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<1>
Accession Number
2031814118
Title
Semaglutide effects on safety and cardiovascular outcomes in patients with
overweight or obesity: a systematic review and meta-analysis: Clinical
Research.
Source
International Journal of Obesity. 49(1) (pp 21-30), 2025. Date of
Publication: 01 Jan 2025.
Author
Cleto A.S.; Schirlo J.M.; Beltrame M.; Gomes V.H.O.; Acras I.H.; Neiverth
G.S.; Silva B.B.; Juliatto B.M.S.; Machozeki J.; Martins C.M.
Institution
(Cleto, Schirlo, Beltrame, Gomes, Acras, Neiverth, Silva, Juliatto,
Machozeki, Martins) State University of Ponta Grossa, Department of
Medicine, Parana, Brazil
Publisher
Springer Nature
Abstract
Background: Semaglutide is a GLP-1 receptor agonist that provides a
reduction in glycated hemoglobin and weight. The objective was to evaluate
whether the use of semaglutide, in individuals with overweight or obesity,
reduces cardiovascular outcomes and adverse effects (AE). Method(s):
The data bases Pubmed, Lilacs, Scielo, Scopus, Web of Science and Cochrane
Library were surveyed. Result(s): Initially, 3333 articles were
found, of which 19 articles were included. An additional search included
19 studies, totaling 38 articles. Relative risk (RR) values were
significant for hospitalization due to heart failure (HF) 0.24 95% CI
0.12-0.57 (n = 2; 1045 participants; I2 = 0.18), death due to
cardiovascular causes 0.83 95% CI 0.71-0.98 (n = 3; 24 084 participants;
I2 = 0.21), death from any cause 0.79 95% CI 0.70-0.89 (n = 3; 24 084
participants; I2 = 0.07), coronary revascularization 0.76 95% CI 0.69-0.85
(n = 2;20 951 participants; I2 = 0.41), and non-fatal myocardial
infarction 0.76 95%CI 0.66-0.88 (n = 3; 24 084 participants; I2 = 0.21),
with a difference between the subgroups (p = 0.05), favoring the
subcutaneous administration route. The RR of stroke was 0.65 95% CI
0.44-0.97 for patients with diabetes (n = 2; 6480 participants; I2 =
0.66). There was no difference between the frequency of constipation and
routes of administration, as well as between doses of oral semaglutide.
The RR of adverse effects was only not significant for discontinuation of
treatment for oral semaglutide. Conclusion(s): The use of semaglutide
reduced 76% in hospitalization due to HF, 17% deaths due to cardiovascular
causes, 21% deaths due to any cause, 24% non-fatal myocardial infarction,
24% coronary revascularization and 35% stroke (in patients with diabetes).
The use of semaglutide was associated with a higher relative risk and
frequency of most adverse effects evaluated. Copyright © The
Author(s), under exclusive licence to Springer Nature Limited 2024.

<2>
Accession Number
2032105651
Title
Components of home-based palliative and supportive care for adults with
heart failure: A scoping review.
Source
Palliative Medicine. 39(1) (pp 86-98), 2025. Date of Publication: 01 Jan
2025.
Author
Perera M.; Halahakone U.; Senanayake S.; Kularatna S.; Parsonage W.; Yates
P.; Singh G.K.
Institution
(Perera, Yates, Singh) Cancer and Palliative Care Outcomes Centre, School
of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
(Perera, Halahakone, Senanayake, Kularatna, Parsonage, Yates, Singh)
Centre for Healthcare Transformation, Faculty of Health, Queensland
University of Technology, Brisbane, QLD, Australia
(Halahakone, Senanayake, Kularatna, Parsonage) Australian Centre for
Health Service Innovation, Queensland University of Technology, Brisbane,
QLD, Australia
(Senanayake, Kularatna) Health Services and Systems Research, Duke-NUS
Medical School, Singapore, Singapore
(Senanayake, Kularatna) National Heart Research Institute Singapore,
National Heart Centre Singapore, Singapore, Singapore
(Parsonage) Department of Cardiology, Royal Brisbane & Women's Hospital,
Brisbane, QLD, Australia
Publisher
SAGE Publications Ltd
Abstract
Background: Palliative care and supportive care provided in the home for
people with heart failure can improve quality of life, caregiver wellbeing
and reduce healthcare costs. Identifying components of home-based
palliative and supportive care in heart failure is useful to inform
tailored care to people with heart failure. Aim(s): To identify and
describe components of home-based palliative and supportive care in adults
with heart failure. Design(s): A scoping review was undertaken in
accordance with Joanna Briggs Institute guidelines. The protocol was
registered prospectively with the Open Science Framework
(https://doi.org/10.17605/OSF.IO/GHCME). Data sources: Embase, PubMed,
CINAHL and Cochrane databases were searched from inception in May 2023 and
re-run in January 2024. Original research focussed on palliative and
supportive care in the home setting that included adults diagnosed with
heart failure who have not undergone nor awaiting a heart transplant was
included. Result(s): Results were extracted from 13 papers based on
eight studies. The findings highlight that nurses supported by a
multidisciplinary team, providing symptom management, patient and carer
education and discussion of goals of care and advance care planning,
facilitates home-based palliative and supportive care for people with
heart failure. Conclusion(s): Ensuring patient and caregiver-centred
care supported by a multidisciplinary team is essential to delivering
home-based palliative and supportive care for people with heart failure.
Further research focussed on the role of digital interventions in
home-based palliative and supportive care, the composition of the
multidisciplinary team and research which includes individuals across all
stages of heart failure is needed. Copyright © The Author(s)
2024.

<3>
Accession Number
2036686668
Title
Wearable devices, ischemic heart disease and cardiovascular outcomes: A
systematic review and meta-analysis.
Source
Maturitas. 193 (no pagination), 2025. Article Number: 108186. Date of
Publication: 01 Feb 2025.
Author
Ballavenuto J.M.A.; Tongtip N.; Fischer N.L.S.; Bardus M.
Institution
(Ballavenuto, Tongtip, Fischer, Bardus) Applied Health Sciences, School of
Health Sciences, College of Medicine and Health, University of Birmingham,
Birmingham, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: To evaluate the impact of wearable devices when associated
with usual care on the incidence of major adverse cardiovascular events
(MACE) in patients with ischemic heart disease compared with usual care
alone. Method(s): Randomised clinical trials with patients aged 18
years and above with ischemic heart disease, using wearable devices and
assessing at least one of the primary outcomes (myocardial infarction,
stroke, cardiovascular mortality, or major adverse cardiovascular events)
or secondary outcomes (all-cause mortality, hospitalisation, all
arrhythmias, heart failure, unstable angina or revascularisation
procedures) were included. MEDLINE, EMBASE, Cochrane Library, CINHAL,
INAHTA and the Web of Science Core Collection were searched in April 2024.
Studies were also identified via citation searching. Cochrane Risk of Bias
version 1 was applied as provided in Covidence. Meta-analyses were
performed when possible. Result(s): Six studies of moderate quality
were included. Wearables showed positive effects in reducing major adverse
cardiovascular events (RR 0.75, 95 % CI 0.57-0.98, two studies) and
all-cause mortality (RR 0.64, 95 % CI 0.43-0.96, three studies); no
significant effects were found on myocardial infarction (RR 0.89, 95 % CI
0.59-1.34, four studies), cardiovascular mortality (RR 0.35, 95 % CI
0.07-1.73, three studies), hospitalisations (RR 0.77, 95 % CI 0.56-1.07,
five studies), all arrhythmias (RR 1.10, 95 % CI 0.49-2.48, two studies),
and heart failure (RR 0.85, 95 % CI 0.61-1.18, two studies). Meta-analysis
could not be performed for stroke, unstable angina, and revascularisation
procedures. Grading of Recommendations Assessment, Development and
Evaluation (GRADE) certainty of evidence was deemed low or very low.
 Discussion(s): While wearables seem to have some positive effects for
patients with ischemic heart disease, only weak recommendations for use
are possible. More large-scale, high-quality randomised clinical trials
are needed to recommend the routine use of wearables in combination with
usual care. Protocol registration on PROSPERO:
CRD42024586137 Copyright © 2024 The Authors

