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<1>
Accession Number
2031656140
Title
Developing an automated algorithm for identification of children and
adolescents with diabetes using electronic health records from the
OneFlorida+ clinical research network.
Source
Diabetes, Obesity and Metabolism. 27(1) (pp 102-110), 2025. Date of
Publication: January 2025.
Author
Li P.; Spector E.; Alkhuzam K.; Patel R.; Donahoo W.T.; Bost S.; Lyu T.;
Wu Y.; Hogan W.; Prosperi M.; Dixon B.E.; Dabelea D.; Utidjian L.H.; Crume
T.L.; Thorpe L.; Liese A.D.; Schatz D.A.; Atkinson M.A.; Haller M.J.;
Shenkman E.A.; Guo Y.; Bian J.; Shao H.
Institution
(Li, Alkhuzam, Patel, Shao) Department of Pharmaceutical Outcomes and
Policy, College of Pharmacy, University of Florida, Gainesville, FL,
United States
(Spector, Bost, Lyu, Wu, Hogan, Prosperi, Shenkman, Guo, Bian) Department
of Health Outcomes and Biomedical Informatics, College of Medicine,
University of Florida, Gainesville, FL, United States
(Donahoo) Division of Endocrinology, Diabetes and Metabolism, College of
Medicine, University of Florida, Gainesville, FL, United States
(Dixon) Department of Epidemiology, Indiana University (IU) Richard M.
Fairbanks School of Public Health, Indianapolis, IN, United States
(Dabelea) Lifecourse Epidemiology of Adiposity and Diabetes Centre,
University of Colorado Anschutz Medical Campus, Aurora, CO, United States
(Utidjian) Division of General Paediatrics and Department of Biomedical
and Health Informatics, Children's Hospital of Philadelphia, Philadelphia,
PA, United States
(Crume) Department of Epidemiology, LEAD Centre, Colorado School of Public
Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United
States
(Thorpe) Department of Population Health, NYU Langone Health, New York,
NY, United States
(Liese) Department of Epidemiology and Biostatistics, Arnold School of
Public Health, University of South Carolina, Columbia, SC, United States
(Schatz, Haller) Department of Paediatrics, University of Florida College
of Medicine, Gainesville, FL, United States
(Atkinson) Diabetes Institute, University of Florida, Gainesville, FL,
United States
(Shao) Hubert Department of Global Health, Rollin School of Public Health,
Emory University, Atlanta, GA, United States
(Shao) Department of Family and Preventive Medicine, School of Medicine,
Emory University, Atlanta, GA, United States
Publisher
John Wiley and Sons Inc
Abstract
Aim: To develop an automated computable phenotype (CP) algorithm for
identifying diabetes cases in children and adolescents using electronic
health records (EHRs) from the UF Health System. Material(s) and
Method(s): The CP algorithm was iteratively derived based on structured
data from EHRs (UF Health System 2012-2020). We randomly selected 536
presumed cases among individuals aged <18 years who had (1) glycated
haemoglobin levels >= 6.5%; or (2) fasting glucose levels >=126 mg/dL; or
(3) random plasma glucose levels >=200 mg/dL; or (4) a diabetes-related
diagnosis code from an inpatient or outpatient encounter; or (5)
prescribed, administered, or dispensed diabetes-related medication. Four
reviewers independently reviewed the patient charts to determine diabetes
status and type. Result(s): Presumed cases without type 1 (T1D) or
type 2 diabetes (T2D) diagnosis codes were categorized as
non-diabetes/other types of diabetes. The rest were categorized as T1D if
the most recent diagnosis was T1D, or otherwise categorized as T2D if the
most recent diagnosis was T2D. Next, we applied a list of diagnoses and
procedures that can determine diabetes type (e.g., steroid use suggests
induced diabetes) to correct misclassifications from Step 1. Among the 536
reviewed cases, 159 and 64 had T1D and T2D, respectively. The sensitivity,
specificity, and positive predictive values of the CP algorithm were 94%,
98% and 96%, respectively, for T1D and 95%, 95% and 73% for T2D.
 Conclusion(s): We developed a highly accurate EHR-based CP for
diabetes in youth based on EHR data from UF Health. Consistent with prior
studies, T2D was more difficult to identify using these
methods. Copyright © 2024 John Wiley & Sons Ltd.

<2>
Accession Number
2032495354
Title
Effect of Postoperative Atrial Fibrillation After Cardiac Surgery: A
Meta-Analysis.
Source
Clinical Cardiology. 47(12) (no pagination), 2024. Article Number: e70053.
Date of Publication: December 2024.
Author
Qu F.; Yang W.; He N.; Qu S.; Zhou X.; Ma H.; Jiang X.
Institution
(Qu, Ma) Medical School, Xizang Minzu University, Xianyang, China
(Yang) Emergency Department, The Affiliated Hospital of Xizang University
for Nationalities, Xianyang, China
(He, Jiang) Department of Cardiology, Shaanxi Provincial People's
Hospital, Shaanxi, China
(Qu) School of Mechanic Engineering, Sichuan University, Sichuan, China
(Zhou) Department of Dermatology, The Second Xiangya Hospital of Central
South University, Changsha, China
Publisher
John Wiley and Sons Inc
Abstract
Background: A meta-analysis study was conducted to determine how to
predict the effect of postoperative atrial fibrillation after cardiac
surgery. Hypothesis: Long-term mortality and cardiovascular morbidity are
linked to postoperative atrial fibrillation. Method(s): Until August
2024, a comprehensive literature study was completed, and 3486 connected
studies were revised. The 38 selected studies included 241 299 cardiac
surgery participants at the beginning of the study. The odds ratio (OR)
and 95% confidence intervals (CIs) were used to look at the effect of
atrial fibrillation after heart surgery using two-sided methods and either
a fixed or random model. Result(s): Individuals with cardiac surgery
with postoperative atrial fibrillation had significantly higher mortality
at 1 year (OR, 1.39; 95% CI, 1.12-1.72, p < 0.001), mortality at 5 years
(OR, 1.61; 95% CI, 1.33-1.94, p < 0.001), mortality at 10 years (OR, 1.61;
95% CI, 1.39-1.87, p < 0.001), and overall stroke (OR, 1.61; 95% CI,
1.34-1.94, p < 0.001) compared to without postoperative atrial
fibrillation. Conclusion(s): Individuals with cardiac surgery with
postoperative atrial fibrillation had significantly higher mortality at 1
year, mortality at 5 years, mortality at 10 years, and overall stroke
compared to those without postoperative atrial fibrillation. To validate
this discovery, more research and caution must be implemented when
interacting with its values. Copyright © 2024 The Author(s).
Clinical Cardiology published by Wiley Periodicals, LLC.

<3>
Accession Number
2032467617
Title
Core Laboratory Versus Center-Reported Echocardiographic Assessment of the
Native and Bioprosthetic Aortic Valve.
Source
Echocardiography. 41(12) (no pagination), 2024. Article Number: e70047.
Date of Publication: December 2024.
Author
Velders B.J.J.; Vriesendorp M.D.; Weissman N.J.; Sabik J.F.; Reardon M.J.;
Dagenais F.; Moront M.G.; Rao V.; Fukuhara S.; Gunzinger R.; van Leeuwen
W.J.; Brown W.M.; Groenwold R.H.H.; Klautz R.J.M.; Asch F.M.
Institution
(Velders, Vriesendorp, Klautz) Cardiothoracic Surgery, Leiden University
Medical Centre, Leiden, Netherlands
(Weissman, Asch) Cardiovascular Core Laboratories, MedStar Health Research
Institute, and Georgetown University, Washington, DC, United States
(Sabik) Surgery, University Hospitals Cleveland Medical Center and Case
Western Reserve University School of Medicine, Cleveland, OH, United
States
(Reardon) Department of Cardiothoracic Surgery, Houston Methodist DeBakey
Heart and Vascular Center, Houston, TX, United States
(Dagenais) Division of Cardiac Surgery, Quebec Heart and Lung Institute,
Quebec, QC, Canada
(Moront) Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, OH,
United States
(Rao) Department of Cardiovascular Surgery, Peter Munk Cardiac Centre,
Toronto General Hospital, Toronto, ON, Canada
(Fukuhara) Department of Cardiac Surgery, University of Michigan, Ann
Arbor, MI, United States
(Gunzinger) Department of Cardiovascular Surgery, German Heart Center
Munich, Technische Universitat Munchen, Munich, Germany
(Gunzinger) Department of Cardiovascular Surgery, German Heart Center
Munich, Insure (Institute for Translational Cardiac Surgery), Technische
Universitat Munchen, Munich, Germany
(van Leeuwen) Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam,
Netherlands
(Brown) Cardiovascular Surgery, Piedmont Heart Institute, Atlanta, GA,
United States
(Groenwold) Clinical Epidemiology & Biomedical Data Science, Leiden
University Medical Center, Leiden, Netherlands
Publisher
John Wiley and Sons Inc
Abstract
Background: Insights into quantitative differences between core laboratory
and center-reported echocardiographic assessment of the native and
bioprosthetic aortic valve are lacking. We aimed to explore clinically
relevant differences between these evaluations. Method(s): Data were
used from the PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON)
Pivotal Trial for the Avalus valve. In this trial, patients with an
indication for surgical aortic valve replacement (SAVR) due to aortic
stenosis or regurgitation (AR) were enrolled. Serial echocardiographic
examinations were performed at each center and blindly reanalyzed by an
independent echocardiographic core laboratory (ECL). For the bioprosthetic
valve analysis, postoperative data throughout the 5-year follow-up were
pooled. Differences between the ECL and the centers in continuous
parameters were quantified in mean differences and intraclass correlation
coefficients (ICCs). Agreement on AR, paravalvular leak (PVL), and
prosthesis-patient mismatch (PPM) classification was investigated using
Cohen's kappa coefficients. Result(s): The analysis on the native
aortic valve was performed on 1118 echocardiograms. The relative mean
difference was largest for the left ventricular outflow tract (LVOT) area,
followed by stroke volume and effective orifice area (index), with
center-reported values being 11%-7% higher. High ICCs of around 0.90 were
observed for the parameters peak aortic jet velocity, mean pressure
gradient, and the velocity-time integral across the aortic valve. Over
5000 echocardiograms were available for the bioprosthetic valve analysis.
Therein, comparable results were observed. The kappa coefficient was 0.59
(95% confidence interval [CI] 0.56, 0.63) for agreement on native AR, 0.28
(95% CI 0.18, 0.37) for PVL, and 0.42 (95% CI 0.40, 0.44) for PPM.
 Conclusion(s): There is high agreement between the ECL and clinical
centers on continuous-wave Doppler-related measurements. In contrast,
agreement is low for parameters that involve measurement of the LVOT
diameter. These results provide important context for the interpretation
of aortic valve performance in studies that lack central ECL evaluation.
Trial Registration: ClinicalTrials.gov identifier:
NCT02088554. Copyright © 2024 The Author(s). Echocardiography
published by Wiley Periodicals LLC.

<4>
Accession Number
2032466487
Title
Trans-femoral versus trans-carotid access for transcatheter aortic valve
replacement: an updated systematic review and meta-analysis.
Source
Future Science OA. 10(1) (no pagination), 2024. Article Number: FSO930.
Date of Publication: 2024.
Author
Yamani N.; Ali S.H.; Sadiq M.; Ahmed A.B.; Bhojwani K.D.; Lohana V.P.;
Fatmah S.; Khalid S.; Shamsi H.R.; Zehra B.; Fatima K.; Baloch Z.Q.
Institution
(Yamani) Division of Cardiology, University of Arizona Phoenix Medical
Center, AZ 85721, United States
(Ali, Sadiq, Ahmed, Shamsi, Fatima) Faculty of Medicine, Dow Medical
College, Dow University of Health Sciences, Karachi 74200, Pakistan
(Bhojwani, Lohana) Faculty of Medicine, Dow International Medical College,
Dow University of Health Sciences, Karachi 74200, Pakistan
(Fatmah, Zehra) Faculty of Medicine, Karachi Medical & Dental College,
Karachi 74700, Pakistan
(Khalid) Faculty of Medicine, Sindh Medical College, Jinnah Sindh Medical
University, Karachi 75510, Pakistan
(Baloch) Division of Cardiology, Sparrow Hospital, Michigan State
University, MI 48912, United States
Publisher
Taylor and Francis Ltd.
Abstract
Aim: This meta-analysis aims to shed light on any primacy the
trans-carotid (TC-TAVR) access may have over the trans-femoral access
(TF-TAVR) for those undergoing transcatheter aortic valve replacement
(TAVR). Method(s): PubMed/MEDLINE and Cochrane Library were searched,
from inception to March 2023 retrieving seven adjusted studies with a
total of 6609 patients, of which 5048 underwent TF-TAVR while 1561
underwent TC-TAVR. Result(s): No divergence in risk of mortality,
major bleeding or stroke/transient ischemic attack in TC-TAVR when
compared with TF-TAVR was found. In TC-TAVR, the risk of vascular
complications was low (OR: 0.51, 95% CI: 0.32-0.83, p = 0.003) as compared
with TF-TAVR. Conclusion(s): As of this analysis, the viability of
TC-TAVR as first alternative to TF-TAVR is plausible. Copyright ©
2024 The Authors.

<5>
[Use Link to view the full text]
Accession Number
2036000612
Title
Catheter Ablation in Patients With End-Stage Heart Failure and Atrial
Fibrillation: Two-Year Follow-Up of the CASTLE-HTx Trial.
Source
Circulation. 150(23) (pp 1904-1906), 2024. Date of Publication: 03 Dec
2024.
Author
Sohns C.; Moersdorf M.; Marrouche N.F.; Bergau L.; Costard-Jaeckle A.;
Crijns H.J.G.M.; Fox H.; Hindricks G.; Dagres N.; Sossalla S.; Schramm R.;
Fink T.; El Hamriti M.; Sciacca V.; Didenko M.; Konietschke F.; Rudolph
V.; Gummert J.; Tijssen J.G.P.; Sommer P.
Institution
(Sohns, Moersdorf, Bergau, Fink, El Hamriti, Sciacca, Didenko, Sommer)
Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW,
Ruhr-Universitat Bochum, Med. Fakultat OWL (Universitat Bielefeld), Bad
Oeynhausen, Germany
(Costard-Jaeckle, Fox, Schramm, Gummert) Clinic for Thoracic and
Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universitat
Bochum, Med. Fakultat OWL (Universitat Bielefeld), Bad Oeynhausen, Germany
(Costard-Jaeckle, Fox, Schramm) Heart Failure Department, Herz- und
Diabeteszentrum NRW, Ruhr-Universitat Bochum, Med. Fakultat OWL
(Universitat Bielefeld), Bad Oeynhausen, Germany
(Rudolph) Clinic for General and Interventional Cardiology/Angiology,
Herz- und Diabeteszentrum NRW, Ruhr-Universitat Bochum, Med. Fakultat OWL
(Universitat Bielefeld), Bad Oeynhausen, Germany
(Marrouche) Cardiology Department, Tulane University School of Medicine,
New Orleans, LA, United States
(Crijns) Department of Cardiology, CARIM, Maastricht University,
Cardiovascular Research Institute, Maastricht, Netherlands
(Hindricks) Department of Cardiology, Angiology and Intensive Care
Medicine, German Heart Center of the Charite, University Medicine Berlin,
Charite Campus Mitte, Germany
(Dagres) Department of Electrophysiology, Heart Centre Leipzig, Germany
(Sossalla) Department of Cardiology and Angiology, University of Giessen &
Kerckhoff Heart Center, Bad Nauheim/DZHK (Partner Site RheinMain), Germany
(Konietschke) Institute of Biometry and Clinical Epidemiology,
Charite-Universitatsmedizin Berlin, Freie Universitat Berlin and
Humboldt-Universitat zu Berlin, Germany
(Tijssen) Department of Cardiology, Amsterdam UMC, University of
Amsterdam, Netherlands
Publisher
Lippincott Williams and Wilkins

<6>
Accession Number
2035284967
Title
Systematic Review of Case Manager Nurse in Heart Transplant and Heart
Failure Consultation.
Source
Transplantation Proceedings. 56(9) (pp 2006-2011), 2024. Date of
Publication: November 2024.
Author
Villarreal-Granda P.; Recio-Platero A.; Martin-Bayo Y.; Durantez-Fernandez
C.; Cardaba-Garcia R.M.; Perez-Perez L.; Madrigal M.; Munoz-del Caz A.;
Bahillo Ruiz E.; Jimenez-Navascues L.; Prieto Zambrano P.;
Velasco-Gonzalez V.
Institution
(Villarreal-Granda, Martin-Bayo) Nursing Department (Graduate in
Nursing-Honorary collaborator), Faculty of Nursing, University of
Valladolid, Valladolid, Spain
(Recio-Platero) Unidad de Insuficiencia Cardiaca y Terapias Avanzadas,
Hospital Clinico Universitario de Valladolid, Valladolid, Spain
(Durantez-Fernandez, Cardaba-Garcia, Perez-Perez, Madrigal, Munoz-del Caz,
Bahillo Ruiz, Jimenez-Navascues, Velasco-Gonzalez) Nursing Department,
Faculty of Nursing, University of Valladolid, Valladolid, Spain
(Durantez-Fernandez, Cardaba-Garcia, Perez-Perez, Madrigal, Munoz-del Caz,
Velasco-Gonzalez) Nursing Care Research (GICE), Faculty of Nursing,
University of Valladolid, Valladolid, Spain
(Perez-Perez) Primary Care Management Valladolid West (SACYL), Valladolid,
Spain
(Munoz-del Caz) Hospital Clinico Universitario de Valladolid (HCUV),
Valladolid, Spain
(Bahillo Ruiz, Jimenez-Navascues) Nursing Department, Faculty of Health
Sciences, University of Valladolid, Soria, Spain
(Prieto Zambrano) Primary Care Management Valladolid East (SACYL),
Valladolid, Spain
Publisher
Elsevier Inc.
Abstract
Objective: To analyze the functions and activities of the case manager
nurse in the specialized practice of transplantation and heart failure.
 Method(s): This systematic review is reported according to the PRISMA
guidelines. Selected articles were subjected to a detailed critical
reading and the evidence levels and recommendation grades of the Joanna
Briggs Institute were verified. The field of documentation search was
limited to the last 5 years. Result(s): Health education provided by
nursing is key in patients with heart failure and heart transplants. It
must be evidence-based and focuses primarily on promoting self-care and
adherence to therapy, although it includes other aspects such as
recognition of signs and symptoms by the patient. Both activities are
essential to prevent decompensations of heart failure, thus reducing
hospital readmissions and mortality rates. Conclusion(s): Nursing has
an essential role in multidisciplinary programs for the care of heart
failure and heart transplant patients. Case manager nurse role stands out
for being cost effective, as well as for improving treatment compliance
and reducing hospital stay and mortality rates. Nursing functions in this
practice ensure continuity and coordination of care between the different
health levels, increasing the patients' quality of life. Copyright
© 2024 Elsevier Inc.

<7>
Accession Number
645883878
Title
Interventions to prevent surgical site infection in adults undergoing
cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2024(12) (no pagination), 2024.
Article Number: CD013332. Date of Publication: 02 Dec 2024.
Author
Rogers L.J.; Vaja R.; Bleetman D.; Ali J.M.; Rochon M.; Sanders J.; Tanner
J.; Lamagni T.L.; Talukder S.; Quijano-Campos J.C.; Lai F.; Loubani M.;
Murphy G.J.
Institution
(Rogers) Bristol Heart Institute, University Hospitals Bristol and Weston
NHS Foundation Trust, Bristol, United Kingdom
(Vaja) National Heart and Lung Institute, Imperial College London, London,
United Kingdom
(Vaja) Department of Cardiac Surgery, Guys and St Thomas' NHS Trust,
London, United Kingdom
(Bleetman, Sanders, Quijano-Campos) St. Bartholomew's Hospital, Barts
Health NHS Trust, London, United Kingdom
(Ali, Talukder) Department of Cardiothoracic Surgery, Royal Papworth
Hospital, Cambridge, United Kingdom
(Rochon) Directorate of Infection, Guy's and St Thomas' NHS Foundation
Trust, London, United Kingdom
(Sanders, Quijano-Campos) William Harvey Research Institute, Queen Mary
University of London, London, United Kingdom
(Tanner) School of Health Sciences, University of Nottingham, Nottingham,
United Kingdom
(Lamagni) Healthcare-Associated Infection & Antimicrobial Resistance
Division, UK Health Security Agency, London, United Kingdom
(Quijano-Campos) Royal Papworth Hospital NHS Foundation Trust, Cambridge,
United Kingdom
(Loubani) Department of Cardiothoracic Surgery, Hull and East Yorkshire
Hospitals NHS Trust, Hull, United Kingdom
(Murphy) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Background: Surgical site infection (SSI) is a common type of
hospital-acquired infection and affects up to a third of patients
following surgical procedures. It is associated with significant mortality
and morbidity. In the United Kingdom alone, it is estimated to add another
30 million to the cost of adult cardiac surgery. Although generic guidance
for SSI prevention exists, this is not specific to adult cardiac surgery.
Furthermore, many of the risk factors for SSI are prevalent within the
cardiac surgery population. Despite this, there is currently no standard
of care for SSI prevention in adults undergoing cardiac surgery throughout
the preoperative, intraoperative and postoperative periods of care, with
variations in practice existing throughout from risk stratification,
decontamination strategies and surveillance. Objective(s):
 Primary Objective: to assess the clinical effectiveness of pre-,
intra-, and postoperative interventions in the prevention of cardiac SSI.
 Secondary Objectives: (i) to evaluate the effects of SSI prevention
interventions on morbidity, mortality, and resource use; (ii) to evaluate
the effects of SSI prevention care bundles on morbidity, mortality, and
resource use. Search Method(s): We searched the Cochrane Central
Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE
(Ovid, from inception) and Embase (Ovid, from inception) on 31 May 2021.
ClinicalTrials.gov and the WHO International Clinical Trials Registry
Platform (ICTRP) were also searched for ongoing or unpublished trials on
21 May 2021. No language restrictions were imposed. Selection
Criteria: We included RCTs evaluating interventions to reduce SSI in
adults (>= 18 years of age) who have undergone any cardiac surgery.
 Data Collection and Analysis: We followed the methods as per our
published Cochrane protocol. Our primary outcome was surgical site
infection. Our secondary outcomes were all-cause mortality, reoperation
for SSI, hospital length of stay, hospital readmissions for SSI,
healthcare costs and cost-effectiveness, quality of life (QoL), and
adverse effects. We used the GRADE approach to assess the certainty of
evidence. Main Result(s): A total of 118 studies involving 51,854
participants were included. Twenty-two interventions to reduce SSI in
adults undergoing cardiac surgery were identified. The risk of bias was
judged to be high in the majority of studies. There was heterogeneity in
the study populations and interventions; consequently, meta-analysis was
not appropriate for many of the comparisons and these are presented as
narrative summaries. We focused our reporting of findings on four
comparisons deemed to be of great clinical relevance by all review
authors. Decolonisation versus no decolonisation. Pooled data from three
studies (n = 1564) using preoperative topical oral/nasal decontamination
in all patients demonstrated an uncertain direction of treatment effect in
relation to total SSI (RR 0.98, 95% CI 0.70 to 1.36; I2 = 0%;
very low-certainty evidence). A single study reported that decolonisation
likely results in little to no difference in superficial SSI (RR 1.35, 95%
CI 0.84 to 2.15; moderate-certainty evidence) and a reduction in deep SSI
(RR 0.36, 95% CI 0.17 to 0.77; high-certainty evidence). The evidence on
all-cause mortality from three studies (n = 1564) is very uncertain (RR
0.66, 95% CI 0.24 to 1.84; I2 = 49%; very low-certainty
evidence). A single study (n = 954) demonstrated that decolonisation may
result in little to no difference in hospital readmission for SSI (RR
0.80, 95% CI 0.44 to 1.45; low-certainty evidence). A single study (n =
954) reported one case of temporary discolouration of teeth in the
decolonisation arm (low-certainty-evidence. Reoperation for SSI was not
reported. Tight glucose control versus standard glucose control. Pooled
data from seven studies (n = 880) showed that tight glucose control may
reduce total SSI, but the evidence is very uncertain (RR 0.41, 95% CI 0.19
to 0.85; I2 = 29%; numbers need to treat to benefit (NNTB) =
13; very-low certainty evidence). Pooled data from seven studies (n =
3334) showed tight glucose control may reduce all-cause mortality, but the
evidence is very uncertain (RR 0.61, 95% CI 0.41 to 0.91; I2 =
0%; very low-certainty evidence). Based on four studies (n = 2793), there
may be little to no difference in episodes of hypoglycaemia between tight
control vs. standard control, but the evidence is very uncertain (RR 2.12,
95% CI 0.51 to 8.76; I2 = 72%; very low-certainty evidence). No
studies reported superficial/deep SSI, reoperation for SSI, or hospital
readmission for SSI. Negative pressure wound therapy (NPWT) versus
standard dressings. NPWT was assessed in two studies (n = 144) and it may
reduce total SSI, but the evidence is very uncertain (RR 0.17, 95% CI 0.03
to 0.97; I2 = 0%; NNTB = 10; very low-certainty evidence). A
single study (n = 80) reported reoperation for SSI. The relative effect
could not be estimated. The certainty of evidence was judged to be very
low. No studies reported superficial/deep SSI, all-cause mortality,
hospital readmission for SSI, or adverse effects. Topical antimicrobials
versus no topical antimicrobials. Five studies (n = 5382) evaluated
topical gentamicin sponge, which may reduce total SSI (RR 0.62, 95% CI
0.46 to 0.84; I2 = 48%; NNTB = 32), superficial SSI (RR 0.60,
95% CI 0.37 to 0.98; I2 = 69%), and deep SSI (RR 0.67, 95% CI
0.47 to 0.96; I2 = 5%; low-certainty evidence. Four studies (n
= 4662) demonstrated that topical gentamicin sponge may result in little
to no difference in all-cause mortality, but the evidence is very
uncertain (RR 0.96, 95% CI 0.65 to 1.42; I2 = 0%; very
low-certainty evidence). Reoperation for SSI, hospital readmission for
SSI, and adverse effects were not reported in any included studies.
Authors' conclusions: This review provides the broadest and most recent
review of the current evidence base for interventions to reduce SSI in
adults undergoing cardiac surgery. Twenty-one interventions were
identified across the perioperative period. Evidence is of low to very low
certainty primarily due to significant heterogeneity in how interventions
were implemented and the definitions of SSI used. Knowledge gaps have been
identified across a number of practices that should represent key areas
for future research. Efforts to standardise SSI outcome reporting are
warranted. Copyright © 2024 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<8>
Accession Number
2029840360
Title
Transcatheter aortic valve replacement for aortic regurgitation: a
systematic review and meta-analysis.
Source
ESC Heart Failure. 11(6) (pp 3488-3500), 2024. Date of Publication:
December 2024.
Author
Liu R.; Fu Z.; Jiang Z.; Yan Y.; Yao J.; Liu X.; Yan X.; Song G.
Institution
(Liu, Fu, Jiang, Yan, Yao, Liu, Song) Department of Interventional Center
of Valvular Heart Disease, Beijing Anzhen Hospital Affiliated to Capital
Medical University, Beijing, China
(Yan) Center for Health Systems Research, Sutter Health, Sacramento, CA,
United States
Publisher
John Wiley and Sons Inc
Abstract
The efficacy and safety of new-generation devices (NGDs) for severe aortic
regurgitation (AR) have mostly been based on single-arm studies with
limited sample sizes. Our goal was to summarize the current evidence on
NGDs and compare the safety and efficacy of 'off-label' and 'on-label'
devices in NGDs. We searched MEDLINE, Embase, Cochrane Library, and Scopus
for articles on transcatheter aortic valve replacement in patients with
AR. A total of 31 studies that included 1851 patients were identified
through April 2023. Among these, 1067 (57.6%) patients received treatment
with 'on-label' devices (JenaValve and J-Valve). For NGDs, the total
device success rate at 30 days was 94.5% (on-label: 97.8%, off-label:
89.9%; P < 0.001), the all-cause mortality was 4.2% (on-label: 2.6%,
off-label: 5.1%; P = 0.006), permanent pacemaker implantation (PPI) was
8.8% (on-label: 6.9%, off-label: 18.4%; P < 0.001), and the rate of
greater-than-mild paravalvular leak (PVL) was 1.2% (on-label: 0.9%,
off-label: 3.8%; P = 0.003). On-label devices showed significantly better
safety and efficacy in terms of the success rate, PPI, greater-than-mild
PVL, and 30 day mortality than off-label devices. Copyright ©
2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on
behalf of European Society of Cardiology.

<9>
Accession Number
2032227498
Title
Regional Analgesia Techniques Following Thoracic Surgery: A Systematic
Review and Network Meta-analysis.
Source
Pain Physician. 27(8) (pp E803-E818), 2024. Date of Publication: November
2024.
Author
Yang M.; Liu G.; Zhang X.; Yan W.; Zhang D.
Institution
(Yang, Zhang, Liu, Zhang) Department of Clinical Laboratory, Gansu
Provincial Hospital, Lanzhou, China
(Yan, Zhang) Department of Anesthesiology, Gansu Provincial Hospital,
Lanzhou, China
Publisher
American Society of Interventional Pain Physicians
Abstract
Background: Regional analgesia techniques have become the basis of
multimodal analgesia for acute and chronic pain. They are widely used in
thoracic surgery, but the best treatment is still uncertain.
 Objective(s): We aimed to compare and rank the effectiveness of
regional analgesia techniques for thoracic surgery. Study Design: A
systematic review and network meta-analysis. Method(s): PubMed,
MEDLINE, Embase, Cochrane Library, Science-Direct, and Web of Science were
searched for articles published from inception through the end of January
2023. The network meta-analysis was conducted using Stata 15.1 software
(StataCorp, LLC). The certainty of evidence was assessed by using
Confidence in Network Meta-analysis (CINeMA https://cinema.ispm.unibe. ch/
A (unibe.ch). The primary outcome was cumulative opioid consumption within
postoperative 24 hours. The secondary outcomes included pain scores at
postoperative 6 hours, 12 hours, and 24 hours. Result(s): A total of
32 trials with 1,996 patients and 11 techniques were included. No major
network inconsistency or heterogeneity were found. Postoperative opioid
consumption within postoperative 24 hours was decreased most by continuous
extrapleural block (cEPB) (standardized mean difference [SMD] = 0.00; 95%
CI,: 0.00-0.00), followed by continuous thoracic epidural analgesia (cTEA)
and continuous serratus plane block (cSAPB). In the postoperative 6 hour
analysis, pain scores were decreased most by cTEA (SMD = 0.16; 95% CI,:
0.05-0.49), followed by thoracic paravertebral block (TPVB) and ESPB
(erector spinae plane block). In the postoperative 12 hour analysis, pain
scores were decreased most by cSAPB (SMD = 0.12; 95% CI, 0.011.84),
followed by TPVB and cTEA. In the postoperative 24 hour analysis, pain
scores were decreased most by ESPB (SMD = 0.09; 95% CI, 0.030.32),
followed by cSAPB and continuous thoracic paravertebral block (cTPVB).
 Limitation(s): Our study has several limitations. First, 4 enrolled
studies had a sample size of less than 40 patients. Second, the different
regimens were potential factors contributing to heterogeneity, such as
local anesthetic dose and volume, infusion time, infusion mode, adding
adjuncts, and rescue analgesic regimens. Third, the number of primary and
secondary outcomes is limited. Fourth, the number of randomized controlled
trials for cEPB is limited. Conclusion(s): The cTEA and cSAPB
techniques are more likely to reduce the cumulative opioid consumption
within 24 hours. The cTEA, cSAPB, ESPB techniques were more likely to
improve pain at postoperative 6, 12, and 24 hours. Therefore, cTEA, cSAPB,
and ESPB are the first choices for pain relief post thoracic surgery,
whereas wound infiltration, intercostal block, continuous wound
infiltration, and continuous intercostal block were less likely to be
effective. We need more high-quality randomized controlled trials with
larger sample sizes to validate our results and to determine the ideal
regional analgesia technique and the optimal drug formula. Copyright
© 2024, American Society of Interventional Pain Physicians. All
rights reserved.

