormond Street Hospital for Children, London, United Kingdom
(Solar-Yohay, Kocun) Novartis Pharmaceuticals Corporation, East Hanover,
NJ, United States
(Garito) Novartis Pharma AG, Basel, Switzerland
(Zhang) Novartis, Shanghai, China
(Mao) Children's Healthcare of Atlanta, Emory University, GA, United
States
(Cilliers) Chris Hani Baragwanath Academic Hospital, University of the
Witwatersrand, Johannesburg, South Africa
(Wang) National Center for Cardiovascular Disease and Fuwai Hospital,
Chinese Academy of Medical Sciences, Peking Union Medical College,
Beijing, China
(Canter) Washington University, School of Medicine, St. Louis, MO, United
States
(Rossano) Children's Hospital of Philadelphia, PA, United States
(Wallis) Levine Children's Hospital, Charlotte, NC, United States
(Daou) Hotel Dieu de France Hospital, Beirut, Lebanon
(Kusa) Regional Specialist Hospital, Wroclaw, Poland
(Tokel) Baskent University Medical Faculty, Ankara, Turkey
(Dilber) University Hospital Centre, Zagreb, Croatia
(Xu) Shanghai Children's Medical Center, Shanghai Jiao Tong University,
School of Medicine, China
(Xiao) Children's Hospital of Shanghai, China
(Halnon) Mattel Children's Hospital, David Geffen School of Medicine,
UCLA, Los Angeles, CA, United States
(Daly, Singh) Boston Children's Hospital, Harvard Medical School, MA,
United States
(Bock) Division of Cardiology, Loma Linda University Children's Hospital,
CA, United States
(Zuckerman) Columbia University Medical Center, Morgan Stanley Children's
Hospital of New York, New York, United States
(Chakrabarti) Department of Congenital & Pediatric Cardiology,
Indraprastha Apollo Hospitals, New Delhi, India
(Levitas) Division of Pediatric Cardiology, Soroka University Medical
Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
(Senni) University of Milan-Bicocca, A.S.S.T. Papa Giovanni XXIII,
Bergamo, Italy
(Grutter) Bambino Gesu Children Hospital, IRCSS, Rome, Italy
(Kim) Seoul National University College of Medicine, Seoul National
University Children's Hospital, South Korea
(Song) Samsung Medical Center, Sungkyunkwan University, School of
Medicine, Seoul, South Korea
(Lee) Pusan National University, Yangsan Hospital, Gyeongsangnam-Do,
Yangsan-si, South Korea
(Chen) Department of Paediatrics, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore
(Sanchez-De-Toledo) Hospital Sant Joan de Deu Esplugues de Llobregat,
Spain
(Law) Seattle Children's Hospital, WA, United States
(Wanitkun) Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
(Cui) Guangzhou Women and Children's Medical Center, Guangdong, Guangzhou,
China
(Anjos) Centro Hospitalar Lisboa Ocidental EPE Hospital de Santa Cruz
Carnaxide, Lisboa, Portugal
(Mese) University of Health Sciences, Turkey Dr. Behcet Uz Childrens
Hospital-Konak/Izmir, Turkey
(Bonnet) M3C-Necker, Congenital and Paediatric Cardiology Department,
Hospital Necker-Enfants Malades, University of Paris Cite, France
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Sacubitril/valsartan, an angiotensin receptor-neprilysin
inhibitor (ARNI), is an established treatment for heart failure (HF) with
reduced left ventricular ejection fraction. It has not been rigorously
compared with angiotensin-converting enzyme inhibitors in children.
PANORAMA-HF (Prospective Trial to Assess the Angiotensin Receptor Blocker
Neprilysin Inhibitor LCZ696 Versus Angiotensin-Converting Enzyme Inhibitor
for the Medical Treatment of Pediatric HF) is a randomized, double-blind
trial that evaluated the pharmacokinetics and pharmacodynamics (PK/PD),
safety, and efficacy of sacubitril/valsartan versus enalapril in children
1 month to <18 years of age with HF attributable to systemic left
ventricular systolic dysfunction (LVSD). METHOD(S): Children with HF
attributable to LVSD were randomized to sacubitril/valsartan versus
enalapril to assess the efficacy and safety of sacubitril/valsartan at 52
weeks of follow-up. The primary end point of the study was to determine
whether sacubitril/valsartan was superior to enalapril for the treatment
of pediatric patients with HF attributable to systemic LVSD, assessed
using a primary global rank end point consisting of ranking patients from
worst to best on the basis of clinical events such as death, listing for
urgent heart transplant, mechanical life support requirement, worsening
HF, New York Heart Association (NYHA)/Ross class, Patient Global
Impression of Severity (PGIS), and Pediatric Quality of Life Inventory
physical functioning domain. The change from baseline to 52 weeks in
NT-proBNP (N-terminal pro-B-type natriuretic peptide) was an exploratory
end point. RESULT(S): A total of 375 children (mean age, 8.1+/-5.6
years; 52% female) were randomized to sacubitril/valsartan (N=187) or
enalapril (N=188). At week 52, no significant difference was observed
between the 2 treatment arms in the global rank end point (Mann-Whitney
probability, 0.52 [95% CI, 0.47-0.58]; Mann-Whitney odds, 0.91 [95% CI,
0.72-1.14]; P=0.42). At week 52, clinically meaningful reductions were
observed in both treatment arms in NYHA/Ross, PGIS, Patient Global
Impression of Change, and NT-proBNP, without significant differences
between groups. Adverse events were similar between treatment arms
(incidence: sacubitril/valsartan, 88.8%; enalapril, 87.8%), and the safety
profile of sacubitril/valsartan was acceptable in children.
 CONCLUSION(S): In this study, sacubitril/valsartan did not show
superiority over enalapril in the treatment of children with HF
attributable to systemic LVSD using the prespecified global rank end
point. However, both treatment arms showed clinically meaningful
improvements over 52 weeks. Copyright © 2024 The Authors.

<7>
Accession Number
2032073930
Title
A Clinical Study on the Efficacy of the Yangxin Huoxue Formula in Treating
Stable Angina Pectoris (Qi Deficiency and Blood Stasis Syndrome) with
Concurrent Anxiety and Depression Disorders.
Source
Journal of Multidisciplinary Healthcare. 17 (pp 5317-5327), 2024. Date of
Publication: 2024.
Author
Weng J.-H.; Hou F.-G.; Wang X.; Wang Z.-Y.; Wu M.-P.
Institution
(Weng, Wang, Wang, Wu) Department of Cardiology, Shanghai Municipal
Hospital of Traditional Chinese Medicine, Shanghai University of
Traditional Chinese Medicine, Shanghai 200071, China
(Hou) Department of Oncology, Shanghai Municipal Hospital of Traditional
Chinese Medicine, Shanghai University of Traditional Chinese Medicine,
Shanghai 200071, China
(Wu) School of Integrated Chinese and Western Medicine, Shanghai
University of Traditional Chinese Medicine, Shanghai 201203, China
Publisher
Dove Medical Press Ltd
Abstract
Objective: This study evaluates the therapeutic effects of the Yangxin
Huoxue Formula in the management of stable angina pectoris associated with
Qi deficiency and blood stasis syndrome, co-occurring with anxiety and
depressive disorders. The primary objective is to determine its efficacy
in enhancing cardiac function and reducing emotional symptoms.
 Method(s): A randomized, single-blind, placebo-controlled clinical
trial was conducted with 94 individuals with stable angina pectoris.
Participants were randomly allocated to either a treatment group receiving
Yangxin Huoxue Formula granules or a placebo group receiving placebo
granules, administered twice daily over a 12-week period. Primary outcome
measures included assessments of cardiac function, angina frequency, PHQ-9
and GAD-7 scores, traditional Chinese medicine (TCM) syndrome
improvements, and inflammatory markers. Result(s): The treatment
group exhibited significantly greater improvements in cardiac output and
reductions in peripheral vascular resistance compared to the placebo
group. Additionally, a significant decrease in the frequency and duration
of angina episodes was observed in the treatment group. Improvements in
TCM syndrome scores and GAD-7 scores were also notably superior in the
treatment group. No significant adverse reactions were recorded during the
safety assessment of the treatment group. Conclusion(s): The Yangxin
Huoxue Formula demonstrates efficacy in improving cardiac function,
alleviating symptoms of anxiety and depression, reducing inflammatory
mediator release, and enhancing quality of life in individuals with stable
angina pectoris. The treatment was well-tolerated, confirming both its
safety and therapeutic effectiveness. Copyright © 2024 Weng et
al.

<8>
Accession Number
2031652599
Title
The Efficacy and Safety of the Rhomboid Intercostal Block for
Postoperative Analgesia in Chest Surgery and Breast Surgery: A Systemic
Review and Meta-Analysis.
Source
Pain Physician. 27(7) (pp 375-385), 2024. Date of Publication:
September-October 2024.
Author
Shen Q.h.; Shen Y.z.; Shi Y.f.; Lai L.; Chen Y.-j.; Zhou Q.-h.
Institution
(Shen, Shen, Shi, Lai, Chen, Zhou) Department of Anesthesiology,
Affiliated Hospital of Jiaxing University, China
Publisher
American Society of Interventional Pain Physicians
Abstract
Background: Prior research has suggested that the rhomboid intercostal
block (RIB) may contribute to postoperative analgesia after surgeries of
the chest and breast Objective: To explore the effectiveness and safety of
RIB for postoperative analgesia, as well as whether RIB is superior to
other types of nerve blocks. Study Design: A systematic review and
meta-analysis. Setting(s): Querying electronic databases, including
the Cochrane Library, PubMed, Embase, and Web of Science, was part of the
process in searching for eligible clinical trials for this meta-analysis
and systematic review. Method(s): The Cochrane Collaboration's tool
for quality evaluation was utilized in assessing the bias risk in the
selected randomized controlled trials (RCTs). meta-analysis was
facilitated through the utilization of Review Manager 5.3. The
determination of the evidence's quality adhered to the Grading of
Recommendations Assessment, Development, and Evaluation (GRADE) approach.
 Result(s): After the inclusion and exclusion criteria were
established, the incorporation of 8 RCTs, encompassing 714 patients, took
place. During the first 24 hours after the operation, patients in the RIB
group exhibited lower pain scores and less opioid consumption than did
those in the no-block group. Furthermore, a decrease in the incidence of
postoperative vomiting and nausea was noted in the RIB group.
Nevertheless, when comparing outcomes, it was revealed that the RIB group
and the other nerve block group did not differ significantly.
 Limitation(s): No subgroup analysis to investigate the sources of
heterogeneity was performed. The number of studies in this meta-analysis
of RIB compared to those that focus on other types of nerve block is
relatively small. The optimal concentrations and volumes of local
anesthetics were not evaluated. Conclusion(s): RIB may be a new
option for pain relief after chest and breast surgery. Copyright
© 2024, American Society of Interventional Pain Physicians. All
rights reserved.

<9>
Accession Number
2029860539
Title
European Stroke Organisation (ESO) Guidelines on the diagnosis and
management of patent foramen ovale (PFO) after stroke.
Source
European Stroke Journal. 9(4) (pp 800-834), 2024. Date of Publication:
December 2024.
Author
Caso V.; Turc G.; Abdul-Rahim A.H.; Castro P.; Hussain S.; Lal A.; Mattle
H.; Korompoki E.; Sondergaard L.; Toni D.; Walter S.; Pristipino C.
Institution
(Caso) Stroke Unit, Santa Maria della Misericordia Hospital-University of
Perugia, Santa Maria della Misericordia Hospital -University of Perugia,
Perugia, Italy
(Turc) Department of Neurology, GHU Paris Psychiatrie et Neurosciences,
Universite de Paris, INSERM U1266, FHU NeuroVasc, Paris, France
(Abdul-Rahim) Liverpool Centre for Cardiovascular Science at University of
Liverpool, Liverpool John Moores University, Liverpool Heart & Chest
Hospital, Liverpool, United Kingdom
(Abdul-Rahim) Department of Cardiovascular and Metabolic Medicine,
Institute of Life Course and Medical Sciences, University of Liverpool,
Liverpool, United Kingdom
(Abdul-Rahim) Stroke Division, Department of Medicine for Older People,
Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust,
Prescot, United Kingdom
(Castro) Department of Neurology, Centro Hospitalar Universitario de Sao
Joao, Faculty of Medicine, University of Porto, Porto, Portugal
(Hussain, Lal) European Stroke Organisation, Basel, Switzerland
(Mattle) Department of Neurology, Inselspital, University of Bern, Bern,
Switzerland
(Korompoki) Department of Clinical Therapeutics, National and Kapodistrian
University of Athens, Alexandra Hospital, Athens, Greece
(Sondergaard) Abbott Structural Heart, Medical Affairs, Santa Clara,
United States
(Toni) Hospital Policlinico Umberto I, Department of Human Neurosciences,
Sapienza University of Rome, Rome, Italy
(Walter) Department of Neurology, Saarland University, Homburg, Germany
(Pristipino) Clinique Turin, Institut Coeur Paris Centre, Paris, France
Publisher
SAGE Publications Ltd
Abstract
Patent foramen ovale (PFO) is frequently identified in young patients with
cryptogenic ischaemic stroke. Potential stroke mechanisms include
paradoxical embolism from a venous clot which traverses the PFO, in situ
clot formation within the PFO, and atrial arrhythmias due to electrical
signalling disruption. The purpose of this guideline is to provide
recommendations for diagnosing, treating, and long-term managing patients
with ischaemic stroke and PFO. Conversely, Transient Ischaemic Attack
(TIA) was not considered an index event in this context because only one
RCT involved TIA patients. However, this subgroup analysis showed no
significant differences between TIA and stroke outcomes. The working group
identified questions and outcomes, graded evidence, and developed
recommendations following the Grading of Recommendations Assessment,
Development, and Evaluation (GRADE) approach and the European Stroke
Organisation (ESO) standard operating procedure for guideline development.
This document underwent peer-review by independent experts and members of
the ESO Guideline Board and Executive Committee. The working group
acknowledges the current evidentiary gap in delineating an unequivocal
diagnostic algorithm for the detection of PFO. Although transoesophageal
echocardiography is conventionally held as the most accurate diagnostic
tool for PFO identification, its status as the 'gold standard' remains
unsubstantiated by rigorously validated evidence. We found high-quality
evidence to recommend PFO closure plus antiplatelet therapy in selected
patients aged 18-60 years in whom no other evident cause of stroke is
found but a PFO (i.e. PFO-associated stroke). The PASCAL classification
system can be used to select such candidates for PFO closure. Patients
with both a large right-to-left shunt and an atrial septal aneurysm
benefit most from PFO closure. There is insufficient evidence to make an
evidence-based recommendation on PFO closure in patients older than 60 and
younger than 18 years. We found low quality evidence to suggest against
PFO closure in patients with unlikely PFO-related stroke according to the
PASCAL classification, except in specific scenarios (Expert Consensus). We
suggest against long-term anticoagulation in patients with PFO-associated
stroke unless anticoagulation is indicated for other medical reasons.
Regarding the long-term AF monitoring after PFO closure, the working group
concluded that there remains significant uncertainty regarding the risks
and benefits associated with the use of long-term cardiac monitoring, such
as implantable loop recorders. This document provides additional guidance,
in the form of evidence-based recommendations or expert consensus
statements, on diagnostic methods for PFO detection, and medical
management after PFO closure. Copyright © European Stroke
Organisation 2024.

<10>
Accession Number
2035866802
Title
Efficacy and safety of inhaled nitric oxide administered during
cardiopulmonary bypass for pediatric cardiac surgery: A systematic review
and meta-analysis.
Source
Annals of Medicine and Surgery. 85(6) (pp 2865-2874), 2023. Date of
Publication: 03 May 2023.
Author
Elnaiem W.; Mohamed Elnour A.; Koko A.E.A.; Madany M.; Hemmeda L.
Institution
(Elnaiem, Mohamed Elnour, Koko, Hemmeda) Faculty of Medicine, University
of Khartoum, Khartoum, Sudan
(Madany) Faculty of Medicine, South Valley University, Qena, Egypt
Publisher
Lippincott Williams and Wilkins
Abstract
Background and aims: Cardiopulmonary bypass (CPB) utilized for cardiac
surgeries has been associated with significant mortality and adverse
outcomes. The benefits of incorporating nitric oxide (NO) into the CPB
circuit have been reported in terms of reduced inflammation, enhanced
dynamic circulation, oxygenation, and end-organ function. This systematic
review and meta-analysis aimed to evaluate the efficacy and safety of
inhaled NO introduced to the CPB circuit among pediatric patients
undergoing various cardiac surgeries. Method(s): A systematic
literature search was conducted on 26 July 2022, using the electronic
databases of PubMed, Cochrane, Scopus, and Web of Science to include
randomized controlled trials, with no restriction regarding the date of
study conduction. The quality of studies was assessed using the Cochrane
tool. RevMan 5.3 software was used to analyze data in the inverse variance
method, with pooling data as mean difference (MD), risk ratio, and 95% CI.
 Result(s): Six trials were included comprising 1666 children who had
undergone the interventions of interest. All studies amenable to
assessment were of good quality. NO was significantly superior to the
control treatments regarding ventilation time (MD=-8.34; 95% CI [-14.50 to
-2.17], P=0.008), postoperative interleukin-6 (IL-6) levels (MD=-0.50; 95%
CI [-0.54 to -0.46], P<0.001), 24-h IL-6 levels (MD=-0.30; 95% CI [-0.32
to -0.20], P<0.001), and 24-h tumor necrosis factor-alpha (TNF-alpha)
levels (MD=-1.72; 95% CI [-3.44 to -1.00], P=0.05). The side effects of NO
and the control treatments were comparable (P=0.9). Conclusion(s): NO
administered as part of the CPB circuit during cardiac surgeries is
efficacious in terms of reducing ventilation time, postoperative IL-6, and
TNF-alpha levels compared to control, with a comparable safety
profile. Copyright © 2023 The Author(s). Published by Wolters
Kluwer Health, Inc.

<11>
Accession Number
2032373521
Title
The role of multimodal imaging in the diagnosis of prosthetic valve and
intracardiac device endocarditis: A review.
Source
International Journal of Cardiovascular Imaging. (no pagination), 2024.
Date of Publication: 2024.
Author
Daniel E.; El-Nayir M.; Ezeani C.; Nwaezeapu K.; Ogedegbe O.J.; Khan M.
Institution
(Daniel, El-Nayir, Nwaezeapu, Ogedegbe, Khan) Trinity Health Ann Arbor,
Ypsilanti, MI, United States
(Ezeani) Baton Rouge General Medical Center, Louisiana, United States
Publisher
Springer Science and Business Media B.V.
Abstract
Infective endocarditis (IE) is a severe cardiac condition associated with
substantial morbidity and mortality. Traditionally, the modified Duke's
criteria have been used to establish the diagnosis of IE, which includes
using transthoracic and transesophageal echocardiography. While
echocardiography performs well in diagnosing native valve endocarditis,
its diagnostic accuracy decreases in patients with prosthetic valves or
implanted cardiac devices such as pacemakers and defibrillators. Given
these limitations and advancements in cardiac imaging, including
multimodal computed tomography, magnetic resonance imaging, and positron
emission tomography, there has been growing interest in the utility of
these techniques for diagnosing prosthetic valve endocarditis (PVE) and
Cardiovascular implantable electronic device infection (CIEDI). Although
numerous studies have investigated the value of these imaging modalities,
their findings have been inconsistent. This article aims to reevaluate the
role of advanced imaging in diagnosing PVE and CIEDI and its impact on
managing prosthetic valves and device-related infective endocarditis.
Methods A comprehensive literature search was conducted in PubMed,
Cochrane library, Google Scholar, Embase, and other relevant databases.
Key terms such as 'infective endocarditis,' 'multimodal imaging,'
'prosthetic valve endocarditis,' '18F-FDG PET,' 'cardiac MRI,' and
'cardiac CT' were used to identify studies that investigated the role of
these imaging modalities in diagnosing PVE and CIEDI. Publications with
full text including randomized controlled trials, retrospective studies,
case reports, case series, reviews of literature, and society guidelines
were included. Copyright © The Author(s), under exclusive licence
to Springer Nature B.V. 2024.

<12>
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.

<13>
Accession Number
2035901140
Title
CTCA Prior to Invasive Coronary Angiography in Patients With Previous
Bypass Surgery: Patient-Related Outcomes, Imaging Resource Utilization,
and Cardiac Events at 3 Years From the BYPASS-CTCA Trial.
Source
Circulation: Cardiovascular Interventions. (no pagination), 2024. Article
Number: e014142. Date of Publication: 2024.
Author
Kelham M.; Beirne A.-M.; Rathod K.S.; Andiapen M.; Wynne L.; Learoyd A.E.;
Forooghi N.; Ramaseshan R.; Moon J.C.; Davies C.; Bourantas C.V.; Baumbach
A.; Manisty C.; Wragg A.; Ahluwalia A.; Pugliese F.; Mathur A.; Jones D.A.
Institution
(Kelham, Beirne, Rathod, Andiapen, Wynne, Forooghi, Ramaseshan, Baumbach,
Ahluwalia, Mathur, Jones) Centre for Cardiovascular Medicine and Devices,
Faculty of Medicine and Dentistry, Queen Mary University of London, United
Kingdom
(Kelham, Beirne, Rathod, Andiapen, Wynne, Forooghi, Ramaseshan, Bourantas,
Baumbach, Wragg, Mathur, Jones) Barts Interventional Group, Barts Health
National Health Service Trust, London, United Kingdom
(Moon, Davies, Manisty, Pugliese) Department of Cardiac Imaging, Barts
Health National Health Service Trust, London, United Kingdom
(Kelham, Beirne, Rathod, Andiapen, Wynne, Forooghi, Ramaseshan, Moon,
Bourantas, Baumbach, Manisty, Wragg, Ahluwalia, Pugliese, Mathur, Jones)
Barts Heart Centre, Barts Health National Health Service Trust, London,
United Kingdom
(Kelham, Beirne, Rathod, Andiapen, Wynne, Forooghi, Ramaseshan, Moon,
Bourantas, Baumbach, Manisty, Wragg, Ahluwalia, Pugliese, Mathur, Jones)
National Institute for Health and Care Research Barts Biomedical Research
Centre, Barts Heart Centre, William Harvey Research Institute, Queen Mary
University of London, United Kingdom
(Learoyd, Ahluwalia, Jones) Barts Cardiovascular Clinical Trials Unit,
Faculty of Medicine and Dentistry, Queen Mary University of London, United
Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: In patients with previous coronary artery bypass grafting,
computed tomography cardiac angiography (CTCA) before invasive coronary
angiography (ICA) was demonstrated in the BYPASS-CTCA trial (Randomized
Controlled Trial to Assess Whether Computed Tomography Cardiac Angiography
Can Improve Invasive Coronary Angiography in Bypass Surgery Patients) to
reduce procedure time and incidence of contrast-associated acute kidney
injury, with greater levels of patient satisfaction. Patient-related
outcomes, utilization of further diagnostic imaging resources, and
longer-term incidence of major adverse cardiac events were key secondary
end points not yet reported. METHOD(S): Patients with prior coronary
artery bypass grafting referred for ICA were randomized 1:1 to undergo
CTCA before ICA or ICA alone and followed up for a median of 3 (2.2-3.4)
years. Angina status was assessed using the Seattle Angina Questionnaire
and overall quality of life using the EQ-5D-5L. The incidence of
noninvasive imaging use and major adverse cardiac events were compared
between the 2 groups. RESULT(S): In all, 688 patients were
randomized, 344 to CTCA+ICA and 344 to ICA only. The mean age of
participants was 69.8 years, with 45% undergoing ICA for acute coronary
syndromes and the remainder stable angina. At 3 months followup, patients
in the CTCA+ICA group were more likely to be angina-free (51.7% versus
43.2%; P=0.03) with greater quality of life (EQ-5D-5L index, 81.6 versus
74.4; P=0.001), although these improvements did not persist. At 3 years
follow-up, imaging resource use (35.8% versus 45.1%; odds ratio, 0.68 [95%
CI, 0.50-0.92]; P=0.013) and incidence of major adverse cardiac events
were lower in the CTCA+ICA group (35.8% versus 43.5%; hazard ratio, 0.73
[95% CI, 0.58-0.93]; P=0.010). CONCLUSION(S): In patients with prior
coronary artery bypass grafting undergoing ICA, CTCA before ICA leads to
reductions in the use of imaging resources and the rate of major cardiac
events out to 3 years, but with similar patient-related outcome measures.
Together with the initial findings of BYPASS-CTCA, these data are
supportive of routinely undertaking a CTCA before ICA in patients with
prior coronary artery bypass grafting. Copyright © 2024 American
Heart Association, Inc.

<14>
Accession Number
2030685289
Title
Beyond the debut: unpacking six years of Hypotension Prediction Index
software in intraoperative hypotension prevention - a systematic review
and meta-analysis.
Source
Journal of Clinical Monitoring and Computing. 38(6) (pp 1367-1377), 2024.
Date of Publication: December 2024.
Author
Pilakouta Depaskouale M.A.; Archonta S.A.; Katsaros D.M.; Paidakakos N.A.;
Dimakopoulou A.N.; Matsota P.K.
Institution
(Pilakouta Depaskouale, Matsota) 2nd Department of Anesthesiology, School
of Medicine, National and Kapodistrian University of Athens, "Attikon"
Hospital, 1 Rimini Street, Athens 12462, Greece
(Pilakouta Depaskouale, Archonta, Katsaros, Dimakopoulou) Department of
Anesthesiology, Athens General Hospital "Georgios Gennimatas", 154
Mesogion Avenue, Athens 11527, Greece
(Paidakakos) Department of Neurosurgery, Athens General Hospital "Georgios
Gennimatas", 154 Mesogion Avenue, Athens 11527, Greece
Publisher
Springer Science and Business Media B.V.
Abstract
Purpose: Intraoperative hypotension (IOH) during general anesthesia is
associated with higher morbidity and mortality, although randomized trials
have not established a causal relation. Historically, our approach to IOH
has been reactive. The Hypotension Prediction Index (HPI) is a machine
learning software that predicts hypotension minutes in advance. This
systematic review and meta-analysis explores whether using HPI alongside a
personalized treatment protocol decreases intraoperative hypotension.
 Method(s): A systematic search was performed in Pubmed and Scopus to
retrieve articles published from January 2018 to February 2024 regarding
the impact of the HPI software on reducing IOH in adult patients
undergoing non-cardio/thoracic surgery. Excluded were case series, case
reports, meta-analyses, systematic reviews, and studies using non-invasive
arterial waveform analysis. The risk of bias was assessed by the Cochrane
risk-of-bias tool (RoB 2) and the Risk Of Bias In Non-randomised Studies
(ROBINS-I). A meta-analysis was undertaken solely for outcomes where
sufficient data were available from the included studies. Result(s):
9 RCTs and 5 cohort studies were retrieved. The overall median differences
between the HPI-guided and the control groups were - 0.21 (95% CI:-0.33,
-0.09) - p < 0.001 for the Time-Weighted Average (TWA) of Mean Arterial
Pressure (MAP) < 65mmHg, -3.71 (95% CI= -6.67, -0.74)-p = 0.014 for the
incidence of hypotensive episodes per patient, and - 10.11 (95% CI=
-15.82, -4.40)-p = 0.001 for the duration of hypotension. Notably a large
amount of heterogeneity was detected among the studies.
 Conclusion(s): While the combination of HPI software with
personalized treatment protocols may prevent intraoperative hypotension
(IOH), the large heterogeneity among the studies and the lack of reliable
data on its clinical significance necessitate further
investigation. Copyright © The Author(s), under exclusive licence
to Springer Nature B.V. 2024.

<15>
Accession Number
2030473406
Title
Infective endocarditis associated with left atrial appendage occlusion
device: a contemporary systematic review.
Source
Journal of Interventional Cardiac Electrophysiology. 67(8) (pp 1891-1904),
2024. Date of Publication: November 2024.
Author
Sanchez-Nadales A.; Iddrisu M.; Wardak R.; Arriola G.M.; Baez-Escudero J.;
Xu B.
Institution
(Sanchez-Nadales, Arriola) Department of Cardiology, Department of
Cardiovascular Disease, Cleveland Clinic Florida, Weston Campus, Weston,
FL 33324, United States
(Iddrisu) Department of Internal Medicine, Advocate Illinois Masonic
Medical Center, Chicago, IL 60657, United States
(Wardak) Department of Internal Medicine, Cleveland Clinic Florida,
Weston, FL 33321, United States
(Baez-Escudero) Department of Cardiac Pacing and Electrophysiology,
Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston
Campus, Weston, FL 33324, United States
(Xu) Section of Cardiovascular Imaging, Robert and Suzanne Tomsich
Department of Cardiovascular Medicine, Sydell and Arnold Miller Family
Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
44195, United States
Publisher
Springer
Abstract
Background: Data are limited regarding infective endocarditis (IE)
complicating left atrial appendage occlusion (LAAO) device procedures.
This systematic review examines the etiology, diagnosis, and management of
infective endocarditis (IE) following LAAO. Method(s): A
comprehensive search of six databases was performed between 2007 and 2022.
In selecting studies, articles were included if they provided information
about IE complicating LAAO, with relevant clinical and imaging details.
Articles were excluded if they were editorials, study protocols, letters,
or abstracts. Result(s): We identified seven cases of IE complicating
LAAO published between 2007 and 2022, from the United States and Europe,
highlighting the exceedingly rare reported incidence of the condition.
Staphylococcus aureus is the predominant organism implicated in LAAO
infections. Echocardiography is a key imaging modality for diagnosing LAAO
IE. Both antibiotic therapy and surgical intervention in appropriate
patients are important for managing LAAO device-related IE.
 Conclusion(s): The limited data in the current literature regarding
LAAO IE underscores the need for prospective clinical trials to establish
evidence-based guidelines for infection prophylaxis, diagnosis, and
management. Our findings emphasize the importance of vigilance for
device-related infections, especially as the use of LAAO devices continues
to grow worldwide. Copyright © The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature
2024.

<16>
Accession Number
2030122238
Title
Associations between intraoperative nociceptive response index and early
postoperative acute kidney injury in patients undergoing non-cardiac
surgery under general anesthesia: a single-center retrospective cohort
study.
Source
Journal of Clinical Monitoring and Computing. 38(6) (pp 1297-1304), 2024.
Date of Publication: December 2024.
Author
Kobata M.; Miyamoto K.; Ooba S.; Saeki A.; Okutani H.; Ueki R.; Kariya N.;
Hirose M.
Institution
(Kobata, Miyamoto, Ooba, Saeki, Okutani, Ueki, Kariya, Hirose) Department
of Anesthesiology, Hyogo Medical University, Faculty of Medicine, 1-1
Mukogawa-cho, Hyogo, Nishinomiya 663-8501, Japan
Publisher
Springer Science and Business Media B.V.
Abstract
Both tissue hypoperfusion and elevated surgical stress during surgery are
involved in the pathogenesis of postoperative acute kidney injury (AKI).
Although intraoperative hypotension, which evokes renal hypoperfusion, has
been reported to be associated with the development of postoperative AKI,
there is no consensus on the association between surgical stress responses
(e.g., hypertension and inflammation) and postoperative AKI. Given that
intraoperative values of nociceptive response (NR) index are reportedly
associated with surgical stress responses, the present study was performed
to assess associations between intraoperative NR index and postoperative
AKI in patients undergoing non-cardiac surgery. In this
single-institutional retrospective cohort study, data of the highest and
lowest values of NR index during surgery were obtained in consecutive
adult patients undergoing non-cardiac surgery under general anesthesia
from February 2022 to August 2023. Data on highest and lowest mean blood
pressure (MBP) during surgery were also obtained. In 5,765 patients
enrolled, multivariate regression analysis revealed that the development
of early postoperative AKI was significantly associated with highest NR
during surgery >= 0.920, lowest MBP during surgery < 54 mmHg, age >= 48
years, male sex, ASA-PS >= III, emergency, and duration of surgery >= 226
min. In addition to intraoperative hypotension, a higher level of
intraoperative NR index is likely associated with higher incidence of
early postoperative AKI in adult patients undergoing non-cardiac surgery
under general anesthesia. Copyright © The Author(s), under
exclusive licence to Springer Nature B.V. 2024.

<17>
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. 50(12) (pp 2114-2124), 2024. Date of Publication:
December 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.

<18>
Accession Number
2036051972
Title
Comparison of Coronary Interventions with Low fluoroscopic frame rate and
normal fluoroscopic frame rate - Prospective, Randomized study.
Source
Indian Heart Journal. Conference: 76th Annual Conference of Cardiological
Society of India 2024. Lucknow India. 76(Supplement 2) (pp S154), 2024.
Date of Publication: December 2024.
Author
Anbarasan S.; Jaisankar P.; Srinivasan S.; Anand G.; Muthuselvan K.;
Sivachandran G.; Singh H.R.
Institution
(Anbarasan, Jaisankar, Srinivasan, Anand, Muthuselvan, Sivachandran,
Singh) Thanjavur Medical College, Tamil Nadu, Thanjavur, India
Publisher
Elsevier B.V.
Abstract
Introduction: Radiation exposure in cardiac catheterization procedures is
great hazard for the Interventional cardiologists and the other staffs
involved. It leads to long term deterministic and stochastic effects.
Appropriate usage of the radiation is extremely important to mitigate
these ill effects in long term. In this study we studied the feasibility,
safety and efficacy of doing all the coronary interventions in our cardiac
cath lab using low fluoroscopic frame rates instead of normally used frame
rates. Method(s): All consecutive patients undergoing any coronary
intervention were randomized in a 1:1 fashion to undergo the procedure
either in the standard fluoroscopic frame rate or reduced fluoroscopic
frame rate. The standard fluoroscopic frame rate was at 15 fluoroscopic
frames per second including cine angiography. In the low fluoroscopic
frame arm, 3.75 frames per second was the setting and cine angiography was
performed at 7.5 frame rate. Total of 200 patients were included. 100
patients in standard frame rate and 100 in low frame rate arm. Primary
PCI, Pharmacoinvasive PCI, Elective PCI, Bifurcation PCI, Left main PCI
were all included and were equally distributed in both the groups. We
compared radiation exposure in terms of Cumulative air kerma, Cumulative
dose area product, Fluoroscopic time were all compared in both the groups.
All the patients were followed at 1 month and 6 months post procedure.
 Result(s): Low fluoroscopic frame rate arm showed 68% reduction in
the radiation exposure measured in terms of Cumulative dose area product
and Air kerma. There was no statistically significant difference in
Fluoroscopic time in both the arms. Also the follow up of patients at 1
month and 6 months did not show any significant difference between the two
groups. There was no significant difference in any adverse event among the
two groups. Conclusion(s): Performing all coronary interventions
including Primary PCI, left main bifurcation and other complex coronary
procedures is possible and safe using low fluoroscopic frame rates without
any significant increase in procedural time. Greater reduction in
radiation exposure is achieved which impacts long term health of
interventionist and staff. The author adopted low fluoro frame rate as
default standard for all our procedures after this study. Copyright
© 2024

<19>
Accession Number
2036051661
Title
To Asses Predictors of Prosthesis Patient Mismatch and Correlation between
its Severity with Performance Index, Various Size and Types of Mechanical
Aortic Valve Prosthesis.
Source
Indian Heart Journal. Conference: 76th Annual Conference of Cardiological
Society of India 2024. Lucknow India. 76(Supplement 2) (pp S79), 2024.
Date of Publication: December 2024.
Author
Khan M.S.; Sahu A.; Pande S.
Institution
(Khan, Sahu, Pande) SGPGIMS, Up, Lucknow, India
Publisher
Elsevier B.V.
Abstract
Background: Prosthesis-patient mismatch (PPM) is present if prosthetic
valve is too small in relation to body size, was first described by
Rahimtoola. PPM was defined if indexed EOA was < 0.85
cm2/m2, moderate PPM as >=0.65
cm2/m2 and <=0.85 cm2/m2, and
severe PPM as <0.65 cm2/m2. Several studies have
reported that the prevalence of PPM after surgical aortic valve
replacement (SAVR) ranged from 20% to 70%, and the higher pressure,
gradients observed in PPM results in reduced reverse remodelling. Besides
meta-analysis has reported that moderate and severe PPM after SAVR was
associated with higher overall mortality. Considering the potential damage
of PPM, it's important to study and evaluate various 2D-ECHO and
demographic parameters which may act as predictors of PPM Aim: To evaluate
various parameters which can serve as Predictors of PPM with Mechanical
Prostheses in Patients in the Aortic Position and correlation between its
severity with various valve size types and their Performance Index (PI).
 Methods and Results: It's a prospective observational single center
study with a sample size of 55 in which all post AVR and DVR patients
coming to OPD for follow up in cardiology and CVTS OPD SGPGIMS Lucknow
between September 2022 to April 2024 were enrolled and various clinical
demographic and various 2D-ECHO parameters were evaluated. Out of 55
patients enrolled with median follow up of 5 years, 39 patients (70.9%)
were between age 41-70 years. Males were 74.5% and females were 25.5%.
Patient with no PPM were 26 (47.3%),9(16.4%) with moderate PPM and 20
(36.4%) have severe PPM.SJM valve was used in maximum patients (30.9%). PI
of BIOCARBON SLIMLINE valve was found to be maximum(mean PI 0.52) followed
by TTK (mean PI 0.5) and minimum of ATS(mean PI 0.29;SD 0.20).Valve size
of 24mm have maximum mean PI of 0.49.PPM was found to have significant
correlation with PI (Severe PPM mean PI 0.19;SD 0.20,Moderate PPM mean PI
0.33;SD 0.06 and with No PPM mean PI 0.45;SD 0.13, P value= 0.00).No
significant correlation was found between severity of PPM and BSA (Severe
PPM mean BSA 1.65;SD 0.17, Moderate PPM mean BSA 1.64;SD 0.13, No PPM mean
BSA 1.57;SD 0.15, P value=0.21).However using linear regression model
showed significant correlation between PPM BSA and valve size(R
Square=0.304; Adjusted R Square=0.277;Pvalue= 0.002). Conclusion(s):
In our study Patients undergoing AVR with Mechanical Aortic Valve
Prosthesis severity of PPM have significant correlation with PI and BSA
and valve size can fairly predict PPM. Copyright © 2024

<20>
Accession Number
2036051561
Title
Evaluating the Efficacy of Coronary Sinus Aspiration During Coronary
Angioplasty to Attenuate the Risk of Contrast - Induced Acute Kidney
Injury in Predisposed Patients.
Source
Indian Heart Journal. Conference: 76th Annual Conference of Cardiological
Society of India 2024. Lucknow India. 76(Supplement 2) (pp S151-S153),
2024. Date of Publication: December 2024.
Author
Verma S.; Ansari A.H.; Kumar R.
Institution
(Verma, Ansari, Kumar) VMMC & Safdarjung Hospital, Delhi, New Delhi, India
Publisher
Elsevier B.V.
Abstract
Background: Cardiac angiography and angioplasty necessitate the use of
iodinated contrast media (CM), posing a risk of contrast-induced
nephropathy (CIN). Approximately 12% of hospital-acquired acute kidney
injuries (AKI) are due to CIN. Earlier studies indicated a 14.5% incidence
of CIN in the general population, while it may be as high as 50% in
high-risk groups. Recent research shows a general incidence of 8.5%, with
high-risk patients experiencing a 33% incidence. Heart failure (HF),
diabetes mellitus (DM), hemodynamic instability, CKD, advanced age,
anemia, and the use of intra-aortic balloon counter pulsation (IABP) are
indicators of risk for developing CI-AKI, with risks as high as 50% if
multiple risk factors are present. Depending on concomitant factors, the
incidence of CIN in individuals with CKD varies from 14.8% to 55%. CIN is
defined as the acute deterioration of renal function that occurs after
parenteral CM exposure in the absence of other causes. Serum Creatinine
(SCr) increase by more than 0.5 mg/dL or by 25% within 48 to 72 hours
following CM delivery are indicative of CIN. Particularly vulnerable are
patients with pre-existing renal impairment and DM, with an eGFR below 60
mL/min/1.73 m2 being a crucial predictor of the reduced number
of functioning nephrons. The volume of contrast administered is the most
significant procedure-related risk factor (8,9). Generally, a contrast
dose under 100 mL is safe, but with every 5 mL increase, the likelihood of
developing CIN rises by 44%. Given the high incidence of procedure-related
AKI, significant efforts are being made to reduce CIN risk. Since there is
no definitive treatment for CIN, identifying high-risk patients and
implementing preventive measures is crucial. These measures include
hydration and minimizing the contrast dose. Peri-procedural hydration with
parenteral isotonic saline should begin 12 hours before the procedure at a
rate of 1-1.5 mL/kg/h and continue for 24 hours post-procedure, barring
any contraindications. While N-acetylcysteine (NAC) has been used for
prevention of CIN in periprocedural period, its effectiveness lacks strong
evidence from large studies. Prophylactic dialysis is not recommended for
CIN prevention, with hemodialysis/hemofiltration reserved for CKD stage 4
or 5 patients, especially when the access is available. Considering the
direct correlation between contrast volume and CIN incidence, techniques
to reduce contrast exposure are being developed. One such novel approach
is coronary sinus aspiration (CSA), which aims to remove CM and minimize
renal exposure to it, particularly in high-risk patients. To the best of
our knowledge, it has not been studied in the Indian population yet, and
randomized clinical trials are lacking. Aim(s): To evaluate the
efficacy of coronary sinus aspiration to attenuate the risk of
contrast-induced acute kidney injury in predisposed patients undergoing
coronary angioplasty. Objective(s): Primary Objective - To compare
the proportion of patients developing CI-AKI in high-risk population
undergoing coronary angioplasty in the control group and the coronary
sinus aspiration group. Secondary Objective - Absolute and percentage
change in serum creatinine in the coronary sinus aspiration group and the
control group. Method(s): Study type: Hospital based interventional
study, Study design: Single blinded randomized control trial, Study
period: 18 months. Sample Size Calculation: Sample size was calculated to
be 24 patients each. But according to central limit theorem, minimum
sample size should be 30. Adding 10% error, the sample size would be 33
patients in each group. Ethical Consideration: Ethical clearance was duly
obtained from the institutional Ethical board and informed consent of all
the participants was taken prior to the study. Inclusion Criteria:
Patients of CKD stage 3 (eGFR 30-60 ml/min) (14) with diagnosed type 2 DM
undergoing coronary angioplasty and fulfilling the following criteria - i)
Age between 18-75 years ii)Both male and female. Exclusion Criteria -
1.Right coronary interventions. 2. Acute coronary syndrome (within 3
months). 3. Emergency conditions such as hemodynamic instability, electric
or mechanical complications. 4. Congestive heart failure. 5. Hemoglobin
level <8 g %. 6. Hyperkalemia (serum K+ >5.3 mEq/L). 7. Obstructive
uropathy Methdology: Our study enrolled 33 patients each in coronary sinus
aspiration and control group after applying inclusion and exclusion
criteria. The RCT was registered in Clinical trial registry-India (CTRI)
and approval was granted. Coronary Sinus Cannulation. In CSA group, CS
cannulation was done via right or left femoral veinusing an Abott SwartzTM
Braided Transeptal Guiding Introducer- SL0 (8.0 French) sheath over
steerable decapolar catheter to cannulate CS in 40degree left anterior
oblique (LAO) projection. CS hooking was confirmed by injecting 1-2 ml dye
in CS under fluoroscopy. (Figure 1) Results: The principal findings of our
study are-1. Baseline characteristics were well matched between both the
case and the control groups. There was no statistically significant
difference between all the baseline parameters including mean age, sex,
comorbidities including hypertension, dyslipidemia and diabetes, and
smoking habits. (Table 1) 2. Most common indication for angioplasty was
AWMI in 30.3% patients and NSTEMI in 25.7%. 3. The mean LVEF was 44.1 +-
11.4% in the case group and 42.3 +-11.9% in control group. (p = 0.43). 4.
Baseline blood parameters were well matched in both the group with only
potassium values being statistically higher in case group. Baseline
hemoglobin in the case group was 12.6 +-1.9 g/dl and 12.7 +-1.8 g/dl in
control group (p = 0.60). Serum creatinine was 1.7 mg/dl in both the group
(p = 0.58). Serum potassium was higher in the case group with mean value
being 4.4 +- 0.5 mEq/L while in the control group it was 4.1 +- 0.2 mEq/L
(p = 0.004). Baseline eGFR was 45.6 +- 8.5 and 48.7 +- 7.1 ml/min/1.73 m2
in the case and control group respectively (p = 0.15). 5. Majority of both
cases (78.8%) and control (72.7%) had single vessel intervention. Majority
of the cases and controls had 1 drug eluting stent (DES) being deployed,
i.e., 78.8% and 69.7% respectively. The difference in number of vessels or
stents is statistically non-significant in both the groups ( p = 0.56 and
p = 0.67 respectively). 6. In CSA group, CS cannulation was done an Abott
SwartzTM Braided Transeptal Guiding Introducer- SL0 (8.0
French) sheath with decapolar catheter in all patients. CS aspiration was
done directly from the sheath in 100% of the patients. In majority of the
patients (72.7%), right femoral vein access was taken to cannulate CS. 7.
The mean CS cannulation time was 9.9 +- 5.7 minutes with mean cannulation
fluoroscopy time being 6.8 +-3.7 minutes. Time for clearance of contrast
from CS was 9.8 +-2.5 seconds. (Table 2) 8. The total volume of injected
contrast (VIC) in the case group is 65.2 +-23 ml while in control group is
75.6 +- 25.1 ml, with no statistically significant difference between the
two groups (p = 0.6). 9. The mean volume of coronary sinus aspirate (VCSA)
was 102.2 +-24.9 ml while the mean VCSA per injection was 10.5 +- 1.7 ml.
10. The mean estimated volume of aspirated contrast (EVAC) in our study
was 18.7 +- 7.1 ml and the mean fraction of evacuated contrast (FAC) was
28.9 +-5.1 %. 11. However, there was a statistically significant
difference found between the post procedural absolute hemoglobin level
Change (Baseline to 24 hours) i.e., cases- minus 0.7 +- 0.3 Vs control-
minus 0.3 +- 0.1 g/dL, p <0.001, percentage hemoglobin level Change
(Baseline to 24 hours) i.e. cases- minus 5.5 +-2.7 % Vs controls- minus
2.3 +-1.1 g/dL, p <0.001, absolute hemoglobin level Change (Baseline to 48
hours) i.e., cases- minus 5.5 +-2.7 g/dL Vs controls- minus 2.3 +-1.1
g/dL, p <0.001 and percentage hemoglobin level Change (Baseline to 48
hours), i.e., cases- minus 5.8 +-2.3 % Vs controls- minus 2.1 +-2.6 g/dL,
p <0.001, of the case and the control group. Post procedural lowest Hb in
the case group was 11.9 +- 1.8 g/dL, which was slightly lower than in the
control group 12.5 +- 1.7 g/dL, however did not reach statistical
significance. Hence, excess blood loss due to CSA did not cause a
statistically significant Hb fall. 12. There was no statistically
significant difference found between the mean post procedural creatinine
levels of 24, 48 and 72 hours in the case and the control group. Also,
there was no statistically significant difference found between the post
procedural absolute and percentage creatinine level change (from baseline
to 24 and 48 hours) in the case and the control group. Post procedural
peak creatinine within 72 hours in the case group was 1.9 +- 0.7 mg/dL,
which was slightly lower than in the control group 12 +- 0.8 mg/dL, but
did not reach statistical significance. 13. Primary endpoint- A total of
27.3% (18/66) patients developed CIN. Among the cases 15.2% (5/33) and
among controls, 39.4 % (13/33) of patients developed CIN. There is
statistically significant lesser number of patients developing CIN in the
case group compared to control group. Among the 5 cases developing CIN, 3
required dialysis and there was no death. Among 13 controls developing
CIN, 8 required dialysis and there was one death. There no statistically
significant difference found between the outcome of CIN patients in the
case and the control group. (Table 2 and 3). 14. Secondary Endpoints
Absolute and percentage change in serum creatinine: There was no
statistically significant difference found between the post procedural
absolute and percentage creatinine level change (from baseline to 24 and
48 hours), in the case and the control group.15. There was 1
procedure-related complication in the form of CS perforation while CS
cannulation. Immediately pericardiocentesis was done under fluoroscopy and
pigtail inserted. Patient was managed conservatively and discharged.
(Figure 3) Strength: 1. To the best of our knowledge, no similar study has
been done so far in India. 2. Our study proves the safety and efficacy of
coronary sinus cannulation and aspiration to attenuate the risk of CIN in
predisposed individual. 3. Our study is the first randomized clinical
trial (RCT) while all the previous studies were non randomized clinical
trial evaluating CSA strategy. 4. We propose a simple and cheap technique
to withdraw more than a third of the given contrast in high-risk patients
without the need of dedicated equipment or advanced technologies. This may
attenuate the fear from CI-AKI, which has deprived many of such patients
from angiography. Conclusion(s): Contrast induced nephropathy is a
growing problem with a greater number of angiographic procedures being
done worldwide. Patients having DM and CKD are at higher risk of
developing CIN. Coronary sinus aspiration is one of the novel methods
being studied for prevention of CIN. Hereby, we demonstrate that CSA is a
safe and practical technique. The finding from the present study suggests
that, coronary sinus aspiration in high-risk patients undergoing coronary
angioplasty reduces the volume of the given contrast by almost one third
and attenuates the risk of CI-AKI in addition to the standard preventive
measures with peri-procedural hydration. This may attenuate the fear of
CI-AKI, which has deprived many high-risk patients from angiography. To
the best of our knowledge, this is the first such study done in the Indian
subcontinent but further studies are needed to support our findings.
[Formula presented] [Formula presented] CS- coronary sinus, VIC- volume of
injected contrast, VCSA- Volume of coronary sinus aspirate, EVAC-
Estimated volume of aspirated contrast, FAC- Fraction of aspirated
contrast. [Formula presented] [Formula presented] [Formula
presented] Copyright © 2024

<21>
Accession Number
2036051545
Title
Impact of intracoronary tirofiban in angiographically proven high-grade
thrombus: A randomized controlled trial.
Source
Indian Heart Journal. Conference: 76th Annual Conference of Cardiological
Society of India 2024. Lucknow India. 76(Supplement 2) (pp S36), 2024.
Date of Publication: December 2024.
Author
Batta A.; Babu R.; Panda P.; Sharma Y.P.
Institution
(Batta, Babu, Panda, Sharma) Dayanand Medical College and Hospital,
Punjab, Ludhiana, India
(Batta, Babu, Panda, Sharma) Postgraduate institute of medical education
and research, Chandigarh, India
Publisher
Elsevier B.V.
Abstract
Background: The presence of angiographic thrombus is associated with poor
outcomes in contemporary cardiology practice. Percutaneous coronary
intervention (PCI) in such lesions is associated with slow flow and
no-reflow phenomenon which translate into poor clinical outcomes.
 Method(s): This was a single-centre, prospective, open-label,
randomized controlled study with 50 patients each in intervention group
and control group. Patients with angiographically proven large thrombus
burden were recruited. In the intervention group, patients were given
loading dose of intracoronary tirofiban (25mcg/kg infused over 5 minutes)
followed by prolonged infusion of tirofiban (0.15mcg/kg/min for 12-18
hours) followed by PCI after 48-72 hours interval. In control group
patients were taken up directly for PCI during the index procedure.
Outcomes were assessed angiographically and in terms of clinical
endpoints. Result(s): The primary composite-endpoint of recurrent
angina, myocardial infarction, cardiovascular death, target lesion
revascularization and unscheduled CABG was significantly lower in the
intervention arm compared to control arm (4% vs 16%, p=0.04). Amongst the
secondary endpoints, a statistically significant 30-day increase in
ejection fraction from baseline was observed in the intervention group
compared to the control group (1.6+/-1.3 vs 0.2 +/- 0.4, p = 0.0001).
Overall mortality was similar in the two groups (4% vs 8%, p=0.39). The
primary safety endpoint of major bleeding was also similar in the 2 groups
(2% vs 0%, p=0.31). Conclusion(s): Tirofiban use prior to PCI in high
thrombus burden was associated with improved clinical and angiographic
endpoints with similar adverse events compared to controls. Copyright
© 2024

<22>
Accession Number
645893428
Title
Beta-Blocker Use in Patients Undergoing Non-Cardiac Surgery: A Systematic
Review and Meta-Analysis.
Source
Medical sciences (Basel, Switzerland). 12(4) (no pagination), 2024. Date
of Publication: 11 Nov 2024.
Author
Herrera Hernandez D.; Abreu B.; Xiao T.S.; Rojas A.; Romero K.L.;
Contreras V.; Nogueyra S.V.; Sosa Z.; Alvarez S.M.; Sanchez Cruz C.;
Calderon Martinez E.
Institution
(Herrera Hernandez) Facultad de Medicina, Pontificia Universidad Catolica
del Ecuador, Quito 170525, Ecuador
(Abreu) Facultad de Medicina, Universidad de Carabobo, Valencia 2005,
Venezuela
(Xiao) Radiology Department, Thomas Jefferson University, Philadelphia PA
19107, United States
(Rojas) Facultad de Medicina, Universidad de Oriente, Barcelona 6001,
Venezuela
(Romero) Facultad de Medicina, Universidad del Salvador, San Salvador
1101, El Salvador
(Contreras) Department of Lymphoma and Myeloma, MD Anderson Cancer Center,
Houston TX 77030, United States
(Nogueyra) Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires
C1053ABK, Argentina
(Sosa) Facultad de medicina, Universidad Evangelica de El Salvador, San
Salvador 1101, El Salvador
(Alvarez) Faculty of Medicine, Saint George's University, Grenada
(Sanchez Cruz, Calderon Martinez) Facultad de Medicina, Universidad
Nacional Autonoma de Mexico, Ciudad de Mexico 04510, Mexico
(Calderon Martinez) Department of Internal Medicine, University of Texas
Health Science Medical Center, Houston TX 77030, United States
Abstract
BACKGROUND: The use of beta-blockers in the perioperative period has been
widely investigated due to their potential to reduce the risk of major
adverse cardiovascular and cerebrovascular events (MACCE) and mortality;
yet their overall impact on various postoperative outcomes remains
debated. This study constitutes a systematic review and meta-analysis of
the impact of beta-blockers on mortality, MI, stroke, and other adverse
effects such as hypotension and bradycardia in patients undergoing
non-cardiac surgery. METHOD(S): A comprehensive systematic review and
meta-analysis were conducted according to PRISMA 2020 guidelines. Searches
were performed across PubMed, Cochrane, Web of Science, Scopus, EMBASE,
and CINAHL databases; we included randomized controlled trials and cohort
and case-control studies published from 1999 to 2024. RESULT(S): This
meta-analysis included data from 28 studies encompassing 1,342,430
patients. Perioperative beta-blockers were associated with a significant
increase in stroke risk (RR 1.42, 95% CI: 1.03 to 1.97, p = 0.03, I2 =
62%). However, no statistically significant association was found between
beta-blocker use and mortality (RR 0.62, 95% CI: 0.38 to 1.01, p = 0.05,
I2 = 100%). Subgroup analyses revealed a protective effect on mortality
for patients with high risks, such as patients with a history of atrial
fibrillation, chronic heart failure, and other arrhythmias. For myocardial
infarction (RR 0.82, 95% CI: 0.53 to 1.28, p = 0.36, I2 = 86%), a
reduction in events was observed in the subgroup of randomized controlled
trials. Beta-blockers significantly increased the risk of hypotension (RR
1.46, 95% CI: 1.26 to 1.70, p < 0.01, I2 = 25%) and bradycardia (RR 2.26,
95% CI: 1.37 to 3.74, p < 0.01, I2 = 64%). CONCLUSION(S):
Perioperative beta-blockers show increasing rates of stroke events
following non-cardiac surgery but do not significantly impact the
incidence of MI or mortality. The increased risks of hypotension and
bradycardia necessitate careful patient selection and monitoring. Future
research should aim to refine patient selection criteria and optimize
perioperative management to balance the benefits and risks of beta-blocker
use in surgical settings.

<23>
Accession Number
2032386044
Title
Preoperative Protein Profiling Among Postoperative Cognitive Dysfunction
(POCD) Patients Following Open-Heart Surgery: A Systematic Review and
Integrated Bioinformatic Analysis.
Source
International Journal of Molecular Sciences. 25(22) (no pagination), 2024.
Article Number: 12238. Date of Publication: November 2024.
Author
Elias M.H.; Abdul Hamid N.; Maluin S.M.; Aris S.; Kadiman S.; Muhammad
Hafidz K.; Juliana N.
Institution
(Elias, Abdul Hamid, Maluin, Aris, Juliana) Faculty of Medicine and Health
Sciences, Universiti Sains Islam Malaysia, Negeri Sembilan, Bandar Baru
Nilai 71800, Malaysia
(Kadiman, Muhammad Hafidz) Department of Anaesthesia and Intensive Care,
Institut Jantung Negara, Kuala Lumpur 50400, Malaysia
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
The inability to accurately predict the occurrence of postoperative
cognitive dysfunction (POCD) among open-heart surgery patients leads to
concerning increases in POCD cases. Preoperative circulating biomarkers
are important to identify as they are non-invasive and could provide an
early prediction of POCD development, allowing for earlier and more
strategized interventions. However, to date, no robust circulating
biomarkers have proven effective for preoperative POCD prediction. This
systematic review aims to synthesize current evidence on preoperative
protein profiling among POCD patients following open-heart surgery. Thus,
a thorough literature search employing PubMed, EBSCOhost, Scopus, and
Science Direct was carried out. This combination of keywords was used as
part of the search strategy: ("Postoperative cognitive decline" OR
"Postoperative cognitive disorders" OR "Postoperative cognitive
dysfunction" OR "Postoperative cognitive complications") AND ("Thoracic
Surgery" OR "Cardiac Surgery" OR "Heart Surgery") AND ("Protein
expression" OR proteomic OR "Protein profiling"). Eight hundred and
twenty-nine studies were retrieved and only clinical studies reporting the
circulating preoperative differentially expressed Proteins (DEPs) in the
POCD patients were selected. Six studies were selected following the
inclusion and exclusion criteria. Only one preoperative DEP and four
immediate postoperative DEPs were extracted from the studies. All four
proteins were selected for analysis using DAVID, STRING, and Cytoscape
software. Due to the very low number of proteins, no clusters have been
identified. This systematic review demonstrates the lack of POCD
preoperative biomarkers for open-heart-surgery patients. Thus, it is
suggested that more studies can be conducted to fill this
gap. Copyright © 2024 by the authors.