<4>
Accession Number
2030893322
Title
The effects of diuretic deprescribing in adult patients: A systematic
review to inform an evidence-based diuretic deprescribing guideline.
Source
British Journal of Clinical Pharmacology. 91(1) (pp 38-54), 2025. Date of
Publication: 01 Jan 2025.
Author
van Poelgeest E.; Paoletti L.; Ozkok S.; Pinar E.; Bahat G.; Vuong V.;
Topinkova E.; Daams J.; McCarthy L.; Thompson W.; van der Velde N.
Institution
(van Poelgeest, van der Velde) Department of Internal Medicine/Geriatrics,
Amsterdam University Medical Center, University of Amsterdam, Meibergdreef
9, Amsterdam, Netherlands
(van Poelgeest, van der Velde) Aging and Later Life, Amsterdam Public
Health Research Institute, Amsterdam, Netherlands
(Paoletti) Pharmacy Department, IRCCS San Raffaele Hospital, Milan, Italy
(Ozkok, Pinar, Bahat) Istanbul Medical Faculty, Department of Internal
Medicine, Division of Geriatrics, Capa, Istanbul University, Istanbul,
Turkey
(Vuong, McCarthy) Trillium Health Partners, Mississauga, ON, Canada
(Vuong, McCarthy) Leslie Dan Faculty of Pharmacy, University of Toronto,
Toronto, ON, Canada
(Topinkova) Department of Geriatrics, 1st Faculty of Medicine Charles
University, Prague, Czechia
(Topinkova) General Faculty Hospital, Prague, Czechia
(Topinkova) Faculty of Health and Social Sciences, University of South
Bohemia, Ceske Budejovice, Czechia
(Daams) Medical Library, Amsterdam University Medical Center, University
of Amsterdam, Amsterdam, Netherlands
(Thompson) Department of Anesthesiology, Pharmacology, and Therapeutics,
Faculty of Medicine, University of British Columbia, Vancouver, Canada
Publisher
John Wiley and Sons Inc
Abstract
In this systematic review, we report on the effects of diuretic
deprescribing compared to continued diuretic use. We included clinical
studies reporting on outcomes such as mortality, heart failure recurrence,
tolerability and feasibility. We assessed risk of bias and certainty of
the evidence using the GRADE framework. We included 25 publications from
22 primary studies (15 randomized controlled trials; 7 nonrandomized
studies). The mean number of participants in the deprescribing groups was
35, and median/mean age 64 years. In patients with heart failure, there
was no clear evidence that diuretic deprescribing was associated with
increased mortality compared to diuretic continuation (low certainty
evidence). The risk of cardiovascular composite outcomes associated with
diuretic deprescribing was inconsistent (studies showing lower risk for
diuretic deprescribing, or comparable risk with diuretic continuation;
very low certainty evidence). The effect on heart failure recurrence after
diuretic deprescribing in patients with diuretics for heart failure, and
of hypertension in patients with diuretics for hypertension was
inconsistent across the included studies (low certainty evidence). In
patients with diuretics for hypertension, diuretic deprescribing was well
tolerated (moderate certainty evidence), while in patients with diuretics
for heart failure, deprescribing diuretics can result in complaints of
peripheral oedema (very low certainty evidence). The overall risk of bias
was generally high. In summary, this systematic review suggests that
diuretic discontinuation could be a safe and feasible treatment option for
carefully selected patients. However, there isa lack of high-quality
evidence on its feasibility, safety and tolerability of diuretic
deprescribing, warranting further research. Copyright © 2024 The
Author(s). British Journal of Clinical Pharmacology published by John
Wiley & Sons Ltd on behalf of British Pharmacological Society.

<5>
Accession Number
2036593191
Title
Comparative safety between transdiaphragmatic and subxiphoid mediastinal
access modality in patients undergoing hybrid Convergent atrial
fibrillation ablation: A systematic review and meta-analysis.
Source
European Journal of Arrhythmia and Electrophysiology. 10(Supplement 1) (pp
82-83), 2024. Date of Publication: 2024.
Author
Urgesi E.U.; Mukhtar I.M.; Ahmed O.A.; Behr E.B.; Momin A.M.; Kaba R.A.K.
Institution
(Urgesi, Mukhtar, Ahmed, Momin, Kaba) Department of Cardiology, Ashford
and St Peter's NHS Foundation Trust, London, United Kingdom
(Ahmed, Behr, Momin, Kaba) Cardiovascular Clinical Academic Group,
Molecular and Clinical Sciences Institute, St George's University of
London and St George's University Hospitals NHS Foundation Trust, London,
United Kingdom
(Kaba) Centre for Biomedical Sciences, Biological Sciences, Royal
Holloway, University of London, London, United Kingdom
Publisher
Touch Medical Media
Abstract
Introduction: Hybrid ablation has become a well-established, efficacious
approach for the treatment of resistant varieties of atrial fibrillation
(AF), with the convergent procedure (CP) emerging as the least invasive
form of such therapy. In recent years, growing concerns regarding the
safety profile of the transabdominal, transdiaphragmatic (TD) CP approach
led to the development of an alternative, and even less invasive,
technique that achieves epicardial access via a subxiphoid (Sub-X) means
of entry. We aimed to perform a review of the available evidence and
compare the safety profiles between TD and Sub-X epicardial components of
the hybrid CP. Method(s): We performed a comprehensive online search
of PubMed for cohort, case-control, or RCT studies investigating adult
patients undergoing the CP via either TD or Sub-X approach, excluding any
concomitant cardiac surgery, patients affected by valvular-AF or
hypertrophic cardiomyopathy. Safety was defined as 30-day operative
mortality and major procedural complication rates. Results are presented
as absolute rates and 95% confidence intervals (CIs), employing
appropriate meta-analysis tools for transformations, risk of biases and
controls for family-wise error rates. Result(s): Of 12,717 screened
articles, 954 patients (293 Sub-X, 661 TD) from 14 (13 cohort, 1 RCT)
studies met our study criteria. No study was found to be at high risk of
bias. Rates of overall major complications (10.4% versus 7.2%), 30-day
operative mortality (1.7% versus 0.7%), atrio-oesophageal fistula (AOF:
0.9% versus 0%), cardiac tamponade (1.7% versus 1.0%), stroke (1.2% versus
0%), major bleeding (1.4% versus 0.3%), and incisional abdominal wall
hernia (1.5% versus 0.3%) were all higher in the TD group. Pericardial
effusions were more common in the Sub-X group (1.7% versus 0.6%). Here,
most major complications (16/22) were reported by the study with the
earliest recruitment period (2009-2020) - lower overall major
complications were noted in the remaining studies (4.4% versus 10.1%).
Meta-analysis showed an overall incidence of major complications of 12.3%
(CI: 7.9-17.5; p<0.001) and 5.4% (CI: 0.9-12.7; p:0.003) in the TD and
Sub-X groups, respectively. Mortality was significant in the TD (0.9%; CI:
0.02-2.4; p: 0.025) but not in the Sub-X group (0.3%; CI: 0-1.7; p:0.259).
In the TD group, AOF represented the leading cause of death, in 6/11
events. Stroke/TIA (1.1%; CI: 0.3-2.3; p<0.001), major bleeding (0.8%; CI:
0.04-1.8; p:0.014) and tamponades/effusions (1.7%; CI: 0.6-3.2; p<0.001)
were all found to be significant in the TD group. Stroke/TIA (0.5%; CI:
0-2.1; p: 0.118) and major bleeding (0.1%; CI: 0-1.2; p: 0.555) were not
significant in the Sub-X group - although tamponades/effusions (2.1%; CI:
0.4-4.7; p: 0.002) was. No significant publication bias or small study
effect were noted. Conclusion(s): Major complications following the
Sub-X CP were found to be less common compared to the TD technique, with a
clear trend favouring the Sub-X CP observed for nearly all point
estimates. Indeed, major complications were found to be twice as common
via meta-analysis in the TD group and seldomly statistically significant
in the Sub-X group. Our data supports the anatomical advantage of the
Sub-X CP over the TD approach, thus advocating for its implementation as
the mainstay of hybrid Convergent therapy in patients undergoing ablation
for the more complex forms of AF.(Image Presented) Copyright ©
(2024), (Touch Medical Media). All Rights Reserved.