<10>
Accession Number
2036263688
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: 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, Sorajja) Allina Health Minneapolis Heart Institute,
Minneapolis, MN, United States
(Cavalcante, Fukui) Minneapolis Heart Institute Foundation Cardiovascular
Imaging Research Center and Core Lab, Minneapolis, MN, United States
(Scherer, Schwartz) Atrium Health Carolinas Medical Center, Charlotte, NC,
United States
(Lerakis, Adams) Mount Sinai Hospital, New York, NY, United States
(Harb, Kapadia) The 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, New York, 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, and Blood
Institute, Bethesda, MD, United States
(Lin, Trusty) Abbott Structural Heart, Santa Clara, CA, United States
Publisher
Elsevier Inc.
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

<11>
Accession Number
2036263446
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: 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
Publisher
Elsevier Inc.
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

<12>
Accession Number
2032551058
Title
A profile of the impella 5.5 for the clinical management of cardiogenic
shock and a review of the current indications for use and future
directions.
Source
Expert Review of Medical Devices. (no pagination), 2024. Date of
Publication: 2024.
Author
Hershenhouse K.S.; Ferrell B.E.; Glezer E.; Wu J.; Goldstein D.
Institution
(Hershenhouse, Ferrell, Glezer, Wu, Goldstein) Department of
Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert
Einstein College of Medicine, Bronx, NY, United States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: The Impella 5.5 device is a surgically inserted,
trans-valvular, microaxial flow device capable of providing 5.5 L/min of
continuous, antegrade flow from the left ventricle (LV) to the aorta. The
ability of the Impella 5.5 to fully pressure and volume unload the
dysfunctional LV while allowing for mobilization and rehabilitation has
rapidly expanded its use. Clinical use scenarios include escalation of
support for acute myocardial infarction cardiogenic shock (AMICS),
transition from extracorporeal membrane oxygenation to mobile support,
bridge to transplantation or durable MCS in acute decompensated heart
failure, or perioperative use in post-cardiotomy cardiogenic shock (PCCS).
Areas covered: This review provides a profile of the Impella 5.5 device,
summarizes the current literature surrounding clinical applications,
reviews active and upcoming clinical trials, and projects future
applications for the device through an expert review. Expert opinion: The
development of the Impella 5.5 has allowed for monitoring of left-heart
recovery, optimizing right ventricular function, and rehabilitating
patients to meet bridging endpoints. The 2018 heart transplant allocation
system modifications have expanded the use of temporary mechanical
circulatory support (tMCS) on the transplant waitlist, increasing the
number of patients transplanted on support. With increased safety and
durability, an expanding frontier is used in perioperative support for
PCCS in high-risk cardiac surgery. Copyright © 2024 Informa UK
Limited, trading as Taylor & Francis Group.

<13>
Accession Number
2032505210
Title
Speckle-tracking echocardiography of left and right ventricle and acute
cellular rejection in orthotropic heart transplantation: a systematic
review and meta-analysis.
Source
International Journal of Cardiovascular Imaging. (no pagination), 2024.
Date of Publication: 2024.
Author
Xourgia E.; Brignoli K.; Linder O.; Neagoe A.-M.; Capek L.; Bruno J.;
Strickler E.; Bakula A.; Pavlicek-Bahlo M.; Furholz M.; Muster C.;
Malagutti P.; Martinelli M.; Hunziker L.; Schnegg B.
Institution
(Xourgia, Neagoe, Capek, Bruno, Strickler, Bakula, Pavlicek-Bahlo,
Furholz, Muster, Malagutti, Martinelli, Hunziker, Schnegg) Department of
Cardiology, Inselspital, Bern University Hospital, University of Bern,
Bern, Switzerland
(Xourgia, Brignoli, Linder) Department of Internal Medicine, Burgerspital
Solothurn, Solothurn, Switzerland
Publisher
Springer Science and Business Media B.V.
Abstract
After a cardiac transplantation, the steering of immunosuppression
requires an active search for acute cellular rejection (ACR). Surveillance
with endomyocardial biopsy (EMB) is the gold standard. Given the costs and
potential complications, there is growing interest in the use of
non-invasive screening methods. Thus, we have conducted a systematic
review and meta-analysis to evaluate the role of speckle-tracking
echocardiography as a screening method for ACR. We searched PubMed
(CENTRAL) and gray literature for studies presenting data on speckle
tracking echocardiography in heart-transplant patients experiencing acute
cellular rejection. The primary outcomes of the meta-analysis were left
and right ventricular global longitudinal strain. We used random effects
models for all our calculations. We pre-registered our meta-analysis with
PROSPERO (CRD42024508654). By incorporating data from over 2000 biopsies
included in 18 studies, we found that both left (LVGLS, MD -1.96, 95% CI
-2.85 to -1.07, p < 0.0001), and right (RVGLS, MD -2.90, 95% CI -4.03 to
-1.76, p < 0.00001) ventricular longitudinal strain were lower among
patients without ACR. The change of LVGLS from baseline over time was also
greater among patients experiencing ACR (MD -2.43, 95% CI -4.82 to -0.05,
p = 0.045). Current data suggest that myocardial strain measured by
speckle tracking echocardiography is affected in ACR and could potentially
be used for early rejection detection as a rule-out strategy, leading to
reduction of routine EMB in heart transplant follow-up. Copyright
© The Author(s) 2024.

<14>
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

<15>
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.

<16>
Accession Number
2031767636
Title
Bariatric surgeries and cardiac structure and function: Systematic review
and network meta-analysis.
Source
Obesity Reviews. 26(1) (no pagination), 2025. Article Number: e13843. Date
of Publication: January 2025.
Author
Zhang X.-Q.; Chen K.-N.; Zhang N.-R.; Zheng F.-J.-Y.; Zhou B.; Meng H.;
Zhang Z.-X.; Niu W.-Q.
Institution
(Zhang, Zhang) Graduate School, Beijing University of Chinese Medicine,
Beijing, China
(Zhang, Zhang, Zhang) Department of Pediatrics, China-Japan Friendship
Hospital, Beijing, China
(Chen) Chinese Academy of Medical Sciences & Peking Union Medical College,
Beijing, China
(Chen) Institute of Clinical Medical Sciences, China-Japan Friendship
Hospital, Beijing, China
(Zhang, Zhou, Meng) Department of General Surgery and Obesity and
Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
(Zheng, Niu) Center for Evidence-Based Medicine, Capital Institute of
Pediatrics, Beijing, China
(Zhang) International Medical Services, China-Japan Friendship Hospital,
Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
Background: Obesity, a global health problem, is causally implicated in
the development of cardiovascular disease. Bariatric surgeries are
effective treatment options for obesity; however, the effectiveness of
different bariatric surgeries on cardiac structure and function is not
fully understood. We undertook a systematic review and network
meta-analysis to comprehensively assess this effectiveness. Data source:
PubMed, Web of Science, and EMBASE were searched from their inception
until November 11, 2023. Studies that compared bariatric surgeries
vis-a-vis non-surgical treatment, placebo, and other bariatric surgeries,
as well as reported changes in left ventricular mass or its index (LVM or
LVMI) or left ventricular ejection fraction (LVEF), were summarized.
 Result(s): Total 19 studies (17 cohort studies and 2 randomized
controlled trials) and 2012 adults were meta-analyzed. Patients receiving
gastric bypass had appreciably lowered LVM (weighted mean difference
[WMD]: -43.86 g, 95% confidence interval [CI] -61.09 to -26.63, p < 0.01)
and LVMI (standardized mean difference: -0.67, 95% CI -1.03 to -0.32, p <
0.01) compared with other bariatric surgeries. No significant improvement
in LVEF was noted across all surgeries. The drop in body mass index was
most pronounced for biliopancreatic diversion with duodenal switch (WMD
-16.33 kg/m2, 95% CI -21.60 to -11.05, p < 0.01).
 Conclusion(s): Our findings of this network meta-analysis indicated
that gastric bypass proved best for the improvement in cardiac structure,
and there was no obvious improvement in cardiac function for all bariatric
surgeries. Further studies are required to better understand the differing
effectiveness of bariatric surgeries on cardiac structure and function and
the underlying molecular mechanisms. Copyright © 2024 World
Obesity Federation.

<17>
Accession Number
2036021199
Title
Comparing the lung isolation efficacy of bronchial blocker positioning via
electromagnetic navigation bronchoscopy versus fiberoptic bronchoscopy: a
randomized study.
Source
Journal of Thoracic Disease. 16(11) (pp 7729-7738), 2024. Date of
Publication: 30 Nov 2024.
Author
Li J.; Liu W.; Liang X.; Zhou R.; Wang M.; Hu B.; Jiang H.; Hu R.
Institution
(Li, Liu, Zhou, Hu, Jiang, Hu) Department of Anesthesiology, Shanghai
Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine,
Centre for Specialty Strategy Research, Shanghai Jiao Tong University
China Hospital Development Institute, Shanghai, China
(Liang, Wang) Department of Thoracic Surgery, Shanghai Ninth People's
Hospital, Shanghai Jiao Tong University School of Medicine, Centre for
Specialty Strategy Research, Shanghai Jiao Tong University China Hospital
Development Institute, Shanghai, China
Publisher
AME Publishing Company
Abstract
Background: The inflated balloon of a bronchial blocker (BB) obstructs the
mainstem bronchus, allowing controlled ventilation of one lung while
collapsing the other for lung isolation during thoracic surgery. We
compared the effects of lung isolation using electromagnetic navigation
bronchoscopy (ENB)-guided versus fiberoptic bronchoscopy (FOB)-guided BB
placement to provide a novel BB positioning method for airway management
during thoracic anesthesia. Method(s): We randomly divided 106
patients who underwent elective one-lung ventilation (OLV) with
intraoperative ENB usage into ENB and FOB groups. We compared subjective
lung collapse scores, time required for correct BB placement, incidence of
BB malposition, and frequency of intraoperative BB repositioning with FOB
between the groups. Heart rate (HR) and mean arterial pressure were
recorded before intubation of single-lumen tracheal tube, and before and
after BB positioning. Blood gas levels were measured before and at 10 and
30 min after initiating OLV. Postoperative follow-up indices, including
blood cell analysis, C-reactive protein levels, and pulmonary
complications, were also recorded. Result(s): The subjective lung
collapse score was significantly higher in the ENB group than in the FOB
group [9.08 (1.36) vs. 8.24 (1.93), P=0.01]. The time required for correct
BB placement was significantly shorter in the ENB group than in the FOB
group [13.00 (10.00, 20.25) vs. 49.00 (35.00, 75.00), P<0.001]. However,
the incidence of BB malposition, frequency of intraoperative BB
repositioning with FOB, HR, mean arterial and peak airway pressure before
and after BB positioning, arterial blood gas analysis, and postoperative
follow-up indices did not differ significantly between the two groups.
 Conclusion(s): ENB-guided BB positioning is an efficient method of
lung isolation, demonstrating superior and more rapid lung collapse
effects compared with conventional FOB-guided BB placement. Copyright
© AME Publishing Company.

<18>
Accession Number
2036013349
Title
The Incidence, Risk Factors, and Hospital Mortality of Prolonged
Mechanical Ventilation among Cardiac Surgery Patients: A Systematic Review
and Meta-Analysis.
Source
Reviews in Cardiovascular Medicine. 25(11) (no pagination), 2024. Article
Number: 409. Date of Publication: November 2024.
Author
Wang Q.; Tao Y.; Zhang X.; Xu S.; Peng Y.; Lin L.; Chen L.; Lin Y.
Institution
(Wang, Xu) The School of Nursing, Fujian Medical University, Fujian,
Fuzhou 350005, China
(Tao) Department of Nursing, Jingmen Peoples Hospital, Hubei, Jingmen
448001, China
(Zhang) Department of Nursing, Women and Children's Hospital, School of
Medicine, Xiamen University, Fujian, Xiamen 361005, China
(Peng, Lin, Chen, Lin) Department of Cardiovascular Surgery, Fujian
Medical University Union Hospital, Fujian, Fuzhou 350001, China
(Lin) Department of Nursing, Fujian Medical University Union Hospital,
Fujian, Fuzhou 350001, China
Publisher
IMR Press Limited
Abstract
Background: Prolonged mechanical ventilation (PMV) is a common
complication after cardiac surgery and is considered a risk factor for
poor outcomes. However, the incidence and in-hospital mortality of PMV
among cardiac surgery patients reported in studies vary widely, and risk
factors are controversial. Method(s): We searched four databases (Web
of Science, Cochrane Library, PubMed, and EMBASE) for English-language
articles from inception to October 2023. The odds ratio (OR), 95%
confidence interval (CI), PMV incidence, and in-hospital mortality were
extracted. Statistical data analysis was performed using Stata software.
We calculated the fixed or random effects model according to the
heterogeneity. The quality of each study was appraised by two independent
reviewers using the Newcastle-Ottawa scale. Result(s): Thirty-two
studies were included. The incidence of PMV was 20%. Twenty-one risk
factors were pooled, fifteen risk factors were found to be statistically
significant (advanced age, being female, ejection fraction <50, body mass
index (BMI), BMI >28 kg/m2, New York Heart Association Class >=III,
chronic obstructive pulmonary disease, chronic renal failure, heart
failure, arrhythmia, previous cardiac surgery, higher white blood cell
count, creatinine, longer cardiopulmonary bypass (CPB) time, and CPB >120
min). In addition, PMV was associated with increased in-hospital mortality
(OR, 14.13, 95% CI, 12.16-16.41, I2 = 90.3%, p <0.01). Conclusion(s):
The PMV incidence was 20%, and it was associated with increased
in-hospital mortality. Fifteen risk factors were identified. More studies
are needed to prevent PMV more effectively according to these risk
factors. Copyright © 2024 The Author(s).

<19>
Accession Number
2035978787
Title
Optimizing perioperative lung protection strategies for reducing
postoperative respiratory complications in pediatric patients: a narrative
review.
Source
Translational Pediatrics. 13(11) (pp 2043-2058), 2024. Date of
Publication: 30 Nov 2024.
Author
Wang Q.; Li Y.; Zhao K.; Zhang J.; Zhou J.
Institution
(Wang, Li, Zhao, Zhang, Zhou) Department of Anaesthesiology and
Perioperative Medicine, Henan Provincial People's Hospital, People's
Hospital of Zhengzhou University, Zhengzhou, China
Publisher
AME Publishing Company
Abstract
Background and Objective: Despite significant advancements in the safe
delivery of anesthesia and improvements in surgical techniques,
postoperative respiratory complications (PRCs) remain a serious concern.
PRCs can lead to increased length of hospital stay, worsened patient
outcomes, and higher hospital and postoperative costs. Perioperative lung
injury and PRCs are more common in children than in adults owing to
children's unique physiology and anatomical characteristics. Studies have
shown that lung-protective ventilation (LPV) strategies can improve lung
function and minimize the risk of PRCs in adults. However, individualized
LPV in children remains underexplored. This narrative review provides an
overview of the various perioperative pulmonary protection strategies and
their effect on pediatric PRCs. Method(s): We searched PubMed for
articles published from 2000 to 2024, setting our inclusion criteria to
include studies that involved pediatric patients, addressed LPV
strategies, and reported data on PRCs. Non-English language studies, case
reports, editorials, conference abstracts, and non-full text published
literatures were excluded. We utilized the following keyword strategy:
(((lung protective ventilation) OR (PEEP)) OR (recruitment maneuver)) OR
(low tidal volume) AND (2000:2024[pdat])) AND (pediatric) filters. In
total, 1,106 articles were retrieved, with only 23 being deemed relevant
to the review. Data extraction and analysis were conducted by two
independent researchers to ensure accuracy and consistency. We conducted
descriptive statistical analysis for quantitative data and thematic
analysis for qualitative data. Key Content and Findings: The key content
are an overview of risk factors for postoperative pulmonary complications
in children including the patients themselves, anesthesia, and surgery, as
well as the effectiveness of LPV strategies in pediatric surgery,
including low tidal volumes (TVs), positive end-expiratory pressure
(PEEP), ultrasound-guided pulmonary recruitment maneuver (RM), low
inspired oxygen concentrations (FiO<inf>2</inf>), pressure-controlled
ventilation (PCV), as well as fluids, pain, and high-flow nasal cannula
(HFNC). We found that age, mechanical ventilation with general anesthesia,
and thoracic surgery increased the risk of PRCs in children. The
application of LPV strategies in pediatric surgery had positive effect,
including low TV combined with titrated PEEP, age- and physiologically
appropriate FiO<inf>2</inf>, ultrasound-guided RM, target directed fluid
infusion, adequate analgesia, and the use of HFNC in special
circumstances. However, we also found that the application of LPV has
certain potential risks and therefore needs to be implemented according to
the patient's actual age and physical condition. Conclusion(s):
Perioperative LPV strategies show potential benefits in reducing lung
injury and PRCs in pediatric patients. These strategies, including low
TVs, appropriate individualized PEEP, lung RM, and avoidance of high
inhaled oxygen concentrations, appear to be effective methods for
protecting lung function in pediatric patients. Additionally,
perioperative fluid management and effective pain control are crucial for
lung protection. The emerging use of HFNC therapy shows promise, but
further research is needed to fully Copyright © AME Publishing
Company.

<20>
Accession Number
2035913549
Title
Risk factors for nosocomial infection in patients undergoing
extracorporeal membrane oxygenation support treatment: A systematic review
and meta-analysis.
Source
PLoS ONE. 19(11) (no pagination), 2024. Article Number: e0308078. Date of
Publication: November 2024.
Author
Lv X.; Han Y.; Liu D.; Chen X.; Chen L.; Huang H.; Huang C.
Institution
(Lv, Liu, Chen, Chen, Huang) Department of Intensive care medicine,
Affiliated Hospital of Chengdu University, Sichuan, Chengdu, China
(Han) Geriatrics Center, Affiliated Hospital of Chengdu University,
Sichuan, Chengdu, China
(Huang) Department of Infection, Affiliated Hospital of Chengdu
University, Sichuan, Chengdu, China
Publisher
Public Library of Science
Abstract
Objective To evaluate the risk factors of nosocomial infection during
Extracorporeal membrane oxygenation (ECMO) treatment through systematic
evaluation and meta-analysis, in order to provide evidence-based basis for
clinical treatment and prevention of nosocomial infection during ECMO
treatment. Method Computer search of Cochrane Library, PubMed, Embase, and
Web of Science databases was conducted to establish a database of relevant
literature published in March 2023. Two researchers independently screened
literature, extracted data, and evaluated quality based on inclusion and
exclusion criteria, and then analyzed the data using STATA 14.0 software.
This plan is registered with PROSPERO as CRD42021271083. Result A total of
2955 ECMO patients, including 933 nosocomial infected patients, were
included in 23 articles. Meta analysis showed that immunosuppression,
Heart transplantation, VAECMO, CRRT, red blood cell input, ECMO support
time, mechanical ventilation time, ICU hospitalization time, and total
hospitalization time were the risk factors for nosocomial infection in
patients supported by ECMO. Conclusion ECMO treatment for nosocomial
infections in patients is related to multiple factors. In clinical work,
medical staff should identify high-risk groups of ECMO nosocomial
infections, actively take preventive measures, and reduce the incidence
and mortality of nosocomial infections. Copyright © 2024 Lv 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.

<21>
Accession Number
2032517015
Title
The effect of omega-3 Polyunsaturated Fatty Acid (PUFA) prescription
preparations on the prevention of clinical cardiovascular disease: a
meta-analysis of RCTs.
Source
Nutrition Journal. 23(1) (no pagination), 2024. Article Number: 157. Date
of Publication: December 2024.
Author
Dong S.; Wang Y.; Bian J.; Chen H.; Dong J.; Zhu J.; Zhang T.; Du Q.; Zhao
R.
Institution
(Dong, Chen, Zhao) Department of Pharmacy, Peking University Third
Hospital, Beijing, China
(Wang, Dong, Zhu, Du) Department of Pharmacy, The Third Affiliated
Hospital of Chongqing Medical University, Chongqing, China
(Wang) College of Pharmacy, Chongqing Medical University, Chongqing, China
(Bian, Chen) Department of Pharmacy Administration and Clinical Pharmacy,
School of Pharmaceutical Sciences, Peking University, Beijing, China
(Bian) Department of Pharmacy, People's Hospital of Peking University,
Beijing, China
(Zhang) Infectious Diseases Department, Second Affiliated Hospital of
Tianjin University of Traditional Chinese Medicine, Tianjin, China
Publisher
BioMed Central Ltd
Abstract
Importance: Evidence from systematic reviews of the cardioprotective
effect of omega-3 polyunsaturated fatty acid (PUFA) remains controversial,
and interventions including PUFAs dietary supplements or prescription
medications cannot accurately reflect the role of PUFA RX in
cardiovascular disease (CVD) prevention. Objective(s): We conducted a
meta-analysis of randomized clinical trials (RCTs) to evaluate the
efficacy of PUFA prescription medication in preventing CVD.
 Method(s): Two reviewers conducted a literature search of Embase,
MEDLINE/PubMed, and the Cochrane Library from their inception to September
2023. The inclusion criteria were RCTs evaluating long-term
supplementation (>= 1 year) with PUFA prescriptions and reporting
cardiovascular outcomes. Data were extracted independently by two authors,
and the certainty of evidence for each outcome was assessed using the
GRADE system. Random-effects models were used to estimate the risk ratios
(RRs) and 95% confidence intervals (CIs). The primary outcomes were
cardiovascular events. Secondary endpoints included major adverse
cardiovascular events (MACEs), cardiac death, all-cause mortality,
myocardial infarction, stroke, and revascularization. Subgroup analyses
were performed based on PUFA components, dosage, follow-up duration, and
risk status. Result(s): Twelve RCTs involving 99,830 participants
were included. The mean age of participants ranged from 59.4 to 74.0
years, with a follow-up period varying from 1 to 6.2 years. Compared with
placebo and statins, PUFA prescription medication was associated with a
reduced risk of cardiovascular events (8 RCTs, n = 75,929, RR, 0.88 [95%
CI, 0.81-0.95]; P = 0.0007; I2 = 45%), cardiac death (10 RCTs,
n = 95,440, RR, 0.91 [95% CI, 0.84-0.99]; P = 0.02; I2 = 23%),
myocardial infarction (9 RCTs, n = 94,877, RR, 0.84 [95% CI, 0.73-0.96]; P
= 0.009; I2 = 62%), and revascularization (9 RCTs, n = 91,242,
RR, 0.91 [95% CI, 0.84-0.99]; P = 0.02; I2 = 63%). Conclusions
and relevance: PUFA prescription medication could lower the risks of
cardiovascular events, cardiac death, myocardial infarction and
revascularization. This research provides insight into the efficacy of
PUFA prescription medications in CVD prevention and contributes to the
ongoing debate on the role of PUFA products in cardiovascular
outcomes. Copyright © The Author(s) 2024.

<22>
Accession Number
2036089730
Title
Normalizing Arterial Blood Pressure in Patients with Aortic Stenosis Does
Not Prevent Grading Discrepancies between Pre-Cardiopulmonary Bypass
Transesophageal Echocardiography and Transthoracic Echocardiography.
Source
Annals of Cardiac Anaesthesia. 26(2) (pp 183-189), 2023. Date of
Publication: 2023.
Author
Whitener G.B.; Wolf B.J.; Francis L.R.; Heinke T.L.; McKinnon J.S.; Guldan
G.J.
Institution
(Whitener, Francis, Heinke, McKinnon, Guldan) Department of Anesthesia and
Perioperative Medicine, Medical University of South Carolina, Charleston,
SC, United States
(Wolf) Department of Public Health Sciences, Medical University of South
Carolina, Charleston, SC, United States
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Aortic stenosis (AS) grading discrepancies exist between
pre-cardiopulmonary (pre-CPB) transesophageal echocardiography (TEE) and
preoperative transthoracic echocardiography (TTE). Prior studies have not
systematically controlled blood pressure. Aim(s): We hypothesized
that normalizing arterial blood pressure during pre-CPB TEE for patients
undergoing valve replacement for AS would result in equivalent grading
measurements when compared to TTE. Setting(s): Single University
Hospital Design: Prospective, Interventional Methods: Thirty-five adult
patients underwent procedures for valvular AS between February 2017 and
December 2020 at Medical University of South Carolina. Study participants
had a TTE within 90 days of their procedure that documented blood
pressure, peak velocity (V p), mean gradient (PG m), aortic valve area
(AVA), and dimensionless index (DI). During pre-CPB TEE, if a patient's
mean arterial pressure (MAP) fell more than 20% below their baseline blood
pressure obtained during TTE, measurements were recorded as 'out of
range.' Phenylephrine was administered to restore MAP to the baseline
range and repeat TEE measurements were recorded as 'in-range.' Statistical
Analysis: Differences between imaging modalities and grading parameters
were examined using a series of linear mixed models. P values were
Bonferroni-adjusted to account for multiple comparisons. Main
Result(s): Significant discrepancies between TEE and TTE were observed for
V p, PG m, and DI despite blood pressure normalization across all subjects
and for out-of-range measures and corrected measures. There were no
statistically significant differences between TEE and TTE for AVA.
 Conclusion(s): Blood pressure normalization during pre-CPB TEE is not
sufficient to avoid AS grading discrepancies with preoperative
TTE. Copyright © 2024 Annals of Cardiac Anaesthesia.

<23>
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

<24>
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.

<25>
Accession Number
2032213094
Title
Prophylactic 24 versus 48 h cephalosporins in cardiac surgery: A
randomized trial.
Source
Asian Cardiovascular and Thoracic Annals. 32(8-9) (pp 462-471), 2024. Date
of Publication: November 2024.
Author
Koudieh M.; Al Saif S.; Oueida F.; Baradai A.; Alkhamees K.; Otabi A.; Al
Tahir H.; Younis H.; Al Qudaihi G.; Essa M.; Maharem T.; Fadel M.; Al
Balwai D.; Eskander K.
Institution
(Koudieh, Oueida, Baradai, Alkhamees, Otabi, Essa, Eskander) Cardiac
Surgery Department, Saud Al Babtain Cardiac Center, Dammam, Saudi Arabia
(Al Saif) Cardiology Department, Saud Al Babtain Cardiac Center, Dammam,
Saudi Arabia
(Baradai) Cardiac Surgery Department, King Salman Heart Center, Riyadh,
Saudi Arabia
(Al Tahir, Maharem, Fadel) Anesthesia Department, Saud Al Babtain Cardiac
Center, Dammam, Saudi Arabia
(Younis) Intensive Care Unit, Saud Al Babtain Cardiac Center, Dammam,
Saudi Arabia
(Al Qudaihi) Epidemiology Department, Qatif Central Hospital, Dammam,
Saudi Arabia
(Al Balwai) Research Unit, Saud al Babtain Cardiac Center, Dammam, Saudi
Arabia
Publisher
SAGE Publications Inc.
Abstract
Background: Recommendations for cardiac surgery advocate for antibiotic
prophylaxis for up to 48 hour after surgery. However, recent reports found
a significant reduction in surgical site infection with extended duration.
We evaluated the effect of the type of prophylactic antibiotics and
administration durations on the postoperative surgical site infection rate
following cardiac surgery in adults. Method(s): An
investigator-initiated randomized controlled trial was conducted from 2018
to 2022 on adult patients undergoing cardiac surgery. Patients were
randomized into four groups based on antibiotic treatment type and
duration: 24 h cefazolin, 24 h cefuroxime, 48 h cefazolin, and 48 h
cefuroxime. The primary outcome was the rate of surgical site infections
within 90 days of surgery. Result(s): A total of 568 patients were
included in this study. The four groups had similar baseline
characteristics, including age, sex, EuroSCORE II, and baseline HbA1c. A
total of 75 patients developed infection within 90 days postoperative. The
overall infection rate was not statistically different across the four
groups (p = 0.193). The efficacy of cefazolin and cefuroxime in reducing
infection was comparable (p = 0.901). Extended prophylaxis was associated
with a significantly reduced overall infection rate within 90 days
postoperatively compared to 24-h prophylaxis (10.2% vs. 16.3%; risk ratio
= 0.62, 95% confidence interval: 0.40-0.96, p = 0.032).
 Conclusion(s): Using cefazolin or cefuroxime for 48 h instead of 24 h
was more effective in reducing the overall surgical site infections rate
up to 90 days after surgery. Copyright © The Author(s) 2024.

<26>
Accession Number
2032456381
Title
Mechanical versus bioprosthetic valve for aortic valve replacement in
dialysis patients: Systematic review and individual patient data
meta-analysis.
Source
Asian Cardiovascular and Thoracic Annals. 32(8-9) (pp 484-493), 2024. Date
of Publication: November 2024.
Author
Zoupas I.; Loufopoulos G.; Tasoudis P.T.; Manaki V.; Namidis I.; Caranasos
T.G.; Iliopoulos D.C.; Athanasiou T.
Institution
(Zoupas, Loufopoulos, Tasoudis, Manaki, Namidis) Cardiothoracic and
Vascular Surgery Working Group, Society of Junior Doctors, Athens, Greece
(Zoupas, Iliopoulos) Department of Cardiac Surgery, Hygeia Hospital,
Athens, Greece
(Tasoudis, Caranasos) Department of Cardiothoracic Surgery, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States
(Manaki) Department of Vascular Surgery, AHEPA University Hospital,
Thessaloniki, Greece
(Iliopoulos) Department of Cardiac Surgery, Faculty of Medicine, National
and Kapodistrian University of Athens, Athens, Greece
(Athanasiou) Department of Cardiac Surgery, Imperial College London, UK,
London, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Objective: There is little evidence regarding the most beneficial choice
between a mechanical and a bioprosthetic valve in the aortic position in
dialysis patients. This meta-analysis compares the survival and freedom
from reintervention rates between mechanical and bioprosthetic valves in
patients on dialysis undergoing aortic valve replacement surgery.
 Method(s): Two databases were searched, and the systematic review was
performed in accordance with the recommendations of the Preferred
Reporting Items for Systematic Reviews and Meta-analyses statement. We
conducted one-stage and two-stage meta-analysis with Kaplan-Meier-derived
individual patient data and meta-analysis with random-effects model.
 Result(s): Eight studies were included, providing data about 1215
dialysis patients receiving mechanical valves and 1851 patients receiving
bioprosthetic valves. During a mean follow-up of 43.1 months, overall
survival rates were significantly improved in the mechanical valve group
in comparison to the bioprosthetic one (hazard ratio [HR]: 0.76, 95%
confidence interval [CI]: 0.69-0.84, p < 0.001). This was confirmed by the
two-stage meta-analysis (HR: 0.72, 95% CI: 0.62-0.83, p = 0.00,
I2 = 17.79%). Regarding freedom from reintervention, no arm
offered a statistically significant advantage, according to the two-stage
generated analysis (HR: 1.025, 95% CI: 0.65-1.61, p = 0.914). Similarly,
there was no evident superiority of a valve type for perioperative
outcomes. Conclusion(s): Mechanical valves are likely to be
associated with a better survival outcome compared to bioprosthetic valves
for patients on dialysis undergoing aortic valve replacement. However,
freedom from reoperation rates and perioperative outcomes were comparable
between the two valve types, with no arm exhibiting a statistically
significant advantage. Copyright © The Author(s) 2024.

<27>
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)

<28>
Accession Number
2031537230
Title
Novel Retractor-Camera System Facilitates Less Traumatic Minimally
Invasive Procedures and Declutters the Operation Field.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 19(5) (pp 541-549), 2024. Date of Publication: September/October
2024.
Author
Sazzad F.; Ng W.H.; Feng G.; Moideen I.S.B.M.; Gohary A.E.; Han Kim K.;
Stevens J.C.; Kofidis T.
Institution
(Sazzad, Moideen, Gohary, Han Kim, Stevens, Kofidis) Department of
Surgery, Yong Loo Lin School of Medicine, National University of
Singapore, Kent Ridge, Singapore
(Ng, Feng, Kofidis) Department of Cardiac, Thoracic and Vascular Surgery,
National University Heart Centre, Kent Ridge, Singapore, Singapore
Publisher
SAGE Publications Ltd
Abstract
Objective: To develop a novel endoscopic system that reduces trauma to the
patient and declutters the surgical field for the surgeon in minimally
invasive heart valve surgery. Method(s): We designed and developed a
retractor-camera combination for minimally invasive heart surgery; the
cable and camera were connected to the underbelly of the left atrial
retractor blade to provide an illuminated, wide-angle view of the mitral
valve. We conducted ex vivo, in vivo, and, ultimately, a first-in-man
randomized, nonanonymized clinical trial on 20 patients who required
minimally invasive mitral valve surgery. Data from the preoperative period
and the immediate postoperative period were gathered, and patients were
followed for 3 months. Result(s): Our camera-retractor combo
demonstrated safe and efficient exposure and vision in all detailed
studies. The total operation time for the intervention group (316.5 +/-
65.1 min) was slightly shorter than for the control group (317.5 +/- 50.8
min). There was no significant difference in the ability to provide
exposure of the mitral valve and surrounding left atrial tissue for both
control and test articles. The novel camera-retractor reduced clutter in
the operation field substantially and eliminated chest penetration for the
camera. We also observed that the camera did not fog, did not stain with
blood, and did not require frequent corrections to its position.
 Conclusion(s): We launch a novel atrial retraction-imaging platform
that is less invasive for the patient and eliminates clutter and redundant
movements for the surgeon. Copyright © The Author(s) 2024.