<24>
Accession Number
2035950092
Title
CHARGE syndrome and congenital heart diseases: systematic review of
literature.
Source
Monaldi Archives for Chest Disease. 94(3) (no pagination), 2024. Article
Number: 2661. Date of Publication: 2024.
Author
Polito M.V.; Ferraioli M.; Nocilla A.; Coppola G.; D'Auria F.; Marzano A.;
Barnabei L.; Malinconico M.; Bossone E.; Ferrara F.
Institution
(Polito, Coppola, D'Auria, Marzano, Barnabei, Malinconico, Ferrara)
Division of Cardiology, Heart Department, "Cava de' Tirreni and Amalfi
Coast" Hospital, University Hospital of Salerno, Italy
(Ferraioli, Nocilla) Department of Medicine Surgery and Dentistry,
University of Salerno, SA, Baronissi, Italy
(Bossone) Department of Public Health, Federico II University of Naples,
Italy
Publisher
Page Press Publications
Abstract
CHARGE syndrome (CS) is a rare genetic disease that affects many areas of
the body. The aim of the present systematic review was to evaluate the
prevalence and types of congenital heart diseases (CHDs) in CS and their
impact on clinical outcome. A systematic review from 1981 to September
2022 was conducted. Clinical studies that reported the association between
CS and CHDs were identified, including a case report of a rare congenital
anomaly of the aortic arch (AA) with persistent fifth AA (PFAA).
Demographic, clinical and outcome data were extracted and analyzed. A
total of 68 studies (44 case reports and 24 case series; n=943 CS
patients) were included. The prevalence of CHDs was 76.6%, patent ductus
arteriosus 26%, ventricular 21%, atrial septal defects 18%, tetralogy of
Fallot 11%, and aortic abnormalities 24%. PFAA has not been previously
reported in CS. Cardiac surgery was performed in more than half of CS
patients (150/242, 62%). The in-hospital mortality rate was about 9.5%
(n=86/900) in case series studies and 12% (n=5/43) in case reports,
including cardiovascular (CV) and non-CV causes. CHDs and feeding
disorders associated with CS may have a substantial impact on prognosis.
CHDs were usually associated with CS and represent important causes of
morbidity and mortality. PFAA, although rare, may also be present. The
prognosis is highly dependent on the presence of cardiac and non-cardiac
developmental abnormalities. Further studies are needed to better identify
the main causes of the long-term outcome of CS patients. Copyright
© Author(s), 2023.

<25>
Accession Number
2031591625
Title
Comparative Outcomes of Transcatheter Versus Surgical Aortic Valve
Replacement in Elderly Patients With Severe Symptomatic Aortic Stenosis: A
Systematic Review.
Source
Journal of the Saudi Heart Association. 36(3) (pp 242-251), 2024. Date of
Publication: 2024.
Author
Hamodat O.; Almuzainy S.; Nizar S.
Institution
(Hamodat, Almuzainy, Nizar) University of Sharjah, College of Medicine,
Sharjah, United Arab Emirates
Publisher
Saudi Heart Association
Abstract
Objectives: Aortic stenosis is the most common valvular heart disease
globally; while transcatheter aortic valve replacement (TAVR) has proven
to be a competitive alternative to surgical aortic valve replacement
(SAVR) and revolutionized treatment, its safety and efficacy has yet to be
comprehensively assessed against SAVR for certain subsets of aortic
stenosis patients; therefore, this study aims to systematically analyze
all the available clinical evidence from randomized clinical trials on
TAVR versus SAVR among intermediate and low-risk patients with severe
symptomatic aortic stenosis. Methodology: We performed a systematic review
of the randomized controlled trials (RCT), studies comparing TAVR and SAVR
in low and intermediate-risk patients were identified by a comprehensive
search of the major databases. Mortality, stroke, length of stay, and
other perioperative outcomes were assessed. Result(s): A
comprehensive screening of 14,384 records identified 9 studies,
encompassing 8884 patients with a mean age of 77.76 years and 49.47% male.
TAVR demonstrated a significantly lower all-cause mortality at both 30
days and 1 year compared to SAVR, with comparable outcomes at 2 years,
underscoring its potential for enhanced survival. Stroke incidence was
markedly lower with TAVR at both 30 days and 1 year, highlighting its
favorable neurological safety profile. Additionally, TAVR showed a reduced
rate of myocardial infarction within the initial 30 days post-procedure.
Prosthetic valve endocarditis rates remained low and comparable between
the two approaches at both 30 days and 1 year. Notably, TAVR was
associated with a significantly shorter hospital stay, suggesting a faster
recovery trajectory and improved patient throughput. These findings
collectively emphasize the superior efficacy and safety profile of TAVR
over SAVR. Conclusion(s): TAVR may serve as a viable therapeutic
option for intermediate and low-risk patients with severe symptomatic
aortic stenosis. Future research should focus on long-term outcomes and
TAVR device durability, especially in younger, lower-risk
populations. Copyright © 2024 Saudi Heart Association.

<26>
Accession Number
645859544
Title
Fenoldopam for preventing and treating acute kidney injury.
Source
Cochrane Database of Systematic Reviews. 2024(11) (no pagination), 2024.
Article Number: CD012905. Date of Publication: 28 Nov 2024.
Author
Esezobor C.I.; Bhatt G.C.; Effa E.E.; Hodson E.M.
Institution
(Esezobor) Department of Paediatrics, College of Medicine, University of
Lagos, Lagos, Nigeria
(Esezobor) Department of Pediatrics, Eastern Virginia Medical School at
Old Dominion University, Norfolk, VA, United States
(Bhatt) Division of Pediatric Nephrology, Department of Pediatrics, All
India Institute of Medical Sciences (AIIMS), Bhopal, India
(Effa) Internal Medicine, College of Medical Sciences, University of
Calabar, Calabar, Nigeria
(Hodson) Cochrane Kidney and Transplant, Centre for Kidney Research, The
Children's Hospital at Westmead, Westmead, Australia
Publisher
John Wiley and Sons Ltd
Abstract
Background: Fenoldopam is a short-acting benzazepine selective
dopaminergic A1 (DA1) receptor agonist with increased activity at the D1
receptor compared with dopamine. Activation of the DA1 receptors increases
kidney blood flow because of dilatation of the afferent and efferent
arterioles. Previous reviews have been published on the efficacy and
safety of fenoldopam for acute kidney injury (AKI); however, they either
combined data on its effect on both prevention and treatment of AKI,
focused on only those undergoing cardiac surgery and/or excluded children.
 Objective(s): This review aimed to assess the benefits and harms of
fenoldopam for the prevention or treatment of AKI in children and adults.
 Search Method(s): We searched the Cochrane Kidney and Transplant
Register of Studies up to 12 November 2024 through contact with the
Information Specialist using search terms relevant to this review. Studies
in the Register were identified through searches of CENTRAL, MEDLINE, and
EMBASE, conference proceedings, the International Clinical Trials Registry
Platform (ICTRP) Search Portal and ClinicalTrials.gov. Selection
Criteria: We included randomised controlled trials (RCTs) evaluating
fenoldopam for the prevention or treatment of AKI in children and adults
following surgery, radiocontrast exposure or sepsis. Data Collection
and Analysis: Two authors independently assessed studies for eligibility,
assessed the studies for risk of bias and extracted data from the studies.
Dichotomous outcomes were presented as relative risk (RR) with 95%
confidence intervals (CI). For continuous outcomes, the mean difference
(MD) with 95% CI was used. Statistical analysis was performed using the
random-effects model. We assessed the certainty of the evidence using the
Grading of Recommendations, Assessment, Development and Evaluations
(GRADE) approach. Main Result(s): We identified 25 RCTs, including
3339 randomised participants. Twenty-three studies used fenoldopam for
preventing AKI and two for the treatment of AKI. Nine studies included
participants undergoing cardiac surgery, and one included children. The
risks of bias for sequence generation and concealment were low in 11 and
13 studies, respectively. Only 13 and 18 studies were at low risk of
performance bias and detection bias, respectively. The risk of attrition
bias and selective reporting were judged to be at low risk of bias in 17
and 10 studies, respectively. We included data in the meta-analyses from
eight of the 14 studies comparing fenoldopam with placebo or saline, all
six studies comparing fenoldopam with dopamine, all five studies comparing
fenoldopam with N-acetylcysteine (NAC) for the prevention of AKI and from
the two studies comparing fenoldopam with placebo or saline for the
treatment of AKI. Compared with placebo or saline fenoldopam probably
results in fewer participants developing AKI (RR 0.72, 95% CI 0.53 to
0.98; 8 studies, 1147 participants; I2 = 48%; moderate
certainty) but may make little or no difference to the number requiring
kidney replacement therapy (KRT) (RR 0.81, 95% CI 0.31 to 2.15; 7 studies,
835 participants; I2 = 17%), risk of death (RR 0.76, 95% CI:
0.58 to 1.00; 7 studies, 944 participants; I2 = 0%) or change
in urine output (SMD 0.20, 95% CI -0.44 to 0.84; 2 studies, 58
participants; I2 = 34%; all low certainty). Fenoldopam may
result in a shorter stay in the ICU (MD -1.81 days; 95% CI -2.41 to -1.21;
4 studies, 403 participants; I2 = 0%). It is uncertain whether
adverse events (hypotension, myocardial infarction, drug intolerance,
cardiac arrhythmias) differed between the treatment groups as the
certainty of the evidence was very low. In patients undergoing cardiac
surgery, fenoldopam, compared to placebo or saline, may make little or no
difference to the prevention of AKI, the need for KRT or death. Compared
with dopamine, fenoldopam may make little or no difference to the
prevention of AKI (RR 0.62, 95% CI 0.23 to 1.68; 4 studies, 398
participants; I2 = 78%), the number requiring KRT (RR 0.74, 95%
CI 0.29 to 1.87; 4 studies, 434 participants; I2 = 0%) or the
risk of death (RR 1.27, 95% CI 0.36 to 4.50; 2 studies, 174 participants;
I2 = 0%) (all low certainty). It is uncertain whether
participants receiving fenoldopam were more likely to develop hypotension
compared with those receiving dopamine (RR 3.00, 95% CI 1.06 to 8.52; 1
study, 80 participants; very low certainty). Change in urine output was
not reported. It is uncertain whether fenoldopam compared with NAC
prevents AKI (RR 1.68, 95% CI 0.79 to 3.56; 3 studies, 359 participants;
I2 = 38%), reduces the need for KRT (RR 0.96, 95% CI 0.15 to
6.26; 2 studies, 137 participants; I2 = 0%), or the risk of
death (RR 1.05, 95% CI 0.07 to 15.66; 1 study, 39 participants) (all very
low certainty). It is uncertain whether hypotension was more frequent with
fenoldopam (RR 5.10, 95% CI 0.25, 104.94; 1 study, 192 participants; very
low certainty). Change in urine output was not reported. In participants
with established AKI, it is uncertain whether fenoldopam compared to
placebo or half saline reduces the numbers needing KRT (RR: 0.91, 95% CI
0.54 to 1.54; 2 studies, 822 participants; I2 = 58%; very low
certainty) or the risk of death (RR 0.81, 95% CI 0.44 to 1.48; 2 studies,
822 participants; I2 = 66%; very low certainty), or if it
increases the risk of hypotension (RR 1.65, 95% CI 1.22 to 2.22; 2
studies, 822 participants; I2 = 0%; very low certainty).
Authors' conclusions: Fenoldopam administration in patients at risk of AKI
is probably associated with a lower risk of developing AKI and shorter ICU
stay when compared with placebo or saline, but has little or no effect on
the need for KRT or the risk of death. In those undergoing cardiac
surgery, fenoldopam may not confer any benefits compared with placebo or
saline. Furthermore, it remains unclear whether fenoldopam is more or less
effective than either dopamine or NAC in reducing the risk for AKI or the
need for KRT. Further well-designed and adequately powered studies are
required to evaluate the efficacy and safety of fenoldopam in preventing
or treating AKI. Copyright © 2024 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<27>
Accession Number
645843069
Title
Prophylactic use of inotropic agents for the prevention of low cardiac
output syndrome and mortality in adults undergoing cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2024(11) (no pagination), 2024.
Article Number: CD013781. Date of Publication: 27 Nov 2024.
Author
Gayatri D.; Tongers J.; Efremov L.; Mikolajczyk R.; Sedding D.; Schumann
J.
Institution
(Gayatri, Schumann) Department of Anaesthesiology and Surgical Intensive
Care, University Medicine Halle, Halle (Saale), Germany
(Gayatri) Department of Epidemiology, Faculty of Public Health,
Universitas Indonesia, Depok, Indonesia
(Tongers, Sedding) Cardiology, Angiology and Intensive Care Medicine,
University Hospital Halle, Halle (Saale), Germany
(Efremov, Mikolajczyk) Institute for Medical Epidemiology, Biometrics and
Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical
School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale),
Germany
Publisher
John Wiley and Sons Ltd
Abstract
Background: As the burden of cardiovascular disease grows, so does the
number of cardiac surgeries. Surgery is increasingly performed on older
people with comorbidities who are at higher risk of developing
perioperative complications such as low cardiac output state (LCOS).
Surgery-associated LCOS represents a serious pathology responsible for
substantial morbidity and mortality. Prevention of LCOS is a critical and
worthwhile aim to further improve the outcome and effectiveness of cardiac
surgery. However, guidelines consistently report a lack of evidence for
pharmacological LCOS prophylaxis. Objective(s): To assess the
benefits and harms of the prophylactic use of any inotropic agent to
prevent low cardiac output and associated morbidity and mortality in
adults undergoing cardiac surgery. Search Method(s): We identified
trials (without language restrictions) via systematic searches of CENTRAL,
MEDLINE, Embase, and CPCI-S Web of Science in October 2022. We checked
reference lists from primary studies and review articles for additional
references. We also searched two registers of ongoing trials.
 Selection Criteria: We included randomised controlled trials (RCTs)
enrolling adults who underwent cardiac surgery and were prophylactically
treated with one or multiple inotropic agent(s) in comparison to any type
of control (i.e. standard cardiac care, placebo, other inotropic agents).
 Data Collection and Analysis: We used established methodological
procedures according to Cochrane standards. Two review authors
independently extracted data and assessed risk of bias according to a
pre-defined protocol. On request, we obtained a reply and additional
information from only one of the included study authors. We used the five
GRADE considerations (study limitations, consistency of effect,
imprecision, indirectness, and publication bias) to assess the certainty
of evidence from the studies that contributed data to the meta-analyses
for the pre-specified outcomes. Based on the identified studies, there
were seven comparison groups: amrinone versus placebo, dopamine versus
placebo, milrinone versus placebo, levosimendan versus dobutamine,
levosimendan versus milrinone, levosimendan versus standard cardiac care,
and levosimendan versus placebo. Main Result(s): We identified 29
eligible studies, including 3307 individuals, and four ongoing studies. In
general, confidence in the results of the analysed studies was reduced due
to relevant study limitations, imprecision, or inconsistency. Domains of
concern encompassed inadequate methods of sequence generation and lack of
blinding. The majority of trials were small, with only a few included
participants, and investigated the prophylactic use of levosimendan. Our
meta-analyses showed that levosimendan as compared to placebo may reduce
the risk of LCOS (risk ratio (RR) 0.43, 95% confidence interval (CI) 0.25
to 0.74; I2 = 66%; 1724 participants, 6 studies; GRADE: low)
and probably reduces all-cause mortality (RR 0.65, 95% CI 0.43 to 0.97;
I2 = 11%; 2347 participants, 14 studies; GRADE: moderate). This
translates into a number needed to treat for an additional beneficial
outcome (NNTB) of 8 to prevent one event of LCOS post surgery and of 44 to
prevent one death at 30 days. Subgroup analyses revealed that the
beneficial effects of levosimendan were predominantly observed in
preoperative drug administration. Our meta-analyses further indicated that
levosimendan as compared to placebo may shorten the length of intensive
care unit (ICU) stay (mean difference -1.00 days, 95% CI -1.63 to -0.37;
572 participants, 7 studies; GRADE: very low) and the duration of
mechanical ventilation (mean difference -8.03 hours, 95% CI -13.17 to
-2.90; 572 participants, 7 studies; GRADE: very low) but the evidence is
very uncertain. The risk of adverse events did not clearly differ between
levosimendan and placebo groups (cardiogenic shock: RR 0.65, 95% CI 0.40
to 1.05; I2 = 0%; 1212 participants, 3 studies; GRADE: high;
atrial fibrillation: RR 1.02, 95% CI 0.82 to 1.27; I2 = 60%;
1934 participants, 11 studies; GRADE: very low; perioperative myocardial
infarction: RR 0.89, 95% CI 0.61 to 1.31; I2 = 13%; 1838
participants, 8 studies; GRADE: moderate; non-embolic stroke or transient
ischaemic attack: RR 0.89, 95% CI 0.58 to 1.38; I2 = 0%; 1786
participants, 8 studies; GRADE: moderate). However, levosimendan as
compared to placebo might reduce the number of participants requiring
mechanical circulatory support (RR 0.47, 95% CI 0.24 to 0.91;
I2 = 74%; 1881 participants, 10 studies; GRADE: low). There was
no conclusive evidence on the effect of levosimendan compared to standard
cardiac care on LCOS (RR 0.49, 95% CI 0.14 to 1.73; I2 = 59%;
208 participants, 3 studies; GRADE: very low), all-cause mortality (RR
0.37, 95% CI 0.13 to 1.04; I2 = 0%; 208 participants, 3
studies; GRADE: low), adverse events (cardiogenic shock: RR 0.62, 95% CI
0.22 to 1.81; 128 participants, 1 study; GRADE: very low; atrial
fibrillation: RR 0.40, 95% CI 0.11 to 1.41; I2 = 60%; 188
participants, 2 studies; GRADE: very low; perioperative myocardial
infarction: RR 0.62, 95% CI 0.22 to 1.81; 128 participants, 1 study;
GRADE: very low; non-embolic stroke or transient ischaemic attack: RR
0.56, 95% CI 0.27 to 1.18; 128 participants, 1 study; GRADE: very low),
length of ICU stay (mean difference 0.33 days, 95% CI -1.16 to 1.83; 80
participants, 2 studies; GRADE: very low), the duration of mechanical
ventilation (mean difference -3.40 hours, 95% CI -11.50 to 4.70; 128
participants, 1 study; GRADE: very low), and the number of participants
requiring mechanical circulatory support (RR 0.88, 95% CI 0.50 to 1.55;
I2 = 0%; 208 participants, 3 studies; GRADE: low). Authors'
conclusions: Prophylactic treatment with levosimendan may reduce the
incidence of LCOS and probably reduces associated mortality in adult
patients undergoing cardiac surgery when compared to placebo only.
Conclusions on the benefits and harms of other inotropic agents cannot be
drawn due to limited study data. Given the limited evidence available,
there is an unmet need for large-scale, well-designed randomised trials.
Future studies of levosimendan ought to be designed to derive potential
benefit in specific patient groups and surgery types, and the optimal
administration protocol. Copyright © 2024 The Authors. Cochrane
Database of Systematic Reviews published by John Wiley & Sons, Ltd. on
behalf of The Cochrane Collaboration.

<28>
Accession Number
2036021318
Title
Efficacy and safety of applying oxidized regenerated cellulose sheets to
the parietal pleura of open chest wounds in thoracic surgery: a
prospective randomized controlled trial protocol.
Source
Journal of Thoracic Disease. 16(11) (pp 8149-8155), 2024. Date of
Publication: 30 Nov 2024.
Author
Ochi T.; Suzuki H.; Sata Y.; Toyoda T.; Inage T.; Tanaka K.; Sakairi Y.;
Matsui Y.; Shiko Y.; Yoshino I.
Institution
(Ochi, Suzuki, Sata, Toyoda, Inage, Tanaka, Sakairi, Matsui, Yoshino)
Department of General Thoracic Surgery, Chiba University Graduate School
of Medicine, Chiba, Japan
(Shiko) Clinical Research Center, Chiba University Hospital, Chiba, Japan
(Yoshino) Department of Thoracic Surgery, International University Health,
Welfare School of Medicine, Narita, Japan
Publisher
AME Publishing Company
Abstract
Background: According to a large-scale clinical trial in Japan,
segmentectomy for small peripheral non-small cell lung cancer has an
advantage over lobectomy in terms of overall survival, while it could also
increase the incidence of local recurrence. In ipsilateral reoperations,
intrathoracic adhesions from a previous surgery increase the risk of lung
injury and bleeding, which may result in intraoperative and postoperative
complications. The ability of oxidized regenerated cellulose (ORC) sheets
to prevent postoperative adhesions has been demonstrated in the abdomen,
and the same effect is expected in the thoracic region. The purpose of
this study is to provide evidence supporting the application of ORC sheets
to the parietal pleura of an open chest wounds to prevent postoperative
adhesions in the thoracic region. Method(s): This phase II
prospective open-label, randomized, parallel-group study will validate
adhesion prevention by applying ORC sheets to the parietal pleura of open
chest wounds at the time of surgical closure. In the control group, the
chest is closed by the usual procedure without ORC sheets. The primary
endpoint is the presence rate of pleural adhesion findings on chest
echography performed 4-20 weeks postoperatively. Data analysis will be
performed in 2025-2026. Discussion(s): This study will provide
evidence to the adhesion prevention effect of ORC sheet in the thoracic
region, with the aim of establishing a strategy to prevent postoperative
intrapleural adhesions. Copyright © AME Publishing Company.

<29>
Accession Number
2036013371
Title
Comparison of Sutureless Aortic Valve Replacement and Transcatheter Aortic
Valve Implantation: A Systematic Review and Meta-Analysis of Propensity
Score Matching.
Source
Reviews in Cardiovascular Medicine. 25(11) (no pagination), 2024. Article
Number: 391. Date of Publication: November 2024.
Author
Liu S.; Chen H.; Zhou W.; Zhao P.; Qi L.; Zhang Y.; Song B.; Yu C.
Institution
(Liu, Chen, Zhou, Zhao, Qi, Song, Yu) The First Clinical Medical College
of Lanzhou University, Gansu, Lanzhou 730000, China
(Liu, Zhou, Zhao, Qi, Zhang, Song, Yu) Department of Cardiovascular
Surgery, First Hospital of Lanzhou University, Gansu, Lanzhou 730013,
China
(Yu) Department of Cardiovascular Surgery, Fuwai Hospital, National Center
for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking
Union Medical College, Beijing 100006, China
Publisher
IMR Press Limited
Abstract
Background: To evaluate the clinical outcomes of sutureless aortic valve
replacement (SUAVR) and transcatheter aortic valve implantation (TAVI).
 Method(s): We systematically searched the electronic database and the
Clinical Trials Registry up to 31 February 2023. Random effects model risk
ratio (RR) and mean differences (MD) with corresponding 95% confidence
intervals (CIs) were pooled for the clinical outcomes. Result(s): The
included 16 studies using propensity-matched analysis consisted of 6516
patients, including 3258 patients in the SUAVR group and 3258 patients in
the TAVI group. The SUAVR group had lower mortality than the TAVI group at
1-year [RR = 0.53, 95% CI (0.32, 0.87), I2 = 49%, p = 0.01], 2-year [RR =
0.56, 95% CI (0.37, 0.82), I2 = 51%, p = 0.03] and 5-year [RR = 0.56, 95%
CI (0.46, 0.70), I2 = 0%, p < 0.01]. The SUAVR group had a significantly
lower rate of new permanent pacemaker implantation (PPI) [RR = 0.74, 95%
CI (0.55, 0.99), I2 = 48%, p = 0.04], moderate-to-severe paravalvular leak
(PVL) [RR = 0.18, 95% CI (0.11, 0.30), I2 = 0%, p < 0.01], more-than-mild
residual aortic regurgitation (AR) [RR = 0.27, 95% CI (0.14, 0.54), I2 =
0%, p < 0.01]. In addition, the SUAVR group had a higher rate of new-onset
atrial fibrillation (AF) [RR = 3.66, 95% CI (1.95, 6.89), I2 = 84%, p <
0.01], major or life-threatening bleeding event [RR = 3.63, 95% CI (1.81,
7.28), I2 = 83%, p < 0.01], and higher postoperative mean aortic gradient
[MD = 1.91, 95% CI (0.73, 3.10), I2 = 91%, p < 0.01] than the TAVI group.
 Conclusion(s): The early and mid-term clinical outcomes of SUAVR were
superior compared to TAVI. Further studies should be conducted to
highlight the specific subgroups of patients. that will benefit from each
technique. Copyright © 2024 The Author(s).

<30>
Accession Number
2036026571
Title
Mitral Valve Repair Versus Replacement in Patients Undergoing Concomitant
Aortic Valve Replacement.
Source
Heart Lung and Circulation. (no pagination), 2024. Date of Publication:
2024.
Author
Zhang Y.; Fu G.; Li G.; Jian B.; Wang R.; Huang Y.; Chu T.; Wu Z.; Zhou
Z.; Liang M.
Institution
(Zhang, Fu, Li, Jian, Huang, Chu, Wu, Zhou, Liang) Department of Cardiac
Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
(Wang) Department of Cardiology, Guangzhou Hospital of Integrated
Traditional and West Medicine, Guangzhou, China
Publisher
Elsevier Ltd
Abstract
Aim: Mitral valve repair (MVr) is associated with more favourable
long-term outcomes than mitral valve replacement (MVR) in cases of
isolated mitral valve disease suitable for repair. However, there is
debate regarding whether the superiority of MVr extends to patients with
concomitant aortic and mitral valve disease. Therefore, this meta-analysis
was conducted to compare the survival benefits between aortic valve
replacement (AVR) plus MVr with a double valve replacement (DVR).
 Method(s): A comprehensive literature search was conducted on PubMed,
EMBASE, and Cochrane until 20 October 2022. Studies comparing MVr and MVR
in patients undergoing concomitant AVR were included. The primary outcome
was long-term survival. The secondary outcomes were early mortality,
mitral valve reoperation, and valve-related adverse events.
 Result(s): Sixteen studies with a total of 140,638 patients were
included in this analysis. Patients undergoing AVR plus MVr exhibited a
favourable trend in long-term survival (HR 0.85; 95% CI 0.71-1.03; p=0.10;
I2=58%). The reconstructed Kaplan-Meier curve revealed that the
long-term survival at 5, 10, and 15 years was higher in the AVR plus MVr
(80.95%, 67.63%, and 51.18%, respectively) than in the DVR group (76.62%,
61.36%, 43.21%, respectively). Aortic valve replacement plus MVr had a
lower risk of early mortality (RR 0.67; 95% CI 0.58-0.79; p<0.001;
I2=77%), thromboembolic events (RR 0.81; 95% CI 0.67-0.98;
p=0.03; I2=5%), and haemorrhagic events (RR 0.87; 95% CI
0.78-0.98; p=0.01; I2=59%). Moreover, both groups displayed
comparable rates of mitral valve reoperation (HR 1.73; 95% CI 0.86-3.48;
p=0.13; I2=60%) and infective endocarditis (RR 1.60; 95% CI
0.65-3.93; p=0.31; I2=0%). However, the rate of reoperation for
AVR plus MVr significantly increased in rheumatic heart disease patients
(HR 3.30, 95% CI 1.66-6.59; p<0.0001). Conclusion(s): Compared with
DVR, AVR plus MVr was associated with favourable long-term survival,
reduced early mortality risk, and a lower incidence of thromboembolic and
haemorrhagic events without increasing the risk of mitral valve
reoperation or infective endocarditis in unselected patients. However,
higher reoperation rates were observed in rheumatic heart disease patients
undergoing AVR plus MVr. Copyright © 2024 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ)

<31>
Accession Number
2036026066
Title
A systematic review of reporting and handling of missing data in
observational studies using the UNOS database.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2024. Date of
Publication: 2024.
Author
Baker W.L.; Moore T.E.; 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, Massachusetts, United States
(Kittleson) Department of Cardiology, Smidt Heart Institute, Cedars-Sinai
Medical Center, Los Angeles, California, United States
(Parker) Departments of Medicine and Public Health Sciences, University of
Chicago Medicine, Chicago, Illinois, United States
(Jaiswal) Hartford HealthCare Heart and Vascular Institute, Hartford
Hospital, Hartford, Connecticut, United States
Publisher
Elsevier Inc.
Abstract
Background: Missing data decreasing study power and introducing bias,
thereby undermining a registry's ability to draw valid inferences. We
evaluated how missing data are reported and addressed in heart
transplantation (HT) studies using the United Network for Organ Sharing
(UNOS) database. Method(s): We conducted a systematic literature
search of Medline from January 1, 2018 through August 22, 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 end-point, 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): Of the 229 included studies, 67 (29.3%) 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%). Thirty-one (13.5%)
studies reported removing covariates from their analysis because of
missingness. 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. Future best practices should include explicit reporting of
missingness, detailed methods, and sensitivity checks. Copyright
© 2024 International Society for the Heart and Lung Transplantation

<32>
Accession Number
2035972076
Title
Meta-Analysis on the Racial Disparity of Outcomes Following Alcohol Septal
Ablation in Hypertrophic Cardiomyopathy.
Source
Cardiology in Review. (no pagination), 2024. Article Number: 0829. Date
of Publication: 2024.
Author
Jain H.; Tariq M.D.; Hurjkaliani S.; Ahmed M.; Ahmed R.; Jain J.; Odat
R.M.; Ullah I.; Khan R.
Institution
(Jain, Jain) Department of Internal Medicine, All India Institute of
Medical Sciences (AIIMS), Jodhpur, India
(Tariq) Department of Internal Medicine, Foundation University Medical
College, Islamabad, Pakistan
(Hurjkaliani) Department of Internal Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Ahmed) Department of Internal Medicine, Rawalpindi Medical University,
Rawalpindi, Pakistan
(Ahmed) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Odat) Department of Internal Medicine, Faculty of Medicine, Jordan
University of Science and Technology, Irbid, Jordan
(Ullah) Department of Internal Medicine, Khyber Teaching Hospital,
Peshawar, Pakistan
(Khan) Department of Internal Medicine, University of Pittsburgh Medical
Center, Harrisburg, PA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Hypertrophic cardiomyopathy (HCM) is a prevalent cardiac condition that
often leads to heart failure, exertional syncope, and sudden cardiac
death. Despite the availability of various treatments for HCM, such as
septal reduction therapy through surgical septal myectomy or alcohol
septal ablation (ASA), disparities in access to care and treatment
outcomes persist, particularly among marginalized racial and ethnic
groups. These disparities underscore the importance of understanding the
influence of race, ethnicity, and regional factors on the management and
outcomes of HCM, necessitating a closer examination of whether access to
ASA and its associated benefits is equitably distributed across diverse
populations. A comprehensive literature search was conducted on various
electronic databases aimed to identify studies evaluating the odds of
undergoing ASA in HCM in racial subgroups and outcomes like all-cause
mortality and stroke. Three studies were included in this meta-analysis
with a total sample size of 24,939 HCM patients. Adjusted odds ratio (OR)
or pooled risk ratios (RR) with 95% confidence intervals (CI) were
calculated using a random-effects model. Blacks were significantly less
likely to undergo ASA for HCM (OR, 0.64; 95% CI, 0.57-0.72; P < 0.01) as
compared to white patients; however, no differences in all-cause mortality
(RR, 0.97; 95% CI, 0.54-1.75) and stroke (RR, 1.29; 95% CI, 0.76-2.18)
were noted. In conclusion, this meta-analysis highlights a significant
association between race and the likelihood of undergoing ASA among
patients with HCM, with minority racial groups potentially facing barriers
to accessing this advanced treatment. Copyright © 2024 Wolters
Kluwer Health, Inc. All rights reserved.

<33>
Accession Number
2035971103
Title
Effect of Exercise-Based Cardiac Rehabilitation on Patients with Chronic
Heart Failure after Transcatheter Aortic Valve Replacement: A Randomized
Controlled Trial.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. (no
pagination), 2024. Article Number: e0912. Date of Publication: 2024.
Author
Song J.; Chen X.; Wang B.; Cheng Y.; Wang Y.
Institution
(Song, Chen, Wang, Cheng, Wang) Department of Cardiology, Xiamen
Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen
University, Fujian, Xiamen, China
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose: The objective of this study was to assess the effect of
exercise-based cardiac rehabilitation (CR) with individualized exercise
prescription in patients with chronic heart failure (HF) undergoing
transcatheter aortic valve replacement (TAVR) in a randomized controlled
trial. Method(s): A total of 60 patients with chronic HF who received
TAVR treatment were randomly divided into the control group (n = 30) and
exercise training (ET) group (n = 30). The control group was treated with
conventional rehabilitation, and the ET group was given personalized
exercise-based CR based on a cardiopulmonary exercise test (CPX). The CPX
parameters, echocardiography, 6-minute walk test distance, and quality of
life were evaluated in the two groups. Result(s): All patients who
completed symptom-restricted CPX showed no complications. After the
12-week rehabilitation period, the levels of anaerobic threshold, peak
oxygen uptake, peak oxygen pulse, peak power, left ventricular ejection
fraction, and 6-minute walk test distance in the ET group were
significantly higher than those in the control group (P <.05). Scores on
the Minnesota Life with Heart Failure Questionnaire in the ET group were
lower than those in the control group (P <.05). Conclusion(s):
Exercise-based CR significantly improves cardiopulmonary function,
exercise tolerance, and quality of life in patients with chronic HF who
undergo TAVR. Copyright © 2024 Wolters Kluwer Health, Inc. All
rights reserved.

<34>
Accession Number
2035905643
Title
Effect of a Machine Learning-Derived Early Warning Tool With Treatment
Protocol on Hypotension During Cardiac Surgery and ICU Stay: The
Hypotension Prediction 2 (HYPE-2) Randomized Clinical Trial.
Source
Critical Care Medicine. (no pagination), 2024. Article Number:
10.1097/CCM.0000000000006518. Date of Publication: 2024.
Author
Schuurmans J.; Rellum S.R.; Schenk J.; van der Ster B.J.P.; van der Ven
W.H.; Geerts B.F.; Hollmann M.W.; Cherpanath T.G.V.; Lagrand W.K.;
Wynandts P.R.; Paulus F.; Driessen A.H.G.; Terwindt L.E.; Eberl S.;
Hermanns H.; Veelo D.P.; Vlaar A.P.J.
Institution
(Schuurmans, Rellum, Schenk, van der Ster, van der Ven, Hollmann,
Wynandts, Terwindt, Eberl, Hermanns, Veelo) Department of Anesthesiology,
Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences,
Amsterdam, Netherlands
(Schuurmans, Rellum, Schenk, Cherpanath, Lagrand, Wynandts, Paulus, Vlaar)
Department of Intensive Care, Amsterdam UMC, University of Amsterdam,
Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
(Schenk) Department of Epidemiology and Data Science, Amsterdam UMC,
University of Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands
(Geerts) Medical Affairs, Healthplus.ai B.V., Amsterdam, Netherlands
(Hollmann) Laboratory of Experimental Intensive Care and Anesthesiology,
Amsterdam UMC, Location AMC, Amsterdam, Netherlands
(Driessen) Department of Cardiothoracic Surgery, Amsterdam UMC, University
of Amsterdam, Heart Center, Amsterdam, Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVES: Cardiac surgery is associated with perioperative
complications, some of which might be attributable to hypotension. The
Hypotension Prediction Index (HPI), a machine-learning-derived early
warning tool for hypotension, has only been evaluated in noncardiac
surgery. We investigated whether using HPI with diagnostic guidance
reduced hypotension during cardiac surgery and in the ICU. DESIGN:
Randomized clinical trial conducted between May 2021 and February 2023.
SETTING: Single-center study conducted in an academic hospital in the
Netherlands. PATIENTS: Adults undergoing elective on-pump coronary artery
bypass grafting, with or without single heart valve surgery, were enrolled
if a mean arterial pressure (MAP) greater than or equal to 65mm Hg was
targeted during the surgical off-pump phases and ICU stay. After
eligibility assessment, 142 of 162 patients approached gave informed
consent for participation. INTERVENTIONS: Patients randomized 1:1 received
either diagnostic guidance in addition to standard care if HPI reached
greater than or equal to 75 (n = 72) or standard care alone (n = 70).
MEASUREMENTS AND MAIN RESULTS: The primary outcome was the severity of
hypotension, measured as time-weighted average (TWA) of MAP less than 65mm
Hg. Secondary outcomes encompassed hypertension severity and intervention
disparities. Of 142 patients randomized, 130 were included in the primary
analysis. The HPI group showed 63% reduction in median TWA of hypotension
compared with the standard care group, with a median of differences of
-0.40mm Hg (95% CI, -0.65 to -0.27; p < 0.001). In the HPI group, patients
spent a median 28 minutes (95% CI, 17-44min) less in hypotension, with a
measurement duration of 322 minutes in the HPI group and 333 minutes in
the standard care group. No significant differences were observed in
hypertension severity, treatment choice, or fluid, vasopressors, and
inotrope amounts. CONCLUSION(S): Using HPI combined with diagnostic
guidance on top of standard care significantly decreased hypotension
severity in elective cardiac surgery patients compared with standard
care. Copyright © 2024 by the Society of Critical Care Medicine
and Wolters Kluwer Health, Inc. All Rights Reserved.

<35>
Accession Number
2035796594
Title
Long-term Survival in Elderly Patients after Coronary Artery Bypass
Grafting Compared to the Age-matched General Population: A Meta-analysis
of Reconstructed Time-to-Event Data.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2024. Date of
Publication: 2024.
Author
Kirov H.; Caldonazo T.; Toshmatov S.; Tasoudis P.; Mukharyamov M.; Diab
M.; Doenst T.
Institution
(Kirov, Caldonazo, Toshmatov, Mukharyamov, Diab, Doenst) Department of
Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
(Tasoudis) Division of Cardiothoracic Surgery, University of North
Carolina, Chapel Hill, NC, United States
Publisher
Georg Thieme Verlag
Abstract
Background Coronary artery disease (CAD) limits life expectancy compared
to the general population. Myocardial infarctions (MIs) are the primary
cause of death. The incidence of MI increases progressively with age and
most MI deaths occur in the population older than 70 years. Coronary
artery bypass grafting (CABG) may prevent the occurrence of new MIs by
bypassing most CAD lesions, providing downstream collateralization to the
diseased vessel, and consequently prolonging survival. We systematically
assessed the survival-improving potential of CABG by comparing elderly
CABG patients to the age-matched general population. Methods Three
databases were assessed. The primary and single outcome was long-term
all-cause mortality. Time-to-event data of the individual studies were
extracted and reconstructed in an overall survival curve. As a sensitivity
analysis, summary hazard ratios (HRs) and 95% confidence intervals (CIs)
for all individual studies were pooled and meta-analytically addressed.
The control group was based on the age-matched general population of each
individual study. Results From 1,352 records, 4 studies (4,045 patients)
were included in the analysis. Elderly patients (>70 years) who underwent
CABG had a significantly lower risk of death in the follow-up compared to
the general age-matched population in the overall survival analysis (HR:
0.88; 95% CI: 0.83, 0.94; p < 0.001: mean follow-up was 7 years).
Conclusion Elderly patients who undergo CABG appear to have significantly
better long-term survival compared to the age-matched general population.
This advantage becomes visible after the first year and underscores the
life-prolonging effect of bypass surgery, which may eliminate the expected
reduction in life expectancy through CAD. Copyright © 2024.
Thieme. All rights reserved.

<36>
Accession Number
2032445256
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: 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, Toledo,
OH, United States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Mitral regurgitation is one of the most common forms of
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, Cochrane, 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 the 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. Copyright © 2024
Informa UK Limited, trading as Taylor & Francis Group.

<37>
Accession Number
645891971
Title
Reduced Direct Oral Anticoagulant Dose versus Dual Antiplatelet Therapy
After Left Atrial Appendage Closure in Patients With Non-Valvular Atrial
Fibrillation: A Systematic Review and Meta-Analysis.
Source
Heart rhythm. (no pagination), 2024. Date of Publication: 22 Nov 2024.
Author
Lima N.A.; Filho F.W.P.A.; Mendes B.X.; Neto V.L.M.; d'Avila A.L.B.
Institution
(Lima) Department of Medicine, Christus University Center, Fortaleza,
Ceara, Brazil
(Filho, Neto) Department of Medicine, Federal University of Ceara, Sobral,
Ceara, Brazil
(Mendes) Department of Medicine, Christus University Center, Fortaleza,
Ceara, Brazil
(d'Avila) Departments of Medicine, Beth Israel Deaconess Medical Center
and Harvard Medical School, Boston, MA, United States
Abstract
BACKGROUND: Left atrial appendage closure is an alternative therapy for
patients with nonvalvular atrial fibrillation who are not eligible for
long-term oral anticoagulation. However, the optimal therapy after this
procedure is still controversial, especially in a subgroup of patients
with severe renal dysfunction. OBJECTIVE(S): We aimed to evaluate the
use of low dose oral anticoagulants (l-DOAC) versus dual antiplatelet
therapy (DAPT) after left atrial appendage closure (LAAC) in patients with
nonvalvular atrial fibrillation. METHOD(S): We systematically
searched PubMed, Embase and Cochrane. Outcomes were the incidence of
device-related thrombus (DRT), major bleeding, stroke, cardiovascular
mortality, all-cause mortality, thromboembolic events (DRT, ischemic
stroke, TIA, peripheral thromboembolism), and the composite outcome of
thromboembolic events and major bleeding. Risk ratios (RRs) with 95%
confidence intervals were calculated using a random effects model. Review
Manager 5.4.1 was used for statistical analyses. Heterogeneity was
assessed with I2 statistics. RESULT(S): A total of 1,015 participants
from 2 randomized controlled trials (RTCs) and 3 non-randomized cohorts
were included. The incidence of DRT was significantly reduced with l-DOAC
relative to DAPT (0.81% vs 5.08%, respectively; RR 0.37; 95% CI 0.15-0.94;
p=0.04; I2=0%). We also found the patients who used l-DOAC had a reduction
in the composite outcomes of thromboembolic events and major bleeding
(1.41% vs 11.13%; RR 0.14; 95% CI 0.05-0.36; p<0.0001; I2=0%).
 CONCLUSION(S): In this systematic review and meta-analysis, the use
of l-DOACs in patients with non-valvular AF who underwent LAAC reduces the
occurrence of the DRT and composite outcomes of thromboembolic events and
major bleeding. Copyright © 2024. Published by Elsevier Inc.

<38>
Accession Number
2032143787
Title
In reply: Comment on: "Superficial parasternal intercostal plane blocks in
cardiac surgery: a systematic review and meta-analysis".
Source
Canadian Journal of Anesthesia. 71(11) (pp 1567-1568), 2024. Date of
Publication: November 2024.
Author
Cameron M.J.; Long J.; Kardash K.; Yang S.S.
Institution
(Cameron, Long, Kardash, Yang) Faculty of Medicine, McGill University,
Montreal, QC, Canada
(Cameron, Kardash, Yang) Department of Anesthesia, Jewish General
Hospital, Montreal, QC, Canada
(Cameron, Yang) Lady Davis Research Institute, Montreal, QC, Canada
Publisher
Springer

<39>
Accession Number
2032143785
Title
Comment on: "Superficial parasternal intercostal plane blocks in cardiac
surgery: a systematic review and meta-analysis".
Source
Canadian Journal of Anesthesia. 71(11) (pp 1565-1566), 2024. Date of
Publication: November 2024.
Author
Sethuraman R.M.; Narayanan S.; UdayaKumar G.S.
Institution
(Sethuraman, Narayanan, UdayaKumar) Department of Anesthesiology, Sree
Balaji Medical College & amp; Hospital, Tamil Nadu, Chennai, India
Publisher
Springer

<40>
Accession Number
2033182878
Title
Cardiovascular disease in adults with a history of out-of-home care during
childhood: a systematic review and meta-analysis of prospective cohort
studies.
Source
The Lancet Regional Health - Europe. 43 (no pagination), 2024. Article
Number: 100984. Date of Publication: August 2024.
Author
Batty G.D.; Kivimaki M.; Almquist Y.B.; Eriksson J.G.; Gissler M.;
Gnanamanickam E.S.; Hamer M.; Jackisch J.; Juon H.-S.; Keski-Santti M.; Li
C.; Mikkola T.M.; Murray E.; Sacker A.; Segal L.; Frank P.
Institution
(Batty, Murray, Sacker, Frank) Department of Epidemiology and Public
Health, University College London, London, United Kingdom
(Kivimaki, Frank) Brain Sciences, University College London, London,
United Kingdom
(Kivimaki, Mikkola) Clinicum, Faculty of Medicine, University of Helsinki,
Helsinki, Finland
(Almquist, Jackisch) Centre for Health Equity Studies, Stockholm
University, Stockholm, Sweden
(Eriksson) Singapore Institute for Clinical Sciences, Singapore
(Eriksson) Department of Obstetrics & Gynaecology and Human Potential
Translational Research Programme, National University of Singapore,
Singapore
(Eriksson, Mikkola) Folkhalsan Research Center, Helsinki, Finland
(Eriksson) Department of General Practice and Primary Health Care,
University of Helsinki, Helsinki, Finland
(Gissler, Keski-Santti) Department of Knowledge Brokers, Finnish Institute
for Health and Welfare, Helsinki, Finland
(Gissler) Academic Primary Health Care Centre, Region Stockholm, Sweden
(Gissler) Department of Molecular Medicine and Surgery, Karolinska
Institutet, Stockholm, Sweden
(Gnanamanickam, Segal) Health Economics and Social Policy Group, Allied
Health & Human Performance, University of South Australia, Adelaide,
Australia
(Hamer) Division of Surgery Interventional Science, University College
London, London, United Kingdom
(Juon) Department of Medical Oncology, Thomas Jefferson University,
Philadelphia, United States
(Li) Department of Epidemiology and Biostatistics, Peking University
Health Science Center, Peking, China
(Mikkola) Population Health Unit, Finnish Institute for Health and
Welfare, Helsinki, Finland
(Murray) Institute of Public Health and Wellbeing, University of Essex,
Colchester, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: While individuals who were separated from their biological
family and placed into the care of the state during childhood (out-of-home
care) are more prone to developing selected adverse health problems in
adulthood, their risk of cardiovascular disease is uncertain. Our aim was
to explore this association by pooling published and unpublished results
from prospective cohort studies. Method(s): We used two approaches to
identifying relevant data on childhood care and adult cardiovascular
disease (PROSPERO registration CRD42021254665). First, to locate published
studies, we searched PubMed (Medline) until November 2023. Second, with
the objective of identifying unpublished studies with the potential to
address the present research question, we scrutinised retrieved reviews on
childhood out-of-home care and other adult health outcomes. Included
studies were required to satisfy three criteria: a cohort study in which
the assessment of care was made prospectively pre-adulthood (in the
avoidance of recall bias); data on an unexposed comparator group were
available (for the computation of relative risk); and a diagnosis of adult
cardiovascular disease events (coronary heart disease, stroke, or their
combination) had been made (as opposed to risk factors only).
Collaborating investigators provided study-specific estimates which were
aggregated using random-effects meta-analysis. The Newcastle-Ottawa Scale
was used to assess individual study quality. Finding(s): Twelve
studies (2 published, 10 unpublished) met the inclusion criteria, and
investigators from nine provided viable results, including updated
analyses of the published studies. Studies comprised 611,601 individuals
(301,129 women) from the US, UK, Sweden, Finland, and Australia. Five of
the nine studies were judged to be of higher methodological quality.
Relative to the unexposed, individuals with a care placement during
childhood had a 51% greater risk of cardiovascular disease in adulthood
(summary rate ratio after age- and sex-adjustment [95% confidence
interval]: 1.51 [1.22, 1.86]; range of study-specific estimates: 1.07 to
2.06; I2 = 69%, p = 0.001). This association was attenuated but
persisted after adjustment for socioeconomic status in childhood (8
studies; 1.41 [1.15, 1.72]) and adulthood (9 studies, 1.29 [1.11, 1.51]).
 Interpretation(s): Our findings show that individuals with experience
of out-of-home care in childhood have a moderately raised risk of
cardiovascular disease in adulthood. Funding(s):Medical Research
Council;National Institute on Aging;Wellcome Trust. Copyright ©
2024 The Author(s)

<41>
Accession Number
2032936348
Title
Impact of a bundle of care (intravenous iron, erythropoietin and
transfusion metabolic adjustment) on post-operative transfusion incidence
in cardiac surgery: a single-centre, randomised, open-label,
parallel-group controlled pilot trial.
Source
The Lancet Regional Health - Europe. 43 (no pagination), 2024. Article
Number: 100966. Date of Publication: August 2024.
Author
Saour M.; Blin C.; Zeroual N.; Mourad M.; Amico M.; Gaudard P.; Picot
M.-C.; Colson P.H.
Institution
(Saour, Blin, Zeroual, Mourad, Gaudard, Colson) Anaesthesiology and
Critical Care Medicine Department, Arnaud de Villeneuve Hospital,
University of Montpellier Hospital Centre, University of Montpellier,
Montpellier, France
(Amico, Picot) Clinical Research and Epidemiology Unit, University of
Montpellier Hospital Centre, University of Montpellier, Montpellier,
France
(Gaudard) University of Montpellier, CNRS (Scientific Research Centre),
INSERM, PhyMedExp, Montpellier, France
(Colson) University of Montpellier, CNRS (Scientific Research Centre),
INSERM, Functional Genome Unit, Montpellier, France
Publisher
Elsevier Ltd
Abstract
Background: Red blood cell (RBC) transfusions are frequent in patients
after cardiac surgery. This study assessed whether a bundle of care
including pre-operative and post-operative administration of
erythropoietin (EPO) with intravenous iron supplementation, and
restrictive transfusion adjusted for ScvO<inf>2</inf> could result in
reduced postoperative transfusions. Method(s): In this single-centre,
randomised, open-label, parallel-group controlled pilot study, patients
undergoing elective cardiac surgery with high risk of transfusion in a
University Hospital were enrolled by the investigator and the
randomisation procedure using a central internet-based system was made by
the clinical research assistant. Since the trial was open-label, no
masking was used. Patients were assigned (1:1) to either the STOP group
(40,000 IU subcutaneous EPO combined with 20 mg/kg intravenous ferric
carboxymaltose if Hb < 13 g/dL the day before surgery or at ICU admission,
and RBC transfusion if Hb <= 8 g/dL and ScvO<inf>2</inf> <= 65%, or
additional EPO dose if 8 < Hb < 13 g/dL) or to the control group (RBC
transfusion if Hb <= 8 g/dL, or, if 8 < Hb < 13 g/dL, intravenous iron
sucrose 200 mg or 300 mg according to weight). Primary outcome was the
incidence of postoperative RBC transfusion up to hospital discharge or
postoperative day 28. The trial is registered with ClinicalTrials.gov,
NCT04141631. Finding(s): Between Jan 20, 2020, and Sept 6, 2022,
among 128 patients enrolled, 123 (male, 54.4%, 67/123) were included in
the full analysis set: 62 in the STOP group and 61 in the control group.
Nine patients (14.5%, 9/62) in the STOP group required RBC transfusion vs
19 (31.2%, 19/61) in the control group (odds ratio 0.37 [95% CI:
0.15-0.91], p = 0.03). The median length of follow up to transfusion was
2.6 days (1.5; 4.6) and 3.3 (1.6; 4.2) in control and STOP groups
respectively (p = 0.61). Interpretation(s): The bundle of care may
reduce postoperative RBC transfusion. The findings should be taken with
caution due to the unblinded and exploratory nature of the study.
 Funding(s): University of Montpellier Hospital and Vifor
Pharma. Copyright © 2024

<42>
Accession Number
2035926414
Title
Personalized perioperative blood pressure management in patients having
major non-cardiac surgery: A bicentric pilot randomized trial.
Source
Journal of Clinical Anesthesia. 100 (no pagination), 2025. Article Number:
111687. Date of Publication: February 2025.
Author
Bergholz A.; Grusser L.; Khader W.T.A.K.; Sierzputowski P.; Krause L.;
Hein M.; Wallqvist J.; Ziemann S.; Thomsen K.K.; Flick M.; Breitfeld P.;
Waldmann M.; Kowark A.; Coburn M.; Kouz K.; Saugel B.
Institution
(Bergholz, Sierzputowski, Thomsen, Flick, Breitfeld, Kouz, Saugel)
Department of Anesthesiology, Center of Anesthesiology and Intensive Care
Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Gruser, Khader, Hein, Wallqvist, Ziemann) Department of Anaesthesiology,
Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
(Krause) Institute of Medical Biometry and Epidemiology, University
Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Breitfeld) Institute for Applied Medical Informatics, University Medical
Center Hamburg-Eppendorf, Hamburg, Germany
(Waldmann) Institute of Clinical Chemistry and Laboratory Medicine,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Kowark, Coburn) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Bonn, Bonn, Germany
(Thomsen, Kouz, Saugel) Outcomes Research Consortium, Cleveland, OH,
United States
Publisher
Elsevier Inc.
Abstract
Study objective: We hypothesize that personalized perioperative blood
pressure management maintaining intraoperative mean arterial pressure
(MAP) above the preoperative mean nighttime MAP reduces perfusion-related
organ injury compared to maintaining intraoperative MAP above 65 mmHg in
patients having major non-cardiac surgery. Before testing this hypothesis
in a large-scale trial, we performed this bicentric pilot trial to
determine a) if performing preoperative automated nighttime blood pressure
monitoring to calculate personalized intraoperative MAP targets is
feasible; b) in what proportion of patients the preoperative mean
nighttime MAP clinically meaningfully differs from a MAP of 65 mmHg; and
c) if maintaining intraoperative MAP above the preoperative mean nighttime
MAP is feasible in patients having major non-cardiac surgery.
 Design(s): Bicentric pilot randomized trial. Setting(s):
University Medical Center Hamburg-Eppendorf, Hamburg, Germany, and RWTH
Aachen University Hospital, Aachen, Germany. Patient(s): Patients >=
45 years old having major non-cardiac surgery. Intervention(s):
Personalized blood pressure management. Measurements: Proportion of
patients in whom preoperative automated nighttime blood pressure
monitoring was possible; proportion of patients in whom the preoperative
mean nighttime MAP clinically meaningfully differed from a MAP of 65 mmHg
(difference > +/-10 mmHg); intraoperative time-weighted average MAP below
the preoperative mean nighttime MAP. Main Result(s): We enrolled 105
patients and randomized 98 patients. In 98 patients (93 %), preoperative
automated nighttime blood pressure monitoring was possible. In 83 patients
(85 %), the preoperative mean nighttime MAP clinically meaningfully
differed from a MAP of 65 mmHg. The median time-weighted average MAP below
the preoperative mean nighttime MAP was 3.29 (1.64, 6.82) mmHg in patients
assigned to personalized blood pressure management. Conclusion(s): It
seems feasible to determine the effect of personalized perioperative blood
pressure management maintaining intraoperative MAP above the preoperative
mean nighttime MAP on postoperative complications in a large multicenter
trial. Copyright © 2024 The Authors

<43>
Accession Number
2033381456
Title
Revascularisation in Left Ventricular Systolic Dysfunction: A
Meta-analysis of Kaplan-Meier Reconstructed Individual Patient Data.
Source
Canadian Journal of Cardiology. 40(11) (pp 2188-2200), 2024. Date of
Publication: November 2024.
Author
Lee G.; Malik A.; Vervoort D.; Tam D.Y.; Marquis-Gravel G.; Redfors B.;
Gaudino M.; Fremes S.E.
Institution
(Lee, Malik, Fremes) Division of Cardiac Surgery, University of Toronto,
Toronto, ON, Canada
(Vervoort, Fremes) Institute of Health Policy, Management and Evaluation,
University of Toronto, Toronto, ON, Canada
(Tam) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Marquis-Gravel) Montreal Heart Institute and Universite de Montreal,
Montreal, Quebec, Canada
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Coronary artery disease is a common cause of ischemic left
ventricular systolic dysfunction (LVSD), for which the optimal
revascularisation strategy remains unclear. We aimed to determine whether
percutaneous coronary intervention (PCI) or coronary artery bypass
grafting (CABG) results in greater survival advantage in patients with
LVSD. Method(s): Study-level (SLMA) and reconstructed individual
patient data (rIPDMA) meta-analyses from Kaplan-Meier (KM) survival curves
were performed. A systematic search of Medline, Embase, and Cochrane
Library was conducted for observational and randomised studies published
after 2010 that compared PCI and CABG in patients with left ventricular
ejection fraction <= 40%. The primary outcome was all-cause mortality at
longest follow-up. The secondary outcomes were myocardial infarction (MI),
stroke, repeated revascularisation, cardiovascular mortality, and major
adverse cardiovascular and cerebrovascular events (MACCE) at longest
follow-up. Result(s): Fourteen studies (11 observational, 3
randomised, 13,063 patients) were eligible for the SLMA. Seven contained
digitisable KM curves from which individual patient data could be
reconstructed. Study-level analysis found PCI to be associated with
increased all-cause mortality (hazard ratio [HR] 1.41, 95% confidence
interval [CI] 1.18-1.69), MI (HR 2.10, 95% CI 1.62-2.72), repeated
revascularisation (HR 2.39, 95% CI 1.37-4.17), and MACCE (HR 1.58, 95% CI
1.23-2.03), without significant differences in stroke (HR 0.86, 95% CI
0.39-1.92) or cardiovascular mortality (HR 1.42, 95% CI 0.78-2.59). In the
rIPDMA, PCI resulted in increased all-cause mortality (HR 1.57, 95% CI
1.34-1.87) and repeated revascularisation (HR 3.63, 95% CI 3.12-4.21) but
overall lower risk of stroke (HR 0.62, 95% CI 0.39-0.99) owing to fewer
events during initial follow-up. Conclusion(s): In patients with
ischemic LVSD, PCI was associated with higher risk of all-cause mortality
and repeated revascularisation than CABG, but lower risk of short-term
stroke. (PROSPERO: CRD42021291408) Copyright © 2024 Canadian
Cardiovascular Society