<6>
Accession Number
2032778819
Title
Sex-based Disparities in Morbidity and Mortality Following Coronary Artery
Bypass Grafting: an Updated Systematic Review and Meta-analysis.
Source
SN Comprehensive Clinical Medicine. 7(1) (no pagination), 2024. Article
Number: 8. Date of Publication: 01 Dec 2024.
Author
Sebastian S.A.; Vaja H.; Shah Y.; Chitagi P.
Institution
(Sebastian) Department of Internal Medicine, Azeezia Medical College,
Kerala, Kollam, India
(Vaja) Department of Internal Medicine, Byramjee Jeejeebhoy Medical
College & Civil Hospital, Gujarat, Ahmedabad, India
(Shah, Chitagi) Department of Internal Medicine, Trinity Health Oakland/
Wayne State University, Pontiac, MI, United States
(Sebastian) AirdrieCanada
Publisher
Springer Nature
Abstract
Sex is suggested to play a role in influencing outcomes after coronary
artery bypass grafting (CABG). However, the evidence regarding its impact
on long-term mortality and other clinical outcomes remains inconclusive.
Our study aims to comprehensively analyze and elucidate sex differences in
morbidity and mortality among individuals undergoing CABG. A systematic
search was performed of the following databases MEDLINE (via PubMed),
Google Scholar, the Cochrane Library, and ScienceDirect to identify
studies on sex differences in post-CABG outcomes from January 2010 to
April 2024. Statistical analysis was performed using RevMan 5.4, applying
an inverse variance random effects model to pool hazard ratio (HR) and
odds ratio (OR) for primary and secondary outcomes. The study protocol is
registered with PROSPERO (CRD42024516859). The final analysis comprised 35
studies involving 14,740,743 participants, with 34.4% being females. The
average age was 67.2 years for females and 63.7 years for males. Upon
pooled analysis, no statistically significant differences were observed in
the composite outcome of major adverse cardiovascular events (MACE) (HR:
1.03, 95% CI: 0.89 to 1.19, p = 0.69). However, there was a significant
increase in the risk of all-cause mortality in females, with a reported HR
of 1.14 (95% CI: 1.09 to 1.19, p < 0.00001). Similarly, females showed a
statistically significant higher risk of short-term mortality
(in-hospital/30-day mortality) with an OR of 1.73 (95% CI: 1.61 to 1.86, p
< 0.00001) and postoperative stroke with an OR of 1.28 (95% CI: 1.15 to
1.43, p < 0.00001), respectively. In contrast, the incidence of myocardial
infarction (MI) (OR: 1.13, 95% CI: 0.97 to 1.32, p = 0.12), cardiovascular
mortality (OR: 1.67, 95% CI: 0.84 to 3.32, p = 0.14), and repeat
revascularization (OR: 1.42, 95% CI: 0.30 to 6.68, p = 0.66) did not show
statistically significant differences between females and males. In
conclusion, females undergoing CABG exhibited an increased risk of
all-cause mortality, short-term mortality, and postoperative stroke,
underscoring the need for focused efforts to understand and mitigate this
sex-based disparity. Copyright © The Author(s), under exclusive
licence to Springer Nature Switzerland AG 2024.

<7>
Accession Number
2032753189
Title
Current Advances and Future Directions of Pluripotent Stem Cells-Derived
Engineered Heart Tissue for Treatment of Cardiovascular Diseases.
Source
Cells. 13(24) (no pagination), 2024. Article Number: 2098. Date of
Publication: 01 Dec 2024.
Author
He X.; Good A.; Kalou W.; Ahmad W.; Dutta S.; Chen S.; Lin C.N.; Chella
Krishnan K.; Fan Y.; Huang W.; Liang J.; Wang Y.
Institution
(He, Good, Kalou, Ahmad, Chen, Lin, Liang, Wang) Department of Pathology
and Laboratory Medicine, College of Medicine, University of Cincinnati,
Cincinnati, OH, United States
(Dutta, Huang) Department of Internal Medicine, College of Medicine,
University of Cincinnati, Cincinnati, OH, United States
(Chella Krishnan) Department of Pharmacology and Systems Physiology,
College of Medicine, University of Cincinnati, Cincinnati, OH, United
States
(Fan) Department of Cancer Biology, College of Medicine, University of
Cincinnati, Cincinnati, OH, United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Cardiovascular diseases resulting from myocardial infarction (MI) remain a
leading cause of death worldwide, imposing a substantial burden on global
health systems. Current MI treatments, primarily pharmacological and
surgical, do not regenerate lost myocardium, leaving patients at high risk
for heart failure. Engineered heart tissue (EHT) offers a promising
solution for MI and related cardiac conditions by replenishing myocardial
loss. However, challenges like immune rejection, inadequate
vascularization, limited mechanical strength, and incomplete tissue
maturation hinder clinical application. The discovery of human-induced
pluripotent stem cells (hiPSCs) has transformed the EHT field, enabling
new bioengineering innovations. This review explores recent advancements
and future directions in hiPSC-derived EHTs, focusing on innovative
materials and fabrication methods like bioprinting and decellularization,
and assessing their therapeutic potential through preclinical and clinical
studies. Achieving functional integration of EHTs in the heart remains
challenging due to the need for synchronized contraction, sufficient
vascularization, and mechanical compatibility. Solutions such as genome
editing, personalized medicine, and AI technologies offer promising
strategies to address these translational barriers. Beyond MI, EHTs also
show potential in treating ischemic cardiomyopathy, heart valve
engineering, and drug screening, underscoring their promise in
cardiovascular regenerative medicine. Copyright © 2024 by the
authors.