<29>
Accession Number
645948945
Title
Retraction Note: Effects of bilateral Pecto-intercostal Fascial Block for
perioperative pain management in patients undergoing open cardiac surgery:
a prospective randomized study.
Source
BMC anesthesiology. 24(1) (pp 445), 2024. Date of Publication: 29 Nov
2024.
Author
Zhang Y.; Gong H.; Zhan B.; Chen S.
Institution
(Zhang, Gong, Chen) Department of Anesthesiology, First Affiliated
Hospital of Nanchang University, 17 Yong wai zheng Street, Nanchang,
Jiangxi 330006, China
(Zhan) Department of cardiology, second Affiliated Hospital of Nanchang
University, NO.1 minde Street, Nanchang, Jiangxi 330006, China

<30>
Accession Number
645945317
Title
Effect of desflurane, sevoflurane or propofol on the incidence of
postoperative delirium in older adults undergoing moderate- to high-risk
major non-cardiac surgery: study protocol for a prospective, randomised,
observer-blinded, clinical trial (RAPID-II trial).
Source
BMJ open. 14(11) (pp e092611), 2024. Date of Publication: 27 Nov 2024.
Author
Taschner A.; Fleischmann E.; Kabon B.; Sinner B.; Eckhardt C.; Horvath K.;
Adamowitsch N.; Hantakova N.; Hochreiter B.; Zotti O.; Fraunschiel M.;
Graf A.; Reiterer C.
Institution
(Taschner, Fleischmann, Kabon, Horvath, Adamowitsch, Hantakova,
Hochreiter, Zotti, Reiterer) Department of Anaesthesia, Intensive Care
Medicine and Pain Medicine, Division of General Anaesthesia and Intensive
Care Medicine, Medical University of Vienna, Vienna, Austria
(Sinner, Eckhardt) Department of Anaesthesia and Intensive Care, Medical
University Innsbruck, Innsbruck, Tirol, Austria
(Fraunschiel) IT Services and Strategic Information Management, Medical
University of Vienna, Vienna, Austria
(Graf) Institute of Medical Statistics, Centre for Medical Data Science,
Medical University of Vienna, Vienna, Austria
Abstract
INTRODUCTION: The effect of different anaesthetics on the incidence of
postoperative delirium is still not entirely clear. Therefore, we will
evaluate the effect of desflurane versus sevoflurane versus propofol for
the maintenance of anaesthesia on the incidence of postoperative delirium
in older adults undergoing moderate- to high-risk major non-cardiac
surgery. We will further compare the incidences of delayed neurocognitive
recovery, long-term postoperative neurocognitive disorder, postoperative
nausea and vomiting between the groups. METHODS AND ANALYSIS: In this
multicentre, prospective, observer-blinded, randomised controlled clinical
trial, we will include 1332 patients >=65 years of age undergoing
moderate- to high-risk major non-cardiac surgery lasting at least 2hours.
Patients will be randomly 1:1:1 assigned to receive desflurane,
sevoflurane or propofol for anaesthesia. Maintenance of anaesthesia will
be performed in a goal-directed manner using processed
electroencephalography with an intraoperative goal of bispectral index
40-60. Our primary outcome will be the incidence of postoperative delirium
within the first five postoperative days. Postoperative delirium will be
assessed using the three-dimensional-confusion assessment method (3D-CAM)
or CAM-intensive care unit (ICU) in the morning and evening of the first
five postoperative days by blinded study personnel. The primary outcome,
the incidence of postoperative delirium, will be compared between the
three study groups using a chi2 test. Furthermore, a logistic regression
model for the incidence of postoperative delirium will be performed,
accounting for randomised groups as well as other predefined confounding
factors. ETHICS AND DISSEMINATION: This clinical trial has been approved
by the ethics committee and the Federal Office for Safety in Healthcare as
the competent authority for clinical trials in Austria. The results of
this trial will be published in a peer-reviewed journal. TRIAL
REGISTRATION NUMBER: ClinicalTrials.gov NCT05990790. Copyright ©
Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.

<31>
Accession Number
2032473430
Title
Safety and therapeutic potential of allogeneic adipose-derived stem cell
spray transplantation in ischemic cardiomyopathy: a phase I clinical
trial.
Source
Journal of Translational Medicine. 22(1) (no pagination), 2024. Article
Number: 1091. Date of Publication: December 2024.
Author
Kawamura T.; Yoshioka D.; Kawamura A.; Misumi Y.; Taguchi T.; Mori D.;
Saito S.; Yamauchi T.; Hata H.; Miyagawa S.
Institution
(Kawamura, Yoshioka, Kawamura, Misumi, Taguchi, Mori, Saito, Yamauchi,
Hata, Miyagawa) Department of Cardiovascular Surgery, Osaka University
Graduate School of Medicine, 2-2 Yamada-Oka, Osaka, Suita 565-0871, Japan
Publisher
BioMed Central Ltd
Abstract
Background: Ischemic cardiomyopathy, characterized by coronary artery
atherosclerosis, impairs the myocardial tissue. Coronary artery bypass
grafting (CABG) is commonly used to revascularize affected areas and
improve patient survival rates; however, it can fail to enhance cardiac
function. Impaired capillary blood flow may obstruct functional recovery,
prompting interest in treatments, such as angiogenic factor
administration. Adipose-derived stem cells (ADSCs), which are known for
immune evasion, have shown the potential to construct capillary networks
and improve myocardial function. This clinical trial aimed to evaluate the
safety and efficacy of ADSC spray therapy combined with CABG.
 Method(s): This single-center, randomized, double-blind study
involved patients with ischemic cardiomyopathy who were scheduled for CABG
and who had a left ventricular ejection fraction <= 40%. The participants
were randomized to receive CABG as well as ADSC spray therapy or placebo.
The primary endpoints were safety, changes in late gadolinium-enhanced
(LGE) magnetic resonance imaging (MRI) volumes, and feasibility. The
secondary endpoints included left ventricular function, exercise
tolerance, and heart failure symptoms. Result(s): Seven patients were
enrolled; of them, six were randomized to receive ADSC therapy (n = 3) or
placebo (n = 3). The procedure was successfully completed with minimal
adverse events. One patient in the ADSC group developed pleural effusion
that was resolved with drainage. The LGE-MRI volumes decreased in the ADSC
group but remained unchanged in the placebo group. Improvements in left
ventricular function and exercise tolerance were noted in the ADSC group,
with heart failure symptoms improving to New York Heart Association class
I. In contrast, the placebo group showed no significant changes, with one
patient experiencing worsening symptoms. Conclusion(s): ADSC spray
therapy combined with CABG demonstrated safety and efficacy at enhancing
cardiac function. ADSC likely contributes to capillary network
reconstruction, thereby augmenting the benefits of CABG. Future phase II
and III trials are warranted to confirm its therapeutic efficacy and
long-term outcomes. This novel approach represents a significant
advancement in the treatment of ischemic cardiomyopathy and offers a
viable strategy for improving myocardial function and patient prognosis.
Trial registration This study was registered with the Japan Registry of
Clinical Trials (jRCT2053190103) and ClinicalTrials.gov
(NCT04695522). Copyright © The Author(s) 2024.

<32>
Accession Number
2036122623
Title
Clinical utility of echocardiography in internal medicine: a narrative
review.
Source
Italian Journal of Medicine. 18(4) (no pagination), 2024. Article Number:
1802. Date of Publication: 2024.
Author
Mumoli N.; Marengo S.
Institution
(Mumoli) Department of Cardiovascular Medicine, Ospedale di Circolo, VA,
Busto Arsizio, Italy
(Marengo) Department of Internal Medicine, AO Ordine Mauriziano, Turin,
Italy
Publisher
Page Press Publications
Abstract
Echocardiography has emerged as an invaluable tool in internal medicine,
providing real-time, non-invasive evaluation of cardiac structure and
function. Its clinical utility spans a wide range of applications,
including the diagnosis and management of heart failure, valvular heart
diseases, and cardiomyopathies, as well as systemic conditions like sepsis
and chronic kidney disease. The ability to perform bedside
echocardiography has made it particularly useful in critical care
settings, allowing for rapid assessment of cardiac function in
hemodynamically unstable patients. Echocardiography also plays a key role
in guiding therapeutic interventions, from fluid management to valvular
repair and replacement procedures. Despite its many advantages,
echocardiography is not without limitations. Image quality may be
compromised in patients with obesity, lung disease, or prior thoracic
surgery, necessitating alternative imaging modalities like cardiac
magnetic resonance imaging or computed tomography. Operator expertise is
another critical factor influencing diagnostic accuracy, underscoring the
importance of proper training. Recent advancements, including artificial
intelligence integration and portable devices, are expected to further
expand the role of echocardiography, making it more accessible in diverse
clinical settings. This narrative review highlights the broad clinical
utility of echocardiography in internal medicine, its challenges, and the
future directions that promise to enhance its role in patient
care. © Copyright: the Author(s), 2024.

<33>
Accession Number
2036208939
Title
Reduced direct oral anticoagulant dose vs dual antiplatelet therapy after
left atrial appendage closure in patients with nonvalvular atrial
fibrillation: A systematic review and meta-analysis.
Source
Heart Rhythm. (no pagination), 2024. Date of Publication: 2024.
Author
Lima N.A.; Filho F.W.P.A.; Mendes B.X.; Neto V.L.M.; d'Avila A.L.B.
Institution
(Lima, Mendes) Department of Medicine, Christus University Center, Ceara,
Fortaleza, Brazil
(Filho, Neto) Department of Medicine, Federal University of Ceara, Ceara,
Sobral, Brazil
(d'Avila) Departments of Medicine, Beth Israel Deaconess Medical Center
and Harvard Medical School, Boston, Massachusetts, United States
Publisher
Elsevier B.V.
Abstract
Background: Left atrial appendage closure (LAAC) 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 still is controversial, especially in a subgroup of patients
with severe renal dysfunction. Objective(s): The purpose of this
study was to evaluate the use of low-dose direct oral anticoagulation
(l-DOAC) vs dual antiplatelet therapy (DAPT) after 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, transient ischemic attack, peripheral thromboembolism), and the
composite outcome of thromboembolic events and major bleeding. Risk ratios
(RRs) with 95% confidence intervals (CIs) 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
1015 participants from 2 randomized controlled trials and 3 nonrandomized
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 = .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
<.0001; I2 = 0%). Conclusion(s): In this systematic review
and meta-analysis, the use of l-DOACs in patients with nonvalvular atrial
fibrillation who underwent LAAC reduces the occurrence of the DRT and
composite outcomes of thromboembolic events and major
bleeding. Copyright © 2024 Heart Rhythm Society

<34>
Accession Number
2036069254
Title
Effect of PCSK9 inhibitors on major cardiac adverse events and
lipoprotein-a in patients with coronary heart disease: A meta-analysis.
Source
Coronary Artery Disease. (no pagination), 2024. Article Number:
10.1097/MCA.0000000000001464. Date of Publication: 2024.
Author
Hu E.; Wan M.
Institution
(Hu) Department of Pharmacy, The Sixth Hospital of Wuhan, Affiliated
Hospital of Jianghan University, Hubei Province, Wuhan, China
(Wan) Department of the Second Clinic, The 940 Hospital of Joint Logistics
Support Force of Chinese PLA, Gansu Province, Lanzhou, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background Lipoprotein(a) [Lp(a)] is an independent risk factor for
cardiovascular disease due to its unique apo(a) component and its
association with atherosclerosis and thrombogenesis. This meta-analysis
was conducted to evaluate the effects of PCSK9 inhibitors on major adverse
cardiac events (MACE) and Lp(a) levels in patients with coronary heart
disease. Methods Randomized controlled trials (RCTs) were systematically
searched in PubMed, the Cochrane Library, and other databases. Stata 15.1
software was used for data analysis, and a random- or fixed-effects model
was selected based on inter-study heterogeneity. Egger's test was applied
to detect publication bias. Results A total of 12 RCTs were included,
involving 48 116 patients with a mean age of 62 years, comprising 65%
males and diverse ethnic backgrounds. The results showed that compared
with the control group, PCSK9 inhibitors significantly reduced low-density
lipoprotein cholesterol (WMD = -1.24 mmol/L, 95% confidence interval (CI):
-1.28 to -1.20), total cholesterol, triglycerides, and Lp(a) levels while
increasing high-density lipoprotein cholesterol levels. In terms of
safety, there was no increased risk of adverse reactions other than
injection site reactions. For MACE, PCSK9 inhibitors significantly reduced
the risk of nonfatal myocardial infarction, stroke, and coronary
revascularization events (RR = 0.87, 95% CI: 0.84-0.89). Conclusion PCSK9
inhibitors not only significantly improve blood lipid profiles and reduce
Lp(a) levels but also reduce the risk of MACE in patients with coronary
heart disease. Therefore, PCSK9 inhibitors offer an effective and safe
treatment option for these patients. Copyright © 2024 Wolters
Kluwer Health, Inc. Unauthorized reproduction of this article is
prohibited.

<35>
Accession Number
2032504495
Title
Melatonin ameliorates inflammation and improves outcomes of
ischemia/reperfusion injury in patients undergoing coronary artery bypass
grafting surgery: a randomized placebo-controlled study.
Source
Apoptosis. (no pagination), 2024. Date of Publication: 2024.
Author
Casper E.A.; Wakeel L.E.; Sabri N.A.; Khorshid R.; Gamal M.A.; Fahmy S.F.
Institution
(Casper, Wakeel, Sabri, Fahmy) Department of Clinical Pharmacy, Faculty of
Pharmacy, Ain Shams University, Ankara Street, Sheraton buildings, Cairo
11566, Egypt
(Khorshid, Gamal) Department of Cardiovascular and Thoracic Surgery, Ain
Shams University Hospital, Faculty of Medicine, Ain Shams University,
Cairo, Egypt
Publisher
Springer
Abstract
To investigate the protective role of high dose melatonin concerning
myocardial I/R injury and inflammation in patients undergoing on-pump
coronary artery bypass grafting (CABG) surgery by evaluating
IR/inflammatory biomarkers and clinical outcomes. This was a prospective;
randomized; single-blinded placebo-controlled study conducted at
cardio-thoracic surgery department of the Academy of the Cardiovascular
and Thoracic Surgery, Ain Shams University. Eligible patients were
randomly allocated to; melatonin-treated group (MTG) or placebo-treated
group (PTG). The MTG (n = 17) received 60 mg/day melatonin capsules daily
starting 5 days before surgery in addition to the standard of care. PTG (n
= 17) received placebo also 5 days before surgery plus standard of care.
The levels of nuclear factor kappa beta (NF-kappab) (primary outcome),
tumor necrosis factor (TNF-alpha), cardiac troponins I, and IL-6 levels
were all assessed for both groups at five time points: baseline before
melatonin or placebo administration (T0), before cross-clamp
application(T1), 5 min after cross-clamp removal(T2), 6 h after
cross-clamp removal(T3) and 24 h after cross-clamp removal(T4). Blood
pressure was assessed at baseline, pre-operative and 24-hours
post-operative. The Quality of recovery-40 score (QOR-40) was assessed for
both groups on day 4 after surgery. TNF-alpha levels decreased in the MTG
at T1(p = 0.034) versus PTG. At T2(p = 0.005), and T3(p = 0.04), TNF-alpha
significantly increased in PTG versus MTG. Troponins significantly
increased in PTG at T3 (p = 0.04) versus MTG. NF-kappaB levels declined at
T1 (p = 0.013) and T2 (p = 0.0001) in MTG compared to PTG. IL-6
significantly increased in PTG versus MTG at T3 (p = 0.04). The QOR-40
score significantly decreased in MTG versus PTG. MTG had statistically
significant decrease in DBP compared to the placebo group (p = 0.024). MTG
had a statistically significant shorter intubation time than did the
placebo group (p = 0.03). Melatonin 60 mg was well-tolerated without any
reported side effects. Our findings suggested that melatonin could
ameliorate myocardial I/R injury after on-pump CABG and that this outcome
was essentially correlated to its antiapoptotic and anti-inflammatory
effects. Trial registration: ClinicalTrials.gov registration number
NCT05552586, 9/2022. Copyright © The Author(s) 2024.

<36>
Accession Number
645950157
Title
Evaluating the prognostic significance of RV-PA coupling in mitral valve
repair via edge-to-edge technique: A systematic review and meta-analysis.
Source
Asian journal of surgery. (no pagination), 2024. Date of Publication: 29
Nov 2024.
Author
Zhong L.; Yin H.; Tang Z.; Xiao Z.
Institution
(Zhong) Department of Cardio-Thoracic Surgery, Chengdu Second People's
Hospital, Chengdu, Sichuan, 610017, China; Chengdu Medical College,
Chengdu, Sichuan, 610500, China. Electronic address: 905419828@qq.com
(Yin) Department of Cardio-Thoracic Surgery, Chengdu Second People's
Hospital, Chengdu, Sichuan, 610017, China; Chengdu Medical College,
Chengdu, Sichuan, 610500, China
(Tang) Department of Cardio-Thoracic Surgery, North Sichuan Medical
College, Sichuan 637000, China
(Xiao) Department of Cardio-Thoracic Surgery, Chengdu Second People's
Hospital, Chengdu, Sichuan, 610017, China; Chengdu Medical College,
Chengdu, Sichuan, 610500, China. Electronic address: 734269726@qq.com

<37>
Accession Number
645948681
Title
Effectiveness of acupuncture as an adjunct to cardiac rehabilitation after
coronary artery bypass grafting.
Source
Acupuncture in medicine : journal of the British Medical Acupuncture
Society. (pp 9645284241298011), 2024. Date of Publication: 29 Nov 2024.
Author
Roshanzamir S.; Mohamadi Jahromi L.S.; Zakeri M.; Ghaderpanah R.; Parvin
R.
Institution
(Roshanzamir) Shiraz Medical School, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Mohamadi Jahromi) Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of
(Zakeri, Parvin) Department of Physical Medicine and Rehabilitation,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Ghaderpanah) Students Research Committee, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Abstract
BACKGROUND: Considering the importance of cardiac rehabilitation after
coronary artery bypass grafting (CABG) and the development of acupuncture
over the past few decades, the aim of this study was to evaluate the
effects of acupuncture on patients' exercise tolerance, heart rate and
blood pressure after CABG. METHOD(S): Thirty-four patients with a
history of recent CABG were recruited between 2019 and 2020 for this
clinical trial and randomly divided into two groups receiving acupuncture
plus cardiac rehabilitation (group A) and cardiac rehabilitation alone
(group B). In both groups, exercise-based rehabilitation exercise was
performed. Group A additionally received acupuncture at PC6, PC4, HT7 and
GB20 bilaterally. Changes in blood pressure, heart rate and Borg scale
score were evaluated before, during and after the course of the treatment.
 RESULT(S): Heart rate was significantly lower in group A compared to
group B after completion of the course of the treatment (P=0.022).
However, there were no statistically significant differences between the
two groups in systolic or diastolic blood pressure or Borg scale scores
(P>0.05). Nevertheless, the Borg scale scores showed a significant
decrease within each group over time (P<0.001), reflecting an improvement
in the patients' ability to tolerate activity after cardiac rehabilitation
with or without acupuncture. CONCLUSION(S): Acupuncture in
combination with exercise-based cardiac rehabilitation was more effective
at decreasing heart rate than cardiac rehabilitation alone after CABG.
Both approaches appeared to be similarly effective at improving exercise
tolerance. In this study, the addition of acupuncture at the
aforementioned traditional acupuncture point locations to exercise-based
cardiac rehabilitation did not affect blood pressure. TRIAL REGISTRATION
NUMBER: IRCT20171208037793N1 (Iranian Registry of Clinical Trials).

<38>
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

<39>
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.

<40>
Accession Number
2036052750
Title
Invasive Coronary Angiography Versus Noninvasive Computed Tomography
Coronary Angiography as Preoperative Coronary Imaging for Valve Surgery.
Source
American Journal of Cardiology. 237 (pp 1-5), 2025. Date of Publication:
15 Feb 2025.
Author
Caldonazo T.; Kirov H.; Dochev I.; Fischer J.; Runkel A.; Dewey M.;
Cardoso R.; Teichgraber U.; Mukharyamov M.; Grager S.; Doenst T.
Institution
(Caldonazo, Kirov, Dochev, Fischer, Runkel, Mukharyamov, Doenst)
Department of Cardiothoracic Surgery, Jena University Hospital, Jena,
Germany
(Dewey) Department of Radiology, Charite University Hospital, Berlin,
Germany
(Cardoso) Division of Cardiovascular Medicine, Heart and Vascular Center,
Brigham and Women's Hospital, Harvard Medical School, Boston,
Massachusetts, United States
(Teichgraber, Grager) Department of Diagnostic and Interventional
Radiology Jena University Hospital, Jena, Germany
Publisher
Elsevier Inc.
Abstract
Coronary computed tomography angiography (CCTA) has emerged as a
noninvasive alternative to invasive coronary angiography (ICA) for
diagnosing coronary artery disease (CAD). Hence, the question of CCTA's
ability to guide surgical decision-making moves into the center of
attention. CCTA is specifically powerful in ruling out CAD. We, therefore,
performed a meta-analysis and systematic review to compare the clinical
end points between patients who received ICA or CCTA to rule out CAD
before valve surgery. A total of 3 databases were assessed. The primary
outcome was perioperative mortality. Secondary outcomes were acute kidney
injury (AKI), myocardial infarction (MI), stroke, and major adverse
cardiovascular events (MACEs). The odds ratio (OR) and the respective
confidence interval (CI) was calculated. A random-effects model was
performed. A total of 5 studies with 6,654 patients qualified for the
analysis. There was no significant difference between the 2 groups
regarding the primary end point (OR 1.20, 95% CI 0.67 to 2.15, p = 0.53).
The secondary outcomes also did not show any significant differences in
AKI (OR 1.14, 95% CI 1.14, 0.88 to 1.49, p = 0.32), MI (OR 0.89, 95% CI
0.65 to 1.22, p = 0.45), stroke (OR 1.12, 95% CI 0.48 to 2.60, p = 0.79),
or MACEs (OR 1.17, 95% CI 0.86 to 1.59, p = 0.33) incidences. The analysis
suggests that CCTA is a safe and reliable noninvasive alternative to ICA
for coronary imaging before valve surgery. Conceivable differences in
imaging modalities were not associated with increases in perioperative
mortality, AKI, MI, stroke, or MACEs. Copyright © 2024 The
Author(s)

<41>
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.

<42>
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.

<43>
Accession Number
2031750328
Title
Rationale and Design of the Randomized COmparison of Methods for Pulmonary
Blood Flow Augmentation: Shunt Versus Stent (COMPASS) Trial: A Pediatric
Heart Network Study.
Source
World Journal for Pediatric and Congenital Heart Surgery. 15(6) (pp
693-702), 2024. Date of Publication: November 2024.
Author
Petit C.J.; Romano J.C.; Zampi J.D.; Pasquali S.K.; McCracken C.E.;
Chanani N.K.; Les A.S.; Burns K.M.; Crosby-Thompson A.; Stylianou M.; Kato
B.; Glatz A.C.
Institution
(Petit) Division of Cardiology, Morgan Stanley Children's Hospital of New
York, Columbia University Vagelos College of Physicians and Surgeons, New
York, NY, United States
(Romano) Department of Cardiac Surgery, Section of Pediatric Cardiac
Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor,
MI, United States
(Zampi, Pasquali, Les) Division of Pediatric Cardiology, Department of
Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann
Arbor, MI, United States
(McCracken, Chanani) Department of Pediatrics, Emory University School of
Medicine, Atlanta, GA, United States
(Burns) Division of Cardiovascular Sciences, National Heart, Lung, and
Blood Institute, NIH, Bethesda, MD, United States
(Crosby-Thompson, Kato) Carelon Research, Newton, MA, United States
(Stylianou) Office of Biostatistics Research, National Heart, Lung, and
Blood Institute, NIH, Bethesda, MD, United States
(Glatz) Division of Cardiology, Washington University School of Medicine,
The Heart Center at St. Louis Children's Hospital, St. Louis, MO, United
States
Publisher
SAGE Publications Inc.
Abstract
Neonates with congenital heart disease and ductal-dependent pulmonary
blood flow (DD-PBF) require early intervention. Historically, this
intervention was most often a surgical systemic-to-pulmonary shunt (SPS;
eg, Blalock-Thomas-Taussig shunt). However, over the past two decades, an
alternative to SPS has emerged in the form of transcatheter ductal artery
stenting (DAS). While many reports have indicated safety and durability of
the DAS approach, few studies compare outcomes between DAS and SPS. The
reports that do exist are comprised primarily of small-cohort
single-center reviews. Two multicenter retrospective studies suggest that
DAS is associated with similar or superior survival compared with SPS.
These studies offer the best evidence to-date, and yet both have important
limitations. The authors describe herein the rationale and design of the
COMPASS (COmparison of Methods for Pulmonary blood flow Augmentation:
Shunt vs Stent [COMPASS]) Trial (NCT05268094, IDE G210212). The COMPASS
Trial aims to randomize 236 neonates with DD-PBF to either DAS or SPS
across approximately 27 pediatric centers in North America. The goal of
this trial is to compare important clinical outcomes between DAS and SPS
over the first year of life in a cohort of neonates balanced by
randomization in order to assess whether one method of palliation
demonstrates therapeutic superiority. Copyright © The Author(s)
2024.

<44>
Accession Number
2015321910
Title
Effectiveness of Sucrose Octasulfate Dressing in the Treatment of
Neuro-Ischaemic Diabetic Foot Heel Ulcers: A Retrospective Single arm
Study.
Source
International Journal of Lower Extremity Wounds. 23(4) (pp 593-599), 2024.
Date of Publication: December 2024.
Author
Meloni M.; Giurato L.; Panunzi A.; Bellia A.; Bohbot S.; Lauro D.; Uccioli
L.
Institution
(Meloni, Giurato, Panunzi, Bellia, Lauro, Uccioli) Department of Systems
Medicine, University of Rome Tor Vergata, Rome, Italy
(Bohbot) Laboratoires URGO, Paris, France
Publisher
SAGE Publications Inc.
Abstract
The study aimed to evaluate the effectiveness of the use of sucrose
octasulfate impregnated dressing (TLC-NOSF [Technology
Lipido-Colloid-Nano-OligoSaccharide Factor]) in the management of persons
with neuro-ischaemic heel diabetic foot ulcers (DFUs). Consecutive
patients who referred for an active non-infected neuro-ischaemic heel DFU
belonging to grade IC (superficial) or IIC (deep to tendons, muscle or
capsule) according to Texas University Classification were included. All
patients were managed by a pre-set limb salvage protocol in the respect of
International guidelines and the TLC-NOSF dressing was used as primary and
specific dressing. Patients were evaluated any 2 to 4 weeks until wound
healing or different outcomes. Primary outcome was the rate of complete
wound healing after 24 weeks of follow-up. The secondary outcomes assessed
the healing time, the rate of wound regression, the re-ulceration in the
case of complete healing and the safety. Thirty patients were included.
The mean age was 67 +/- 11 years, 17 (56.7%) were male, all of them were
affected by type 2 diabetes with a mean duration of 18 +/- 7 years. Twenty
patients (66.7%) showed deep ulcers (grade 2 of Texas University
Classification); the mean TcPO2 at the inclusion was 42 +/- 7 mm Hg.
Twenty-two patients (73.3%) healed by Week 24. The mean time of healing
was 84 +/- 32 days, 2 (6.7%) patients had ulcer relapse after healing, 28
(93.3%) had wound regression >50%, 2 (6.7%) had mild infection, 1 (3.3%)
reported major amputation. No serious adverse events related to TLC-NOSF
dressing or local reactions were reported. This current study showed the
potential benefit of sucrose octasulfate for treating neuro-ischaemic heel
DFUs in addition to the standard of care. Copyright © The
Author(s) 2022.

<45>
Accession Number
2036122466
Title
The Effectiveness and Application of Transcutaneous Electrical Acupoint
Stimulation in the Prevention of Postoperative Nausea and Vomiting.
Source
Heart Surgery Forum. 27(11) (pp E1351-E1359), 2024. Date of Publication:
2024.
Author
Yang K.; Hu J.; Yang L.; Xia R.; Xu W.
Institution
(Yang, Xia, Xu) Department of Anesthesiology, The First Affiliated
Hospital of Yangtze University, Hubei, Jingzhou 434000, China
(Hu) Gynecology Department, The Third People's Hospital of Jingzhou,
Hubei, Jingzhou 434001, China
(Yang) Department of Cardiology, Jiangxi Provincial People's Hospital, The
First Affiliated Hospital of Nanchang Medical College, Jiangxi, Nanchang
330006, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: Effective management of postoperative nausea and vomiting
(PONV) is crucial for enhancing postoperative recovery and improving the
quality of life. Transcutaneous electrical acupoint stimulation (TEAS) is
an innovative non-pharmacological intervention that has gained significant
attention in PONV management, especially following thoracic surgery.
 Method(s): This systematic review aims to evaluate the effectiveness
and application potential of TEAS in alleviating PONV and promoting
postoperative recovery. The review includes a detailed analysis of recent
randomized controlled trials (RCTs) and observational studies that
investigate the use of TEAS in various surgical procedures, with a
particular focus on video-assisted thoracoscopic lobectomy (VATSL). The
principles, procedures, and safety aspects of TEAS are comprehensively
discussed. Result(s): The analysis of the included studies
demonstrates that TEAS is effective in reducing the incidence of PONV and
improving postoperative recovery outcomes across different types of
surgeries, including VATSL and other common surgical procedures. The
effectiveness of TEAS in PONV management is supported by evidence from
multiple RCTs and observational studies, which report a significant
reduction in nausea and vomiting rates, as well as improved recovery
indicators. Conclusion(s): TEAS shows promising potential as a
non-pharmacological intervention for managing PONV and enhancing
postoperative recovery. However, the current evidence highlights several
limitations and controversies that require further investigation. Future
research should focus on addressing these gaps and exploring new
directions for the application of TEAS. Practical recommendations are
provided for the clinical application of TEAS, emphasizing its role in
effective PONV management to promote better postoperative
outcomes. Copyright © 2024 The Author(s). Published by Forum
Multimedia Publishing, LLC.

<46>
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.

<47>
Accession Number
2036090057
Title
Comparison of Hemodynamic Consequences of Hand Ventilation Versus Machine
Ventilation for Transportation of Post-Operative Pediatric Cardiac
Patients.
Source
Annals of Cardiac Anaesthesia. 26(2) (pp 166-170), 2023. Date of
Publication: 2023.
Author
Chauhan A.; Rajesh V.S.P.; Pujara J.; Singh G.; Patel P.; Patel K.; Pandya
H.
Institution
(Chauhan, Rajesh, Pujara, Singh, Patel, Patel) Departments of Cardiac
Anesthesia, U.N. Mehta Institute of Cardiology and Research Center,
Gujarat, Ahmedabad, India
(Pandya) Departments of Research, U.N. Mehta Institute of Cardiology and
Research Center, Gujarat, Ahmedabad, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Learning Objective: Hemodynamic monitoring during in-hospital transport of
intubated patients is vital; however, no prospective randomized trials
have evaluated the hemodynamic consequences of hand versus machine
ventilation during transport among pediatric patients' post-cardiac
surgery. The authors hypothesized that manual ventilation after pediatric
cardiac surgery would alter hemodynamic and arterial blood gas (ABG)
parameters during transport compared to mechanical ventilation.
 Design(s): A prospective randomized trial. Setting(s): Tertiary
cardiac care hospital. Participant(s): Pediatric cardiac surgery
patients. Material(s) and Method(s): One hundred intubated pediatric
patients were randomized to hand or machine ventilation immediately
post-cardiac surgery during transport from the operating room to the
pediatric post-operative intensive care unit (PICU). Hemodynamic
variables, including end-tidal CO<inf>2</inf> (ETCO<inf>2</inf>), oxygen
saturation, heart rate, systolic blood pressure (SBP), diastolic blood
pressure (DBP), peak airway pressure (Ppeak), and mean airway pressure
(Pmean), were measured at origin, during transport, and at the
destination. ABG was measured before and upon arrival in the PICU, and
adverse events were recorded.The Chi-square test and independent t-test
were used for comparison of categorical and continuous parameters,
respectively. Results and Discussion: The mean transpor t time was
comparable between hand-ventilated (5.77 +/- 1.46 min) and
machine-ventilated (5.96 +/- 1.19 min) groups (P = 0.47). ETCO<inf>2</inf>
consistently dropped during transport and after shifting in the
hand-ventilated group, with significantly higher ETCO<inf>2</inf>
excursion than in machine-ventilated patients (P < 0.05). SBP and DBP
significantly decreased during transport (at 5 and 6 min intervals) and
after shifting in hand-ventilated patients than in the other group (P <
0.05). Additionally, after shifting, a significant increase in Ppeak (P <
0.001), Pmean (P < 0.001), and pH (P < 0.001), and a decrease in
pCO<inf>2</inf> (P = 0.0072) was observed in hand-ventilated patients than
machine-ventilated patients. No adverse event was noted during either mode
of ventilation. Conclusion(s): Hand ventilation leads to more
significant variation in ABG and hemodynamic parameters than machine
ventilation in pediatric patients during transport post-cardiac surgery.
Therefore, using a mechanical ventilator is the preferred method for
transporting post-operative pediatric cardiac patients. Copyright
© 2023 Annals of Cardiac Anaesthesia Published by Wolters
Kluwer - Medknow.

<48>
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.

<49>
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.