<44>
Accession Number
2033192303
Title
Outcomes and Safety of Transcaval Transcatheter Aortic Valve Replacement:
A Systematic Review and Meta-analysis.
Source
Canadian Journal of Cardiology. 40(11) (pp 2054-2062), 2024. Date of
Publication: November 2024.
Author
Salihu A.; Ferlay C.; Kirsch M.; Shah P.B.; Skali H.; Fournier S.; Meier
D.; Muller O.; Hugelshofer S.; Skalidis I.; Tzimas G.; Monney P.; Eeckhout
E.; Arangalage D.; Rancati V.; Antiochos P.; Lu H.
Institution
(Salihu, Ferlay, Fournier, Meier, Muller, Hugelshofer, Skalidis, Tzimas,
Monney, Eeckhout, Arangalage, Antiochos, Lu) Division of Cardiology,
Lausanne University Hospital and University of Lausanne, Lausanne,
Switzerland
(Ferlay) Adult Intensive Care Unit, Lausanne University Hospital and
University of Lausanne, Lausanne, Switzerland
(Ferlay, Kirsch) Division of Cardiac Surgery, Lausanne University Hospital
and University of Lausanne, Lausanne, Switzerland
(Shah, Skali, Lu) Division of Cardiovascular Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Arangalage) Cardiology Department, AP-HP, Bichat Hospital and Universite
de Paris, Paris, France
(Rancati) Division of Anaesthesiology, Lausanne University Hospital and
University of Lausanne, Lausanne, Switzerland
Publisher
Elsevier Inc.
Abstract
Background: The transcaval (TCv) vascular approach is increasingly used in
transcatheter aortic valve replacement (TAVR) in patients unsuitable for
the gold-standard transfemoral approach. We aimed to evaluate the
efficacy, safety, and clinical outcomes associated with TCv-TAVR.
 Method(s): A systematic review and meta-analysis was conducted by
searching PubMed/Medline, Embase, and the Cochrane Library for all
articles assessing the TCv approach published through December 2023.
Outcomes included 30-day and 1-year all-cause mortality (ACM), 30-day
rehospitalisation, perioperative complications and postoperative
complications at 30 days. The meta-analysis was registered on the PROSPERO
database with the identifier CRD42024501921. Result(s): A total of 8
studies with 467 patients were included. TCv-TAVR procedures achieved a
success rate of 98.5%. TCv-TAVR was associated with a 30-day ACM rate of
6.1% (95% confidence interval [CI]: 3.9%-8.2%), a 1-year ACM rate of 14.9%
(95% CI 2.3%-27.6%) and a 30-day rehospitalisation rate of 4.2% (95% CI
-2.2% to 10.6%). Postoperative stroke or transient ischemic attack, major
vascular complications, and major or life-threatening bleeding occurred in
3.3%, 8.7%, and 7.5% of cases, respectively. Cumulative meta-analyses
showed a temporal trend of decreasing rates of vascular complications.
 Conclusion(s): The TCv approach in TAVR demonstrated a reassuring
efficacy and safety profile, with mortality and postoperative complication
rates similar to those reported for supra-aortic alternative TAVR access
routes. The temporal decrease in vascular complications suggests potential
improvements in procedural techniques and device technology. These
findings further support the TCv approach as a viable option in patients
ineligible for the transfemoral access. PROSPERO:
CRD42024501921 Copyright © 2024 The Authors

<45>
Accession Number
2032346012
Title
Low-dose warfarin with a novel mechanical aortic valve: Interim registry
results at 5-year follow-up.
Source
Journal of Thoracic and Cardiovascular Surgery. 168(6) (pp 1645-1655.e6),
2024. Date of Publication: December 2024.
Author
Gerdisch M.W.; Hagberg R.C.; Perchinsky M.J.; Joseph M.; Oo A.Y.; Loubani
M.; Tsang G.M.; Zacharias J.; Sathyamoorthy M.
Institution
(Gerdisch) Department of Cardiothoracic Surgery, Franciscan Health,
Indianapolis, Ind, United States
(Hagberg) Department of Cardiac Surgery, Hartford Hospital, Hartford,
Conn, United States
(Perchinsky) Department of Surgery, Royal Jubilee Hospital, Victoria, BC,
Canada
(Joseph) Department of Surgery, Virginia Tech Carilion School of Medicine,
Roanoke, VA, United States
(Oo) Department of Cardiovascular Surgery, Bart's Health NHS Trust,
London, United Kingdom
(Loubani) Department of Cardiothoracic Surgery, Hull University Teaching
Hospitals NHS Trust, Hull, United Kingdom
(Tsang) Department of Cardiac Surgery, Southampton General Hospital,
Southampton, United Kingdom
(Zacharias) Department of Cardiothoracic Surgery, Blackpool Teaching
Hospitals Foundation Trust, Blackpool, United Kingdom
(Sathyamoorthy) Department of Internal Medicine, Burnett School of
Medicine at TCU, Fort Worth, Tex, United States
Publisher
Elsevier Inc.
Abstract
Objectives: To evaluate whether warfarin targeted at an international
normalized ratio of 1.8 (range, 1.5-2.0) after On-X mechanical aortic
valve implant is safe for all patients. Method(s): This prospective,
observational clinical registry assessed adverse event rates in adult
patients receiving low-dose warfarin (target international normalized
ratio, 1.8; range, 1.5-2.0) plus daily aspirin (75-100 mg) during a 5-year
period after On-X aortic valve implant. The primary end point is the
combined rate of major bleeding, valve thrombosis, and thromboembolism
overall and in 4 subgroups. The comparator is the Prospective Randomized
On-X Anticoagulation Trial control group patients on standard-dose
warfarin (international normalized ratio, 2.0-3.0) plus aspirin 81
milligrams daily. Result(s): A total of 510 patients were recruited
at 23 centers in the United States, United Kingdom, and Canada between
November 2015 and January 2022. This interim analysis includes 229
patients scheduled to complete 5-year follow-up by August 16, 2023. The
linearized occurrence rate (in percent per patient-year) of the primary
composite end point of major bleeding, valve thrombosis, and
thromboembolism is 1.83% compared with 5.39% (95% confidence interval,
4.12%-6.93%) in the comparator group. Results are consistent in
clinic-monitored and home-monitored patients and in those at high risk for
thromboembolism. Major bleeding and total bleeding were reduced by 87% and
71%, respectively, versus the comparator group, without an increase in
thromboembolic events. Conclusion(s): Interim results support the
continued safety of the On-X aortic mechanical valve with a target
international normalized ratio of 1.8 plus low-dose aspirin through 5
years after implant, with or without home monitoring. Copyright ©
2024 The Authors

<46>
Accession Number
2032005042
Title
Stent Underexpansion Is an Underestimated Cause of Intrastent Restenosis:
Insights From RESTO Registry.
Source
Journal of the American Heart Association. 13(21) (no pagination), 2024.
Article Number: e036065. Date of Publication: 05 Nov 2024.
Author
Souteyrand G.; Mouyen T.; Honton B.; Mulliez A.; Lattuca B.; Dilinger
J.-G.; Levesque S.; Range G.; Combaret N.; Marliere S.; Lamallem O.;
Quillot M.; Gerbaud E.; Motreff P.; Amabile N.
Institution
(Souteyrand, Mulliez, Combaret, Lamallem, Motreff) Institut Pascal,
Therapies Guidees par l'Image, CNRS, SIGMA UCA UMR 6602, University
Hospital Gabriel Montpied, Clermont-Ferrand, France
(Mouyen) Jacques Lacarin Vichy Hospital Centre, Vichy Cedex, France
(Honton) Clinique Pasteur, Toulouse, France
(Lattuca) University Hospital of Nimes, Nimes, France
(Dilinger) Universite Paris-Cite, Assistance Publique-Hopitaux de Paris,
Hopital Lariboisiere, Inserm U-942, Paris, France
(Levesque) Centre Hospitalier Universitaire de Poitiers, Poitiers, France
(Range) Les hopitaux de Chartres, Chartres, France
(Marliere) CHU Grenoble, Grenoble, France
(Quillot) Centre Hospitalier Henri Duffaut, Avignon, France
(Gerbaud) CHU Bordeaux, Bordeaux, France
(Amabile) Institut Cardiovasculaire Paris Sud, Massy, France
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Despite improvement in devices, in-stent restenosis remains a
frequent and challenging complication of percutaneous coronary
interventions. METHODS AND RESULTS: The RESTO (Morphological Parameters of
In-Stent Restenosis Assessed and Identified by OCT [Optical Coherence
Tomography]; study NCT04268875) was a prospective multicenter registry
including patients presenting with coronary syndromes related to in-stent
restenosis. All patients underwent preintervention OCT analysis, which led
to analysis of in-stent restenosis phenotype, number of strut layers, and
presence of stent underexpansion. The primary end point was the in-stent
restenosis type according to the OCT morphological classification. The
1-year incidence of target vessel failure (a composite of death from
cardiac causes, target-vessel myocardial infarction, or ischemia-driven
target-vessel revascularization) was assessed. The study included 297
patients. The culprit stent was a drug-eluting stent in 74.2% of cases.
OCT analysis revealed the presence of neoatherosclerosis in 57% (52%
calcified), neointimal hyperplasia in 43% (58% homogeneous), stent
underexpansion (minimal stent area <4.5 mm2) in 43%, and
multiple stent layers in 30%. The prepercutaneous coronary intervention
OCT analysis modified the operator's strategy for management in 30% of
cases. Treatment involved drug-eluting stent implantation in 61.6% and
drug-eluting balloon angioplasty in 36.1% of cases with only 63.2% optimal
results. The 1-year target vessel failure incidence was 11% (95% CI,
9%-13%). Residual postpercutaneous coronary intervention stent
underexpansion was associated with significantly higher target vessel
failure incidence (19% [95% CI, 14%-24%] versus 7% [95% CI, 5-9], P=0.01).
 CONCLUSION(S): OCT identified neoatherosclerosis and neointimal
hyperplasia in comparable proportions. Stent underexpansion was frequent
and favored subsequent adverse clinical outcomes. Copyright ©
2024 The Author(s).

<47>
Accession Number
2032005026
Title
Invasive Versus Conservative Strategy in Older Adults >=75 Years of Age
With Non-ST-segment-Elevation Acute Coronary Syndrome: A Systematic Review
and Meta-Analysis of Randomized Controlled Trials.
Source
Journal of the American Heart Association. 13(21) (no pagination), 2024.
Article Number: e036151. Date of Publication: 05 Nov 2024.
Author
Rout A.; Moumneh M.B.; Kalra K.; Singh S.; Garg A.; Kunadian V.; Biscaglia
S.; Alkhouli M.A.; Rymer J.A.; Batchelor W.B.; Nanna M.G.; Damluji A.A.
Institution
(Rout) Division of Cardiology, University of Louisville, Louisville, KY,
United States
(Moumneh, Kalra, Batchelor, Damluji) Inova Center of Outcomes Research,
Falls Church, VA, United States
(Singh) Department of Medicine, Sinai Hospital of Baltimore, Baltimore,
MD, United States
(Garg) Division of Cardiology, Ellis Hospital, Schenectady, NY, United
States
(Kunadian) Translational and Clinical Research Institute, Faculty of
Medical Sciences, Newcastle University, Newcastle upon Tyne, United
Kingdom
(Kunadian) Cardiology Unit, Cardiothoracic Centre, Freeman Hospital,
Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne,
United Kingdom
(Biscaglia) Azienda Ospedaliero-Universitaria di Ferrara, FE, Cona, Italy
(Alkhouli) Department of Cardiology, Mayo Clinic School of Medicine,
Rochester, MN, United States
(Rymer) Duke University School of Medicine, Durham, NC, United States
(Rymer) Duke Clinical Research Institute, Durham, NC, United States
(Nanna) Yale University School of Medicine, New Haven, CT, United States
(Damluji) Johns Hopkins University School of Medicine, Baltimore, MD,
United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Older adults with non-ST-segment-elevation acute coronary
syndrome are less likely to undergo an invasive strategy compared with
younger patients. Randomized controlled trials traditionally exclude older
adults because of their high burden of geriatric conditions. METHODS AND
RESULTS: We searched for randomized controlled trials comparing invasive
versus medical management or a selective invasive (conservative) strategy
for older patients (age>=75 years) with non-ST-segment-elevation acute
coronary syndrome. Fixed effects meta-analysis was conducted to estimate
the odds ratio (OR) with 95% CI for the composite of death or myocardial
infarction (MI) and individual secondary end points of all-cause death,
cardiovascular death, MI, revascularization, stroke, and major bleeding.
Nine studies with 2429 patients (invasive: 1228 versus control: 1201) with
a mean follow-up of 21months were included. An invasive strategy was
associated with a significantly decreased risk of a composite of death and
MI (OR, 0.67 [95% CI, 0.54-0.83], P<0.001), MI (OR, 0.56 [95% CI,
0.45-0.70], P<0.001) and subsequent revascularization (OR, 0.27 [95% CI,
0.16-0.48], P<0.001). There was no difference in all-cause death (OR, 0.84
[95% CI, 0.65-1.10], P=0.21), cardiovascular death (OR, 0.85 [95% CI,
0.63-1.15], P=0.30), stroke (OR, 0.74 [95% CI, 0.38-1.47], P=0.39), or
major bleeding (OR, 1.24 [95% CI, 0.42-3.66], P=0.70). CONCLUSION(S):
In older patients >=75 years old with non-ST-segment-elevation acute
coronary syndrome, an invasive strategy reduced the risk of a composite of
death and MI, MI, and subsequent revascularization compared with a
conservative strategy alone. Older adults with higher burden of geriatric
conditions should be included in future trials to improve generalizability
to this growing population. Copyright © 2024 The Author(s).

<48>
Accession Number
2031775382
Title
Prognostic value of KRAS G12V mutation in lung adenocarcinoma stratified
by stages and radiological features.
Source
Journal of Thoracic and Cardiovascular Surgery. 168(6) (pp 1525-1537.e6),
2024. Date of Publication: December 2024.
Author
Zhu W.; Han H.; Ma Z.; Cao H.; Yan Y.; Zhao Y.; Deng C.; Xu H.; Fu F.; Fan
F.; Zhang Y.; Chen H.
Institution
(Zhu, Han, Ma, Cao, Yan, Zhao, Deng, Fu, Fan, Zhang, Chen) Department of
Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan
University Shanghai Cancer Center, Shanghai, China
(Zhu, Han, Ma, Cao, Yan, Zhao, Deng, Fu, Fan, Zhang, Chen) Institute of
Thoracic Oncology, Fudan University, Shanghai, China
(Zhu, Han, Ma, Cao, Yan, Zhao, Deng, Fu, Fan, Zhang, Chen) Department of
Oncology, Shanghai Medical College, Fudan University, Shanghai, China
(Xu) University of Michigan-Shanghai Jiao Tong University Joint Institute,
Shanghai Jiao Tong University, Shanghai, China
Publisher
Elsevier Inc.
Abstract
Objective: KRAS G12V is one of the most common KRAS mutation variants in
lung adenocarcinoma (LUAD), and yet its prognostic value is still
unrevealed. In this study, we investigated the clinicopathologic
characteristics and prognostic value of the KRAS G12V mutation in LUAD.
 Method(s): Data of 3829 patients who underwent LUAD resection between
2008 and 2020 were collected. Mutations were classified as wild-type,
G12V, or non-G12V. The clinicopathologic characteristics, postoperative
outcomes, and recurrence pattern were analyzed among groups.
 Result(s): In total, 3554 patients were wild-type and 275 patients
harbored a KRAS mutation: 60 patients with G12V (22.2%) and 215 patients
with non-G12V (77.8%). The KRAS G12V mutation was more frequent in male
patients, older patients (>=60 years), former/current smokers, those
patients with radiologic solid nodules, and those with highly invasive
histologic subtypes. Tumors carrying KRAS G12V mutation exhibited elevated
programmed death-ligand 1 expression in comparison with wild-type tumors.
KRAS G12V was more prevalent in older patients and had less lymphovascular
invasion compared with other mutation types. FGF3, RET, and KDR
co-mutations occurred more frequently in the KRAS G12V group. Multivariate
analysis demonstrated that the KRAS G12V mutation was an independent
prognostic factor in stage tumors, whereas the KRAS non-G12V mutation was
not. KRAS G12V was associated with early recurrence and locoregional
recurrence. Conclusion(s): The KRAS G12V mutation was associated with
aggressive clinical-pathologic phenotype and early recurrence. To note,
this mutation exhibited a significantly worse prognosis in patients with
part-solid and stage lung adenocarcinoma. Meanwhile, the prognostic
significance of KRAS G12C and G12V variants was comparable. Copyright
© 2024 The American Association for Thoracic Surgery

<49>
Accession Number
2035803867
Title
The value of serum cystatin c in predicting acute kidney injury after
cardiac surgery: A systematic review and meta-analysis.
Source
PLoS ONE. 19(11 November) (no pagination), 2024. Article Number: e0310049.
Date of Publication: November 2024.
Author
Peng P.; Fu X.C.; Wang Y.; Zheng X.; Bian L.; Zhati N.; Zhang S.; Wei W.
Institution
(Peng, Fu, Wang, Zheng, Bian, Zhati, Zhang) Department of Rehabilitation
Medicine Technology, School of Nursing, Jilin University, Jilin Province,
Changchun, China
(Wei) Urology surgery, The first hospital of Jilin University, Jilin
Province, Changchun, China
Publisher
Public Library of Science
Abstract
Objective This study aims to review relevant research and assess the
diagnostic value of serum cystatin C (CysC) for post-cardiac surgery acute
kidney injury (PCSAKI). Method We searched databases (PubMed, Embase,
Cochrane, WanFang, CNKI, VIP) for literature published up to January 10,
2024. Quality was assessed using Quality Assessment of Diagnostic Accuracy
Studies-2 (QUADAS-2). Extracted data from eligible studies and summarized
sensitivity, specificity, and area under the curve (AUC) values. Results A
total of 24 studies involving 3,427 patients were included. The estimated
diagnostic sensitivity of CysC for PCSAKI was 0.67 (95% CI, 0.57-0.76),
with a specificity of 0.87 (95% CI, 0.81-0.91). The positive likelihood
ratio (+LR) was 5.17 (95% CI, 3.45-7.73), and the negative likelihood
ratio (-LR) was 0.38 (95% CI, 0.28-0.51). The diagnostic odds ratio (DOR)
was 14 (95% CI, 7-26), the diagnostic score (DS) was 2.62 (95% CI,
1.99-3.24), and AUC was 0.86 (95% CI, 0.83-0.89). The sub-analysis results
indicate that gender distribution, serum storage temperature, CysC
detection method, and detection time all have a significant impact on
sensitivity and specificity. Conclusion CysC has high specificity and good
sensitivity in diagnosing PCSAKI during the perioperative period, with
better detection results 24 hours before surgery, making it suitable for
early detection. However, whether and how CysC is commonly used in
clinical diagnosis still requires further research and clinical
trials. Copyright: © 2024 Peng 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.

<50>
[Use Link to view the full text]
Accession Number
2035748335
Title
Transcatheter Repair versus Mitral-Valve Surgery for Secondary Mitral
Regurgitation.
Source
New England Journal of Medicine. 391(19) (pp 1787-1798), 2024. Date of
Publication: 14 Nov 2024.
Author
Baldus S.; Doenst T.; Pfister R.; Gummert J.; Kessler M.; Boekstegers P.;
Lubos E.; Schroder J.; Thiele H.; Walther T.; Kelm M.; Hausleiter J.;
Eitel I.; Fischer-Rasokat U.; Bufe A.; Schmeisser A.; Ince H.; Lurz P.;
Von Bardeleben R.S.; Hagl C.; Noack T.; Reith S.; Beucher H.;
Reichenspurner H.; Rottbauer W.; Schulze P.C.; Muller W.; Frank J.;
Hellmich M.; Wahlers T.; Rudolph V.
Institution
(Baldus, Pfister) Department Of Internal Medicine Iii, United States
(Muller, Frank, Hellmich) Institute Of Medical Statistics And
Computational Biology, United States
(Wahlers) Cardiothoracic Surgery, Faculty Of Medicine, University Hospital
Cologne, University Of Cologne, Cologne, Germany
(Doenst) Department Of Cardiothoracic Surgery, Germany
(Schulze) Cardiology, Jena University Hospital,
Friedrich-Schiller-University Of Jena, Jena, Germany
(Gummert) Thoracic And Cardiovascular Surgery, Germany
(Rudolph) General And Interventional Cardiology/Angiology, Heart And
Diabetes Center Nrw, University Hospital Of The Ruhr-University Bochum,
Medical Faculty Owl, Bad Oeynhausen, Germany
(Kessler, Rottbauer) Department Of Cardiology, Ulm University Heart
Center, Ulm, Germany
(Boekstegers) Faculty Of Health, School Of Medicine, Germany
(Bufe) Helios Klinikum Krefeld, University Witten/Herdecke, Witten,
Germany
(Lubos) Marienkrankenhaus, Germany
(Lubos) Department Of Cardiology, University Hospital Eppendorf, Germany
(Reichenspurner) Department Of Cardiothoracic Surgery, University Heart
And Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany
(Schroder) Department Of Internal Medicine I, University Hospital Aachen,
Rwth Aachen University, Aachen, Germany
(Noack) Cardiac Surgery, Germany
(Thiele) Heart Center Leipzig At Leipzig University, Germany
(Thiele) Leipzig Heart Science, Leipzig, Germany
(Walther) Department Of Cardiovascular Surgery, University Hospital
Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
(Kelm) University Hospital Dusseldorf, Carid (Cardiovascular Research
Institute Dusseldorf), Dusseldorf, Germany
(Hausleiter) Medical Clinic And Polyclinic I, Germany
(Hagl) Department Of Cardiac Surgery, Ludwig Maximilian University Munich,
Munich, Germany
(Eitel) Medical Clinic Ii, University Heart Center Lubeck, German Center
For Cardiovascular Research (DZHK), Lubeck, Germany
(Fischer-Rasokat) Department Of Cardiology, Kerckhoff Heart Center, Bad
Nauheim, Germany
(Schmeisser) Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
(Ince) Department Of Cardiology, University Medical Center Rostock,
Rostock, Germany
(Lurz, Von Bardeleben) Department Of Cardiology, University Medical Center
Mainz, Germany
(Lurz) German Center For Cardiovascular Research (DZHK) Partner Site Rhine
Main, Mainz, Germany
(Reith) St. Franziskus Hospital, Munster, Germany
(Beucher) Department Of Cardiology, Helios Klinikum Siegburg, Siegburg,
Germany
Publisher
Massachussetts Medical Society
Abstract
Background Current treatment recommendations for patients with heart
failure and secondary mitral regurgitation include transcatheter
edge-to-edge repair and mitral-valve surgery. Data from randomized trials
comparing these therapies are lacking in this patient population. Methods
In this noninferiority trial conducted in Germany, patients with heart
failure and secondary mitral regurgitation who continued to have symptoms
despite guideline-directed medical therapy were randomly assigned, in a
1:1 ratio, to undergo either transcatheter edge-to-edge repair
(intervention group) or surgical mitral-valve repair or replacement
(surgery group). The primary efficacy end point was a composite of death,
hospitalization for heart failure, mitral-valve reintervention,
implantation of an assist device, or stroke within 1 year after the
procedure. The primary safety end point was a composite of major adverse
events within 30 days after the procedure. Results A total of 210 patients
underwent randomization. The mean (+/-SD) age of the patients was
70.5+/-7.9 years, 39.9% were women, and the mean left ventricular ejection
fraction was 43.0+/-11.7%. Within 1 year, at least one of the components
of the primary efficacy end point occurred in 16 of the 96 patients with
available data (16.7%) in the intervention group and in 20 of the 89 with
available data (22.5%) in the surgery group (estimated mean difference, -6
percentage points; 95% confidence interval [CI], -17 to 6; P<0.001 for
noninferiority). A primary safety end-point event occurred in 15 of the
101 patients with available data (14.9%) in the intervention group and in
51 of the 93 patients with available data (54.8%) in the surgery group
(estimated mean difference, -40 percentage points; 95% CI, -51 to -27;
P<0.001). Conclusions Among patients with heart failure and secondary
mitral regurgitation, transcatheter edge-to-edge repair was noninferior to
mitral-valve surgery with respect to a composite of death,
rehospitalization for heart failure, stroke, reintervention, or
implantation of an assist device in the left ventricle at 1 year. (Funded
by Abbott Vascular; MATTERHORN ClinicalTrials.gov number,
NCT02371512.) Copyright © 2024 Massachusetts Medical Society.

<51>
Accession Number
645874424
Title
Serratus plane block for postoperative pain management after minimally
invasive heart valve surgery: case series.
Source
Regional Anesthesia and Pain Medicine. Conference: 41st European Society
of Regional Anaesthesia and Pain Therapy Congress, ESRA 2024. Prague
Czechia. 49(Supplement 1) (pp A310), 2024. Date of Publication: September
2024.
Author
Karaca Y.; Guvenli Y.; Omeroilu L.K.; Karaman Y.
Institution
(Karaca) Anesthesiology and Reanimation, Tepecik Training and Research
Hospital, Izmir, Turkey
(Guvenli) Anesthesiology and Reanimation, Onep Clinic, Istanbul, Turkey
(Omeroilu) Anesthesiology and Reanimation, Dr Suat Seren Chest Diseases
and Chest Surgery Training and Research Hospital, Izmir, Turkey
(Karaman) Anesthesiology and Reanimation, Izmir Bayrakl State Hospital,
Izmir, Turkey
Publisher
BMJ Publishing Group
Abstract
Please confirm that an ethics committee approval has been applied for or
granted: Not relevant (see information at the bottom of this page)
Background and Aims The widespread use of ultrasonography in regional
anesthesia in recent years; resulted in the identification of new blocks
such as serratus plane block (SPB). SPB is a regional analgesic technique
that blocks T2- T9 which has an excellent role in postoperative pain
management for cardiothoracic surgeries. We performed a SPB for
postoperative analgesia in 5 patients undergoing minimally invasive heart
valve surgery (MIHVS). Methods SPB block was performed after induction of
general anesthesia and before the surgical incision, using 1,5mg/kg 0.25%
bupivacaine. The pain was measured using a visual analogue score (VAS) (0,
no pain; 10, worst pain imaginable) in recovery and at the 6th, 12th,
18th, and 24th hours. VAS was less than 3 for the 24th hour and patients
had no need for additional analgesics for a post-block period of 12 hours.
Results SPB provides prolonged postoperative analgesia in patients
undergoing MIHVS. Further randomized controlled trials are needcd to
enhance the efficacy of the SPB. Conclusions Thoracic pain is thought to
be transmitted via nerves originating from T2 to T9. Blockade of
unilateral intercostal nerves can provide sufficient analgesia after
MIHVS. A combination of opioids, non-steroidal antiinflammatory agents,
and regional methods; with different mechanisms of action in postoperative
pain management is considered to be more effective for postoperative
analgesia and minimizes side effects as well as reduces the incidence of
chronic pain.

<52>
Accession Number
645874415
Title
Impact of the bilateral deep parasternal intercostal plane block on
intraoperative opioid consumption in open heart surgery: a pilot study.
Source
Regional Anesthesia and Pain Medicine. Conference: 41st European Society
of Regional Anaesthesia and Pain Therapy Congress, ESRA 2024. Prague
Czechia. 49(Supplement 1) (pp A297), 2024. Date of Publication: September
2024.
Author
Tantri A.R.; Jaya A.A.G.P.S.; Heriwardito A.; Mansjoer A.; Soenarto R.F.
Institution
(Tantri, Jaya, Heriwardito, Soenarto) Department of Anesthesiology and
Intensive Care, Faculty of Medicine Universitas Indonesia, Dr. Cipto
Mangunkusumo National General Hospital, Jakarta, Indonesia
(Mansjoer) Division of Cardiology, Department of Internal Medicine,
Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
Publisher
BMJ Publishing Group
Abstract
Background and Aims Recently, opioid-sparing methods in cardiac surgery
have been developed for faster emergence from anesthesia and recovery
after surgery. Several cardiac surgery protocols used multimodal analgesia
with the application of regional anesthesia techniques. This study aims to
assess the effect of preoperative bilateral ultrasound-guided deep
parasternal intercostal plane block (DPIPB) on intraoperative adult
open-heart surgery opioid consumption. Methods The Institutional Ethics
Committee has approved this study. This was a double-blind, randomized,
controlled study with two parallel groups. Patients aged 19-75 years old
who would undergo elective open-heart surgery with a median sternotomy
approach were included in this study. Participants were randomly assigned
to either DPIPB or control group with a 1:1 allocation. The measured
outcomes were total intraoperative fentanyl consumption, the time of rst
intraoperative analgetic rescue, and the injury of the internal thoracic
artery Results Thirty-four patients were recruited, and two subjects were
withdrawn. The subject's baseline characteristics were comparable. The
total intraoperative fentanyl consumption was signicantly higher in the
control group than in the DPIPB group (median of 200 [100] vs 100 [50]
mcg, p=<0.001). The time of the rst intraoperative analgetic rescue was
signicantly longer in the DPIPB group than in the control group (median of
121.5 [141.5] vs 4.5 [4.75] minutes, p=<0.001). No injury of the internal
thoracic artery was found Conclusions The preoperative bilateral DPIPB is
effective for reducing intraoperative opioid consumption in adult
open-heart surgery and, therefore, can be used as a regional anesthesia
technique as part of multimodal analgesia for enhanced recovery after
cardiac surgery protocol.

<53>
Accession Number
645874384
Title
Comparative efficacy of thoracic paravertebral block and serratus
posterior superior intercostal plane block for postoperative pain
management in VATS lung resections: a randomized controlled trial.
Source
Regional Anesthesia and Pain Medicine. Conference: 41st European Society
of Regional Anaesthesia and Pain Therapy Congress, ESRA 2024. Prague
Czechia. 49(Supplement 1) (pp A37), 2024. Date of Publication: September
2024.
Author
Manici M.; Kalyoncu I.; Sincer Y.; Tanju S.; Gurkan Y.
Institution
(Manici, Kalyoncu, Sincer) Department of Anesthesiology and Reanimation,
Koc University, Istanbul, Turkey
(Tanju) Department of Thoracic Surgery, Koc University, istanbul, Turkey
(Gurkan) Anesthesiology and Reanimation, Koc University, Istanbul, Turkey
Publisher
BMJ Publishing Group
Abstract
Background and Aims Video-assisted thoracoscopic surgery (VATS) is
increasingly preferred for lung resections due to its reduced
postoperative pain and faster recovery compared to traditional
thoracotomy. However, effective pain management remains a challenge. This
study aimed to compare the analgesic efficacy of Thoracic Paravertebral
Block (TPVB) and Serratus Posterior Superior Intercostal Plane Block
(SPSIP) in patients undergoing VATS. Methods In this prospective,
randomized controlled trial conducted at Koc University Hospital,
Istanbul, Turkey, 34 patients scheduled for VATS lung resection were
randomly assigned to receive either TPVB or SPSIP in addition to standard
general anesthesia. Numeric Rating Scale (NRS) scores for pain were
recorded at 0, 6, 12, 24, and 48 hours postoperatively. Intravenous
patient-controlled analgesia (PCA) morphine consumption was also measured
over the same period.Non-parametric tests were used due to small sample
size and data distribution.Results The median NRS scores were higher
initially for the Paravertebral Block group (5.00) compared to the SPISP
group (3.00). The Friedman test showed significant differences in pain
scores over time within both groups (Paravertebral Block: p < .001, SPISP:
p = .002). The Mann-Whitney U test indicated that while the NRS scores
were lower in the SPISP group at all time points, the differences were not
statistically significant.Morphine consumption was significantly lower in
the SPISP group (median 21.00 mg) compared to the Paravertebral Block
group (median 45.50 mg, p = .012). Conclusions SPSIP is associated with
lower morphine requirements, suggesting it may provide superior pain
management.Further studies are warranted to confirm these findings and to
optimize postoperative analgesia in thoracic surgery.

<54>
Accession Number
645874351
Title
Serratus posterior superior intercostal plane block: a case series of four
patients undergoing minimally invasive cardiac surgery.
Source
Regional Anesthesia and Pain Medicine. Conference: 41st European Society
of Regional Anaesthesia and Pain Therapy Congress, ESRA 2024. Prague
Czechia. 49(Supplement 1) (pp A312), 2024. Date of Publication: September
2024.
Author
Yilmaz M.U.; Sincer Y.; Sogut M.S.; Manici M.; Darcin K.; Gurkan Y.
Institution
(Yilmaz, Sincer, Sogut, Manici, Darcin, Gurkan) Koc University Hospital,
Istanbul, Turkey
Publisher
BMJ Publishing Group
Abstract
Background and Aims Median sternotomy is the traditional method for
cardiac surgery. It comes with drawbacks like intense pain, extended
hospitalization, and aesthetic issues. Minimally invasive cardiac surgery
(MCIS) avoids these disadvantages, enabling faster recovery after surgery.
Patients might still experience significant pain due to the involvement of
intercostal nerves and rib retraction. The serratus posterior superior
intercostal plane block (SPSIPB) is a new technique performed between the
serratus posterior superior muscle and the intercostal muscles. We wanted
to share our experience with SPSIPBs for MICS in four patients. All
patients provided written informed consent. Methods The patients'
demographics were as follows: male aged 53 years (Patient 1), female aged
35 years (Patient 2), female aged 74 years (Patient 3) and male aged 38
years (Patient 4). Before induction of anesthesia, each patient had SPSIPB
applied in the sitting position. After proper placement of the block
needle between the third rib and the serratus posterior superior muscle,
40 ml of 0.25% bupivacaine was delivered. Results The patients were
transferred to the cardiovascular intensive care unit after surgery and
were attached to a patient-controlled analgesia device containing
morphine. Pain was evaluated using the numerical rating scale (NRS). The
NRS scores at extubation time, 1, 6, 12, and 24 h were recorded.
Conclusions We assessed the effectiveness of SPSIPB in patients who had
MICS. SPSIPB may offer effective pain management following MICS.
Randomized controlled trials are needed to determine the feasibility of
SPSIPB more accurately.

<55>
Accession Number
645873924
Title
Successful cutaneous sensory blockade following single and double
injection techniques of ultrasoundguided superficial parasternal
intercostal plane block: a randomized controlled trial.
Source
Regional Anesthesia and Pain Medicine. Conference: 41st European Society
of Regional Anaesthesia and Pain Therapy Congress, ESRA 2024. Prague
Czechia. 49(Supplement 1) (pp A60), 2024. Date of Publication: September
2024.
Author
Samerchua A.; Lapisatepun P.; Sroiwong C.; Leurcharusmee P.; Pipanmekaporn
T.; Sukhupragarn W.; Boonsri S.; Bunchungmongkol N.
Institution
(Samerchua, Lapisatepun, Sroiwong, Leurcharusmee, Pipanmekaporn,
Sukhupragarn, Boonsri, Bunchungmongkol) Anesthesiology, Faculty of
Medicine, Chiang Mai University, Chiang mai, Thailand
Publisher
BMJ Publishing Group
Abstract
Background and Aims This study aimed to compare the efficacy of single and
double injections of ultrasound-guided superficial parasternal intercostal
plane blocks (S-PIPB). We hypothesized that double injections would yield
superior success rates in achieving sensory blockade compared to the
single injection technique. Methods Seventy cardiac patients undergoing
median sternotomy were randomly assigned to receive single or double
injections of S-PIPB bilaterally. Each patient received 40 mL of 0.25%
bupivacaine with epinephrine 5 mug/mL and dexamethasone 10 mg. Twenty
mL/side was injected at the 3rd intercostal level in single-injection
group, while 10 mL/injection was administered at the 2nd and 4th
intercostal spaces in double-injection group. The primary outcome was
successful S-PIPB, defined as sensory loss in the T2-T6 dermatomes at 30
minutes post-block. Secondary outcomes included block-related
complications, intraoperative hemodynamics during sternotomy, fentanyl
consumption, postoperative pain, and recovery quality. Results Double
injections of S-PIPB achieved greater success rates on both sides of the
chest walls (81% vs 51%, P<0.001) and increased the percentage of blockade
in dermatomes T1 (83% vs 59%, P<0.003), T7 (67% vs 46%, P<0.017), and T8
(61% vs 39%, P=0.001) compared to single injection. One hematoma occurred
in the doubleinjection group. Intraoperative hemodynamics, postoperative
pain, and recovery outcomes were comparable between the two groups.
Conclusions When compared to a single injection, double injections of
S-PIPB provided extended coverage of the T2- T6 dermatomes, which are
crucial for median sternotomy. However, no differences were observed in
intraoperative hemodynamic effects or postoperative pain control after
cardiac surgery.

<56>
Accession Number
645873800
Title
Peripheral nerve block for thoracic surgery. A narrative review.
Source
Regional Anesthesia and Pain Medicine. Conference: 41st European Society
of Regional Anaesthesia and Pain Therapy Congress, ESRA 2024. Prague
Czechia. 49(Supplement 1) (pp A394-A395), 2024. Date of Publication:
September 2024.
Author
Fernandez M.T.
Institution
(Fernandez) Anesthesia,Rio Hortega University hospital, Valladolid, Spain
Publisher
BMJ Publishing Group
Abstract
Introduction Pain after thoracic surgery is of moderate-to-severe
intensity and can cause increased postoperative distress and impair
functional recovery. Peripheral nerve blocks (PNBs) have gained
considerable attention in perioperative pain management as a method to
reduce systemic opioid consumption and improve pain control. This
narrative review aims to describe the different peripheral regional blocks
in the context of thoracic surgery. PubMed and Embase were searched for
all RCTs and reviews involving adult participants undergoing thoracic
surgery with PNB as analgesia. A total of 157 articles were retrieved
according to the search strategy in Pubmed and 234 in Embase. After
screening of the title and abstract,92 articles (68 RCT,24 reviews) were
selected finally. Regional anaesthesia is a useful choice in thoracic
surgery and peripheral nerve block can improve patient outcomes. Due to
the lack of RCTs, it is still not possible to determine the most
appropriate block in individual surgical situations, although we have the
PROSPECT recommendations. Discussion Intercostal nerve blocks are a
relatively easy procedure to perform and can provide potent analgesia in a
fast and reliable manner48. One advantage of intercostal blocks is that
they can be performed under direct visualisation in the pleural cavity by
the surgeon in the field or percutaneously by the anaesthetist. Due to the
circumscribed nature of the intercostal nerves innervating the chest wall,
multiple levels of injection are required to ensure adequate analgesia. A
systematic review and meta-analysis revealed that the administration of a
single-injection ICNB among adults undergoing thoracic surgery was
associated with a modest reduction in pain scores during the initial
24-hour postoperative period. Intercostal nerve block analgesia was
superior to systemic opioid-based analgesia, noninferior to TEA, and
marginally inferior to PVB. Because ICNB analgesia was also associated
with better pulmonary function and a reduction in the risk of pulmonary
complications, these findings were clinically relevant. The data suggested
that the benefit of ICNB analgesia decreases progressively and disappears
at 24 to 48 hours after surgery. Reliance on ICNB after this period may
result in an abrupt lack of analgesia or rebound pain, represented by
higher pain scores at 24 hours after surgery for dynamic pain and 48 hours
after surgery for static pain. These factors have motivated further
research with the objective of developing a more efficient technique. The
anterior serratus plane block was the first describen. It is a type of
regional anaesthetic that is simple to perform and highly effective in
providing analgesia. It has no adverse effects, such as respiratory or
circulatory depression. In comparison to traditional local infiltration
anaesthesia, SAPB necessitates a reduced quantity of local anaesthetics,
is devoid of the potential for local anaesthetic poisoning, and extends
the duration of analgesia through catheterisation. In comparison to a
thoracic epidural block, SAPB does not result in spinal cord injury,
epidural haematoma, respiratory depression, or fluctuations50. In
comparison to an intercostal nerve block, a SAPB is a relatively simple
procedure, necessitating fewer injections and presenting a lower incidence
of complications such as pneumothorax. In comparison to a thoracic
paravertebral nerve block, a SAPB is a less challenging procedure with no
risk of orthostatic hypotension or urinary retention51. In comparison with
total intravenous analgesia, SAPB has the advantage of not causing adverse
reactions such as nausea and vomiting, excessive sedation, or respiratory
depression caused by opioids. Furthermore, opioids are a more expensive
option. Consequently, future research on SAPB may be conducted in an
ambulatory setting, such as during breast nodule resection, breast
prosthesis implantation, invasive procedures, such as breast tissue
pathological biopsy and treatment of intercostal neuralgia. A relatively
recent regional anaesthetic technique that offers significant advantages
and has been gaining popularity in the context of thoracic surgery is the
erector spinae block. As with numerous other regional techniques, this
block can be performed as a single-shot procedure with an appropriate
volume of local anaesthetic, or alternatively, by placing a catheter for
continuous infusion. Furthermore, this technique is demonstrating
encouraging results in the treatment of trauma patients with rib
fractures. The existing literature on the use of ESPB in thoracic surgery
is limited to case reports, editorials, and a few clinical trials. The
ESPB has been demonstrated to be an efficacious peripheral technique for
postoperative pain management in this cohort of patients. These findings
are in accordance with the results of the present study, which
demonstrated that ESPB provided adequate analgesia following
minithoracotomy. The average static and dynamic NRS scores remained below
3 throughout the follow-up period, and the number of requests for
additional analgesic drugs was low. In comparison to TEA and TPVB, ESPB
appears to be a safer option, with a minimal risk of pleural puncture and
epidural spread. Furthermore, the risk of coagulopathy should be minimal,
given that the procedure is performed at a distance from the spinal cord
or the epidural venous plexus, thereby avoiding the risk of epidural
haematoma. In the initial 48 hours following surgery, patients undergoing
continuous ESPB exhibited reduced opioid requirements and reported
diminished pain compared to those undergoing ICNB55. There were no
differences in respiratory muscle strength, postoperative complications,
or time to hospital discharge. However, TPVB appeared to be the preferable
method compared with ESPB and ICNB, with a more successful analgesia and
less morphine consumption. In comparison with other regional anaesthetic
techniques, a variety of outcomes have been documented. Although
statistical analysis indicated that ESPB was less effective than thoracic
paravertebral block and intercostal nerve block and more effective than
serratus anterior plane block in postoperative analgesia, the clinical
differences remain unclear. The incidence of haematoma was found to be
lower in the ESPB group than in the other groups (odds ratio 0.19, 95% CI
0.05-0.73)20. Erector spinae plane (ESP) block and serratus anterior plane
(SAP) block promise effective thoracic analgesia compared with
systemically administered opioids. Compared with SAP, ESP provides
superior quality of recovery at 24 h, lower morbidity, and better
analgesia after minimally invasive thoracic surgery. However, the SAP
block can play an important role in the management of pain after thoracic
surgery by reducing both pain scores and 24-h postoperative opioids
consumption. In addition, there is fewer incidence of PONV in the SAP
block group. Regarding the pain control in emergency department Dr Armin
recommends ESPB in blunt or penetrating thoracic trauma27. Analgesia in
breast surgery has different connotations, as it involves both intercostal
and pectoral nerves. The results of some meta-analysis demonstrate that
the Pecs II block is a valuable adjunct for postoperative analgesia in
patients undergoing breast cancer surgery. Compared with patients who
received only systemic analgesia, patients who received a Pecs II block
not only had significantly less pain at all measured postoperative
time-points up to 24 h but also a time to first analgesia request that was
prolonged by 5 h on average. Although some might question the clinical
significance of a 1-2-point reduction in pain scores on a 0-10 scale, it
is worth noting that this represents a reduction of 39-55% from the
average pain scores of 2.4-3.5 reported in the control groups.
Furthermore, this was achieved with a simultaneous 59% reduction in 24-h
opioid consumption. Although the role of peri-operative opioids in tumour
metastasis remains uncertain, the importance of fully attenuating the
peri-operative stress response possible is unquestioned56 One reason for
the popularity of the Pecs II block is that it is a simpler and safer
alternative to a thoracic paravertebral block, which many find a
challenging technique to perform. Conclusions With the development of ERAS
protocols, the classical approach to post-operative pain control has
changed; narcotics are no longer enough. In this area, peripheral nerve
blocks have shown good results. Nowadays, peripheral nerve blocks and
their different approaches have shown to be an alternative to central
blocks (paravertebral and epidural). ICNB, SAPB, ESPB and PECS are
associated with a reduction in pain during the first 24 hours after
thoracic surgery and reduce the amount of opioids during the postoperative
period. Furthermore, the current literature supports that some of them
offer non-inferior or comparable analgesic efficacy to a TPVB, suggesting
that they may also be beneficial in cases where TEA and PVB are not
indicated, and even the Pecs II block warrants consideration as a
first-line option for regional analgesia in breast surgery.

<57>
Accession Number
645873680
Title
Green-gional anaesthesia: aligning the triple bottom line.
Source
Regional Anesthesia and Pain Medicine. Conference: 41st European Society
of Regional Anaesthesia and Pain Therapy Congress, ESRA 2024. Prague
Czechia. 49(Supplement 1) (pp A380-A382), 2024. Date of Publication:
September 2024.
Author
Ip V.
Institution
(Ip) University of Calgary, Calgary, Canada
Publisher
BMJ Publishing Group
Abstract
Introduction Environmental Sustainability involves making responsible
choices that ensure long-term health of our planet and supply of
resources. It ultimately affects human health in numerous ways, especially
those at the extremes of ages. The health effects of these disruption
include increased respiratory1 and cardiovascular disease2,3, injuries,
and premature deaths related to extreme weather events, changes in the
prevalence and geographical distribution of food- and water-borne
illnesses and other infectious disease, and threats to mental health4. A
record 2.2 million hectares was burnt across Alberta, Canada, displacing
adjacent community and interrupting healthcare provision5. About 60
wildfires (10 times more than average) that begin in the previous seasons
and smoulder underground for months before reigniting in the spring once
the snow melts, and the cycle continues.5 Climate change, has received
increasing attention in recent years with the extremes of weather events,
retreating glacier leading to rising sea-level threatens food and water
supply, as well as altering natural ecosystems on which human depends, is
now a climate crisis as action is urgently needed6. The Lancet Climate
Change Commission declared climate change as the greatest health threat of
the 21st Century7. The World Health Organization is projecting an
additional 250,000 deaths per year attributable to climate change in the
coming decades8. If global health care sector were a country, it would be
the fifth largest greenhouse gas emitter on the planet9. Health care's
climate footprint is equivalent to 4.4% of global net emissions (2
gigatons of carbon dioxide equivalent), or equivalent to the annual
greenhouse gas emissions from 514 coal-fired power plants.9 Until
recently, there was limited awareness on the significant contribution the
health care sector makes to the carbon footprint. The European Union as a
political union is forging a collective political response to the climate
crisis. It has set goals to drive action on a national level9. Some
regions in Europe, particularly in Scandinavia and the Netherlands, zero
emissions hospital buildings, innovative climate-smart technologies, and
strategies to address supply chain emissions.10 In the United Kingdom, the
National Health Service is leading the environmental sustainability
efforts in health care with over a decade of experience with sustainable
practice in anesthesia. They have set targets to reach net zero by 2040
with an ambition to reach an 80% reduction by 2028 to 203211. Across the
Atlantic in Canada, it has committed to a 40-45% emission reduction by
2030 and to reach net zero emission by 2050. Given that carbon footprint
of 1 hospital bed equals that of 5 households, curbing 12 carbon emissions
in healthcare could play a major role. As with other industries, health
care needs to adopt the 'Triple Bottom Line' which was fist described in
the business model by John Elkington in 1990s where he suggests that
competing corporate entities seek to main their relative position by
addressing people and planet issues as well as profit maximization,
namely13, the 3 'Ps': P eople, P lanet, P rofit. Therefore, rather than
focusing on profit alone, social equity, wellbeing of people, as well as
environmental sustainability and energy conservation are equally
important. This framework is applicable in regional anesthesia as it
suggests that patient care has three domains and by maximizing patient
safety and care does not necessarily result in financial and environmental
trade-offs. Aligning all 3 'Ps' helps the bottom line when considering the
significant future costs than otherwise. It is often assumed that regional
anesthesia is more environmentally sustainable than alternatives. In fact,
recent publication has shown the significant amount of carbon dioxide
emission (an equivalent of 26, 900 lbs of coal burnt, or 2750 gallons of
gasoline consumed) by increasing the amount of regional anesthesia
performed for total knee arthroplasty.14 Contrastingly, the publication
from Australia showed that regional anesthesia, general anesthesia and the
combination of both, could be comparable depending on the specifics of
institutional anesthesia practices.15 It is an observational study
evaluating their different anesthesia practice for total knee
arthroplasty. Upon examining the breakdown of the life cycle analysis, it
is apparent that the specifics of their practice in general anesthesia is
much more environmentally sustainable, with the use of sevoflurane, and
reusable operating attire and equipment. On the other hand, their practice
in regional anesthesia is less environmentally sustainable owing to the
use of high flow oxygen, as the process of compressing oxygen into liquid
oxygen for medical use is highly energy intensive. Furthermore, a large
amount of procedure attire was used and towels for hand-drying, despite
being reusable, contributed to substantial environmental impact in the
regional anesthesia group. This highlights the need to reflect on clinical
practice in regional anesthesia to balance infection control and
environmental sustainability. As a result, a Delphi consensus study across
multiple countries was conducted, to provide guidance on environmentally
sustainable practice in regional anesthesia from experts within various
subspecialties, including regional anesthesia, obstetrics anesthesia,
intensive care, and infection prevention, reconciling infection control
with resource stewardship. It was found that infection control practices
which are rooted in evidence often do not interfere with sustainability
and reach consensus, while less evidence-supported measures, only gained
weak consensus.16 There were strong consensus that a sterile gown was
unnecessary for either single injection of peripheral nerve blocks or
spinal, and trending towards not required for catheter techniques.16 There
was also strong consensus that minimal equipment should be included in the
pre-made pack and the pre-existing packaging for equipment such as nerve
block catheter, can be used as sterile work space.16 Only weak consensus
was obtained in using small plastic adhesive cover for the ultrasound
transducer for single injection peripheral nerve blocks and
catheter-over-needle assembly with very short catheters.16 Another
unexpected finding was a high degree of uncertainty amongst the experts
regarding reusable versus disposable attires, despite existing life cycle
analysis data appraising the environmental impact, demonstrating the need
to raise awareness of such data, which is less familiar for most
anesthetists.16 Electricity contributes significantly to the carbon
footprint in healthcare,9 and opportunity to reduce this is by reflecting
on how ultrasound machines are used in regional anesthesia. Recently, we
performed a study on energy consumption used by a single ultrasound
machine, comparing control group: standard practice of leaving ultrasound
machine on during the day, against intervention: turning off the
ultrasound machine when not in use. The primary outcome was energy
consumption. Our unpublished data showed 87% reduction in energy
consumption when accounting for the differences in duration of use between
the groups. A total of 1.55kWh of energy saving per day was logged which
equates to 161.2kg reduction in carbon dioxide emissions and almost 74
Euros yearly cost savings per ultrasound machine.17 Given the scale of
ultrasound use in healthcare, even minor changes can contribute to a
cumulative impact on an ever-increasing environmental impact from
healthcare. This is a simple measure to contribute to a responsible
resource stewardship. Another area where regional anesthesia reduces
carbon emission is the ambulatory program where patients can be discharged
with a nerve block catheter infusion. In Canada, carbon footprint for 1
hospital bed is equivalent to that of 5 household, by discharging those
patients who only required to stay as in-patient due to pain control can
both reduce environmental impact and benefit patient in terms of better
pain control with minimal opioid, if any. This also reduces the potential
for improper opioid disposal and opioid diversion in the community. The
second 'P'-profit is divided into short- and long-term, both favoring
regional anesthesia, especially when used solely for surgical anesthesia.
This approach negates the need for costly volatile agents, which are
potent greenhouse gases. Regional anesthesia also reduces opioid use and
the associated complications, and ambulatory regional anesthesia programs
can lower the cost of hospital stay. Long-term cost savings are supported
by large meta-analyses demonstrated a reduction in major complications
post total joint arthroplasty in the neuraxial anesthesia group compared
to the general anesthesia, with the former associated with lower odds or
no difference in virtually all reported complications, except for urinary
retention.18 Similar benefits are observed with peripheral nerve blocks,
improving outcomes such as lower odds for cognitive dysfunction,
respiratory failure, cardiac complications, surgical site infection,
thromboembolism and blood transfusion.18 Fewer complications reduce both
costs and the environmental impact on the healthcare system, creating a
positive cycle by reducing associated morbidities and mortalities. With
the last 'P' being people, encompasses social equity, well-being and
patient safety. Prioritizing patient care while reducing environmental
footprint can optimize costs by accounting for future expense of not
addressing environmental impact on healthcare. Numerous studies highlight
the benefits and safety of regional anesthesia.

<58>
Accession Number
645873661
Title
Regional anesthesia and the prevention of chronic post-surgical pain.
Source
Regional Anesthesia and Pain Medicine. Conference: 41st European Society
of Regional Anaesthesia and Pain Therapy Congress, ESRA 2024. Prague
Czechia. 49(Supplement 1) (pp A375-A377), 2024. Date of Publication:
September 2024.
Author
Lavand'Hommep P.
Institution
(Lavand'Hommep) Anesthesiology, Cliniques Universitaires St Luc (CUCL),
Brussels, Belgium
Publisher
BMJ Publishing Group
Abstract
Introduction Acute pain following a surgical procedure remains a prominent
healthcare concern.1 Pain persistence or recurrence after surgery, in
other words chronic post-surgical pain (CPSP), has received considerable
interest since the first report in 1998 which stated that surgery
contributed to pain in 22.5% of patients attending a chronic pain clinic.2
With more than 313 million surgical procedures performed worldwide each
year (over 15 million procedures in Europe), the socio-economic burden of
CPSP may be large.3 The expected volume of CPSP has promoted its inclusion
in the new version of the International Classification of Diseases
(ICD-11). Therefore, a common definition of CPSP has been proposed: pain
that persists or recurs longer than 3 months, is located in the surgical
area, has a negative impact on the patient's quality of life, and is
directly related to the surgical procedure (other causes for the pain
being excluded).4 Beyond pain intensity, CPSP diagnosis should taken into
account pain severity which encompasses 3 dimensions: pain intensity,
pain-related distress and pain-related interference with activities of
daily living.5 Using the later definition i.e. intensity combined to
functional interference, the incidence of CPSP was 3.3 to 4.1% in a large
European cohort 6(PainOUT registry, N=2319). Similar incidence of
persistent incisional pain (3.3%; 2.9% in patients without preoperative
chronic pain condition and 7.3% in patients with a preoperative chronic
pain condition) was found in a large international prospective cohort. All
studies mention signs of neuropathic pain being present in 57% to 81% of
CPSP patients, always associated to more severe pain, poorer quality of
life and chronic analgesics intake. By consequence, 'there are two
pressing matters: accurately identifying patients with a high risk to
develop CPSP and implementing effective prevention strategies'.1 These two
issues still remain unsolved. Regional Anesthesia and CPSP prevention: the
current picture Regional Anesthesia (RA) techniques, i.e. neuraxial,
peripheral nerve blocks and local infiltration, are part of multimodal
anesthesia and analgesia protocoles. RA plays a key role in the control of
postoperative nociceptive transmission caused by local and systemic
inflammation as well as nerve injury. RA also allows a reduction of opioid
analgesics consumption and is very effective to control severe pain during
mobilization. The control of acute pain associated to earlier mobilization
is important in the process of recovery. First, to prevent the occurrence
of complications, including medical complications, which may promote
persistent pain after the surgical procedure.8 Second, because the time
spent in severe pain during the first 24h, rather than the pain intensity
itself, may predict the risk to develop CPSP.7 Although effective RA
promotes rapid recovery after a surgical procedure, RA longterm benefits
in term of CPSP prevention are still debated.9 In their updated Cochrane
systematic review (60 RCTs included) assessing the preventive effect of
regional anesthesia techniques, Levene and colleagues10 have reported a
possible benefit for thoracic surgery like thoracotomy and breast cancer
surgery (moderate-quality evidence due to a majority of trials unpowered).
After thoracotomy, epidural analgesia could prevent CPSP in one patient
over 7 (OR 0.52; 95%CI 0.32 to 0.84) and similarly, paravertebral block
and local infiltration prevented chronic post-mastectomy pain in one woman
out of 7. Later, those preventive effects have been questioned in a novel
systematic review.11 In this metaanalysis, 11statistical significance was
only achieved for paravertebral block (OR 0.73; 95%CI 0.50-1.05).
Interestingly, the protective effect of paravertebral block to reduce the
intensity of the neuropathic component of CPSP after breast cancer surgery
has been questioned in several meta-analysis12 and in large RCTs but has
not been confirmed. Besides thoracic procedures, orthopedic surgery
carries a very high risk of persistent pain and CPSP. These observations
correlate with the published reports of the Transitional Pain Services
where thoracic and orthopedic surgeries are the most common ones referred,
severe pain involving a neuropathic component in 70% of the patients. RA
techniques are particularly effective to control acute postoperative pain
in orthopedic patients. Nevertheless, peripheral nerve blocks and local
infiltrations have not proven their efficacy to prevent CPSP development
or to reduce CPSP intensity after a major procedure like knee
arthroplasty. As those patients endure severe longlasting pain before
joint replacement, preoperative pain control at surgery site using
radiofrequency ablation of genicular nerves has been attempted to reduce
preoperative local and central sensitization. The failure of knee
denervation to reduce CPSP after knee replacement deserves to be
questioned. A large recent review (14 RCTs, N=90 666 with RA in 50 021
patients) has assessed the effect of upper extremity regional anesthesia
(plexus blocks, IVRA and WALANT) on post-surgical outcomes such as pain
intensity at 3 months, CRPS development, functioning and opioid intake.
The conclusions of this large review were that upper extremity RA compared
to general anesthesia is unlikely to change pain intensity at 3 months and
later (overall moderate to low certainity of evidence). Further, RA was
not protective against the development of CRPS at 6 months (1 RCT, N=301).
In summary, current analysis of the literature provides limited
information and RA protective effects are unpredictable. As stated by some
authors, the study designs are very often insufficient to address the
complexity of CPSP, a multifactorial problem. Regional Anesthesia and CPSP
prevention: what do we have missed? The aforementioned deceiving reports
should prompt us to question possible explanations regarding RA failures
to prevent or even to reduce CPSP incidence and/or intensity. As part of
multimodal analgesia, RA ability to control acute pain, particularly
during mobilization, is an evidence. A recent network meta-analysis
comparing preventive interventions (both systemic drugs and RA techniques)
to each other's instead of comparing interventions to controls, pointed
out both the utility of multimodal analgesia and the fact that immediate
postoperative analgesic benefit was an important mediator for the
reduction of CPSP. Consequently, preventive failure of RA might be
explained by inadequate selection of high risk patients, yielding to poor
application and perhaps poor timing of RA application. As stated
previously, identifying patient with high risk for CPSP development is
mandatory because it is inextricably linked to the success or the failure
of a treatment protective effect. First, the actual incidence of severe
acute postoperative pain strongly questions the effectiveness of
multimodal analgesia treatments (evidence-based and procedure-specific
treatments) used in the majority of the patients. Understanding why some
patients fail to respond to a 'standard treatment' should help to improve
health cares and perhaps may help to predict patients at higher risk to
develop CPSP. A contrario, understanding the higher efficacy of a
treatment in some patients may help to apply protective RA in high risk
patients. The best example to date concerns the protective benefit of RA
in cancer breast surgery. In these patients, the addition of a parietal
block to multimodal analgesic regimen was associated both to better acute
pain control and to reduced chronic pain severity at 12-months only in
women with high baseline catastrophizing scores. In the women with no/low
baseline catastrophizing, addition of parietal block demonstrated less
benefit, no significant impact on postoperative acute pain and chronic
pain severity. Female sex, high anxiety and catastrophizing are well known
risk factors for persistent pain and CPSP. Second, patients who attribute
their pain to a specific cause like trauma or surgery seem to suffer
higher emotional distress and higher pain. The preclinical literature
suggests that the transition point from acute to chronic pain might be far
earlier than the 3-months time point mentioned in the CPSP definition.
More importantly, the transition might occur at time points near injury
and may even concurrently occur with injury, hence before the surgical
procedure to fix the trauma injury. The previous findings argue for RA
administration earlier than perioperatively and some results seem to favor
that hypothesis. Orthopedic surgery, specifically surgery in the context
of trauma and fracture, critically doubles the risk for developing CPSP.
Bone fracture induces severe acute pain, combining sharp nociceptive pain
with neuropathic symptoms. Fractures convert to chronic pain in 43% to 65%
of the patients. In trauma patients, posttraumatic high pain intensity is
considered to be a major risk factor for pain persistence and
posttraumatic pain rather than postsurgical origin promotes CPSP
development. The benefits of timely RA providing early pain relief have
been highlighted in military personnel who suffered combat-related
extremity injury.