<8>
Accession Number
2036717605
Title
ERS statement on benign pleural effusions in adults.
Source
European Respiratory Journal. 64(6) (no pagination), 2024. Article Number:
64. Date of Publication: 2024.
Author
Sundaralingam A.; Grabczak E.M.; Burra P.; Costa M.I.; George V.; Harriss
E.; Jankowska E.A.; Janssen J.P.; Karpathiou G.; Laursen C.B.; Maceviciute
K.; Maskell N.; Mei F.; Nagavci B.; Panou V.; Pinelli V.; Porcel J.M.;
Ricciardi S.; Shojaee S.; Welch H.; Zanetto A.; Udayaraj U.P.; Cardillo
G.; Rahman N.M.
Institution
(Sundaralingam, Rahman) Oxford Respiratory Trials Unit, Churchill
Hospital, Headington, United Kingdom
(Sundaralingam, Rahman) Oxford Pleural Unit, Oxford Centre for Respiratory
Medicine, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
(Sundaralingam) School of Pharmacy and Biomedical Sciences, University of
Portsmouth, Portsmouth, United Kingdom
(Grabczak) Department of Internal Medicine, Pulmonary Diseases and
Allergy, Medical University of Warsaw, Warsaw, Poland
(Burra, Zanetto) Gastroenterology and Multivisceral Transplant Unit,
Department of Surgery, Oncology, and Gastroenterology, Padua University
Hospital, Padua, Italy
(Costa) Pulmonology Department, Centro Hospitalar Universitario de Santo
Antonio, Porto, Portugal
(George) Department of Respiratory and Sleep Medicine, John Hunter
Hospital, Newcastle, Australia
(George) Hunter Medical Research Institute, Newcastle, Australia
(Harriss) Bodleian Health Care Libraries, University of Oxford, Oxford,
United Kingdom
(Jankowska) Division of Translational Cardiology and Clinical Registries,
Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
(Janssen) Dept of Pulmonary Diseases, Canisius Wilhelmina Hospital,
Nijmegen, Netherlands
(Karpathiou) Pathology Department, University Hospital of Saint Etienne,
Saint Etienne, France
(Laursen, Panou) Department of Respiratory Medicine, Odense University
Hospital, Odense, Denmark
(Laursen, Panou) Odense Respiratory Research Unit (ODIN), Department of
Clinical Research, University of Southern Denmark, Odense, Denmark
(Maceviciute) St Bartholomew's Hospital, London, United Kingdom
(Maskell, Welch) Academic Respiratory Unit, University of Bristol,
Bristol, United Kingdom
(Mei) Department of Biomedical Sciences and Public Health, Polytechnic
University of Marche, Marche, Italy
(Mei) Respiratory Disease Unit, University Hospital, Ancona, Italy
(Nagavci) Institute for Evidence in Medicine, Faculty of Medicine and
Medical Center, University of Freiburg, Freiburg, Germany
(Panou) Department of Respiratory Diseases, Aalborg University Hospital,
Aalborg, Denmark
(Pinelli) Division of Pulmonology, ASL5 Spezzino, La Spezia, Italy
(Porcel) Pleural Medicine Unit, Arnau de Vilanova University Hospital,
Lleida, Spain
(Ricciardi) Division of Thoracic Surgery, San Camillo Forlanini Hospital,
Rome, Italy
(Ricciardi) PhD program Alma Mater Studiorum, University of Bologna,
Bologna, Italy
(Shojaee) Division of Allergy, Pulmonary and Critical Care Medicine,
Vanderbilt University Medical Center, Nashville, TN, United States
(Udayaraj) Oxford Kidney Unit, Churchill Hospital, Oxford, United Kingdom
(Udayaraj) Nuffield Department of Medicine, Henry Wellcome Building for
Molecular Physiology, University of Oxford, Oxford, United Kingdom
(Cardillo) Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo
Forlanini, Rome, Italy
(Cardillo) Unicamillus, International University of Health Sciences, Rome,
Italy
(Rahman) NIHR Oxford Biomedical Research Centre, University of Oxford,
Oxford, United Kingdom
(Rahman) Chinese Academy of Medical Health Sciences, University of Oxford,
Oxford, United Kingdom
Publisher
European Respiratory Society
Abstract
The incidence of non-malignant pleural effusions far outweighs that of
malignant pleural effusions and is estimated to be at least 3-fold higher.
These so-called benign effusions do not follow a "benign course" in many
cases, with mortality rates matching and sometimes exceeding those of
malignant pleural effusions. In addition to the impact on patients,
healthcare systems are also significantly affected, with recent US
epidemiological data demonstrating that 75% of resource allocation for
pleural effusion management is spent on non-malignant pleural effusions
(excluding empyema). Despite this significant burden of disease, and by
existing at the junction of multiple medical specialties, reflecting a
heterogenous constellation of medical conditions, non-malignant pleural
effusions are rarely the focus of research or the subject of management
guidelines. With this European Respiratory Society Task Force, we
assembled a multispecialty collaborative across 11 countries and three
continents to provide a statement based on systematic searches of the
medical literature to highlight evidence in the management of the
following clinical areas: a diagnostic approach to transudative effusions,
heart failure, hepatic hydrothorax, end-stage renal failure, benign
asbestos-related pleural effusion, post-surgical effusion and nonspecific
pleuritis. Copyright ©The authors 2024.

<9>
Accession Number
2032040496
Title
Drug-coated balloons in high-risk patients and diabetes mellitus: A
meta-analysis of 10 studies.
Source
Catheterization and Cardiovascular Interventions. 104(7) (pp 1423-1433),
2024. Date of Publication: 01 Dec 2024.
Author
Verdoia M.; Nardin M.; Rognoni A.; Cortese B.
Institution
(Verdoia, Rognoni) Division of Cardiology, ASL, Biella, Italy
(Nardin) Department of Internal Medicine, Spedali Civili, Brescia, Italy
(Cortese) Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
(Cortese) DCB Academy, Milano, Italy
Publisher
John Wiley and Sons Inc
Abstract
Background: Despite the improvements in drug eluting stents (DES)
technology, suboptimal results have been observed in certain higher-risk
subsets of patients, as in diabetes mellitus (DM). Drug-coated balloons
(DCB) could represent an alternative to DES in complex populations and
anatomies, as in DM. Aim(s): The present meta-analysis aimed at
assessing the role of DCBs in patients with diabetes mellitus.
 Method(s): Studies comparing DCB versus percutaneous coronary
revascularization (PCI) with/without DES for PCI in high-risk populations
(>30% DM) were included. The primary efficacy endpoint was overall
mortality, secondary endpoints were myocardial infarction, target lesion
revascularization (TLR), and major adverse cardiovascular events (MACE).
 Result(s): We included 10 studies, comprising 2026 patients. Among
them, 1002 patients (49.5%) were treated with DCB and 1024 with DES
implantation. Among the included studies, 6 only enrolled diabetic
patients and 2 had a prevalence of diabetes of 50%. At a mean follow-up of
15.3 months, mortality rate was 3.8% (82 patients), significantly lower
with DCB (3.2% vs. 4.9% with DES; odds ratio [OR] [95% confidence interval
{CI}] = 0.61 [0.38, 0.97], p = 0.04 p<inf>het</inf> = 0.34. A similar
reduction in favor of DCB was observed for MACE (13.6% vs. 17.6%; OR [95%
CI] = 0.79 [0.61, 1.04], p = 0.09, p<inf>het</inf> = 0.25), while TLR was
significantly reduced only in the diabetic-restricted sub-analysis.
 Conclusion(s): In the present meta-analysis, we showed a significant
survival benefit and an absolute reduction in MACE and TLR with a
DCB-based strategy as compared to DES in high-risk patients, mostly with
DM. Future large-scale randomized trials, dedicated to this population,
are deserved to confirm our findings. What is Known: Complex coronary
anatomies and diabetes mellitus (DM) represent the pitfall of drug eluting
stents (DES), mainly due to inflammatory and thrombotic complications,
which should be reduced with drug-coated balloons (DCB). What is New: We
confirmed a significant advantage of DCB versus DES in the treatment of de
novo lesions in high-risk patients and mainly in DM, reducing overall
mortality, MACE and target lesion revascularization. Copyright ©
2024 Wiley Periodicals LLC.