<50>
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

<51>
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. 40(12) (pp 2649-2659), 2024. Date of
Publication: December 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

<52>
Accession Number
2013170133
Title
Early Comparison of Major Bleeding, Stroke and Associated Medical Costs
Among Treatment-Naive Non-Valvular Atrial Fibrillation Patients Initiating
Apixaban, Dabigatran, Rivaroxaban or Warfarin.
Source
Blood. Conference: 58th ASH Annual Meeting. San Diego United States.
126(23) (pp 745), 2015. Date of Publication: 03 Dec 2015.
Author
Alpesh A.N.; Keshishian A.; Xie L.; Baser O.; Price K.; Vo L.; Singh P.;
Bruno A.; Mardekian J.; Tan W.; Singhal S.; Patel C.; Odell K.; Trocio J.
Institution
(Alpesh) University of California, Irvine, CA, United States
(Keshishian, Xie) STATinMED Research, Ann Arbor, MI, United States
(Baser) STATinMED Research, New York, NY, United States
(Baser) Center for Innovation & Outcomes Research, Department of Surgery,
Columbia University, New York, NY, United States
(Price, Mardekian, Tan, Odell, Trocio) Pfizer Inc., New York, NY, United
States
(Vo, Singh, Bruno, Singhal, Patel) Bristol-Myers Squibb, New York, NY,
United States
Publisher
Elsevier B.V.
Abstract
[Formula presented] INTRODUCTION: Recent large randomized controlled
trials have shown that novel oral anticoagulants (NOACs) are at least as
effective as warfarin for risk reduction of stroke or systemic embolism in
patients with non-valvular atrial fibrillation (NVAF) and are associated
with similar or lower rates of bleeding.1,2,3,4 The study aimed
to compare real-world major bleeding and stroke risk reduction and their
related medical costs following initiation of apixaban compared to other
oral anticoagulants (OACs) among treatment-naive NVAF patients.
 METHOD(S): From a large national commercial and Medicare advantage
insurance database, adult patients initiating apixaban, dabigatran,
rivaroxaban, or warfarin (01/01/2013-12/31/2014) were identified. The OAC
prescription date was designated as the index date. Patients were required
to have an AF diagnosis (ICD-9-CM: 427.31) and continuous health plan
enrollment for 6 months pre-index date. Patients with evidence of mitral
valvular heart disease, valve replacement procedures, pregnancy, or OAC
claims before the index date were excluded. Patients were classified into
four cohorts based on their index prescription: apixaban, dabigatran,
rivaroxaban and warfarin. Time-to- first stroke and major bleeding events,
identified by the Cunningham algorithm plus additional bleeding sites,
were compared using a Cox proportional hazards model. Major bleeding and
stroke-related medical costs including those for recurring events were
calculated per patient per month (PPPM) and compared using
propensity-weighted generalized linear models. RESULT(S): The study
included 5,573 apixaban, 4,104 dabigatran, 13,370 rivaroxaban, and 25,978
warfarin patients. Apixaban patients had significantly higher
CHA<inf>2</inf>DS<inf>2</inf>-VASc (3.6) and HAS-BLED (2.4) scores
compared to dabigatran (CHA<inf>2</inf>DS<inf>2</inf>-VASc=3.3,
HAS-BLED=2.2; p<0.001) and rivaroxaban
(CHA<inf>2</inf>DS<inf>2</inf>-VASc=3.3, HAS-BLED=2.3; p<0.001) patients
but lower scores compared to warfarin patients
(CHA<inf>2</inf>DS<inf>2</inf>-VASc=4.0, HAS-BLED=2.7; p<0.001). After
adjusting for baseline characteristics, apixaban patients were
significantly less likely to have the first major-bleeding event within 1
year of treatment initiation compared to rivaroxaban (HR=0.71; 95%
CI=0.62-0.82), warfarin (HR=0.71; 95% CI=0.62-0.80) patients, and trended
towards numerically lower risk compared to dabigatran (HR=0.87; 95%
CI=0.74-1.03) patients. Furthermore, apixaban patients were 26% less
likely to have the first stroke within 1 year of treatment initiation
compared to warfarin patients (HR=0.74; 95% CI=0.68-0.81), and trended
towards numerically lower risk compared to rivaroxaban (HR=0.94; 95%
CI=0.86-1.04) and dabigatran (HR=0.91; 95% CI=0.81-1.02) patients. Major
bleeding-related medical costs were lower in apixaban patients compared to
rivaroxaban ($85, p<0.001) and warfarin ($122, p<0.001) patients. The
stroke-related medical costs were not significantly different; however,
patients treated with apixaban had numerically lower PPPM stroke-related
costs ($46) compared to those treated with rivaroxaban ($51) and warfarin
($68). CONCLUSION(S): In a large insured population, treatment-naive
NVAF patients treated with apixaban were significantly less likely to have
a major bleed compared to those prescribed rivaroxaban or warfarin and
less likely to have a stroke compared to those prescribed warfarin.
Additionally, patients prescribed apixaban had lower major bleeding costs
compared to those prescribed rivaroxaban and warfarin. 1 Lip
GYH, Halperin JL, Petersen P, Rodgers GM, Pall D, Renfurm RW. A phase II,
double-blind, randomized, parallel group, dose-finding study of the safety
and tolerability of darexaban compared with warfarin in patients with
non-valvular atrial fibrillation: the oral factor Xa inhibitor for
prophylaxis of stroke in atrial fibrillation study 2 (OPAL-2). J
Thrombrosis Haemostasis. 2015;13:1405-13. 2 O'Donoghue ML, Ruff
CT, Giugliano RP, et al. Edoxaban vs. warfarin in vitamin K antagonist
experienced and naive patients with atrial fibrillation. Eur Heart J.
2015;36(23):1470-7. 3 Agnelli G, Buller HR, Cohen A, et al.
Apixaban for extended treatment of venous thromboembolism. N Engl J Med
2013;368(8):699-708. 4 Lanssen M, Raskob G, Gallus A, et al.
Apixaban versus enoxaparin for thromboprophylaxis after knee replacement
(ADVANCE-2): A randomized double-blind trial. Lancet
2010;375(9717):807-15. Disclosures: Alpesh: Pfizer Inc.: Consultancy.
Keshishian: Pfizer Inc.: Consultancy, Other: A. Keshishian is an employee
of STATinMED Research, which is a paid consultant to Pfizer Inc. Xie:
Pfizer Inc.: Consultancy, Other: L. Xie is an employee of STATinMED
Research, which is a paid consultant to Pfizer Inc. Baser: Pfizer Inc.:
Consultancy, Other: O. Baser is an employee of STATinMED Research, which
is a paid consultant to Pfizer Inc. Price: Pfizer Inc.: Employment. Vo:
Bristol-Myers Squibb: Employment. Singh: Bristol-Myers Squibb: Employment.
Bruno: Bristol-Myers Squibb: Employment. Mardekian: Pfizer Inc.:
Employment. Tan: Pfizer Inc.: Employment. Singhal: Bristol-Myers Squibb:
Employment. Patel: Bristol-Myers Squibb: Employment. Odell: Pfizer Inc.:
Employment. Trocio: Pfizer Inc.: Employment. Copyright © 2015
American Society of Hematology

<53>
Accession Number
645906977
Title
Hemodynamic Effects of Dexmedetomidine in Pediatric Patients with
Congenital Heart Disease: A Systematic Review and Meta- Analysis.
Source
Anesthesia and Analgesia. Conference: 2024 International Anesthesia
Research Society, IARS and the Society for Critical Care
Anesthesiologists, SOCCA Annual Meeting. Seattle, WA United States. 139(5
Supplement) (pp 645-647), 2024. Date of Publication: November 2024.
Author
Rose N.; Jackson W.
Institution
(Rose) Sackler School of Medicine, United States
(Jackson) Montefiore Medical Center, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Dexmedetomidine (DEX) is frequently used in pediatric
anesthesia. Several studies have been published documenting its use in
patients with congenital heart disease (CHD), but a detailed analysis of
hemodynamic changes after administration in these patients has not been
published. We performed a systematic review and meta-analyses examining
hemodynamic changes after dexmedetomidine administration in patients with
CHD. Method(s): We conducted a systematic review of studies published
and indexed on Pubmed, Embase, and Medline from January 1, 1993 until July
1, 2023. Inclusion criteria were randomized clinical trials or
observational studies that contained children with CHD who received DEX as
part of anesthesia for a cardiac procedure and reported one or more
hemodynamic variables both before and after administration of DEX.
Exclusion criteria were studies that included subjects older than 21 years
or that included patients undergoing noncardiac procedures. We performed a
meta-analysis on hemodynamic variables that were reported by at least four
studies. Result(s): We screened 5383 abstracts after removal of
duplicates. We included 85 studies for full text review, and 8 studies
were accepted for three meta-analyses (heart rate (HR), 8 studies, n =
478; systolic blood pressure (SBP), 5 studies, n = 343; diastolic blood
pressure (DBP), 4 studies, n = 291). While all three analyses showed a
statistically significant reduction in the variable studied (p <0.001),
the clinical difference was minimal with a decrease in HR of 9.3 beats per
minute, and a decrease in SBP/DBP of 4.5 and 6.2 mmHg respectively.
Heterogeneity was high, suggesting that covariates such as age, complexity
of heart disease, and the dose of DEX administered may be worth exploring.
 Conclusion(s): DEX is associated with minimal changes in HR, SBP, and
DBP when administered to children with CHD. Further studies and analysis
should attempt to identify specific subgroups that may have a higher risk
for hemodynamic adverse effects from DEX administration. (Figure
Presented).

<54>
Accession Number
645906894
Title
To study the efficacy of USG Guided Pecto- Intercostal Fascial Plane Block
In Patients Undergoing Midline Sternotomy in Open Cardiac Surgery: A
Randomized Prospective Comparative Study.
Source
Anesthesia and Analgesia. Conference: 2024 International Anesthesia
Research Society, IARS and the Society for Critical Care
Anesthesiologists, SOCCA Annual Meeting. Seattle, WA United States. 139(5
Supplement) (pp 899-901), 2024. Date of Publication: November 2024.
Author
Shamshery C.; Dhiraaj S.
Institution
(Shamshery) Sanjay Gandhi Post Graduate Institute of Medical Sciences,
India
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The incidence of post-sternotomy pain after cardiac surgery
is 80% which is predominantly dynamic in nature(62-78%), and the
persistent pain at 1 year is 31% especially if postsurgical pain is
moderate to severe.1 Analgesics given parenterally have systemic
sideeffects, plane blocks like serratus anterior, pectoralis or erector
spinae are far away from the site of incision or transthoracis muscle
plane block involves risk of pleural puncture and central neuraxial
procedures involve the risk of hematoma. Also studies on postoperative
pain report respiratory complications in terms of incidence of inadequate
cough efforts, atelectasis, pneumonia etc. But rarely evaluate respiratory
efficiency based on objective parameters. Hence we performed
Pectointercostal fascial plane block (PIFB)(Fig1A,B) adjacent to sternum
to anaesthetize anterior cutaneous branches of the intercostal nerves with
the primary objective: * To study the efficacy of USG PIFB for dynamic
pain relief using Numeric rating scale (NRS) after midline sternotomy in
cases of open cardiac surgery at 3 hrs after the block. Secondary
objective was to study the * Efficacy of USG PIFB for dynamic pain relief
at 6, 12, 24hrs after PIFB using NRS * Efficacy of USG PIFB for static
pain relief at 3, 6, 12, 24hrs after PIFB using NRS * Peak expiratory flow
rate at 3, 6, 12, 24hrs after PIFB Methods: A Randomized controlled,
double blinded, prospective comparative trial was conducted at a tertiary
centre following the CONSORT criteria * Approval from institute: IEC no:
2018-200-MD-107 * Helsinki Declaration-2013 was followed. *
CTRI/2020/06/025942) Written & informed consent were takenby all the
patients Inclusion criterion were: * patients of mid line sternotomy for
open cardiac surgery * >18yrs<65 yrs. * NYHA Class 2 &3 * hemodynamically
stable post-op A total of 60 patients were enrolled and randomly divided
them into three groups. Group 1: PIFB was administered bilaterally before
extubation with 15 ml 0.125% bupivacaine Group 2: PIFB was administered
bilaterally before extubation with 15 ml 0.125% bupivacaine + clonidine
0.25mugm/kg b/l Group 3: No intervention was performed. All patients
received acetaminophen 1 gram three times a day and injectable tramadol
1mg/kg as rescue analgesic Study intervention USG linear probe (resolution
6-13mhz) was placed 3cms lateral to the sternum A 20- gauge needle was
inserted in plane at 3rd intercostal space Drug was injected between
pectoralis major and intercostal muscle plane in cranial to caudal
direction A separate resident unaware of group allocation, assessed pain
on Numeric Rating Scale of 11(NRS). For NRS of dynamic pain >= 5 rescue
analgesia was administered. Result(s): * Baseline characteristics
were similar amongst all the groups.(Table-1) * Numeric Rating Scale (NRS)
for pain was statistically lower (p<0.05)in group I and II compared to
group III at rest, deep breathing and coughing at 3, 6 and 12hrs after
extubation. (Table-2) * NRS on deep breathing in group I, II and III was
{(2.28, 1.50, 4.35) at 3hr,( 2.28, 1.55, 4.25) at 6hrs, (1.83, 2.10, 3.95)
at 12hrs, and {(4.33, 3.55, 3.65)} at 24hrs after extubation. * Peak
Expiratory Flow Rate (PEFR) was highest in group I. * Rescue analgesia was
not required in group I. Conclusion(s): Dynamic and static pain was
significantly lower(p<0.05) in Group I and II similar to Kumar etal(1)
Intense but statistically insignificant analgesia was achieved by adding
0.5mcg/kg clonidine same as Singelyn et al.(2) Group I/II/III achieved
61%, 49% and 32% PEFR compared to preop PEFR and none required
reintubationcontrary to Nakahara et al who reported respiratory failure if
FEV1 was decreased by 10%. (3) PIFB shows promise as an effective and safe
analgesic technique for treatment of dynamic and static sternotomy pain
after cardiac surgery, with delayed requirement of rescue analgesia and
improved respiratory mechanics in terms of peak expiratory flow rate.
(Figure Presented).

<55>
Accession Number
645906869
Title
A Systematic Review on the Effect of Incentive Spirometry Use on Reducing
Postoperative Pulmonary Complications in Intensive Care Unit Patients.
Source
Anesthesia and Analgesia. Conference: 2024 International Anesthesia
Research Society, IARS and the Society for Critical Care
Anesthesiologists, SOCCA Annual Meeting. Seattle, WA United States. 139(5
Supplement) (pp 761), 2024. Date of Publication: November 2024.
Author
Ahmad F.; Costin B.
Institution
(Ahmad, Costin) Duke University, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Following surgery, patients are at risk of adverse events
known as postoperative pulmonary complications (PPCs). PPCs defined as
respiratory tract infections or atelectasis, among others. These
complications often require invasive or non-invasive mechanical
ventilation and are a leading cause of mortality following high-risk
surgery. Incentive spirometry (IS) is mechanical technique that aims to
recruit atelectatic lung areas and can be used post-operatively. IS
targets inspiratory lung volumes through the recording and visual feedback
of successful breathing maneuvers. The overall effectiveness of IS in
preventing PPCs remains unclear. The objective of this study is to
determine whether IS for adult patients undergoing high risk surgery
significantly reduces PPCs. Method(s): The literature search used
MEDLINE via PubMed, Embase via Elsevier, CINAHL via Ebsco, and Scopus via
Elsevier. Procedures originally included were abdominal, thoracic, urgent,
head and neck, neurosurgery or cardiac surgery requiring ICU level of
care. Additionally, the surgery must be >2 hours with blood loss > 500 ml
and the patient extubated within 24 hours after surgery. Additional
exclusion criteria were healthy patient (ASA 1), neuraxial or regional
anesthesia use and use of pulmonary rehab prior to procedure. Studies with
unclear methodology were also excluded. Result(s): 27 studies
involving adults undergoing cardiac, thoracic, neurosurgery or abdominal
surgery were included. Of these, 88% of studies were done in the cardiac
surgical population with the remainder being equally split among thoracic,
abdominal and neurosurgery. We decided to focus on cardiac surgery and 23
randomized control trials were ultimately included. Of these, 44% of
studies showed IS improved patient recovery and prevented PPCs following
cardiac surgery. 26% of studies showed non-inferior effect. 30% of studies
suggest IS may have been inferior. The IS protocols used in each study
type were evaluated. In half of the studies showing IS improved patient
recovery following cardiac surgery, IS was used hourly while the patient
was awake. In the studies indicating IS may be inferior to other methods,
only 1 study indicated that IS was used hourly in patients.
 Conclusion(s): Very few studies on IS are done in critically ill
adults. The majority of studies completed on critically ill adults focus
on cardiac surgery. Most studies show that IS either improved patient
recovery following cardiac surgery or showed a non-inferior effect when
compared to other methods. Standardized use of IS and evaluation of its
use should be expanded to trauma and acute care surgery populations.

<56>
Accession Number
645906856
Title
Intraoperative Oxygen Treatment, Tissue Oxygen Delivery, and Organ Injury
Following Cardiac Surgery.
Source
Anesthesia and Analgesia. Conference: 2024 International Anesthesia
Research Society, IARS and the Society for Critical Care
Anesthesiologists, SOCCA Annual Meeting. Seattle, WA United States. 139(5
Supplement) (pp 99-100), 2024. Date of Publication: November 2024.
Author
Chellman C.; Lopez M.; Hennessy C.; Shotwell M.; Billings F.
Institution
(Chellman) A.T. Still University, School of Osteopathic Medicine, United
States
(Lopez, Hennessy, Shotwell, Billings) Vanderbilt University Medical
Center, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Up to 50% of patients receiving cardiac surgery develop
acute kidney injury (AKI), delirium, atrial fibrillation, or myocardial
injury following surgery. These organ injuries increase short-term
mortality 5-fold and lead to long-term morbidity. Prior studies indicate
that low intraoperative oxygen delivery (DO<inf>2</inf>) is associated
with postoperative organ injury.1 The impacts of inhaled oxygen treatment
on oxygen delivery and on associations between oxygen delivery and organ
injury are not known. We hypothesized that 1) intraoperative oxygen
treatment (hyperoxia vs. normoxia) affects DO<inf>2</inf>, 2)
DO<inf>2</inf> is associated with postoperative organ injuries, and 3)
oxygen treatment modifies any association between DO<inf>2</inf> and organ
injury. Method(s): The study cohort was comprised of participants
from the Risk of Oxygen during Cardiac Surgery (ROCS) trial, a 200-patient
randomized clinical trial that tested the hypothesis that intraoperative
hyperoxia (1.00 fraction of inspired oxygen [FiO<inf>2</inf>] throughout
surgery) vs. normoxia (minimum FiO<inf>2</inf> to maintain oxygen
saturation levels [SpO<inf>2</inf>] 95-97%) affects postoperative organ
injury.2 DO<inf>2</inf> was measured at induction of anesthesia
(baseline), 30 minutes after the initiation of cardiopulmonary bypass
(CPB), following separation from CPB, and at intensive care unit (ICU)
admission by calculating the product of arterial O<inf>2</inf> content
(CaO<inf>2</inf>) and cardiac index (CI), where CaO<inf>2</inf> =
SpO<inf>2</inf> x hemoglobin x 1.34 + 0.003 x PaO<inf>2</inf> and CI =
cardiac output measured with a pulmonary artery catheter body surface
area. AKI was defined using KDIGO criteria, delirium using CAM-ICU
assessments, atrial fibrillation by reviewing telemetry data and clinical
documentation, and myocardial injury by measuring plasma CK-MB on
postoperative day 1. Student T-test was used to measure the effect of
oxygen treatment on DO<inf>2</inf>, and Lasso regression was used to
measure the associations between DO<inf>2</inf> and each organ injury and
to determine if oxygen treatment modified the effect of these
associations. Model covariates included potential confounders and organ
injury risk factors. Result(s): 200 patients (median age 66 years,
30% female, 36% with congestive heart failure, 25% with history of atrial
fibrillation, and 42.5% with chronic kidney disease [eGFR< 60ml/min/1.73])
were studied. Participants randomly assigned hyperoxia (n=100) had median
FIO<inf>2</inf>=0.95, SpO<inf>2</inf>=100%, PaO<inf>2</inf>=377 mmHg, and
DO<inf>2</inf>=339 ml/min/m2 during surgery, and those assigned
normoxia (n=100) had median FIO<inf>2</inf>=0.28, SpO<inf>2</inf>=97%,
PaO<inf>2</inf>=100 mmHg, and DO<inf>2</inf>=336 ml/min/m2.
Oxygen treatment did not affect DO2 during surgery (Figure 1), except
during CPB, during which DO2 was 23 ml/min/ m2 (95% CI: 17 to
42) greater in participants assigned hyperoxia. Forty-two participants
(21.0%) developed AKI, 38 (19.0%) delirium, and 83 (41.5%) atrial
fibrillation, and the median CK-MB on postoperative day 1 was 25.9 ng/ ml.
In adjusted analyses, participants at the 75th percentile of
intraoperative DO2 (average of DO2 following induction, during CPB, and
post CPB = 392 ml/min/m2) had 51% lower odds of developing
postoperative delirium (odds ratio: 0.49 [95% CI: 0.26 to 0.91]) than
participants at the 25th percentile of intraoperative DO2 (295
ml/min/m2) (Figure 2). Increased intraoperative DO<inf>2</inf>
was not independently associated with AKI (odds ratio: 1.30 [95% CI: 0.71
to 2.40]), atrial fibrillation (odds ratio: 0.77 [95% CI: 0.53 to 1.12]),
or myocardial injury (6.1 ng/ ml CK-MB [95% CI: -4.4 to 16.6]). There was
no evidence that randomized intraoperative oxygen treatment (hyperoxia vs.
normoxia) modifies the associations between DO<inf>2</inf> and delirium
(p=0.31), AKI (p=0.80), atrial fibrillation (p=0.72), or myocardial injury
(p=0.13). Conclusion(s): Hyperoxia treatment compared to normoxia
treatment did not significantly impact DO<inf>2</inf> during cardiac
surgery. Increased intraoperative DO<inf>2</inf> was associated with
decreased postoperative delirium, but there was no evidence of association
between DO<inf>2</inf> and AKI, atrial fibrillation, or myocardial injury.
Randomized oxygen treatment did not modify the associations between
DO<inf>2</inf> and delirium or other organ injuries. Increasing
DO<inf>2</inf> during cardiac surgery may impact postoperative delirium
and should be studied. These techniques may include augmenting cardiac
output or hemoglobin concentration but not increasing inhaled oxygen.
(Figure Presented).

<57>
Accession Number
645906823
Title
Finding Strategies to Use Dynamic Changes in The Electroencephalogram to
Assess the Risk for A Postoperative Neurocognitive Disorder.
Source
Anesthesia and Analgesia. Conference: 2024 International Anesthesia
Research Society, IARS and the Society for Critical Care
Anesthesiologists, SOCCA Annual Meeting. Seattle, WA United States. 139(5
Supplement) (pp 365-366), 2024. Date of Publication: November 2024.
Author
Mehler D.; Ostertag J.; Schneider G.; Kreuzer M.; Sepulveda P.
Institution
(Mehler, Ostertag, Schneider, Kreuzer) Technical University of Munich,
Valdivia, Chile
(Sepulveda) Hospital Base San Jose, Osorno/Universidad Austral, Valdivia,
Chile
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Monitoring the electroencephalogram (EEG) during the
perioperative period is important for adjusting anesthesia levels and
preventing both insufficient and excessively deep states. Evidence
suggests that EEGguided anesthesia can mitigate instances of
intraoperative awareness and postoperative neurocognitive disorder (PND)
[1]. Concerning PND, research indicates that patients exhibiting PND
demonstrate a diminished EEG response to an intraoperative ketamine bolus
when under propofol [2]. This finding may imply that the "frail" brain
exhibits less dynamics than a healthy one. Anesthesia induction with
propofol induces a transient acceleration of the EEG called paradoxical
beta activation. This effect was demonstrated in young and healthy adults
and is considered an indicator of robust brain function during induction
[3]. This alteration in EEG dynamics may potentially serve as a future
indicator of a patient's brain frailty. Through our pilot analyses, we
aimed to investigate whether geriatric patients can manifest these beta
activation patterns and whether this response is attenuated in the
presence of a "disruptive factor," such as dexmedetomidine, in our study.
 Method(s): A total of 23 patients were included in our prospective,
randomized clinical trial with non-blinded intervention. 10 patients, with
a median age of 75 [71-83] years, underwent a slow induction with propofol
followed by a propofol Target-Controlled Infusion (TCI). 13 patients, with
a median age of 82 [70-93] years, received a dexmedetomidine infusion
followed by a propofol TCI. All patients were scheduled for
non-neurologic, non-cardiac surgeries lasting in median 176 [100-456]
minutes. Frontal EEG recordings were obtained using a SEDLine Monitor, and
the relative beta-band power (13-30 Hz) was monitored from the initiation
of drug administration until 15 minutes after loss of responsiveness
(LoR). Additionally, we examined the trend of relative beta power
throughout the specified time frame. Cognitive assessments were performed
with the Montreal Cognitive Assessment Test (MoCa) before and one hour
after RoR. At post-anesthesia care unit (PACU) a postoperative sedation
agitation scale was also carried out 10min, 30min and 60min after RoR.
 Result(s): We observed a significant activation in beta-band power
during the induction period in the propofol group. Patients receiving an
additional continuous infusion of dexmedetomidine exhibited no increase in
beta activity and generally showed lower relative beta power over the
entire observation period. Fifteen minutes post LoR, beta activity in the
propofol group appeared to decrease to a stable power level around 0.06
[dB], while the beta power in the dexmedetomidine group stabilized at a
level of 0.04 [dB]. These stable levels persisted throughout the entire
duration of anesthesia, with no instances of burst suppressions observed
in any of our patients. Cognitive evaluations post-emergence revealed no
significant decline in cognitive performance or signs of PND compared to
the preoperative status. Conclusion(s): Our findings indicate a
robust beta-band activation in geriatric patients during propofol
induction, which is not evident in the presence of dexmedetomidine. From
this observation, we conclude that a slow induction of propofol can induce
a strong beta-response in elderly with potentially frail brains thereby
aiding in mitigating the risk of PND. Additionally, our results suggest
that a disruptive factor like dexmedetomidine significantly influences the
brain's ability to generate faster rhythms during anesthesia. The absence
of these patterns also does not contribute negatively to the occurrence of
PND. Given that we can observe these effects in a high-risk population for
PND, we speculate that future studies may identify at-risk patients for
PND based on their lack of developing beta patterns during propofol
induction. This pilot study serves to raise awareness among medical
personnel administering anesthesia to elderly and frail patients,
highlighting the significant effects certain drugs have on EEG patterns.
This knowledge should be considered when interpreting perioperative EEG
rhythms and adjusting the dosage of narcotics. (Figure Presented).

<58>
Accession Number
645906816
Title
Comparison of Ultrasound-Guided Bilateral Erector Spinae Plane Block to
Intrathecal Fentanyl for Post Operative Analgesia after LSCS.
Source
Anesthesia and Analgesia. Conference: 2024 International Anesthesia
Research Society, IARS and the Society for Critical Care
Anesthesiologists, SOCCA Annual Meeting. Seattle, WA United States. 139(5
Supplement) (pp 486), 2024. Date of Publication: November 2024.
Author
Lata I.; Sahu S.; Singh A.
Institution
(Lata, Sahu, Singh) Sanjay Gandhi Postgraduate Institute of Medical
Sciences, UP, Lucknow, India
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The USG-guided erector spinae plane block (ESPB), a type of
abdominal fascial plane block was recently proven very effective for the
management of postoperative pain after various thoracic and abdominal
surgeries. [1] ESPB has been used successfully in various types of
surgeries and provides a variable duration of longer postoperative
analgesia. Recently it was also found effective for postoperative pain
management after LSCS. The possible mechanisms of analgesia of the ESPB
are multifactorial. Based on recent studies, the most probable primary
mechanism is a direct effect of local anesthetic via physical spread and
diffusion to neural structures in the fascial plane deep into the erector
spinae muscles and adjacent tissue compartments. [2,3] The primary
objective of our study was to compare the analgesic efficacy of USG-guided
Erector spinae plane block (UBESPB) to Intrathecal fentanyl after elective
LSCS under spinal anesthesia. Method(s): After approval from the
Institutional Ethical Committee and registration with the Clinical Trials
Registry- India, this prospective, randomized controlled trial was
conducted from May 2021 to September 2022. During the study written
informed consent was taken from all the patients and followed the
guidelines as per the declaration of Helsinki and good clinical practice
guidelines. Full-term primary gravida Parturients, with a singleton
pregnancy, American Society of Anaesthesiologists (ASA) status 1 and 2,
scheduled for elective LSCS with planned Pfannenstiel incision under
spinal anesthesia were included. 60 term Parturients of ASA 1-2 with
singleton pregnancy planned for elective LSCS were randomized into Group 1
(UBESPB group) (N=30) were given Spinal Anaesthesia with 1.5ml heavy
bupivacaine (0.5%), followed by bilateral UBESPB at T9 level with
Levobupivacaine (0.25%) 30ml, at the end of surgery and Group 2 (ITFG)
(N=30): were given Spinal Anaesthesia with 1.5ml heavy bupivacaine (0.5%)
added with 25 mcg Fentanyl respectively. The Static and dynamic pain by
Numerical rating scale (NRS), total Fentanyl consumption, residual motor
blockade, duration when ability to ambulate and breastfeed, patient
satisfaction rate, and opioid-related complications were evaluated for up
to 48 hours postoperatively. Result(s): In the UBESPB group mean
static and dynamic NRS pain scores were significantly lower, and the mean
total fentanyl consumption was also lower (170.73 + 37.71 mcg) as compared
to the ITF group (642.03 + 177.49 mcg). No additional increase in the
residual motor blockade was seen in both groups. Most of the patients in
the UBESPB group were highly satisfied, able to ambulate early, and able
to breastfeed early as compared to the ITF group. Conclusion(s): USG
bilateral Erector spinae plane block proved to be significantly more
efficacious in terms of quality of pain relief (static/dynamic), patients'
satisfaction, early ambulate and breastfeed with better care of new born
as compared to intrathecal fentanyl group.

<59>
Accession Number
645906742
Title
Cost-Effectiveness Analysis of a Randomized Clinical Trial Comparing
Inhaled Epoprostenol with Nitric Oxide in Adults Undergoing Major Cardiac
Surgery.
Source
Anesthesia and Analgesia. Conference: 2024 International Anesthesia
Research Society, IARS and the Society for Critical Care
Anesthesiologists, SOCCA Annual Meeting. Seattle, WA United States. 139(5
Supplement) (pp 85-87), 2024. Date of Publication: November 2024.
Author
Nowell T.; Rosser M.; Cutrone M.; DeVore A.; McCartney S.; Schroder J.;
Milano C.; Engel J.; Ghadimi K.
Institution
(Nowell, Rosser, Cutrone, DeVore, McCartney, Schroder, Milano, Ghadimi)
Duke University, School of Medicine, United States
(Engel) Duke University Health System, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Among adults undergoing major cardiac surgery, inhaled
epoprostenol (iEPO) and nitric oxide (iNO) are associated with similar
risks for the development of right ventricular failure (RVF).1 Given
variable contract pricing of iEPO and iNO across various health systems
nationwide, here we determine incremental cost-effectiveness ratios (ICER)
independent of contract pricing for our health system, to comparatively
index the effects of each treatment group on healthcare resource
utilization and outcome prevention after major cardiac surgery.
 Method(s): Leveraging the INSPIRE-FLO trial, per-patient charges for
each index hospitalization were obtained from our health system's Office
of Finance. We investigated group differences in direct variable cost by
service line, total direct variable cost, and the total direct cost (the
sum of direct variable and direct fixed costs). Direct variable costs were
charges that were incurred for hospital services, supplies, diagnostics,
and medications. Of note, iEPO and iNO treatment both incur the same
current procedural terminology (CPT) codes. Direct fixed costs were
expenses that were tied to hospital admission, building maintenance,
utilities, equipment, employee salary, and overhead. Primary outcome was
the ICER for RVF, defined as the ratio of differences in cost to the RVF
event-free rate by treatment group.2 Secondary outcome was (1) the ICER
for the composite rate of RVF or 1-year mortality event and (2) the
absolute cost minimization between groups. Result(s): Of 231 trial
participants, 139 patients (70 in iEPO group and 69 in iNO group) had
available healthcare resource cost data (Figure 1). In this subset, RVF
occurred in 22.9% of the iEPO group and 20.3% in the iNO group and the
composite rate of RVF or 1-year mortality was 30.0% in the iEPO group and
26.1% in the iNO group. No differences in ICER values were seen between
groups for primary or secondary outcomes by service line or total cost
measures (Table). No differences were seen between treatment groups for
absolute cost minimization related to total direct variable costs and
total direct costs (variable + fixed) (Figure 2). Conclusion(s):
Independent of health system-specific contract pricing, there were no
differences in the cost-to-outcome ratios between iEPO and iNO. Given
specific contract pricing in our health system, these findings support the
cost-effectiveness of using iEPO over iNO in adult patients undergoing
major cardiac surgery. Validation of our findings are encouraged within
the cost structure of each individual healthcare system that administers
both iNO or iEPO in this population. (Figure Presented).