<59>
Accession Number
645873546
Title
Intravenous lidocaine is to be preferred over epidural catheter
management: pro.
Source
Regional Anesthesia and Pain Medicine. Conference: 41st European Society
of Regional Anaesthesia and Pain Therapy Congress, ESRA 2024. Prague
Czechia. 49(Supplement 1) (pp A367-A369), 2024. Date of Publication:
September 2024.
Author
Girish J.P.
Institution
(Girish) Anesthesiology and Pain Management, University of Texas,
Southwestern Medical Center, Dallas, TX, United States
Publisher
BMJ Publishing Group
Abstract
Introduction Enhanced recovery after surgery (ERAS) pathways have become
standard of care, as they reduce perioperative complications and
accelerate recovery. Optimal postoperative pain management is considered a
prerequisite to enhancing recovery after surgery because it facilitates
ambulation and rehabilitation.1 However, postoperative pain continues to
be inadequately managed. One of the major reasons for inadequate pain
control includes inappropriate clinical application of current knowledge.
Because pain is a complex phenomenon, a multimodal approach has been
recommended.2 Although optimal multimodal analgesic regimen remains
controversial, it is well accepted that combination of paracetamol
(acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) or
cyclooxygenase (COX)-2 specific inhibitor should be administered unless
there are contraindications. In addition, local and/or regional analgesia
is recommended. The choice of the regional analgesia technique should be
procedure specific. Furthermore, analgesic adjuncts such as ketamine,
dexmedetomidine, and lidocaine infusions have been evaluated as components
of multimodal analgesic regimen and/or opioid-free anesthesia.3 The aim of
this pro/con discussion is to present the current evidence on the role of
epidural analgesia and intravenous lidocaine infusion as components of
multimodal analgesia technique for enhanced recovery. Epidural Analgesia
Epidural analgesia provides excellent dynamic pain relief and has been
shown to reduce postoperative morbidity and mortality.4.5 Advantages of
epidural analgesia include reduced pulmonary, cardiovascular,
gastrointestinal, and venous thromboembolic complications. Given these
benefits thoracic epidural has been recommended in patients with
significant comorbid conditions including cardiovascular disease and
chronic obstructive pulmonary disease.6 Therefore, epidural analgesia has
been considered as a gold standard for patients undergoing major
thoraco-abdominal surgery.7-9 However, in recent years the clinical
benefits of epidural analgesia have been questioned.10-13 This probably is
due to implementation of ERAS pathways, improved surgical techniques,
improved postoperative care (e.g., avoidance of nasogastric tubes and
drains), improved pulmonary physiotherapy, early oral intake and early
mobilization. A systematic review of randomized trials in patients
undergoing laparoscopic colonic surgery revealed that pain scores in
patients receiving optimal multimodal analgesia were within an acceptable
range, suggesting that epidural analgesia may not be necessary for
laparoscopic procedures.14 Also, there were no differences between the
epidural analgesia and the non-epidural analgesia groups with respect to
return of bowel function, pulmonary function, length of stay, and quality
of life. Other studies in patients undergoing laparoscopic colorectal
surgery also found that epidural analgesia increased the incidence of
urinary infection and longer hospital length of stay15-17 without
providing any analgesic benefits over conventional analgesic regimen.
Also, epidural analgesia did not reduce post-discharge opioid
requirements18 or postopeerative venous thromboembolism.19 Epidural
analgesia is limited by a significant failure rate for catheter placement
and malfunction as well as adverse effects related to sympathetic and
motor blockade. In addition, use of epidural opioids can increase
postoperative pruritis, nausea, and urinary retention. Also, epidural
analgesia can delay ambulation due to the presence of catheters/pumps and
difficulties in catheter management due to routine use of VTE
prophylaxis.Also, epidural analgesia is invasive, labor-intensive, and
expensive.20.21 Given the lack of clinical benefits and the potential for
increased complications including delayed ambulation, epidural analgesia
is being replaced with more distal regional analgesia techniques such as
interfascial plane blocks and/or surgical site infiltration. Intravenous
Lidocaine Infusion Lidocaine has analgesic, anti-hyperalgesic, and
anti-inflammatory effects. It also has anti-neoplastic properties, and
therefore may provide benefits in patients undergoing cancer surgery.22
Lidocaine can reduce nociception and/or cardiovascular responses to
surgical stress. Also, perioperative (intraoperative and immediate
postoperative) intravenous lidocaine infusion has been found to reduce
pain scores and opioid requirements. In addition to improved pain control,
some studies have reported beneficial effects on the gastrointestinal
tract (decrease in postoperative ileus, shortening of both the time to
first flatus and the time to first bowel movement, decrease in
postoperative nausea and vomiting).23-26 These benefits are observed only
in patients undergoing abdominal surgery (laparoscopic and open
approaches), but not for any other surgical procedures, although the
reason for this specificity is poorly understood. Overall, intraopertive
lidocaine infusion has been used widely as a component of multimodal
analgesic technique, particularly in patients undergoing abdmonial
surgery. Also, intravenous lidocaine infusion could be recommended in
patients undergoing open abdominal surgery with contraindications to basic
analgesics (e.g. paracetamol and NSAIDs). Furthermore, lidociane infusion
may be suitable for patients at high risk of postoperative pain, however,
the evidence for this is lacking. Although the exact mechanism of action
of lidocaine infusion are not well understood,26 the plasma concentrations
of lidocaine infusion are like those obtained during epidural
administration, which may be its mechanism of action. Therefore,
intravenous lidocaine infusion has been labelled as 'the poor man's
epidural.' A recent study found that lidocaine infusion provides
clinically meaningful difference in postoperative pain.28 However, almost
10% of patients experienced symptoms consistent with local anesthetic
toxicity (LAST) including one patient having cardiac arrest who recovered
after receiving intravenous lipid emulsion. The potential for LAST
increases with the use of local/regional analgesia techniques, which are
increasingly being used in current clinical practice. Therefore, some
suggest that lidocaine infusion should be considered as a 'high-risk'
approach for pain management.29.30 Significant caution is advised to
prevent LAST. It is recommended that the lidocaine infusion dose should be
calculated based on Ideal body weight, not actual body weight. Lidocaine
infusion should not be used in patients weighing <40 kg. The loading dose
should be <=1.5 mg/kg, given over 10 min followed by infusion rate of
<=1.5 mg/kg/h for maximum of 24 h. Total lidocaine dose infused should be
<120 mg/h. Intravenous lidocaine should be avoided when regional analgesic
blocks are used. If regional analgesia technique is planned, the choice of
loco/regional blocks may become limited with the use of lidocaine
infusion. It is recommended to avoid a regional analgesia technique with
high risk of LAST based on local anesthetic absorption characteristics
(e.g. intercostal, paravertebral, or fascial plane blocks, and midline
surgeries needing bilateral blockade) or characteristics of surrounding
structures. Choose techniques where the minimum effective dose is small,
such as selective root blocks of the brachial plexus. Also, continuous
catheter techniques should be avoided when using lidocaine infusion.
Lidocaine metabolism can be affected by the duration and direct effects of
GA and surgery on liver blood flow. Vigilance is needed in patients with
existing comorbidity. When administered on the wards, patients should be
managed in a monitored high dependency unit. Also, lidocaine infusion
should be administered through a dedicated intravenous cannula using a
suitable infusion device. There should be a separate lidocaine monitoring
chart. Physician and staff should be educated regarding patient
susceptibility and selection as well as infusion preparation and infusion
pump programing. Conclusions In summary, the role of epidural analgesia in
current clinical practice of enhanced recovery after surgery is
diminishing. Peripheral regional blocks such as interfascial plane blocks
and local infiltration analgesia. Intravenous lidocaine infusion has been
shown to influence postoperative outcomes after abdominal surgery.
However, the optimal duration of administration appears to be for 24 h.
Also, there are concerns of LAST particularly with concomitant use of
local/regional analgesia techniques. Therefore, it is imperative to follow
rigorous precautions for prevention as well as early diagnosis and
management of LAST.

<60>
Accession Number
645873489
Title
Comparison between erector spine block (ESPB) to thoracic paravertebral
plane block (TVPB) using ropivacaine plasma concentration analysis: a
randomized double-blind clinical trial.
Source
Regional Anesthesia and Pain Medicine. Conference: 41st European Society
of Regional Anaesthesia and Pain Therapy Congress, ESRA 2024. Prague
Czechia. 49(Supplement 1) (pp A23-A24), 2024. Date of Publication:
September 2024.
Author
Pereira V.E.; De Paula Garcia W.N.; Junior L.S.B.; Garcia L.V.; Guedes
I.H.L.
Institution
(Pereira, De Paula Garcia, Garcia) Department of Anesthesiology,
University of Sao Paulo - Ribeirao Preto, Sao Paulo, Brazil
(Junior) Restauracao Hospital, Recife, Brazil
(Guedes) Alcides Carneiro University Hospital, Federal University of
Campina Grande, Campina Grande-PB, Brazil
Publisher
BMJ Publishing Group
Abstract
Background and Aims Ultrasound-guided anesthesia popularized erector
spinae plane block (ESPB) as an alternative to thoracic paravertebral
block (TPVB) in video-assisted thoracic surgery (VATS). Concerns about
systemic toxicity persist due to the large doses of local anesthetic used.
This study compares arterial plasma concentration curves of ropivacaine
between ESPB and TPVB to assess safety and toxicity. Methods This clinical
trial was prospective, randomized, double-blind, controlled and with two
parallel arms: 18 patients who received ESPB and 16 received TPVB (figure
1). Epidemiologic data were collected (table 1). All blockades were
performed with the aid of ultrasound and after induction of general
anesthesia. Ropivacaine plasma concentration were quantified every 2.5
minutes until 30 minutes. Continuous ropivacaine infusion via catheter
began post-surgery and lasted 24 hours, with a subsequent blood sample
collected. Results Both groups showed similar modest plasma
concentrations, with mean peak levels of 1.62 mug/ml (ESPB) and 1.70
mug/ml (TPVB). After continuous infusion, all concentrations dropped below
2 mug/ml (figure 2). No adverse intra or post-operative events were noted,
and total plasma concentrations of unbound and free fraction of
ropivacaine at 30 minutes did not significantly differ between
groups.Conclusions Both blocks exhibited comparable plasma concentration
curves, possibly due to factors beyond anatomical location, such as the
pharmacokinetic properties of the local anesthetic or individual patient
variability. In addition, similar unbound and free fraction plasma
concentrations indicate uniformity in terms of proteinemia across the
population. These results suggest that ESPB and TPVB are safe alternatives
with comparable pharmacokinetics, guiding future dosage selection and more
clinical studies.

<61>
Accession Number
645873410
Title
Review article: sacral erector spinae plane block- An effective
alternative to conventional anesthetic options for anorectal & lower limb
surgeries.
Source
Regional Anesthesia and Pain Medicine. Conference: 41st European Society
of Regional Anaesthesia and Pain Therapy Congress, ESRA 2024. Prague
Czechia. 49(Supplement 1) (pp A80), 2024. Date of Publication: September
2024.
Author
Arun N.; Krishnandas C.P.; Toble Y.M.R.A.
Institution
(Arun, Krishnandas, Toble) Hamad Medical Corporation, Doha, Qatar
Publisher
BMJ Publishing Group
Abstract
Background and Aims Erector Spinae Plane Block (ESPB) was introduced in
2016 as an analgesic block for thoracic neuropathic pain. Later, it was
incorporated as one of the technics of multi-modal analgesia for
peri-operative pain control in thoracic surgeries. Following that Lumbar
ESPB emerged, which is widely being used as an analgesic & anesthetic
block for spine, abdomen, inguinal and lower limb surgeries. Recent
development is Sacral ESPB which is being used as an analgesic and
anesthetic block for Ano-rectal, sacral, and hip surgeries. We would like
to explore further on the anesthetic potential of sacral ESPB, as it is a
novel technic, and it can be beneficial in high-risk patients for the
conventional methods of Anesthesia. Methods We reviewed all the articles
which were published about Sacral ESPB, as an anesthetic block. We could
find a Single-Centre Retrospective Cohort Feasibility Study which included
10 patients who underwent sacral reconstructive surgeries, as case report
which included 2 patients who underwent ano-rectal surgeries and another
case report which included a patient who underwent hip surgery, solely
under sacral erector spinae plane block. Results All the above patients
tolerated the procedures very well with minimal sedation and they had
effective postoperative analgesia as well. Conclusions Sacral erector
spinae plane block can be effectively used as an anesthetic technic in
patients undergoing sacral, anorectal & hip surgeries. However, most of
the information is available only from case reports. We need further RCTs
to establish their effectiveness as an anesthetic block. (Figure
Presented).

<62>
Accession Number
645873409
Title
An observational study comparing the ecacy of ultrasound guided serratus
anterior plane (SAP) block vs erector spinae block (ESPB) for
postoperative pain management and stress response in patients undergoing
minimally invasive cardiac surgery (MICS).
Source
Regional Anesthesia and Pain Medicine. Conference: 41st European Society
of Regional Anaesthesia and Pain Therapy Congress, ESRA 2024. Prague
Czechia. 49(Supplement 1) (pp A40), 2024. Date of Publication: September
2024.
Author
Sengupta S.
Institution
(Sengupta) Anaesthesiology,Apollo Multispeciality Hospitals, Kolkata,
India
Publisher
BMJ Publishing Group
Abstract
Background and Aims Early extubation and optimal pain control and
minimizing stress response is an important aspect after Minimally Invasive
Cardiac Surgery (MICS). Erector Spinae Plane Block (ESPB) and Serratus
Anterior Plane Block (SAPB) are recently described techniques for chest
wall analgesia. Their role in MICS is yet to be well determined. We tried
to assess ecacy and safety of ultrasound guided SAPB compared to ESPB in
the management of pain and stress response in patient undergoing MICS
Methods Patients undergoing MICS for coronary artery bypass grafting were
randomly assigned into two groups. Both SAPB group (group A) and ESPB
(group B) were given 0.2% of 20 ml Ropivacaine followed by catheter
insertion for continuous inltration at the end of the procedure. The
primary outcome measured were changes in VAS Score (Pain) and cortisol
levels (for stress response) in both the groups Results There was no
signicant difference of mean VAS score between the two groups. Hemodynamic
parameters were stable in both the groups. Stress response in the form of
serum cortisol level showed no major difference between the two groups.
There was a statistically signicant difference in the spirometry values
between the two groups. The duration of ICU stay was signicantly lower in
the ESPB group as compared to SAPB group Conclusions Both ESPB and SAPB
offer good quality of analgesia in MICS.ESPB is better as it blocks both
dorsal and ventral rami of the thoracic spinal nerves and elicits some
degree of sympathetic blockade, while SAPB, targets only branches of the
nerve.

<63>
Accession Number
2013034390
Title
Healthcare Resource Utilization Trends over Time with Continuous
Lenalidomide Treatment (Tx) in Patients (Pts) with Newly Diagnosed
Multiple Myeloma (NDMM).
Source
Blood. Conference: 56th ASH Annual Meeting. San Francisco United States.
124(21) (pp 1326), 2014. Date of Publication: 06 Dec 2014.
Author
Weisel K.; Vogl D.T.; Delforge M.; Song K.; Dimopoulos M.; Cavenagh J.;
Hulin C.; Rodon P.; Arnulf B.; Foa R.; Oriol A.; Guo S.; Monzini M.S.; Van
Oostendorp J.; Ervin-Haynes A.; Facon T.
Institution
(Weisel) University Hospital of Tuebingen, Tuebingen, Germany
(Vogl) University of Pennsylvania, Philadelphia, PA, United States
(Delforge) University Hospital Leuven, Leuven, Belgium
(Song) Vancouver General Hospital, Vancouver, Canada
(Dimopoulos) University of Athens School of Medicine, Athens, Greece
(Cavenagh) St. Bartholomew's Hospital, London, United Kingdom
(Hulin) Department of Hematology and Internal Medicine, CHU Nancy-Brabois,
Nancy, France
(Rodon) Centre Hospitalier de Blois, Blois, France
(Arnulf) Hopital Saint-Louis, Paris, France
(Foa) Hematology, Department of Cellular Biotechnologies and Hematology,
Sapienza University, Rome, Italy
(Oriol) Hospital Germans Trias i Pujol, Barcelona, Spain
(Guo) Evidera, Lexington, MA, United States
(Monzini, Van Oostendorp, Ervin-Haynes) Celgene Corporation, Summit, NJ,
United States
(Facon) Hospital Claude Huriez, Lille, France
Publisher
Elsevier B.V.
Abstract
Introduction: Multiple myeloma (MM) is an incurable hematologic condition
that is associated with high Tx costs. Resource consumption is driven by
hospitalization and medical utilization, which is highest during periods
of uncontrolled disease, such as after diagnosis and during relapses (De
Portu 2013). In the pivotal phase 3 FIRST trial, continuous Tx with
lenalidomide plus low-dose dexamethasone (Rd) was compared with
fixed-duration Rd (Rd18) or fixed-duration combination Tx with melphalan,
prednisone, and thalidomide (MPT), each for 18 months (mos), in NDMM pts
who were ineligible for stem cell transplantation. Continuous Rd extended
progression-free survival (PFS) and overall survival (interim analysis)
vs. MPT. However, it is still unclear whether extending Tx duration with
Rd adversely affects healthcare resource utilization. This analysis
quantifies the rates of hospitalizations and medical utilization with
continuous Rd over time based on data collected in the FIRST trial.
 Method(s): The FIRST trial (N = 1,623) was a pivotal multinational,
randomized, open-label study with a median follow up of 37 mos.
Non-protocol-driven resource-use data was collected until subjects
discontinued study Tx. To assess whether continuous Rd increases
healthcare resource utilization over time, the rates of resource
utilization for subjects treated with continuous Rd (N = 535) were plotted
for up to 48 mos. In addition, hospitalization and medical utilization
rates during the Tx period (18 mos) were estimated and compared between
the 2 fixed-duration Tx arms. Result(s): Resource utilization amongst
pts treated with continuous Rd declined over time (Figure). The annualized
hospitalization rate in the first 3 mos was 3.2 times higher than the
average rate for the remaining 45 mos of follow-up (2.02 vs. 0.62), and
4.2 times higher for medical utilization (5.66 vs. 1.34). After 4 years
(yrs) of continuous Rd Tx, hospitalization and medical utilization rates
were estimated to be 83% and 84% lower than those observed in the first 3
mos of Tx, reflecting the long-term disease control observed with
continuous Rd in the FIRST trial. The highest hospitalization rates were
associated with infections (0.20 per patient year), cardiovascular
disorders (0.06), and respiratory and thoracic disorders (0.05). The mean
(standard deviation) length of stay per admission was 14.08 (21.19) days.
The highest medical utilization rates were associated with blood
transfusions (0.76 interventions per patient year), general imaging
procedures (0.21), respiratory and thoracic imaging procedures (0.20), and
therapeutic interventions (0.09).The hospitalization rates for the fixed
dose Tx arms were 0.91 (Rd18) and 0.79 (MPT) per patient year of follow-up
during the Tx period of 18 mos, resulting in a rate ratio (RR) of 1.15
(1.01-1.30). The equivalent rates for medical utilization were 3.00 (Rd18)
and 2.86 (MPT) medical interventions per patient year (RR = 1.05
[0.98-1.12]). Conclusion(s): The rates of resource utilization among
pts treated with continuous Rd dropped substantially after the first 3 mos
of Tx, and then gradually declined as Tx duration increased. The findings
suggest that continuous Tx with Rd does not further increase resource
utilization in hospitalizations and medical utilization compared to
fixed-duration Tx. A comparison between the 2 fixed arms showed a 15%
increase in hospitalization with Rd18 vs. MPT, and no differences in
medical utilization between the 2 arms. A limitation of this analysis is
that the resources were collected only while pts were receiving their
respective Txs. Future analysis should include all costs generated by
healthcare resources throughout pts Tx, including Tx-free intervals, and
the costs associated with relapses. [Formula presented] Disclosures:
Weisel: BMS: Consultancy; Onyx: Consultancy, Honoraria; Janssen:
Consultancy, Honoraria; Celgene Corporation: Consultancy, Honoraria;
Noxxon: Consultancy. Off Label Use: Lenalidomide used in newly diagnosed
multiple myeloma patients. Vogl: Amgen: Consultancy; Millennium/Takeda:
Research Funding; GSK: Research Funding; Acetylon: Research Funding;
Celgene Corporation: Consultancy. Delforge: Janssen: Honoraria; Celgene
Corporation: Honoraria. Song: Celgene Corporation: Consultancy, Honoraria,
Membership on an entity's Board of Directors or advisory committees.
Dimopoulos: Celgene Corporation: Consultancy, Honoraria. Cavenagh: Celgene
Corporation: Honoraria. Hulin: Celgene Corporation: Honoraria. Foa:
Celgene Corporation: Consultancy. Oriol: Janssen: Consultancy, Speakers
Bureau; Celgene Corporation: Consultancy, Speakers Bureau. Guo: Celgene
Corporation: Consultancy. Monzini: Celgene Corporation: Employment, Equity
Ownership. Van Oostendorp: Celgene: Employment. Ervin-Haynes: Celgene:
Employment. Facon: Celgene Corporation: Membership on an entity's Board of
Directors or advisory committees, Speakers Bureau. Copyright ©
2014 American Society of Hematology

<64>
Accession Number
2013034258
Title
Transfusion with Washed vs. Unwashed Packed Red Cells in Coronary Artery
Bypass Graft (CABG) Surgery: Major Outcome Differences.
Source
Blood. Conference: 56th ASH Annual Meeting. San Francisco United States.
124(21) (pp 2887), 2014. Date of Publication: 06 Dec 2014.
Author
Jy W.; Gomez-Marin O.; Salerno T.A.; Panos A.; Williams D.; Shariatmadar
S.; Johansen M.E.; Bidot C.; Horstman L.L.; Ahn Y.-S.
Institution
(Jy, Gomez-Marin, Salerno, Panos, Williams, Shariatmadar, Bidot, Horstman,
Ahn) Miller School of Medicine, University of Miami, Miami, FL, United
States
(Johansen) University of Miami Miller School of Medicine, Department of
Medicine, Division of Hematology/Oncology, Miami, FL, United States
Publisher
Elsevier B.V.
Abstract
BACKGROUND: Blood transfusion (Tx) carries greater risks of adverse events
(AEs) than previously appreciated. These adverse effects include higher
incidence of post-surgical infections, longer hospital stay, higher
mortality, more frequent serious adverse events (SAE's), and generally
poorer surgical outcomes. Accordingly, ameliorating these adverse effects
constitutes an urgent challenge to medical science. Factors responsible
for Tx-related adverse events (AE's) are not well understood. Many
potentially toxic substances are released during blood storage, and many
of them have been implicated or postulated as culprits. Washing of packed
RBC remove these products and may ameliorate transfusion-related AE's.
Benefits of washed RBC are well established for pediatric surgical
patients, chiefly by preventing hyperkalemia, but use of washed RBC in
adult surgical patients has not heretofore been systematically
investigated. We here report results of a prospective randomized study
directly comparing surgical outcomes, in terms of mortality and AE's,
between groups of adult CABG patients transfused with either washed or
unwashed (conventional) RBC. METHOD(S): A prospective randomized
study of 148 patients undergoing coronary artery bypass graft (CABG) was
conducted. Fifty-eight patients were randomized to receive unwashed
(conventional) RBC (UW group) and 41 to washed RBC (W group). The
remaining 49 did not require Tx. The main in-hospital outcomes recorded
included mortality, serious adverse events (SAE's), non-serious adverse
events (AE's), and SOFA scores pre- and post-surgery. A telephone
interview was conducted at day 30 post-discharge, and mortality at
one-year was also assessed. The statistical techniques used for the
comparison of the UW and W RBC groups included: independent sample t-tests
for variables with normal or approximately normal distribution;
Mann-Whitney tests for variables with skewed distributions and for ordinal
variables; chi-squared tests or Fisher's exact tests for discrete
variables; and logistic regression model for assessing different factors
as predictors of the occurrence of each kind of event. RESULT(S):
Between the 2 groups, demographic, clinical, and comorbidity data were
similar and there was no statistically significant difference in number of
serious AE's (SAE's). However, 4 of 6 patients died from SAE's in the UW
group but all 7of 7 with SAE in the W group survived. The in-hospital
mortality was greater in the UW group (4 vs. 0, p = 0.149) but 1-year
post-op mortality was significantly higher in UW group (7 vs. 0, p=0.036).
Frequency of less serious AE's was higher in UW group in every category.
Negative binomial regression analyses showed that, after adjusting for
comorbidities, UW-group are likely to experience 64% more AEs (p= 0.027).
The 30-day follow-up showed similar trends of higher AE's in UW-group, but
only CNS-related AE's were significant (30 vs. 5, p<0.01). CONCLUSIONS /
DISCUSSION: These data suggest major benefits to patient outcomes by use
of washed RBC in CABG. Most important is significant reduction of
mortality. Less serious AE's were also lower in the W group in nearly
every category, but only CNS-related AE's were statistically significant
in this comparatively small patient population. To our knowledge, this is
the first prospective randomized study in adults to assess possible
benefits of washing RBC prior to cardiac surgery. At present, washed RBCs
are seldom used in adults but the present study clearly demonstrates major
advantages. It may be possible to reduce costs of washing by using on-site
cell call-salvage equipment but this needs to be evaluated. This study was
undertaken with the hypothesis that cell-derived microparticles (MP) are
major culprits in Tx-associated AE's. Further study is needed to determine
if that hypothesis is correct. Other evidence has led us to conjecture
that MP are largely responsible for post-surgical adverse outcomes; the
present study is consistent with that conjecture but does not prove it. A
major shortcoming of this study is the comparatively small patient
population. A much larger study, including other types of surgery, is
certainly warranted by these findings, and should be designed to include
more quantitative evaluation of post-surgical cognitive impairment.
Disclosures: No relevant conflicts of interest to declare. Copyright
© 2014 American Society of Hematology

<65>
Accession Number
2013033799
Title
Systematic Review of Cases of Transfusion Associated
Graft-Versus-Host-Disease (TA-GVHD): Analysis of Patient Characteristics
and Outcomes.
Source
Blood. Conference: 56th ASH Annual Meeting. San Francisco United States.
124(21) (pp 2885), 2014. Date of Publication: 06 Dec 2014.
Author
Ostro J.; Kopolovic I.; Lin Y.; Dzik W.H.; Cserti C.; Tsubota H.; Keir A.;
Messner H.A.; DenHollander N.; Callum J.
Institution
(Ostro, Kopolovic) University of Toronto, Toronto, Canada
(Lin, Tsubota, Callum) Sunnybrook Health Sciences Centre, Toronto, Canada
(Dzik) Massachusetts General Hospital, Boston, MA, United States
(Cserti, DenHollander) University Health Network, Toronto, Canada
(Keir) The Hospital for Sick Children, Toronto, Canada
(Messner) Princess Margaret Cancer Centre, Toronto, Canada
Publisher
Elsevier B.V.
Abstract
Introduction: TA-GVHD is a rare, usually fatal complication from blood
transfusions wherein donor lymphocytes engraft and mount an immune
response against recipient tissues. Immunocompromised hosts who are unable
to recognize and destroy foreign lymphocytes are at theoretical risk of
TA-GVHD, and a variety of immune incompetencies thus form the indications
for cellular blood component irradiation. Much of our understanding on who
is at risk of TA-GVHD as well as policies regarding who should receive
irradiated components derive from case reports and small case series. We
performed a systematic review of cases of TA-GVHD to refine evidence-based
guidelines for the use of gamma-irradiated blood components, assess the
usefulness of the Centers for Disease Control (CDC) criteria in making the
diagnosis of TA-GVHD and to define the minimum details of a case of
TA-GVHD that should be reported. Method(s): Our systematic review,
which was registered with PROSPERO, included all reported cases of TA-GVHD
from 1947 until September 2013 with no restrictions on language or date.
Titles and abstracts were reviewed by two independent reviewers.
References were assessed for additional cases. Data collected included
patient demographics, details regarding the transfusion(s),
clinicolaboratory features outlined in the CDC criteria (rash, diarrhea,
fever, hepatomegaly, liver dysfunction, marrow aplasia and pancytopenia),
patient outcomes and results of HLA and chimerism studies. Result(s):
After duplicates were removed, 2130 publications were available for
review, with 348 cases of TA-GVHD included in the analysis. The median age
was 58 years (IQR 18, 68) with 61.6% males. The most frequent underlying
diagnoses were non-cardiac surgery (n=81, 23.3%), cardiac surgery (n=71,
20.4%) and hematologic malignancy (n=66, 19.0%). According to our
institutional guidelines for irradiation of blood components
(Massachusetts General Hospital, Sunnybrook Health Sciences Centre, The
Hospital for Sick Children and University Health Network), 121 cases
(34.5%) met the criteria for requiring irradiation of blood components.
Among the 245 patients in whom time of symptom onset was reported, the
first symptom of TA-GVHD occurred a median of 11 (IQR 8, 14) days from the
implicated transfusion. Patients had an average of 3.6 symptoms and/or
signs of TA-GVHD using the CDC definition, with rash being the most common
finding in 80.2% of cases (Figure 1). A biopsy was performed in 67.5% of
cases, with skin as the most common site in 97.0% of cases. Chimerism
studies were done in 103 cases (29.7%) to confirm the diagnosis. According
to the CDC case definition, 215 (62.0%) had definitive and 73 (21.0%) had
probable TA-GVHD. The case imputability based on the CDC definition was
definite, probable, possible and doubtful in 28.5, 2.3, 50.0 and 2.0% of
cases, respectively. The implicated blood component was red blood cells in
132 cases (37.9%), whole blood in 92 cases (26.4%), and platelets in 20
cases (5.7%). The treatment for TA-GVHD was immunosuppression therapy
(IST) in 48.9%, bone marrow transplant (BMT) in 2.3%, and no intervention
in 46.7%. Of those treated with IST or BMT, 10.7% survived, whereas 5.6%
of the untreated survived, p = 0.063. Overall, 29 patients (8.4%)
survived; of these, 3 (10.3%) received BMT, 16 (55.2%) IST and 10 (31.0%)
no therapy. Conclusion(s): To our knowledge this is the largest
systematic review of reported cases of TA-GVHD. This review describes the
diversity of patient characteristics and presentations of TA-GVHD.
Firstly, patients at risk for TA-GVHD encompass all levels of immune
integrity, and reliance on the patient's underlying diagnosis to dictate
the need for irradiated blood components limits mitigation, as blood
component or donor-recipient factors may be more important considerations.
Secondly, the analysis of cases revealed limitations and inconsistencies
in reported details, underscoring the need for consensus on reporting
criteria, without which TA-GVHD case confirmation is challenging. [Formula
presented] Disclosures: No relevant conflicts of interest to
declare. Copyright © 2014 American Society of Hematology

<66>
Accession Number
2032426042
Title
Metabolomic profiling of infants undergoing cardiopulmonary bypass and
association with clinical outcomes: a systematic review.
Source
Frontiers in Cardiovascular Medicine. 11 (no pagination), 2024. Article
Number: 1491046. Date of Publication: 2024.
Author
Meggiolaro L.; Moschino L.; Stocchero M.; Giordano G.; Vida V.; Di Salvo
G.; Baraldi E.
Institution
(Meggiolaro, Moschino, Baraldi) Neonatal Intensive Care Unit, Department
of Women's and Children's Health, University of Padova, Padova, Italy
(Moschino, Stocchero, Giordano, Baraldi) Fondazione Istituto di Ricerca
Pediatrica Citta Della Speranza, Padova, Italy
(Vida) Paediatric Cardiac Surgery, Padova University Hospital, Padova,
Italy
(Di Salvo) Paediatric Cardiology Unit, Department of Women's and
Children's Health, Padova University Hospital, Padova, Italy
Publisher
Frontiers Media SA
Abstract
Introduction: The incidence of adverse short-term outcomes for infants who
undergo complex congenital heart disease (CHD) surgery with
cardiopulmonary bypass (CPB) is still high. Early identification and
treatment of high-risk patients remain challenging, especially because
clinical risk factors often fail to explain the different outcomes of this
vulnerable population. Metabolomics offers insight into the phenotype of
the patient and the complex interplay between the genetic substrate and
the environmental influences at the time of sampling. For these reasons,
it may be helpful to identify the mechanisms of physio-pathological
disruptions experienced in neonates undergoing congenital heart surgery
and to identify potential therapeutic targets. Method(s): We
conducted a systematic review (PROSPERO: ID 565112) of studies
investigating the association between targeted or untargeted metabolomic
analysis of infants undergoing elective surgery with CPB for CHD and
clinical outcomes. The PRISMA guidelines were followed. We searched
MEDLINE via PubMed, EMBASE via Ovid, the Cochrane Central Register of
Controlled Trials, the Cochrane Library, ClinicalTrials.gov and the World
Health Organization's International Trials Registry and Platform.
 Result(s): Seven studies involving 509 children (aged 1 day to 21.3
months), all of whom underwent cardiac surgery requiring CPB, were
included for qualitative analysis. We found associations between
metabolomic profiles and various clinical outcomes, such as mortality,
acute kidney injury (AKI), and neurological outcomes. Specific metabolites
(mainly amino acids, their metabolic products and fatty acids) were
identified as potential biomarkers for these outcomes, demonstrating the
utility of metabolomics in predicting certain postoperative complications.
 Conclusion(s): The quality of the evidence was limited due to
heterogeneity in study designs and small sample sizes, but the findings
are promising and suggest that further research is warranted to confirm
these associations. Systematic Review Registration:
https://www.crd.york.ac.uk/prospero/, PROSPERO ID 565112. Copyright
2024 Meggiolaro, Moschino, Stocchero, Giordano, Vida, Di Salvo and
Baraldi.

<67>
Accession Number
2036026839
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. (no pagination), 2024. Article
Number: 132597. Date of Publication: 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
Publisher
Elsevier Ireland Ltd
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.

<68>
Accession Number
2036026353
Title
Global Cost-Effectiveness of Transcatheter vs Surgical Aortic Valve
Replacement in Severe Aortic Stenosis: A Systematic Review and
Meta-analysis.
Source
Canadian Journal of Cardiology. (no pagination), 2024. Date of
Publication: 2024.
Author
Zhou X.; Duan X.; Shao L.; Tan N.; Zuo S.; Shan H.; Li G.; Du X.; Shrestha
U.D.; Ke T.; Zhou F.; Ma H.; Xu Y.; Ouyang Z.; Liao C.
Institution
(Zhou, Duan, Shao, Tan, Zuo, Shan, Li, Du, Shrestha, Zhou, Xu, Ouyang,
Liao) Department of Radiology, Kunming Yan'an Hospital (Yan'an Hospital
Affiliated to Kunming Medical University), Kunming, China
(Ke) Department of Radiology, Yunnan Cancer Hospital (Third Affiliated
Hospital of Kunming Medical University), Kunming, China
(Ma) Department of Radiology, Third People's Hospital of Yunnan Province
(Second Affiliated Hospital of Dali University), Kunming, China
Publisher
Elsevier Inc.
Abstract
Backgroud: Transcatheter aortic valve replacement (TAVR) is a less
invasive treatment option for patients with severe aortic valve stenosis
(AS); however, its economic benefits in patients with low to intermediate
surgical risk remain controversial and vary by country. We conducted a
systematic review to compare the economic benefits of TAVR vs surgical
aortic valve replacement (SAVR). Method(s): We searched 6 databases,
including PubMed, Medline, Scopus, Web of Science, Embase, and Clinical
Trials for randomised controlled trials on the economic benefits of TAVR
with different valve types and SAVR in symptomatic AS patients with low to
intermediate surgical risk, from inception to October 2023. We extracted
data on quality-adjusted life-years (QALYs), and incremental
cost-effectiveness ratio (ICER), with ICER converted to 2023 US dollars.
 Result(s): Fifteen studies met the inclusion criteria, with the
overall quality ranging from intermediate to high. Among these, TAVR was
found to be cost-effective in 14 studies, whereas in 1 study conducted in
a developing country, TAVR was not cost-effective. When adjusted to 2023
USD, the ICER values ranged from $3,669 to $340,038 per QALY gained.
 Conclusion(s): TAVR appears to be a cost-effective alternative to
SAVR in patients with low- to intermediate-risk AS. In all studies, TAVR
was associated with a significant increase in QALYs compared with SAVR.
Because it is an expensive procedure, the cost-effectiveness of TAVR
depends on each country's ICER and willingness-to-pay
threshold. Copyright © 2024 Canadian Cardiovascular Society

<69>
Accession Number
2032445662
Title
Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke Following
Cardiac Interventions: A Systematic Review and Meta-Analysis.
Source
CardioVascular and Interventional Radiology. (no pagination), 2024. Date
of Publication: 2024.
Author
Jazayeri S.B.; Al-Janabi O.M.; Ghozy S.; Rabinstein A.A.; Kadirvel R.;
Kallmes D.F.
Institution
(Jazayeri) Sina Trauma and Surgery Research Center, Sina Hospital, Tehran
University of Medical Sciences, 11365-3876, Building 7, Hassan-Abad
Square, Tehran, Iran, Islamic Republic of
(Jazayeri, Ghozy, Kadirvel, Kallmes) Department of Radiology, Mayo Clinic,
Rochester, MN, United States
(Al-Janabi) Department of Neurology, Baptist Health, Lexington, KY, United
States
(Ghozy) Department of Neurologic Surgery, Mayo Clinic, Rochester, MN,
United States
(Rabinstein) Department of Neurology, Mayo Clinic, Rochester, United
States
Publisher
Springer
Abstract
Purpose: The purpose of this study is to pool the evidence on the safety
and efficacy of mechanical thrombectomy (MT) in patients who develop acute
ischemic stroke (AIS) due to large vessel occlusion (LVO) following recent
cardiac interventions. Method(s): PubMed, Embase and Scopus were
searched from inception up to February 2024 using a combination of
"cardiac interventions" and "mechanical thrombectomy" as keywords. Studies
that evaluated AIS within 30 days of a recent cardiac intervention who
underwent MT were included. The proportion of mortality, favorable
functional outcome (modified Rankin Scale (mRS) 0-2), successful
reperfusion (TICI >= 2b or TIMI >= 2) and symptomatic intracranial
hemorrhage (sICH) were pooled using generalized linear mixed model.
 Result(s): Thirty-one case reports/series and 11 observational
studies including 195 MT procedures were included. The patients' mean age
was 72 years. The most common cardiac intervention associated with AIS was
transcatheter aortic valve replacement/implantation in 96/192 cases (50%).
The median onset of stoke was 0 (IQR 0-3) days after cardiac intervention.
Rate of successful reperfusion was 79.4% [95%confidence interval (CI)
66.7-88.1%], rate of mRS 0-2 after 90 days was 42.7% [95%CI 32.5-53.6%],
and rate of mortality at 90 days was 30.3% [95%CI 21.7-40.6%]. The rate of
sICH was 11.6% [95%CI 5.9-21.5%]. Conclusion(s): MT to treat AIS due
to LVO after cardiac interventions may result in good rates of functional
recovery, though mortality and sICH may be higher. Regular and repeated
neurological examinations should be performed following cardiac
interventions, with special attention to stroke. If stroke is detected, MT
should be considered as a viable option. Graphical abstract: (Figure
presented.) Copyright © Springer Science+Business Media, LLC,
part of Springer Nature and the Cardiovascular and Interventional
Radiological Society of Europe (CIRSE) 2024.

<70>
Accession Number
2032445546
Title
Acute Effects of Aminophylline Effects on Hemodynamic Parameters and Fluid
Balance in Pediatric Cardiac Intensive Care Patients: Machine Learning
Insights Using High Fidelity Data.
Source
Pediatric Cardiology. (no pagination), 2024. Date of Publication: 2024.
Author
Loomba R.S.; Patel R.; Miceli A.; Savly O.; Wong J.
Institution
(Loomba, Patel) Ann & amp; Robert H. Lurie Children's Hospital,
Northwestern University Feinberg School of Medicine, Chicago, IL, United
States
(Miceli, Wong) Advocate Children's Hospital, Oak Lawn, IL, United States
(Savly) Children's Hospital Kanthabopha IV, Phnom Pneh, Cambodia
Publisher
Springer
Abstract
Fluid overload is associated with increased morbidity and mortality after
pediatric cardiac surgery. Management of fluid overload can be difficult
and conventional tools may increase the risk of acute kidney injury. This
study aimed to study the effects of aminophylline on fluid balance, urine
output, blood urea nitrogen, and serum creatinine. Pediatric cardiac
surgical patients who received aminophylline between September 2022 and
December 2023 were identified. Data for various clinical parameters before
and after an aminophylline dose were collected. Paired univariable
analyses and a random forest classifier were conducted to help
characterize the effects of aminophylline. A total of 169 aminophylline
administrations in 72 unique patients were included in the final analyses.
Fluid balance decreased by 115% in the 24 h after aminophylline
administration compared to the 24 h preceding. Urine output peaked at 2 h
after administration and increased 100% from baseline. Heart rate
increased by 5% after administration and peaked between 2 and 4 h after.
In pediatric patients after cardiac surgery, a 5 mg/kg dose of
aminophylline is safe and is associated with a reduction in fluid balance
and increase in urine output without significantly changing blood urea
nitrogen or serum creatinine levels. Copyright © The Author(s),
under exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature 2024.

<71>
Accession Number
2032444100
Title
Definition of Palliative Surgery in Cancer Care: A Systematic Review.
Source
Journal of Surgical Oncology. (no pagination), 2024. Date of Publication:
2024.
Author
Min J.W.S.; Low X.C.; Farber O.N.; Mack J.W.; Cooper Z.; Lilley E.J.
Institution
(Min, Farber, Cooper, Lilley) Center for Surgery and Public Health,
Department of Surgery, Brigham and Woman's Hospital, Boston, MA, United
States
(Min, Low) Department of Sarcoma, Peritoneal & Rare Tumors, Division of
Surgery and Surgical Oncology, National Cancer Center Singapore &
Singapore General Hospital, Singapore City, Singapore
(Low) Programme in Health Services and Systems Research, Duke-NUS Medical
School, Singapore City, Singapore
(Farber, Cooper, Lilley) Department of Surgery, Brigham and Woman's
Hospital, Boston, MA, United States
(Farber, Cooper, Lilley) Department of Surgery, Harvard Medical School,
Boston, MA, United States
(Mack) Department of Pediatric Oncology, Dana-Farber Cancer Institute,
Boston, MA, United States
(Lilley) Department of Psychosocial Oncology and Palliative Care,
Dana-Farber Cancer Institute, Boston, MA, United States
Publisher
John Wiley and Sons Inc
Abstract
Palliative surgery is commonly performed in cancer centers worldwide. Yet,
there is little agreement on the definition of palliative surgery or its
relevant outcomes. This systematic review sought to characterize the
definitions of palliative surgery and outcomes for patients with cancer
undergoing thoraco-abdominal procedures. Following PRISMA guidelines, we
conducted a search using PubMed, EMBASE and CINAHL databases to identify
English-language publications between August 1, 2005, and December 31,
2023 reporting palliative thoraco-abdominal procedures for patients with
cancer. Definitions of palliative surgery were coded and analyzed using an
inductive approach. Outcomes were classified according to an outcome
measures hierarchy. Among 92 articles met inclusion criteria and four
themes emerged in how palliative surgery was defined throughout the
literature: prognosis (incurable cancer diagnosis), purpose (intent to
treat symptoms or improve quality of life), procedure type (specific
operative interventions), or persistent disease following surgery
(incomplete cytoreduction). Survival (90%) and perioperative
complications/morbidity (72%) were the most commonly reported outcomes,
whereas symptom relief, quality of life, and sustainability of success
were infrequently reported. Definitions of palliative surgery vary across
studies of patients with cancer undergoing thoracic or abdominal
procedures and measured outcomes often do not align with the intent of
surgery. Copyright © 2024 Wiley Periodicals LLC.

<72>
Accession Number
645871125
Title
Hemoperfusion with the HA330/HA380 cartridge in intensive care settings: a
state-of-the-art review.
Source
Blood purification. (pp 1-18), 2024. Date of Publication: 21 Nov 2024.
Author
Li Y.; Han M.; Yang M.; Su B.
Abstract
Hemoperfusion with the HA330/HA380 cartridge have markedly evolved during
the past decade, and has thus been widely used in intensive care settings
to treat critical or hyperinflammatory illnesses. A large number of
clinical studies have demonstrated that HA330/HA380 hemoperfusion might
mitigate systemic inflammatory response syndrome and organ dysfunction in
ICU patients by removing inflammatory mediators and metabolic toxins from
the blood. However, there is currently lacking a systematic evaluation on
the safety and efficacy of HA330/HA380 hemoperfusion in intensive care
settings. We are thus motivated to perform a state-of-the-art review of
HA330/HA380 hemoperfusion to advance its use in daily critical care
practice. In this paper, we first discuss the basic technique
characteristics and ex vivo investigations of the HA330/HA380 cartridge.
Then, we extensively summarize the latest clinical evidence regarding the
use of HA330/HA380 hemoperfusion for the treatment of sepsis, severe
COVID-19, cardiac surgery, acute pancreatitis, liver failure, and blunt
trauma in sequence. Finally, drug clearance by the HA330/HA380 cartridge
is also highlighted to address its safety concerns. Copyright S.
Karger AG, Basel.

<73>
Accession Number
644437768
Title
You Heard Me Right! A Rare Case of Proteus Mirabilis Endocarditis.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society 2024 International Conference. San Diego, CA
United States. 209 (no pagination), 2024. Date of Publication: May 2024.
Author
Santone D.; Sigua N.L.
Institution
(Santone) Pulmonology and Critical Care Medicine, Indiana University,
School of Medicine, Indianapolis, IN, United States
(Sigua) Indiana University, College of Medicine, Indianapolis, IN, United
States
Publisher
American Thoracic Society
Abstract
RD is an 87 year old gentleman with multiple comorbidities notable for
heart failure with preserved ejection fraction, mild aortic valve
regurgitation and stenosis, mild cognitive impairment, history of Miller
Fisher Syndrome, and a recent admission for Proteus mirabilis urinary
tract infection and bacteremia along with Clostridium difficil colitis and
discharged after completing appropriate antibiotics for Proteus and on PO
vancomycin. (Repeat blood cultures at the end of his hospitalization
showed clearance of the blood infection.) He presented 8 days after
discharge with hypotension refractory to fluid boluses, worsening
encephalopathy, and new left arm weakness. The patient required intubation
and dual pressor support to maintain perfusion. Initial CT head imaging
was negative for hemorrhagic stroke or large ischemic infarct, and MRI was
postponed due to clinical instability. Infectious disease was consulted,
and the patient was started on empiric broad spectrum antibiotics for
clostridial colitis and undifferentiated with vancomycin, cefepime,
metronidazole, and a one time dose of tobramycin. Blood cultures grew
Proteus mirabalis on hospital day 2 and patient was narrowed to
ampicillin-sulbactam and PO vancomycin. Initial concern was for a
nephrogenic or gastrointestinal, but CT scan of the abdomen only showed
mild colitis. On hospital day 3, a transthoracic echocardiogram showed
normal ejection fraction, mild diastolic dysfunction and no vegetations.
Hospital day 4, a brain MRI showed multifocal acute infarcts throughout
all portions of the brain likely from a cardioembolic etiology. Given the
patient's comorbid aortic valve calcification and positive blood culture,
there was concern for endocarditis, even though it is exceedingly rare in
Proteus species. On hospital day 7 (delay due to limited echocardiography
staff on weekend), a transesophageal echocardiogram noted a 1.9 x 1.5 cm
vegetation on the posterior flap of the mitral valve. Cardiothoracic
surgery was consulted but declined surgery given the estimated risk of
serious morbidity and mortality for surgical repair approached 80%. The
patient slowly improved with antibiotics, was weaned off pressors, and
able to be extubated. Given the poor prognosis, the family made the
patient comfort care, and the patient passed on hospital day 16. While
exceedingly rare (a 2020 systematic review identified 16 case reports),
Proteus species are able to form biofilms and are an uncommon and often
lethal form of endocarditis.

<74>
Accession Number
623021950
Title
Non-invasive evaluation of atherosclerotic coronary artery disease in
diabetic patients by current functional and anatomical imaging modalities.
Source
Atherosclerosis Supplements. Conference: 18th International Symposium on
Atherosclerosis, ISA 2018. Toronto, ON Canada. 32 (pp 158-159), 2018. Date
of Publication: June 2018.
Author
Elhendy A.
Institution
(Elhendy) Marshfield Clinic, Marshfield, WI, United States
Publisher
Elsevier Ireland Ltd
Abstract
Objective: Diabetes mellitus is a major risk factor for atherosclerotic
coronary artery disease and adverse cardiovascular outcome. Coronary
artery disease is often silent or may present with atypical symptoms due
to autonomic neuropathy and therefore, many patients with minimal or no
symptoms remain at high risk The aim of this review is to discuss the role
of cardiovascular imaging modalities in the diagnosis and risk
stratification of coronary artery disease in diabetic patients.
 Method(s): We reviewed current literature of original studies on
diagnosis and risk stratification of coronary artery disease in diabetic
patients by stress and anatomical non-invasive imaging. Result(s): In
patients who are able to exercise, a normal stress echocardio-gram
identifies patients at low risk The pattern of multi-vessel abnormality is
associated with a dramatic increase in cardiac events with approximately a
third of these patients developing cardiac death and non-fatal myocardial
infarction within a few years after the test. Myocardial contrast imaging
during dobutamine stress test is a promising tool and offers improved
sensitivity at submaximal heart rate and allows incremental risk
assessment. Myocardial perfusion imaging with radionuclide techniques is
widely used and has a well established diagnostic and prognostic value.
However, even after a normal study, diabetic patients remain at higher of
cardiac events compared to non diabetic patients with a normal imaging
study The low risk warrantee period after a normal imaging study is
shorter in diabetic versus non diabetic patients which necessitate closer
follow up of high risk patients. Coronary calcium scoring is useful in
detecting early phase of atherosclerosis and provides objective
information to predict cardiac events. CT angiography may serve as a gate
keeper for invasive angiography with a high sensitivity in patients with
equivocal or non-feasible stress test. Prognostic value is established,
but information is largely influenced by early revascularization.
Limitations include artifacts, irradiation and risk of contrast
nephropathy. Conclusion(s): In patients with diabetes mellitus, a
comprehensive assessment of the advantages and limitations of stress and
functional imaging techniques can provide guidance for risk
stratification, implementation of aggressive preventive therapy and
selection of those who may benefit from coronary revascularization.

<75>
Accession Number
623221271
Title
Comparison rheumatic fever (RF) and rheumatic heart disease (RHD) in
Afghanistan and world wide.
Source
American Journal of Cardiology. Conference: 14th International Congress of
Update in Cardiology and Cardiovascular Surgery, UCCVS. Antalya Turkey.
121(8 Supplement 1) (pp e105), 2018. Date of Publication: April 2018.
Author
Naebkhil A.
Institution
(Naebkhil) Kateb Medical School-Kateb University, Kabul, Afghanistan
Publisher
Elsevier Inc.
Abstract
Rheumatic fever and rheumatic heart disease nowadays in Afghanistan taking
life of young generation of Afghanistan which in world sin world stage
Afghanistan is number one regarding incidence and turkey is number 4th
after in ranking regarding incidence of this disease. we reached to
appoint to organize a concerted effort of national and international
agencies to work to gather with strong links to support clinical and
public health infrastructure,and advocacy and funding support from
international community to fucus on good prospect for contriving RF and
RHD over next few years. RF and RHD recent years become mostly is a
regional and need world wide efforts tackle Rf and RH. these disease
related to poverty specially countries affected by war or internal
conflicts and specially affected life of young people in third world
countries we now stand at a critical junction of RF and RHd. This brings
real opportunities to make dramatic progress in the next few years,if we
miss these opportunities these disease may reached to an endemic point in
the third world countries Research is the base to find out the severity of
the disease and incidence and prevalence and we must organize a global
solution to control the spreared of RF and RHD. With concreted efforts
mixture of basic,applied and implementation science-strong links to
clinical and public health infrastructure,advocacy and funding support
from international community and same efforts as going on to tackle
Polio,Malaria and Tuberculosis. to tackle the disease we have plan
solution for the following chalnges 1-chalnge-1st new approaches to
integrating centralized control research program 2-chalange 2th clinical
trial and basics research to understand new phases-to tackle and reduce
the incidence 3-chalange 3th To find a vaccination to prevent the
disease-to identify people with with RF in first stages-and specific
research regarding effecient medical treatment and surgical treatment
before heart failure occur.

<76>
Accession Number
623221166
Title
Application of titanium plate fixation in sternal dehiscence after cardiac
surgery.
Source
American Journal of Cardiology. Conference: 14th International Congress of
Update in Cardiology and Cardiovascular Surgery, UCCVS. Antalya Turkey.
121(8 Supplement 1) (pp e26-e27), 2018. Date of Publication: April 2018.
Author
Atay M.; Toz H.; Acikgoz B.; Turkyilmaz S.; Kavala A.A.
Institution
(Atay, Toz, Acikgoz, Turkyilmaz, Kavala) Bakirkoy Dr. Sadi Konuk Egitim Ve
Arastirma Hastanesi, Istanbul, Turkey
Publisher
Elsevier Inc.
Abstract
Objective: Sternal dehiscence which occurs 0,4-5,1% after cardiac surgery
is a risk factor for morbidity and mortality. Steel wire, steel cable,
titanium clips and titanium plates can be used for sternal repair.We aim
to present our results of titanium plate fixation in the patients with
sternal dehiscence after cardiac surgery. Method(s): We
retrospectively reviewed 14 patients who underwent sternal dehiscence
repair with titanium plate after cardiac surgery between January
2017-December 2017 in our department. Age, gender, comorbid diseases, body
mass index (BMI), number of reoperations, hospital stay and mortality was
assessed. Result(s): Mean BMI was 30,6 +/- 3,4 kg/m2. Seven patients
had diabetes while 2 patients scheduled for dialysis due to chronic kidney
disease. Infection was detected in 5 patients who had sternal drainage and
they immediately scheduled for antibiotherapy. Vacuum assisted closure
(VAC) was also planned in this group of patients. Mean hospital stay for
all patients was 39.2 +/- 33,5 days. Conclusion(s): Sternal
stabilization can be done using different application methods in the
sternal dehiscence after cardiac surgery. Titanium plate fixation can be
the treatment of choice especially in obese patients. However, we conclude
that randomized controlled studies should be done to assess the treatment
modalities.