<10>
Accession Number
2032687865
Title
Identifying Paediatric Populations with Increased Risk for Oropharyngeal
Dysphagia in Acute and Critical Care Settings: A Scoping Review.
Source
Dysphagia. (no pagination), 2024. Date of Publication: 2024.
Author
Grunke C.; Marshall J.; Miles A.; Carrigg B.; Ward E.C.
Institution
(Grunke, Marshall, Ward) School of Health and Rehabilitation Sciences, The
University of Queensland, Brisbane, Australia
(Marshall) Queensland Children's Hospital, Children's Health Queensland
Hospital and Health Service, Brisbane, Australia
(Miles) Speech Science, School of Psychology, The University of Auckland,
Auckland, New Zealand
(Carrigg) The Royal Children's Hospital, Melbourne, Australia
(Ward) Centre for Functioning and Health Research (CFAHR), Metro South
Hospital and Health Service, Brisbane, Australia
Publisher
Springer
Abstract
Dysphagia is common in hospitalised children. Clarity regarding its
prevalence is required to direct service needs. This review reports
oropharyngeal dysphagia prevalence in children admitted to acute and/or
critical care, following acute illness, medical or surgical intervention.
It also explores patient characteristics significantly associated with
oropharyngeal dysphagia in these settings. Five electronic databases
(EMBASE, CINAHL, Cochrane, PubMed, Scopus) were searched. Studies
identified for inclusion involved children (0-16 years), in acute or
critical care settings, where prevalence data for new-onset or worsening
oropharyngeal dysphagia was reported. Peer reviewed journal articles,
including systematic reviews were included. Data was extracted and
synthesised using a purpose designed extraction tool. A total of 7,522
studies were screened and 67 studies met criteria. The most researched
populations included congenital heart disease surgeries, posterior fossa
tumour resections, stroke and post-extubation dysphagia. Populations with
the highest documented dysphagia prevalence were children after posterior
fossa tumour resection with a new tracheostomy, children using nasal
continuous positive airway pressure, and children following ischemic
stroke. Characteristics significantly associated with oropharyngeal
dysphagia were younger age, lower weight, longer intubation, upper/middle
airway dysfunction (e.g., vocal paresis), and presence of additional
comorbidities. This review presents synthesised prevalence data for
children in acute and critical care settings with new-onset or worsening
oropharyngeal dysphagia. It highlights the broad nature of oropharyngeal
dysphagia in hospitalised children and the need for more rigorous research
into characteristics associated with increased risk to better support
screening and early identification of oropharyngeal dysphagia in these
settings. Copyright © The Author(s), under exclusive licence to
Springer Science+Business Media, LLC, part of Springer Nature 2024.

<11>
Accession Number
2036604226
Title
The effect of stand-alone and additional preoperative video education on
patients' knowledge of anaesthesia: A randomised controlled trial.
Source
European Journal of Anaesthesiology. (no pagination), 2024. Article
Number: 10.1097/EJA.0000000000002109. Date of Publication: 2024.
Author
Van Den Heuvel S.F.; Jonker P.; Hoeks S.E.; Ismail S.Y.; Stolker R.J.;
Korstanje J.-W.H.
Institution
(Van Den Heuvel, Jonker, Hoeks, Stolker, Korstanje) Department of
Anaesthesiology, Erasmus MC University, Medical Centre Rotterdam, CA,
Rotterdam, Netherlands
(Ismail) The Department of Psychiatry, Erasmus MC University, Medical
Centre Rotterdam, Rotterdam, Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND Fully digital preoperative information could save valuable time
and resources. However, compared with face to face consultations,
equivalent levels of safety, patient satisfaction and participation need
to be maintained when using other methods to inform patients. This trial
compared knowledge retention between preoperative stand-alone video
education and face-to-face education by an anaesthesiologist. OBJECTIVES
To assess if video education, alone or combined with face-to-face
education, leads to better knowledge retention more than conventional
face-to-face education. DESIGN A randomised controlled trial with four
arms: Video, Anaesthesiologist, Video & Anaesthesiologist, and Reference
for baseline measurements and exploration of a test-enhanced learning
effect. SETTING A Dutch tertiary care centre from February 2022 to
February 2023. PATIENTS A total of 767 adult patients undergoing
preoperative consultation for elective non-cardiothoracic surgery, with
677 included in the complete case analysis. INTERVENTION(S) Stand-alone
preoperative video education and video education in combination with
face-to-face education in the preoperative outpatient clinic. MAIN OUTCOME
MEASURES Primary outcome, measured by the Rotterdam Anaesthesia Knowledge
Questionnaire, was knowledge retention on day 0. Secondary outcomes
included knowledge retention at 14 and 42 days, preoperative anxiety, and
the need for additional information using the Amsterdam Preoperative
Anxiety and Information Scale. Other outcomes were satisfaction,
self-assessed knowledge, and test-enhanced learning effect. RESULTS
Stand-alone video education led to higher Rotterdam Anaesthesia Knowledge
Questionnaire scores than face-to-face education on day 0: median [IQR],
87.5 [81.3 to 93.8] vs. 81.3 [68.8 to 87.5], P < 0.001. Combined education
in the "Video & Anaesthesiologist"group led to better knowledge retention
compared with both the "Anaesthesiologist"group and the Video group: 93.8
[87.5 to 93.8] vs. 81.3 [68.8 to 87.5], P < 0.001; 93.8 [87.5 to 93.8] vs.
87.5 [81.3 to 93.8], P = 0.01, respectively. No differences in the
patients' preoperative anxiety and satisfaction levels were found.
CONCLUSION Compared with face-to-face education by an anaesthesiologist,
stand-alone video and combined video education improve short-term
knowledge retention, without increasing patient anxiety. TRIAL
REGISTRATION ClinicalTrials.gov Identifier: NCT05188547
(https://clinicaltrials.gov/ct2/show/NCT05188547). Copyright ©
2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of
the European Society of Anaesthesiology.

<12>
Accession Number
2032709185
Title
Effect of individualized versus conventional perioperative blood pressure
management on postoperative major complications in high-risk patients
undergoing noncardiac surgery: study protocol for the SPROUT-4 multicenter
randomized controlled trial.
Source
Trials. 25(1) (no pagination), 2024. Article Number: 850. Date of
Publication: 01 Dec 2024.
Author
Chung J.; Koo C.-H.; Park J.; Kim H.-B.; Bae J.; Ju J.-W.; Lee S.; Oh
A.R.; Kim H.S.; Park S.J.; Jeon Y.; Nam K.
Institution
(Chung, Ju, Jeon, Nam) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul National University College of
Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, South Korea
(Koo, Lee) Department of Anesthesiology and Pain Medicine, Seoul National
University Bundang Hospital, Gyeonggi Province, Seongnam, South Korea
(Park, Oh) Department of Anesthesiology and Pain Medicine, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
(Kim, Kim) Department of Anesthesiology and Pain Medicine, Korea
University Guro Hospital, Korea University College of Medicine, Seoul,
South Korea
(Bae, Park) Department of Anesthesiology and Pain Medicine, Ajou
University Medical Center, Ajou University of College of Medicine,
Gyeonggi Province, Suwon, South Korea
Publisher
BioMed Central Ltd
Abstract
Background: Intraoperative hypotension is very common during surgery and
is linked to major organ dysfunction and mortality. Current perioperative
blood pressure management is largely based on universal blood pressure
thresholds ranging from a mean arterial pressure of 60-70 mmHg. However,
the effectiveness of this conventional management remains unproven in
prospective randomized trials. Therefore, we will conduct this study to
test if individualized perioperative blood pressure management decreases
the incidence of postoperative major adverse outcomes. Method(s):
This multicenter, randomized controlled superiority trial will enroll 1896
high-risk patients undergoing major noncardiac surgery from five tertiary
university hospitals in South Korea. In the control group, mean arterial
pressure will be maintained at >= 65 mmHg and systolic blood pressure >=
90 mmHg during surgery. In the intervention group, mean arterial pressure
and systolic blood pressure will be maintained at no less than 20% of
their baseline values. The baseline values are calculated as the average
of all values measured from the day before surgery until the morning of
surgery. These targets will be maintained until the patient is discharged
from the post-anesthesia care unit or, for those who are transferred to
the intensive care unit after surgery, until the end of the surgery. No
specific restrictions, except for these blood pressure targets, will be
applied to perioperative management. The primary composite outcome
consists of all-cause death, stroke, myocardial infarction, new or
worsening congestive heart failure, unplanned coronary revascularization,
and acute kidney injury within 7 days after noncardiac surgery or until
hospital discharge, whichever occurs first. Discussion(s): This study
will reveal if individualized perioperative blood pressure management
decreases the risk of major adverse outcomes in patients at high-risk
undergoing noncardiac surgery. Trial registration: ClinicalTrials.gov
NCT06225453. Registered on January 26, 2024. Copyright © The
Author(s) 2024.