<60>
Accession Number
645906663
Title
Endothelial Dysfunction and Postoperative Atrial Fibrillation after
Cardiac Surgery.
Source
Anesthesia and Analgesia. Conference: 2024 International Anesthesia
Research Society, IARS and the Society for Critical Care
Anesthesiologists, SOCCA Annual Meeting. Seattle, WA United States. 139(5
Supplement) (pp 209-212), 2024. Date of Publication: November 2024.
Author
Wei J.; Ao M.; Baker T.; Billings F.; Lopez M.
Institution
(Wei, Ao, Baker, Billings, Lopez) Vanderbilt University Medical Center,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Postoperative atrial fibrillation (POAF) occurs in up to
25-50% of patients after cardiac surgery and is associated with
significant morbidity and mortality, including perioperative inflammation
and oxidative damage to the endothelium (1,2). We investigated the
hypothesis that endothelial dysfunction is associated with increased
incidence of new-onset POAF after cardiac surgery. Method(s): The
study cohort was composed of participants enrolled in a randomized
clinical trial of intraoperative hyperoxia vs. normoxia during cardiac
surgery (3). Inclusion criteria were patients aged 18 years and older
undergoing surgery on the heart or aorta. Exclusion criteria included
active acute coronary syndrome, preoperative oxygen requirement,
intracardiac shunt, planned intraoperative circulatory arrest, and
pregnancy. Patients with preoperative atrial fibrillation were also
excluded. We measured endothelial function following induction of
anesthesia and immediately postoperatively in the ICU by quantifying
flow-mediated dilation (FMD) of the brachial artery with ultrasound and
reactive hyperemia index (RHI) with fingertip pulse amplitude artery
tonometry. We quantified plasma biomarkers of endothelial function
plasminogen activator inhibitor-1 (PAI-1), E-selectin, and Syndecan-1 at
induction of anesthesia, ICU admission, and 6 to 12 hours postoperatively.
The primary outcome was POAF. The associations between endothelial
function assessments (FMD, RHI, and biomarkers) and POAF were assessed
with logistic regression adjusted for potential confounders and risk
factors for POAF, specifically CHA2DS2-VASC score, valvular surgery,
cardiopulmonary bypass time, and randomized oxygen treatment. FMD models
were adjusted for shear rate. Result(s): Fifty out of 151 (33%)
participants developed POAF. Patients with POAF were older (67.5 years vs
63.0 years) and more likely to have undergone valvular surgery (66.0% vs.
42.6%). For the cohort, median (IQR) preoperative FMD was 6.6% (2.6 - 9.7)
and decreased to 5.1% (1.6 - 8.2) postoperatively. Preoperative RHI was
1.2 (1.1-2.6) and increased to 1.4 (1.0-1.8).Preoperative PAI-1 was 16.2
(11.6 - 19.1) ng/mL, increased to 32.6 (25.7 - 42.7) ng/mL at ICU
admission, and remained elevated at 25.4 (18.7 - 31.7) ng/mL
postoperatively. Preoperative E-selectin was 20.8 (13.8 - 30.9) ng/mL,
decreased to 16.4 (11.0 - 23.1) ng/mL, and remained low at 16.3 (11.5 -
22.5) ng/mL. Preoperative Syndecan-1 was 161.4 (97.8 - 347.0) ng/mL,
increased to 304.3 (182.2 - 481.7) ng/mL, and remained elevated at 262.3
(163.1 - 513.4) ng/mL. FMD was not associated with POAF (preoperative FMD:
OR 1.00, 95% CI 0.95 - 1.04; p=0.98) and (postoperative FMD: OR 1.01, 95%
CI 0.96 - 1.07; p=0.66 for postoperative FMD, respectively). RHI was also
not associated with POAF (preoperative RHI: OR 1.16, 95% CI 0.46-2.91;
p=0.75) and (postoperative RHI: OR 1.58, 95% CI 0.76-3.28; p=0.22 for
postoperative RHI, respectively). Baseline E-selectin was independently
associated with lower odds of POAF (3% lower odds per 1 ng/ml increase
[95% CI: 5% to 0%]; p=0.03), and postoperatively E-selectin was associated
with 4% lower odds of POAF (O.R. 0.96, 95% CI 0.93-1.00; p=0.03).
 Conclusion(s): Functional markers of endothelial dysfunction were not
associated with new-onset POAF following cardiac surgery. E-selectin,
however, was independently associated with decreased odds of POAF adjusted
for potential confounders and risk factors throughout the perioperative
period. As E-selectin regulates leukocyte adhesion and endothelial
activation, this suggests an immunologic role in modulation of POAF.
Furthermore, cardiopulmonary bypass may also induce increased turnover of
E-selectin in patients in an inflammatory state (4). Future studies are
needed to better understand the impact of endothelial activation and POAF.
(Table Presented).

<61>
Accession Number
645906629
Title
The REPOSE Study: Reducing Delirium by Enhancing Postoperative Sleep with
Suvorexant.
Source
Anesthesia and Analgesia. Conference: 2024 International Anesthesia
Research Society, IARS and the Society for Critical Care
Anesthesiologists, SOCCA Annual Meeting. Seattle, WA United States. 139(5
Supplement) (pp 860), 2024. Date of Publication: November 2024.
Author
Fallon J.; Hashemaghaie M.; Wu S.; Valdes J.; Zhu D.; Tran D.; Raghunathan
K.; Treggiari M.; Sasannejad C.; Devinney M.
Institution
(Fallon, Hashemaghaie, Wu, Valdes, Tran, Raghunathan, Treggiari,
Sasannejad, Devinney) Duke University, United States
(Zhu) Duke University, School of Medicine, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Up to 40% of older surgical patients experience
postoperative delirium1. Postoperative delirium is characterized by
fluctuating changes in attention and level of consciousness, and is
associated with longer hospitalizations, long-term cognitive impairment,
and increased mortality2,3. Although delirium risk may be increased by
postoperative sleep disturbances, there are few studies of pharmacologic
sleep aids to decrease postoperative delirium, in part because many
available sleep promoting drugs are also associated with increased
delirium risk4. However, the FDA-approved orexin antagonist suvorexant is
an effective outpatient insomnia therapy in older adults, which has been
associated with decreased postoperative delirium rates in retrospective
studies5. Yet, it remains unknown whether suvorexant is efficacious in
improving postoperative sleep and in preventing delirium. We designed a
double-blind, placebo-controlled, randomized trial to evaluate the
efficacy of suvorexant to increase postoperative total sleep time and
decrease delirium severity in older patients undergoing non-cardiac
surgery. Method(s): In this single-center randomized controlled trial
(NCT05733286), we will enroll 130 patients (age>=65 years) undergoing
non-cardiac surgery with planned postoperative inpatient overnight stay.
Participants will be randomized to receive oral suvorexant (20 mg) or
placebo between 8-10 pm for the first three postoperative nights (while in
hospital). Patients with history of psychotic disorders, severe sleep
apnea requiring non-invasive ventilation, liver failure, a body mass index
>40, sedating sleep aids > twice per week, and preoperative use of
moderate or strong CYP3A inhibitors or inducers will be excluded. The
primary endpoint of total sleep time will be measured with
electroencephalography (EEG) during the first three postoperative nights.
The secondary endpoint, delirium severity, will be assessed with the
3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM, if verbal)
or the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU,
if non-verbal or intubated) through postoperative day 5 or until hospital
discharge. Exploratory endpoints include sleep architecture measured with
EEG, sustained attention measured with a psychomotor vigilance test, and
postoperative changes in pupillary unrest to ambient light measured with a
pupilometer. We will also evaluate postoperative subjective sleep quality
with the Richards-Campbell sleep quality questionnaire. To assess the risk
factors for postoperative sleep insufficiency and delirium, we will
evaluate baseline characteristics, including sleep quality and excessive
daytime sleepiness using the Athens Insomnia Scale and the Epworth
Sleepiness Scale. Additionally, baseline cognitive status will be
evaluated using the Montreal Cognitive Assessment. For the main analysis,
total postoperative sleep time and peak postoperative delirium scores will
be compared between suvorexant and placebo groups using two-sample
Student's t-tests. Result(s): As of 12/1/2023, 14 participants have
been enrolled in the REPOSE trial and received the study drug (placebo or
suvorexant) with no serious adverse events related to study drug
administration. Of 37 postoperative EEG recordings, 36 EEG measurements
were of sufficient quality for sleep scoring. Of 37 planned study drug
doses, 4 doses were not given, with 3 missed doses due to restrictions on
enteral intake and 1 from surgery extending beyond the study drug
administration time. Conclusion(s): Overall, the REPOSE study is
likely to shed insights on the role of orexin antagonists in postoperative
sleep promotion and delirium prevention. If we find that suvorexant
administration improves total sleep time or other EEG sleep
characteristics, our data would suggest that suvorexant is an effective
pharmacologic sleep promoting therapy for older surgical patients. If we
find that suvorexant decreases postoperative delirium severity,
postoperative suvorexant administration may also have a role in delirium
prevention strategies.

<62>
Accession Number
645906489
Title
Preoperative Management of Renin- Angiotensin System Inhibitors in Major
Noncardiac Surgery: Pooled Observational Analysis of The Two Large
Prospective Studies.
Source
Anesthesia and Analgesia. Conference: 2024 International Anesthesia
Research Society, IARS and the Society for Critical Care
Anesthesiologists, SOCCA Annual Meeting. Seattle, WA United States. 139(5
Supplement) (pp 840-841), 2024. Date of Publication: November 2024.
Author
Roshanov P.; Cuerden M.; Devereaux P.J.
Institution
(Roshanov) Western University, Canada
(Cuerden) London Health Science Centre, Canada
(Devereaux) McMaster University, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The effects of withholding renin-angiotensin system
inhibitor (RASi) medications before major noncardiac surgery are
uncertain. The primary objective of this study was to evaluate the effects
of withholding versus continuing RASi medications in the 24 hours before
major noncardiac surgery. Method(s): We performed a two-step
individual participant meta-analysis of two prospective cohorts: the
Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION)
and the Perioperative Ischemic Evaluation 2 (POISE-2). Participants were
12,906 patients from 28 centers in 14 countries (VISION) and 5,733
patients from 135 centers in 23 countries (POISE-2) who were 45 years or
older preoperative users of a RASi medication who underwent inpatient
noncardiac surgery. The exposure of interest was the practice of
withholding RASi medications at least 24 hours before surgery versus
continuing these medications in the 24 hours before surgery. In each study
we estimated adjusted relative risks of vascular events (the primary
vascular outcome was a composite of myocardial injury after noncardiac
surgery, non-fatal cardiac arrest, stroke, or death from any cause with 30
days after surgery), acute kidney injury, and all-cause mortality up to 30
days after surgery, and intraoperative and postoperative hypotension. We
then pooled the results across the two studies by random-effects
meta-analysis. Result(s): In the VISION and POISE-2 studies,
respectively: RASi medications were withheld among 3,314/12,906 (25.7%)
and 2,227/5,733 (38.8%) patients, and the primary vascular composite
occurred in 665/3,314 (20.1%) and 414/2,227 (18.6%) patients; acute kidney
injury, 139/1,314 (10.6%) and 187/1,594 (11.7%); and all-cause death,
58/3,314 (1.7%) and 30/2,227 (1.3%). The pooled associations were not
statistically significant between preoperative withholding of RASi and the
primary vascular composite outcome (adjusted relative risk, 0.97; 95% CI,
0.84 to 1.12), acute kidney injury (0.92; 0.75 to 1.12), and all-cause
mortality (1.06; 0.64 to 1.76) - Figure 1. There was also no significant
association with intraoperative and postoperative hypotension. Results
were consistent across several subgroup analyses and extensive sensitivity
analyses. Conclusion(s): Pooled analysis of two large prospective
studies did not suggest that withholding RASi medications within 24 hours
before major noncardiac surgery associates with perioperative vascular,
kidney, mortality, or hemodynamic outcomes. (Table Presented).

<63>
Accession Number
645906418
Title
The Effect of Benzodiazepine-free Cardiac Anesthesia on the Frequency of
Positive Delirium Assessments after Cardiac Surgery: A Secondary Analysis
of the B-Free Pragmatic Cluster Randomized Crossover Trial.
Source
Anesthesia and Analgesia. Conference: 2024 International Anesthesia
Research Society, IARS and the Society for Critical Care
Anesthesiologists, SOCCA Annual Meeting. Seattle, WA United States. 139(5
Supplement) (pp 432-433), 2024. Date of Publication: November 2024.
Author
Spence J.; Belley-Cote E.; Fu Lee S.; Whitlock R.; Connolly S.
Institution
(Spence) McMaster University, Canada
(Belley-Cote, Fu Lee, Whitlock, Connolly) Population Health Research
Institute, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Delirium is common after cardiac surgery and associated with
adverse outcomes. Intraoperative benzodiazepines may increase
postoperative delirium. In the B-Free trial, we sought to determine
whether an institutional policy of restricted intraoperative
benzodiazepine administration reduced the incidence of postoperative
delirium after cardiac surgery. In this secondary analysis, we evaluated
whether an institutional policy of restricted intraoperative
benzodiazepine administration reduced the frequency of positive delirium
assessments during ICU admission. Method(s): We undertook a
pragmatic, multi-period, patient and assessor blinded, cluster randomized,
crossover trial in 20 North American cardiac surgical centers. All adults
undergoing open cardiac surgery at participating centers during the trial
period (November 2019 to December 2023) were included. We compared
institutional policies of restricted versus liberal intraoperative
benzodiazepine administration during 12 to 18 four-week crossover periods.
Hospitals were randomized to use one of the two policies in all patients,
with crossover to the other policy at random. The primary outcome was the
number of positive delirium assessments within 72 hours of surgery as
detected in routine clinical care, using either the Confusion Assessment
Method-ICU or the Intensive Care Delirium Screening Checklist. We assessed
intraoperative awareness by patient report as an adverse event.
 Result(s): During the trial, 19,768 patients underwent cardiac
surgery: 9,827 during restricted benzodiazepine periods and 9,941 during
liberal benzodiazepine periods. During restricted periods, clinicians
adhered to assigned policy in 90.9% of patients, compared to 93.2% of
patients during liberal periods. Patients who had surgery during
restricted policy periods had fewer assessments positive for delirium
during the 72 hours after surgery compared to patients who had surgery
during liberal policy periods (adjusted risk ratio [aRR], 0.88; 95% CI,
0.79 to 0.97; P = 0.02). When considering only patients managed according
to the intraoperative benzodiazepine policy in place at the time of
surgery (i.e., patients in the restrictive arm who did not receive
benzodiazepines and patients in the liberal arm who received >=2 mg
Midazolam equivalent), the effect of benzodiazepines on delirium frequency
became more pronounced (aRR, 0.87; 95% CI, 0.78 to 0.97; P = 0.01). No
patients reported intraoperative awareness in either arm.
 Conclusion(s): Restriction of benzodiazepines during cardiac surgery
reduced the number of positive delirium assessments with no demonstration
of an increase in adverse events such as intraoperative awareness.
Restriction of intraoperative benzodiazepines should be considered.
(Figure Presented).

<64>
Accession Number
645906145
Title
The Effects of Volatile and Intravenous Sedative Agents on Pulmonary and
Systemic Inflammation: A Systematic Review And Meta- Analysis.
Source
Anesthesia and Analgesia. Conference: 2024 International Anesthesia
Research Society, IARS and the Society for Critical Care
Anesthesiologists, SOCCA Annual Meeting. Seattle, WA United States. 139(5
Supplement) (pp 273-275), 2024. Date of Publication: November 2024.
Author
Rouhani S.; Gupta S.; Hanley C.; Raheel H.; Gao A.; Iansavitchene A.; Cao
X.; Slessarev M.; Jerath A.; Heybati K.
Institution
(Rouhani) University of Ottawa, Canada
(Gupta, Jerath) University of Toronto, Canada
(Hanley) University of Galway, Ireland
(Raheel, Gao, Slessarev) Western University, Canada
(Iansavitchene) London Health Sciences Centre, Canada
(Cao) Sunnybrook Hospital, Canada
(Heybati) Mayo Clinic, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Inhaled volatile anesthetics are capable of providing both
surgical levels of anesthesia and sedation for critically ill patients
1,2. Early evidence suggests that inhalational agents can attenuate the
inflammatory response to surgery and lung injury via their widespread
immune effects particularly via lowering the pro-inflammatory cytokine
[i.e., interleukin (IL) 6, IL8 and tumor necrosis factor-alpha (TNFa)]
response3,4,8. In patients with lung injury from surgical lung resection
or hypoxic respiratory failure, inhaled anesthetics may offer clinical
benefits such as improved oxygenation, lower mortality, and shorter
duration of ventilation, hospitalization and ICU stay 3, 5-7. Several
studies have examined the effect of inhalational versus intravenous
anesthesia on inflammatory cytokines but these data have not been
systematically summarized. In this systematic review and meta-analysis, we
aim to summarize the effect of inhaled versus intravenous anesthetics on
pro-inflammatory cytokines in adult patients undergoing surgical lung
resection or receiving mechanical ventilation for hypoxic respiratory
failure. Method(s): Following PRISMA guidelines, we performed a
systematic literature search in Medline, EMBASE, and Cochrane Central
Register of Controlled Trials (CENTRAL) of English studies from 2000 to
2021. Inclusion criteria were 1) studies in ventilated adult patients in
critical care with acute respiratory distress and perioperative lung
resections settings, 2) randomized control trials, prospective and
retrospective observational studies, 3) comparing inhaled volatile and
intravenous sedative agents, and 4) published in English. Quasi-randomized
studies, crossover studies, case reports/ series, preclinical studies and
animal studies were excluded. The primary outcome was inflammatory
cytokine levels at specific time points (before anesthesia, 1-2 hours, 3-4
hours, and 24 hours post anesthesia) in thoracic surgical and critical
care patients receiving either inhaled or intravenous anesthesia. Specific
cytokines studied were TNFa, IL6, IL8 and IL10 in bronchoalveolar lavage
(BAL) fluid and serum. Secondary outcomes included patient mortality,
post-operative pulmonary complications, and duration of anesthesia,
hospitalization and ICU stay. Cytokine data was meta-analyzed using a
random effects model with heterogeneity assessed using I2. Risk
of bias was assessed using standardized tools. The study protocol was
registered on PROSPERO (CRD42023444105). Result(s): From 2,522
screened studies a total of 28 studies (27 lung resection and 1 critical
care) with 4,175 patients were included. The quality of evidence was mixed
with 11 studies deemed low risk and 7 with uncertain risk of bias.
Meta-analysis of lung resection studies showed no baseline difference in
BAL or serum, but significantly lower levels of alveolar TNFa (standard
mean difference 1.04, 95% CI 0.32 - 1.77; p<.01, I2 82%) and
IL6 levels (standard mean difference 0.64, 95% CI 0.52 - 0.75;
I2 0%, p<.01) at 1-2 hours in the inhaled anesthesia group
compared to the IV group. No significant difference was observed in BAL
IL8 and IL10, and there were no cytokine differences observed in serum
samples across time points. The single critical care study demonstrated
significantly lower serum levels of IL6 and TNFa, and lower alveolar
levels of IL6, IL8 and TNFa in the sevoflurane group compared to the
midazolam group at 48h. Clinical and health system data were infrequently
reported in lung resection studies and not meta-analyzed.
 Conclusion(s): Evidence examining biological markers in lung
resection and acute respiratory distress is limited and showed high
heterogeneity. Ealy evidence shows lower levels of proinflammatory
cytokines IL6 and TNFa during lung resection in patients receiving
inhalational anesthesia compared to intravenous agents. Further powered
studies are needed to study the effect of inhalational agents on
biological markers and important patient-centred clinical and health
system outcomes. (Figure Presented).

<65>
Accession Number
645906130
Title
Analgesic Efficacy of Bilateral Ultrasound Guided Erector Spinae Plane
Block in A Patient Undergoing Cardiac Surgery with Midline Sternotomy: A
Prospective, Randomised, Study.
Source
Anesthesia and Analgesia. Conference: 2024 International Anesthesia
Research Society, IARS and the Society for Critical Care
Anesthesiologists, SOCCA Annual Meeting. Seattle, WA United States. 139(5
Supplement) (pp 529), 2024. Date of Publication: November 2024.
Author
Kamal M.; Mohan M.; Bhatia P.
Institution
(Kamal, Mohan, Bhatia) AIIMS Jodhpur, India
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The effective analgesia following cardiac surgery with
minimum opioid usage prevent post-operative pulmonary complications. The
study aimed to assess the analgesic efficacy and safety of Ultrasound
guided single shotbilateral Erector spinae plane (ESP) block compared to
conventional intravenous patient controlled opioid analgesia in patients
undergoing cardiac surgeries with midline sternotomy. Method(s):
Total 102 patients belonging to ASA status II and III, aged between 18 to
70 years, scheduled for elective cardiac surgerywere enrolled and randomly
allocated into two groups. The patient in group 1 received ESP block with
0.3 ml/kg of 0.5% ropivacaine under ultrasound guidance before anaesthesia
induction at T5 spinous level, while patients in group 2 did not receive
any block. After surgical procedures, patients were sent to the intensive
care unit and extubated in accordance with protocol. The primary objective
was on comparing post-operative fentanyl consumption within the first 24
hours of ICU stay after extubation. Data collected were analysed using the
Chi-square test or Students' t-test with the help of SPSS 22.0.
 Result(s): The median fentanyl (IQR)(range) consumed (in mug) in
first 24 h of ICU stay was significantly lower in ESP block group [160
(71.50). (10-420)] compared to IV PCA fentanyl group [380 (132.50)
(130-600)](P value <0.001). Conclusion(s): Use of bilateral ESP block
provides effective analgesia promoting early extubation of patients, and
also reduces post-operative opioid consumption and its associated side
effect with better patient's satisfaction in relieving acute postoperative
pain after cardiac surgery.

<66>
Accession Number
2036071884
Title
FATAL COMPLICATION AFTER OVARIAN PRP TREATMENT.
Source
Reproductive BioMedicine Online. Conference: 12th Scientific Meeting of
The Turkish Society of Reproductive Medicine. Kaya Palazzo Otel & Congress
Center, Antalya Turkey. 49(Supplement) (no pagination), 2024. Article
Number: 104531. Date of Publication: November 2024.
Author
BARUT M.U.; SAK S.; DEMIR M.
Institution
(BARUT, SAK) Harran University Faculty of Medicine, Department of
Obstetrics and Gynecology, Sanliurfa, Turkey
(DEMIR) Harran University Faculty of Medicine, Department of Radiology,
Sanliurfa, Turkey
Publisher
Elsevier Ltd
Abstract
Objective: Management of a fatal complication after PRP therapy in an
infertile patient. Case report: 39 years old, G0P0A0L0 patient who had had
ovarian platelet-rich plasma (PRP) procedure 2 days earlier at an external
center was referred to the emergency department with acute abdomen. She
had a history of heart valve prosthesis in 2009 and cerebrovascular event
in 2017. She was on low molecular weight and warfarin. She had a blood
pressure of 100/60 mmHg, Pulse 116 bpm, Respiration Rate: 28/minute and
oxygen saturation of 89%. The abdomen was distended and there were
ecchymosis on the abdomen. Pelvic ultrasound showed a normal uterus, and
diffuse free fluid in the pouch of Douglas, pouch of Morrison and
perisplenic area. Ovaries were not visible. Laboratory values were as
follows: Hemoglobin 7.8 g/dL, Hematocrit 23%, Platelet 24
000/mm3, INR: 2.36,; FSH: 75.87 IU/L, LH: 55.77 IU/L, E2:
<11.80 pg/mL, AMH: <0.01 ng/mL. Contrast-enhanced abdominal CT showed
effusions in the perihepatic and perisplenic areas, between the intestines
and in the pelvic region, reaching a depth of approximately 11 cm in the
deepest part. Multiple high density appearances were observed in the
epigastric region and in the skin-subcutaneous tissue in the lower abdomen
consistnet with hemorrhage. Ovaries were not visible. Hyperdense
appearance was observed in the right ovarian lobe suggesting contrast
agent extravasation. Defective skin appearance and air images were
observed in the left lower quadrant of the abdomen. A 5.5 cm diameter
hypodense lesion was observed in the anterior part of the uterine fundus
(Figures 1 and 2). Warfarin was stopped. She was transfused with 2 units
of fresh frozen plasma (TDP) and 3 units of erythrocyte suspension. And an
ampoule of K vit was administered. Upon normalization of INR she underwent
a laparotomy through a median incision below the umbilicus. Approximately4
lt of hemorrhagic fluid and hematoma were drained. On exploration, a
bleeding focus due to PRP procedure was observed on the right ovary. The
bleeding area was cauterized. Discussion(s): PRP treatment is
popularized as a form of ovarian 'rejuvenation' (1). It is clear from
previously published case series and randomized controlled trial that PRP,
at least as currently practiced, is not a 'fountain of youth'. Even
previous studies have not shown a long-lasting effect that could be called
'rejuvenation'(2). Among patients with decreased ovarian
reservIntraovarian injection of autologous PRP did not result in a
significant difference in the number of oocytes retrieved, the number of
blastocysts produced or the rate of sustained implantation in the IVF
cycle following PRP administration compared to no injection. These
findings do not support the use of PRP in the treatment of POR(3) It
should be kept in mind that PRP is an invasive intervention and
catastrophic complications may develop after intra-ovarian injection of
platelet-rich plasma. Performance of the procedure while the patient was
on anticoagulants was a grave error in this case. Copyright ©
2024

<67>
Accession Number
2013171669
Title
Impact of Four-Factor Prothrombin Complex Concentrate on Urgent
Warfarin-Reversal in Patients with Ventricular Assist Devices Going for
Heart Transplants.
Source
Blood. Conference: 66th ASH Annual Meeting. San Diego United States.
126(23) (pp 3568), 2015. Date of Publication: 03 Dec 2015.
Author
Wu D.W.; Joan U.; James S.; Kala M.; Walsh R.; Karim S.; Himchak E.; Gupta
R.; Goldstein D.
Institution
(Wu, Joan, James, Kala, Walsh, Karim, Himchak, Gupta, Goldstein)
Montefiore medical center, Bronx, NY, United States
Publisher
Elsevier B.V.
Abstract
BACKGROUND The four-factor Prothrombin Complex Concentrate (4f PCC) is FDA
approved for urgent reversal of vitamin K antagonist (VKA)
anticoagulation. It offers an alternative to plasma with immediate, low
volume reversal. However, there is a risk of thromboembolic events
associated with the use of 4f PCC. Patients with ventricular assist
devices (VAD) while awaiting heart transplantation are routinely
anticoagulated with warfarin and aspirin. At the time of transplant, these
must be reversed. We believed that warfarin reversal with 4f PCC could
offer advantages over plasma to these patients, but could also increase
the risk of thromboembolic events. PATIENTS AND METHODS We retrospectively
investigated the effects of 4f PCC on bleeding and thromboembolism in VAD
patients who underwent orthotopic heart transplantation (VAD-OHT) at our
institution. One arm included VAD-OHT patients receiving 4f PCC for urgent
warfarin reversal prior to OHT. The other non-4f PCC (control) arm is
consecutive VAD-OHT patients receiving plasma for VKA reversal before 4f
PCC availability. Endpoints included intra-operative and 24 hour
post-operative blood component use; cardiopulmonary bypass (CPB) time, OR
time; chest tube output within 24 hour postoperative period; incidence of
reoperation for bleeding; time to extubation; 30-day in-house incidence of
thrombosis/embolism and 30-day in-house mortality. 4f PCC's impact on the
cost of blood components for VAD-OHT patients was investigated by
comparing the combined costs of blood products and 4f PCC. Unpaired T-test
and chi-square test were used for the statistical analysis. RESULTS There
were 17 patients in the 4f PCC arm, and 20 patients in non-4f PCC arm. 4f
PCC significantly reduced the number of units of transfused red blood
cells, single donor platelets, and cryoprecipitate during OHT. The average
cost saving from reduced blood product use per patient in the 4f PCC arm
was $2388. The average cost of 4f PCC over plasma for warfarin reversal
was $2569 per patient, resulting in a net overall additional cost of 4f
PCC use per patient of $181. 4f PCC was also associated with a reduced CPB
time during the operation. 4f PCC did not significantly affect the other
endpoints, suggesting it may have a similar safety profile to plasma for
warfarin reversal in VAD-OHT patients. DISCUSSION This study shows that 4f
PCC, similar to plasma, can be safely used for urgent warfarin reversal in
VAD-OHT patients. 4f PCC may be superior to plasma for intraoperative
hemostasis in VAD-OHT patients, resulting in a significant reduction in
blood component use. The cost saving of intra-and post-operative blood
product use mitigated the expense of 4f PCC. To our knowledge, this is the
first report on the impact of 4f PCC on VAD-OHT patients. A prospective
randomized trial with a larger number of VAD-OHT patients with adequate
statistical power is warranted to provide more insight. [Formula
presented] Disclosures: No relevant conflicts of interest to
declare. Copyright © 2015 American Society of Hematology

<68>
Accession Number
644535388
Title
Empagliflozin limits AKI incidence and severity following cardiac surgery:
an open-label phase IV randomized pilot study.
Source
Nephrology Dialysis Transplantation. Conference: 61st ERA Congress.
Stockholm Sweden. 39(Supplement 1) (pp i207-i208), 2024. Date of
Publication: May 2024.
Author
Snel L.; Oosterom-Eijmael M.; Rampanelli E.; Lankadeva Y.; Plummer M.;
Preckel B.; Hermanides J.; Van Raalte D.; Hulst B.
Institution
(Snel, Oosterom-Eijmael, Preckel, Hermanides, Hulst) Department of
Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam,
Netherlands
(Rampanelli) Experimental Vascular Medicine, Amsterdam UMC, University of
Amsterdam, Amsterdam, Netherlands
(Lankadeva, Plummer) University of Melbourne, Department of Critical Care,
Melbourne Medical School, Melbourne, Australia
(Plummer) Royal Adelaide Hospital, Adelaide, Australia
(Van Raalte) Department of Endocrinology, Amsterdam UMC, University of
Amsterdam, Amsterdam, Netherlands
Publisher
Oxford University Press
Abstract
Background and Aims: Cardiac surgery-associated acute kidney injury
(CSA-AKI) is a frequent complication of cardiac surgery assisted by
cardiopulmonary bypass (CPB). Currently, no effective preventative
strategies exist to reduce the incidence of acute kidney injury (AKI).
Sodium-glucose transport protein 2 (SGLT2) inhibitors are effective in
reducing the incidence of AKI in studies conducted in patients with
chronic kidney disease. Therefore, we hypothesized that perioperative
SGLT2 inhibition could reduce the incidence of CSA-AKI. Method(s): In
this open-label phase IV, randomized, parallel-group, balanced (1:1),
pilot study, adult patients undergoing elective cardiac surgery with CPB
were randomized to receive 10 mg empagliflozin per os once daily three
days before surgery until two days after surgery, or standard care. The
primary outcome was AKI incidence according to the Kidney Disease:
Improving Global Outcomes (KDIGO) criteria. Other outcomes included
hypoxia-inducible factor 1 alpha (HIF1A) and urinary Kidney Injury
Molecule (KIM-1), urinary neutrophil gelatinase associated lipocalin
(NGAL) and metabolic parameters such as plasma ketone and glucose
concentrations. Result(s): Between March 2022 and April 2023, 60
patients were randomized to empagliflozin (n = 29) or control (n = 31).
All patients who underwent cardiac surgery with CPB were included in the
intention-to-treat analysis (n = 25; empagliflozin group, n = 30; control
group). SGLT2 inhibition significantly reduced the incidence of all stages
of AKI (20% vs 66.7%; absolute difference 46%, 95% CI .13 to .63, P <
.001). This decline in AKI incidence was reflected in the kidney
biomarkers. SGLT2 inhibition also significantly reduced the number of
patients with postoperative hyperglycemia (28% vs 60%; absolute difference
32%, 95% CI -56.8 to -7.2, P = .029). We observed no differences in the
incidence of neither ketoacidosis nor hypoglycemic events.
 Conclusion(s): Perioperative SGLT2 inhibition, compared with standard
of care, demonstrated a significant reduction in AKI incidence rates.
These findings merit validation in a larger placebo-controlled trial which
is currently ongoing. (Figure Presented).

<69>
[Use Link to view the full text]
Accession Number
644293038
Title
SEEING VASECTOMY THROUGH A DIFFERENT LENS: UTILIZING VIRTUAL REALITY TO
ENHANCE VASECTOMY COMFORT AND REDUCE ANXIETY IN SINGLE-CENTER, RANDOMIZED,
OPEN-LABEL CLINICAL TRIAL.
Source
Journal of Urology. Conference: American Urological Association's Annual
Meeting, AUA 2024. San Antonio, TX United States. 211(5 Supplement) (pp
e766), 2024. Date of Publication: May 2024.
Author
Codrington J.; Qureshi F.; Evans A.; Rahman F.; Sandler M.; Ramasamy R.;
Deebel N.A.
Institution
(Codrington, Qureshi, Evans, Rahman, Sandler, Ramasamy) MiamiFLUnited
States
(Deebel) Winston-SalemNCUnited States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION AND OBJECTIVE: Vasectomy is a widely practiced method for
male sterilization, performed around 33 million times globally each year.
While generally safe, concerns about pain and anxiety can deter potential
patients from an in-office procedure. Research on VR headsets during
vasectomy is limited. In an ongoing single-center, randomized clinical
trial, we present interim data on the SmileyScope VR device's
effectiveness in reducing anxiety and pain during in-office vasectomy
under local anesthesia. The main objective of this study is to assess how
virtual reality (VR) devices can reduce anxiety and pain during in-office
vasectomy under local anesthesia. Additionally, we aim to compare the
effectiveness of interactive VR, where patients can control the
experience, with static VR, which lacks patient control. METHOD(S):
Patients scheduled for in-office vasectomy with a single urologist at the
University of Miami were enrolled. Patients were randomly assigned to one
of three groups: the control group receiving standard in-office vasectomy
without a VR headset, the static VR intervention group, or the interactive
VR intervention group. The primary outcome measures included
patient-reported pain and anxiety levels before and after the procedure,
along with heart rate measurements recorded utilizing a FitBit Versa 3
wearable device. RESULT(S): Interim analysis of this ongoing study
includes data from a total of 107 men. 37 men were in the control group,
34 in the static VR arm, and 36 in the interactive VR arm. There was no
observed difference in subjective pain scores (p=0.2354), pre-procedure
anxiety (p=0.2105), or heart rate variability during the procedure
(p=0.0663). CONCLUSION(S): Initial results from our ongoing
randomized clinical trial indicate that although the use of VR headsets
during inoffice vasectomy is safe and feasible, there is no statistically
significant difference in pre-procedure anxiety, heart rate variability or
subjective pain. (Figure Presented).