<77>
Accession Number
623221095
Title
Comparison of left atriotomy and superior transseptal approaches in mitral
valve surgery.
Source
American Journal of Cardiology. Conference: 14th International Congress of
Update in Cardiology and Cardiovascular Surgery, UCCVS. Antalya Turkey.
121(8 Supplement 1) (pp e96), 2018. Date of Publication: April 2018.
Author
Turkyilmaz S.
Institution
(Turkyilmaz) Bakirkoy Dr. Sadi Konuk Egitim Ve Arastirma Hastanesi,
Istanbul, Turkey
Publisher
Elsevier Inc.
Abstract
Purpose: To compare the operative and post-operative outcomes of mitral
valve surgery (MVS) with a superior transseptal (STS) approach and a left
atriotomy (LA) approach. Method(s): In two tertiary academic centers,
the charts of patients who underwent MVS between 2012 and 2016 were
analyzed retrospectively. A total of 135 patients underwent MVS. Forty
patients who underwent MVS with the STS approach were enrolled in the
study as Group 1. In the same period, we selected 40 patients who
underwent MVS with the LA approach to serve as the control group (Group
2). To minimize the bias related to the lack of randomization in this
observational study, Group 2 patients were selected using propensity score
matching. Result(s): According to the study design, the preoperative
characteristics of gender, age, mitral valve stenosis and mitral valve
insufficiency were matched (p = 0.368, p = 0.920, p = 0.250 and p = 0.057,
respectively). The cardiopulmonary bypass time was 91.2 +/- 12.1 minutes
in the superior transseptal group and 72.8 +/- 6.4 minutes in the left
atriotomy group (p<0.001). Additionally, duration of clamp time was
significantly shorter in the left atriotomy group (p<0.001). Hemorrhage
was significantly less in patients with a left atriotomy (535.8 ml vs
658.0 ml, p<0.001). Duration of intensive care unit stay and
hospitalization time were significantly longer in patients who underwent
the superior transseptal approach compared to patients who underwent left
atriotomy (p<0.001 vs p<0.001, respectively). Post-operative dysrhythmia
rate and mortality rate were similar between the groups.
 Conclusion(s): Our study demonstrated that MVS with LA decreased
cardiopulmonary bypass time, duration of clamp time, amount of hemorrhage,
duration of intensive care unit stay and hospitalization time compared to
MVS with STS.

<78>
Accession Number
622559298
Title
Role of local hyperfibrinolysis in the postoperative blood loss after
open-heart surgery with cardiopulmonary bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 32nd Annual
Meeting of the European Association of Cardiothoracic Anaesthelologists.
Berlin Germany. 31(Supplement 1) (pp S65), 2017. Date of Publication:
April 2017.
Author
Kolbintsev S.; Dimova O.; Zjuljaeva T.; Javorovskiy A.
Institution
(Kolbintsev, Javorovskiy) I. M. Sechenov First Moscow State Medical
University, Department of Anaesthesiology, Moscow, Russian Federation
(Dimova, Zjuljaeva) National Research Surgical Center B. V. Petrovski,
Moscow, Russian Federation
Publisher
W.B. Saunders
Abstract
Introduction: Cardiopulmonary bypass can activate hyperfibrinolysis. In
spite of pharmacological intervention and detailed surgical hemostasis,
post-bypass bleeding remains the problem. Local hyperfibrinolysis can be
one of the reasons of nonsurgical bleeding after open-heart surgery with
CPB. Method(s): This blind randomised clinical trial recruited two
groups of patients (TXA 1 - 32 patients, TXA 2 - 28 patients) undergoing
coronary artery bypass graft surgery or valve replacement surgery with
CPB. In 1 group TXA has been administered at a dose of 15 mg/kg tranexamic
acid after induction of anesthesia and 1mg/kg during all operation. As
well there was local application of 1g TXA in the cavity of the
pericardium in group 2. Criteria for evaluation: interoperative blood
loss(ml), postoperative blood loss(ml), tempo of chest tube drainage on 2,
4, 6, 16 hours, thromboelastometry (ROTEM) after protamine.
 Result(s): Intraoperative blood loss consisted in TXA 1 - 870 ml, TXA
2 - 910 ml. There is no difference between the groups. Tempo of chest tube
drainage on 2 hour was 40 ml/h in TXA 1, 25 ml/h in TXA 2, on 4 hour - 20
ml/h and 15 ml/h, on 6 hour - 17,5 ml/h and 10 ml/h, on 16 hour - 8 ml/h
and 8 ml/h. There is not a difference between the groups. Patients in the
TXA 2 group had a significantly lower postoperative blood loss (180 ml)
than the TXA 1 group (265 ml) (P<0,05). There is no difference between
results of thromboelastometry in group TXA 1 and TXA 2. LY 30 was 100% in
two groups. Conclusion(s): Postoperative blood loss was significantly
lower in the TXA group 2 then the TXA group1, however there is no
difference between results of thromboelastometry in both groups.
Consequently, there is a possibility of local hyperfibrinolysis in group
TXA 1.

<79>
Accession Number
622993665
Title
Using lean management and team research to assess surgical site infections
in cardiac surgery.
Source
Canadian Journal of Cardiology. Conference: 70th Annual Meeting of the
Canadian Cardiovascular Society. Vancouver, BC Canada. 33(10 Supplement 1)
(pp S213), 2017. Date of Publication: October 2017.
Author
Duteil J.; Senner W.
Institution
(Duteil, Senner) Interior Health Authority, Kelowna General Hospital,
Kelowna, BC, Canada
Publisher
Elsevier Inc.
Abstract
In 2016, clinical observations indicated rising cardiac surgical site
infections (SSI) at both saphenous and sternal sites. We confirmed this
observation using the cardiac surgery database. As a result, we
implemented a systematic review of our clinical practices. SSIs have been
shown to increase risk to patients' morbidity; including increased length
of stay, re-hospitalizations, and program costs. LEAN management steps
were implemented to increase staff awareness, identify areas for clinical
improvement and initiate necessary changes to lower SSI rates. We
simultaneously began three streams of team research: monthly data reports,
infection control statistical analysis and observational studies. Monthly
data reports and infection control analysis provided us with in-depth
knowledge of the types, causes and frequency of infections. The
observational research followed patients through the continuum of cardiac
surgery from the operating theater, cardiac surgery intensive care unit
and cardiac surgery in-patient unit. We examined a total of 1,610
procedures from April 2014 to December 2016 that indicated an overall SSI
rate of 2.8% (95% confidence interval, 2.0 aV'' 3.6). In addition, SSI
rates rose from 1.5% in 2015 to 3.4% in 2016, (p =0.04). The data
collected allowed us to implement changes in practice (including a back to
basics approach on wound care, review of hyperglycemia management,
continence care, and patient teaching) which aimed to improving patient
outcomes, lowering program costs and decreasing SSI to less than 1.5%.

<80>
Accession Number
621719446
Title
Scandinavian heart transplant everolimus de novo study with early
calcineurin inhibitors avoidance (schedule): Results after 6 years of
follow-up.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. Nice France. 37(4 Supplement 1) (pp S18),
2018. Date of Publication: April 2018.
Author
Andreassen A.K.
Institution
(Andreassen) Oslo University Hospital, Oslo, Norway
Publisher
Elsevier USA
Abstract
Summary of Objectives: The SCHEDULE trial investigated whether initiation
of the proliferation signal inhibitor everolimus and early cyclosporine
avoidance could improve renal function and reduce cardiac allograft
vasculopathy in de-novo heart transplant recipients. After 12 months, we
reported significantly higher measured glomerular filtration rates (mGFR)
among patients treated with everolimus vs. conventional cyclosporine
(79.8+/-17.7 vs. 61.5+/-19.6 mL/kg/1.73 m2; p< 0.001), and significantly
reduced incidence of cardiac allograft vasculopathy (CAV) (50.0% vs.
64.6%; p= 0.003) and CAV progression (DELTA maximal intimal thickness;
0.03+/-0.06 vs. 0.08+/-0.12 mm; p< 0.01) assessed by IVUS. Both
developments in mGFR and CAV remained significantly in favor of everolimus
treatment also in our reports after 36 months. With a further extension of
the treatment period to 6 years, results of renal function and CAV
according to study arm will be presented. Method(s): The SCHEDULE
trial is a multicenter trial with 115 de-novo heart transplant recipients
randomized to low exposure everolimus with reducedexposure cyclosporine
(cyclosporine withdrawn after 7-11 weeks) or standard-exposure
cyclosporine, both with mycophenolate and corticosteroids. The 6 year
follow-up of the SCHEDULE trial has been completed, with assessments of
renal function, angiography with IVUS, echocardiography, and adverse
events available by 01.12.17. Endpoints: The primary endpoint is renal
function as assessed by mGFR. Secondary endpoints include eGFR and
creatinine, maximal intimal thickness, serious adverse events including a
composite of major clinical adverse events, non-fatal major cardiac
events, and non-fatal major cardiac events +angiographic CAV.

<81>
Accession Number
621719430
Title
Average daily dose of mycophenolate mofetil in the first posttransplant
year and long term clinical outcomes: A single center retrospective study.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. Nice France. 37(4 Supplement 1) (pp S420),
2018. Date of Publication: April 2018.
Author
Wong K.; Pereira N.; Kushwaha S.
Institution
(Wong, Kushwaha) Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, MN, United States
(Pereira) Department of Cardiovascular Diseases, Molecular Pharmacology
and Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
Publisher
Elsevier USA
Abstract
Purpose: Mycophenolate mofetil (MMF) is routinely used as an
immunosuppressant following heart transplantation. Adjustments in MMF
dosing due to side effects are common but the effect of such decreased
dosing on clinical outcome is unknown. Method(s): This was a
retrospective study with all adult patients received heart transplantation
at Mayo Clinic, Rochester, Minnesota from 1995-2014 with MMF as initial
immunosuppressive regime retrieved. Average MMF dose was calculated by
dividing the cumulative MMF dose with the number of days from initial
hospital discharge to one year after heart transplantation. All
endomyocardial biopsy results were retrieved for calculation of the
rejection score and severe rejection-free survival. Result(s): A
total of 154 consecutive adult heart transplant recipients were included.
Low-normal dose group (LNDG) and high dose group (HDG) were defined as
average MMF daily dose of less than or equal to 2000mg/ day and more than
2000mg/day respectively. Patients in LNDG had significantly lower acute
cellular rejection (ACR) score (0.345 vs 0.474, p< 0.001). Survival free
from severe ACR, defined as grade 2R or more, conditional on severe
ACR-free survival to 1 year was significantly better in LNDG compared to
HDG (89% vs 70.9% at 10 year, p= 0.021) while long term actuarial survival
conditional on survival to 1 year was similar between the two groups
(76.1% vs 74.3% at 10 year, p= 0.489). Multivariate analysis revealed LNDG
was independently associated with lower risk of rejection (OR= 0.163, p=
0.001) and had significant better severe ACR-free survival conditional on
severe ACR-free survival to 1 year (HR= 0.367, p= 0.043).
 Conclusion(s): Average MMF daily dose less than or equal to
2000mg/day in the first post-transplant year due to intolerance was
associated with lower risk of cellular rejection and no significant
difference in long term actuarial survival. The role of altered
pharmacokinetics of MMF in these two groups needs to be explored.

<82>
Accession Number
621718636
Title
The impact of left ventricular assist device infections on post cardiac
transplant survival: A meta-analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 38th Annual Meeting
and Scientific Sessions of the International Society for Heart And Lung
Transplantation, ISHLT 2018. Nice France. 37(4 Supplement 1) (pp
S134-S135), 2018. Date of Publication: April 2018.
Author
Chahal D.; Sepehry A.; Nazzari H.; Wright A.J.; Toma M.
Institution
(Chahal, Sepehry, Nazzari, Wright, Toma) University of British Columbia,
Vancouver, BC, Canada
Publisher
Elsevier USA
Abstract
Purpose: Left ventricular assist devices (LVADs) improve survival for
patients with end stage heart failure while they await transplantation,
but may develop infections. The impact that LVAD related infections have
on outcomes after transplantation is not well studied. We sought to
determine if LVAD infection negatively influences survival after
transplantation. Method(s): We searched Medline, Embase, and Cochrane
Central Register of Controlled Trials for eligible full text studies. We
also searched study bibliographies. Eligible studies included those that
identified LVAD related infections and reported on post-transplant
outcomes. Meta-analyses of posttransplant survival were conducted
utilizing a random effects model. Result(s): We identified 2373
records; 13 cohort studies were selected (n= 6631, 82% male, mean age 50
+/-14 years). 3718 continuous flow LVADs and 1752 pulsatile LVADs were
identified. Of these, 2586 (39 %) developed LVAD related infections.
Patients with LVAD related infections were younger (49.7 +/-13.1 vs. 52.5
+/-12.5, p = 0.02), had higher mean BMIs (28.5 vs. 26.6, p < 0.01), and
longer LVAD support times (252 days vs. 198 days, p < 0.01). LVAD
infection patients had lower incidence of ischemic etiology of heart
failure (40% vs. 44%). Meta-analysis of all studies demonstrated
significantly increased post-transplant mortality in thosepatients who had
a documented LVAD infection (HR 1.3, 95% CI 1.16-1.46, p< 0.001) (Fig 1).
Sub-group meta-analyses by continuous flow and pulsatile device type
demonstrated significant hazard ratios (1.47, 95% CI 1.22-1.76, p< 0.001
and 1.71, 95% CI 1.19-2.45, p= 0.004, respectively). Meta-analyses by
driveline or bloodstream infection type did not display significance,
likely due to small sample size. Sub-group meta-analyses by study size
where greater than 100 patients were included also revealed a significant
hazard ratio (HR 1.35, 95% CI 1.18-1.54, p< 0.001). Post-hoc
meta-regression revealed significant impact of age, BMI, ischemic etiology
and LVAD duration on post-transplant survival. Conclusion(s): LVAD
infection patients have higher BMIs and longer LVAD support times. LVAD
related infections may result in a 30% increase in post cardiac
transplantation mortality. This may be due to increased rejection or
infectious events after transplantation.

<83>
[Use Link to view the full text]
Accession Number
619900158
Title
Coronary artery bypass grafting with or without mitral valve repair for
moderate ischemic mitral valve regurgitation treatment; A meta-analysis.
Source
International Journal of Surgery. Conference: 2017 ASiT International
Surgical Conference. Bournemouth United Kingdom. 47(Supplement 1) (pp
S23), 2017. Date of Publication: November 2017.
Author
Husain M.
Institution
(Husain) Edinburgh University, Edinburgh, United Kingdom
Publisher
Elsevier Ltd
Abstract
Aim: A meta-analysis of RCTs was conducted in attempt to determine whether
CABG only or CABG + mitral valve repair (MVR) are associated with better
outcomes in relation to mortality and survival rates (primary outcome).
Also, the effects on NYHA functional classification; Left Ventricular End
Systolic Volume Index (LVESVI); and hospitalization were explored as
(secondary outcomes). Method(s): The analysis included only RCTs
looking into patients with moderate IMR with similar baseline and
operative characteristics (Grade 2/4, ERO < 20 mm2) and MLVEF% of (40-60%)
who underwent GABG with or without mitral valve repair. Result(s):
Primary outcome: Mortality rate in one year after surgery showed no
statistically significant difference between the two treatment groups.
 Secondary Outcomes: showed immediate beneficial effects of adding MVR
to CABG procedure in regards to patients' NYHA functional class, LVESVI
and hospitalization. Conclusion(s): The current available evidence
suggests that adding MVR to CABG doesn't decrease the mortality rate or
improve the functionality measurements of moderate IMR patients at one
year post-surgery. Furthermore, adding MVR to CABG results in an increased
length of hospital stay duration. For future development of the quality of
evidence, larger RCTs with longer follow-up periods for patients with
moderate IMR are recommended.

<84>
Accession Number
618690473
Title
The impact of LVAD related infections on post cardiac transplant outcomes:
A systematic review.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. San Diego, CA United States. 36(4 Supplement
1) (pp S39), 2017. Date of Publication: April 2017.
Author
Chahal D.; Wright A.J.; Toma M.
Institution
(Chahal) University of British Columbia, Vancouver, BC, Canada
(Wright) Division of Infectious Diseases, University of British Columbia,
Vancouver, BC, Canada
(Toma) Division of Cardiology, University of British Columbia, Vancouver,
BC, Canada
Publisher
Elsevier USA
Abstract
Purpose: Left ventricular assist devices (LVADs) improve survival for
patients with end stage heart failure while they wait for transplantation.
LVADs may develop complications, such as infections. Development of an
infection decreases survival while on LVAD support. The impact of LVAD
related infections (LRIs) on outcomes after transplantation is less well
studied. We sought to determine if the presence of infection while on LVAD
support negatively influences clinical outcomes after cardiac
transplantation. Method(s): We performed a systematic review by
searching Medline, Embase, and Cochrane Central Register of Controlled
Trials for eligible full text studies. We also hand searched study
bibliographies. Eligible studies included those that identified LRIs
during support and reported on outcomes after cardiac transplantation.
Reviewers determined study quality and collected baseline and outcomes
data. Result(s): Electronic search identified 1876 records; 16 were
selected for analysis (n= 5794, 64.7-92.1% male, mean age 34-55 years).
3173 continuous flow LVADs and 2497 pulsatile LVADs were identified. 1749
developed LRIs. In general, patients with LRIs seemed to have higher
incidence of diabetes (14.1-63.9% vs. 16.2-42.3%), and lower incidence of
ischemia as etiology of heart failure (33.0-44.2% vs 42.1-62.0%). Patients
with LRIs had longer LVAD support times (38.5-389.2 days vs. 25.0-220.0)
and higher rates of infection after cardiac transplantation (18.4-80.0%
vs. 2.6-36.1%). 1443 out of 1749 (82.5%) patients with LRIs were
transplanted. Post cardiac transplant survival at 1, 3, and 5 years was
similar for patients who had LRIs vs. those who did not (60.0-96.0% vs.
72.7-95.0%, 37.5-100.0% vs. 48.6-100.0%, and 20.0-83.3% vs. 28.6-83.0%).
 Conclusion(s): Data regarding the impact of LRIs on post cardiac
transplantation outcomes is a relatively understudied area. Most studies
report on older, pulsatile devices which may not be representative of
newer, continuous flow devices. Given the increasing use of LVADs, further
studies are required that focus on LVAD infections and their
post-transplant impact.

<85>
Accession Number
618689767
Title
Management and outcomes of LVAD thrombosis: A systematic review and
meta-analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. San Diego, CA United States. 36(4 Supplement
1) (pp S109-S110), 2017. Date of Publication: April 2017.
Author
Tchantchaleishvili V.; Luc J.G.; Phan K.; Dunlay S.M.; Maltais S.; Stulak
J.M.
Institution
(Tchantchaleishvili, Maltais, Stulak) Department of Cardiovascular
Surgery, Mayo Clinic, Rochester, MN, United States
(Luc) Faculty of Medicine and Dentistry, University of Alberta, Edmonton,
AB, Canada
(Phan) Faculty of Medicine, University of Sydney, Sydney, Australia
(Dunlay) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
Publisher
Elsevier USA
Abstract
Purpose: Pump thrombosis is a major adverse event in patients supported on
a left ventricular assist device (LVAD). Treatment approaches include
surgical (device exchange) or medical (lytic, anticoagulation, and
antiplatelet therapy). Few large studies have examined differing treatment
outcomes, and the optimal strategy has not been fully elucidated.
 Method(s): Large studies addressing pump thrombosis in the modern
LVAD era were systematically reviewed. A meta-analysis of proportions was
performed and subgroup analysis (surgical vs. medical therapy) followed by
random-effects meta-regression was conducted. Weighted Pearson's
coefficient was used to calculate correlation coefficients for
meta-regression analysis of temporal trend of thrombus rates based on
midpoint of study periods. Result(s): Total of 11 studies with 10750
patients were pooled for analysis, and 620 (4.0%, 95% CI 2.1-6.4%)
patients developed pump thrombus. Of those, 445 (72%) patients had
surgical pump exchange, 150 (24%) were treated medically, and 11 (2%)
underwent heart transplant, while the intervention for 14 (2%) patients
was not reported. Surgical therapy resulted in higher success (93.2%, 95%
CI 86.6-99.8) compared to medical management (43.3%, 95% CI 33.2-53.5) (p<
0.001), while medical therapy had a higher mortality rate (28.5%, 95% CI
14.7-42.3) compared to surgical therapy (4.6% 95% CI 2.6-6.6) (p= 0.001).
Recurrence of pump thrombosis after successful therapy was comparable
between surgical (10.5%, 95% CI 2.3-18.7) and medical therapy (17.7%, 95%
CI 0.6-34.8) (p= 0.434). Metaregression of the studies included in the
analysis was consistent with temporal increase of the thrombosis rate
(Figure, p= 0.047).(Figure presented). Conclusion(s): In properly
selected patients, surgical therapy offers higher success rate with lower
mortality. Recurrence rate does not differ between medically and
surgically treated patients. There appears to be a temporal increase in
the pump thrombosis rate.

<86>
Accession Number
618669204
Title
The prevalence of Rome IV non-erosive esophageal phenotypes in children.
Source
Gastroenterology. Conference: Digestive Disease Week 2017, DDW 2017.
Chicago, IL United States. 152(5 Supplement 1) (pp S708), 2017. Date of
Publication: April 2017.
Author
Mahoney L.B.; Rosen R.
Publisher
W.B. Saunders
Abstract
Introduction: The majority of children with reflux symptoms do not have
erosive esophagitis at the time of endoscopy. The new Rome IV criteria
define a variety of non-erosive esophageal phenotypes based on the results
of 24-hour multichannel intraluminal impedance with pH (pH-MII) testing.
While these phenotypes are well-described in adults, there is little data
in children. The aim of this study was to characterize, in a large cohort
of children, the prevalence of Rome IV phenotypes, distribution of reflux
symptoms, rates of proton pump inhibitor (PPI) responsiveness and
frequency of microscopic esophagitis. Method(s): Children < 2 years
who underwent upper endoscopy and pH-MII testing for evaluation of typical
reflux symptoms (pain, heartburn, chest pain, reflux, or regurgitation)
between 2004 and 2016 were included. All children underwent a minimum of
an 8-week PPI trial prior to diagnostic studies, though all studies were
performed off PPI therapy. Children with erosive reflux disease,
eosinophilic esophagitis, prior thoracic or abdominal surgery and those
who did not report symptoms during the pH-MII study were excluded.
Patients with abnormal esophageal acid exposure (pH <4 for >6% of the
study) were classified as having nonerosive reflux disease (NERD). Those
with normal acid exposure, but a positive symptom index (SI) to either
acid or nonacid reflux, were classified as acid or nonacid reflux
hypersensitivity. Those with normal acid exposure and negative SI were
classified as functional heartburn. Result(s): 50 children reported
symptoms during pH-MII monitoring (mean age 10.4+/-5.2 years, 52% female).
Reported symptoms included heartburn (36%), non-specific pain (50%),
abdominal pain (26%), chest pain (4%), reflux (14%) and regurgitation
(20%). The distribution of Rome IV non-erosive esophageal phenotypes was:
28% NERD, 32% reflux hypersensitivity (30% acid and 2% nonacid) and 40%
functional heartburn. 64% of NERD patients, 73% of acid reflux
hypersensitivity patients, 0% of nonacid reflux hypersensitivity patients
and 50% of functional heartburn patients had at least some symptomatic
improvement with PPI use, though there were no significant differences
between groups (p=0.32). 20% of all children had evidence of microscopic
reflux esophagitis on histology. Among subtypes, 14% of NERD patients, 27%
of patients with acid reflux hypersensitivity, 0% of those with nonacid
reflux hypersensitivity and 20% with functional heartburn had microscopic
esophagitis (p= 0.86). Conclusion(s): There is an even distribution
of non-erosive esophageal phenotypes in pediatric patients. The
characteristics of reflux symptoms, presence of microscopic esophagitis
and responsiveness to a PPI trial is not significantly different between
phenotypes. Correct diagnosis of patients requires the use of pH-MII
testing and is important to help guide future therapeutic options.

<87>
Accession Number
618192094
Title
Cost-effectiveness of genotype-guided warfarin dosing in the patients with
mechanical heart valve replacement under fee-for-service system.
Source
Clinical Therapeutics. Conference: 13th Congress of the European
Association for Clinical Pharmacology and Therapeutics, EACPT 2017. Prague
Czechia. 39(8 Supplement 1) (pp e9), 2017. Date of Publication: August
2017.
Author
Kim D.-J.; Kim H.-S.; Oh M.K.; Kim E.-Y.; Shin J.-G.
Institution
(Kim, Kim, Oh, Kim, Shin) Inje University College of Medicine, Busan,
South Korea
(Kim, Kim, Shin) Inje University Busan Paik Hospital, Busan, South Korea
Publisher
Excerpta Medica Inc.
Abstract
Background: Although studies assessing the cost-effectiveness of
genotype-guided warfarin dosing for the management of atrial fbril-lation
and venous thromboembolism have been reported, no publications have
addressed genotype-guided warfarin therapy in mechanical heart valve
replacement (MHVR) patients or genotype-guided warfarin therapy under the
fee-for-service insurance system. The aim of this study was to evaluate
the cost-effectiveness of genotype-guided warfarin dosing in patients with
MHVR under the fee-for-service system from the Korea healthcare sector
perspective. Method(s): A decision-analytic Markov model was
developed to evaluate the cost-effectiveness of genotype-guided warfarin
dosing compared to standard dosing. Estimates of clinical adverse event
rates and health state utilities were derived from the published
literature. The outcome measure was the incremental cost-effectiveness
ratio (ICER) per quality-adjusted life-year (QALY). One-way and
probabilistic sensitivity analyses were performed to explore the range of
plausible results. Result(s): In a base-case analysis,
genotype-guided warfarin dosing was associated with marginally higher
QALYs compared to standard warfarin dosing (6.088 vs. 6.083,
respectively), at a slightly higher cost (US$6.8). The ICER was US$1,356.2
per QALY gained. In probabilistic sensitivity analysis, there was an 82.7%
probability that genotype-guided dosing was dominant over standard dosing,
and a 99.8% probability that it was cost-effective at a willingness-to-pay
threshold of US$50,000 per QALY gained. Conclusion(s): Compared with
only standard warfarin therapy, gen-otype-guided warfarin dosing was
cost-effective in MHVR patients under the fee-for-service insurance
system.

<88>
Accession Number
619777766
Title
The impact of cardiopulmonary metabolic exercise test and resting
echocardiogram results upon bariatric surgery outcomes.
Source
Surgery for Obesity and Related Diseases. Conference: 33rd American
Society for Metabolic Surgery Annual Meeting, ASMBS 2016. New Orleans, LA
United States. 12(7 Supplement 1) (pp S196-S197), 2016. Date of
Publication: August 2016.
Author
Smith A.; Hartman M.; Woodson J.; Renner M.; Morton J.
Institution
(Smith) Stanford School of Medicine, Fort Worth, TX, United States
(Hartman, Woodson, Renner) Stanford School of Medicine, Irving, TX, United
States
(Morton) Stanford School of Medicine, Stanford, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: Obesity is a major and modifiable risk factor for heart
disease. Bariatric surgery is known to be a safe, effective and enduring
treatment for obesity. A hallmark of both safety and effectiveness in
bariatric surgery is preoperative risk assessment and correlation of
testing results to weight loss. Both exercise capacity and cardiac
assessment can be difficult or slow to obtain in a bariatric surgery
clinic due to lack of either equipment and/or qualified specialists. A
potential solution to the lack of timely access to needed cardio-metabolic
testing is to have studies performed in a bariatric surgery clinic and
then confirmed by specialists. This study examines the prevalence,
improvement and correlation of weight loss to Cardiopulmonary Metabolic
Exercise Test (CMET) and Resting Echocardiogram results performed in
bariatric surgery clinics with results confirmed by specialists.
 Method(s): 112 patients who underwent bariatric surgery and had
preoperative Cardiopulmonary Metabolic Exercise Tests (CMET) and Resting
Echocardiograms performed were included in this study. In addition, a
subset of patients had repeat testing performed postoperatively. All tests
were obtained in bariatric surgery clinics with ambulatory equipment and
read by qualified specialists. From 4 100 variables, the following
selected variables are reported: (HR) resting Heart Rate, (SysBP) Systolic
Blood Pressure, (Dia BP) Diastolic Blood Pressure, (RR) Respiratory Rate,
(Max VO2, mL/kg/min) maximal oxygen consumption, (VO2 Max VCO2 (L/min)
maximal carbon dioxide produced and exhaled at peak in liters per minute,
(VO2 Max RER) Respiratory Exchange Ratio, ratio between the amount of CO2
produced during metabolism and the O2 being consumed, (VO2 Max MET)
Metabolic equivalents of 1 MET = 3.5 mL/kg/min, AT VO2/Pred (%), Anearobic
Threshold, the point at which metabolism shifts from aerobic to anaerobic,
(VO2.Max, VO2WorkSlope.mL.min.watt) VO2 over workrate, (VO2.Max. VE.VCO2),
abnormal ventilatory response to exercise is identified by an increased
slope of ventilation vs. CO2 production to incremental workload
(VO2.Max.SpO2), Oxygen saturation at peak, PF Pre SVC (L), the maximum
volume of air that can be exhaled slowly after slow maximum inhalation, PF
Pre IC (L) inspiratory reserve volume (IRV), PF Pre ERV (L) expiratory
reserve volume (ERV), PF Pre FEV1 (L) the volume of air that can forcibly
be blown out in one second, after full inspiration, PF Pre FVC (L) volume
of air that can forcibly be blown out after full inspiration, PF Pre
FEV1/FVC (%) calculated ratio used in the diagnosis of obstructive and
restrictive lung disease, PF Pre FEF Max (L/sec) Forced expiratory flow
(FEF) PF Pre Expiratory Time (sec) 'amount of time it takes for the
patient to clear all the air from their lungs, PF Pre DLCOunc
(ml/min/mmHg) Diffusing capacity of the lungs for carbon monoxide, a
measure of how much oxygen travels from the alveoli of the lungs to the
blood stream, PF Pre FRC (N2) (L) functional residual capacity, PF Pre RV
(N2) (L) residual volume, PF Pre TLC (N2) (L) total lung capacity, LVOT
Left Ventricular Outflow Tract Diameter, MV-AV Mitral Valve-Aortic Valve
Velocity and PFVI Pulmonary Flow Velocity. Continuous and categorical data
were analyzed by T-test or Chi-Square analysis as appropriate.
Preoperative testing results were then correlated to postoperative weight
loss results by Spearman correlation. Significance was set as p<. 05. All
data were analyzed using GraphPad Prism v6.01. Result(s): Average
patient demographics included: Age 42 Years, BMI 44, 82% female, 64%
Caucasian, BMI Reduction Post-operative 14. The following variables were
noted to be abnormal preoperatively, (%): Rest.sysBP.mmHg (31.3),
Rest.diaBP.mmHg (19.6), VO2.Max.sysBP.mmHg (15.1), VO2.Max.diaBP.mmHg
(2.6), Rest.HR. BPM (8.03), VO2.Max.HR.Pred (27.7), Rest.RR. br.min
(21.4), VO2.Max.RR.br.min (10.7), VO2.Max.BR (100), VO2.Max.VO2.Pred
(37.5), VO2.Max.RER (31.3), VO2.Max. METS (15.2),
VO2.Max.VO2WorkSlope.mL.min.watt (76.8), VO2.Max.VE.VCO2 (3.6),
VO2.Max.Max.SpO2 (25), AT.VO2. Pred (19.6), PF.Pred.Pre.SVC.L, PF (1.8),
Pred.Pre.ICL, PF (93.8), Pred.Pre.ERV.L (17.9), PF.Pred.Pre.FEV1.L (25),
PF. Pred.Pre.FVC.L (0.8), PF.Pre.FEV1.FVC (7.1), PF.Pred.Pre.FEF.
Max.L.sec (16.1), PF.Pre.Expiratory.Time.sec. (97.3), PF.Pre.
DLCOunc.ml.min.mmHg (100), PF.Pred.Pre.DLCOunc.ml.min. mmHg. (50),
PF.Pred.Pre.FRC.N2.L. (91.1), PF.Pred.Pre.RV.N2. L. (74.1),
PF.Pred.Pre.TLC.N2.L. (54.5) PF.Pre.RV.TLC.N2 (100). Variables
significantly correlated with surgical weight loss included: PF PreFEV1
(-0.77), PF PreFVC (-0.74), Rest CO (-0.83). Furthermore, PF Pre-Final was
also significantly correlated to Systolic Blood Pressure change (-0.9). In
addition, cardiac echo results demonstrated significant correlation to
change in BMI including LVOT Diameter (0.8), MV-AV Velocity (0.75) and HR
(-0.73) and PFVI (-0.83). Conclusion(s): This study finds multiple
and significant preoperative abnormalities in patients undergoing
bariatric surgery. These abnormal findings include cardiac, pulmonary and
exercise tolerance parameters that may have important implications for
both patient safety and effectiveness. The correlation of cardiopulmonary
parameters like preoperative CO, FEV1, FVC, LVOT Diameter, MV-AV velocity,
HR And PFVI to surgical weight loss and comorbidity remission indicate
opportunities to enhance surgical weight loss. Surgical prehabilitation
such as cardio-pulmonary training for these parameters could improve
weight loss and comorbidity remission. Abnormal preoperative
cardio-pulmonary parameters can have complication consequences.
Recognition of these abnormal values can guide the use of risk mitigation
strategies. Cardiopulmonary Metabolic Exercise Tests and Resting
Echocardiograms can enhance bariatric surgery outcomes for safety and
effectiveness.

<89>
Accession Number
613017081
Title
Hybrid coronary revascularization: A promising coronary revascularization
technique. The Canadian experience with long-term follow up.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S96), 2016. Date of Publication: October 2016.
Author
Giambruno V.; Hafiz A.; Fox S.; Jeanmart H.; Cook R.; Khaliel F.; Teefy
P.; Sridhar K.; Lavi S.; Bagur R.; Iglesias I.; Jones P.; Harle C.;
Bainbridge D.; Chu M.; Kiaii B.
Institution
(Giambruno, Hafiz, Fox, Jeanmart, Cook, Khaliel, Teefy, Sridhar, Lavi,
Bagur, Iglesias, Jones, Harle, Bainbridge, Chu, Kiaii) LondonONCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Hybrid Coronary Revascularization (HCR) is offered as an
alternative strategy for patients with multivessel coronary artery disease
(CAD). It combines the advantages of both surgical and percutaneous
revascularization eliminating at the same time the disadvantages of both
procedures. In fact, this evolving revascularization technique utilizes
the survival benefit conferred by the left internal thoracic artery (LITA)
graft to the left anterior descending coronary artery (LAD) while
providing the patients with complete and truly minimally invasive
revascularization with PCI to the non-LAD vessels. The objective of this
study was to assess graft and stent patency at 6 months, rate of bleeding,
ICU and hospital stay, rate of reintervention and long term clinical
follow up. METHOD(S): From March 2004 to March 2016 a total of 209
patients (61.7+/-11.0 years; 163 males and 46 females) underwent
robotic-assisted minimally invasive direct coronary artery bypass (RADCAB)
graft of the LITA to the LAD and PCI in a non-LAD vessel in a single or
two stage, in three different centres. Patients underwent 6 months
angiographic follow up. The average clinical follow up was 77.82+/-41.4
months. RESULT(S): Successful HCR occurred in 202 of the 209 patients
(7 patients required intraoperative conversion to conventional coronary
artery bypass). 152 patients underwent simultaneous surgical and
percutaneous intervention. 19 patient underwent PCI before surgery, 38
patient underwent PCI after surgery. 195 patients were treated with
drug-eluting stents, whereas 14 patients were treated with bare metal
stents. No in-hospital mortality occurred. The average ICU stay was 1+/-1
days and the average hospital stay was 5+/-2 days. Only 12.9% of patients
required a blood transfusion. Six-month coronary angiogram follow up has
been performed in 95 patients. Angiographic evaluation demonstrated a LITA
anastomotic patency of 97.9% and stent patency of 92.6%. At 77.8+/-41.4
months clinical follow up demonstrated 95.7% survival, 92.8% freedom from
angina, 90.9% freedom from any form of coronary revascularization (PCI of
LITA-to-LAD anastomosis was performed in 5 patients, in one case the
anastomosis was surgically revised and PCI was repeated in 13 patients).
 CONCLUSION(S): Hybrid revascularization appears to be a promising and
safe revascularization strategy. It provides selected patients with an
alternative, functionally complete revascularization with minimal surgical
trauma and good longterm clinical outcomes. However, randomized
prospective trials comparing HCR with conventional CABG procedures or
multivessel PCI will be necessary to further evaluate the effectiveness of
this alternative coronary artery revascularization technique.

<90>
Accession Number
613016697
Title
Haloperidol prophylaxis in cardiac surgery for patients at risk for
delirium: A randomized placebocontrolled pilot study.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S231), 2016. Date of Publication: October 2016.
Author
Travale I.L.; Drake K.A.; Power P.; Schoenberg J.; Toito F.; Lamy A.
Institution
(Travale, Drake, Power, Schoenberg, Toito, Lamy) HamiltonONCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Post Cardiotomy Delirium (PCD) is a devastating
neuropsychologic complication resulting from imbalances in
neurotransmitters that regulate cognition. Risk factors include cognitive
impairment, previous stroke/TIA, atrial fibrillation, and advanced age.
Incidence rates can be as high as 78% and are associated with an increase
in morbidity, mortality, adverse events, and LOS. METHOD(S): This
pilot study utilized a double-blind, randomized, placebo-controlled trial
methodology. Primary outcomes were safety and feasibility. Secondary
outcomes included PCD incidence, duration, and severity. Patients
undergoing sternotomy were eligible if age > 70 yrs. or 60-69 yrs. with >1
risk factor for PCD. Twenty-five patients were enrolled in this pilot
study. RESULT(S): There were 4 adverse events, 2 in each arm, but
none were related to the treatment. Feasibility related to recruitment
proved difficult. Patient concerns included not wanting to take additional
medications, believing they would not get confused, not enough time to
decide, and concerns over side effects of Haloperidol. Logistical issues
included competition with other studies, timing of consent, completion of
pre-operative MoCA, timely administration of study drug, and
incomplete/missed documentation. The overall PCD incidence rate was 28%
and higher in the treatment group (33% vs. 23%). The average duration of
delirium was higher in the placebo group (2.3 days vs. 1.75 days).
Similarly, the placebo group had higher delirium severity scores than the
treatment group (30 vs. 19.75). Despite randomization, patients in the
treatment group had lower pre-operative MoCA scores (24.44 vs. 26.18),
higher EuroSCOREs (4.44 vs. 3.95), and higher transfusion rates (4.1 vs
1.6). Patients in the placebo group had more hypertension (92% vs. 67%),
diabetes (62% vs. 17%) and positive smoking history (69% vs. 50%).
 CONCLUSION(S): The study was safe, but feasibility was a challenge.
All adverse events were not related to treatment, but patients were
reluctant to enroll in the study because of the use of an antipsychotic
and not having family members present to render an opinion. The overall
PCD incidence was low considering the enrolment of a high-risk population.
The treatment group was at higher risk for PCD but had fewer average days
of delirium than the placebo group. Severity scores higher in the placebo
group possibly reflect the treatment's effect, but the sample size was too
small and thus it limited the power to detect secondary outcomes to make
this inference. Future studies should include a larger sample size to
detect the true effect of the proposed treatment.

<91>
Accession Number
613016624
Title
Long term results of paediatric ross procedure: A new methodology of
timeto-event data meta-analysis.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S170-S171), 2016. Date of Publication: October 2016.
Author
Ben Ali W.; Ducruet T.; El-Hamamsy I.; Bouchard D.; Poirier N.C.
Institution
(Ben Ali, Ducruet, El-Hamamsy, Bouchard, Poirier) MontrealQCCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Ross procedure has been used for over 40 years in the surgical
management of irreparable aortic valve disease in children. Little
clinical long-term information is available regarding the durability of
the autograft in the aortic position and the pulmonary conduit substitute.
Moreover, there is no fully established methodology to perform
time-to-event data meta-analysis. The aim of study was to develop a new
methodology to perform such meta-analysis and therefore pool the long term
results of paediatric Ross procedure. METHOD(S): Pubmed, Medline,
Embase and Internet were searched for eligible studies published until
December 2015. Data extraction was conducted by 4 independent authors.
Kaplan Meier (KM) curves reproduced in each paper were digitized. We
developed with the support of Cochrane Canada an algorithm to derive the
original patient time-to-event data and the censored informations. Derived
KM curves were graphically checked with the original ones and validated
with an accuracy of 99%. The KM data from different studies were stored
together and Statistical methods for time-to-event data were employed to
analyze outcomes at follow-up, including the KM estimator with the
log-rank test. Results were stratified in term of age at intervention
(neonate versus pediatric) and era of surgery (enrolment before and after
2010). RESULT(S): A total of 9 studies were eligible for the
metaanalysis (1022 patients). The KM estimates of survival at 10 and 15
years were, respectively, 91% [95% CI 89% to 93%] and 90% [95% CI 88% to
92%]. Pooled mortality was significantly higher in the neonate subgroup
(log-rank p value : 0.01). Pooled freedom from reoperation at 5, 10 and 15
years were respectively 87% [95% CI 85% to 89%], 78% [95% CI 74% to 82%]
and 60% [95% CI 54% to 66%]. Pooled freedom from autograft reoperation at
5, 10 and 15 years were respectively 97% [95% CI 95% to 99%], 91% [95% CI
89% to 93%] and 83% [95% CI 79% to 87%]. The freedom from overall
reoperation and autograft reoperation were significantly higher in the
recent series subgroup ( logrank p value respectively 0.002 and 0.007).
 CONCLUSION(S): The new developed methodology gives an objective
appraisal of time-to-event data and is actually validated by Cochrane
collaboration. Present meta-analysis validates the Ross procedure as low
risk palliative procedure for isolated aortic valve or complex left heart
obstruction in children, with good early and late survival. Durability
limitations become apparent by the end of the first postoperative decade.

<92>
Accession Number
613016559
Title
Incidence of sternal wound infection following tracheostomy in cardiac
surgery patients: A systematic review and meta-analysis.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S229), 2016. Date of Publication: October 2016.
Author
Toeg H.; French D.; Glibert S.; Rubens F.
Institution
(Toeg, French, Glibert, Rubens) OttawaONCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: This systematic review and meta-analysis was performed to
determine whether timing or type of tracheostomy was associated with
superficial or deep sternal wound infections (SWI) after cardiac surgery.
 METHOD(S): All studies reporting the incidence of SWI after
tracheostomy in cardiac surgery patients were collected and analyzed.
Subgroup analyses determined a priori included timing of tracheostomy and
type of procedure (open versus percutaneous). All analyses used the random
effects model. A meta-regression analysis was performed on the proportion
of SWI and number of days between tracheostomy and initial cardiac
surgery. RESULT(S): A total of 13 studies met inclusion criteria. The
incidence of SWI across all studies reported was 7% (95% CI (confidence
interval)[4, 10]). The percutaneous tracheostomy group had a SWI
proportion of 3% (95% CI [1, 8]) while the open tracheostomy group had a
SWI proportion of 9% (95% CI [5, 14]). The incidence of SWI with early (<
14 days)(7%; (95% CI [3,11]) versus late (+/- 14 days)(7%; (95% CI[4,10])
tracheostomy was similar. Meta-regression demonstrated no significant
relationship between incidence of SWI and number of days between
tracheostomy and initial cardiac surgery (R2=6.13%, p=0.72).
 CONCLUSION(S): The incidence of SWI following tracheostomy in cardiac
surgery patients remains high at 7 % (95% CI [4,10]). Either open or
percutaneous tracheostomy following cardiac surgery is a feasible option
since the incidence of SWI is comparable. Further studies are needed to
determine which strategy (open versus percutaneous; early versus late)
generates faster patient recovery and lowers overall cost.

<93>
Accession Number
613016536
Title
Haloperidol prophylaxis in cardiac surgery for patients at risk of
delirium: A randomized placebocontrolled pilot study.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S315), 2016. Date of Publication: October 2016.
Author
Travale I.; Drake K.
Institution
(Travale, Drake) Hamilton Health Sciences, Hamilton, ON, Canada
Publisher
Pulsus Group Inc.
Abstract
Post Cardiotomy Delirium (PCD) is a devastating neuropsychic complication
resulting from imbalances in neurotransmitters that regulate cognition.
Risk factors include cognitive impairment, previous stroke/TIA, atrial
fibrillation, and advanced age. Incidence rates are as high as 78% and are
associated with an increase in morbidity and mortality, adverse events,
and length of stay. The purpose of this pilot RCT was to determine the
safety and feasibility of haloperidol prophylaxis to inform future
research in cardiac surgery. This pilot study utilized a double-blind,
randomized, placebo-controlled trial methodology replicating a previous
study in the hip surgery population. Primary outcomes were safety and
feasibility, secondary outcomes included PCD incidence, duration, and
severity. Patients undergoing sternotomy were eligible if age > 70 yrs. or
60-69 yrs. with >1 risk factors for PCD. Twenty-five patients were
enrolled. There were 4 adverse events, none related to the treatment.
Feasibility related to recruitment proved difficult, but the protocol was
simple. Patients in the treatment group had lower MoCA scores (24.44 vs.
26.18) higher euroSCOREs (4.44 vs. 3.95) and higher severity scores (30
vs. 19.7). Overall PCD incidence was 28% with no statistical difference
between groups. Finally, the study was safe but feasibility was a
challenge. The PCD incidence and duration did not differ unlike severity,
but the treatment group was at higher risk for PCD. There are many
limitations to the study since it was not powered to detect secondary
outcomes. Future studies should include a larger sample size to detect the
true effect of the proposed treatment.

<94>
Accession Number
613016412
Title
Transvenous laser lead extractions: Risk factors for mortality and
complications derived from a single centre experience.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S288-S289), 2016. Date of Publication: October 2016.
Author
Plourde B.; Kuriachan V.; Rothschild J.M.; Exner D.V.
Institution
(Plourde, Kuriachan, Rothschild, Exner) CalgaryABCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Transvenous laser lead extractions (TLLE) are deemed safe and
efficient procedures albeit performed in highrisk patient. Previous
studies have established procedural efficacy but with a narrow focus on
the peri-procedural period. The objective of the present report is to
document mortality, complication rates and risk factors in a broader
perspective. METHOD(S): All adult patients who underwent TLLE in a
single tertiary centre between January 2012 and December 2015 were
analyzed. Baseline demographics, device information, surgical procedures,
hospital stay, and follow up data were collected through provincial
electronic database and hospital charts. Follow up was extended to the
first device clinic visit, hospital stay or death, whichever came first.
 RESULT(S): During the observation period, 159 TLLE were performed in
155 patients. Median age was 64+/-16.3 years and the majority of patients
were men (74%). Forty percent of extracted systems were pacemakers, 43%
were defibrillators (ICD) and 16% were cardiac resynchronization therapy
defibrillators (CRT-D). There were 274 leads extracted (average of
1.7+/-0.8 leads by procedure). Average lead duration was 99+/-57.6 months
(range 5 to 370 months). Complete system extraction was done in 133
(83.6%) procedures, some leads were abandoned in 25 (15.7%) procedures.
Clinical success was achieved in 152 procedures (95.6%), partial success
in 6 (3.8%) and 1 procedure (0.6%) was unsuccessful. Median follow up was
29+/-15.4 months during which 21 (13.2%) patients died. Amongst those, 7
were in-hospital deaths including one peri-procedural death. In univariate
analysis, statistically significant risk factors for mortality were age,
atrial fibrillation/flutter, chronic kidney disease, hypertension, and
hemoglobin level. In multivariate analysis, only hemoglobin level (10 g/L
increments) increased significantly the risk of mortality (OR 1.42 95% CI
[1.11-1,81], p=0.005). There were 48 (30,2%) procedures with at least one
complication. Individual complication rate remains low (Table 1). Overall,
the most common complication was re-operation for lead dislodgement (12,
7,5%) which occurred more frequently in patients who had TLLE for system
upgrade (9; 75%, p= 0,018). Statistically significant univariate risk
factors for overall complications included age, history of cardiac surgery
and atrial fibrillation/flutter however, no risk factors were
statistically significant in multivariate analysis. For major
complications, age greater than 65 years significantly increased the risk
(OR 3,19 95% CI [1.04-9.86], p=0.043). CONCLUSION(S): TLLE are
complex procedures done in patients with significant co-existing
illnesses. Not surprisingly the overall mortality and complications rates
are high although procedure-related death and serious complications remain
relatively low given the patient population.

<95>
Accession Number
613016384
Title
Impact of optical coherence tomography on management of pediatric heart
transplant recipients: Data from the international pediatric OCT registry.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S84-S85), 2016. Date of Publication: October 2016.
Author
Harris K.C.; Schubert S.; Voss C.; Balbacid E.; Hosking M.C.
Institution
(Harris, Schubert, Voss, Balbacid, Hosking) VancouverBCCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Cardiac allograft vasculopathy (CAV) is a leading risk factor
for graft failure and mortality in pediatric cardiac transplant
recipients. Optical coherence tomography (OCT) is a high-resolution
intravascular imaging technique that has shown promise at detecting early
signs of CAV which are not yet detectable by conventional angiography. We
established an International Pediatric OCT Registry to: 1) evaluate the
impact of OCT on clinical care; and 2) document the safety profile of this
technique across pediatric centres. METHOD(S): We established an
International Pediatric OCT Registry from three centres in Canada (BC
Children's Hospital Vancouver), Germany (Deutsches Herzzentrum Berlin) and
Spain (Hospital Universitario La Paz, Madrid). Participating sites input
relevant patient demographics (age, sex, diagnosis), clinical data, and
cardiac catherization procedural data (indication for OCT, technical
aspects, case complications) directly to a secure online research database
(REDCap). OCT images were quantitatively and qualitatively analyzed at the
core imaging laboratory at BC Children's Hospital, Canada. Coronary
angiograms were read centrally with investigators blinded to the OCT
results. RESULT(S): The International Pediatric OCT Registry includes
n=115 cardiac catherization cases including n=85 children (12.5+/-4.5 yrs;
59% male), of whom most were cardiac transplant recipients (n=75,
5.4+/-4.9 yrs at Tx). Indication for OCT was routine surveillance (85%) or
follow-up of CAV (15%). OCT findings lead to changes in medical management
in 20% of cases, including changes to pharmacological therapy or changes
to surveillance frequency. Severe intimal thickening was angiographically
silent in 60% of cases. In 67% of patients who had intensification of
their immunosuppression this was done on the basis of OCT findings alone
as selective coronary angiography was normal. Overall, 5% of cases were
associated with minor intra-procedural complications (predominantly
transient ECG changes including ST elevation or T wave inversion); there
were two cases of arrhythmias requiring intervention. There were no post
procedural complications observed. CONCLUSION(S): OCT imaging
provides additional anatomic insight to coronary changes in pediatric
heart transplant recipients at risk of CAV. These data result in changes
to medical management in 20% of cases. The safety profile of OCT is
similar to that of selective coronary angiography in children. The impact
of OCT on long-term outcomes in this patient population remains unknown
but it appears to have the potential to improve early diagnosis and
management of CAV.

<96>
Accession Number
613016329
Title
Quantitative assessment of intimal thickening using optical coherence
tomography - Relationship to cardiac allograft vasculopathy.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S84), 2016. Date of Publication: October 2016.
Author
Hosking M.C.; Schubert S.; Voss C.; Balbacid E.; Harris K.C.
Institution
(Hosking, Schubert, Voss, Balbacid, Harris) VancouverBCCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Cardiac allograft vasculopathy (CAV) is a cause of graft
failure and mortality in pediatric heart transplant recipients. Optical
coherence tomography (OCT) is an ultra high-resolution intravascular
imaging technique that can detect angiographically silent coronary
changes. We sought to characterize OCT-derived parameters indicative of
evolving CAV in pediatric heart transplant patients. METHOD(S): We
extracted data from the International Pediatric OCT Registry, which
includes pediatric heart transplant recipients who underwent OCT imaging
(St Jude Medical) during cardiac catherization procedures in Canada,
Germany and Spain. For quantitative OCT analyses, we identified 10-20
cross-sectional frames that were >=1 mm apart and measured cross-sectional
area (CSA) for the intima and media, as well as maximal intimal thickness.
We measured the maximal intimal thickness and a median value for the
intima to media CSA ratio (I/M). CAV classification was determined by
angiography which was evaluated by investigators blinded to the OCT
findings. RESULT(S): We included 57 pediatric heart transplant
patients (age at Tx 5.1+/-4.6yrs; age at OCT 13.1+/-.3.5yrs; 62%male) who
had OCT performed in 93 coronary arteries (n=40 RCA; n=24 LAD;n=25 LCx;
n=4 other coronary artery). We measured 14+/-3 cross-sectional frames over
an average vessel segment length of 24+/-11mm. Maximal intimal thickness
was 0.21+/-0.1mm, with 6 vessels (in 6 patients) presenting with severe
intimal thickening (>=0.4mm). All 6 cases presented with abnormal I/M, but
only 2 had concurrent abnormal angiographic findings consistent with CAV;
all 6 cases had a history of biopsy-confirmed rejection. Maximal intimal
thickness was not related to sex, age at Tx, time since Tx, age at OCT,
preexisting diagnosis of CAV or previous biopsy-confirmed rejection.
Maximal thickness was significantly higher in those who had a concurrent
biopsy-confirmed episode of rejection (n=10 patients; 0.31+/-0.2 vs
0.19+/-0.1mm; p=0.025), or newly diagnosed CAV (n=2 patients; 0.47+/-0.3
vs. 0.20+/-0.1mm, p<0.001). Overall, I/M was 1.3+/-0.4, with 82% of
vessels presenting with an abnormal I/M (>=1). I/M was not related to sex,
age at Tx, time since Tx, age at OCT, previous or current diagnosis of
CAV, or episode of biopsy-confirmed rejection. CONCLUSION(S): Mild
intimal thickening is common in pediatric heart transplant recipients.
Severe intimal thickening is rare but is more common in those with a new
diagnosis of CAV. Prospective serial evaluation may better determine
pediatric cutoffs for intimal thickness that is predictive of the future
development of CAV. Intravascular imaging technology may provide an
opportunity for early intervention in the setting of evolving CAV.

<97>
Accession Number
613016300
Title
Severe coagulopathy after cardiac surgery: Is FEIBA a viable therapy?.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S113), 2016. Date of Publication: October 2016.
Author
Murphy T.; Forgie R.; MacLeod J.; Brown C.; Hassan A.; Pelletier M.
Institution
(Murphy, Forgie, MacLeod, Brown, Hassan, Pelletier) Saint JohnNBCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: FEIBA (Factor VIII Inhibitor Bypassing Activity) is a
potentially important therapy for patients with uncontrollable bleeding
after cardiac surgery. The objective of this study was to evaluate the
safety and efficacy of FEIBA for the treatment of persistent coagulopathy
following cardiac surgery. METHOD(S): From Jan 2008 to June 2015,
patients who underwent cardiac surgery and also received either
intraoperative or postoperative FEIBA were identified utilizing an
institutional database of prospectively gathered data. All patients
received tranexamic acid while on cardiopulmonary bypass, followed by
protamine administration once weaned from bypass. All patients initially
received fresh frozen plasma and platelets for persistent coagulopathy. If
bleeding persisted beyond this, FEIBA was used as adjuvant therapy. The
intraoperative characteristics and postoperative results of those patients
were extracted and analyzed. RESULT(S): During the study period, 5551
patients had cardiac surgery, of which 276 (5.0%) received FEIBA for
refractory bleeding. Most received FEIBA either intraoperatively (Group 1,
n=120) or postoperatively (Group 2, n=133), while some received both
intra- and postoperative doses (n=23). All patients received FEIBA only
after failure of conventional therapy. Patient characteristics and results
are found in Table 1. Group 1 patients were more likely to require an
emergent procedure (p<0.001) and 85% underwent complex or combination
procedures (p<0.001). Cardiopulmonary bypass and cross clamp times were
longer (p<0.001) in Group 1. FEIBA was effective in expediting hemostasis
and chest closure. These patients had a low reoperation rate (1.7%) but a
high rate of significant complications, including neurological injury and
renal failure, partly indicative of their complex presentation. Group 2
patients were less likely to require emergent or complex procedures, with
47% requiring isolated CABG or valve surgery. Their bypass and cross clamp
times were shorter, and bleeding was only problematic after arriving to
the ICU. For most, postoperative chest tube hourly output decreased
significantly after FEIBA (363 +/- 314 ml/hr before FEIBA, 69 +/- 61 ml/hr
after FEIBA). While 14.2% required re-exploration, CNS and myocardial
injuries were low (1.5% and 0%). Mortality was high in both groups,
reflecting the complex nature of their diagnoses and procedures.
 CONCLUSION(S): This is the largest reported series of FEIBA
administration for the treatment of diffuse coagulopathy in cardiac
surgery. While deemed clinically effective in controlling perioperative
bleeding, high complication rates were observed. Definitive safety and
efficacy standards will need to be established through a randomized
controlled trial. (Table Presented).