<13>
Accession Number
2032779000
Title
Building Evidence in Perioperative Mechanical Ventilation--10 Years of
Randomized Trials.
Source
Current Anesthesiology Reports. 15(1) (no pagination), 2025. Article
Number: 7. Date of Publication: 01 Dec 2025.
Author
Hol L.; Gasteiger L.; Mazzinari G.; Schultz M.J.
Institution
(Hol) Department of Anesthesiology, Amsterdam UMC, Location AMC,
Amsterdam, Netherlands
(Gasteiger) Department of Anesthesiology and Intensive Care, Medical
University Innsbruck, Innsbruck, Austria
(Mazzinari) Department of Anesthesiology, La Fe University and Polytechnic
Hospital, Valencia, Spain
(Mazzinari) Department of Statistics and Operational Research, University
of Valencia, Valencia, Spain
(Schultz) Department of Intensive Care, Amsterdam UMC, Location AMC,
Amsterdam, Netherlands
(Schultz) Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol
University, Bangkok, Thailand
(Schultz) Nuffield Department of Medicine, University of Oxford, Oxford,
United Kingdom
(Schultz) Department of Anaesthesiology, General Intensive Care and Pain
Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive
Care Medicine, Medical University Vienna, Vienna, Austria
Publisher
Springer
Abstract
Purpose of Review: The aims of this narrative review are to describe the
evolution of randomized clinical trials (RCTs) assessing intraoperative
mechanical ventilation strategies over the years and to summarize their
key findings. Recent Findings: Over the past decade, numerous RCTs have
investigated various intraoperative ventilation settings. A frequently
utilized outcome measure in these studies has been the incidence of
postoperative pulmonary complications (PPCs). Summary: We conducted a
PubMed search to evaluate the impact of intraoperative ventilation
strategies on the occurrence of PPCs. We included only English language
RCTs published within the last 10 years. To be eligible, PPCs had to be
either the primary endpoint or a significant secondary endpoint. Studies
involving pediatric patients or those undergoing thoracic of cardiac
procedures were excluded. Studies indicate that the combination of high
positive end-expiratory pressure (PEEP) and low tidal volumes protects
patients against the development of PPCs. However, RCTs comparing only
tidal volumes, only PEEP, only recruitment maneuvers (RMs), or only
fractions of inspired oxygen, have not demonstrated differences in the
incidence of PPCs. In recent years, there has been a shift towards
individualized ventilation settings. Although individualized RMs have not
improved outcomes, studies suggest that individualized PEEP could protect
patients against the development of PPCs. Ongoing studies on the
individualization of PEEP are expected to provide further clarity on this
matter in the future. Copyright © The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature
2024.

<14>
Accession Number
2032846634
Title
Del Nido versus conventional blood cardioplegia in tetralogy of fallot
repair: A systematic review and meta-analysis of randomized controlled
trials.
Source
Perfusion (United Kingdom). (no pagination), 2025. Date of Publication:
2025.
Author
Consoli L.N.; Koziakas I.G.; Kanakis M.
Institution
(Consoli) Federal University of Bahia, Faculty of Medicine, Bahia, Brazil
(Koziakas) Department of Anesthesiology, Onassis Cardiac Surgery Center,
Athens, Greece
(Kanakis) Department of Pediatric and Congenital Heart Surgery, Onassis
Cardiac Surgery Center, Athens, Greece
Publisher
SAGE Publications Ltd
Abstract
Objectives: Compare outcomes of Del Nido (DN) versus conventional blood
cardioplegia (BC) in the surgical repair of Tetralogy of Fallot (ToF).
 Method(s): Medical databases were searched to identify relevant
clinical trials. Meta-analysis was conducted for primary (cardiopulmonary
bypass [CPB] and aortic cross-clamp [ACC] times, hospital and intensive
care unit [ICU] length of stay [LOS], mechanical ventilation time) and
secondary (adverse events, lactate levels, volume of additional
cardioplegia) endpoints. Analysis was conducted for DN versus conventional
blood cardioplegia, and we performed sensitivity analysis with leave
one-out analysis for the primary outcome. Result(s): 4 randomized
controlled trials were included (n = 275). Mean differences (MD) with 95%
confidence intervals (CI) were calculated with a random-effects model.
Groups had similar CPB (MD -5.76 minutes; [-23.32 to 11.80]; p = 0.52) and
ACC (MD 3.06 minutes; [-13.64 to 7.52]; p = 0.57) times, ICU (MD -6.42
hours; [-25.62 to 12.78]; p = 0.51) LOS and additional cardioplegia volume
(MD -195.18 mL; [-434.19 to 43.82]; p = 0.11). The DN group had shorter
hospital LOS (MD -0.81 days; [-1.25 to -0.36]; p = 0.0003) and time under
mechanical ventilation (MD -4.57 hours; [-8.73 to -0.42]; p = 0.03). There
was no difference in mortality. Conclusion(s): DN cardioplegia has
similar clinical outcomes and operative times compared to conventional
blood cardioplegia in ToF surgery. Copyright © The Author(s)
2025.

<15>
Accession Number
2032815026
Title
Safety and efficacy of a pharmacist-driven protocolized transition from
insulin infusion to subcutaneous insulin in patients undergoing
cardiothoracic surgery.
Source
JACCP Journal of the American College of Clinical Pharmacy. (no
pagination), 2025. Date of Publication: 2025.
Author
Bird S.A.; Thuyns M.R.
Institution
(Bird, Thuyns) Renown Regional Medical Center, Reno, NV, United States
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Few validated approaches exist for the transition from
intravenous (IV) insulin infusion to subcutaneous (SQ) insulin
post-operatively in cardiothoracic surgery patients. Objective(s):
This study aimed to assess whether a pharmacist-driven protocol utilizing
basal, prandial, correctional, or correctional-only SQ insulin is safe and
efficacious for post-operative glycemic control following 24 h of IV
insulin administration. Method(s): A retrospective, single-center,
observational study investigating outcomes associated with a
pharmacist-driven protocol utilizing basal, prandial, correctional, or
correctional-only insulin from May 2023 through July 2023 when compared
with a historical nursing-driven protocol observed from May 2021 through
July 2021. Adult cardiac intensive care unit patients who received an
insulin infusion within 24 h of cardiothoracic surgery and subsequently
transitioned to SQ insulin were observed. The primary outcome was
percentage of blood glucose (BG) readings at goal (140-180 mg/dL).
Secondary outcomes included percentage of BG readings in a clinically
acceptable range (110-180 mg/dL), hypoglycemia (<70 mg/dL), severe
hypoglycemia (<40 mg/dL), administration of rescue dextrose, reinitiation
of insulin infusion following transition, and surgical site infection.
 Result(s): Use of a pharmacist-driven protocol improved the
percentage of BG readings in goal range when compared with a nursing
driven protocol (24.4% vs. 12.4%, p = 0.001). More BG readings were in the
clinically acceptable range in the pharmacist-driven group: 69.6% of
readings versus 58.5% in the nursing-driven group (p = 0.011). There were
fewer hypoglycemic events in the pharmacist-driven group. There were no
reports of severe hypoglycemia, further IV insulin requirements, or
surgical site infections in either group. Pharmacist compliance to the
protocol was high at 92.4%. Conclusion(s): A pharmacist-driven
protocolized approach to the transition to SQ insulin post-operatively in
cardiothoracic patients is both safe and efficacious. The
pharmacist-driven protocol resulted in an improved percentage of BG
readings in goal range and fewer hypoglycemic events when compared with
the historical nursing-driven protocol. Copyright © 2025
Pharmacotherapy Publications, Inc.