<70>
Accession Number
643566381
Title
LISTERIA MONOCYTOGENES AORTIC ABSCESS: A RARE FORM OF INVASIVE
LISTERIOSIS.
Source
European Journal of Case Reports in Internal Medicine. Conference: 18th
Conference in Internal Medicine. Lisbon Portugal. 6(Supplement 1) (pp
544), 2019. Date of Publication: 2019.
Author
Garcia O.A.; Lacalzada M.M.; Fernandez J.A.; Alarcon L.G.; Sanz P.B.; Vaca
L.F.A.; Rodriguez-Navarro C.Q.
Institution
(Garcia, Lacalzada, Sanz, Vaca, Rodriguez-Navarro) Hospital Universitario
Ramon y Cajal, Madrid, Spain
(Fernandez) Clinica Universidad de Navarra, Pamplona, Spain
(Alarcon) Hospital Universitario Infanta Elena, Valdemoro, Spain
Publisher
SMC Media Srl
Abstract
Introduction Listeria monocytogenes is a facultative anaerobic,
non-sporeforming gram-positive, motile rod-shaped bacterium that causes
listeriosis. It can be found in soil, water, the gastrointestinal tract of
different mammals and is the food-borne pathogen associated with the
highest case-fatality rate in the western hemisphere. The spectrum of
infection may range from mildly symptomatic gastroenteritis to invasive
infection, i.e. chorioamnionitis, bacteremia or CNS involvement
(neurolisteriosis). Localized forms such as osteomyelitis or endocarditis
are rare. Case description An immunocompetent 76-years-old male with a
history of an aortic valve replacement and a Bentall procedure in 2012,
presented to the Emergency Department with a 5 day history of pleuritic
chest pain, dyspnea, malaise and fever (38oC). Physical examination
revealed was unremarkable and a rise in CRP levels and leukocyte count was
observed on laboratory tests. Chest X ray revealed mild right pleural
effusion and a probable infiltrate of the right inferior lobe. Blood
cultures were obtained and the patient was discharged with a diagnosis of
lower respiratory tract infection and was prescribed Levofloxacin. 48
hours later Listeria monocytogenes grow on 1/2 blood cultures. The patient
was admitted and antibiotic treatment switched to ampicillin plus
cotrimoxazole iv. An echocardiogram and thoracic CT-scan were performed,
which revealed an aortic abscess surrounding the prosthetic tube.
Emergency surgery (prosthetic valve and tube replacement) was performed.
The patient gradually improved and was discharged after 6 weeks of
antibiotic treatment. Discussion Localized forms of invasive listeriosis
are rare and associated with different comorbidities (malignancy, alcohol
abuse, immunosuppression; etc.). Listeria monocytogenes endovascular
infections are mainly described in patients with heart conditions or
prosthetic devices. Only a hundred cases have been reported worldwide with
a mortality of 12-16%. While ampicillin, alone or combined with
aminoglycosides has been the most commonly used treatment, the optimal
treatment has not been stablished. The management of localized forms of
invasive listeriosis is complex and requires high level of expertise.
There is a lack of randomized clinical trials to identify the optimal
treatment choices. Here we report a case with favorable outcome with
combined (surgical and medical treatment). Further research is needed.

<71>
Accession Number
643579618
Title
Delayed rewarming for neuroprotection in infants following congenital
heart surgery: A safety study.
Source
Journal of Clinical and Translational Science. Conference: Association for
Clinical and Translational Science, ACTS 2017. Washington, DC United
States. 1(Supplement 1) (pp 35-36), 2017. Date of Publication: September
2017.
Author
Craig A.K.
Publisher
Cambridge University Press
Abstract
OBJECTIVES/SPECIFIC AIMS: Congenital heart disease (CHD) is the most
frequently occurring birth defect in the United States affecting about
40,000 infants born every year. Despite significant advances in
postsurgical survival, developmental outcomes remain disproportionately
poor. Therapeutic hypothermia has been used for neuroprotection during
cardiac surgery since the 1950s. Infants undergoing cardiac surgery are
typically cooled to 28-33degreeC during the operation and then rapidly
rewarmed to normothermia following surgery at a rate of 1degreeC every 3-5
minutes to minimize concerns surrounding the risks associated with
prolonged bypass exposure. However, emerging evidence from animal models
has shown rapid temperature changes following surgery may diminish or even
negate the neuroprotective effect of intraoperative hypothermia. No
prospective studies have assessed the safety or impact of alternative
approaches to postoperative temperature management on the outcome of
infants with CHD undergoing cardiac surgery. Therefore, we conducted a
pilot study to examine the safety of a novel application of a
temperature-regulating device to slowly rewarm infants with congenital
heart disease over the 12 hours following cardiac surgery. METHODS/STUDY
POPULATION: From November 2014 to July 2016, infants with CHD requiring
surgery with cardiopulmonary bypass before the age of 12 months were
prospectively recruited. Infants were randomized in blocks of 3 with 1
allocated to standard of care and 2 to the experimental protocol. Infants
assigned to the standard of care were rewarmed in the operating room while
on bypass at a rate of 1degreeC every 3-5 minutes back to a temperature of
37degreeC. Infants assigned to the experimental intervention, were
rewarmed on bypass to 35degreeC and then over the subsequent 12 hours
following surgery, gradually rewarmed using an FDA approved cooling
blanket to increase temperature by 0.3degreeC every 2 hours for 6 hours
and then by 0.2degreeC every 2 hours for 6 hours until the goal
temperature of 36.5degreeC was achieved. Frequency of serious, moderate
and other adverse events were tracked. Detailed vital sign data was
collected hourly for the first 12 hours after surgery and then every 6
hours for the next 36 hours and included temperature, highest and lowest
heart rate, highest and lowest systolic blood pressure, and highest and
lowest diastolic blood pressure. Presence or absence of abnormal cardiac
rhythms was recorded per 24-hour interval. Chest tube output was recorded
in cc/kg/ 8 hours for as long as the chest tube was in place. Laboratory
data points included serum creatinine level, serum glucose level, liver
function tests (AST and ALT), platelet count, hematocrit level, PTT, INR,
fibrinogen, white blood cell count and lactate. Blood samples for
biomarkers of brain injury (s100b and NSE) were obtained on all infants at
the following 4 intervals; the preoperative setting for baseline,
postoperatively after bypass, on postoperative day 1, and on postoperative
day 2. For this safety study, the primary outcome measure was a composite
outcome of the frequency of serious adverse events as well as the
frequency of any adverse events and was compared among treatment groups.
Data were analyzed using an intent to treat analysis. The study was
approved by the Maine Medical Center Institutional Review Board.
RESULTS/ANTICIPATED RESULTS: Seven infants were randomized to the standard
of care group and 9 were randomized to the experimental group. There were
2 exclusions after randomization in the standard of care group with 1
death in the operating room and 1 unsuccessful attempt to wean from
bypass. The mean temperature upon arrival to the PICU for the experimental
infants was 35.2degreeC (range 34-36degree C) and for the standard of care
infants was 37.5degreeC (range 36.9-38.9degreeC). For the first 8 hours
after surgery, infants in the standard of care group had mean temperatures
over 37.0degreeC. There were no significant differences in the frequency
of serious, moderate, or other adverse events between the standard of care
group and experimental group. No infant in either group had need for
cardiopulmonary resuscitation or exploratory surgery within 48 hours
following surgery nor did any infant experience any clinically appreciated
adverse neurological events such as stroke or seizure. No infant in either
group experienced clinically significant bradycardia of less than 100
beats per minute or sustained tachycardia of greater than 160 beats per
minute. There was a trend toward lower heart rates in the experimental
group. Junctional Ectopic tachycardia (JET) occurred in 2 patients in the
experimental group and 1 in the standard of care group. The mean highest
INR in both groups was 1.4 (range 1.2-1.6). The mean lowest recorded
platelet level in the first 48 hours was 128.8 (range 87-160) in the
standard of care group and 123.8 (range 49-229) in the experimental group.
Infants in the experimental group had lower chest tube output overall than
the standard of care infants. The mean days of intubation for standard of
care infants was 5 days (range 1-15 days) and for experimental infants the
mean was 3.7 days (range 0-16 d). The PICU length of stay was shorter for
the experimental infants (6.9 vs. 12 d for standard of care). The total
length of stay was also shorter for experimental infants (12.4 vs. 16.4 d
for standard of care). Serum biomarkers of brain injury (s100b and Neuron
specific enolase) were elevated in the immediate postoperative period for
infants in the standard of care group compared with the experimental group
but normalized more quickly for standard of care. DISCUSSION/SIGNIFICANCE
OF IMPACT: This small pilot study suggests that mild hypothermia following
congenital heart surgery in infants under the age of 12 months is safe as
there was no increase in the rate of severe, moderate, or other adverse
outcomes in infants who received the experimental treatment of delayed
rewarming. This study provides evidence for the efficacy of the cooling
blanket in regulating the temperature of infants after surgery. Trends
toward lower chest tube output, shorter intubation and decreased length of
stay are possibly the result of improved hemodynamic stability in the
absence of postoperative fever. Future studies will need to assess the
effect of mild hypothermia compared with a normothemic control group.

<72>
Accession Number
2032185990
Title
The Efficacy of Liposomal Bupivacaine in Thoracic Surgery: A Systematic
Review and Meta-Analysis.
Source
Journal of Pain Research. 17 (pp 4039-4051), 2024. Date of Publication:
2024.
Author
Gong R.; Tan G.; Huang Y.
Institution
(Gong, Tan, Huang) Department of Anesthesiology, Peking Union Medical
College Hospital, Beijing 100730, China
Publisher
Dove Medical Press Ltd
Abstract
Purpose: Patients undergoing thoracic surgery suffer from severe
postoperative pain, and a series of complications will occur if there is
no effective analgesic treatment. Liposomal bupivacaine (LB) is a novel
multivesicular formulation with up to 72 hours of analgesia, which can be
used in thoracic surgery. This meta-analysis aimed to evaluate the
efficacy of LB in improving recovery in patients undergoing thoracic
surgery compared with non-liposomal local anesthetics. Patients and
Methods: A literature search was conducted using PubMed, Cochrane Library,
Embase, and Web of science, and to identify all observational or
retrospective studies and randomized controlled trials (RCTs) from
inception to December 2023. The primary outcome was the in-hospital
postsurgical opioid consumption in morphine milligram equivalents (MMEs).
Secondary outcomes included 24-hour postoperative MMEs, postoperative pain
score in the first 24 and 48 hours, hospital length of stay (LOS), time to
first ambulation, readmission, and perioperative complications. RevMan 5.3
was used for the data analysis. Result(s): A total of 10 studies were
included in the analysis, of which eight were observational or
retrospective analyses and two were RCTs. There were no significant
differences in the postoperative MMEs, pain score, LOS, time to first
ambulation, readmission, and perioperative complications.
 Conclusion(s): According to this meta-analysis, LB was found to be
not superior to non-liposomal local anesthetics for analgesic and
functional outcomes in thoracic surgery. Copyright © 2024 Gong et
al.

<73>
Accession Number
2036090935
Title
Impact of pre-admission physical activity on benefits of physiology-guided
complete revascularization in older patients with myocardial infarction:
insights from the FIRE trial.
Source
European Journal of Preventive Cardiology. 31(12) (pp 1451-1459), 2024.
Date of Publication: 01 Sep 2024.
Author
Pavasini R.; Campo G.; Serenelli M.; Tonet E.; Guiducci V.; Escaned J.;
Moreno R.; Casella G.; Cavazza C.; Varbella F.; Sacchetta G.; Arena M.;
Santos I.A.; Ibanes E.G.; Scarsini R.; D'Amico G.; Ruiz-Poveda F.L.; Diez
Gil J.L.; Pignatelli G.; Iannopollo G.; Colaiori I.; Santos R.C.; Marrone
A.; Fileti L.; Rigattieri S.; Barbato E.; Ocaranza-Sanchez R.; Biscaglia
S.
Institution
(Pavasini, Campo, Serenelli, Tonet, Marrone, Biscaglia) Cardiology Unit,
Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Ferrara
44124, Italy
(Guiducci, Pignatelli) Cardiology Unit, Azienda USL-IRCCS Reggio Emilia,
S. Maria Nuova Hospital, Viale Risorgimento 80, Reggio Emilia 42123, Italy
(Escaned) Cardiovascular Department, Hospital Clinico San Carlos, IDISCC,
Complutense University of Madrid, Calle del Prof Martin Lagos s/n, Madrid
28040, Spain
(Moreno) Interventional Cardiology, University Hospital La Paz, Paseo La
Castellana, 261, Madrid 28046, Spain
(Casella, Iannopollo) Cardiology Unit, Ospedale Maggiore, Largo Nigrisoli
2, Bologna 40133, Italy
(Cavazza) Cardiovascular Department, Infermi Hospital, Viale Luigi
Settembrini 2, Rimini 47923, Italy
(Varbella) Interventional Cardiology Unit, San Luigi Gonzaga University
Hospital, Orbassano, and Rivoli Infermi Hospital ASLTO3, Rivoli 10098,
Italy
(Sacchetta) Cardiology Unit, Umberto I Hospital, ASP Siracusa, Via
Giuseppe Testaferrata, 1, Siracusa 96100, Italy
(Arena) S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia
19124, Italy
(Santos) Department of Cardiology, Centro de Investigacion Biomedica en
Red en Enfermedades Cardiovasculares (CIBERCV), Hospital Clinico
Universitario, Av. Ramon y Cajal, 3, Valladolid 47003, Spain
(Ibanes) Department of Cardiology, Centro de Investigation Biomedica end
Red en Enfermedades Cardiovasculares, H. Universitario y Politecnico La
Fe, Valencia 46026, Spain
(Scarsini) Cardiovascular Department, Azienda Ospedaliero Universitaria
Integrata di Verona, Piazzale Aristide Stefani, 1, Verona 37126, Italy
(D'Amico) Interventional Cardiology, Department of Cardio-Thoracic and
Vascular Sciences, Ospedale dell'Angelo, Via Paccagnella, 12, Venice,
Mestre 35128, Italy
(Ruiz-Poveda) Cardiovascular Department, Hospital General Universitario de
Ciudad Real, Ciudad Real 13001, Spain
(Diez Gil) Cardiology Unit, Hospital San Giovanni di Dio, Azienda
Sanitaria Provinciale Agrigento, Agrigento 92100, Italy
(Colaiori) Cardiology Unit, Ospedale Santa Maria Goretti, Via Lucia
Scaravelli, Latina 04100, Italy
(Santos) Department of Interventional Cardiology, Complexo Hospitalario
Universitario A Coruna (CHUAC), As Xubias, 84, A Coruna 15006, Spain
(Fileti) Cardiology Department, S. Maria delle Croci Hospital, Viale Randi
5, Ravenna 48121, Italy
(Rigattieri, Barbato) Department of Clinical and Molecular Medicine,
Sapienza University of Rome, Via di Grottarossa, 1035/1039, Roma 00189,
Italy
(Ocaranza-Sanchez) Servicio de Cardiologia, Hospital Universitario Lucus
Augusti, Lugo 27001, Spain
Publisher
Oxford University Press
Abstract
Aims. The present analysis from the Functional Assessment in Elderly
Myocardial Infarction Patients with Multivessel Disease (FIRE) trial aims
to explore the significance of pre-admission physical activity and assess
whether the benefits of physiology-guided complete revascularization apply
consistently to sedentary and active older patients. Methods and results.
Patients aged 75 years or more with myocardial infarction (MI) and
multivessel disease were randomized to receive physiology-guided complete
revascularization or culprit-only strategy. The primary outcome was a
composite of death, MI, stroke, or any revascularization within a year.
Secondary endpoints included the composite of cardiovascular death or MI,
as well as single components of the primary endpoint. Pre-admission
physical activity was categorized into three groups: (i) absent
(sedentary), (ii) light, and (iii) vigorous. Among 1445 patients, 692
(48%) were sedentary, whereas 560 (39%) and 193 (13%) performed light and
vigorous physical activity, respectively. Patients engaging in light or
vigorous pre-admission physical activity exhibited a reduced risk of the
primary outcome compared with sedentary individuals [light hazard ratio
(HR) 0.70, 95% confidence interval (CI) 0.55-0.91 and vigorous HR 0.14,
95% CI 0.07-0.91, respectively]. These trends were also observed for
death, cardiovascular death, or MI. When comparing physiology-guided
complete revascularization vs. culprit-only strategy, no significant
interaction was observed for primary and secondary endpoints when
stratified by sedentary or active status. Conclusion. In older patients
with MI, pre-admission physical activity emerges as a robust and
independent prognostic determinant. Physiology-guided complete
revascularization stands out an effective strategy in reducing ischaemic
adverse events, irrespective of pre-admission physical activity status.
Clinical Trial Registration. Copyright © The Author(s) 2024.
Published by Oxford University Press on behalf of the European Society of
Cardiology. All rights reserved.

<74>
Accession Number
2036088356
Title
Large bore access for transcatheter aortic valve replacement, endovascular
aortic repair, and thoracic endovascular aortic repair A review of
anatomic challenges and operative considerations.
Source
Journal of Cardiovascular Surgery. 65(5) (pp 460-467), 2024. Date of
Publication: October 2024.
Author
Pozolo C.G.; Giese A.S.; Babrowski T.A.
Institution
(Pozolo) Division of Vascular Surgery, Department of Surgery, Mike
O'Callaghan Military Medical Center, Nellis Air Force Base, NV, United
States
(Giese) Division of Vascular and Endovascular Surgery, Department Surgery,
University of California - Davis, Sacramento, CA, United States
(Babrowski) Section of Vascular Surgery and Endovascular Therapy,
Department of Surgery, University of Chicago Medical Center, Chicago, IL,
United States
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: Transcatheter aortic valve replacement (TAVR), endovascular
aortic repair (EVAR), and thoracic endovascular aortic repair (TEVAR) are
standard and prolific procedures in the modern cardiovascular world, and
appropriate delivery of these endoprostheses requires adequate
understanding of the requisite large bore access. Percutaneous large bore
access is the preferred route but may be accompanied by complications like
thrombosis, hemorrhage, or inability to deliver the device. Anatomic
limitations such as vessel tortuosity, small size, and heavy calcification
may require alternative approaches for successful large bore access. This
study aimed to better define large bore access, as well as to elucidate
optimal adjuncts and alternatives to enable successful delivery of large
bore endoprostheses. EVIDENCE ACQUISITION: A systematic review for "large
bore access" in the cardiovascular literature was conducted on PubMed and
the Cochrane Library Central according to PRISMA guidelines. Identified
articles were filtered and sub-selected for TAVR, EVAR, and TEVAR; studies
related to other large bore interventions were excluded. EVIDENCE
SYNTHESIS: A representative selection of 39 full-text studies included
both cardiac and vascular studies and was critically interpreted to
identify a consensus definition for large bore access, challenging
anatomy, and adjuncts or alternative approaches to the standard
transfemoral approach. CONCLUSION(S): Transfemoral access remains the
first-line approach but in the setting of unfavorable anatomy, adjunct
maneuvers (e.g. intravascular lithotripsy, endoconduits) or alternative
approaches (supra-aortic, transcaval) help decrease morbidity, mortality,
length of procedure, and overall health care cost in large bore
access. Copyright © 2024 EDIZIONI MINERVA MEDICA.

<75>
Accession Number
2032486884
Title
Efficacy and safety of sacubitril/valsartan on postoperative atrial
fibrillation in adult patients undergoing cardiac surgery: a real-world
observational study.
Source
Frontiers in Cardiovascular Medicine. 11 (no pagination), 2024. Article
Number: 1477858. Date of Publication: 2024.
Author
Chen X.; Liu P.; Zhu F.; Wang D.; Yang S.; Yan W.
Institution
(Chen, Liu, Zhu, Wang, Yang, Yan) Department of Cardiac Surgery, The
Affiliated Hospital of Qingdao University, Qingdao, China
Publisher
Frontiers Media SA
Abstract
Background: The mechanism underlying new-onset postoperative atrial
fibrillation (POAF) in adult cardiac surgery is not well understood.
However, efficient pharmacological methods to prevent and treat arrhythmic
complications are still lacking. In the present study, we explored the
efficacy and safety of sacubitril/valsartan (sac/val) in the control of
POAF in adult cardiac surgery patients. Method(s): Between January
2021 and December 2021, 667 eligible adult patients who underwent cardiac
surgery at the Affiliated Hospital of Qingdao University were enrolled.
The participants were divided into two groups according to whether sac/val
was used: the sac/val group (N = 101) and the control group (N = 566). The
main observational endpoints were the incidence of POAF, left ventricular
ejection fraction (LVEF) recovery, in-hospital mortality, and short-term
mortality. Result(s): Patients in the sac/val group had a lower
incidence of POAF than those in the control group (26/101 vs. 204/566, P =
0.045). Patients in the sac/val group also showed a higher communicative
risk for POAF incidence using the Kaplan-Meier survival analysis. In
addition, patients in the sac/val group showed better LVEF recovery, with
dynamic changes in LVEF superior to that of the control group. The change
in LVEF in the sac/val group was 1.78 +/- 5.41, compared with -1.19 +/-
10.92 in the control group (P = 0.008). Conclusion(s): This is the
first observational study to evaluate the efficacy and safety of sac/val
in the prevention and treatment of POAF after cardiac surgery. The results
demonstrated that compared with patients who did not receive sac/val
treatment, those who received Sac/val treatment showed better POAF control
and LVEF recovery. These results should be cautiously interpreted and
further confirmed using larger sample sizes and prospective randomized
controlled trials. Copyright 2024 Chen, Liu, Zhu, Wang, Yang and Yan.

<76>
Accession Number
645932509
Title
Development of and recovery from acute kidney injury after cardiac
surgery: Randomized phase 2 trial of the hepatocyte growth factor mimetic
ANG-3777.
Source
The Journal of thoracic and cardiovascular surgery. (no pagination),
2024. Date of Publication: 25 Nov 2024.
Author
Ayad S.S.; Beaver T.; Corteville D.; Swaminathan M.; Pearl R.G.; Aslam S.;
Csomor P.A.; Alperovich G.; Neylan J.
Institution
(Ayad) Outcomes Research Department, Anesthesiology Institute, Cleveland
Clinic, Cleveland, OH, United States
(Beaver) Division of Thoracic and Cardiovascular Surgery, Department of
Surgery, University of Florida, Gainesville, Fla
(Corteville) Sands-Constellation Heart Institute, Rochester Regional
Health, Rochester, NY, United States
(Swaminathan) Department of Anesthesiology, Atrium Health Wake Forest
Baptist, Wake Forest University School of Medicine, Winston-Salem, NC,
United States
(Pearl) Department of Anesthesiology, Pain Medicine, Stanford University
School of Medicine, Stanford, United States
(Aslam, Neylan) Angion Biomedica, Uniondale, NY, United States
(Csomor) CSL Vifor, Switzerland
(Alperovich) CSL Vifor, Madrid, Spain
Abstract
OBJECTIVES: To investigate the safety and efficacy of ANG-3777, a
hepatocyte growth factor mimetic, in mitigating the risk of acute kidney
injury (AKI) in patients undergoing cardiac surgery with cardiopulmonary
bypass. METHOD(S): In this double-blind placebo-controlled study
(GUARD), patients were randomized to receive intravenous ANG-3777 2 mg/kg
or placebo once daily for 4 days. The primary endpoint was AKI severity,
measured by mean area under the concentration-time curve on percent
increase in serum creatinine from days 2 to 6. Secondary endpoints
included the proportions of patients who developed major adverse kidney
events by day 30 or 90 and the percentage of patients diagnosed with AKI
through day 5. RESULT(S): In total, 259 patients received study
treatment (ANG-3777, n = 129; placebo, n = 130). Through day 6, there was
no significant difference in least-squares mean change in serum creatinine
between ANG-3777 and placebo (1.1%; 95% CI, -6.2, 8.4; P = .77), or in
proportions of patients who developed major adverse kidney events by day
30 (18.6% vs 16.2%; P = .60) or day 90 (14.7% vs 21.5%; P = .16). Similar
proportions of patients were diagnosed with AKI through day 5 (ANG-3777,
47.3%; placebo, 48.5%); however, exploratory analysis revealed more
patients diagnosed with AKI postoperatively showed signs of recovery
following treatment with ANG-3777 than placebo. Overall, ANG-3777 was well
tolerated, with similar incidences of treatment-emergent adverse events
between treatment arms. CONCLUSION(S): Findings from this study do
not support the efficacy of ANG-3777 in preventing the development of AKI
following cardiopulmonary bypass. Copyright © 2024. Published by
Elsevier Inc.

<77>
[Use Link to view the full text]
Accession Number
629629713
Title
Effects of corticosteroids on endothelial dysfunction in cardiac surgery
patients.
Source
Critical Care Medicine. Conference: 48th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2019. San Diego, CA United States.
47(1 Supplement 1) (no pagination), 2019. Date of Publication: January
2019.
Author
Halenarova K.
Institution
(Halenarova) Erasme, ULB, Brussels, Belgium
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Endothelium plays a key role in multiple
physiological and pathophysiological processes and its dysfunction in
different clinical situations is associated with worse outcome. Cardiac
surgery with cardiopulmonary bypass represents an important endothelial
insult leading to alterations of its functions. The objectives of the
present study were to investigate cardiopulmonary bypass-induced
endothelial dysfunction on three different levels: macrocirculatory, as
assessed by flow mediated vasodilation; microcirculatory, as assessed by
NIRS during a vascular occlusion test; and biological, as assessed by a
core glycocalyx protein Syndecan-1 analysis. Our hypothesis was that a
single high dose corticosteroid administration at the induction of
anesthesia in cardiac surgery patients would have a potentially protective
effect on endothelial cell function. Method(s): In this prospective,
randomized, double-blinded trial, we used three different methods (flow
mediated dilation FMD, near-infrared spectroscopy NIRS, performed both
during vascular occlusion test (VOT), and biological analysis of a marker
of endothelial degradation Syndecan-1, to assess cardiopulmonary (CPB)
induced endothelial dysfunction. We included 40 patients, randomized in
two groups, methylprednisolone (MP, n=20) and placebo (P, n=20).
Hemodynamic, macro- and microcirculatory variables were obtained before
the surgery, on admission to the intensive care unit after the surgery and
on postoperative day 1; blood samples were obtained also at anesthesia
induction and on postoperative day 2. Data were analyzed using
Mann-Whitney and Fisher's exact test. Results are presented as median
(25th to 75th percentile). Result(s): Results issued from the
preliminary analysis of first 16 patients (methylprednisolone MP=10,
placebo P=6) showed that endothelial function was altered with
cardiopulmonary bypass in both groups, as shown by decreased recovery StO2
slope during VOT immediately after CPB; this was significantly attenuated
in methylprednisolone group: StO2 asc = 1,14 %/s (0,75 - 1,4) compared to
StO2 asc = 0,08 %/s (0,5 - 0,94) in placebo group, P=0,042). FMD% showed
less consistent results in these patients. In both groups, the micro- and
macrocirculatory alterations improved with time, more rapidly in
methylprednisolone group than with placebo. Conclusion(s):
Endothelial function is altered immediately after CBP, likely to a lesser
extent when prophylactic methylprednisolone is administered.

<78>
[Use Link to view the full text]
Accession Number
629628522
Title
Effect of 4-factor pcc reversal protocol in LVAD patients undergoing heart
transplantation.
Source
Critical Care Medicine. Conference: 48th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2019. San Diego, CA United States.
47(1 Supplement 1) (no pagination), 2019. Date of Publication: January
2019.
Author
Wong M.-C.; Mak H.; Ferreira R.
Institution
(Wong) Pharm D BCPS, Seattle, WA, United States
(Wong, Mak, Ferreira) University of Washington Medical Center, Seattle,
WA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Learning Objectives: Patients with left ventricular assist devices (LVADs)
undergoing heart transplantation (HT) are at higher bleeding risk due to
chronic anticoagulation therapy with warfarin. The use of 4-factor
prothrombin complex concentrate (4F-PCC) provides rapid reversal of
international normalized ratio (INR). Various studies have suggested that
4F-PCC may be associated with a reduction in blood product transfusions
(BPT). The aim of the study is to evaluate outcomes associated with
implementation of a hemostasis protocol using 4F-PCC during HT. The
hemostasis protocol also included administration of fresh frozen plasma
(FFP) 10-15ml/kg if INR >2 in the operating room. Method(s): This is
a single-center, retrospective study to compare outcomes among LVAD
patients undergoing HT between the pre-protocol group without 4F-PCC
(n=29) and post-protocol group with 4F-PCC (n=27). The primary outcome was
the use of intra-and 24-hour post-operative BPT. Secondary outcomes were
drug and BPT costs, thrombotic complications, length of hospital stay and
mortality rate. Continuous variables were analyzed using Mann-Whitney U
test and categorical variables were analyzed with Fisher exact test with p
values <0.05 being statistically significant. Result(s): The combined
intra-and post-operative BPT was significantly lower in the post-protocol
group compared to the preprotocol group (22 [17-27] vs 15 [10-23],
p=0.01). Specifically, utilization of FFP in the post-protocol group was 5
units fewer than the pre-protocol group (12 [8-15] vs 7 [5-10], p<0.008).
There was also a trend of less red blood cells used in the postprotocol
group by 1 unit (p=0.065). There was no difference in cardiopulmonary
bypass time and chest tube output within 24 hours post-operatively between
pre-and post-protocol groups. Thrombotic complications (17% vs 22%),
length of hospital stay (16 vs 17 days), and in-hospital mortality (7% vs
0%) were not statistically different between pre-and post-protocol groups.
The protocol did not appear to reduce cost, but instead may increase
average cost by $3421 per patient. Conclusion(s): The implementation
of a hemostasis protocol primarily reduced FFP transfusion among patients
with LVADs undergoing HT. Due to the lack of benefit in clinical outcomes
and cost-effectiveness, a randomized control trial is warranted before
utilizing 4F-PCC routinely.

<79>
Accession Number
623584577
Title
Postoperative complication rate of three different surgeries in the
treatment of lung cancer in Chinese patients: Literature review and
single-arm meta-analysis.
Source
Value in Health. Conference: 23rd Annual Meeting of the International
Society for Pharmacoeconomics and Outcomes Research, ISPOR 2018.
Baltimore, MD United States. 21(Supplement 1) (pp S20), 2018. Date of
Publication: May 2018.
Author
Yin C.; Zhao M.; Roy S.; Metz L.
Institution
(Yin, Metz) Johnson and Johnson Medical Asia Pacific, Singapore, Singapore
(Zhao) China Pharmaceutical University, NanJing, China
(Roy) Ethicon Inc, Somerville, NJ, United States
Publisher
Elsevier Ltd
Abstract
Objectives: Video-assisted thoracic surgery (VATS), hybrid VATS (hVATS)
and thoracotomy (TH) are three major approaches for lung cancer surgery in
China, involving an increasing order of invasiveness and trauma. The
objective of this meta-analysis is to assess the relative clinical
evidence of postoperative complications (POC) among the three surgical
approaches. Method(s): A thorough search of major electronic
databases was conducted to identify studies through September 2017
reporting POC in Chinese population undergoing lung cancer surgery.
Randomeffects meta-analysis was conducted using non-comparative binary
data in RevMan software to estimate mean (95% CI) for POC rate.
 Result(s): 58 studies, with a total of 7,813 patients (4,403 VATS,
531 hVATS, and 2,879 TH), were included. The overall POC rate was 14.5%
(12.3%-16.7%). TH had the highest POC rate (21.9%, 18.0%-25.9%), followed
by hVATS (11.5%, 6.5%-18.7%), and VATS (10.7%, 9.1%-13.8%). Overall among
the three approaches, major POCs were air leak (3.8%, 2.9%-5.7%),
arrhythmia (3.8%, 2.9%-5.7%), pneumonia (3.8%, 2.9%-5.7%), pneumothorax
(2.9%, 2.0%-5.7%) and surgical site infection (SSI) (2.9%, 2.0%-3.8%).
However, top POCs varied by approach, as follows: VATS-arrhythmia (5.7%,
4.8%-6.5%), air leaks (3.8%, 2.0%-5.7%), atelectasis (3.8%, 2.9%-5.7%),
pleural effusion (3.8%, 1.0%-9.1%), and pneumonia (2.9%, 2.0%-4.8%);
hVATS-pleural effusion (5.7%, 2.0%-16.7%), pneumonia (5.7%, 3.8%-9.9%),
air leaks (3.8%, 2.0%-9.1%), SSI (3.8%, 2.0%-9.1%), and arrhythmia (3.8%,
2.0%-7.4%); and TH-air leak (5.7%, 2.9%-9.1%), pneumonia (5.7%,
3.8%-8.3%), arrhythmia (5.7%, 3.8%-8.3%), pneumothorax (5.7%, 2.9%-9.9%),
and SSI (4.8%,3.8%-6.5%). Postoperative bleeding was the lowest in VATS
(1.0%, 1.0%-2.9%), followed by hVATS 2.9% (0%-1.9%), and the highest in TH
(3.8%, 2.0%-7.4%). Conclusion(s): Postoperative complications in
surgical treatment of lung cancer in China is still very high. This
analysis suggests that less traumatic procedures are associated with
reduced postoperative complication rates, and may be considered for
broader adoption.