<98>
Accession Number
613016221
Title
Prevalence of pulmonary vein electrical reconnection after surgical atrial
fibrillation ablation: A multicenter study.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S256-S257), 2016. Date of Publication: October 2016.
Author
Nery P.B.; Roux J.F.; Sarrazin J.F.; Lam B.K.; Nair G.M.; Samardhi H.;
Redpath C.J.; Sadek M.M.; Green M.S.; Birnie D.H.
Institution
(Nery, Roux, Sarrazin, Lam, Nair, Samardhi, Redpath, Sadek, Green, Birnie)
OttawaONCanada
Publisher
Pulsus Group Inc.
Abstract
INTRODUCTION: Surgical ablation of atrial fibrillation (AF) is often
performed in patients undergoing concomitant cardiac surgery. While
surgical AF ablation is associated with a reduction in AF burden, there is
limited data on its effectiveness in achieving durable pulmonary vein (PV)
electrical isolation. The goal of this study was to assess the status of
PV to left atrium (LA) electrical conduction in subjects experiencing
recurrent atrial arrhythmias after surgical AF ablation. METHOD(S):
We evaluated consecutive patients presenting with recurrent atrial
arrhythmias after surgical AF ablation from 3 tertiary care centers.
Subjects referred for subsequent electrophysiological study (EPS) and
catheter ablation were included. The status of PV-LA conduction post
surgical ablation was evaluated using a multipolar circular catheter at
EPS. RESULT(S): Twenty-five patients were identified, 7 of whom were
diagnosed with right atrial flutter. LA mapping was completed in 14
subjects, and 56 pulmonary veins were evaluated. Baseline characteristics
were the following: Nine (64%) subjects were male; mean age at the time of
EPS was 59+/-9 years; mean LA volume was 48+/-15.8 ml/m2; and average LVEF
was 49+/-8%. Ten subjects (71%) underwent concomitant mitral valve surgery
at the time of surgical ablation. The median time from surgical ablation
to EPS was 31 months. Indications for repeat ablation included LA flutter
(n=10; 71%) and AF (n=4; 29%). At repeat EPS, 45/56 (80%) PVs were
electrically connected to LA in 13 (93%) subjects. PV-LA electrical
connection was observed in 4 PVs in 9 (64%) patients, 3 PVs in one (7%)
and in two ipsilateral PVs in 3 (21%). All PVs were electrically isolated
in one (7%) patient. There was no correlation between the indication for
repeat ablation and the status of PV-LA conduction. CONCLUSION(S):
Pulmonary vein reconnection is common in patients presenting with
recurrent atrial arrhythmias post surgical AF ablation. This data
highlights the challenges in achieving durable PV isolation. Prospective
studies are needed to confirm these findings.

<99>
Accession Number
613016152
Title
Risk of stroke associated with atrial fibrillation after non-cardiac
surgery: Insights from a meta-analysis of randomized controlled studies
and observational studies.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S255-S256), 2016. Date of Publication: October 2016.
Author
AlTurki A.; Marafi M.; Cardinale D.; Blackwell R.H.; Bessissow A.; Essebag
V.; Healey J.S.; Huynh T.
Institution
(AlTurki, Marafi, Cardinale, Blackwell, Bessissow, Essebag, Healey, Huynh)
MontrealQCCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Post-operative atrial fibrillation (POAF) is a frequent
occurrence after non-cardiac surgery. Due to its generally short duration,
it remains uncertain whether POAF after non-cardiac surgery is associated
with increased risk of stroke. Therefore, we aim to elucidate the risk of
stroke associated with POAF following non-cardiac surgery by a
meta-analysis of randomized controlled studies and observational studies.
 METHOD(S): We searched MEDLINE, EMBASE, Web of Science, Scopus and
clinicaltrials.gov from inception up to April 1 2016, for all studies that
reported strokes in patients who developed POAF following non-cardiac
surgery (no language restriction). Two reviewers independently performed
the literature search and extraction. We used a random-effects model to
summarize the studies. RESULT(S): From a total of 4364 abstracts
screened, we retained 13 studies enrolling 1,694,663 patients for the
final analyses. 16,061 patients had POAF, in whom the mean ages ranged
from 60-72 years and females ranged from 21%-41%. In addition, 30%-72%
were hypertensive, 11%-33% were diabetic and 15%-50% had coronary artery
disease. In comparison, 1,678,602 patients did not have POAF. Their mean
ages ranged from 56-72 years, females ranged from 22%-60%. Moreover,
22%-70% were hypertensive, 7%-31% were diabetic and 10%-40% had coronary
artery disease. There were four randomized controlled studies, two
prospective and 7 retrospective cohort studies. At one month follow-up,
POAF was associated with approximately three times increase in risk of
short-term stroke [odds ratio (OR): 3.09 (95% Confidence intervals (CI):
2.14-4.46); n=9 studies]. POAF was associated with approximately four
times increase in long-term risk of stroke with OR: 3.97(95% CI:
3.46-4.57) in four studies with +/-12-month follow-up. Combining all 13
studies, the overall increase in risk of stroke associated with POAF was
3.84 (95% CI: 3.38-4.38) (Figure 1). CONCLUSION(S): POAF was
associated with increased short and long-term risk of stroke after
non-cardiac surgery. Future studies are needed to evaluate the impact of
anticoagulation in decreasing the risk of stroke in these patients. (Table
presented).

<100>
Accession Number
613016125
Title
Positive effect of the PPAR-gamma agonist rosiglitazone on hemodynamic
response to exercise in type 2 diabetic men after coronary artery bypass
graft surgery: A 1-yr randomized study.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S223-S224), 2016. Date of Publication: October 2016.
Author
Laberge A.; Brassard P.; Arsenault B.; Costerousse O.; Poirier P.;
Bertrand O.; Despres J.; Piche M.
Institution
(Laberge, Brassard, Arsenault, Costerousse, Poirier, Bertrand, Despres,
Piche) QuebecQCCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: To assess the effects of a 1-yr treatment with the
PPAR-agonist rosiglitazone on the hemodynamic response to exercise in
post-coronary artery bypass graft (CABG) surgery male patients with type 2
diabetes (T2D). METHOD(S): A total of 116 men (age: 64+/-7 years)
with T2D (HbA1c: 6.6+/-0.8 %) who underwent CABG were randomly assigned to
a PPAR-agonist (rosiglitazone; 8mg/day) (n=57) or placebo (n=59) for a
12-month period. Body fat composition and distribution were assessed at
baseline and at 12 months. Hemodynamic response to exercise was evaluated
during a maximal treadmill test. Exercise-induced hypertension (EIH) was
defined asmaximal systolic blood pressure (BP) (SBP)+/-220 mmHg and/or
maximal diastolic blood pressure (DBP) +/- 100 mmHg. Insulin resistance
was estimated usingHOMA-IRindex. RESULT(S): An increase in BMI
(32.0+/-4.5 vs. 30.7+/-4.1 kg/m2, p<0.0001) andwaist circumference (WC)
(109+/-12 vs. 107+/-12 cm, p=0.004) was observed at 12 months in the
rosiglitazone group, mostly attributed to increased subcutaneous adipose
tissue (AT) (SAT) (1718+/-743 vs. 1463+/-623 cm3, p<0.0001)with no change
in visceral AT (VAT) (2024+/-584 vs. 2075+/-586 cm3, p=0.41). PPAR-agonist
treated patients displayed improvements in HbA1c (6.3+/-0.7 vs. 6.6+/-0.8
%, p=0.007) and insulin resistance (3.9+/-2.4 vs. 6.0+/-3.4, p<0.0001) as
well as in several cardiometabolic parameters such as triglycerides
(p=0.0284), HDL-cholesterol (p<0.0001), free fatty acids (p=0.001) and
adiponectin levels (p<0.0001). In addition, resting BP (SBP: 135+/-18 vs.
141+/-16 mmHg, p=0.008; DBP: 71+/-9 vs. 77+/-9 mmHg), p<0.0001) and
maximal exercise DBP (84+/-15 vs. 89+/-15 mmHg, p=0.01) were reduced in
the PPAR-agonist group. Maximal exercise SBP tended to decrease (189+/-33
vs. 195+/-29 mmHg, p=0.07), whereas maximal exercise duration was
unchanged (702+/-54 vs 708+/-42 seconds, p=0.39). The proportion of men
with EIH decreased (25 vs. 39 %) in the PPAR-agonist group. In the
sub-group with EIH at baseline, resting DBP (p=0.001), resting
rate-pressure product (p=0.03), maximal exercise SBP (p=0.06) and DBP
(p=0.008), as well as recovery DBP (p=0.05) were all reduced.
 CONCLUSION(S): Treatment with the PPAR-gamma agonist rosiglitazone
for 1-yr was associated with a preferential accumulation of SAT that had
no adverse effects on hemodynamic response to exercise in T2D men. In
fact, rosiglitazone improved baseline BP and BP exercise response at
12-month follow-up, such positive effect being even more pronounced among
the subgroup of men who initially had EIH.

<101>
Accession Number
613015980
Title
Effect of intra-coronary (IC) tirofiban following aspiration thrombectomy
on infarct size, in patients with large anterior ST-segment elevation
myocardial infarction (STEMI) undergoing primary percutaneous coronary
intervention.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S253), 2016. Date of Publication: October 2016.
Author
Basuoni A.M.; El-Naggar W.M.; Mahdy M.A.; Al-Kaffas S.H.
Institution
(Basuoni, El-Naggar, Mahdy, Al-Kaffas) CairoEgypt
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Thrombus embolization during percutaneous coronary
intervention (PCI) in ST-segment elevation myocardial infarction (STEMI)
is common and RESULTS in sub-optimal myocardial perfusion and increased
infarct size. Two strategies proposed to reduce distal embolization and
improve outcomes after primary PCI are bolus intra-coronary (IC) Tirofiban
and manual Aspiration Thrombectomy. OBJECTIVE(S): To evaluate effect
of Intra-coronary delivery of bolus Tirofiban following Aspiration
Thrombectomy on reduction of infarct size using cardiac magnetic resonance
imaging (cMRI) in patients with large anterior STEMI undergoing primary
PCI. METHOD(S): A Prospective single-blind randomized controlled
trial was conducted between August, 2014 and November, 2015. 50 patients
with large anterior STEMI were screened at 2 sites in one country (Egypt).
Aspiration Thrombectomy was performed in all patients using a 6 F
aspiration catheter. Patients were randomized to IC Tirofiban (Study
group) and no IC Tirofiban (control group). To ensure high intra-thrombus
drug concentrations, a 0.25-mg/kg bolus of Tirofiban was administered
locally at the site of the infarct lesion via the aspiration catheter
after flushing of the aspiration catheter well. Assessment of final TIMI
flow and myocardial blush was done by blinded observer. OUTCOME(S):
Primary end point: Infarct Size at 30 Days measured by cMRI. Secondary end
point: Myocardial blush grade at the end of the PCI procedure. Major
Adverse Cardiac Events (MACE) at 30 days defined as re-infarction, stroke,
severe heart failure and death. Bleeding risk was assessed using TIMI
(major and minor) risk scores. RESULT(S): Evaluable MRI results at 30
days where present in only 40 of 50 patients (80%), with the most common
reasons for missing data being patient re-infarction prior to 30 days and
inability to tolerate the procedure. Patients randomized to IC Tirofiban
compared with no IC Tirofiban had a significant reduction at 30 days
infarct size (median, 15451 mm3-IQR, 17404 mm3-n=20) vs (median, 43828
mm3-IQR, 49599 mm3-n=20) P value= 0.002. Patients randomized to IC
Tirofiban compared with no IC Tirofiban had no significant difference at
post PCI Myocardial blush grade (P value= 0.67). CONCLUSION(S): In
patients with large anterior STEMI presenting early after symptom onset
and undergoing primary PCI, infarct size at 30 days was significantly
reduced by bolus IC Tirofiban delivered to the infarct lesion site
following manual Aspiration Thrombectomy. There is no significance in MACE
at 30 days between patients received bolus IC Tirofiban and patients who
did not receive. (Table presented).

<102>
Accession Number
613015787
Title
Right ventricular remodeling in peripartum cardiomyopathy: Insights from a
provincial multicenter study.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S193), 2016. Date of Publication: October 2016.
Author
Pacheco C.; Marquis-Gravel G.; Tremblay-Gravel M.; Couture E.; Avram R.;
Desplantie O.; Bibas L.; Simard F.; Berube L.; Ducharme A.; Jolicoeur M.;
Tournoux F.
Institution
(Pacheco, Marquis-Gravel, Tremblay-Gravel, Couture, Avram, Desplantie,
Bibas, Simard, Berube, Ducharme, Jolicoeur, Tournoux) MontrealQCCanada
Publisher
Pulsus Group Inc.
Abstract
INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a rare, serious
condition affecting previously healthy young women. Most of the past
studies at the early stage of the PPCM reported echocardiographic data
only on the left ventricle (LV). Right ventricular (RV) remodeling is a
strong predictor ourvival in heart failure (HF) patients, however its
prevalence in PPCM is uncertain. We sought to characterize RV remodeling
in PPCM and to determine whether its presence correlates with LV
dysfunction. METHOD(S): We conducted a retrospective multicenter
study, identifying 38 patients with PPCM, defined as HF presenting between
1-month antepartum to 5-months post partum, without an alternative cause.
Echocardiogram at diagnosis was available for offline analysis in 22
patients. A single operator was blinded to clinical data and outcomes. RV
function using tricuspid annular plan systolic excursion (TAPSE) and
fractional area change (FAC) and structural remodeling (RV dimensions)
were assessed in addition to the data on LV remodeling. RESULT(S):
Patients were 30+/-7y old and PPCM was diagnosed after delivery in all
patients. The median time between delivery and diagnosis was 6 [2-35]
days. The majority (68%, n=15) were severely symptomatic with NYHA class 4
symptoms, and 32% (n=7) required temporary mechanical support. One heart
transplantation and one death occurred during the initial hospitalization.
The LV had a mean end diastolic (LVEDD) diameter of 56+/-8 mm, with severe
dilatation in 32% (n=7). Mean LV ejection fraction (EF) was 35+/-12% and
64% had LVEF <40%. Dimensions of the RV in the parasternal long axis view
(PLAX) and in the apical view were 30+/-5mm and 36+/-5mm, respectively,
enlarged in at least one dimension for 7 (32%) patients (2 patients had
both dimensions increased). In terms of RV function, mean TAPSE was
19+/-2mm and FAC 35+/-13%. TAPSE was abnormal in 41% (n=9) of the patients
and FAC in 50% (n=11). Seven patients (32%) had abnormally low values in
both parameters. There was a significant correlation between LVEDD and
RVPLAX dimension (Figure, panel A) as well as between LVEF and FAC (panel
B). CONCLUSION(S): In our cohort, RV dilation and dysfunction at the
early stage of PPCM occurred in about one third of the patients. Its
severity correlated with LV abnormalities, suggesting that PPCM may cause
important biventricular dysfunction in a proportion of patients. To our
knowledge, this is the first Canadian data concerning detailed
echocardiographic assessment of RV remodeling in PPCM. (Figure Presented).

<103>
Accession Number
613015528
Title
Efficacy and safety of inhaled anesthetic for postoperative sedation
during mechanical ventilation in adult cardiac surgery patients: A
systematic review and meta-analysis.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S301-S302), 2016. Date of Publication: October 2016.
Author
Spence J.; Belley-Cote E.; Ma K.; Donald S.; Centofanti J.; Hussain S.;
Gupta S.; Devereaux P.; Whitlock R.
Institution
(Spence, Belley-Cote, Ma, Donald, Centofanti, Hussain, Gupta, Devereaux,
Whitlock) DundasONCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Volatile anesthetics have pharmacokinetic and pharmacodynamic
properties that are ideally suited to the cardiac surgical ICU. Since the
development of the Anesthetic Conserving Device (AnaCONDaTM, Sedana
Medical, Uppsala, Sweden), their use in this setting has increased.
Randomized trials have shown it to be associated with shorter time to
extubation and, in the cardiac surgery population, lower postoperative
biomarker peak, suggesting a potential therapeutic benefit. Existing
studies have been underpowered to show an impact on ICU or hospital
length-of-stay (LOS), major adverse cardiovascular events (MACE) or
mortality. As such, we undertook a systematic review and meta-analysis,
emphasizing their efficacy and safety in the context of a fasttrack
approach to postoperative care. METHOD(S): We searched MEDLINE,
EMBASE, Cochrane Library, ISI Web of Science, and Clinicaltrials.gov for
randomized controlled trials in postoperative, adult, cardiac surgical
patients comparing inhaled anesthetic with intravenous sedation. Crossover
studies were excluded. No language or date of publication restrictions
were applied. Primary outcomes of interest were time to extubation, ICU
LOS, and hospital LOS. Secondary outcomes included postoperative troponin
peak, MACE, and kidney injury, effectiveness of sedation, and inpatient
costs. References were screened independently and in duplicate, and
studies deemed to be potentially relevant were evaluated for inclusion by
full-text review. Risk of bias was assessed using the Cochrane tool. Data
were meta-analysed using RevMan 5.3 software (Cochrane Collaboration,
Oxford, United Kingdom) and the overall quality of evidence for each
outcome was evaluated using the GRADE framework. RESULT(S): 8 studies
including 610 patients met eligibility criteria. Studies were assessed as
having a high risk of bias because blinding and per protocol analysis.
Outcomes are summarized in Figure 1 below. Volatile anesthetic sedation
was associated with a shorter time to extubation, both after ICU admission
(SMD 76 minutes, 95% CI 150-2, very low quality evidence) and
discontinuation of sedation (SMD 74 minutes, 95% CI 126-23, moderate
quality evidence). There was no difference in ICU or hospital LOS. Peak
troponin levels were significantly lower (SMD 0.72ng/mL, 95% 1.2-0.2, high
quality evidence) in the volatile anesthetic group. Studies varied in
their reporting of MACE, which were summarized narratively.
 CONCLUSION(S): Volatile sedation is associated with shorter time to
extubation, though this does not translate to shorter ICU or hospital LOS.
Though it was associated lower postoperative troponin levels, further
study is needed to evaluate whether this surrogate outcome has an impact
on morbidity or mortality. (Table presented).

<104>
Accession Number
613015487
Title
Gait speed and operative mortality in older adults following cardiac
surgery.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S244-S245), 2016. Date of Publication: October 2016.
Author
Afilalo J.; Kim S.; O'Brien S.; Brennan J.M.; Edwards F.H.; Mack M.J.;
McClurken J.B.; Cleveland J.C.; Smith P.K.; Shahian D.M.; Alexander K.P.
Institution
(Afilalo, Kim, O'Brien, Brennan, Edwards, Mack, McClurken, Cleveland,
Smith, Shahian, Alexander) MontrealQCCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Prediction of operative risk is a critical step in
decision-making for cardiac surgery. Existing risk models may be improved
by integrating a measure of frailty such as 5-meter gait speed to better
capture the heterogeneity of the older adult population. Previous studies
suggested that gait speed was predictive of surgical complications, albeit
with limited sample sizes underpowered to detect differences in mortality.
Thus, we sought to determine the association of 5-meter gait speed with
operative mortality in older adults undergoing cardiac surgery.
 METHOD(S): We conducted a prospective cohort study at 119 centres
participating in the Society of Thoracic Surgeons (STS) Adult Cardiac
Surgery Database from 2011 to 2014. The 5-meter gait speed test was
performed in patients aged 60 years or older undergoing coronary artery
bypass, aortic valve surgery, mitral valve surgery, and combined
procedures. The endpoints of interest were all-cause mortality during the
first 30 days after surgery; secondarily, a composite outcome of mortality
or major morbidity during the index hospitalization. RESULT(S): The
cohort consisted of 15,171 cardiac surgery patients including 2,481
octogenarians. The median age was 71 years and 31% were female. Compared
to patients in the fastest gait speed tertile (>1.00 m/s), operative
mortality was increased for those in the middle tertile (0.83-1.00 m/s; OR
1.77, 95% CI 1.34 to 2.34) and slowest tertile (<0.83 m/s; OR 3.16, 95% CI
2.31 to 4.33). After adjusting for the STS predicted risk of mortality and
the surgical procedure, gait speed remained independently predictive of
operative mortality (OR 1.11 per 0.1 m/s decrease gait speed, 95% CI 1.07
to 1.16). Gait speed was also predictive of the composite outcome of
mortality or major morbidity (OR 1.03 per 0.1 m/s decrease gait speed, 95%
CI 1.00 to 1.05). Addition of gait speed to the STS predicted risk
resulted in a c-statistic change of 0.005 and an integrated discrimination
improvement of 0.003. CONCLUSION(S): Gait speed is an independent
predictor of adverse outcomes after cardiac surgery, with each 0.1 m/s
decrease conferring an 11% relative increase in mortality. Gait speed can
be used to refine estimates of operative risk, to support decision-making,
and, since incremental value is modest when used as a sole criterion for
frailty, to screen older adults that could benefit from further geriatric
assessment.

<105>
Accession Number
613015419
Title
Transcatheter aortic valve implantation (TAVI) in native aortic valve
regurgitation: A systematic review.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S100), 2016. Date of Publication: October 2016.
Author
MacDonald Z.D.; Yousef A.; Simard T.; Russo J.J.; Feder J.; Froeschl M.V.;
Dick A.; Glover C.; Burwash I.G.; Hibbert B.; Labinaz M.
Institution
(MacDonald, Yousef, Simard, Russo, Feder, Froeschl, Dick, Glover, Burwash,
Hibbert, Labinaz) OttawaONCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Transcatheter Aortic Valve Implantation (TAVI) has redefined
the treatment strategy in patients with severe aortic stenosis. However,
small case reports have been published about its performance in patients
suffering from native aortic regurgitation (NAVR) with prohibitive or high
risk for surgical intervention. OBJECTIVE(S): This is the first
systematic review conducted in the literature to evaluate the safety and
feasibility of TAVI in patients with NAVR. METHOD(S): All published
articles and abstracts in English language were systematically reviewed
between 2002 and 2016 in Medline, Embase, Pubmed, Cochrane Controlled
Trials Register (CCTR) and Cochrane Database of Systematic Reviews (CDSR).
We have only included patients with pure severe aortic regurgitation who
underwent TAVI. Primary endpoint is device success. Secondary endpoint
included procedural complications (paravalvular leak AR2+, major bleeding,
stroke, acute myocardial infarction, acute kidney injury, pacemaker
insertion) and early and late clinical outcomes (30 day and one year
mortality rate, cardiovascular mortality rate and NYHA I/II).
 RESULT(S): A total of 176 patients were included from 31 studies. The
majority of patients (92.2%) are reported to have NYHA class III/IV, with
a mean STS score and Log-Euroscore of 9.5% and 23.8% respectively.
Majority of patients (55.4%) received first generation self-expandable
valve. Device success was reported in 85.8% of patients. Secondary
endpoint showed no procedural death, myocardial infarction or annulus
rupture. PVL 2+ was noted in 17.6%, stroke rate of 1.5%, major bleeding in
11.4%, and pacemaker in 10.7%. A 30 day and 1 year mortality rate of 9.6%
and 21.3% were found respectively. More than 80% of patients had
remarkable improvement in their shortness of breath with NYHA I/ II at 30
days. CONCLUSION(S): In this cohort study of patients with aortic
regurgitation and prohibitive surgical risk, TAVI seems feasible and with
reasonable safety outcome.

<106>
Accession Number
613015347
Title
Comparison of mechanically expanded and self-expanding transcatheter
aortic valve prostheses.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S126-S127), 2016. Date of Publication: October 2016.
Author
Chan A.; Wong D.; Latham T.; Charania J.; Drescher L.
Institution
(Chan, Wong, Latham, Charania, Drescher) New WestminsterBCCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: The latest generation mechanically expanded Lotus Valve System
offers potential benefits over the self-expanding CoreValve and Evolut-R
System by having full repositionability and adaptive seal that reduce the
risk of coronary obstruction and paravalvular regurgitation. There has
been no comparative data of the two valve systems in the real world
practice. METHOD(S): From 01/2013 to 04/2016, 172 patients underwent
transcatheter aortic valve implantation in our institution. All clinical
and procedural data were prospectively recorded. All endpoints were
defined according to Valve Academic Research Consortium-2. RESULT(S):
A total of 140 patients received self-expanding transcatheter heart valves
(120 Corevalve and 20 Evolut-R) and 32 patients received Lotus Valve. The
overall age (84.8+/-5.8 years), gender (43% females), and the Society of
Thoracic Surgeons Predicted Risk of Mortality (6.7+/-4.8%) were similar
between the 2 groups. Device success was 100% for the Lotus group and
87.9% for the self-expanding cohort (p=0.04), and the difference was
largely driven by the lower rate of moderate-severe paraprosthetic
regurgitation (0% vs 10.7%, respectively; p=0.07). The rates of all-cause
mortality (0% vs 0.3%, respectively; p=1.0), stroke (0% vs 1.4%,
respectively; p=1.0), coronary obstruction (0% vs 2%, respectively;
p=1.0), and new pacemaker implantation (28% vs 23%, respectively; p=0.63),
were similar at 30 days in the Lotus and self-expanding valve cohorts.
Significantly higher proportion of patients in the Lotus group underwent
the procedure under conscious sedation as compared to those receiving the
self-expanding valve (72% vs 24%, respectively; p<0.01), without the need
of transesophageal echocardiography monitoring during the prosthesis
deployment. CONCLUSION(S): In this non-randomized comparison within
the high-surgical risk cohort undergoing transcatheter aortic valve
implantation, the mechanically expanded Lotus Valve was associated with a
higher rate of device success than the self-expanding prostheses, largely
related to the more accurate positioningwhich in turn resulted in less
incidence of significant paraprosthetic regurgitation. A large randomized
study with a longer term follow-up will be needed to confirm the clinical
significance of this observation.

<107>
Accession Number
613015338
Title
Right ventricular strain rate prior to stage 2 palliation (Glenn) improves
test sensitivity and negative predictive value for death or
transplantation in children with hypoplastic left heart syndrome.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S184), 2016. Date of Publication: October 2016.
Author
Lin L.; Conway J.; Alvarez S.; Goot B.; Tham E.B.; Colen T.; Kutty S.;
Khoo N.S.
Institution
(Lin, Conway, Alvarez, Goot, Tham, Colen, Kutty, Khoo) EdmontonABCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Right ventricular (RV) dysfunction is a risk factor for
mortality in children with hypoplastic left heart syndrome (HLHS). RV
fractional area change (FAC) < 35% is the current two-dimensional
echocardiographic standard for denoting RV dysfunction. Speckle tracking
echocardiography strain rate (SR) is increasingly recognized as a measure
of ventricular contractility. The objective of this study is to assess the
sensitivity and specificity of RV FAC and SR prior to Glenn operation for
predicting death or heart transplantation. METHOD(S): We
prospectively recruited 43 children with HLHS who successfully underwent
their Glenn surgery. RV FAC and longitudinal (long) and circumferential
(circ) strain (S) and SR were measured on echocardiograms performed at an
average of 28 days prior to their Glenn surgery. Patients were divided
into those alive (Group 1) and those who died or underwent heart
transplantation (Group 2) at latest follow up. Echocardiographic analyses
comparing groups were performed blinded to outcome. Receiver Operating
Characteristic area under the curve for S and SR were plotted and cutoff
values optimizing sensitivity and specificity were derived.
 RESULT(S): The subtypes of HLHS included mitral and aortic stenosis
(11), mitral stenosis and aortic atresia (20) and mitral and aortic
atresia (12). The cohort contained 28 male patients (65%). The mean
follow-up was 5.4 +/- 2.3 years. There were 35 patients in Group 1 and 8
patients in Group 2 with 6 deaths and 2 transplantations. Group 2 had
reduced long and circ SR and RV FAC (Table 1a). RV FAC < 35% had 50%
sensitivity and 94% specificity with 67% positive predictive value and 89%
negative predictive value for predicting death/ transplantation. The
addition of either long SR > -0.97 1/s (AUC 0.82, p < 0.001) or circ SR >
-0.86 1/s (AUC is 0.83, p < 0.001) increased test sensitivity and negative
predictive value for predicting death or transplantation (Table 1b).
 CONCLUSION(S): In children with hypoplastic left heart syndrome,
reduced RV FAC is specific, but not sensitive for predicting death or
transplantation following Glenn operation. The addition of long or circ SR
by speckle tracking echocardiography increased sensitivity and improved
negative predictive value. SR in combination with RV FAC may be a useful
tool for medium term prognostication in HLHS patients and warrants further
investigation. (Table Presented).

<108>
Accession Number
613015314
Title
Indications and midterm outcomes of geriatric congenital cardiac surgery:
A multicenter study.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S183-S184), 2016. Date of Publication: October 2016.
Author
Mazine A.; Laurin C.; Han Yee Yu M.; Iriart X.; Khairy P.; Roubertie F.;
Poirier N.C.
Institution
(Mazine, Laurin, Han Yee Yu, Iriart, Khairy, Roubertie, Poirier)
TorontoONCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: The prevalence of adult congenital heart disease (ACHD) is
increasing. There is a paucity of data regarding surgical treatment of
congenital heart defects in patients 60 years of age and older. The
purpose of this study was to examine the surgical indications and midterm
clinical and echocardiographic results of surgical intervention in this
patient population. METHOD(S): Clinical and echocardiographic data
were retrospectively gathered from a surgical database of ACHD in two
tertiary academic centers. Patients with isolated congenital aortic valve
disease were excluded from the present analysis. The median follow-up was
26 months (IQR 3-55 months). RESULT(S): Between 2000 and 2015, 91
consecutive patients (mean 67+/-5 years; range 60-82 years) underwent
surgery for a congenital cardiac defect. Thirty-seven patients (41%) were
in NYHA class-III/IV. The mean preoperative EuroSCORE II was 4.1+/-6.1%
(range 0.6-44.2%). Nineteen patients (21%) had undergone previous cardiac
surgery. Cardiac diagnoses included Ebstein anomaly in 7 patients,
atrioventricular septal defect in 13, secundum atrial septal defect (ASD)
in 23, sinus venosus ASD in 24, pulmonary stenosis/ Tetralogy of Fallot in
12, coarctation in 2, and coronary anomalies in 2, and miscellaneous
defects in 8. Preoperative echocardiography revealed moderate tricuspid
regurgitation (TR) in 30 patients (33%), and severe TR in 20 (22%), with a
calculated mean systolic pulmonary artery pressure (sPAP) of 44+/-15 mmHg
(range: 20-104 mmHg). Operative mortality occurred in 3 patients (4%). The
cause of death was cardiogenic shock in 2 patients and respiratory failure
in 1. In addition, one patient with documented Child B cirrhosis died 2
months postoperatively of aspergillosis peritonitis. The median ICU stay
was 2 days (IQR 1-4). Thirty-three patients (36%) received a blood product
transfusion. Postoperative morbidity included arrhythmias necessitating
medication in 22 patients (24%), pericardial effusion drainage in 4 (4%),
acute renal insufficiency in 6 (7%), and a permanent pacemaker
implantation in 2 (2%). At last follow-up, only 2 patients were in NYHA
functional class >II/IV. Follow-up echocardiography showed residual
moderate TR in 11 patients, severe TR in 3, with a mean estimated sPAP of
35+/-13 mmHg (range 12-72 mm Hg). CONCLUSION(S): The majority of our
geriatric ACHD patients underwent surgery for either shunt lesions or
right heart valve lesions. Despite this high predicted risk of mortality,
our data demonstrate that surgery can be performed safely in this patient
population. Surgical therapy led to improvement in functional status,
systolic PAP and TR at intermediate follow-up.

<109>
Accession Number
613015306
Title
Surgical ablation of atrial fibrillation in 11 countries: The LAAOS III
trial.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S98), 2016. Date of Publication: October 2016.
Author
Belley-Cote E.P.; Connolly S.J.; Brady K.; Singal R.K.; Healey J.; Lamy
A.; Balasubramanian K.; Devereaux P.J.; Whitlock R.P.
Institution
(Belley-Cote, Connolly, Brady, Singal, Healey, Lamy, Balasubramanian,
Devereaux, Whitlock) HamiltonONCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Atrial fibrillation (AF) ablation can be performed at the time
of cardiac surgery. However, uncertainty persists regarding its efficacy,
optimal patient selection, and the choice of lesion set. METHOD(S):
LAAOS III is an ongoing international randomized controlled trial of
surgical left atrial appendage occlusion versus no occlusion in patients
with a history of AF undergoing cardiac surgery. In this trial, the
conduct of AF ablation is at the discretion of the local surgeon. We
compared the characteristics of enrolled patients with at least 6 months
of follow-up, including the conduct of surgical AF ablation and specific
lesion sets, energy used, and outcomes. RESULT(S): Of the 1541
randomized patients, 880 had completed 6 months of follow-up. In the 36
centres in 11 countries, AF ablation rates varied from 0% to 100%.
Sixtyone of 127 surgeons (48%) performed AF ablation in 293 (33%)
patients. Patients who underwent AF ablation were significantly younger
(70+/-9 years vs. 73+/-9 years; p<0.01) and more likely to require
isolated valve surgery (relative risk [RR] 1.4; 95% confidence interval
[CI] 1.1, 1.8; p<0.01). Patients with paroxysmal AF were more likely to be
ablated (paroxysmal 169/453 [37%] vs. non-paroxysmal 123/420 [29%],
p=0.01). AF was present on the baseline ECG in 56% (164/293) of ablation
patients and in 57% (331/583) of non-ablation patients (p=0.82). In
patients with concomitant AF ablation, surgeons performed bi-atrial
ablation in 125 (43%) patients, complete left atrial ablation in 98
patients (33%) and pulmonary vein isolation in 70 patients (24%).
Radiofrequency was the most frequently used energy (69%) followed by
cryotherapy (19%), cut and sew (11%), and laser and microwave (1%). Exit
block confirmation was performed in 98 patients (33%). At the latest
follow-up, significantly more patients who had undergone AF ablation were
taking anti-arrhythmic drugs (31% vs 13%, p<0.001). Sinus rhythm was more
common in the ablated patients at hospital discharge (57% vs. 43%; RR 1.3;
95% CI [1.2, 1.5]; p<0.01), 30 days of follow-up (41% vs. 28% RR 1.4; 95%
CI [1.2, 1.7]; p<0.01 ), and 6 months (30% vs. 21% RR 1.4; 95% CI [1.1,
1.8]; p<0.01). CONCLUSION(S): The use of surgical AF ablation ranges
from 0% to 100% across 36 sites in 11 countries. In an international
cardiac surgery trial recruiting AF patients, 33% undergo concomitant AF
ablation. Most surgeons perform bi-atrial lesions and use radiofrequency
ablation. AF ablation modestly reduces AF recurrence.

<110>
Accession Number
613015277
Title
Surgical atrial fibrillation ablation: A systematic review of randomized
trials.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Montreal, QC Canada. 32(10 Supplement 1)
(pp S97), 2016. Date of Publication: October 2016.
Author
McClure G.R.; Belley-Cote E.P.; Dvirnik N.; An K.; Fortin G.; Jaffer I.;
Spence J.; Singal R.K.; Whitlock R.P.
Institution
(McClure, Belley-Cote, Dvirnik, An, Fortin, Jaffer, Spence, Singal,
Whitlock) HamiltonONCanada
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Surgical ablation for atrial fibrillation significantly
improves maintenance of sinus rhythm and is recommended as a concomitant
procedure in patients undergoing cardiac surgery. However, a recent
randomized trial (RCT) suggested harm by surgical ablation with an almost
threefold increase in the requirement for permanent pacemaker
postablation. The small to medium size published trials lack power to
assess for patient-important outcomes such as mortality, stroke, and
pacemaker requirement. We performed a systematic review and meta-analysis
to evaluate the efficacy and safety of surgical AF ablation.
 METHOD(S): Wesearched CochraneCENTRAL,MEDLINE and EMBASE from
inception to July 2015 for RCTs evaluating surgical AF ablation, including
any lesion set, versus no surgical AF ablation in adults with AF
undergoing any type of cardiac surgery. We performed reference screening,
full-text eligibility assessment, risk of bias evaluation and data
collection independently and in duplicate. We evaluated the risk of bias
for individual studies with the modified Cochrane tool and we pooled data
using a random effects model in Revman 5.3. We evaluated the overall
quality of evidence with the GRADE framework. RESULT(S): We
identified 22 studies (including 1668 patients) meeting eligibility
criteria. Sixteen included studies were considered at high risk of bias.
SurgicalAF ablationwas associated with more freedom from AF at 12 months
(RR 2.35, 95% CI [1.92 to 2.88], p<0.001, I2 = 46%, low quality). However,
no significant difference was seen in mortality (RR 0.99, 95% CI [0.68 to
1.43], I2=0%,moderate quality), stroke (RR1.19, 95% CI [0.59 to 2.39], p=,
0.63, I2=0% moderate quality), and pacemaker implantation (RR 1.27, 95% CI
[0.82 to 1.98], p=0.28, I2= 3%, high quality). When comparing pulmonary
vein isolation (PVI) and Cox Maze lesion sets, no significant difference
was seen in freedom from AF at 12 months (p for interaction=0.06),
mortality (p for interaction=0.87) or stroke (p for interaction=0.21)).
However, Cox Maze procedures conferred a significantly increased risk of
pacemaker requirement (RR 3.01, 95%CI[1.54 to 5.88], p=0.001, I2=0%) while
PVI lesion sets did not (RR 1.04, 95%CI[0.65 to 1.66], p=0.52, I2=0%),
this difference was significant (p for interaction=0.01).
 CONCLUSION(S): Surgical AF ablation concomitant to cardiac surgery
improved freedom from AF on follow-up. However, patient-important outcomes
including mortality and stroke did not differ between groups. Maze
procedures when compared to PVI showed no difference in freedom from AF,
mortality or stroke but was associated with a significantly increased risk
of pacemaker requirement. (Figure Presented).

<111>
Accession Number
614798045
Title
Intracavitary ECG for tip location in atrial fibrillation patients.
Source
JAVA - Journal of the Association for Vascular Access. Conference: Annual
Scientific Meeting of the Association for Vascular Access, AVA 2016. Lake
Buena Vista, FL United States. 21(4) (pp 252-253), 2016. Date of
Publication: December 2016.
Author
Pittiruti M.; La Greca A.; Biasucci D.
Publisher
Elsevier B.V.
Abstract
Purpose/Design: Prospective observational cohort pilot study to assess if
intracavitary electrocardiography (IC-ECG) may be used for placing the tip
of a central venous access device at the caval-atrial junction (CAJ) in
patients with atrial fibrillation (AF). Primary end-point: to verify if a
difference in IC-ECG at different tip positions can be detected and used
to locate the CAJ. Secondary end-point: safety of the method, in terms of
incidence of rhythm disturbances and other undesired effects.
 Method(s): Ten adult patients with AF undergoing cardiac surgery and
needing trans-esophageal echocardiography (TEE) for intraoperative
monitoring were prospectively enrolled. Exclusion criteria were the
presence of a pacemaker and contraindications to TEE. A 7.5 Fr
chlorhexidine-coated triple lumen CVAD was inserted by ultrasound-guided
puncture of a central vein. Under TEE and IC-ECG control, the CVAD was
advanced and its tip position recorded as follows: right atrium, 2 cm
below the CT (CAJ+2); superior vena cava, 2 cm above the CT (CAJ-2); at
the CT (final position, CAJ). The IC-ECG at each tip position was recorded
and analyzed. Result(s): CVAD insertion was successful and uneventful
in all patients. An increase in the mean IC-ECG amplitude of the f waves
in the T-Q segment was recorded with the J-tip placed at the CT; a clear
reduction in amplitude was evident in the two alternative positions in all
patients. ECG traces have been renamed according to a random sequence and
post-procedural qualitative (width of the f waves) and quantitative
(energy of the electrical signal recorded in the TQ tract) analysis
performed by a blinded expert cardiologist confirmed the results.
 Conclusion(s): IC-ECG is feasible, safe and accurate in verifying
correct tip location at the CAJ in patients with AF.

<112>
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

<113>
Accession Number
2035936156
Title
Anatomic and Physiologic Repair of Congenitally Corrected Transposition of
the Great Arteries.
Source
Journal of the American College of Cardiology. 84(25) (pp 2471-2486),
2024. Date of Publication: 17 Dec 2024.
Author
Jacob K.A.; Horer J.; Hraska V.; Agbor V.N.; Duchateau S.; van Wijk A.;
Barron D.J.; Schoof P.H.
Institution
(Jacob, Duchateau, van Wijk, Schoof) Division of Pediatrics,
Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical
Center Utrecht, Utrecht, Netherlands
(Horer) German Heart Center Munich, Technical University of Munich School
of Medicine, Munich, Germany
(Horer) University Hospital of Munich, Ludwig-Maximilians-Universitat,
Munich, Germany
(Hraska) Department of Surgery, Medical College of Wisconsin, Herma Heart
Institute, Children's Wisconsin, Milwaukee, WI, United States
(Agbor) Clinical Trial Service Unit and Epidemiological Studies Unit,
Nuffield Department of Population Health, University of Oxford, Oxford,
United Kingdom
(Barron) Department of Cardiovascular Surgery, Hospital for Sick Children,
Toronto, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: Congenitally corrected transposition of the great arteries
(ccTGA) is a rare cardiac anomaly. The management strategy historically
consisted of physiologic repair, leaving the morphologic right ventricle
to support the systemic circulation. More recently, anatomic repair has
been implemented to bring the left ventricle into the systemic
circulation. Uncertainty persists about which repair strategy has the best
outcome. Objective(s): This meta-analysis aimed to summarize the
long-term mortality risks following anatomic and physiologic repair of
ccTGA. Method(s): PubMed, Embase, and the Cochrane Database were
searched. Data were extracted using prespecified data forms. The primary
outcome was the composite risk of all-cause mortality or heart
transplantation during hospitalization and at 1, 5, and 10 years of
follow-up. Secondary outcomes included reintervention risk.
 Result(s): Forty-seven studies totaling 2,844 patients were included.
The incidence risk of mortality at 10 years was 11.7% (95% CI: 8.5%-15.3%)
and 17.4% (95% CI: 12.4%-23.0%) in the anatomic and physiologic repair
groups, respectively. The incidence risk of reintervention at 10 years was
24.5% (95% CI: 19.2%-30.1%) and 30.3% (95% CI: 23.5%-37.6%), respectively.
The primary outcome was significantly lower at 10 years in anatomically
repaired patients who had surgery at <5 years of age and who had
preoperative pulmonary artery banding (P<inf>heterogeneity</inf> < 0.01).
 Conclusion(s): Anatomic repair of ccTGA patients results in higher
overall and reintervention-free survival compared to physiologic repair.
Specifically, patients who had anatomic repair at <5 years of age or who
had preoperative pulmonary artery banding have better
survival. Copyright © 2024 American College of Cardiology
Foundation

<114>
Accession Number
2032331736
Title
The clinical effectiveness and safety of low/moderate-intensity statins &
ezetimibe combination therapy vs. high-intensity statin monotherapy: a
systematic review and meta-analysis.
Source
BMC Cardiovascular Disorders. 24(1) (no pagination), 2024. Article Number:
660. Date of Publication: December 2024.
Author
Sydhom P.; Al-Quraishi B.; El-Shawaf M.; Osman M.T.; Naji N.; Awwad N.;
Shehata N.; Osama M.; Sergany H.; Maurice K.F.; Sayed A.
Institution
(Sydhom, Al-Quraishi, El-Shawaf, Osman, Naji, Awwad, Shehata, Osama,
Sergany, Maurice, Sayed) Faculty of Medicine, Ain-Shams University, 56Th
Abbaseyia Street, Cairo, Egypt
Publisher
BioMed Central Ltd
Abstract
Background: Despite widespread use of high-intensity statin monotherapy,
achieving target LDL-C levels and reducing cardiovascular events in
patients with or at high risk of developing ASCVD remains challenging. Our
study measured the effects of low/moderate-intensity statins and ezetimibe
combination therapy compared to high-dose statin monotherapy on major
adverse cardiovascular events (MACEs) and coronary atherosclerotic plaque
reduction. Method(s): We searched PubMed, Scopus, Web of Science, and
Cochrane CENTRAL register of trials for studies comparing the combination
therapy to high-intensity statin monotherapy in terms of MACEs and
coronary atherosclerotic plaque reduction. The primary outcome was a
composite of cardiovascular death or major cardiovascular events (MI, HF,
Revascularization, or non-fatal stroke). Other outcomes included other
MACEs, lipid-lowering efficacy, and safety outcomes. A protocol was
registered to PROSPERO under registration number [CRD42024545807].
 Result(s): 15 studies encompassing 251,450 participants were included
in our meta-analysis. In our pooled analysis of observational studies,
combination therapy was associated with lower rates of the primary
composite outcome (HR = 0.76, CI 95% [0.73, 0.80]), cardiovascular death
(HR = 0.80, CI 95% [0.74, 0.88]), all-cause death (HR = 0.84, CI 95%
[0.78, 0.91]), and non-fatal stroke (HR = 0.81, CI 95% [0.75, 0.87]).
However, the pooled analysis of RCTs did not demonstrate a statistically
significant difference between both arms concerning clinical endpoints.
Combination therapy had a higher number of patients with LDL-C < 70 mg/dL
(RR = 1.27, CI 95% [1.21, 1.34]), significantly lowered LDL-C (MD = -7.95,
CI 95% [-10.02, -5.89]) and TC (MD = -26.77, CI 95% [-27.64, -25.89]) in
the pooled analysis of RCTs. In terms of safety, the combination therapy
lowered muscle-related adverse events (RR = 0.52, CI 95% [0.32, 0.85]) and
number of patients with liver enzyme elevation (RR = 0.51, CI 95% [0.29,
0.89]) in the pooled analysis of RCTs and was associated with lower rates
of new-onset diabetes (HR = 0.80, CI 95% [0.74, 0.87]) in the pooled
analysis of observational studies. Conclusion(s): Evidence from RCTs
indicates that low/moderate statin therapy in combination with ezetimibe
has a superior lipid-lowering effect and reduces side effects compared to
high-dose statins. Observational studies suggest improved clinical
outcomes but need to be corroborated by large, outcomes-powered RCTs over
longer follow-up periods. Copyright © The Author(s) 2024.

<115>
Accession Number
621978576
Title
Reducing risk of spinal haematoma from spinal and epidural pain
procedures.
Source
Scandinavian Journal of Pain. 18(2) (pp 129-150), 2018. Date of
Publication: 25 Apr 2018.
Author
Breivik H.; Norum H.; Fenger-Eriksen C.; Alahuhta S.; Vigfusson G.; Thomas
O.; Lagerkranser M.
Institution
(Breivik) Oslo University Hospital, Division of Emergencies and Critical
Care, Department of Pain Management and Research, Oslo 0424, Norway
(Breivik) University of Oslo, Faculty of Medicine, Oslo, Norway
(Norum) Oslo University Hospital, Division of Emergencies and Critical
Care, Department of Anaesthesiology, Oslo, Norway
(Fenger-Eriksen) Department of Anaesthesiology, Aarhus University
Hospital, Aarhus, Denmark
(Alahuhta) Department of Anaesthesiology, MRC Oulu, University of Oulu,
Oulu University Hospital, Oulu, Finland
(Vigfusson) Department of Anaesthesia and Intensive Care, University
Hospital Landspitalinn, Reykjavik, Iceland
(Thomas) Institute of Clinical Sciences, University of Lund, Department of
Paediatric Anaesthesiology and Intensive Care, SUS Lund University
Hospital, Lund, Sweden
(Lagerkranser) Section for Anaesthesiology and Intensive Care Medicine,
Department of Physiology and Pharmacology, Karolinska Institute,
Stockholm, Sweden
Publisher
Walter de Gruyter GmbH
Abstract
Central neuraxial blocks (CNB: epidural, spinal and their combinations)
and other spinal pain procedures can cause serious harm to the spinal cord
in patients on antihaemostatic drugs or who have other risk-factors for
bleeding in the spinal canal. The purpose of this narrative review is to
provide a practise advisory on how to reduce risk of spinal cord injury
from spinal haematoma (SH) during CNBs and other spinal pain procedures.
Scandinavian guidelines from 2010 are part of the background for this
practise advisory. We searched recent guidelines, PubMed (MEDLINE), SCOPUS
and EMBASE for new and relevant randomised controlled trials (RCT),
case-reports and original articles concerning benefits of neuraxial
blocks, risks of SH due to anti-haemostatic drugs, patient-related risk
factors, especially renal impairment with delayed excretion of
antihaemostatic drugs, and specific risk factors related to the neuraxial
pain procedures. Epidural and spinal analgesic techniques, as well as
their combination provide superior analgesia and reduce the risk of
postoperative and obstetric morbidity and mortality. Spinal pain procedure
can be highly effective for cancer patients, less so for chronic
non-cancer patients. We did not identify any RCT with SH as outcome. We
evaluated risks and recommend precautions for SH when patients are treated
with antiplatelet, anticoagulant, or fibrinolytic drugs, when patients'
comorbidities may increase risks, and when procedure-specific risk factors
are present. Inserting and withdrawing epidural catheters appear to have
similar risks for initiating a SH. Invasive neuraxial pain procedures,
e.g. spinal cord stimulation, have higher risks of bleeding than
traditional neuraxial blocks. We recommend robust monitoring routines and
treatment protocol to ensure early diagnosis and effective treatment of SH
should this rare but potentially serious complication occur. When
neuraxial analgesia is considered for a patient on anti-haemostatic
medication, with patient-related, or procedure-related risk factors, the
balance of benefits against risks of bleeding is decisive; when CNB are
offered exclusively to patients who will have a reduction of postoperative
morbidity and mortality, then a higher risk of bleeding may be accepted.
Robust routines should ensure appropriate discontinuation of
anti-haemostatic drugs and early detection and treatment of SH. There is
an on-going development of drugs for prevention of thromboembolic events
following surgery and childbirth. The present practise advisory provides
up-to-date knowledge and experts' experiences so that patients who will
greatly benefit from neuraxial pain procedures and have increased risk of
bleeding can safely benefit from these procedures. There are always
individual factors for the clinician to evaluate and consider.
Increasingly it is necessary for the anaesthesia and analgesia provider to
collaborate with specialists in haemostasis. Surgeons and obstetricians
must be equally well prepared to collaborate for the best outcome for
their patients suffering from acute or chronic pain. Optimal pain
management is a prerequisite for enhanced recovery after surgery, but
there is a multitude of additional concerns, such as early mobilisation,
early oral feeding and ileus prevention that surgeons and anaesthesia
providers need to optimise for the best outcome and least risk of
complications. Copyright © 2018 2018 Harald Breivik et al.,
published by De Gruyter, Berlin/Boston.

<116>
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.

<117>
Accession Number
2029315917
Title
Retraction speed and chronic poststernotomy pain: A randomized controlled
trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 168(6) (pp 1560-1567.e1),
2024. Date of Publication: December 2024.
Author
Phelan R.; Petsikas D.; Shelley J.; Hopman W.M.; DuMerton D.; Parry M.;
Payne D.; Allard R.; Cummings M.; Parlow J.L.; Tanzola R.; Wang L.T.S.;
Stewart C.; Saha T.K.
Institution
(Phelan, Shelley, DuMerton, Allard, Cummings, Parlow, Tanzola, Wang, Saha)
Department of Anesthesiology and Perioperative Medicine, Queen's
University, Kingston, ON, Canada
(Petsikas, Payne) Division of Cardiac Surgery, Department of Surgery,
Queen's University, Kingston, ON, Canada
(Hopman) Kingston General Health Research Institute, Kingston Health
Sciences Centre, Kingston, ON, Canada
(Hopman) Department of Public Health Sciences, Queen's University,
Kingston, ON, Canada
(Parry) Lawrence S. Bloomberg Faculty of Nursing, University of Toronto,
Toronto, ON, Canada
(Stewart) School of Medicine, Queen's University, Kingston, ON, Canada
Publisher
Elsevier Inc.
Abstract
Objectives: Approximately 30% of patients develop chronic poststernotomy
pain (CPSP) following cardiac surgery with sternal retraction. Risk
factors have been described but no causal determinants identified.
Investigators hypothesized that opening the sternum slowly would impart
less force (and thereby less nerve/tissue damage) and translate to a
reduced incidence of CPSP. The main objectives were to determine whether
or not slower sternal retraction would reduce the incidence of CPSP and
improve health-related quality of life. Method(s): Patients
undergoing coronary artery bypass graft surgery were recruited to this
randomized controlled trial. Patients were randomized to slow or standard
retraction (ie, sternum opened over 15 minutes vs 30 seconds,
respectively). Although the anesthesiologist and surgeon were aware of the
randomization, the patients, assessors, and postoperative nursing staff
remained blinded. Sternotomy pain and analgesics were measured in
hospital. At 3, 6, and 12 months postoperatively, all patients completed
the Medical Outcomes Survey Short Form and reported on CPSP and
complications requiring rehospitalization. Thirty-day rehospitalizations
and mortality were recorded. Result(s): In total, 326 patients
consented to participate and 313 were randomized to slow (n = 159) versus
standard retraction (n = 154). No clinically relevant differences were
detected in acute pain, analgesic consumption, or the incidence of CPSP or
health-related quality of life. Although the slow group had significantly
more hospitalizations at 3 and 12 months postoperatively, the reasons were
unrelated to retraction speed. No differences were observed in 30-day
rehospitalizations or mortality. Conclusion(s): All outcomes were
consistent with previous reports, but no clinically significant
differences were observed with retraction speed. Copyright © 2023
The American Association for Thoracic Surgery

<118>
Accession Number
2035038346
Title
Impact of Renal and Liver Function on Clinical Outcomes Following
Tricuspid Valve Transcatheter Edge-to-Edge Repair.
Source
Journal of the American College of Cardiology. 84(25) (pp 2446-2456),
2024. Date of Publication: 17 Dec 2024.
Author
Jorde U.P.; Benza R.; McCarthy P.M.; Ailawadi G.; Whisenant B.; Makkar R.;
Tadros P.; Naik H.; Fam N.; Sauer A.J.; Murthy S.; Kar S.; von Bardeleben
R.S.; Hahn R.T.; Hamid N.; Zbinden J.; Sorajja P.; Adams D.
Institution
(Jorde, Murthy) Montefiore Medical Center, New York, NY, United States
(Benza, Adams) Mount Sinai, New York, NY, United States
(McCarthy) Northwestern Memorial Hospital, Chicago, IL, United States
(Ailawadi) University of Michigan, Ann Arbor, MI, United States
(Whisenant) Intermountain Healthcare, Murray, UT, United States
(Makkar) Cedars Sinai, Los Angeles, CA, United States
(Tadros) University of Kansas, Kansas City, KS, United States
(Naik) Arizona Cardiovascular Research Center, Phoenix, AZ, United States
(Fam) St Michael's Hospital, Toronto, ON, Canada
(Sauer) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Kar) Los Robles Regional, Thousand Oaks, CA, United States
(von Bardeleben) University Medical Center Mainz, Mainz, Germany
(Hahn) The New York-Presbyterian/Columbia University Irving Medical
Center, New York, NY, United States
(Hamid, Sorajja) Minneapolis Heart Institute, Minneapolis, MN, United
States
(Zbinden) Abbott, Maple Grove, MN, United States
Publisher
Elsevier Inc.
Abstract
Background: The TRILUMINATE Pivotal trial is a prospective, randomized,
controlled study of patients with severe tricuspid regurgitation (TR).
Venous congestion due to TR may lead to end-organ dysfunction and failure.
The potential to reverse or stop further deterioration in end-organ
function is an important goal of treatment. Objective(s): This study
sought to examine changes in end-organ function after tricuspid
transcatheter edge-to-edge repair (TEER) and assess the association of
baseline end-organ function with heart failure (HF) hospitalizations and
mortality. Method(s): Subjects were randomized 1:1 to either the TEER
group (TriClip System + medical therapy) or control group (medical therapy
alone). Laboratory assessments and TR grading were performed at baseline
and at all follow-up visits (discharge, 30 days, 6 months, and 12 months).
An independent echocardiography core laboratory assessed TR severity and
an independent clinical events committee adjudicated adverse events.
 Result(s): A total of 572 subjects were enrolled and randomized (285
TEER, 287 control patients). Patients with moderate-to-severe end-organ
impairment (estimated glomerular ejection fraction [eGFR] <45 mL/min/1.73
m2 or Model for End-Stage Liver Disease excluding INR [MELD-XI]
>15) at baseline had increased incidence of HF hospitalization and death
through 12 months, regardless of treatment. There were no statistically
significant differences between TEER and control patients in eGFR or
MELD-XI at 12 months. In subgroup analyses examining only successful TEER
patients (moderate or less TR at discharge) compared with control
patients, as well as when censoring patients with normal baseline values,
both eGFR (+3.55 +/- 1.04 mL/min/1.73 m2 vs 0.07 +/- 1.10
mL/min/1.73 m2; P = 0.022) and MELD-XI (-0.52 +/- 0.18 vs 0.34
+/- 0.18; P = 0.0007) improved. Conclusion(s): Baseline end-organ
function was associated with HF hospitalization and death in patients with
severe TR. At 12 months, eGFR and MELD-XI scores were not statistically
significantly different between the overall TEER and control groups. In
patients who had successful TEER, statistically significant, yet small,
favorable changes occurred for both eGFR and MELD-XI. Further
investigation is needed to assess whether these changes in end-organ
function after successful TEER are clinically meaningful and reduce HF
hospitalization or death. (Clinical Trial to Evaluate Cardiovascular
Outcomes In Patients Treated With the Tricuspid Valve Repair System
Pivotal [TRILUMINATE Pivotal]; NCT03904147) Copyright © 2024

<119>
Accession Number
2032373358
Title
Rationale and Design of Dual Antiplatelet Therapy in Patients with
Coronary Multi-Vessel Disease (DAPT-MVD): A Multicenter, Randomized,
Controlled Trial.
Source
Clinical Cardiology. 47(12) (no pagination), 2024. Article Number: e70049.
Date of Publication: December 2024.
Author
Tian J.; Wang Z.; Wang F.; Wang Y.; Zhao P.; Hou X.; Peng X.; Tian M.;
Wang D.; Yu B.
Institution
(Tian, Wang, Wang, Wang, Wang, Zhao, Hou, Peng, Yu) Department of
Cardiology, The Second Affiliated Hospital of Harbin Medical University,
Harbin, China
(Tian, Wang, Yu) State Key Laboratory of Frigid Zone Cardiovascular
Diseases (SKLFZCD), Harbin Medical University, Harbin, China
(Tian, Wang, Wang, Wang, Wang, Zhao, Hou, Peng, Yu) The Key Laboratory of
Myocardial Ischemia, Harbin Medical University, Ministry of Education,
Harbin, China
(Tian) Heilongjiang Provincial Key Laboratory of Panvascular Disease,
Harbin, China
(Tian) School of Public Health, Harbin Medical University, Harbin, China
(Wang) Global Health Trials Unit, Liverpool School of Tropical Medicine,
Liverpool, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Background: The optimal duration of dual antiplatelet therapy (DAPT) for
patients with coronary multi-vessel disease (MVD) who have received
drug-eluting stents (DES) remains unclear. Hypothesis and Methods: The
Dual Antiplatelet Therapy in Patients with Coronary Multi-Vessel Disease
(DAPT-MVD) study is a multicenter, open-label, randomized controlled trial
designed to assess the efficacy and safety of extended DAPT in MVD
patients 12 months following DES implantation. We plan to enroll 8250
patients across approximately 100 sites in China. Participants will be
randomized in a 1:1 ratio to receive either extended DAPT (75 mg
clopidogrel plus 75-150 mg aspirin daily) or monotherapy (75-150 mg
aspirin daily) beyond 12 months post-DES implantation. The follow-up
period will last at least 12 months, with all potential endpoints
adjudicated by a blinded Clinical Events Committee. The primary endpoint
is major adverse cardiovascular and cerebrovascular events (MACCE),
including cardiovascular death, nonfatal myocardial infarction, or
nonfatal stroke. Result(s): As of April 2024, a total of 8250
participants have been enrolled in the study. The mean age of the enrolled
patients was 60.5 +/- 8.8years, with 5753 (69.7%) being men.
 Conclusion(s): The DAPT-MVD study is the first large-scale trial to
evaluate the efficacy and safety of prolonged DAPT with clopidogrel plus
aspirin beyond 12 months after DES implantation in MVD patients. The trial
will provide novel insights into the optimal duration of DAPT for MVD
patients (ClinicalTrials. gov ID: NCT04624854. Registered on
10/27/2020). Copyright © 2024 The Author(s). Clinical Cardiology
published by Wiley Periodicals, LLC.