<16>
Accession Number
2032783208
Title
The efficacy and safety of Empagliflozin on outcomes of patients with
myocardial infarction undergoing primary PCI: a systematic review and
meta-analysis.
Source
Naunyn-Schmiedeberg's Archives of Pharmacology. (no pagination), 2024.
Date of Publication: 2024.
Author
Alizadehasl A.; Hakimian H.; Abdolkarimi L.; Afsari Zonooz Y.;
Amini-Salehi E.; Hosseini Jebelli S.F.; Yalameh Aliabadi A.
Institution
(Alizadehasl, Hakimian, Afsari Zonooz, Hosseini Jebelli, Yalameh Aliabadi)
Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and
Research Center, Iran University of Medical Science, Tehran, Iran, Islamic
Republic of
(Abdolkarimi) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Science, Tehran, Iran, Islamic Republic of
(Amini-Salehi) Guilan University of Medical Science, Rasht, Iran, Islamic
Republic of
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Empagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, has
garnered significant interest due to its potential cardiovascular
benefits, particularly in patients experiencing acute myocardial
infarction (AMI) who are undergoing primary percutaneous coronary
intervention (PCI). This systematic review aims to evaluate the
effectiveness of Empagliflozin in improving clinical outcomes in this
patient population. A systematic review of randomized controlled trials
(RCTs) was conducted to assess the effects of Empagliflozin on clinical
outcomes in patients with AMI undergoing primary PCI. Electronic
databases, including PubMed, Scopus, Web of Science, Cochrane, and the
Scientific Information Database, were searched up to July 31, 2024. The
risk of bias in the included studies was evaluated using the Cochrane
Collaboration criteria. Data analysis was performed using Comprehensive
Meta-Analysis software version 3, with outcomes expressed as risk ratios
(RR) and 95% confidence intervals (CI). Seven studies were included in the
meta-analysis. The results demonstrated that Empagliflozin significantly
reduced the risk of heart failure hospitalization compared to placebo,
with a risk ratio of 0.48 (95% CI: 0.23-0.99; P = 0.049), indicating a 52%
reduction in hospitalization risk. However, secondary outcomes showed that
Empagliflozin was associated with a reduction in cardiovascular mortality
(RR = 0.45; 95% CI: 0.06-3.02; P = 0.415) and the need for coronary
revascularization (RR = 0.75; 95% CI: 0.15-3.59; P = 0.717), although
these results did not achieve statistical significance. Empagliflozin is
associated with a significant reduction in heart failure hospitalizations
among patients with AMI undergoing primary PCI, while its effects on
cardiovascular mortality and the necessity for coronary revascularization
were not statistically significant. Despite these secondary outcomes, the
favorable safety profile of Empagliflozin supports its use as a treatment
option for high-risk patients following acute coronary events. Further
research is warranted to investigate the long-term impact of Empagliflozin
on cardiovascular outcomes in this population. Copyright © The
Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part
of Springer Nature 2024.

<17>
Accession Number
646163667
Title
Long-term outcomes after percutaneous coronary intervention versus
coronary artery bypass grafting in women, a meta-analysis.
Source
Journal of cardiothoracic surgery. 19(1) (pp 666), 2024. Date of
Publication: 20 Dec 2024.
Author
Perez-Camargo D.; Campelos-Fernandez P.; Travieso A.; Montero-Cruces L.;
Carnero-Alcazar M.; Olmos-Blanco C.; Cobiella-Carnicer J.; Alvarez-Arcaya
A.; Reguillo-Lacruz F.; Maroto-Castellanos L.C.
Institution
(Perez-Camargo, Campelos-Fernandez, Montero-Cruces, Carnero-Alcazar,
Cobiella-Carnicer, Alvarez-Arcaya, Reguillo-Lacruz, Maroto-Castellanos)
Cardiac Surgery Department, Hospital Universitario Clinico San Carlos,
Calle Martin Lagos S/N, Madrid, Spain
(Travieso) Heart Centre, Rigshospitalet, Copenhagen, Denmark
(Olmos-Blanco) Cardiology Department, Hospital Universitario Clinico San
Carlos, Madrid, Spain
Abstract
BACKGROUND: Despite the advances in the last decades for treatment of
ischemic heart disease, women continue to experience poorer prognosis than
men and currently, there is a gap in knowledge regarding the optimal
revascularization strategy in women. OBJECTIVE(S): Compare the
long-term outcomes of percutaneous coronary intervention (PCI) and
coronary artery bypass grafting (CABG) for the treatment of stable
ischemic heart disease in women. METHOD(S): A systematic search was
conducted including randomized clinical trials (RCTs) comparing PCI with
drug-eluting stents with CABG. The primary outcome were the composite
outcomes of death, stroke or myocardial infarction (MI) and death, stroke,
MI or repeat revascularization. Secondary outcomes included the individual
components of the primary outcomes. Pooled hazard ratios with 95%
confidence intervals were calculated in a fixed- effects meta-analysis
using the inverse of variance method. Risk of bias and sensitivity
analyses were also conducted. RESULT(S): Six multicenter, RCTs were
included after eligibility assessment. Median follow-up was 6.25 years
(IQR: 5- 2.5). A significant benefit for CABG over PCI was observed for
the primary composite outcomes of death, stroke, MI (HR = 1.24; 95% CI
1.01-1.52; p = 0.037) and death, stroke, MI or repeat revascularization
(HR = 1.60; 95% CI 1.25-2.03; p < 0.000). CONCLUSION(S): In the
present study-level metanalysis, CABG is associated with a lower risk of
major adverse cardiovascular events than PCI at long term follow-up in
women. Copyright © 2024. The Author(s).

<18>
Accession Number
646156044
Title
The complex anatomy of the bronchial arteries: a meta-analysis with
potential implications for thoracic surgery and hemoptysis treatment.
Source
Scientific reports. 14(1) (pp 30942), 2024. Date of Publication: 28 Dec
2024.
Author
Ostrowski P.; Bonczar M.; Gladys K.; Klimeczek-Chrapusta M.; Musial A.;
Matuszyk A.; Balawender K.; Walocha J.; Koziej M.; Clarke E.; Polguj M.;
Smedra A.; Zytkowski A.; Wysiadecki G.
Institution
(Ostrowski, Bonczar, Gladys, Klimeczek-Chrapusta, Musial, Matuszyk,
Walocha, Koziej) Department of Anatomy, Jagiellonian University Medical
College, Krakow, Poland
(Ostrowski, Bonczar, Walocha, Koziej) Youth Research Organization, Krakow,
Poland
(Balawender) Department of Normal and Clinical Anatomy, Institute of
Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
(Clarke, Wysiadecki) Laboratory of Neuroanatomy, Department of Normal and
Clinical Anatomy, Chair of Anatomy and Histology, Medical University of
Lodz, ul. Zeligowskiego 7/9Lodz, Poland
(Polguj) Department of Normal and Clinical Anatomy, Chair of Anatomy and
Histology, Medical University of Lodz, Lodz, Poland
(Smedra) Chair and Department of Forensic Medicine, Medical Faculty,
Medical University of Lodz, Lodz, Poland
(Zytkowski) Department of Anatomy, Faculty of Medicine, University of
Social Sciences in Lodz, Lodz, Poland
(Zytkowski) Norbert Barlicki Memorial Teaching Hospital No. 1 of the
Medical University of Lodz, Lodz, Poland
Abstract
The present meta-analysis aimed to provide the most detailed and
comprehensive anatomical description of bronchial arteries (BAs) using
data available in the literature. Adequate knowledge of the normal anatomy
and morphological variations of BAs can be clinically significant; for
example, this approach can prevent potential risks while undertaking
bronchial artery embolization (BAE) procedures and, ultimately, lead to
better patient outcomes. Major medical databases such as PubMed, Scopus,
Embase, Web of Science, Google Scholar, and the Cochrane Library were
searched. The overall search process was conducted in three main stages.
The number of BAs varied from one to six, and 16 arterial patterns were
observed. The most common variation was in one right BA and one left BA,
with a pooled prevalence of 19.54% (95% CI 6.69-36.44%). The pooled
prevalence of BAs originating separately from the aorta was 41.42% (95% CI
37.42-45.48%). The number and location of BAs are highly inconsistent.
However, the most prevalent pattern involved two BAs: one in the right BA
and one in the left BA. Although BAs most frequently originate from the
descending aorta, the cooccurrence of at least one ectopic BA is
relatively high. The results of our meta-analysis can serve as a source of
comprehensive information for thoracic surgeons and physicians performing
endovascular procedures, especially BAE, a treatment for life-threatening
hemoptysis. Copyright © 2024. The Author(s).