<80>
Accession Number
623584194
Title
Comparison of video-assisted thoracic surgery segmentectomy (VATS-S)
versus video-assisted thoracic surgery lobectomy (VATS-L) for stage I
non-small cell lung cancer (NSCLC-I) in Chinese patients: A systemic
review and meta-analysis.
Source
Value in Health. Conference: 23rd Annual Meeting of the International
Society for Pharmacoeconomics and Outcomes Research, ISPOR 2018.
Baltimore, MD United States. 21(Supplement 1) (pp S18), 2018. Date of
Publication: May 2018.
Author
Yin C.; Zhao M.; Roy S.; Metz L.
Institution
(Yin, Metz) Johnson and Johnson Medical Asia Pacific, Singapore, Singapore
(Zhao) China Pharmaceutical University, NanJing, China
(Roy) Ethicon Inc, Somerville, NJ, United States
Publisher
Elsevier Ltd
Abstract
Objectives: VATS-S is a newly introduced surgical technique in the
treatment of stage I NSCLC. However, owing to small sample sizes of
relevant clinical studies, there is no conclusive evidence of the relative
benefit between the outcomes of VATS-S and VATS-L in Chinese patients.
This meta-analysis offers the first robust comparative assessment of the
safety and clinical outcomes of VATS-S versus VATS-L in Chinese patients
with NSCLC-I. Method(s): A thorough search of major electronic
databases was conducted to identify surgical studies on Chinese patients
with NSCLC-I till September 2017. Random-effects meta-analysis was used to
estimate risk ratios (RRs, 95% CI) and mean differences (MD, 95% CI) for
dichotomous and continuous variables, respectively. The main outcomes and
measures were operating room time (ORT), intraoperative blood loss (BL),
number of lymph nodes resected (LNRN), total volume of chest tube drainage
postoperatively (TVCTD), chest tube duration (CTD), length of stay (LOS),
post-operative complications (POC), overall cancer recurrence rate (ORR),
local cancer recurrence rate (LRR) and distal cancer recurrence rate
(DRR). Result(s): 7 studies, with 762 NSCLC-I patients (229 VATS-S,
533 VATS-L), were included. Patient characteristic baselines were matched
between 2 groups, including age (p= 0.22), gender (p= 0.67) and
comorbidity rate (p= 0.37). The average follow-up time was 10.2 to 27
months. VATS-S group was associated with a reduction in TVCTD by 224.42 ml
(MD:-224.42, 95%CI (-345.06,-103.79), p= 0.0003); a reduction of CTD by
0.73 days (-1.42,-0.03; p= 0.04); and a reduction of LOS by 0.58 days
(-1.04,-0.11; p= 0.02). There was no significant difference between the
groups in BL, LNRN, POC, ORT, ORR, LRR, and DRR. Conclusion(s):
VATS-S is a less invasive surgical technique which is associated with less
chest tube drainage volume, shorter chest tube duration, and shorter
length of stay compared to VATS-L in the treatment of Chinese patients
with stage I NSCLC.

<81>
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.

<82>
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.

<83>
Accession Number
2032384438
Title
Comprehensive analysis of donor-site chest deformities after autologous
costal cartilage microtia reconstruction: A systematic review.
Source
Journal of Plastic, Reconstructive and Aesthetic Surgery. 94 (pp 128-140),
2024. Date of Publication: July 2024.
Author
Kim J.; Park C.; Oh K.S.; Lim S.Y.
Institution
(Kim, Park, Lim) Department of Plastic Surgery, Samsung Medical Center,
Sungkyunkwan University School of Medicine, Seoul, South Korea
(Oh) Department of Plastic surgery, Kangbuk Samsung Hospital, Sungkyunkwan
University School of Medicine, Seoul, South Korea
Publisher
Churchill Livingstone
Abstract
Background: Autologous costal cartilage has gained widespread acceptance
as an important material for ear reconstruction in patients with microtia.
Despite its recognition as being "worth the trade-off," attention should
be directed toward donor-site deformities. This systematic review focused
on existing English literature related to microtia reconstruction and
aimed to reveal the incidence of chest wall deformities and assess the
effectiveness of the various proposed surgical techniques aimed at
reducing donor-site morbidities. Method(s): A comprehensive search
was conducted on Pubmed and OVID using the keywords "microtia," and "chest
deformity" or "rib harvest." Articles were screened based on predefined
inclusion and exclusion criteria. Data acquisition encompassed patient
demographics, employed surgical techniques, methods for evaluating chest
deformity, and incidence of associated complications. Result(s):
Among the 362 identified articles, 21 met the inclusion criteria. A total
of 2600 cases involving 2433 patients with microtia were analyzed in this
review. Perichondrium preservation during cartilage harvesting led to a
significant reduction in chest deformities. However, the wide incidence
range (0% to 50%) and the lack of specific assessment methods suggested
potential underestimation. Computed tomography revealed reduced chest wall
growth in the transverse and sagittal directions, resulting in decreased
thoracic area. Innovative surgical techniques have shown promising results
in reducing chest deformities. Conclusion(s): Although a quantitative
analysis was not feasible, objective evidence of deformities was
established through computed tomography scans. This analysis highlighted
the need for dedicated studies with larger sample sizes to further advance
our understanding of chest wall deformities in microtia
reconstruction. Copyright © 2024

<84>
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.

<85>
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 failure, 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.

<86>
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.

<87>
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.

<88>
Accession Number
2035997350
Title
Combined arm-leg endurance training vs. leg endurance training in patients
with an implantable cardioverter defibrillator: A randomized controlled
study.
Source
Heart and Lung. 70 (pp 82-92), 2025. Date of Publication: 01 Mar 2025.
Author
Akdal A.; Karavelioglu Y.; Gokdeniz T.; Turk A.C.; Unal F.; Kutukcu E.C.
Institution
(Akdal) Hitit University, Erol Olcok Education and Research Hospital,
Cardiac Rehabilitation Center, Corum, Turkey
(Karavelioglu, Gokdeniz) Istinye University Hospital Medical Park
Gaziosmanpasa, Department of Cardiology, Istanbul, Turkey
(Turk) Hitit University, Erol Olcok Education and Research Hospital,
Department of Physical Medicine and Rehabilitation, Corum, Turkey
(Unal) Data Management Unit, Middle East Technical University, Ankara,
Turkey
(Kutukcu) Hacettepe University, Faculty of Physical Physiotherapy and
Rehabilitation, Department of Cardiorespiratory Physiotherapy and
Rehabilitation, Ankara, Turkey
Publisher
Elsevier Inc.
Abstract
Background: There is a lack of evidence regarding the effect of combining
arm and leg training on arm exercise capacity, upper extremity
functionality and safety in patients with implantable
cardioverter-defibrillators (ICDs). Objective(s): The aim of this
study was to compare the effects of combined arm-leg endurance training
(ET<inf>arm+leg</inf>) with leg endurance training (ET<inf>leg</inf>)
alone on arm exercise capacity, cardiorespiratory fitness, and safety
issues in patients with ICDs. Method(s): In this prospective
randomized controlled study, 24 caucasian patients with an ICD (NYHA class
II-III, mean age: 59.38+/-11.54 years, 20 male, 4 female) underwent
cardiopulmonary exercise testing (CPET) and arm ergometry. The
ET<inf>leg</inf> intervention consisted of cycle ergometer training for 40
min at workload of 70-80 % of peak oxygen consumption
(VO<inf>2peak</inf>). The ET<inf>arm+leg</inf> intervention also included
arm ergometer training for 20 min at 60 % peak workload
(W<inf>peak</inf>). Both exercise programs were performed for a total of
30 sessions (5 days for 6 weeks). Quade's non-parametric covariance
analysis was performed for changes between groups by adjusting before
treatment. Result(s): Significant increases in time to reach
VO<inf>2peak</inf> (min), VO<inf>2peak</inf> (L), VO<inf>2peak</inf>/kg
(L/kg/min), VO<inf>2peak</inf> (%), W<inf>peak</inf>, and test duration
during arm ergometry were observed in the ET<inf>arm+leg</inf> group (p <
0.05). No shocks or ventricular tachycardia/fibrillation episodes were
recorded. Conclusion(s): ET<inf>arm+leg</inf> had a more pronounced
effect on cardiopulmonary exercise capacity and arm exercise capacity in
patients with ICDs. Arm exercise training is safe in terms of ICD
parameters and should be incorporated into cardiac rehabilitation for
patients with ICDs. Copyright © 2024

<89>
Accession Number
2035965256
Title
A systematic review of the use of GLP-1 receptor agonists in surgery.
Source
American Journal of Surgery. 240 (no pagination), 2025. Article Number:
116119. Date of Publication: February 2025.
Author
Ihnat J.M.H.; De Baun H.; Carrillo G.; Dony A.; Mukherjee T.J.; Ayyala
H.S.
Institution
(Ihnat, Carrillo, Mukherjee, Ayyala) Division of Plastic and
Reconstructive Surgery, Department of Surgery, Yale School of Medicine,
New Haven, CT, United States
(De Baun) Renaissance School of Medicine at Stony Brook University, Stony
Brook, NY, United States
(Dony) University of Leeds School of Medicine, Leeds, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: Surgeons are likely to encounter patients on GLP-1 receptor
agonists (GLP-1RAs) and should be aware of any associated risks or
complications. Here we review the existing literature on GLP-1RA use as it
pertains to non-bariatric surgeons. Method(s): A systematic review
was conducted following PRISMA 2020 guidelines. Three databases were
queried for articles discussing the use of GLP-1RAs in a surgical context.
Articles went through two rounds of manual screening. Result(s): 21
articles were included in analysis, which found that pre-operatively,
GLP-1RAs can aid patients in meeting the BMI threshold for surgery.
Peri-operatively, GLP-1RAs were associated with improved glycemic control
and lower intraoperative insulin use. Complications such as delayed
gastric emptying and increased rates of hypoglycemic events were reported.
 Conclusion(s): Surgeons may leverage GLP-1RAs to help prepare
patients for surgery and should understand potential surgical
complications associated with the use of these medications and to screen
preoperative patients appropriately. Copyright © 2024 Elsevier
Inc.

<90>
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).

<91>
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.

<92>
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.

<93>
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.

<94>
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.

<95>
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

<96>
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

<97>
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.

<98>
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.

<99>
Accession Number
2032422224
Title
Pulmonary Endometriosis: A Systematic Review.
Source
Journal of Personalized Medicine. 14(11) (no pagination), 2024. Article
Number: 1085. Date of Publication: November 2024.
Author
Nikolettos K.; Patsouras A.; Kotanidou S.; Garmpis N.; Psilopatis I.;
Garmpi A.; Effraimidou E.I.; Daniilidis A.; Dimitroulis D.; Nikolettos N.;
Tsikouras P.; Gerede A.; Papoutsas D.; Kontomanolis E.; Damaskos C.
Institution
(Nikolettos, Kotanidou, Nikolettos, Tsikouras, Gerede, Kontomanolis)
Department of Obstetrics and Gynecology, University Hospital of
Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Dragana
68110, Greece
(Patsouras) Second Department of Pulmonology, Sotiria General Hospital,
Athens 11527, Greece
(Garmpis, Papoutsas) Department of Surgery, Sotiria General Hospital,
Athens 11527, Greece
(Garmpis, Damaskos) N.S. Christeas Laboratory of Experimental Surgery and
Surgical Research, Medical School, National and Kapodistrian University of
Athens, Athens 11527, Greece
(Psilopatis) Department of Obstetrics and Gynecology, University Erlangen
Hospital, Erlangen 91054, Germany
(Garmpi) First Department of Propedeutic Internal Medicine, Laiko General
Hospital, Medical School, National and Kapodistrian University of Athens,
Athens 11527, Greece
(Effraimidou) First Surgical Department, University Hospital of
Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Dragana
68110, Greece
(Daniilidis) First University, Department in Obstetrics and Gynecology,
Papageorgiou General Hospital, School of Medicine, Aristotle University of
Thessaloniki, Thessaloniki 56429, Greece
(Dimitroulis) Second Department of Propedeutic Surgery, Laiko General
Hospital, Medical School, National and Kapodistrian University of Athens,
Athens 11527, Greece
(Damaskos) Department of Emergency Surgery, Laiko General Hospital, Athens
11527, Greece
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Endometriosis is characterized by the presence of
ectopic endometrial-like glands and stroma outside the endometrial cavity,
which mainly occurs in the pelvic cavity. Pulmonary endometriosis, or
thoracic endometriosis syndrome (TES), describes the rare presence of
endometrial-like cells in the thoracic cavity and includes catamenial
pneumothorax, catamenial hemothorax, hemoptysis, and lung nodules. Our aim
is to summarize the results of all reported cases of TES. Method(s):
Extensive research was conducted through MEDLINE/PUBMED using the keywords
"thoracic endometriosis", "thoracic endometriosis syndrome", "catamenial
pneumothorax", "catamenial hemoptysis", and "TES". Following PRISMA
guidelines, all published cases of TES between January 1950 and March 2024
were included. A systematic review of 202 studies in English, including
592 patients, was performed. Result(s): The median age of women with
TES is 33.8 years old. The most common clinical presentation is catamenial
pneumothorax (68.4%), while lesions are mainly found in the right lung
unilaterally (79.9%). Chest computed tomography (CT) was used alone or
after an X-ray to determine the pathological findings. Ground-glass
opacity nodules and cystic lesions represent the most common finding in
CT, while pneumothorax is the most common finding in X-rays.
Video-assisted thoracoscopic surgery (VATS) is the main therapeutic
approach, usually in combination with hormonal therapy, including GnRH
analogues, progestins, androgens, or combined oral contraceptives.
Hormonal therapy was also administered as monotherapy. Symptom recurrence
was reported in 10.1% of all cases after the treatment.
 Conclusion(s): High clinical awareness and a multidisciplinary
approach are necessary for the best clinical outcome for TES patients.
More studies are required to extract safer conclusions. Copyright
© 2024 by the authors.

<100>
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.

<101>
Accession Number
2032407283
Title
Modified Balloon Use After Rotational Atherectomy Reduces Major Adverse
Cardiovascular Event Rates in Severely Calcified Coronary Lesions: A
Systematic Review and Meta-Analysis.
Source
Journal of Clinical Medicine. 13(22) (no pagination), 2024. Article
Number: 6853. Date of Publication: November 2024.
Author
Ehrenberger R.; Masszi R.; Zsigmond E.-J.; Nguyen Do To U.; Turan C.;
Walter A.; Hegyi P.; Engh M.A.; Duray G.Z.; Molnar Z.; Merkely B.; Edes
I.F.
Institution
(Ehrenberger, Masszi, Zsigmond, Nguyen Do To, Turan, Hegyi, Engh, Duray,
Molnar) Centre for Translational Medicine, Semmelweis University, Budapest
1085, Hungary
(Ehrenberger, Masszi, Duray, Merkely, Edes) Heart and Vascular Centre,
Semmelweis University, Budapest 1122, Hungary
(Zsigmond, Duray) Department of Cardiology, Central Hospital of Northern
Pest, Military Hospital, Budapest 1134, Hungary
(Zsigmond) Doctoral School of Clinical Medicine, University of Szeged,
Szeged 6720, Hungary
(Turan, Molnar) Department of Anaesthesiology and Intensive Therapy,
Semmelweis University, Budapest 1428, Hungary
(Walter, Hegyi) Institute for Translational Medicine, Medical School,
University of Pecs, Pecs 7624, Hungary
(Hegyi) Institute of Pancreatic Diseases, Semmelweis University, Budapest
1083, Hungary
(Molnar) Department of Anaesthesiology and Intensive Therapy, Poznan
University of Medical Sciences, Poznan 61-701, Poland
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Calcified coronary lesions require plaque
modification techniques for optimal stent apposition, of which rotational
atherectomy (RA) is the most commonly used one. Challenging cases require
the use of additional dedicated devices (such as modified balloons, MB);
however, data available for evidence-based device selection are limited.
The aim of this study is to determine the impact of the balloon-based
technology used after successful RA treatment on outcomes. Method(s):
This study was carried out according to the PRISMA guidelines. MEDLINE,
CENTRAL and Embase databases were systematically searched for eligible
randomized and non-randomized studies. Result(s): A total of nine
studies and 1024 patients were included in the analysis. Patients were
treated with RA followed by either plain balloon angioplasty (RA + BA) or
modified balloon (RA + MB) treatment prior to stent implantation. There
was no significant difference in MACE (major adverse cardiovascular
events; OR: 0.53; 95% CI: 0.21-1.34; p = 0.153), all-cause mortality (OR:
0.68; 95% CI: 0.33-1.42; p = 0.265), and target lesion revascularization
(OR: 0.64; 95% CI: 0.27-1.55; p = 0.264) between the two groups. However,
a sensitivity analysis demonstrated a significant decrease in MACE for
patients with severely calcified lesions (OR: 0.42; 95% CI: 0.25-0.70; p =
0.009) in the RA + MB group. The analyses of the safety outcomes of slow
flow/no reflow (OR: 0.59; 95% CI: 0.29-1.22; p = 0.128) and coronary
artery perforation (OR: 1.18; 95% CI: 0.70-1.99; p = 0.480) showed no
difference between the two groups. Conclusion(s): Our meta-analysis
suggests that the benefit of the more invasive RA + MB treatment is
statistically significant for severely calcified lesions, but is not
associated with additional procedural complications. Copyright ©
2024 by the authors.

<102>
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.

<103>
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.

<104>
[Use Link to view the full text]
Accession Number
2035799201
Title
Research frontiers and hotspots of coronary chronic total occlusion: A
bibliometric analysis.
Source
Medicine (United States). 103(46) (pp e40537), 2024. Date of Publication:
15 Nov 2024.
Author
Li S.; Zhang M.; Li W.; Sun Z.; Zhang Y.; Zuo Y.; Chen S.
Institution
(Li, Li, Sun, Zhang) Shandong University of Traditional Chinese Medicine,
Jinan, China
(Zhang, Zuo, Chen) The Second Affiliated Hospital of Shandong University
of Traditional Chinese Medicine, Jinan, China
Publisher
Lippincott Williams and Wilkins
Abstract
By analyzing the relevant literature, we can accurately grasp the current
status of diagnosis and treatment of chronic total occlusion of coronary
artery, and clarify the development trend, research frontiers and hotspots
of this disease. A literature search with "chronic total occlusion"as the
title was performed in the Web of Science database. The title, author,
abstract, keywords, institution, publication, country, reference, and
other endnotes of the selected literature were exported in the form of
text. The author, country, institution, and keywords of the literature
were analyzed through Citespace and VOSviewer. The United States has the
highest proportion of articles. The institution with the largest number of
publications in this field is the Minneapolis Heart Institute Foundation.
Brilakis Emmanouil S is the author with the most published articles. The
journal system with the largest number of articles in this field is
Cardiac Cardiovascular Systems. The keywords with the highest frequency
are "chronic total occlusion,""percutaneous coronary
intervention,""recanalization,"and "revascularization."The burst detection
analysis of hot keywords shows that "algorithm,""management,"and
"mortality"are the research hotspots in this field in recent years. At
present, the research on this disease mainly focuses on the opening of
occluded coronary arteries through various treatment methods. In the near
future and the next few years, the research hotspots may be the scoring
system algorithms for the treatment of chronic total occlusion of coronary
artery and the management strategies for patients. Copyright ©
2024 the Author(s). Published by Wolters Kluwer Health, Inc.

<105>
Accession Number
2035106479
Title
Thrombus on Mitral Annular Calcification: A Systematic Review of
Management and Outcomes.
Source
CJC Open. 6(12) (pp 1538-1548), 2024. Date of Publication: December 2024.
Author
Cintosun A.; Belzile D.; Sooriyakanthan M.; Orchanian-Cheff A.; Tsang W.
Institution
(Cintosun) Department of Medicine, University of Toronto, Toronto, ON,
Canada
(Belzile, Sooriyakanthan, Tsang) Division of Cardiology, Toronto General
Hospital, University of Toronto, Toronto, ON, Canada
(Orchanian-Cheff) Library and Information Services, University Health
Network, Toronto, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: Mitral annular calcification (MAC) is a common chronic
degenerative process of the mitral valve. Thrombus formation on MAC is a
rare complication that likely contributes to the increased risk of
thromboembolic events. Outcomes and management strategies for this
condition are unknown. The aim of this study was to perform a systematic
review to describe the management and outcomes of patients who have
thrombus on MAC. Method(s): The MEDLINE, Embase, and Cochrane
databases were searched. Patients with a prior mitral valve intervention
or prosthesis were excluded. The primary outcomes were treatment,
mortality, and thromboembolic events. Result(s): Fifteen studies,
with a total of 22 cases (patients aged 69.1 +/- 14.8 years; n = 18 [82%]
female) were included. Most patients presented with stroke or a transient
ischemic event (n = 15; 68%) or myocardial infarction (n = 4; 18%). All
patients were diagnosed with either transthoracic (n = 18; 82%) or
transesophageal (n = 4; 18%) echocardiography. Seventeen patients (77%)
were treated with anticoagulation therapy alone, and 5 (23%) required
surgery. The most common surgical indication was prevention of recurrent
embolization (n = 3; 14%). No mortality was reported. Six patients (27%)
had thromboembolic events after diagnosis. For those treated with
anticoagulation therapy alone, 5 (23%) had persistent thrombus with or
without embolization. Conclusion(s): In this systematic review,
patients with MAC who present with a thromboembolic event require careful
echocardiographic assessment of the MAC, to exclude the presence of
thrombus. Although most patients can be managed with anticoagulation
therapy alone, a significant number will require surgery. Persistent
thrombus, despite anticoagulation therapy, and recurrent embolization are
common. Larger studies are needed to elucidate what constitutes the
optimal long-term care for these patients. Copyright © 2024 The
Authors

<106>
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.

<107>
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.

<108>
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.

<109>
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.

<110>
Accession Number
645206205
Title
The cardioprotective effects of adenosine-induced cardioplegic arrest
versus saline in aortic valve replacement patients: A randomized
controlled trial.
Source
Scandinavian journal of surgery : SJS : official organ for the Finnish
Surgical Society and the Scandinavian Surgical Society. 113(4) (pp
273-281), 2024. Date of Publication: 01 Dec 2024.
Author
Mattila M.S.; Jarvela K.M.; Rantanen M.J.; Tuohinen S.; Nikus K.C.;
Laurikka J.O.
Institution
(Mattila) Heart Hospital Tampere University Hospital Tays Sydankeskus Oy
PL 2000 33521 Tampere Finland Faculty of Medicine and Health Technology
Tampere University Tampere Finland The Wellbeing Services County of
Pirkanmaa Tampere Finland, Finland
(Jarvela, Rantanen, Nikus, Laurikka) Heart Hospital, Tampere University
Hospital, Tampere, Finland
(Jarvela, Nikus, Laurikka) Faculty of Medicine and Health Technology,
Tampere University, Tampere, Finland
(Jarvela, Rantanen, Nikus, Laurikka) Wellbeing Services County of
Pirkanmaa, Tampere, Finland
(Tuohinen) Heart and Lung Center, Helsinki University Central Hospital,
HUS, Helsinki, Finland
Abstract
BACKGROUND AND AIMS: Adenosine is a widely used potent cardioprotective
drug, but the effect of an adenosine bolus in initial cardioplegia on
cardioprotection in aortic valve replacement (AVR) patients has not been
demonstrated. The aim of this double-blind randomized clinical trial was
to compare intra-aortic adenosine bolus with saline on the postoperative
myocardial function in patients undergoing AVR. METHOD(S): Aortic
valve stenosis patients scheduled for elective or urgent AVR surgery were
randomized to receive either a 20mg (4mL) single dose of adenosine or a
saline into the ascending aorta during the first cardioplegia infusion.
The primary outcome was cardiac index (CI (L/min/m2) at four timepoints
(before incision, after weaning from cardiopulmonary bypass (CPB), at 7
p.m. on the operation day, and at 6 a.m. the next morning). Secondary
outcomes included left ventricular stroke work index, right ventricular
stroke work index, and myocardial biomarkers at the same timepoints.
 RESULT(S): Between November 2015 and March 2018, 45 patients were
recruited, 23 in the adenosine group and 22 in the placebo group. The last
follow-up date was 17 March 2018. There were no statistically significant
differences in CI (mean differences with 95% confidence interval (95% CI):
0.09L/min/m2 at baseline (-0.20 to 0.38), -1.39L/min/m2 (-3.47 to 0.70) at
post-CPB, -0.39L/min/m2 (-0.78 to 0.004) at 7 p.m., and -0.32L/min/m2
(-0.68 to 0.05) at 6 a.m., (p=0.066)), right ventricular stroke work
index, (p=0.24), or cardiac biomarkers between the groups. Left
ventricular stroke work index was lower in the adenosine group (-3.66gm/m2
(-11.13 to 3.81) at baseline, -17.42gm/m2 (-37.81 to 2.98) at post-CPB,
-3.36gm/m2 (-11.10 to 4.38) at 7 p.m., and -3.77gm/m2 (-10.19 to 2.66) at
6 a.m. (p=0.021)). CONCLUSION(S): There were no differences between
20mg adenosine bolus and saline in the first cardioplegia infusion in CI
improvement in AVR surgery for aortic valve stenosis.EudraCT number:
2014-001382-26.

<111>
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.

<112>
Accession Number
2036086978
Title
Anesthetic technique and postoperative pulmonary complications (PPC) after
Video Assisted Thoracic (VATS) lobectomy: A retrospective observational
cohort study.
Source
PLoS ONE. 19(12) (no pagination), 2024. Article Number: e0310147. Date of
Publication: December 2024.
Author
Singla P.; Brenner B.; Tsang S.; Elkassabany N.; Martin L.W.; Carrott P.;
Scott C.; Mazzeffi M.
Institution
(Singla, Brenner, Tsang, Elkassabany, Mazzeffi) Department of
Anesthesiology, University of Virginia, Charlottesville, VA, United States
(Martin, Carrott, Scott) Department of Surgery, University of Virginia,
Charlottesville, VA, United States
Publisher
Public Library of Science
Abstract
Introduction Thoracic surgery is associated with an 8-10% incidence of
postoperative pulmonary complications (PPCs). Introduction of minimally
invasive Video-assisted thoracoscopic surgery (VATS) aimed to reduce pain
related and pulmonary complications. However, PPCs remain a common cause
of morbidity after VATS. Methods The American College of Surgeons National
Surgical Quality Improvement Program database was searched for VATS
lobectomy cases from 2017 to 2021 with General Anesthesia (GA) as the
primary anesthetic technique. Cases were stratified into four groups-GA
alone, GA+local, GA+Regional and GA+Epidural. Generalized linear
regression models were used to examine whether PPCs differ by anesthetic
technique, controlling for morbidity risk factors. The study's primary
outcome was the occurrence of any PPC (pneumonia, rein-tubation or
prolonged mechanical ventilation). The secondary outcome was length of
hospital stay (LOS). Results A total of 15,084 VATS lobectomy cases were
identified and 14,477 cases met inclusion criteria. The PPC rate was
between 3.5-5.2%. There was no statistically significant difference in the
odds of PPCs across the groups. Compared to the GA alone group, the
regional and local group had significantly shorter LOS (9.1% and 5.5%,
respectively, both ps < .001), whereas the epidural group had
significantly longer LOS (18%, p < .001). Conclusion Our analysis suggests
that the addition of regional or local anesthesia is associated with
shorter LOS after VATS lobectomy. However, these techniques were not
associated with lower PPC incidence. Future randomized controlled trials
could help to elucidate the best anesthetic technique to reduce pain and
enhance recovery. Copyright © 2024 Singla 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.

<113>
Accession Number
2036013331
Title
Comparison of Various Surgical Approaches for Moderate-to-Severe Ischemic
Mitral Regurgitation: A Systematic Review and Network Meta-Analysis.
Source
Reviews in Cardiovascular Medicine. 25(11) (no pagination), 2024. Article
Number: 425. Date of Publication: November 2024.
Author
Wei Z.; Dong S.; Li X.; Chen Y.; Liu S.; Song B.
Institution
(Wei, Dong, Li, Chen, Liu) The First Clinical Medical College, Lanzhou
University, Gansu, Lanzhou 730000, China
(Wei, Dong, Li, Chen, Liu, Song) Department of Cardiovascular Surgery,
First Hospital of Lanzhou University, Gansu, Lanzhou 730000, China
Publisher
IMR Press Limited
Abstract
Background: This study aims to systematically review the efficacy of
various surgical approaches in the treatment of ischemic mitral
regurgitation (IMR). Method(s): A comprehensive literature search was
conducted using computerized databases, including PubMed, Cochrane
Library, Embase, and Web of Science, up to February 2024. In our network
meta-analysis, we utilized the Cochrane Handbook tool for quality
evaluation, while a consistency model and the odds ratio (OR) were used to
compile and analyze the data from the studies included, employing Stata
17.0 software for this purpose. Result(s): The systematic review
included a total of 20 randomized controlled trials (RCTs), which
collectively involved 3111 patients and evaluated six different surgical
techniques. The network metaanalysis demonstrated that mitral valve repair
(MVr) exhibited a significant reduction in 30-day all-cause mortality
rates when compared to coronary artery bypass grafting (CABG), mitral
valve replacement (MVR), CABG combined with MVR, and transcatheter mitral
valve edge-to-edge repair (TEER) using MitraClip. Furthermore, probability
ranking analysis suggested that MVr may be the most effective approach in
reducing 30-day all-cause mortality, while CABG combined with MVr had
significantly fewer renal complications compared to CABG combined with
MVR. Probability rankings also indicated that CABG+MVr may be the most
effective technique in minimizing renal complications. However, there were
no statistically significant differences observed in other outcome
measures among the different surgical techniques. Conclusion(s):
Current limited evidence indicates that CABG combined with MVr may be the
best surgical approach for patients with IMR. However, these conclusions
are tentative and require further confirmation from more additional
high-quality studies. INPLASY Registration Number: INPLASY202420049. This
study can be accessed at the following detailed address:
https://inplasy.com/inplasy-2024-2-0049/, last accessed on February 11,
2024. Copyright © 2024 The Author(s).