<120>
Accession Number
2032355312
Title
Comparative analysis of TPVB and ESPB for postoperative pain management in
thoracic and breast surgeries.
Source
Future Science OA. 10(1) (no pagination), 2024. Article Number: 2430852.
Date of Publication: 2024.
Author
Akram M.; Iftikhar M.R.; Fatima Q.; Ubaida M.; Khan H.; Mohsin H.; Ibrahim
M.; Wattoo M.A.H.; Tahir M.U.; Ali M.
Institution
(Akram, Iftikhar, Fatima, Ubaida, Khan, Mohsin, Wattoo, Tahir, Ali) Allama
Iqbal Medical College, Lahore, Pakistan
(Ibrahim) Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College,
Lahore, Pakistan
Publisher
Taylor and Francis Ltd.
Abstract
Objective: This meta-analysis assesses the efficacy and safety of erector
spinae block (ESPB) and paravertebral block (PVB) for managing
postoperative pain in thoracic and breast surgeries. Design(s): Data
from 12 randomized controlled trials (RCTs) published between 2019 and
2022 were included, and selected based on stringent criteria.
 Setting(s): The RCTs were conducted across various clinical settings,
including operating theaters worldwide. Patient(s): The analysis
involved 844 patients undergoing thoracic or breast surgery under regional
anesthesia, representing diverse health statuses. Intervention(s):
Patients received either PVB or ESPB, typically guided by ultrasound, for
postoperative pain control. Main Findings: PVB demonstrated superior pain
management during rest and mobility, requiring fewer additional analgesics
than ESPB. Incidences of postoperative nausea and vomiting (PONV) and
opioid consumption did not differ significantly between the methods. ESPB
showed more effective block placement. Conclusion(s): PVB is
preferred for reducing analgesic requirements and managing postoperative
pain, especially during rest and activity. ESPB offers advantages in block
placement. Surgical type and patient preferences should guide the choice
between PVB and ESPB, necessitating further research for optimized
clinical application. Copyright © 2024 The Author(s). Published
by Informa UK Limited, trading as Taylor & Francis Group.

<121>
Accession Number
2032004989
Title
Trends in Transcatheter Versus Surgical Aortic Valve Replacement Outcomes
in Patients With Low-Surgical Risk: A Systematic Review and Meta-Analysis
of Randomized Trials.
Source
Journal of the American Heart Association. 13(21) (no pagination), 2024.
Article Number: e036179. Date of Publication: 05 Nov 2024.
Author
Kazemian S.; Fallahtafti P.; Sharifi M.; Mohammadi N.S.H.; Soleimani H.;
Moghadam A.S.; Karimi E.; Sattar Y.; Jenab Y.; Mehrani M.; Hajizeinali A.;
Iskander M.; Sabet M.F.; Salehi N.; Al-Azizi K.; Hakim D.; Alam M.;
Hosseini K.
Institution
(Kazemian, Mohammadi, Soleimani, Jenab, Mehrani, Hosseini) Cardiac Primary
Prevention Research Center, Cardiovascular Diseases Research Institute,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Kazemian, Fallahtafti, Sharifi, Mohammadi, Soleimani, Moghadam, Karimi,
Jenab, Mehrani, Hajizeinali, Hosseini) Tehran Heart Center, Cardiovascular
Diseases Research Institute, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Fallahtafti, Karimi) School of Medicine, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Sattar) Department of Cardiology, West Virginia University, Morgantown,
WV, United States
(Iskander) Department of Medicine-Cardiology, Medical College of
Wisconsin, Milwaukee, WI, United States
(Sabet) Department of Internal Medicine, McLaren/Flint/Michigan State
University, Flint, MI, United States
(Salehi) Heart, Vascular and Thoracic Institute, Cleveland Clinic Akron
General Hospital, Akron, OH, United States
(Al-Azizi) Department of Cardiology, Baylor Scott and White The Heart
Hospital, Plano, TX, United States
(Hakim) Cardiovascular Division, Brigham & Women's Hospital/Harvard
Medical School, Boston, MA, United States
(Alam) The Texas Heart Institute, Baylor College of Medicine, Houston, TX,
United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Limited data exist on long-term outcomes after transcatheter
aortic valve replacement (TAVR) and surgical aortic valve replacement
(SAVR). This meta-analysis aims to elucidate outcome trends following TAVR
versus SAVR in patients with severe aortic stenosis and low-surgical risk.
METHODS AND RESULTS: A systematic search was conducted in PubMed, Embase,
Scopus, and the Cochrane Library databases from inception until May 2024,
to identify studies comparing TAVR versus SAVR in patients with
low-surgical risk (Society of Thoracic Surgeons predicted risk of
mortality score <4%). The primary outcome was all-cause mortality.
Secondary outcomes included cardiovascular mortality, stroke, disabling
stroke, rehospitalization, myocardial infarction, aortic valve
reintervention, permanent pacemaker implantation, and new-onset atrial
fibrillation. Binary random-effects models were used to compare the risk
of each outcome across various follow-up intervals and the risk of bias
was assessed using the Cochrane Collaboration's Risk of Bias-2 tool. The
meta-analysis included 6 randomized trials including 4682 patients. TAVR
was associated with a lower risk of all-cause mortality than SAVR in the
30-day (hazard ratio [HR: 0.45] [95% CI: 0.26-0.77], I2: 0%)
and 30-day to 1-year (HR: 0.55 [95% CI: 0.37-0.81], I2: 16%)
follow-ups. However, the risk of all-cause mortality was similar during
>1-year follow-ups. TAVR was associated with a significantly lower risk of
cardiovascular mortality, disabling stroke, rehospitalization, new-onset
atrial fibrillation, and a higher risk of permanent pacemaker implantation
compared with SAVR during the 30-day follow-up. CONCLUSION(S): TAVR
was associated with a lower risk of all-cause mortality within the first
year of post-procedural follow-up compared with SAVR. However, the risk of
all-cause mortality was similar in >1-year follow-ups. Copyright
© 2024 The Author(s).

<122>
Accession Number
2031983028
Title
Protocol for a Randomized Controlled Trial on the Development and
Effectiveness of an Educational Mobile Application Using an Integrated
Change Model to Prevent Atherosclerotic Cardiovascular Disease Risk
Factors.
Source
Journal of Tehran University Heart Center. 19(3) (pp 170-183), 2024. Date
of Publication: 2024.
Author
Aein A.; Solhi M.; Farahani A.V.; Aljasem M.; Alaeddini F.; Janani L.;
Omidi N.; Taghdisi M.H.
Institution
(Aein, Solhi, Taghdisi) Department of Education and Health Promotion,
School of Public Health, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Farahani, Alaeddini, Omidi) Cardiac Primary Prevention Research Center,
Cardiovascular Diseases Research Institute, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Aljasem) School of Medicine, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Janani) Department of Biostatistics, School of Public Health, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Omidi) Department of Cardiovascular Imaging, Tehran Heart Center, School
of Medicine, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Tehran Heart Center
Abstract
Background: An effective approach to preventing cardiovascular issues is
the use of mobile health applications to improve modifiable risk factors.
This protocol for a randomized controlled trial aims to evaluate the
development and effectiveness of an educational mobile app that employs an
integrated change model to reduce risk factors for atherosclerotic
cardiovascular disease (ASCVD) among individuals aged 20 to 69 years.
 Method(s): This study will be a parallel, randomized, single-blind
clinical trial utilizing the randomized block design involving 430
participants. The participants will be divided into a control group
receiving standard clinical care and an intervention group receiving
standard clinical care along with app-based education, over approximately
6 months. Conclusion(s): This application has been designed to
enhance motivation, awareness, and positive habits to reduce risk factors
in individuals at increased risk of ASCVD. Consequently, the results could
improve cardiovascular health knowledge, manage biological risk factors,
and modify cardiac behaviors through mobile applications. This research is
expected to present a promising approach to utilizing mobile apps for
managing cardiovascular health and contribute to the growing body of
research on digital health interventions. Copyright © 2024 Tehran
University of Medical Sciences.

<123>
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.

<124>
Accession Number
2035799942
Title
Outcome of surgery for congenital heart disease - A perspective from
Malaysia.
Source
Annals of Pediatric Cardiology. 17(4) (pp 229-230), 2024. Date of
Publication: 2024.
Author
Sivalingam S.
Institution
(Sivalingam) Department of Cardiothoracic Surgery, National Heart
Institute, Kuala Lumpur, Malaysia
Publisher
Wolters Kluwer Medknow Publications

<125>
Accession Number
2032219199
Title
Ciprofol versus propofol for anesthesia induction in cardiac surgery: a
randomized double-blind controlled clinical trial.
Source
BMC Anesthesiology. 24(1) (no pagination), 2024. Article Number: 412. Date
of Publication: December 2024.
Author
Yu L.; Liu X.; Zhao X.; Shan X.; Bischof E.; Lu H.-H.
Institution
(Yu, Liu, Zhao, Shan, Lu) Department of Anesthesiology, East Hospital,
Tongji University School of Medicine, Shanghai 200120, China
(Bischof) Department of Medical Oncology, School of Medicine, Renji
Hospital, Shanghai Jiao Tong University, Shanghai, China
(Bischof) Shanghai University of Medicine and Health Sciences, Shanghai,
China
Publisher
BioMed Central Ltd
Abstract
Background: Ciprofol, a novel intravenous general anesthetic with a
chemical structure similar to propofol, exhibits significantly enhanced
potency. It offers a rapid onset, reduced incidence of injection pain, and
has comparable effects on heart rate and blood pressure to propofol.
However, clinical data on its use for anesthesia induction in cardiac
surgery remain limited. Method(s): Seventy-eight patients undergoing
coronary artery bypass grafting or valve replacement surgery were randomly
assigned to receive either ciprofol (N = 40) or propofol (N = 38) for
anesthesia induction. Variables recorded included changes in mean arterial
pressure and heart rate during anesthesia, alterations in the oxygenation
index and lactic acid concentration before and 10 min after anesthesia
induction, and the incidence of adverse events such as bradycardia,
hypotension, and injection pain. Result(s): The incidence of
anesthesia-induced injection pain was significantly lower in the ciprofol
group compared to the propofol group (3% vs. 18%, P < 0.05). The incidence
of other adverse events was similar between the groups. No significant
differences in hemodynamics or oxygenation index were observed during
anesthesia induction between ciprofol and propofol. Conclusion(s):
Ciprofol demonstrated a significantly lower incidence of injection pain
compared to propofol, potentially improving patient comfort during
anesthesia induction. Additionally, ciprofol showed comparable circulatory
stability to propofol during anesthesia induction in cardiac surgery,
suggesting it may be a suitable alternative to propofol for this
application. Trial registration: The trial was registered at the
ClinicalTrials.gov on 03/10/2024 (NCT06312345). Copyright © The
Author(s) 2024.

<126>
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.

<127>
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.

<128>
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.

<129>
Accession Number
2032344118
Title
In-hospital and long-term clinical outcomes of spontaneous coronary artery
dissection (SCAD): a meta-analysis of conservative versus
revascularization approaches.
Source
Egyptian Heart Journal. 76(1) (no pagination), 2024. Article Number: 153.
Date of Publication: December 2024.
Author
Pitliya A.; Vasudevan S.S.; Yadav K.P.; Shabbir M.B.; Zahoor S.; Shabbir
A.; Ibrahim A.D.; Jeswani B.M.; Jonnala R.R.; Singla R.
Institution
(Pitliya) Department of Hospitalist Medicine, Camden Clark Medical Center,
Parkersburg, WV, United States
(Pitliya) Department of Internal Medicine, Mercy Catholic Medical Center,
Darby, PA, United States
(Vasudevan) Department of Otorhinolaryngology- Head and Neck Surgery,
Louisiana State University Health Center, Shreveport, LA, United States
(Yadav) Department of Medicine, Goa Medical College and Hospital, Goa,
India
(Shabbir, Zahoor) Department of Medicine, Army Medical College,
Rawalpindi, Pakistan
(Shabbir) Department of Medicine, King Edward Medical University, Lahore,
Pakistan
(Ibrahim) Department of Internal Medicine, Piedmont Atlanta Hospital,
Atlanta, GA, United States
(Jeswani) Department of Medicine, GCS Medical College and Hospital,
Ahmedabad, India
(Jonnala) Department of Medicine, AIIMS, Bhopal, India
(Singla) Department of Neurology, Medical University of South Carolina,
Columbia, SC, United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: The ideal treatment strategy for spontaneous coronary artery
dissection (SCAD) remains unclear, with patients potentially treated with
either conservative medical care or a revascularization approach.
 Method(s): We performed a systematic review and meta-analysis
adhering to PRISMA 2020 guidelines. Inclusion criteria involved studies
with confirmed SCAD diagnosis, reporting initial management strategies,
and original research with >= 10 participants. Random-effect models were
applied for insignificant heterogeneity with significance at p <= 0.05.
Sensitivity analysis and funnel plots assessed potential publication bias.
 Result(s): Our analysis found no significant differences in major
adverse cardiac events (MACE) (OR = 0.61, p = 0.49), unstable angina
pectoris (UAP) (OR = 1.04, p = 0.93), non-ST segment elevation myocardial
infarction (NSTEMI) (OR = 1.16, p = 0.82), recurrent myocardial infarction
(MI) (OR = 0.78, p = 0.56), stroke (OR = 0.35, p = 0.07), heart failure
(OR = 0.41, p = 0.24), in-hospital mortality (OR = 0.35, p = 0.09),
post-discharge mortality (OR = 1.66, p = 0.27), or ST segment elevation
myocardial infarction (STEMI) (OR = 0.45, p = 0.23) between conservative
management and revascularization procedures. However, sensitivity analysis
reveals significant decreases in odds of inferior wall STEMI (OR = 0.41
[95% CI 0.17-0.97], p = 0.04) and heart failure (OR = 0.18 [95% CI
0.06-0.54], p = 0.002) in conservative treatment compared to
revascularization group. Conclusion(s): Conservative therapy
significantly decreased inferior wall STEMI and heart failure as compared
to revascularization in SCAD. Although no significant differences in
cardiovascular outcomes, sensitivity analysis highlights potential
benefits of conservative management. Copyright © The Author(s)
2024.

<130>
Accession Number
2035807946
Title
Rationale and design of the multicentric randomized EVAOLD trial:
Evaluation of a strategy guided by imaging versus routine invasive
strategy in elderly patients with ischemia.
Source
American Heart Journal. 279 (pp 94-103), 2025. Date of Publication:
January 2025.
Author
Barone-Rochette G.; Vanzetto G.; Danchin N.; Steg P.G.; Hanon O.; Charlon
C.; David-Tchouda S.; Gavazzi G.; Simon T.; Bosson J.-L.
Institution
(Barone-Rochette, Vanzetto, Charlon) Department of Cardiology, University
Hospital, Alpes, Grenoble, France
(Barone-Rochette, Vanzetto) INSERM U1039, Bioclinic Radiopharmaceutics
Laboratory, Alpes, Grenoble, France
(Barone-Rochette, Vanzetto, Danchin, Steg, Simon) French Alliance for
Cardiovascular Trials, Paris, France
(Danchin) Department of Cardiology, HEGP, AP-HP, Paris, France
(Danchin) Paris-Descartes University, Sorbonne Paris Cite, Paris, France
(Steg) Universite Paris Cite, INSERM U-1148/LVTS, Paris, France
(Steg) Assistance Publique-Hopitaux de Paris, Hopital Bichat, Paris,
France
(Steg) Institut Universitaire de France, Paris, France
(Hanon) Department of Geriatrics, AP-HP, Groupe Hospitalier Paris-Centre,
Broca Hospital, Paris, France
(Hanon) EA 4468, Universite Paris Descartes, Sorbonne Paris Cite, Paris,
France
(David-Tchouda, Bosson) Grenoble Alpes University, CNRS, TIMC lab, Public
Health department Grenoble University Hospital, Grenoble, France
(David-Tchouda) Department of Health Economic and Clinical Research in
Innovation, Grenoble University Hospital, Grenoble, France
(Gavazzi) Geriatric department, Grenoble University Hospital, Grenoble,
France
(Gavazzi) Grenoble Alpes University, CNRS, TIMC lab, Grepi team, France
(Simon) Assistance Publique-Hopitaux de Paris, Department of Clinical
Pharmacology and the Clinical Research Platform of East of Paris Hopital
Saint-Antoine, Paris, France
(Simon) Sorbonne Universite, Faculte de Sante, Paris, France
(Simon) Inserm U-698, Paris, France
(Bosson) Centre d'Investigation Clinique Innovation Technologique, Inserm
CIC003, Grenoble University Hospital, Grenoble, France
Publisher
Elsevier Inc.
Abstract
Background: The management of myocardial infarction without ST segment
elevation (NSTEMI) in elderly patients remains challenging, in particular
the benefit/risk balance of routine revascularization remains uncertain.
Study design: EVAOLD is s a multicenter, prospective, open-label trial
with 2 parallel arms in NSTEMI patients >=80 years of age. The aim of the
trial is to test whether a strategy of selective invasive management
guided by ischemia stress imaging (IMG group) will be noninferior in
preventing Major Adverse Cardiac and Cerebrovascular Events (MACCE, ie
all-cause death, nonfatal myocardial infarction, nonfatal stroke) rates at
1 year compared with a routine invasive strategy (INV Group). Geriatric
assessment and cost- effectiveness analysis will also be performed. A
sample size of 1,756 patients (assuming a 10% rate of patients lost to
follow-up) is needed to show noninferiority with 80% power. Noninferiority
based on exponential survival curves will be declared if the upper limit
of the 1-sided 97.5% confidence interval for the hazard ratio is lower
than 1.24, corresponding to a noninferiority margin of 7% in absolute
difference and an event rate of 40% in the INV group. Conclusion(s):
EVAOLD is a nationwide, prospective, open-label trial testing the
noninferiority of a strategy of selective invasive management guided by
ischemia stress imaging versus routine invasive strategy in elderly NSTEMI
patients. ClinicalTrials.gov Identifier: NCT03289728. Copyright ©
2024 Elsevier Inc.

<131>
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

<132>
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.

<133>
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

<134>
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.

<135>
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.

<136>
Accession Number
2034110329
Title
Efficacy and safety of COVID-19 vaccination in solid organ transplant
recipients: A systematic review and network meta-analysis.
Source
American Journal of Transplantation. 24(12) (pp 2269-2281), 2024. Date of
Publication: December 2024.
Author
Rayner D.G.; Nunes J.T.; Gou D.; Chu A.W.L.; Dai S.-C.; Sheikh A.; Meng
D.; Orchanian-Cheff A.; Oss S.; Rotstein C.; Aleksova N.; Foroutan F.
Institution
(Rayner, Foroutan) Department of Health Research Methods, Evidence, and
Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON,
Canada
(Nunes, Orchanian-Cheff, Oss, Rotstein, Aleksova, Foroutan) Ted Rogers
Centre for Heart Research, University Health Network, Toronto, ON, Canada
(Gou, Sheikh) Faculty of Health Sciences, McMaster University, Hamilton,
ON, Canada
(Chu, Dai, Meng) Department of Medicine, Faculty of Health Sciences,
McMaster University, Hamilton, ON, Canada
Publisher
Elsevier B.V.
Abstract
The impact of COVID-19 vaccination on clinical outcomes in solid organ
transplant (SOT) recipients remains unclear. This systematic review and
network meta-analysis sought to assess the efficacy and safety of COVID-19
vaccination in SOT recipients. We searched 6 databases from inception to
March 1, 2024 for randomized controlled trials (RCTs) and observational
studies evaluating different COVID-19 vaccination strategies in SOT
recipients. Based on patient-important outcomes, we performed frequentist
random-effects pairwise meta-analyses and network meta-analyses,
separating RCTs and nonrandomized evidence, and used the Grading of
Recommendation, Assessment, Development, and Evaluation approach to assess
our certainty in the evidence. We included 6 RCTs (N = 814) and 43
observational studies (N = 125 199). Overall, there is a paucity of
randomized evidence evaluating COVID-19 vaccines in SOT recipients. The
nonrandomized evidence evaluating COVID-19 vaccination strategies
patient-important outcomes, including COVID-19 infection, mortality,
hospitalization, ICU admission, and rejection, demonstrated low to very
low certainty due to the included studies' risk of bias. Throughout the
COVID-19 pandemic, clinicians and SOT recipients worked with minimal, very
low-quality evidence in relation to COVID-19 vaccines in this population.
In the instance of future public health emergencies, clinicians and
researchers should collaborate closely with patient partners to ensure
there is sufficient evidence in the transplant population on
patient-important outcomes. Copyright © 2024 The Author(s)

<137>
Accession Number
2035782052
Title
Sex related differences in applied tidal volume with flow-controlled
ventilation: a subgroup analysis.
Source
Minerva Anestesiologica. 90(11) (pp 997-1003), 2024. Date of Publication:
November 2024.
Author
Spraider P.; Abram J.; Glodny B.; Tscholl P.; Hell T.; Martini J.
Institution
(Spraider, Abram, Martini) Department of Anesthesia and Intensive Care
Medicine, Medical University of Innsbruck, Innsbruck, Austria
(Glodny) Department of Radiology, Medical University of Innsbruck,
Innsbruck, Austria
(Tscholl, Hell) Data Lab Hell, Non-University Research Institution, Zirl,
Austria
Publisher
Edizioni Minerva Medica
Abstract
BACKGROUND: Flow-controlled ventilation (FCV) ensures a constant gas flow
whereby precise determination of dynamic compliance is feasible.
Accordingly, ventilator pressure settings can be adjusted to achieve the
highest compliance. This setting will automatically adapt tidal volume to
the functionally available lung volume as a personalized approach. This is
in contrast to current ventilation settings, where fixed tidal volumes
according to predicted body weight (PBW) are recommended. Aim of this
subgroup-analysis was to determine whether applied tidal volume differs in
male and female patients after compliance guided individualization of
ventilation parameters. METHOD(S): A sub-group analysis of 24
patients randomized to receive flow-controlled ventilation in cardiac
surgery was performed. Linear mixed-effects model was used in order to
investigate sex related differences in respiratory parameters.
 RESULT(S): Compliance guided pressure titration led to comparable
pressure settings in male (N.=18) and female (N.=6) patients. In contrast,
the applied tidal volume was significantly lower in female patients (8.6
vs. 9.9, 95% CI: -2.3 to -0.2 mL/kg PBW; P=0.029) compared to male
individuals, due to a significantly lower compliance (49.3 vs. 70.3, 95%
CI: -33.1 to -8.8 mL/cmH2O; P=0.003). Gas exchange parameters were
comparable in either sex. CONCLUSION(S): Female patients were found
to receive lower tidal volumes after compliance guided individualization
compared to men during cardiac surgery. This finding may indicate that the
functionally available lung volume in women is lower and thus using PBW
may not adequately comply with sex related differences, which supports the
use of a personalized ventilation strategy. Copyright © 2024
EDIZIONI MINERVA MEDICA.

<138>
Accession Number
2032224484
Title
Oxidative Stress, Ferroptosis Indicators, and Nicorandil Efficacy in STEMI
Patients During Percutaneous Coronary Intervention.
Source
Clinical and Applied Thrombosis/Hemostasis. 30 (no pagination), 2024. Date
of Publication: January-December 2024.
Author
Jia S.; Tian D.; Zhang W.; Jia H.; Zhang J.; Jia X.; Li Y.
Institution
(Jia, Li) Department of Cardiology, The Second Hospital of Hebei Medical
University, Shijiazhuang, China
(Tian) Tianjjin Key Laboratory of Metabolic Diseases, Tianjin Medical
University, Tianjin, China
(Zhang, Jia, Zhang, Jia) Department of Cardiology, Affiliated Hospital of
Hebei University, Baoding, China
Publisher
SAGE Publications Inc.
Abstract
Background: Myocardial ischemia-reperfusion injury (MI/RI) poses a
significant challenge during coronary revascularization. This research
investigated alterations in oxidative stress and ferroptosis, alongside
the impact of nicorandil on these aspects, among patients undergoing acute
ST-elevation myocardial infarction (STEMI) and receiving primary
percutaneous coronary intervention (pPCI). Method(s): 121 patients
with STEMI who were undergoing pPCI were included in the study, and we
documented their thrombolysis in myocardial infarction (TIMI) blood flow
grades before and after the procedure. The serum levels of creatine
kinase-MB, creatinine, and N-terminal prohormone of brain natriuretic
peptide (NTpro-BNP) were assessed. Additionally, we analyzed serum levels
of SIRT1, HIF-1alpha, GPX-4, FTH1, FSP1, 4-HNE, and SI before pPCI and 6 h
post-pPCI. Follow-ups were conducted 12 weeks after discharge, with major
adverse cardiovascular events (MACEs) documented. Result(s): The
nicorandil group showed significantly improved TIMI blood flow grades and
lower CK-MB and NTpro-BNP levels at 24, 48, and 72 h after PCI. Although
preoperative SIRT1, HIF-1alpha, and ferroptosis-related indicators were
similar, post-PCI, SIRT1 increased less and HIF-1alpha increased more in
the nicorandil group. The nicorandil group exhibited higher GPX4, FTH1,
and FSP1 levels, and lower levels of 4-HNE and SI. While no significant
differences in left ventricular function were observed, the nicorandil
group had lower LVEDD at 12 weeks. Importantly, the incidence of unstable
angina and heart failure was significantly lower in the nicorandil group.
 Conclusion(s): Administering nicorandil perioperatively during pPCI
alleviates MI/RI, preserves cardiac and renal function, and reduces
unstable anginarisk at 12 weeks post-PCI. These benefits of nicorandil may
be attributed to its anti-oxidative stress and anti-ferroptosis
effects. Copyright © The Author(s) 2024.

<139>
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.

<140>
Accession Number
2032332692
Title
Totally Endoscopic Coronary Artery Bypass Graft: Systematic Review and
Meta-Analysis of Reconstructed Patient-Level Data.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. (no pagination), 2024. Date of Publication: 2024.
Author
Zoupas I.; Manaki V.; Tasoudis P.T.; Karela N.-R.; Avgerinos D.V.; Mylonas
K.S.
Institution
(Zoupas, Manaki, Tasoudis, Karela) Cardiothoracic and Vascular Surgery
Working Group, Society of Junior Doctors, Athens, Greece
(Zoupas) Department of Cardiac Surgery, Hygeia Hospital, Athens, Greece
(Manaki) Department of Vascular Surgery, AHEPA University Hospital,
Thessaloniki, Greece
(Karela) Department of Neurosurgery, "Panagiotis & Aglaia Kyriakou"
Children's Hospital, Athens, Greece
(Avgerinos, Mylonas) Department of Cardiac Surgery, Onassis Cardiac
Surgery Center, Athens, Greece
(Mylonas) Department of Pediatric Cardiothoracic Surgery, University of
Rochester, NY, United States
Publisher
SAGE Publications Ltd
Abstract
Objective: The standard approach for coronary artery bypass grafting is
open surgery. Totally endoscopic coronary artery bypass has emerged as an
alternative for selected patients. This meta-analysis sought to evaluate
clinical outcomes with this emerging technique. Method(s): A
PRISMA-compliant search was performed up to December 14, 2022, in PubMed
(MEDLINE), Scopus, and Cochrane. Time-to-event data were reconstructed
using Kaplan-Meier curves from source literature. Result(s): A total
of 2,774 patients with symptomatic coronary artery disease underwent
totally endoscopic coronary artery bypass in 18 eligible studies. The mean
patient age was 63.2 +/- 12.3 years, and 77.5% (95% confidence interval
[CI]: 72.2% to 82.4%) of the included patients were males. The mean
operative time was 304.2 +/- 155 min, whereas the mean internal mammary
artery takedown time was 38.3 +/- 18.4 min. Of the patients, 4.7% (95% CI:
1.6% to 9.1%) required conversions to open surgery. The 30-day
complication rate was 5.9% (95% CI: 1.2% to 13.1%), whereas late
complications developed in 4.8% (95% CI: 1.9% to 8.5%) of the patients.
Freedom from major adverse cardiac events was 93.4% (95% CI: 85.3% to
94.8%) and 1-year, 5-year, and 10-year survival rates were 95.2%, 83.2%,
and 81.7%, respectively. Reintervention was required in 3.3% (95% CI: 2.3%
to 4.4%) of the cohort within a mean follow-up of 42.5 +/- 27.8 months.
 Conclusion(s): Totally endoscopic coronary artery bypass may be a
safe and viable alternative for selected patients with coronary artery
disease. Long-term follow-up will help define the place of robotic
endoscopic treatment in the armamentarium of myocardial
revascularization. Copyright © The Author(s) 2024.

<141>
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.

<142>
Accession Number
2032293413
Title
Intracerebral haemorrhage - mechanisms, diagnosis and prospects for
treatment and prevention.
Source
Nature Reviews Neurology. 20(12) (pp 708-723), 2024. Date of Publication:
December 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.

<143>
Accession Number
637507990
Title
Veno-Arterial Partial Pressure of Carbon Dioxide Difference as a Metric of
Systemic Oxygen Delivery: Insights from a Correlative Meta-Analysis.
Source
Journal of Pediatric Intensive Care. 13(4) (pp 372-378), 2022. Date of
Publication: 28 Feb 2022.
Author
Loomba R.S.; Farias J.S.; Savorgnan F.; Acosta S.; Flores S.; Villarreal
E.G.
Institution
(Loomba) Division of Cardiology, Advocate Children's Hospital, Chicago,
IL, United States
(Loomba) Department of Pediatrics, Chicago Medical School/Rosalind
Franklin University of Medicine and Science, Chicago, IL, United States
(Farias, Villarreal) Section of Critical Care Medicine and Cardiology,
Texas Children's Hospital, Houston, TX, United States
(Savorgnan, Acosta, Flores) Department of Pediatrics, Baylor College of
Medicine, Houston, TX, United States
(Savorgnan, Acosta, Flores) Tecnologico de Monterrey, School of Medicine
and Health Sciences, Nuevo Leon, Monterrey, Mexico
Publisher
Georg Thieme Verlag
Abstract
The assessment of cardiac output and adequacy of systemic oxygen delivery
in children after cardiac surgery require the use of an aggregate of
hemodynamic monitors and blood tests. There are previously published data
regarding the utility of the veno-arterial partial pressure of carbon
dioxide difference (AVDco2) to help with this. This study pooled data on
the correlation of AVDco2 with other metrics of cardiac output and
systemic oxygen delivery such as arteriovenous oxygen saturation
difference, venous saturation, and serum lactate. A systematic review of
the literature was done to identify studies analyzing the correlation of
AVDco2 with other hemodynamic and laboratory values. Data were extracted,
and correlation coefficients were pooled for each specific comparison to
create a point estimate for the overall correlation. A total of four
studies with 350 patients and 809 paired blood gases were pooled. Adequate
data were available to assess the correlation of AVDco2 with arteriovenous
oxygen saturation difference, venous saturation, and serum lactate. There
was a significant, moderate correlation with arteriovenous oxygen
saturation difference and venous saturation. A significant, weak
correlation with serum lactate was found. The AVDco2 has significant,
moderate correlations with other metrics of the adequacy of systemic
oxygen delivery such as arteriovenous oxygen saturation difference and
venous saturation. There was a significant but only weak correlation with
serum lactate. AVDco2 may be complementary to assess the adequacy of
cardiac output and systemic oxygen delivery. Copyright © 2022.
Thieme. All rights reserved.

<144>
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

<145>
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. 274(8) (pp
1797-1817), 2024. Date of Publication: December 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.

<146>
Accession Number
645834109
Title
Effect of a 2-4 week home-based prehabilitation intervention on
objectively measured preoperative physical activity.
Source
Swiss Medical Weekly. Conference: Annual Congress Swiss Society for
Anaesthesiology and Perioperative Medicine Swiss Association for
Anaesthesia Care. Interlaken Switzerland. 154(Supplement 282) (pp 6S),
2024. Date of Publication: November 2024.
Author
Vetsch T.; Engel D.; Beilstein C.M.; Matthias W.; Prisca E.; Wuethrich
P.Y.
Institution
(Vetsch, Engel, Beilstein, Wuethrich) Inselspital,Bern University
Hospital, Anaesthesiology and Pain Medicine, Bern, Switzerland
(Vetsch, Matthias, Prisca) Inselspital,Bern University Hospital, Centre
for Rehabili-tation and Sports Medicine, Bern, Switzerland
Publisher
SMW supporting association
Abstract
Background: Low functional capacity in patients undergoing major elective
surgery is associated with postoperative compli-cations. Prehabilitation
aims to increase functional capacity by increasing physical activity. Data
regarding the effectiveness of a home-based prehabilitation intervention
to increase acceler-ometry derived physical activity before surgery is
limited. We hypothesize that home-based prehabilitation leads to an
in-crease in physical activity in patients undergoing major cardiac and
noncardiac surgery. Material(s) and Method(s): Patients were
randomized to either standard of care or prehabilitation. The intervention
group re-ceived a home-based prehabilitation intervention 2-4 weeks before
scheduled surgery. As part of this intervention, patients were prescribed
a walking regimen. Patients were followed up with weekly telephone calls.
To measure physical activity, eu-clidean norm minus one (ENMO) was
extracted from acceler-ometry data. P-values were assessed by a two-sided
t-test. Results and discussion: 62 patients scheduled for noncardiac and
37 for cardiac surgery were included. Home-based preha-bilitation led to
an increase in physical activity levels in patients undergoing noncardiac
surgery (ENMO mean difference 3.01 mg, p = 0.03) but not in patients
undergoing cardiac surgery (ENMO mean difference 0.27mg, p = 0.95).
Patients undergoing cardiac surgery had higher activity levels compared to
noncar-diac and prehabilitation did not lead to further increase. Higher
activity levels may be explained by previous recommendations in routine
cardiac follow-up.

<147>
Accession Number
645834098
Title
First-attempt success of endotracheal intubation using hyper-angulated
videolaryngoscopy versus conventional direct laryngoscopy: A randomized
multiple cross-over cluster trial.
Source
Swiss Medical Weekly. Conference: Annual Congress Swiss Society for
Anaesthesiology and Perioperative Medicine Swiss Association for
Anaesthesia Care. Interlaken Switzerland. 154(Supplement 282) (pp 5S),
2024. Date of Publication: November 2024.
Author
Schmidt M.T.; Ott S.; Muller-Wirtz L.M.; Turan A.; Ruetzler K.
Institution
(Schmidt, Ott, Muller-Wirtz, Turan, Ruetzler) Department of Outcomes
Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, United
States
Publisher
SMW supporting association
Abstract
Introduction: Endotracheal tubes are usually inserted with di-rect
laryngoscopy, but patients sometimes require multiple at-tempts which can
provoke morbidity. Videolaryngoscopy im-proves airway visualization, but
endotracheal tubes are none-theless sometimes difficult to pass through
the vocal cords. Whether improved glottis visualization facilitates
intubation and reduces intubation attempts remains unclear.
 Objective(s): We therefore tested the primary hypothesis that fewer
intubation attempts are required when initial laryngos-copy is performed
with videolaryngoscopy than with direct lar-yngoscopy in surgical
patients. Method(s): We conducted a cluster-randomized multiple
cross-over trial in patients having cardiothoracic or vascular surgery at
the Cleveland Clinic Main Campus, Cleveland, OH. Patients were randomized
to either hyperangulated videolaryngoscopy or direct laryngoscopy for the
initial intubation attempt. The pri-mary outcome was number of intubation
attempts. Secondary outcomes were intubation failure and a composite of
airway and dental injuries. The trial was registered with
clinicaltri-als.gov (identifier NCT04701762), current trial status closed
for enrollment. Result(s): We enrolled 8,429 surgeries from March
2021 to De-cember 2022. 4,413 (52%) surgeries were randomized to
vide-olaryngoscopy, and 4,016 (48%) to direct laryngoscopy. About 70% of
initial intubations were performed by nurse anesthetists or residents,
supervised by attending anesthesiologists. Vide-olaryngoscopy reduced the
need for multiple intubations by about a factor-of-four from 7.6% to 1.7%.
and reduced the num-ber of intubation attempts compared to direct
laryngoscopy [(OR 0.19 (95% CI: 0.13, 0.28; P <0.001)]. Intubation failed
in 0.27% with videolaryngoscopy vs. 4% with direct laryngoscopy [RR 0.05
(95% CI: 0.02, 0.12; p <0.001)]. Airway and dental in-juries did not
differ between videolaryngoscopy (41 injuries, 0.93%) vs. direct
laryngoscopy (42 injuries, 1.1%), RR 0.85 (95% CI: 0.53, 1.39; P =
0.376)]. Conclusion(s): Videolaryngoscopy is a preferable initial
ap-proach for intubating surgical patients. Grant acknowledgment: This
trial was supported by depart-mental and institutional support only. The
GlideScope video laryngoscopes and GlideRite stylets were provided by
Verathon Inc.

<148>
Accession Number
645834167
Title
Comparing Erector Spinae Plane (ESP) and Thoracic Paravertebral (TPV)
Block analgesic effect after elective Video Assisted Thoracic Surgery
(VATS): A Single Center, Randomized, Multiple-blinded, Controlled,
Non-Inferiority Trial.
Source
Swiss Medical Weekly. Conference: Annual Congress Swiss Society for
Anaesthesiology and Perioperative Medicine Swiss Association for
Anaesthesia Care. Interlaken Switzerland. 154(Supplement 282) (pp 14S),
2024. Date of Publication: November 2024.
Author
Simona Z.; Andrea S.; Roberto D.
Institution
(Simona, Andrea, Roberto) Ospedale Regionale Bellinzona e Valli,
Department of Anaesthesia, Switzerland
Publisher
SMW supporting association
Abstract
Introduction: Video-assisted thoracic surgery (VATS) is the gold standard
for minimally invasive lung resections, offering quicker recovery and less
discomfort than open thoracotomy. However, postoperative pain from VATS
can hinder breathing and increase complications. Thoracic epidural
analgesia (TEA) is effective but invasive, with notable drawbacks. Less
invasive options like thoracic paravertebral block (TPVB) and erector
spinae plane (ESP) block are being explored. TPVB is effective but
requires advanced skills, while ESP is simpler and safer, though its
mechanism is unclear. This study compares ESP and TPVB in a randomized,
non-inferiority trial, focusing on opioid consumption post-VATS.
 Method(s): This single-center, randomized, multiple-blinded,
controlled, non-inferiority trial included 50 patients undergoing VATS at
the Regional Hospital of Bellinzona and Valli. Patients were randomized to
receive either an ESP block with local an-esthetic and a TPV block with
saline (ESP group) or a TPV block with local anesthetic and an ESP block
with saline (TPV group). The primary outcome was the cumulative dose of
rescue opi-oids at 24 and 48 hours postoperatively. Secondary outcomes
included pain scores, cardiopulmonary complications, proce-dural time,
need for anti-nausea medication, episodes of vom-iting, urinary retention,
and the need for an epidural catheter. Result(s): Data from 47
patients were analyzed. There was no statistically significant difference
in opioid consumption be-tween the ESP and TPV groups at 24 hours (p =
0.094) and 48 hours (p = 0.121). In a sub-analysis by type of surgery, the
NRS values were higher, as postulated, in major surgery. Eight pa-tients
in the ESP group and twelve in the TPV group required epidural catheters
due to block failure or conversion to thora-cotomy. Cardiopulmonary
complications and procedural times were low and comparable between groups.
 Conclusion(s): The study did not demonstrate the non-inferiority of
the ESP block compared to the TPV block for postoperative analgesia
following VATS. However, both blocks provided ef-fective pain relief with
no significant differences in outcomes. The findings suggest that both ESP
and TPV blocks are viable alternatives to thoracic epidural analgesia, but
further research is needed to optimize patient selection and procedural
tech-niques.

<149>
Accession Number
2032427699
Title
Sleep apnea prevalence and severity after coronary revascularization
versus no intervention: a systematic review & meta-analysis.
Source
Sleep and Breathing. 29(1) (no pagination), 2025. Article Number: 13. Date
of Publication: March 2025.
Author
Marjo A.; Satu S.; Tero V.; Ulla A.-L.; Peker Y.; Nea K.; Jenni T.
Institution
(Marjo, Satu, Nea, Jenni) Department of Pulmonary Diseases and Clinical
Allergology, Sleep Research Center, University of Turku, Turku, Finland
(Marjo, Ulla, Jenni) Department of Anesthesiology and Intensive Care,
University of Turku, Turku, Finland
(Marjo, Jenni) Division of Perioperative Services, Intensive Care and Pain
Medicine, Turku University Hospital, Turku, Finland
(Tero) Department of Biostatistics, University of Turku and Turku
University Hospital, Turku, Finland
(Nea) Heart Center, Turku University Hospital, University of Turku, Turku,
Finland
(Peker) Department of Pulmonary Medicine, Koc University School of
Medicine, TR, Istanbul 34010, Turkey
(Peker) Department of Molecular and Clinical Medicine, Sahlgrenska
Academy, University of Gothenburg, SE, Gothenburg 40530, Sweden
(Peker) Department of Clinical Sciences, Respiratory Medicine and
Allergology, Faculty of Medicine, Lund University, SE, Lund 22185, Sweden
(Peker) Division of Pulmonary, Allergy, and Critical Care Medicine,
University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United
States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Obstructive sleep apnea (OSA) is a common disease in patients
with coronary artery disease (CAD). Approximately 40-80% of cardiovascular
disease patients have obstructive sleep apnea. The manifestation of it can
vary significantly in different types of CAD patients. This systematic
review and meta-analysis investigate the prevalence and severity of OSA in
patients with acute coronary syndrome (ACS). Method(s): This
systematic review was conducted according to PRISMA guidelines. The first
inclusion criteria were that a reliable sleep study had to be done after
treating the patients' acute coronary incident. All patients in the
studies included were adults suffering from an ACS who underwent either
coronary artery bypass grafting surgery (CABG), a percutaneous coronary
intervention (PCI) or had no invasive coronary intervention done. A search
was conducted within four valid databases 27.1.2023 and all suitable
articles published after 1.1.2010 were included. Result(s): Eight
studies fulfilled the full inclusion criteria. In five of them, a sleep
study had been performed after PCI, in two after no coronary intervention,
and in one study after CABG. Mean AHI in no-OSA group after PCI was 9.5 /h
(95% CI 5.3-13.7) and in the no intervention group 6.4 /h (95% CI
3.5-9.4). In OSA patients, mean AHI after PCI was 34.9 /h (95% CI
25.9-43.8) vs. 24.1 /h without intervention (95% CI 15.6-32.6).
 Conclusion(s): Sleep apnea is very common among ACS patients and
should be screened for and addressed after the acute coronary
intervention. Moreover, we found that OSA is more severe in patients in
whom PCI for ACS was indicated as opposed to patients who underwent no
coronary intervention. Copyright © The Author(s) 2024.

<150>
Accession Number
2032417417
Title
Cardiac Rehabilitation After Open Heart Surgery: A Narrative Systematic
Review.
Source
Journal of Cardiovascular Development and Disease. 11(11) (no pagination),
2024. Article Number: 376. Date of Publication: November 2024.
Author
Delimanoli E.; Muurlink O.; Myrianthefs P.; Korompeli A.
Institution
(Delimanoli, Myrianthefs, Korompeli) Department of Nursing, National and
Kapodistrian University of Athens, Athens 11527, Greece
(Muurlink) School of Business and Law, Central Queensland University,
Brisbane, QLD 4000, Australia
(Myrianthefs, Korompeli) ICU University Unit at "Agioi Anargyroi" General
Hospital, School of Health Sciences, National and Kapodistrian University
of Athens, Kifisia 14564, Greece
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Postoperative cardiac rehabilitation (CR) programs are
increasingly recommended by clinicians, but only a minority of patients
who have undergone open heart surgery participate in such programs.
Participation rates in postoperative CR, if anything, appear to be
declining. This systematic review examines the effectiveness of
post-operative CR and reveals possible participation barriers.
 Method(s): A search of two scholarly databases for primary research
papers published in the last decade examining the impact of post-operative
CR was conducted and the resultant papers reviewed. Result(s): The 21
resulting studies revealed physiological functioning improvement and a
reduction in mortality and readmission rates, while highlighting an
enhancement in mental status. Some of the studies recognized the need for
nutritional support and suggested that age, gender, access to CR centers,
and socioeconomic variables impact participation in CR.
 Conclusion(s): Post-operative CR participation rates continue to
decline despite increasing evidence of the value of the
approach. Copyright © 2024 by the authors.

<151>
Accession Number
2032412671
Title
From the INVICTUS Trial to Current Considerations: It's Not Time to Retire
Vitamin K Inhibitors Yet!.
Source
Pharmaceuticals. 17(11) (no pagination), 2024. Article Number: 1459. Date
of Publication: November 2024.
Author
Pradhan A.; Mahalawat S.; Perrone M.A.
Institution
(Pradhan, Mahalawat) Department of Cardiology, King George's Medical
University, Lucknow 226003, India
(Perrone) Division of Cardiology and CardioLab, Department of Clinical
Sciences and Translational Medicine, University of Rome Tor Vergata, Rome
00133, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Atrial fibrillation (AF) is a common arrhythmia in clinical practice, and
oral anticoagulation is the cornerstone of stroke prevention in AF. Direct
oral anticoagulants (DOAC) significantly reduce the incidence of
intracerebral hemorrhage with preserved efficacy for preventing stroke
compared to vitamin K antagonists (VKA). However, the pivotal randomized
controlled trials (RCTs) of DOAC excluded patients with valvular heart
disease, especially mitral stenosis, which remains an exclusion criterion
for DOAC use. The INVICTUS study was a large multicenter global RCT aimed
at evaluating the role of DOAC compared to VKA in stroke prevention among
patients with rheumatic valvular AF. In this study, rivaroxaban failed to
prove superiority over VKA in preventing the composite primary efficacy
endpoints of stroke, systemic embolism, myocardial infarction, and death.
Unfortunately, the bleeding rates were not lower with rivaroxaban either.
The death and drug discontinuation rates were higher in the DOAC arm.
Close to the heels of the dismal results of INVICTUS, an apixaban trial in
prosthetic heart valves, PROACT-Xa, was also prematurely terminated due to
futility. Hence, for AF complicating moderate-to-severe mitral stenosis or
prosthetic valve VKA remains the standard of care. However, DOAC can be
used in patients with surgical bioprosthetic valve implantation, TAVR, and
other native valve diseases with AF, except for moderate-to-severe mitral
stenosis. Factor XI inhibitors represent a breakthrough in anticoagulation
as they aim to dissociate thrombosis from hemostasis, thereby indicating a
potential to cut down bleeding further. Multiple agents (monoclonal
antibodies-e.g., osocimab, anti-sense oligonucleotides-e.g., fesomersen,
and small molecule inhibitors-e.g., milvexian) have garnered positive data
from phase II studies, and many have entered the phase III studies in
AF/Venous thromboembolism. Future studies on conventional DOAC and
new-generation DOAC will shed further light on whether DOAC can dethrone
VKA in valvular heart disease. Copyright © 2024 by the authors.

<152>
Accession Number
2032411366
Title
Understanding Surgeons' Reluctance to Adopt Intraoperative Coronary Graft
Verification Procedures: A Literature Review Combined to AI-Driven
Insights Under Human Supervision.
Source
Journal of Clinical Medicine. 13(22) (no pagination), 2024. Article
Number: 6889. Date of Publication: November 2024.
Author
Di Giammarco G.; Cammertoni F.; Testa N.; Massetti M.
Institution
(Di Giammarco) Department of Neuroscience, Imaging and Clinical Science,
School of Medicine and Health Science, Universita "G.D'Annunzio"
Chieti-Pescara, Chieti 66100, Italy
(Di Giammarco, Massetti) Faculty of Medicine and Surgery, Catholic
University of Sacred Heart, Rome 00168, Italy
(Cammertoni, Testa, Massetti) Department of Cardiovascular Sciences,
Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome 00168, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Intraoperative graft verification in coronary surgery is
accepted worldwidand equally discussed. In spite of multiple sources of
evidence published up to now in favor of clinical benefits following the
use of the procedure, there is a persistent skepticism in adopting the
available technologies. The object of the present review is to analyze the
reluctance of surgeons toward the adoption of assessment methods.
 Material(s) and Method(s): A thorough literature review was carried
out on Google Scholar based on the results obtained from AI's answer to
the question about the reasons for that reluctance. We took advantage of
using ChatGPT-4 since the research based on PubMed Central alone was not
able to return a detailed response, maybe because the reasons for the
reluctance are veiled in the text of the published papers. Through the
items suggested by AI and taken from the literature, we deepened the
research, pointing attention to the issues published so far about the
various technologies. Result(s): There are many convincing pieces of
evidence about the utility of intraoperative graft control in coronary
surgery, involving improved clinical outcome, efficacy and safety, and
social cost saving. The opinion that arose through this analysis is that,
beyond the objective difficulties in utilizing some technologies and the
equally objective limitations of an economic and organizational nature,
the reluctance is the result of a real unwillingness based on the various
implications that the discovery of the technical error entails.
 Conclusion(s): This negative attitude, in light of the convincing
scientific and clinical evidence published up to now, appears to overwhelm
the benefits for patients. Copyright © 2024 by the authors.

<153>
Accession Number
2032406916
Title
Sutureless Bioprostheses for Aortic Valve Replacement: An Updated
Systematic Review with Long-Term Results.
Source
Journal of Clinical Medicine. 13(22) (no pagination), 2024. Article
Number: 6829. Date of Publication: November 2024.
Author
Chiariello G.A.; Di Mauro M.; Villa E.; Koulouroudias M.; Bruno P.; Mazza
A.; Pasquini A.; D'Avino S.; De Angelis G.; Corigliano K.; Marcolini A.;
Zancanaro E.; Saitto G.; Meani P.; Massetti M.; Lorusso R.
Institution
(Chiariello, Bruno, Mazza, Pasquini, D'Avino, De Angelis, Corigliano,
Marcolini, Massetti) Department of Cardiovascular Sciences, Agostino
Gemelli Foundation Polyclinic IRCCS, Rome 00136, Italy
(Chiariello, Bruno, Mazza, Pasquini, De Angelis, Corigliano, Marcolini,
Massetti) School of Medicine and Surgery, Catholic University of the
Sacred Heart, Rome 00168, Italy
(Chiariello, Di Mauro, Koulouroudias, Zancanaro, Meani, Lorusso)
Cardiovascular Research Institute, CARIM, Maastricht 6629 ER, Netherlands
(Villa) Department of Cardiovascular Surgery, Poliambulanza Foundation
Hospital, Brescia 25124, Italy
(Koulouroudias) Department of Cardiac Surgery, Trent Cardiac Centre,
Nottingham University Hospitals, NG5, Nottingham 1PB, United Kingdom
(Zancanaro) Department of Cardiac Surgery, San Raffaele Hospital, Milan
20132, Italy
(Saitto) Department of Cardiac Surgery and Transplantation, S. Camillo
Hospital, Rome 00152, Italy
(Lorusso) Heart and Vascular Centre, Maastricht University Medical Centre,
Maastricht 6229 HX, Netherlands
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: In recent years, in case of aortic valve replacement (AVR), a
significant increase in the use of bioprostheses has been observed. The
Perceval sutureless bioprosthesis has proven to be safe and reliable in
the short and mid-term, with limited but promising long-term results. An
updated systematic review with the long-term results of patients who
underwent a sutureless bioprosthesis implantation with a Perceval
biological valve is herewith presented. Method(s): Studies published
between 2015 and 2024, including the long-term outcomes-with clinical as
well as echocardiographic information for up to five years-of patients who
underwent a Perceval implantation for AVR were selected from the published
literature. The Cochrane GRADE system was used to assess the study
quality, and the risk of bias in non-randomized studies (ROBINS-I) tool
was used to evaluate studies. Result(s): Ten studies were selected
with an overall number of 5221 patients. The long-term survival ranged
from 64.8 to 87.9%, freedom from structural valve degeneration (SVD) from
96.1 to 100%, freedom from significant paravalvular leak from 98.5 to
100%, freedom from prosthetic endocarditis from 90.7 to 99%, and freedom
from reintervention from 94 to 100%. The long-term mortality ranged from
6.5 to 27.4%. SVD was observed in 0-4.8% patients. Significant
paravalvular leak was observed in 0-3.4% patients, and infective
endocarditis was observed in 0-3.4%. A bioprosthesis-related
reintervention at long-term follow-up was required for 0-4.3% of patients,
and 1.7-7.1% of patients required a late new pacemaker implantation. The
transprosthetic mean pressure gradient ranged from 9 to 14.7 mmHg, peak
pressure gradient ranged from 17.8 to 26.5 mmHg, and EOA ranged from 1.5
to 1.7 cm2. Conclusion(s): This systematic review shows
that there is still a paucity of data about sutureless bioprostheses.
Nevertheless, the clinical results from prospective studies or
retrospective series are encouraging. Medium- and long-term results seem
to support the increasing use of this type of prosthesis. Copyright
© 2024 by the authors.

<154>
Accession Number
2032406911
Title
Optimizing Myocardial Protection in Minimally Invasive Cardiac Surgeries:
A Network Comparison of Del Nido, Histidine-Tryptophan-Ketoglutarate, and
Blood Cardioplegia.
Source
Journal of Clinical Medicine. 13(22) (no pagination), 2024. Article
Number: 6977. Date of Publication: November 2024.
Author
Al-Hasan-Al-Saegh S.; Takemoto S.; Benenati S.; Shafiei S.; Yavuz S.;
Galli M.; Helms F.; Amanov L.; De Manna N.D.; Torabi S.; Karsten J.;
Schmitto J.D.; Ius F.; Kaufeld T.; Salman J.; Popov A.-F.; Schmack B.;
Ruhparwar A.; Zubarevich A.; Weymann A.
Institution
(Al-Hasan-Al-Saegh, Helms, Amanov, De Manna, Schmitto, Ius, Kaufeld,
Salman, Popov, Schmack, Ruhparwar, Zubarevich, Weymann) Department of
Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical
School, Hannover 30625, Germany
(Takemoto) Center for Transplantation Sciences, Department of Surgery,
Massachusetts General Hospital and Harvard Medical School, Boston, MA
02114, United States
(Benenati) Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San
Martino, IRCCS Italian Cardiology Network, Genova 16132, Italy
(Shafiei) Department of Cardiac and Thoracic Vascular Surgery, Marburg
University Hospital, Marburg 35043, Germany
(Yavuz) Department of Cardiovascular Surgery, University of Health
Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa
16310, Turkey
(Galli) Department of Cardiology, Maria Cecilia Hospital, GVM Care &
Research, Cotignola 48033, Italy
(Torabi) Department of Anesthesiology, University Hospital Cologne,
Cologne 50931, Germany
(Karsten) Department of Anaesthesiology and Intensive Care Medicine,
Hannover Medical School, Hannover 30625, Germany
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: The optimal choice of cardioplegia solution in
minimally invasive cardiac surgeries (MICS) remains debated, as prolonged
myocardial protection is essential to avoid interruptions to the surgical
flow, which can prolong aortic cross-clamp time and cardiopulmonary bypass
time, especially in the constrained surgical field. We conducted a network
meta-analysis to evaluate the safety and efficacy of the del Nido (DN),
histidine-tryptophan-ketoglutarate (HTK), blood cardioplegia (BC), and St.
Thomas' (STH) solutions in MICS. Method(s): Medical electronic
databases were thoroughly searched without time restrictions, including
all types of studies except for study protocols and animal research. The
final search was completed in June 2024. Subsequently, a network
meta-regression was performed on both primary and secondary endpoints,
utilizing R (The R Foundation for Statistical Computing, version 3.6.2)
for the analysis. Meta-analyses were carried out using Review Manager
software. Result(s): A total of 15 studies, enrolling 2282 patients,
were included in the analysis. None of the comparisons showed
statistically significant differences in in-hospital mortality between the
four cardioplegia solutions (BC vs. HTK, OR: 3.21, 95% CI: 0.13-80.84; DN
vs. HTK, OR: 1.42, 95% CI: 0.28-7.23; STH vs. HTK, OR: 1.25, 95% CI:
0.19-8.20). Conclusion(s): In this network meta-analysis of
cardioplegia solutions in MICS, no significant differences were observed
in major clinical outcomes across the solutions. Cardioplegia solutions
that provide long-lasting myocardial protection with a single dose, such
as DN and HTK, were found to be safely applied in MICS. DN was associated
with shorter CPB times and HTK was associated with shorter hospital stays,
though these differences may not have clinical implications. Copyright
© 2024 by the authors.