<114>
Accession Number
2036120458
Title
Aortic Valve Replacement vs Clinical Surveillance in Asymptomatic Severe
Aortic Stenosis: A Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. (no pagination), 2024.
Date of Publication: 2024.
Author
Genereux P.; Banovic M.; Kang D.-H.; Giustino G.; Prendergast B.D.;
Lindman B.R.; Newby D.E.; Pibarot P.; Redfors B.; Craig N.J.; Bartunek J.;
Schwartz A.; Seyedin R.; Cohen D.J.; Iung B.; Leon M.B.; Dweck M.R.
Institution
(Genereux, Giustino) Gagnon Cardiovascular Institute, Morristown Medical
Center, Morristown, NJ, United States
(Banovic) Belgrade Medical School, University of Belgrade, Belgrade,
Serbia
(Banovic) Cardiology Department, University Clinical Center of Serbia,
Belgrade, Serbia
(Kang) Asan Medical Center, College of Medicine, University of Ulsan,
Seoul, South Korea
(Prendergast) Department of Cardiology, Guys and St Thomas' NHS Foundation
Trust Hospital London, London, United Kingdom
(Prendergast) Heart, Vascular and Thoracic Institute, Cleveland Clinic
London, London, United Kingdom
(Lindman) Structural Heart and Valve Center, Vanderbilt University Medical
Center, Nashville, TN, United States
(Newby, Dweck) British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Edinburgh, United Kingdom
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec City,
QC, Canada
(Redfors) Department of Molecular and Clinical Medicine, Institute of
Medicine, Gothenburg University, Gothenburg, Sweden
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Redfors) Department of Population Health Sciences, Weill Cornell
Medicine, New York, NY, United States
(Craig) Centre for Cardiovascular Sciences, University of Edinburgh,
Edinburgh, United Kingdom
(Bartunek) Clinical Trial Service Unit and Epidemiological Studies Unit,
Nuffield Department of Population Health, University of Oxford, Oxford,
United Kingdom
(Schwartz, Leon) Columbia University Medical Center/NewYork-Presbyterian
Hospital, New York, NY, United States
(Seyedin) Edwards Lifesciences, Irvine, CA, United States
(Cohen) St. Francis Hospital and Heart Center, Roslyn, NY, United States
(Cohen, Leon) Cardiovascular Research Foundation, New York, NY, United
States
(Iung) Bichat Hospital, Assistance Publique-Hopitaux de Paris, and INSERM
LVTS 1148, Universite Paris-Cite, Paris, France
Publisher
Elsevier Inc.
Abstract
Background: Current guidelines recommend a strategy of clinical
surveillance (CS) for patients with asymptomatic severe aortic stenosis
(AS) and a normal left ventricular ejection fraction. Objective(s):
The aim of this study was to conduct a study-level meta-analysis of
randomized controlled trials (RCTs) evaluating the effect of early aortic
valve replacement (AVR) compared with CS in patients with asymptomatic
severe AS. Method(s): Studies were quantitatively assessed in a
meta-analysis using random-effects modeling. Prespecified outcomes
included all-cause and cardiovascular mortality, unplanned cardiovascular
or heart failure (HF) hospitalization, and stroke. The meta-analysis is
registered at the International Platform of Registered Systematic Review
and Meta-Analysis Protocols (INPLASY202490002). Result(s): Four RCTs
were identified, including a total of 1,427 patients (719 in the early AVR
group and 708 in the CS group). At an average follow-up time of 4.1 years,
early AVR was associated with a significant reduction in unplanned
cardiovascular or HF hospitalization (pooled rate 14.6% vs 31.9%; HR:
0.40; 95% CI: 0.30-0.53; I2 = 4%; P < 0.01) and stroke (pooled
rate 4.5% vs 7.2%; HR: 0.62; 95% CI: 0.40-0.97; I2 = 0%; P =
0.03). No differences in all-cause mortality (pooled rate 9.7% vs 13.7%;
HR: 0.68; 95% CI: 0.40-1.17; I2 = 61%; P = 0.17) and
cardiovascular mortality (pooled rate 5.1% vs 8.3%; HR: 0.67; 95% CI:
0.35-1.29; I2 = 50%; P = 0.23) were observed with early AVR
compared with CS, although there was a high degree of heterogeneity among
studies. Conclusion(s): In this meta-analysis of 4 RCTs, early AVR
was associated with a significant reduction in unplanned cardiovascular or
HF hospitalization and stroke and no differences in all-cause and
cardiovascular mortality compared with CS. Copyright © 2024 The
Authors

<115>
Accession Number
2036018406
Title
HTK Solution Cardioplegia in Pediatric Patients: A Meta-analysis.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2024. Date of
Publication: 2024.
Author
Galvao L.K.C.S.; de Farias Santos A.C.F.; dos Santos N.P.; Zamora F.V.;
Biavatti B.B.V.; Salles J.P.C.E.A.; Mendonca H.S.
Institution
(Galvao, Zamora) Federal University of Minas Gerais Medicine School, Belo
Horizonte, Brazil
(de Farias Santos) UNICID, Sao Paulo, Brazil
(dos Santos, Salles) UNIRIO, Rio de Janeiro, Brazil
(Biavatti) UNICAMP, Sao Paulo, Campinas, Brazil
(Mendonca) Prevent Senior Private Health Operator, Sao Paulo, Brazil
Publisher
Georg Thieme Verlag
Abstract
Introduction Cardioplegia, a therapy designed to induce reversible cardiac
arrest, revolutionized cardiovascular surgery. Among the various
pharmacological approaches is the histidine-tryptophan-ketoglutarate (HTK)
solution. Despite numerous studies, no meta-analysis has investigated the
efficacy of the HTK solution in the pediatric population. Therefore, we
aim to conduct a meta-analysis comparing HTK and other cardioplegia
solutions in pediatric patients undergoing cardiovascular surgery. Methods
PubMed, Embase, and Cochrane databases were searched from inception
through April 2024. Endpoints were computed in odds ratios (OR) with 95%
confidence intervals (CI) for dichotomous variables, whereas continuous
variables were compared using mean differences (MD) with 95% CI. Results A
total of 11 studies comprising 1,349 patients were included, of whom 677
(50.19%) received HTK cardioplegia. The results were similar between
groups regarding mortality (OR 0.98; 95% CI 0.29, 3.29), length of
hospital stay (MD 0.32 days; 95% CI -0.88, 1.51), Mechanical ventilation
(MV) (MD -17.72 hours; 95% CI -51.29, 15.85), arrhythmias (OR 1.27; 95% CI
0.83, 1.95), and delayed sternal closure (OR 0.89; 95% 0.56, 1.43).
However, transfusion volume was lower in the HTK group (MD -452.39; 95% CI
-890.24, -14.53; p = 0.04). Conclusion The use of HTK solution was
demonstrated to be similar regarding its clinical efficacy to other
approaches for cardioplegia, and it may present advantages to patients
prone to hypervolemia. Copyright © 2024. Thieme. All rights
reserved.

<116>
Accession Number
645903996
Title
Tricuspid valve replacement with mechanical versus biological prostheses:
a systematic review and meta-analysis.
Source
Journal of cardiothoracic surgery. 19(1) (pp 636), 2024. Date of
Publication: 26 Nov 2024.
Author
Abdul Qadeer M.; Abdullah A.; Noorani A.; Khan A.H.; Mustafa M.S.; Nadeem
Z.A.; Samad S.; Siddiq M.U.; Siddiqui R.Q.U.; Said S.M.
Institution
(Abdul Qadeer, Abdullah, Khan, Mustafa, Samad, Siddiq) Department of
Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
(Noorani, Siddiqui) Department of Biochemistry, Jinnah Sindh Medical
University, Karachi, Pakistan
(Nadeem) Department of Medicine, Allama Iqbal Medical College, Lahore,
Pakistan
(Said) Department of Surgery, Division of Pediatric and Adult Congenital
Cardiac Surgery, Maria Fareri Children's Hospital, Westchester Medical
Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595,
United States
(Said) Department of Cardiothoracic Surgery, Faculty of Medicine,
Alexandria University, Alexandria, Egypt
Abstract
BACKGROUND AND OBJECTIVE: Tricuspid valve replacement (TVR) is required
when repair is not feasible, and it continues to be a relatively high-risk
procedure owing to the complex medical and/or surgical profile of
patients. The choice between mechanical and biological prostheses for TVR
remains a subject of debate owing to their distinct advantages and
disadvantages. This study aimed to analyse and compare the clinical
outcomes of these two types of prostheses in the tricuspid position.
 METHOD(S): PubMed, EMBASE, Web of Science, and the COCHRANE library
were searched from 1995 to April 2023 for studies comparing clinical
outcomes of mechanical versus biological valves in the tricuspid position.
Data on 30-day mortality, reoperations, 5-year valve failure rates,
thrombotic/thromboembolic events, and long-term survival were extracted,
pooled, and analysed. Forest plots were generated using a random-effects
model. RESULT(S): From an initial pool of 4716 citations, 37 studies
meeting our inclusion criteria were assessed, collectively encompassing
8316 prostheses (3796 mechanical, 4520 bioprostheses). Our analysis
revealed that mechanical valves exhibited a non-significant trend towards
diminished 30-day mortality (RR=0.85, 95% CI=0.69-1.06). A distinct
disparity emerged in valve durability, with mechanical valves
demonstrating a significantly increased risk of 5-year valve failure
(RR=2.21, 95% CI=1.38-3.56). Strikingly, mechanical valves displayed a
substantial six-fold elevated risk of thrombotic events (RR=6.29, 95%
CI=3.98-9.92). In contrast, the long-term survival and reoperation rates
demonstrated no statistically significant differences between the two
valve types. CONCLUSION(S): This systematic review and meta-analysis
provides insights into the selection of mechanical and bioprosthetic
valves for TVR. These findings highlight the potential advantages and
disadvantages of mechanical and bioprosthetic valves in terms of early
mortality, valve durability, and thrombotic risk. Our analysis provides
clinicians with evidence-based guidance for optimizing outcomes in TVR,
offering a foundation for informed decision-making in this intricate
surgical landscape. Despite these insights, clinicians must overcome the
limitations of retrospective studies, evolving healthcare, and
anticoagulant disparities to ensure careful consideration in tricuspid
valve replacement decisions. Copyright © 2024. The Author(s).

<117>
Accession Number
2032467698
Title
Thromboelastography or rotational thromboelastometry guided algorithms in
bleeding patients: An updated systematic review with meta-analysis and
trial sequential analysis.
Source
Acta Anaesthesiologica Scandinavica. 69(1) (no pagination), 2025. Article
Number: e14558. Date of Publication: January 2025.
Author
Kvisselgaard A.D.; Wolthers S.A.; Wikkelso A.; Holst L.B.; Drivenes B.;
Afshari A.
Institution
(Kvisselgaard) Department of Anesthesia and Intensive Care, Copenhagen
University Hospital-Herlev, Copenhagen, Denmark
(Wolthers) Prehospital Centre Zealand, Naestved, Denmark
(Wikkelso) Department of Anesthesia and Intensive Care Medicine, Zealand
University Hospital-Roskilde, Roskilde, Denmark
(Holst, Afshari) Department of Anesthesia, Juliane Marie Center,
Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
(Drivenes) Department of Intensive Care, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
(Afshari) Institute of Clinical Medicine, University of Copenhagen,
Copenhagen, Denmark
Publisher
John Wiley and Sons Inc
Abstract
Background: Bleeding patients face significant morbidity and mortality due
to impaired haemostasis. Haemostatic resuscitation has evolved, yet the
optimal approach remains unclear. The primary objective was to assess the
benefits and risks of transfusion guided by TEG/ROTEM versus standard of
care in bleeding patients in an updated review. Method(s): This
systematic review of randomised controlled trials with meta-analyses and
trial sequential analysis was conducted according to Cochrane
Collaboration methodology, PRISMA and GRADE guidelines. A literature
search was conducted in five major databases. Both paediatric and adult
patients were included. The primary outcome was mortality, and secondary
outcomes were the administration of blood products, blood loss, surgical
reintervention, and dialysis-dependent renal injury. Result(s): This
systematic review included 31 randomised trials (n = 2756), with most
patients undergoing elective cardiac surgery. TEG-/ROTEM-guided algorithms
reduced the amount of transfused fresh frozen plasma (RR 0.5, 95% CI
0.32-0.72, I2: 94%), platelets (RR 0.7, 95% CI 0.55-0.91,
I2: 57%), the risk for surgical reintervention (RR 0.65, 95% CI
0.47-0.94, I2: 0%), and bleeding with a standard mean
difference of -0.31 (95% CI -0.55 to -0.08, I2: 75%). No
statistically significant difference was demonstrated for mortality (RR
0.76, 95% CI 0.57-1.00, I2: 5%). According to GRADE
methodology, the certainty of the evidence was very low for all outcomes.
Trial sequential analysis of mortality analysis indicated that 54% of the
optimal information size was reached with an alpha-boundary RR of 0.81
(95% CI 0.63-1.03). Conclusion(s): TEG-/ROTEM-guided transfusion
algorithms may reduce the risk of mortality, bleeding volume, and the need
for fresh frozen plasma and platelets, but the evidence is very uncertain.
Further, the results were primarily based on the adult population
undergoing elective cardiac surgery. Copyright © 2024 Acta
Anaesthesiologica Scandinavica Foundation.

<118>
[Use Link to view the full text]
Accession Number
2035740936
Title
Transcatheter Valve Repair in Heart Failure with Moderate to Severe Mitral
Regurgitation.
Source
New England Journal of Medicine. 391(19) (pp 1799-1809), 2024. Date of
Publication: 14 Nov 2024.
Author
Anker S.D.; Friede T.; von Bardeleben R.-S.; Butler J.; Khan M.-S.; Diek
M.; Heinrich J.; Geyer M.; Placzek M.; Ferrari R.; Abraham W.T.; Alfieri
O.; Auricchio A.; Bayes-Genis A.; Cleland J.G.F.; Filippatos G.;
Gustafsson F.; Haverkamp W.; Kelm M.; Kuck K.-H.; Landmesser U.; Maggioni
A.P.; Metra M.; Ninios V.; Petrie M.C.; Rassaf T.; Ruschitzka F.; Schafer
U.; Christian Schulze P.; Spargias K.; Vahanian A.; Zamorano J.L.; Zeiher
A.; Karakas M.; Koehler F.; Lainscak M.; Oner A.; Mezilis N.;
Theofilogiannakos E.K.; Ninios I.; Chrissoheris M.; Kourkoveli P.;
Papadopoulos K.; Smolka G.; Wojakowski W.; Reczuch K.; Pinto F.J.;
Wiewiorka L.; Kalarus Z.; Adamo M.; Santiago-Vacas E.; Ruf T.F.; Gross M.;
Tongers J.; Hasenfuss G.; Schillinger W.; Ponikowski P.
Institution
(Anker, Diek, Haverkamp) Department of Cardiology, German Heart Center
Charite, The Institute of Health Center for Regenerative Therapies, German
Center for Cardiovascular Research (DZHK) Partner Site Berlin, Charite
Universitatsmedizin, Germany
(von Bardeleben, Landmesser) Department of Cardiology, Angiology, and
Intensive Care Medicine, Deutsches Herzzentrum der Charite, Campus
Benjamin Franklin, The Berlin Institute of Health, DZHK Partner Site
Berlin, Germany
(Koehler) Deutsches Herzzentrum der Charite, The Department of Cardiology,
Angiology, and Intensive Care Medicine, Campus Charite Mitte, The Center
for Cardiovascular Telemedicine, DZHK Partner Site Berlin, Charite
Universitatsmedizin Berlin, Germany
(Anker, Diek, Hasenfuss, Schillinger) The Departments of Cardiology and
Pneumology, Germany
(Friede) Departments of Medical Statistics, Germany
(Heinrich) The Clinical Trial Unit, Germany
(Schillinger) University Medical Center Gottingen, The Heart Center,
Germany
(von Bardeleben) Department of Cardiology, Georg August University of
Gottingen, DZHK Partner Site Gottingen, Gottingen, Germany
(Geyer) The Department of Cardiology, University Medical Center, The
Johannes Gutenberg-University Mainz, Mainz, Germany
(Kelm) The Department of Cardiology, Pulmonology, and Vascular Medicine,
University Hospital Dusseldorf, Medical Faculty, The Heinrich Heine
University Dusseldorf, Cardiovascular Research Institute Dusseldorf,
Medical Faculty, University Hospital Dusseldorf, Heinrich Heine
University, Dusseldorf, Germany
(Placzek) The Department of Rhythmology, University Heart Center Lubeck,
University Hospital Schleswig-Holstein, Lubeck, Germany
(Kuck) The West German Heart and Vascular Center, Department of Cardiology
and Vascular Medicine, University Hospital Essen, University
Duisburg-Essen, Essen, Germany
(Schafer) The Heart and Vascular Center, Bad Bevensen, Germany
(Christian Schulze, Ruf) The Department of Internal Medicine I,
Cardiology, University Hospital Jena, Jena, Germany
(Zeiher) The Institute for Cardiovascular Regeneration, Goethe University
Frankfurt, DZHK Partner Site Rhein-Main, Frankfurt am Main, Germany
(Rassaf) The Department of Intensive Care Medicine, University Medical
Center Hamburg-Eppendorf, DZHK Partner Site Hamburg-Kiel-Lubeck, Hamburg,
Germany
(Oner) The Department of Cardiology, Rostock University Medical Center,
Rostock, Germany
(Karakas, Gross) The Department of Medicine, Heart and Vascular Center,
Division of Cardiology and Vascular Medicine, Johanniter Hospital Stendal,
Stendal, Germany
(Tongers) The Mid-German Heart Center, Department of Cardiology,
Angiology, and Intensive Care Medicine, University Hospital Halle, Halle,
Germany
(Butler) The Department of Medicine, University of Mississippi Medical
Center, Jackson, United States
(Butler, Khan) Baylor Scott and White Research Institute, Dallas Baylor
Scott and White the Heart Hospital Plano, Plano, United States
(Khan) The Department of Medicine, Baylor College of Medicine, Temple, TX,
United States
(Ferrari) The Department of Translational Medicine, University of Ferrara,
Ferrara, Italy
(Alfieri) The Cardiac Surgery Unit, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Maggioni) ANMCO Associazione Nazionale Medici Cardiologi Ospedalieri
Research Center, Heart Care Foundation, Florence, Italy
(Metra, Adamo) The Institute of Cardiology, Azienda Socio Sanitaria
Territoriale degli Spedali Civili di Brescia, The Department of Medical
and Surgical Specialties, Radiologic Sciences and Public Health,
University of Brescia, Brescia, Italy
(Abraham) The Division of Cardiovascular Medicine, Ohio State University,
Columbus, United States
(Auricchio) The Department of Cardiology, Cardiocentro Ticino Institute,
Ente Ospedaliero Cantonale, Lugano, Switzerland
(Ruschitzka) The Center for Translational and Experimental Cardiology,
Department of Cardiology, University Hospital Zurich, University of
Zurich, Zurich, Switzerland
(Bayes-Genis, Santiago-Vacas) The Heart Institute, Hospital Universitari
Germans Trias i Pujol, Barcelona, Spain
(Zamorano) The Department of Cardiology, Hospital Universitario Ramon y
Cajal, Centro de Investigacion Biomedica en Red de Enfermedades
Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
(Cleland, Petrie) The School of Cardiovascular and Metabolic Health,
University of Glasgow, British Heart Foundation Glasgow Cardiovascular
Research Centre, Glasgow, United Kingdom
(Filippatos) The Department of Cardiology, Attikon University Hospital,
School of Medicine, National and Kapodistrian University of Athens, Greece
(Spargias, Chrissoheris, Kourkoveli, Papadopoulos) The Department of
Transcatheter Heart Valves, Hygeia Hospital Athens, Greece
(Mezilis, Theofilogiannakos) The Department of Cardiology, St. Luke's
Hospital, Greece
(Ninios, Ninios, Papadopoulos) The European Interbalkan Medical Center,
Thessaloniki, Greece
(Gustafsson) The Department of Cardiology, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
(Vahanian) Unite Formation et Recherche Medecine, Universite de
Paris-Cite, site Bichat, Laboratoire de Recherche Vasculaire
Translationnelle, INSERM, Groupe Hospitalier Bichat, Paris, France
(Lainscak) The Division of Cardiology, General Hospital Murska Sobota,
Murska Sobota, Slovenia
(Lainscak) The Faculty of Medicine, University of Ljubljana, Ljubljana,
Slovenia
(Smolka, Wojakowski) The Division of Cardiology and Structural Heart
Diseases, Poland
(Kalarus) The Department of Cardiology, Congenital Heart Diseases,
Electrotherapy Medical University of Silesia, Katowice, Poland
(Reczuch, Ponikowski) The Institute of Heart Diseases, Medical University,
University Hospital, Wroclaw, Poland
(Wiewiorka) The Department of Interventional Cardiology, Department of
Radiology and Diagnostic Imaging, John Paul II Hospital, Krakow, Poland
(Pinto) Centro Academico de Medicina de Lisboa, Faculdade de Medicina,
Universidade de Lisboa, Lisbon, Portugal
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Whether transcatheter mitral-valve repair improves outcomes in
patients with heart failure and functional mitral regurgitation is
uncertain. METHODS We conducted a randomized, controlled trial involving
patients with heart failure and moderate to severe functional mitral
regurgitation from 30 sites in nine countries. The patients were assigned
in a 1:1 ratio to either transcatheter mitral-valve repair and
guideline-recommended medical therapy (device group) or medical therapy
alone (control group). The three primary end points were the rate of the
composite of first or recurrent hospitalization for heart failure or
cardiovascular death during 24 months; the rate of first or recurrent
hospitalization for heart failure during 24 months; and the change from
baseline to 12 months in the score on the Kansas City Cardiomyopathy
Questionnaire-Overall Summary (KCCQ-OS; scores range from 0 to 100, with
higher scores indicating better health status). RESULTS A total of 505
patients underwent randomization: 250 were assigned to the device group
and 255 to the control group. At 24 months, the rate of first or recurrent
hospitalization for heart failure or cardiovascular death was 37.0 events
per 100 patient-years in the device group and 58.9 events per 100
patient-years in the control group (rate ratio, 0.64; 95% confidence
interval [CI], 0.48 to 0.85; P=0.002). The rate of first or recurrent
hospitalization for heart failure was 26.9 events per 100 patient-years in
the device group and 46.6 events per 100 patient-years in the control
group (rate ratio, 0.59; 95% CI, 0.42 to 0.82; P=0.002). The KCCQ-OS score
increased by a mean (+/-SD) of 21.6+/-26.9 points in the device group and
8.0+/-24.5 points in the control group (mean difference, 10.9 points; 95%
CI, 6.8 to 15.0; P<0.001). Device-specific safety events occurred in 4
patients (1.6%). CONCLUSIONS Among patients with heart failure with
moderate to severe functional mitral regurgitation who received medical
therapy, the addition of transcatheter mitral-valve repair led to a lower
rate of first or recurrent hospitalization for heart failure or
cardiovascular death and a lower rate of first or recurrent
hospitalization for heart failure at 24 months and better health status at
12 months than medical therapy Copyright © 2024 Massachusetts
Medical Society.

<119>
Accession Number
2032490562
Title
Hemoadsorption during cardiopulmonary bypass to absorb plasma-free
hemoglobin in patients with acute type a aortic dissection: A randomized
controlled trial.
Source
Perfusion (United Kingdom). (no pagination), 2024. Date of Publication:
2024.
Author
Bao Y.; Wang X.; Zi Y.; Qian X.; Li Y.; Li S.; Wang Z.
Institution
(Bao, Wang, Zi, Qian, Li, Li, Wang) Department of Cardiovascular Surgery,
Yan'an Affiliated Hospital of Kunming Medical University, Kunming, China
(Bao, Wang, Zi, Qian, Li, Li, Wang) Key Laboratory of Cardiovascular
Disease of Yunnan Province, China
Publisher
SAGE Publications Ltd
Abstract
Aims: This study aimed to investigate the effect of hemoadsorption (HA) on
plasma-free hemoglobin (pfHb) levels during cardiopulmonary bypass (CPB)
and the clinical outcomes in patients with acute type A aortic dissection
(ATAAD). Method(s): In this single-center randomized trial, patients
were assigned to either a group using the HA380 device or a control group
without it. The primary outcome was changes in pfHb levels during CPB and
within the first 48 hours after surgery. The study concentrated on
comparing compared the data between the two groups using analysis of
variance for repeated measures. Concurrently, both correlation and linear
regression analyses were employed to identify the factors influencing pfHb
levels. Result(s): The mean pfHb concentration was lower in the HA380
group than in the control group,but there were no significant differences
between the two groups (F = 2.883, 95% confidence interval CI: -0.006 to
0.072, p =.093) using a repeated measures analysis of covariance model.
Linear regression analysis identified body mass index (BMI) as the primary
factor influencing the adsorption effect (B = 0.01, 95% CI: 0.36-1.24, p
=.001). Additionally, the major postoperative complications within the
first 48 hours did not show significant differences between the groups,
including acute kidney injury (AKI) (25% HA380 group vs 36% control group,
p =.261) and postoperative liver dysfunction (PLD) (5% HA380 group vs 16%
control group, p =.106). Conclusion(s): The use of the HA380 device
in CPB during cardiac operations may contribute to reduced pfHb levels.
However, the difference was statistically non-significant because pfHb
adsorption was notably influenced by the patient's BMI. Consequently, BMI
should be considered when deploying HA380 in prolonged CPB procedures,
including ATADD repair. Enhancing either the number of devices or the
duration of HA in patients with overweight or obesity may potentially
improve postoperative clinical outcomes. Copyright © The
Author(s) 2024.

<120>
Accession Number
2032458521
Title
Effect of Kuanxiong Aerosol on Perioperative Coronary Microcirculation in
Patients with Unstable Angina Undergoing Elective PCI: A Pilot Randomized
Controlled Trial.
Source
Chinese Journal of Integrative Medicine. (no pagination), 2024. Date of
Publication: 2024.
Author
Liu Z.-H.; Xing W.-L.; Liu H.-X.; Shang J.-J.; Li A.-Y.; Zhou Q.; Zhang
Z.-M.; Li Z.-B.; Chen K.-J.
Institution
(Liu, Xing, Liu, Shang, Li, Zhou, Zhang, Li) Cardiovascular Department,
Beijing Hospital of Traditional Chinese Medicine, Capital Medical
University, Beijing 100010, China
(Chen) Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing
100091, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objective: To evaluate the immediate effect of Kuanxiong Aerosol (KXA) on
perioperative coronary microcirculation in patients with unstable angina
(UA) suffering from elective percutaneous coronary intervention (PCI).
 Method(s): From February 2021 to July 2023, UA inpatients who
underwent PCI alone in the left anterior descending (LAD) branch were
included. Random numbers were generated to divide patients into the trial
group and the control group at a ratio of 1:1. The index of coronary
microcirculation resistance (IMR) was measured before PCI, and the trial
group was given two sprays of KXA, while the control group was not given.
IMR was measured again after PCI, cardiac troponin I (cTnI) and creatine
kinase isoenzyme-MB (CK-MB) were detected before and 24 h after surgery,
and major cardiovascular adverse events (MACEs) were recorded for 30 days.
The data statistics and analysis personnel were blinded. Result(s):
Totally 859 patients were screened, and 62 of them were involved into this
study. Finally, 1 patient in the trial group failed to complete the
post-PCI IMR and was excluded, 30 patients were included for data
analysis, while 31 patients in the control group were enrolled in data
analysis. There was no significant difference in baseline data (age,
gender, risk factors, previous history, biochemical index, and drug
therapy, etc.) between the two groups. In addition, differences in IMR,
cTnI and CK-MB were not statistically significant between the two groups
before surgery. After PCI, the IMR level of the trial group was
significantly lower than that of the control group (19.56 +/- 14.37 vs.
27.15 +/- 15.03, P=0.048). Besides, the incidence of perioperative
myocardial injury (PMI) was lower in the trial group, but the difference
was not statistically significant (6.67% vs. 16.13%, P=0.425). No MACEs
were reported in either group. Conclusion(s): KXA has the potential
of improving coronary microvascular dysfunction. This study provides
reference for the application of KXA in UA patients undergoing elective
PCI. (Registration No. ChiCTR2300069831) Copyright © The Chinese
Journal of Integrated Traditional and Western Medicine Press and
Springer-Verlag GmbH Germany, part of Springer Nature 2024.

<121>
Accession Number
645903617
Title
Early outcomes of the novel Myval THV series compared to SAPIEN THV series
and Evolut THV series in individuals with severe aortic stenosis.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
(no pagination), 2024. Date of Publication: 26 Nov 2024.
Author
Royen N.V.; Amat-Santos I.J.; Hudec M.; Bunc M.; Ijsselmuiden A.; Laanmets
P.; Unic D.; Merkely B.; Hermanides R.S.; Ninios V.; Protasiewicz M.;
Rensing B.J.W.M.; Martin P.L.; Feres F.; Sousa M.; Belle E.V.; Linke A.;
Ielasi A.; Montorfano M.; Webster M.; Toutouzas K.; Teiger E.; Bedogni F.;
Voskuil M.; Pan M.; Angeras O.; Kim W.-K.; Rothe J.; Kristic I.; Peral V.;
Van den Branden B.J.L.; Westermann D.; Bellini B.; Garcia-Gomez M.; Tobe
A.; Tsai T.-Y.; Garg S.; Thakkar A.; Chandra U.; Morice M.-C.; Soliman O.;
Onuma Y.; Serruys P.W.; Baumbach A.
Institution
(Royen) Department of Cardiology, Radboud University Hospital, Nijmegen,
Netherlands
(Amat-Santos, Garcia-Gomez) Centro de Investigacion Biomedica en Red -
Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III,
Madrid, Spain
(Amat-Santos, Garcia-Gomez) Department of Cardiology, Hospital Clinico
Universitario de Valladolid, Valladolid, Spain
(Hudec) Department of Acute Cardiology, Middle-Slovak Institute of
Cardiovascular Diseases, Banska Bystrica, Slovakia
(Bunc) Department of Cardiology, University Medical Centre Ljubljana,
Ljubljana, Slovenia
(Ijsselmuiden, Van den Branden) Department of Cardiology, Amphia Hospital,
Breda, Netherlands
(Ijsselmuiden) Zuyderland Hospital, Limburg, Netherlands
(Laanmets) Department of Invasive Cardiology, North Estonia Medical
Centre, Tallinn, Estonia
(Unic) Department of Cardiac and Transplant Surgery, University Hospital
Dubrava, Zagreb, Croatia
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Hermanides) Department of Cardiology, Isala Hospital, Zwolle, Netherlands
(Ninios) Department of Cardiology, European Interbalkan Medical Center,
Thessaloniki, Greece
(Protasiewicz) Department of Cardiology, Institute of Heart Diseases,
Wroclaw Medical University, Wroclaw, Poland
(Rensing) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Netherlands
(Martin) Department of Interventional Cardiology, University Hospital of
Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
(Feres) Department of Invasive Cardiology, Instituto Dante Pazzanese, Sao
Paulo, Brazil
(Sousa) NOVA Medical School, NOVA University Lisbon, Lisbon, Portugal
(Belle) Department of Interventional Cardiology, Lille University, Lille,
France
(Linke) Department of Internal Medicine and Cardiology, University Clinic,
Heart Center Dresden, University of Technology Dresden, Dresden, Germany
(Ielasi) Department of Interventional Cardiology, IRCCS Ospedale Galeazzi
Sant'Ambrogio, Milan, Italy
(Montorfano) 22. School of Medicine, Vita-Salute San Raffaele University,
Milan, Italy
(Montorfano, Bellini) Interventional Cardiology Unit, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Webster) Department of Cardiology, Auckland City Hospital, Auckland, New
Zealand
(Toutouzas) Department of Cardiology, Hippokration Hospital, Athens,
Greece
(Teiger) Department of Interventional Cardiology, Henri Mondor University
Hospital, Creteil, France
(Bedogni) Department of Clinical Cardiology, San Donato Hospital, Milan,
Italy
(Voskuil) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Pan) Department of Cardiology, University Hospital Reina Sofia,
University of Cordoba, IMIBIC, Cordoba, Spain
(Angeras) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Angeras) Department of Molecular and Clinical Medicine, Institute of
Medicine, University of Gothenburg, Gothenburg, Sweden
(Kim) Department of Cardiology & Angiology, University of Giessen and
Marburg, Giesen, Germany
(Kim) Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim,
Germany
(Rothe, Westermann) Department of Cardiology and Angiology, University
Heart Center-University of Freiburg, Campus Bad Krozingen, Bad Krozingen,
Germany
(Rothe) Faculty of Medicine, University of Freiburg, Freiburg, Germany
(Kristic) Department of Cardiology, University Hospital of Split, Split,
Croatia
(Peral) Department of Cardiology University Hospital Son Espases, Health
Research Institute of the Balearic Islands (IdISBa), Palma, Balearic
Islands, Spain
(Tobe, Tsai, Soliman, Onuma, Serruys) Department of Cardiology, School of
Medicine, University of Galway, Galway, Ireland
(Tsai) Cardiovascular Center, Taichung Veterans Hospital, Taiwan (Republic
of China)
(Garg) Department of Cardiology, Royal Blackburn Hospital, Blackburn,
United Kingdom
(Garg) School of Medicine, University of Central Lancashire, Preston,
United Kingdom
(Thakkar, Chandra) Department of Clinical Research, Meril Life Sciences
Pvt. Ltd., Vapi, India
(Morice) Cardiovascular European Research Center (CERC), Massy, France
(Morice) ICPS, Hopital prive Jacques Cartier, Massy, France
(Onuma) Galway University Hospital, Galway, Ireland
(Baumbach) Centre for Cardiovascular Medicine and Devices, William Harvey
Research Institute, Queen Mary University of London and Barts Heart
Centre, London, United Kingdom
(Baumbach) Cleveland Clinic, London, United Kingdom
Abstract
BACKGROUND: There are limited head-to-head randomised trials comparing the
performance of different transcatheter heart valves (THVs). AIMS: We aimed
to evaluate the non-inferiority of the balloon-expandable Myval THV series
compared to the balloon-expandable SAPIEN THV series or the self-expanding
Evolut THV series. METHOD(S): The LANDMARK trial randomised 768
patients in a 1:1 ratio, (Myval THV series [n=384] vs contemporary series
with 50% SAPIEN THV series [n=192] and 50% Evolut THV series [n=192]). The
non-inferiority of Myval over the SAPIEN or Evolut THV series in terms of
the 30-day primary composite safety and effectiveness endpoint as per the
third Valve Academic Research Consortium (VARC-3) was tested in an
intention-to-treat population with a predefined statistical power of 80%
(1-sided alpha of 5%) for a non-inferiority margin of 10.44%.
 RESULT(S): The Myval THV series achieved non-inferiority for the
primary composite endpoint over the SAPIEN THV series (24.7% vs 24.1%,
risk difference [95% confidence interval {CI}]: 0.6% [not applicable {NA}
to 8.0]; p=0.0033) and the Evolut THV series (24.7% vs 30.0%, risk
difference [95% CI]: -5.3% [NA to 2.5]; p<0.0001). The incidences of
pacemaker implantation were comparable (Myval THV series: 15.0%, SAPIEN
THV series: 17.3%, Evolut THV series: 16.8%). At 30 days, the mean
pressure gradient and effective orifice area were significantly better
with the Myval THV series compared to the SAPIEN THV series (p<0.0001) and
better with the Evolut THV series than with the Myval THV series
(p<0.0001). At 30 days, the proportion of moderate to severe prosthetic
valve regurgitation was numerically higher with the Evolut THV series
compared to the Myval THV series (7.4% vs 3.4%; p=0.06), while not
significantly different between the Myval THV series and the SAPIEN THV
series (3.4% vs 1.6%; p=0.32). CONCLUSION(S): The Myval THV series is
non-inferior to the SAPIEN THV series and the Evolut THV series in terms
of the primary composite endpoint at 30 days. CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov: NCT04275726; EudraCT number 2020-000,137-40.

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