<155>
Accession Number
2032436936
Title
Whether monitored anesthesia care is the optimal anesthetic strategy for
transcatheter aortic valve implantation surgery? a meta-analysis and
systematic review.
Source
BMC Anesthesiology. 24(1) (no pagination), 2024. Article Number: 429. Date
of Publication: December 2024.
Author
Xie L.; Lang Z.; Liu Y.; Yue H.; Chen Q.; Tao G.
Institution
(Xie, Liu, Yue, Chen, Tao) Department of Anesthesia and Surgery, First
Hospital of Lanzhou University, Gansu, Lanzhou 730000, China
(Lang) The First Clinical Medical College of Lanzhou University, Gansu,
Lanzhou 730000, China
Publisher
BioMed Central Ltd
Abstract
Objectives: To explore whether monitored anesthesia care is more
beneficial to the outcome of transcatheter aortic valve implantation.
 Method(s): The research methodology involved comprehensive searches
across major databases, including the Cochrane Library, PubMed, Scopus,
and Web of Science, covering the period from January 1, 2010, to March 1,
2024. The aim was to identify trials comparing different anesthetic
methods for transcatheter aortic valve implantation. The primary outcomes
assessed were mortality and length of hospital stay, while secondary
outcomes included common complications such as bleeding, stroke,
paravalvular leakage, renal failur e, and others. Data synthesis was
conducted using risk ratios or standardized mean differences, along with
95% confidence intervals. The study protocol was prospectively registered
with PROSPERO (CRD42024507749). Result(s): A total of 35 trials and
45,616 patients were included in this study. The results showed that
monitored anesthesia care significantly reduced the patient's risk of
death, shortened the patient's length of hospital stay, and also reduced
the risk of common complications such as paravalvular leakage (RR, 0.80;
95% CI: 0.72 to 0.88; p < 0.00001; I2 = 0) and stroke (RR,
0.80; 95% CI: 0.65 to 0.99; p = 0.04; I2 = 0).
 Conclusion(s): Monitored anesthesia care has an absolute advantage in
patient survival and effectively shortens the length of hospitalization.
In addition, it also reduces the risk of complications such as
paravalvular leakage and stroke. Monitoring care under anesthesia plays a
vital role during TAVI surgery, not only helping to ensure the smooth
progress of the surgery and patient safety, but also promoting the
patient's recovery and recovery. Copyright © The Author(s) 2024.

<156>
Accession Number
2032087958
Title
Comparative Efficacy and Safety of Transcatheter Mitral Valve Repair
Versus Mitral-valve Surgery in Elderly Patients With Mitral Regurgitation:
A Systematic Review and Meta-analysis.
Source
Journal of the Saudi Heart Association. 36(4) (pp 316-334), 2024. Date of
Publication: 2024.
Author
Almuzainy S.; Lemine M.; Aljubeh R.; Alsalem S.
Institution
(Almuzainy, Lemine, Aljubeh, Alsalem) College of Medicine, University of
Sharjah, Sharjah, United Arab Emirates
Publisher
Saudi Heart Association
Abstract
Objectives: Mitral valve surgery is the reference treatment for severe
symptomatic mitral regurgitation (MR). Percutaneous mitral valve
interventions, such as the MitraClip procedure, offer an alternative,
particularly for high-risk patients. The aim of this systematic review and
meta-analysis was to analyze the safety and effectiveness of transcatheter
mitral valve repair (TMVR) compared to surgical mitral valve repair or
replacement (SMVR) in elderly patients with mitral regurgitation.
 Method(s): We searched PubMed, Scopus, Ovid, EBSCO, and ProQuest
through July 2024. Eligible studies were randomized controlled trials and
observational comparative studies of TMVR versus SMVR for patients with
MR, reporting outcomes such as all-cause mortality, MR recurrence, stroke,
myocardial infarction, and length of stay (LOS). Statistical analyses were
performed using RevMan. Result(s): Our search identified 3166
records, with 2756 screened and 21 studies included after review. The
studies, comprising 20 retrospective cohorts and 1 randomized controlled
trial with 20,900 patients, compared TMVR to SMVR. TMVR patients were
significantly older than SMVR patients (MD 3.44 years; P < 0.00001).
Mortality rates were similar at 30 days (relative risk (RR) 1.08; P 1/4
0.79) and one year (RR 1.27; P 1/4 0.18), but SMVR showed lower mortality
at three years (RR 1.82; P 1/4 0.006). SMVR also significantly reduced MR
>= 3 recurrence at 30 days (RR 6.95; P < 0.00001), one year (RR 3.31; P
1/4 0.0001), and three years (RR 4.37; P < 0.00001). TMVR was associated
with higher myocardial infarction rates (RR 1.58; P 1/4 0.02) but reduced
LOS (MD-4.88 days; P < 0.00001). Sensitivity analysis showed consistent
results for recurrence of MR >= 3 and variable outcomes for other metrics.
Evidence of publication bias was noted for mortality at 30 days and LOS.
 Conclusion(s): While TMVR with the MitraClip offers shorter hospital
stays and is less invasive, SMVR provides better longterm survival and
lower MR recurrence rates, emphasizing the need for a tailored approach
based on patient risk profiles. Copyright © 2024 Saudi Heart
Association.

<157>
Accession Number
645837235
Title
Inotropes for the prevention of low cardiac output syndrome and mortality
for paediatric patients undergoing surgery for congenital heart disease: a
network meta-analysis.
Source
Cochrane Database of Systematic Reviews. 2024(11) (no pagination), 2024.
Article Number: CD013707. Date of Publication: 26 Nov 2024.
Author
Burkhardt B.E.U.; Hummel J.; Rucker G.; Stiller B.
Institution
(Burkhardt) Pediatric Cardiology, Pediatric Heart Center, Department of
Surgery, University Children's Hospital Zurich, Zurich, Switzerland
(Hummel) Department of Congenital Heart Disease/Pediatric Cardiology,
Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen,
Germany
(Rucker) Institute of Medical Biometry and Statistics, Faculty of Medicine
and Medical Center - University of Freiburg, Freiburg, Germany
(Stiller) Department of Congenital Heart Disease and Pediatric Cardiology,
University Heart Center, Medical Center - University of Freiburg, Faculty
of Medicine, University of Freiburg, Freiburg, Germany
Publisher
John Wiley and Sons Ltd
Abstract
Background: Paediatric patients undergoing surgery for congenital heart
disease (CHD) are at risk for postoperative low cardiac output syndrome
(LCOS) and mortality. LCOS affects up to 25% of children after heart
surgery. It consists of reduced myocardial function and increases
postoperative morbidity, prolongs mechanical ventilation, and lengthens
the duration of intensive care unit (ICU) stay. Pharmacological
prophylaxis involves inotropes, including catecholamines,
phosphodiesterase III inhibitors, or calcium sensitisers, to enhance
myocardial contractility. It is unclear whether they are effective in
preventing LCOS or death in this vulnerable population. Objective(s):
1. To evaluate the relative benefits and harms of inotropes for the
prevention of LCOS and mortality in paediatric patients undergoing surgery
for CHD. 2. To generate a clinically useful ranking of prophylactic
inotropes for the prevention of LCOS and mortality in paediatric patients
undergoing surgery for CHD according to benefits and harms. Search
Method(s): We searched CENTRAL, MEDLINE, Embase, Web of Science, and
clinical trial registries, most recently in December 2023 and April 2024.
We also checked reference lists from identified studies and review
articles. We did not apply any language restrictions. Selection
Criteria: We included randomised controlled trials comparing inotropes
from one drug class (catecholamines, phosphodiesterase type III
inhibitors, calcium sensitisers) to another (either alone or in
combination) or placebo, in paediatric patients (birth to 18 years of age)
undergoing surgery for CHD. Data Collection and Analysis: Two review
authors independently selected studies, extracted data, assessed risk of
bias, and rated the certainty of evidence using the CINeMA framework. We
performed random-effects network and pairwise meta-analyses comparing the
relative effects of each possible pair of medications with each other or
placebo. Where meta-analysis was not possible, we provided a narrative
description of the results. We ranked the prophylactic medications
according to their effects relative to each other. The primary outcomes
were all-cause mortality within 30 days, time to death, and LCOS
incidence; secondary outcomes were length of ICU stay, length of hospital
stay, duration of mechanical ventilation, inotrope score, mechanical
circulatory support, and adverse events. Main Result(s): We included
13 studies with 937 participants. All except two multicentre studies were
conducted at single tertiary care hospitals. Participants comprised
children from birth to 14 years of age undergoing surgery for different
types of CHD on cardiopulmonary bypass. Five studies compared levosimendan
versus milrinone; two compared levosimendan versus placebo; two compared
milrinone versus placebo (one comparing two different doses); one compared
levosimendan versus dobutamine, another milrinone versus dobutamine. Two
studies used combinations of inotropes. Study duration was between less
than one year and 5.3 years, with follow-up mostly during ICU or hospital
stay. Funding sources included governmental bodies and hospital
departments, but also drug manufacturers. We downgraded the certainty of
evidence for high risk of bias at study level, or imprecision at
comparison level. Primary outcomes. Compared to placebo, levosimendan
likely results in a large reduction in mortality (risk ratio (RR) 0.57,
95% confidence interval (CI) 0.15 to 2.13) and milrinone likely results in
no difference (RR 0.97, 95% CI 0.11 to 8.49), whereas for dobutamine, no
effect was estimable; all moderate-certainty evidence (9 studies, 557
participants, 14 events). LCOS was largely reduced with levosimendan (RR
0.45, 95% CI 0.24 to 0.83; high-certainty evidence), likely largely
reduced with milrinone (RR 0.46, 95% CI 0.24 to 0.89; moderate-certainty
evidence), and may be reduced with low-dose milrinone (RR 0.7, 95% CI 0.39
to 1.28; low-certainty evidence), compared with placebo (5 studies, 513
participants, 85 events). Secondary outcomes. The length of ICU stay may
be no different with levosimendan (ratio of means (ROM) 1.12, 95% CI 0.77
to 1.63; low-certainty evidence), and is likely no different with
milrinone (ROM 1.13, 95% CI 0.75 to 1.69) or with dobutamine (ROM 1.11,
95% CI 0.66 to 1.86), compared with placebo (9 studies, 577 participants);
both moderate-certainty evidence. The length of hospital stay, compared
with placebo, is likely no different with levosimendan (ROM 1.03, 95% CI
0.84 to 1.27) or with milrinone (ROM 1, 95% CI 0.78 to 1.3), but is likely
reduced with dobutamine (ROM 0.68, 95% CI 0.37 to 1.26); all
moderate-certainty evidence (7 studies, 297 participants). The duration of
mechanical ventilation, compared with placebo, is likely increased with
levosimendan (ROM 1.17, 95% CI 0.65 to 2.12) or with milrinone (ROM 1.25,
5% CI 0.67 to 2.36) and is likely no different with dobutamine (ROM 1.04,
95% CI 0.45 to 2.38); all moderate-certainty evidence (9 studies, 577
participants). There is moderate-certainty evidence that adverse events
are likely increased with levosimendan (incidence rate ratio (IRR) 1.23,
95% CI 0.78 to 1.96) or dobutamine (IRR 1.24, 95% CI 0.75 to 2.03) and
low-certainty evidence that they may be increased with milrinone (IRR
1.31, 95% CI 0.96 to 1.79) and decreased with low-dose milrinone (IRR
0.84, 95% CI 0.47 to 1.5), compared with placebo (8 studies, 706
participants, 380 events). Authors' conclusions: Levosimendan likely
results in a large reduction in mortality compared to placebo in
paediatric patients undergoing surgery for congenital heart disease,
whereas milrinone likely results in no difference, and the effect of
dobutamine is unknown. Low cardiac output syndrome (LCOS) is largely
reduced with levosimendan, likely largely reduced with milrinone, and may
be reduced with low-dose milrinone, compared to placebo. The length of ICU
stay may be no different with levosimendan and is likely no different with
milrinone or with dobutamine, compared to placebo. The length of hospital
stay is likely no different with levosimendan or with milrinone, but is
likely reduced with dobutamine, compared to placebo. The duration of
mechanical ventilation is likely increased with levosimendan or with
milrinone and is likely no different with dobutamine, compared to placebo.
Adverse events are likely increased with levosimendan or dobutamine, and
may be increased with milrinone and decreased with low-dose milrinone,
compared to placebo. The evidence is based on few, heterogeneous studies,
with small numbers of patients and short follow-up periods. Future
research should include large numbers of patients, consistently report all
co-interventions, and ensure the longest possible follow-up. Copyright
© 2024 The Authors. Cochrane Database of Systematic Reviews published
by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.

<158>
Accession Number
2035866810
Title
Differences in treatment and outcomes among patients with ST-segment
elevation myocardial infarction with and without standard modifiable risk
factors: A systematic review and meta-analysis.
Source
Annals of Medicine and Surgery. 85(6) (pp 2916-2923), 2023. Date of
Publication: 03 May 2023.
Author
Shrestha B.; Shrestha D.B.; Sedhai Y.R.; Shtembari J.; Oli P.R.;
Shikhrakar S.; Paudel B.; Roberts M.; Patel N.K.; Singh A.; Singh K.;
Waheed I.; Basnyat S.; Khan M.S.; Kazimuddin M.; Elgendy I.Y.
Institution
(Shrestha) Department of Internal Medicine, Tower Health Program, West
Reading, PA, United States
(Singh) Department of Internal Medicine, Division of Cardiology, Tower
Health Program, West Reading, PA, United States
(Shrestha, Shtembari) Department of Internal Medicine, Mount Sinai
Hospital, Chicago, United States
(Paudel) Department of Internal Medicine, AMITA Health, Ascension Saint
Francis, Evanston, IL, United States
(Basnyat) Department of Internal Medicine, University of Kentucky, College
of Medicine, Bowling Green Campus, United States
(Khan, Kazimuddin) Department of Internal Medicine, Division of
Cardiology, University of Kentucky, College of Medicine, Bowling Green
Campus, Bowling Green, United States
(Elgendy) Division of Cardiovascular Medicine, Gill Heart Institute,
University of Kentucky, Lexington, United States
(Sedhai, Singh, Waheed) Department of Internal Medicine, Division of
Pulmonary Disease and Critical Care, University of Kentucky, College of
Medicine, Bowling Green Campus, Bowling Green, KY, United States
(Roberts) Department of Internal Medicine, Division of Cardiology, Tulane
University, New Orleans, LA, United States
(Patel) Department of Internal Medicine, Division of Cardiology, VCU
Pauley Heart Center, Virginia Commonwealth University, School of Medicine,
Richmond, VA, United States
(Oli) Department of Internal Medicine, Province Hospital, Birendranagar,
Surkhet, Nepal
(Shikhrakar) Department of Internal Medicine, Kathmandu University, School
of Medical Sciences, Kavrepalanchok, Dhulikhel, Nepal
Publisher
Lippincott Williams and Wilkins
Abstract
Background: There are limited data available on outcomes and
pathophysiology behind ST-segment elevation myocardial infarction (STEMI)
in populations without standard modifiable risk factors (SMuRFs). The
authors carried out this meta-analysis to understand the differences in
treatment and outcomes of STEMI patients with and without SMuRFs.
 Method(s): A systematic database search was performed for relevant
studies. Studies reporting desired outcomes among STEMI patients with and
without SMuRFs were selected based on predefined criteria in the study
protocol (PROSPERO: CRD42022341389). Two reviewers independently screened
titles and abstracts using Covidence. Full texts of the selected studies
were independently reviewed to confirm eligibility. Data were extracted
from all eligible studies via a full-text review of the primary article
for qualitative and quantitative analysis. In-hospital mortality following
the first episode of STEMI was the primary outcome, with major adverse
cardiovascular events (MACE), repeat myocardial infarction (MI),
cardiogenic shock, heart failure, and stroke as secondary outcomes of
interest. Odds ratio (OR) with a 95% CI was used to estimate the effect.
 Result(s): A total of 2135 studies were identified from database
search, six studies with 521 150 patients with the first STEMI episode
were included in the analysis. The authors found higher in-hospital
mortality (OR: 1.43; CI: 1.40-1.47) and cardiogenic shock (OR: 1.59; 95%
CI: 1.55-1.63) in the SMuRF-less group with no differences in MACE,
recurrent MI, major bleeding, heart failure, and stroke. There were lower
prescriptions of statin (OR: 0.62; CI: 0.42-0.91) and Angiotensin
converting enzyme inhibitor /Angiotensin II receptor blocker (OR: 0.49;
CI: 0.28-0.87) at discharge in SMuRF-less patients. There was no
difference in procedures like coronary artery bypass graft, percutaneous
coronary intervention, and thrombolysis. Conclusion(s): In the
SMuRF-less STEMI patients, higher in-hospital mortality and treatment
discrepancies were noted at discharge. Copyright © 2023 The
Author(s). Published by Wolters Kluwer Health, Inc.

<159>
Accession Number
2035866805
Title
Percutaneous coronary intervention versus coronary artery bypass grafting
among patients with left ventricular systolic dysfunction: A systematic
review and meta-analysis.
Source
Annals of Medicine and Surgery. 85(6) (pp 2849-2857), 2023. Date of
Publication: 17 Apr 2023.
Author
Jaiswal V.; Ang S.P.; Shrestha A.B.; Joshi A.; Ishak A.; Chia J.E.;
Kanakannavr S.S.; Naz S.; Doshi N.; Nanavaty D.; Gera A.; Kumar V.;
Daneshvar F.; Song D.; Rajak K.
Institution
(Jaiswal) JCCR Cardiology Research, Varanasi, India
(Doshi) Pravara Institute of Medical Science, Maharashtra, India
(Ang) Division of Internal Medicine, Rutgers Health, Community Medical
Center, NJ, United States
(Song) Department of Internal Medicine, Icahn School of Medicine, Mount
Sinai Elmhurst Hospital Center, Queens, NY, United States
(Rajak) Department of Internal Medicine, UPMC, Harrisburg, PA, United
States
(Naz) The University of Texas, MD Anderson Cancer Center, Houston, TX,
United States
(Jaiswal, Joshi, Ishak, Chia, Kanakannavr, Gera) Department of Research,
Larkin Community Hospital, South Miami, United States
(Daneshvar) Department of Cardiology, AdventHealth, FL, United States
(Nanavaty, Kumar) The Brooklyn Hospital Center, Brooklyn, United States
(Shrestha) Department of Medicine, M Abdur Rahim Medical College,
Dinajpur, Bangladesh
(Chia) Department of Medicine, International Medical University, Kuala
Lumpur, Malaysia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Current guidelines have shown the superiority of coronary
artery bypass grafting (CABG) over medical therapy. However, there is a
paucity of data evaluating the optimal revascularization strategy in
patients with ischemic left ventricular systolic dysfunction (LVSD).
 Objective(s): The authors aimed to evaluate the clinical outcomes of
postpercutaneous coronary intervention (PCI) and CABG among patients with
LVSD. Method(s): The authors performed a systematic literature search
using the PubMed, Embase, Scopus, and the Cochrane Libraries for relevant
articles from inception until 30 November 2022. Outcomes were reported as
pooled odds ratio (OR), and their corresponding 95% CI using STATA
(version 17.0, StataCorp). Result(s): A total of 10 studies with 13
324 patients were included in the analysis. The mean age of patients in
PCI was 65.3 years, and 64.1 years in the CABG group. The most common
comorbidities included: HTN (80 vs. 78%) and DM (49.2 vs. 49%). The mean
follow-up duration was 3.75 years. Compared with CABG, the PCI group had
higher odds of all-cause mortality (OR 1.15, 95% CI 1.01-1.31, P=0.03),
repeat revascularization (OR 3.57, 95% CI 2.56-4.97, P<0.001), MI (OR
1.92, 95% CI 1.01-3.86, P=0.048) while the incidence of cardiovascular
mortality (OR 1.23, 95% CI 0.98-1.55, P=0.07), stroke (OR 0.73 95% CI:
0.51-1.04, P=0.08), major adverse cardiovascular and cerebrovascular
events (OR 1.36, 95% CI 0.99-1.87, P=0.06), and ventricular tachycardia
(OR 0.79, 95% CI 0.22-2.86, P=0.72) was comparable between both the
procedures. Conclusion(s): The results of this meta-analysis suggest
that CABG is superior to PCI for patients with LVSD. CABG was associated
with a lower risk of all-cause mortality, repeat revascularization, and
incidence of myocardial infarction compared with PCI in patients with
LVSD. Copyright © 2023 The Author(s). Published by Wolters
Kluwer Health, Inc.

<160>
Accession Number
2035944245
Title
The Society of Thoracic Surgeons Expert Consensus on the Multidisciplinary
Management and Resectability of Locally Advanced Non-small Cell Lung
Cancer.
Source
Annals of Thoracic Surgery. (no pagination), 2024. Date of Publication:
2024.
Author
Kim S.S.; Cooke D.T.; Kidane B.; Tapias L.F.; Lazar J.F.; Awori Hayanga
J.W.; Patel J.D.; Neal J.W.; Abazeed M.E.; Willers H.; Shrager J.B.
Institution
(Kim) Canning Thoracic Institute, Northwestern Memorial Hospital,
Northwestern University Feinberg School of Medicine, Chicago, Illinois,
United States
(Cooke) Division of General Thoracic Surgery, University of California
Davis Health, Sacramento, California, United States
(Kidane) Section of Thoracic Surgery, CancerCare Manitoba and University
of Manitoba, Winnipeg, MB, Canada
(Tapias) Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota,
United States
(Lazar) Division of Thoracic Surgery, Ascension Saint Thomas Hospital,
University of Tennessee Health Science Center, Nashville, TN, United
States
(Awori Hayanga) Department of Cardiothoracic and Vascular Surgery, West
Virginia University Medicine, Morgantown, WV, United States
(Patel) Division of Hematology/Oncology, Department of Medicine,
Northwestern University, Chicago, Illinois, United States
(Neal) Division of Oncology, Department of Medicine, Stanford Cancer
Institute, Stanford, California, United States
(Abazeed) Department of Radiation Oncology, Northwestern University,
Feinberg School of Medicine, Chicago, Illinois, United States
(Willers) Department of Radiation Oncology, Massachusetts General
Hospital, Harvard Medical School, Boston, Massachusetts, United States
(Shrager) Division of Thoracic Surgery, Department of Cardiothoracic
Surgery, Stanford University School of Medicine, Stanford, California,
United States
(Shrager) Department of Surgery, Veterans Affairs Palo Altos Health Care
System, Stanford, California, United States
Publisher
Elsevier Inc.
Abstract
Background: The contemporary management and resectability of locally
advanced lung cancer are undergoing significant changes as new data emerge
regarding immunotherapy and targeted treatments. The objective of this
document is to review the literature and present consensus among a group
of multidisciplinary experts to guide the determination of resectability
and management of locally advanced non-small cell lung cancer (NSCLC) in
the context of contemporary evidence. Method(s): The Society of
Thoracic Surgeon Workforce on Thoracic Surgery assembled a
multidisciplinary expert panel composed of thoracic surgeons and medical
and radiation oncologists with established expertise in the management of
lung cancer. A focused literature review was performed, and expert
consensus statements were developed using a modified Delphi process to
address 3 major themes: (1) assessing resectability and multidisciplinary
management of locally advanced lung cancer, (2) neoadjuvant (including
perioperative) therapy, and (3) adjuvant therapy. Result(s): A
consensus was reached on 19 recommendations. These consensus statements
reflect updated insights on resectability and multidisciplinary management
of locally advanced lung cancer based on the latest literature and current
clinical experience, mainly focusing on the appropriateness of surgical
therapy and emerging data regarding neoadjuvant and adjuvant therapies.
 Conclusion(s): Despite the complex decision-making process in
managing locally advanced lung cancer, this expert panel agreed on several
key recommendations. This document provides guidance for thoracic surgeons
and other medical professionals in the optimal management of locally
advanced lung cancer based on the most updated evidence and
literature. Copyright © 2024 The Authors

<161>
Accession Number
2035773512
Title
Echocardiographic and Clinical Outcomes of Concomitant Secondary Chordal
Cutting to Surgical Myectomy in Hypertrophic Obstructive Cardiomyopathy: A
Systematic Review and Meta-analysis.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2024. Date of
Publication: 2024.
Author
Heeringa T.J.P.; Hegeman R.R.M.J.J.; Houwelingen L.V.; Hoogewerf M.;
Stecher D.; Kelder J.C.; Harst P.V.D.; Swaans M.J.; Mokhles M.M.; Vaartjes
I.; Klein P.; Kaaij N.P.V.D.
Institution
(Heeringa, Houwelingen, Hoogewerf, Mokhles, Kaaij) Department of
Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht,
Netherlands
(Hegeman, Klein) Department of Cardiothoracic Surgery, St Antonius
Hospital, Nieuwegein, Utrecht, Netherlands
(Stecher) Department of Cardiothoracic Surgery, Medical Centre Leeuwarden,
Fryslan, Leeuwarden, Netherlands
(Kelder) Department of Clinical Epidemiology, St Antonius Hospital,
Nieuwegein, Utrecht, Netherlands
(Harst) Department of Cardiology, University Medical Centre Utrecht,
Utrecht, Utrecht, Netherlands
(Swaans) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Utrecht, Netherlands
(Vaartjes) Department of Cardiovascular Epidemiology, Julius Center for
Health Sciences and Primary Care, Utrecht, Utrecht, Netherlands
(Klein) Department of Cardiothoracic Surgery, Amsterdam University,
Medical Centres, Noord-Holland, Amsterdam, Netherlands
(Kaaij) Department of Cardiothoracic Surgery, Erasmus Medical Centre,
Zuid-Holland, Rotterdam, Netherlands
Publisher
Georg Thieme Verlag
Abstract
In patients who underwent surgical myectomy for hypertrophic obstructive
cardiomyopathy (HOCM), additional mitral valve repair may offer additional
benefits in terms of further reducing left ventricular outflow tract
(LVOT) gradients, systolic anterior motion (SAM), and mitral regurgitation
(MR). We performed a systematic review of the literature to evaluate the
evidence of surgical myectomy with additional secondary chordal cutting in
patients with HOCM. A systematic literature search in MEDLINE and EMBASE
was performed until April 2024. The primary outcome studied was
postoperative echocardiographic LVOT gradient. A random effects
meta-analysis of means was performed for the primary outcome. The
secondary outcomes studied were postoperative residual MR grade, 30-day
new permanent pacemaker implantation, and in-hospital mortality. From
1,911 unique publications, a total of 6 articles fulfilled the inclusion
criteria and comprised 471 patients with a pooled mean preoperative
resting LVOT gradient of 84 mm Hg (95% confidence interval [CI]: 76-91).
The postoperative pooled mean LVOT gradient was 11 mm Hg (95% CI: 10-12)
with a low heterogeneity (I 2 = 44%). The residual LVOT gradient exceeding
30 mm Hg was present in nine (1%) patients. MR grade 3 or 4 at hospital
discharge was present in seven (1%) patients. The 30-day new permanent
pacemaker implantation rate was 7% and the in-hospital mortality was 0.4%.
This systematic review and meta-analysis demonstrate that combining
surgical myectomy with secondary chordal cutting can be performed safely
and effectively eliminate LVOT obstruction in HOCM patients. Further
studies are needed to determine the additive effectiveness of additional
secondary chordal cuttings. Copyright © 2024. The Author(s).

<162>
Accession Number
2032362214
Title
Heart failure after left atrial appendage occlusion: Insights from the
LAAOS III randomized trial.
Source
European Journal of Heart Failure. (no pagination), 2024. Date of
Publication: 2024.
Author
Krisai P.; Belley-Cote E.P.; McIntyre W.F.; Wong J.; Tsiplova K.; Brady
K.; Joseph P.; Johansson I.; Johnson L.; Xing L.Y.; Colli A.; McGuinness
S.; Punjabi P.; Reents W.; Rega F.; Budera P.; Royse A.G.; Paparella D.;
Connolly S.; Whitlock R.P.; Healey J.S.
Institution
(Krisai) Department of Cardiology and Cardiovascular Research Institute
Basel, University Hospital Basel, University of Basel, Basel, Switzerland
(Belley-Cote, McIntyre, Wong, Tsiplova, Brady, Joseph, Connolly, Whitlock,
Healey) McMaster University, Hamilton, ON, Canada
(Belley-Cote, McIntyre, Wong, Brady, Joseph, Connolly, Whitlock, Healey)
Hamilton Health Sciences, Hamilton, ON, Canada
(Belley-Cote, McIntyre, Wong, Brady, Joseph, Johansson, Johnson, Connolly,
Whitlock, Healey) Population Health Research Institute, Hamilton, ON,
Canada
(Johansson) Division of Cardiology, Department of Medicine K2, Karolinska
University Hospital Solna, Karolinska Institutet, Stockholm, Sweden
(Johnson) Department of Clinical Sciences Malmo, Lund University, Lund,
Sweden
(Xing) Department of Cardiology, Copenhagen University Hospital -
Rigshospitalet, Copenhagen, Denmark
(Colli) Department of Surgical, Medical and Molecular Pathology and
Critical Care, University of Pisa, Pisa, Italy
(McGuinness) Auckland City Hospital, Auckland, New Zealand
(Punjabi) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Reents) Rhon-Klinikum Campus Bad Neustadt, Bad Neustadt, Germany
(Rega) Department of Cardiac Surgery, University Hospitals Leuven, Leuven,
Belgium
(Budera) Institute for Clinical and Experimental Medicine, Prague, Czechia
(Royse) University of Melbourne and Royal Melbourne Hospital, Melbourne,
VIC, Australia
(Paparella) Department Medicine and Surgical Science, University of
Foggia, and Santa Maria Hospital, GVM Care & Research, Bari, Italy
Publisher
John Wiley and Sons Ltd
Abstract
Aims: The left atrial appendage (LAA) produces natriuretic peptides and
its removal or occlusion might increase the risk of heart failure (HF). We
aimed to investigate the incidence of HF after LAA occlusion or removal
(LAAO) in the Left Atrial Appendage Occlusion Study (LAAOS III).
 Methods and Results: Patients (n = 4811) with atrial fibrillation
(AF) and a CHA<inf>2</inf>DS<inf>2</inf>-VASc score >=2, who were having
cardiac surgery for another indication, were randomized to undergo
surgical LAAO or not. We compared the composite outcome of HF-related
hospitalizations and HF death between the two groups. HF assessment
required clinical and radiographic evidence of HF. Analyses included a
landmark analysis before and after 30 days and subgroups. Mean age was
71.2 years, 67.5% were male and 57.0% had prior HF. Over a mean follow-up
of 3.8 years, 396 (8.3%) patients met the composite HF outcome: 209 (8.8%)
with LAAO (n = 2379) and 187 (7.8%) without LAAO (n = 2391) (hazard ratio
[HR] 1.12, 95% confidence interval [CI] 0.92-1.37, p = 0.25). There was no
difference between the two groups in the first 30 days (1.6% vs. 1.1%; p =
0.12) and thereafter (7.6% vs. 7.1%; p = 0.57). Subgroups based on age,
sex, body mass index, AF type, prior HF, cardiac rhythm or left
ventricular ejection fraction showed consistent results. There was no
difference in HF outcomes with LAAO between the cut-and-sew (HR 0.93, 95%
CI 0.70-1.23, p = 0.62) versus other closure methods (HR 1.05, 95% CI
0.77-1.41, p = 0.77). Conclusion(s): Left atrial appendage occlusion
or removal at the time of cardiac surgery does not appear to alter the
risk of HF-related hospitalization or death. Clinical Trial Registration:
ClinicalTrials.gov NCT01561651. Copyright © 2024 The Author(s).
European Journal of Heart Failure published by John Wiley & Sons Ltd on
behalf of European Society of Cardiology.

<163>
Accession Number
645858068
Title
5-Year Results From the AMPLATZER Amulet Left Atrial Appendage Occluder
Randomized Controlled Trial.
Source
Journal of the American College of Cardiology. (no pagination), 2024.
Date of Publication: 15 Nov 2024.
Author
Lakkireddy D.; Ellis C.R.; Thaler D.; Swarup V.; Gambhir A.; Hermiller J.;
Nielsen-Kudsk J.E.; Worthley S.; Nair D.; Schmidt B.; Horton R.; Gupta N.;
Anderson J.A.; Zhao H.; Alkhouli M.; Windecker S.
Institution
(Lakkireddy) Kansas City Heart Rhythm Institute and Research Foundation,
Overland Park, KS, United States
(Ellis) Vanderbilt Heart Institute, Nashville, TN, United States
(Thaler) Tufts Medical Center, Boston, MA, United States
(Swarup) Arizona Cardiovascular Research Center, Phoenix, AZ, United
States
(Gambhir) Northside Hospital Cardiovascular Institute, Atlanta, GA, United
States
(Hermiller) St Vincent Medical Group, Inc, Indianapolis, IN, United States
(Nielsen-Kudsk) Aarhus University Hospital, Aarhus, Denmark
(Worthley) Macquarie University Hospital, Macquarie Park, NSW, Australia
(Nair) St Bernards Healthcare Cardiology Associates, Batesville, AR,
United States
(Schmidt) Cardiovascular Center Bethanien, Frankfurt, Germany
(Horton) Texas Cardiac Arrhythmia, Austin, TX, United States
(Gupta) Los Angeles Medical Center, Los Angeles, CA, United States
(Anderson, Zhao) Abbott Structural Heart, Plymouth, MN, United States
(Alkhouli) Mayo Clinic, Rochester, MN, United States
(Windecker) University Hospital of Bern, Bern, Switzerland
Abstract
BACKGROUND: The Amulet IDE trial (AMPLATZER Amulet Left Atrial Appendage
Occluder [LAAO] Investigational Device Exemption [IDE] Trial) evaluated
the safety and effectiveness of the Amulet occluder (Abbott) in patients
with nonvalvular atrial fibrillation. The Amulet IDE trial is the largest
randomized LAAO trial, comparing the Amulet occluder with the Watchman 2.5
device (Boston Scientific). OBJECTIVE(S): This analysis presents the
5-year results from the trial comparing the 2 devices head to head.
 METHOD(S): Patients enrolled in the Amulet IDE trial were at a high
risk of stroke or systemic embolism defined as a CHADS2 score >=2 or
CHA2DS2-VASc score >=3. Oral anticoagulation (OAC) use and key clinical
outcomes are presented through 5 years. RESULT(S): A total of 1,878
patients were randomized, with 1,833 undergoing a device implantation
attempt (n = 917, Amulet occluder; and n = 916, Watchman device). A
significantly higher percentage of patients were free of OAC in the Amulet
occluder group at each follow-up visit, with 94.0% and 90.9% free of OAC
at the last 5-year follow-up visit in the Amulet and Watchman device
groups, respectively (P = 0.009). The 5-year clinical outcomes were
similar between the Amulet and Watchman devices, including the composite
of ischemic stroke or systemic embolism (7.4% vs 7.1%; P = 0.851), the
composite of stroke, systemic embolism, or cardiovascular death (20.3% vs
20.7%; P = 0.666), major bleeding (20.1% vs 20.0%; P = 0.882),
cardiovascular (CV) death (14.3% vs 15.4%; P = 0.429), and all-cause death
(28.7% vs 31.1%; P = 0.217). Annualized ischemic stroke rates at 5 years
were low and the same for Amulet (1.6%/y) and Watchman (1.6%/y) devices.
Strokes in patients with the Amulet occluder were less severe (n = 38,
nondisabling; n = 11, disabling; n = 11, fatal; n = 12, unknown) than
strokes in patients with the Watchman device (n = 19, nondisabling; n =
22, disabling; n = 17, fatal; n = 10, unknown). Moreover, device factors
(device-related thrombus or peridevice leak >=3 mm) preceded stroke events
and CV deaths more frequently in patients with the Watchman device (n =
63) compared with patients with the Amulet occluder (n = 31).
 CONCLUSION(S): The 5-year outcomes from the largest randomized LAAO
clinical trial demonstrated the long-term safety and effectiveness of the
Amulet occluder and Watchman 2.5 devices. The dual-seal Amulet occluder
reduces atrial fibrillation-related thromboembolic events while
eliminating the need for long-term OAC. (AMPLATZER Amulet Left Atrial
Appendage Occluder [LAAO] Investigational Device Exemption [IDE] Trial
[Amulet IDE trial]; NCT02879448). Copyright © 2024 American
College of Cardiology Foundation. Published by Elsevier Inc. All rights
reserved.

<164>
Accession Number
645857518
Title
Meta-Analysis of Dedicated vs Off-Label Transcatheter Devices for Native
Aortic Regurgitation.
Source
JACC. Cardiovascular interventions. (no pagination), 2024. Date of
Publication: 25 Oct 2024.
Author
Samimi S.; Hatab T.; Kharsa C.; Khan S.U.; Bou Chaaya R.G.; Qamar F.; Aoun
J.; Zaid S.; Faza N.; Atkins M.D.; Little S.H.; Zoghbi W.A.; Reardon M.J.;
Kleiman N.S.; Goel S.S.
Institution
(Samimi, Hatab, Kharsa, Khan, Bou Chaaya, Aoun, Faza, Atkins, Little,
Zoghbi, Kleiman, Goel) Houston Methodist DeBakey Heart and Vascular
Center, Houston, TX, United States
(Qamar, Reardon) Department of Cardiovascular Surgery, Houston Methodist
Hospital, Houston, TX, United States
(Zaid) Section of Cardiology, Baylor College of Medicine, Michael E
DeBakey Veterans Affairs Medical Center, Houston, TX, United States
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) for high
surgical risk patients with severe native aortic regurgitation (AR)
presents unique challenges. Dedicated devices such as the JenaValve
(JenaValve Technology) and J-Valve (JC Medical Inc) show promising results
in addressing these challenges. OBJECTIVE(S): This study compares the
safety and efficacy of dedicated vs off-label devices among high surgical
risk patients with pure native AR. METHOD(S): We systematically
searched PubMed, EMBASE, and Cochrane Central Register of Controlled
Trials through July 11, 2024, for studies on TAVR among patients with pure
severe native AR. The primary endpoint was 30-day all-cause mortality.
Secondary endpoints were device success, residual AR >= moderate, valve
embolization/migration, pacemaker implantation, reintervention, and
all-cause mortality at 1 year. Summary estimates were constructed using a
random effects model. RESULT(S): A total of 34 studies encompassing
2,162 patients (mean age 75.4 +/- 0.2, 42.8% women) were included in the
meta-analysis. Patients undergoing TAVR with dedicated devices had a lower
all-cause 30-day mortality rate (3% vs 9%; P < 0.01) and higher device
success (93% vs 82%; P < 0.01) compared with off-label devices. The risk
of AR >= moderate (2% vs 5%; P = 0.03), valve embolization/migration (2%
vs 8%; P < 0.01), pacemaker implantation (11% vs 20%; P < 0.01), and
reintervention (4% vs 10%; P < 0.01) at 30 days and all-cause mortality at
1 year (6% vs 24%; P < 0.01) were lower in the dedicated device group.
 CONCLUSION(S): Dedicated TAVR devices for native AR show superior
device success and reduced mortality, residual AR, and reintervention
rates compared with off-label devices. These findings support the use of
dedicated devices as a safer alternative for high-risk
patients. Copyright Published by Elsevier Inc.

<165>
Accession Number
645857287
Title
Advanced Imaging Assessment of the Impact of Tricuspid Regurgitation on
Cardiac Remodeling: The TRILUMINATE Pivotal Imaging Substudy.
Source
Journal of the American College of Cardiology. (no pagination), 2024.
Date of Publication: 30 Oct 2024.
Author
Cavalcante J.L.; Scherer M.; Fukui M.; Lerakis S.; Harb S.; Pursnani A.;
Schwartz J.G.; Kapadia S.; Ricciardi M.J.; Khalique O.; Kodali S.; Shah
D.; Little S.H.; Sekaran N.; Whisenant B.; Flueckiger P.; Yadav P.;
Emaminia A.; Batchelor W.; Kellman P.; Lin Z.; Trusty P.M.; Hahn R.T.;
Adams D.; Sorajja P.
Institution
(Cavalcante) Allina Health Minneapolis Heart Institute, Minneapolis,
Minnesota, USA; Minneapolis Heart Institute Foundation Cardiovascular
Imaging Research Center and Core Lab, Minneapolis, Minnesota, USA
(Scherer, Schwartz) Atrium Health Carolinas Medical Center, Charlotte,
North Carolina, USA
(Fukui) Minneapolis Heart Institute Foundation Cardiovascular Imaging
Research Center and Core Lab, Minneapolis, MN, United States
(Lerakis, Adams) Mount Sinai Hospital, NY, United States
(Harb, Kapadia) Cleveland Clinic Foundation, Cleveland, OH, United States
(Pursnani, Ricciardi) NorthShore University Health System, Evanston, IL,
United States
(Khalique, Kodali, Hahn) New York-Presbyterian/Columbia University Medical
Center, NY, United States
(Shah, Little) Houston Methodist Debakey Heart and Vascular Center,
Houston, TX, United States
(Sekaran, Whisenant) Intermountain Medical Center, Murray, UT, United
States
(Flueckiger, Yadav) Piedmont Heart Institute, Atlanta, GA, United States
(Emaminia, Batchelor) Inova Heart and Vascular Institute, Fairfax, VA,
United States
(Kellman) National Institutes of Health, National Heart, Lung, Blood
Institute, Bethesda, MD, United States
(Lin, Trusty) Abbott Structural Heart, Santa Clara, CA, United States
(Sorajja) Allina Health Minneapolis Heart Institute, Minneapolis, MN,
United States
Abstract
BACKGROUND: The impact of tricuspid regurgitation (TR) on cardiac
remodeling has not been thoroughly studied in a randomized controlled
trial using advanced imaging. OBJECTIVE(S): The goal of this analysis
was to provide comparative longitudinal changes in right heart remodeling
using cardiac magnetic resonance and time-resolved functional computed
tomography (4D-CT) in patients with symptomatic severe TR randomized to
TriClip vs medical therapy (control). METHOD(S): TRILUMINATE Pivotal
(Clinical Trial to Evaluate Cardiovascular Outcomes In Patients Treated
With the Tricuspid Valve Repair System Pivotal) is an international
randomized controlled trial in symptomatic patients with severe TR. A
prospective imaging substudy was performed on TRILUMINATE Pivotal subjects
at 10 sites. Cardiac magnetic resonance and 4D-CT were performed following
dedicated imaging protocols at baseline and at 30 days, and a final 4D-CT
at 1 year (all assessed by an imaging core lab). RESULT(S):
Sixty-nine randomized subjects (31 TriClip, 38 control) were enrolled. TR
volume significantly decreased with TriClip at 30 days (P < 0.0001; 70%
reduction). A strong association (r = 0.90; P < 0.0001) was observed
between changes in TR volume and right ventricular end-diastolic volume at
30 days. Significant reductions in right ventricular end-diastolic volume
(12% reduction; P < 0.001) and tricuspid annular area (11% reduction; P <
0.0001) were seen at 30 days and sustained through 1 year with TriClip. No
meaningful changes were observed in the control group. CONCLUSION(S):
Advanced imaging from the TRILUMINATE Pivotal imaging substudy
demonstrated that TriClip effectively reduced TR. Significant cardiac
remodeling was observed at 30 days and sustained at 1 year. With TriClip,
the extent of cardiac remodeling was associated with the degree of TR
reduction. (Clinical Trial to Evaluate Cardiovascular Outcomes In Patients
Treated With the Tricuspid Valve Repair System Pivotal;
NCT03904147). Copyright © 2024 American College of Cardiology
Foundation. Published by Elsevier Inc. All rights reserved.

<166>
Accession Number
2035919668
Title
Perioperative respiratory muscle exercise in patients undergoing cardiac
surgery: An evidence-based review.
Source
Heart and Lung. 70 (pp 73-81), 2025. Date of Publication: 01 Mar 2025.
Author
Wang Q.; Peng Y.; Xu S.; Guo H.; Chen Y.; Lin L.; Chen L.; Lin Y.
Institution
(Wang, Peng, Lin, Chen, Lin) Department of Cardiovascular Surgery, Fujian
Medical University Union Hospital, No. 29, Xinquan Road, Fujian, Fuzhou,
China
(Wang, Peng, Lin, Lin) Department of Nursing, Fujian Medical University
Union Hospital, No. 29, Xinquan Road, Fujian, Fuzhou, China
(Xu, Guo, Chen) The school of Nursing, Fujian Medical University, No. 1,
Xuefu North Road, Fujian, Fuzhou, China
Publisher
Elsevier Inc.
Abstract
Background: Enhanced respiratory muscle management is imperative in
cardiac surgery patients due to their universal risk of decreased
perioperative respiratory muscle strength. Objective(s): Most
existing articles primarily examine respiratory muscle exercise during
either the preoperative, postoperative, or at-home phases. Consequently,
there is a crucial need to consolidate the evidence for respiratory muscle
exercise throughout the perioperative period of cardiac surgery.
 Method(s): A literature search was performed, encompassing guideline
networks and databases up until July 2023. The literature was classified
into seven thematic categories: preoperative assessment, patient
education, trainers, training plans, quality control, safety monitoring,
and outcome assessment. The quality of the included literature was
assessed using the GRAGE evidence grading system to ascertain the level of
recommendation associated with each piece of evidence. Result(s):
Nineteen papers were reviewed, encompassing 24 suggestions. These
consisted of two suggestions on preoperative assessment, four on patient
education, two on trainers, six on training programs, seven on quality
control, two on safety monitoring, and one on outcome assessment. All 24
suggestions were categorized as strong recommendations, with 14 classified
as high-quality evidence and ten as moderate-quality evidence.
 Conclusion(s): Our study presents a succinct synthesis of the most
robust evidence available on perioperative respiratory muscle exercise in
cardiac surgery patients. We identified ten high-quality suggestions while
an additional 14 moderate-quality suggestions. In the context of
perioperative exercise, we recommend that moderate-intensity inspiratory
muscle exercises be provided during the preoperative and postoperative
phases upon transfer to the ward. We advocate for the implementation of
low-intensity inspiratory muscle exercises during the postoperative phase
while patients are in the intensive care unit. Copyright © 2024

<167>
Accession Number
2035944752
Title
Prehabilitation before cardiac surgery.
Source
British Journal of Anaesthesia. (no pagination), 2024. Date of
Publication: 2024.
Author
Gibbison B.; Pufulete M.
Institution
(Gibbison) Cardiac Anaesthesia and Intensive Care, Bristol Medical School,
University of Bristol, Bristol, United Kingdom
(Gibbison) Cardiac Anaesthesia and Intensive Care, University Hospitals
Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
(Pufulete) Bristol Medical School, University of Bristol, Bristol, United
Kingdom
Publisher
Elsevier Ltd
Abstract
Prehabilitation aims to reduce the impact of major surgery by improving
the physical and psychological resilience of patients. Although exercise
represents one component of prehabilitation, nutritional and psychological
support are also critical to its effectiveness, and any benefits are only
likely to be realised if the different components are implemented
together, ideally in a behaviour change framework. Implementation of
prehabilitation in cardiac surgery has not been as widespread as in other
types of surgery, despite many randomised controlled trials (RCTs) of
single interventions in this setting. The late adoption of a
prehabilitation programme in cardiac surgery represents an opportunity to
ensure that it is both clinically effective and cost-effective before
widespread roll-out. This was mostly not done for prehabilitation in
noncardiac surgery, where programmes were implemented largely without
trials of these combined interventions. The most likely chance of an
effective prehabilitation programme for cardiac surgery is to combine all
the efficacious and implementable single interventions together in one
comprehensive evidence-based programme. This should then be tested in an
adequately powered multicentre RCT in a representative cardiac surgery
population. Copyright © 2024 British Journal of Anaesthesia

<168>
Accession Number
645847053
Title
Alternative LDL Cholesterol-Lowering Strategy vs High-Intensity Statins in
Atherosclerotic Cardiovascular Disease: A Systematic Review and Individual
Patient Data Meta-Analysis.
Source
JAMA cardiology. (no pagination), 2024. Date of Publication: 20 Nov 2024.
Author
Lee Y.-J.; Hong B.-K.; Yun K.H.; Kang W.C.; Hong S.J.; Lee S.-H.; Lee
S.-J.; Hong S.-J.; Ahn C.-M.; Kim J.-S.; Kim B.-K.; Ko Y.-G.; Choi D.;
Jang Y.; Hong M.-K.
Institution
(Lee, Lee, Lee, Hong, Ahn, Kim, Kim, Ko, Choi, Hong) Division of
Cardiology, Severance Hospital, Yonsei University College of Medicine,
Seoul, South Korea
(Hong) Gangnam Severance Hospital, Seoul, South Korea
(Yun) Wonkwang University Hospital, Iksan, South Korea
(Kang) Gachon University College of Medicine, Incheon, South Korea
(Hong) Korea University College of Medicine, Seoul, South Korea
(Jang) CHA University College of Medicine, Seongnam, South Korea
Abstract
Importance: In patients with atherosclerotic cardiovascular disease
(ASCVD), intensive lowering of low-density lipoprotein (LDL) cholesterol
levels with high-intensity statins is generally recommended. However,
alternative approaches considering statin-related adverse effects and
intolerance are needed. Objective(s): To compare the long-term
efficacy and safety of an alternative LDL cholesterol-lowering strategy vs
high-intensity statin strategy in patients with ASCVD in randomized
clinical trials. Data Sources: PubMed, Embase, and other websites
(ClinicalTrials.gov, European Society of Cardiology, tctMD) were
systematically searched from inception to April 19, 2024. Study Selection:
Randomized clinical trials comparing an alternative LDL
cholesterol-lowering strategy vs a high-intensity statin strategy in
patients with ASCVD, with presence of cardiovascular events as end points.
Data Extraction and Synthesis: Individual patient data were obtained from
randomized clinical trials that met the prespecified eligibility criteria:
RACING (Randomized Comparison of Efficacy and Safety of Lipid-Lowering
With Statin Monotherapy vs Statin/Ezetimibe Combination for High-Risk
Cardiovascular Disease) and LODESTAR (Low-Density Lipoprotein
Cholesterol-Targeting Statin Therapy vs Intensity-Based Statin Therapy in
Patients With Coronary Artery Disease). The moderate-intensity statin with
ezetimibe combination therapy in the RACING trial and the treat-to-target
strategy in the LODESTAR trial were classified as alternative LDL
cholesterol-lowering strategies. The primary analysis was based on a
1-stage approach. Main Outcomes and Measures: The primary end point
was a 3-year composite of all-cause death, myocardial infarction, stroke,
or coronary revascularization. The secondary end points comprised clinical
efficacy and safety end points. Result(s): Individual patient data
from 2 trials including 8180 patients with ASCVD (mean [SD] age, 64.5
[9.8] years; 2182 [26.7%] female; 5998 male [73.3%]) were analyzed. The
rate of the primary end point did not differ between the alternative
strategy and high-intensity statin strategy groups (7.5% [304 of 4094] vs
7.7% [310 of 4086]; hazard ratio,0.98; 95% CI, 0.84-1.15; P=.82). The mean
(SD) LDL cholesterol level during treatment was 64.8 (19.0) mg/dL in the
alternative strategy group and 68.5 (20.7) mg/dL in the high-intensity
statin strategy group (P<.001). The alternative strategy group had a lower
rate of new-onset diabetes (10.2% [271 of 2658] vs 11.9% [316 of 2656];
P=.047), initiation of antidiabetic medication for new-onset diabetes
(6.5% [173 of 2658] vs 8.2% [217 of 2656]; P=.02), and intolerance-related
discontinuation or dose reduction of assigned therapy (4.0% [163 of 4094]
vs 6.7% [273 of 4086]; P<.001). Conclusions and Relevance: Results of
this systematic review and individual patient data meta-analysis suggest
that compared with a high-intensity statin strategy, the alternative LDL
cholesterol-lowering strategy demonstrated comparable efficacy regarding
3-year death or cardiovascular events in patients with ASCVD, with an
associated reduction in LDL cholesterol levels and risk for new-onset
diabetes and intolerance. Study Registration: PROSPERO CRD42024532550.

<169>
Accession Number
2035902310
Title
Valve Choice for TAVR: Much Left to re-SOLVE.
Source
Journal of the American College of Cardiology. (no pagination), 2024.
Date of Publication: 2024.
Author
Butala N.M.; Krishnaswamy A.
Institution
(Butala) Rocky Mountain Regional VA Medical Center, Aurora, CO, United
States
(Butala) University of Colorado School of Medicine, Aurora, CO, United
States
(Krishnaswamy) Department of Cardiovascular Medicine, Heart, Vascular and
Thoracic Institute, Cleveland Clinic, Cleveland Ohio, United States
Publisher
Elsevier Inc.

<170>
Accession Number
2035902137
Title
Effect of Valve Type and Anesthesia Strategy for TAVR: 5-Year Results of
the SOLVE-TAVI Trial.
Source
Journal of the American College of Cardiology. (no pagination), 2024.
Date of Publication: 2024.
Author
Feistritzer H.-J.; Kurz T.; Vonthein R.; Schroder L.; Stachel G.; Eitel
I.; Marquetand C.; Saraei R.; Kirchhof E.; Heringlake M.; Abdel-Wahab M.;
Desch S.; Thiele H.
Institution
(Feistritzer, Stachel, Abdel-Wahab, Desch, Thiele) Heart Center Leipzig at
University of Leipzig, Leipzig, Germany
(Kurz, Eitel, Marquetand, Saraei, Heringlake) University Heart Center
Lubeck, Lubeck, Germany
(Kurz, Eitel, Marquetand, Saraei, Heringlake, Desch) German Center for
Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lubeck, Lubeck,
Germany
(Vonthein, Schroder) Institute of Medical Biometry and Statistics, Lubeck,
Germany
(Stachel) Clinic and Policlinic for Cardiology, Leipzig University Clinic,
Leipzig, Germany
(Kirchhof) Helios Health Institute, Leipzig, Germany
Publisher
Elsevier Inc.
Abstract
Background: In the randomized SOLVE-TAVI (compariSon of secOnd-generation
seLf-expandable vs. balloon-expandable Valves and gEneral vs. local
anesthesia in Transcatheter Aortic Valve Implantation) trial comparing
newer-generation self-expanding valves (SEV) and balloon-expandable valves
(BEV), as well as conscious sedation (CS) and general anesthesia (GA),
clinical outcomes were similar both for valve and anesthesia comparison at
30 days and 1 year. Prosthesis durability may affect clinical outcomes
during long-term follow-up. Moreover, the impact of the anesthesia
strategy on long-term clinical outcomes is unknown so far.
 Objective(s): The authors sought to compare clinical outcomes during
5-year follow-up in the randomized SOLVE-TAVI trial. Method(s): In
the randomized, multicenter, 2 x 2 factorial, open-label SOLVE-TAVI trial,
447 intermediate- to high-risk patients with severe, symptomatic aortic
stenosis were randomly assigned to transfemoral transcatheter aortic valve
replacement (TAVR) using either SEV (Evolut R, Medtronic) or BEV (SAPIEN
3, Edwards Lifesciences) and also to CS vs GA. Patients were followed-up
for 5 years. Result(s): During 5 years of follow-up, the combined
predefined endpoint of all-cause mortality, stroke, moderate or severe
paravalvular leakage, and permanent pacemaker implantation was similar in
the SEV and BEV groups (67.7% vs 63.4%; HR: 0.89; 95% CI: 0.70-1.13; P =
0.34). Stroke rates at 5 years were lower in the SEV group (2.2% vs 9.6%;
HR: 4.84; 95% CI: 1.65-14.18; P = 0.002). Regarding the anesthesia
comparison, the primary endpoint of all-cause mortality, stroke,
myocardial infarction, and acute kidney injury occurred in 51.4% in the CS
group and 61.3% in the GA group (HR: 0.80; 95% CI: 0.62-1.04; P = 0.09).
All-cause mortality at 5 years was lower for CS (41.5% vs 54.3%; HR: 0.70;
95% CI: 0.53-0.94; P = 0.02). Conclusion(s): Transfemoral TAVR using
either SEV and BEV as well as CS and GA showed similar clinical outcomes
at 5 years using a combined clinical endpoint. Copyright © 2024
American College of Cardiology Foundation

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