<19>
Accession Number
646160624
Title
Percutaneous Coronary Intervention (PCI) in Patients of Rheumatoid
Arthritis(RA): A Systematic Review and Meta-Analysis.
Source
Indian heart journal. (no pagination), 2024. Date of Publication: 20 Dec
2024.
Author
Piplani S.; Kostojchin A.; Kong S.; Brown D.; Jelic V.; Chaturvedi S.;
Reddy V.; Chang Pieri K.; Akpan E.; Simpson T.; Xiao W.; Sakellakis M.;
Sharma A.; Jain P.; Radulovic M.
Institution
(Piplani, Kong, Brown, Jelic, Chaturvedi, Reddy, Chang Pieri, Akpan,
Simpson, Xiao, Sakellakis, Sharma, Radulovic) Jacobi Medical Center/North
Central Bronx, Albert Einstein College of Medicine, NYC Health and
Hospitals, Bronx, NY, United States
(Kostojchin) Icahn School of Mount Sinai, Department of Cardiology North
Central Bronx Hospital/VA Medical Center, Bronx, NY, United States
(Sharma) Department of Cardiology, Yale School of Medicine, 333 Cedar
Street, New Haven, CT, United States
(Jain) Department of Internal Medicine, Jawaharlal Nehru Medical College,
Karnataka, India
Abstract
AIM: The present study aims to investigate the outcomes of Percutaneous
coronary intervention (PCI) in patients with Rheumatoid arthritis (RA).
 METHOD(S): A systemic search was conducted from electronic databases
(PubMed/Medline, Cochrane Library, and Google Scholar) from inception to
15th September 2023. All statistical analyses were conducted using Review
Manager 5.4.1. Studies meeting inclusion criteria were selected. A
random-effect model was used when heterogeneity was seen to pool the
studies, and the result was reported in the odds ratio (OR) and the
corresponding 95% confidence interval (CI). RESULT(S): Eight
observational studies were selected to conduct the analysis. A
statistically significant increase in major adverse cardiovascular event
(MACE) was seen in RA patients after undergoing PCI as compared to the
control group (OR = 1.18 (1.16, 1.21); p < 0.00001; I2 = 0%). There was no
significant difference found in the long-term revascularization outcome
between the RA and non-RA patients (OR = 1.18 (0.81, 1.71); p = 0.39; I2 =
93%). Survival rates of all-cause mortality in the long-term outcome were
statistically insignificant among the two groups (OR = 1.21 (0.84, 1.74);
p = 0.31; I2 = 99%). CONCLUSION(S): Percutaneous coronary
intervention is an important intervention to reduce morbidity and
mortality but special precautions and attention should be made when it
comes to patients with RA. Different precautions such as close monitoring
for medication interaction, and tailored post-procedural care are
essential in reducing morbidity and mortality. Copyright © 2024.
Published by Elsevier, a division of RELX India, Pvt. Ltd.

<20>
Accession Number
646163954
Title
Risk factors of delirium after cardiac surgery: a systematic review and
meta-analysis.
Source
Journal of cardiothoracic surgery. 19(1) (pp 675), 2024. Date of
Publication: 20 Dec 2024.
Author
Wang Y.; Wang B.
Institution
(Wang) Cardiovascular Medicine Department, Shengjing Hospital of China
Medical University, Liaoning Province, China
(Wang) Cardiovascular Medicine Department, Shengjing Hospital of China
Medical University, Liaoning Province, China
Abstract
BACKGROUND: Post-operative delirium (POD) is a relatively common
occurrence following surgical procedures, particularly cardiac surgeries.
Given that the majority of pharmacologic treatments for delirium have
demonstrated inadequate efficacy, it is of great importance to identify
risk factors to prevent delirium or reduce its complications.
Consequently, in this systematic review and meta-analysis, we identified
risk factors of POD after cardiac surgery. METHOD(S): A comprehensive
search of the literature was conducted using the databases Scopus, PubMed,
and Web of Science from the inception to April 22, 2024. The objective was
to identify prospective cohorts that had assessed the risk factors
associated with POD in patients undergoing cardiac surgery using
multivariate regression. RESULT(S): Of the 3,166 studies that were
initially screened, 23 were included in the review. Nine risk factors were
evaluated including age (OR 1.06, 95% CI (1.04, 1.08), p < 0.001),
pre-operative depression (OR 3.71, 95% CI (2.45, 5.62), p < 0.001),
post-operative atrial fibrillation (AF) (OR 2.39, 95% CI (1.79, 3.21), p <
0.001), hypertension (HTN) (OR 1.64, 95% CI (0.75, 3.56), p = 0.212), age
>= 65 (OR 3.32, 95% CI (2.40, 4.60), p < 0.001), pre-operative AF (OR
4.43, 95% CI (2.56, 7.69), p < 0.001), diabetes mellitus (OR 2.16, 95% CI
(1.39, 3.35), p = 0.001), combined coronary artery bypass graft (CABG) +
valve surgery (OR 2.73, 95% CI (1.66, 4.49), p < 0.001), and
cardiopulmonary bypass (CPB) time (OR 1.02, 95% CI (1.01, 1.04), p =
0.001). CONCLUSION(S): A total of nine risk factors were evaluated,
from which eight were found to have a statistically significant effect on
the risk of developing POD. These factors can be employed to more
effectively identify at-risk patients and to prevent the occurrence of
POD. Furthermore, this approach can facilitate earlier diagnosis and more
effective patient care. Copyright © 2024. The Author(s).

<21>
Accession Number
2036814824
Title
Antireflux mucosal valvuloplasty versus proton pump inhibitors for the
treatment of patients with gastro-oesophageal reflux disease in a tertiary
healthcare centre in China: Study protocol for a randomised controlled
trial.
Source
BMJ Open. 14(12) (no pagination), 2024. Article Number: e088970. Date of
Publication: 22 Dec 2024.
Author
Lv X.; Ma W.; Zeng Y.; Lu J.
Institution
(Lv, Ma, Zeng, Lu) Department of Gastroenterology, Qilu Hospital, Shandong
University, Shandong, Jinan, China
(Lu) Medical Integration and Practice Center, Shandong University,
Shandong, Jinan, China
Publisher
BMJ Publishing Group
Abstract
Introduction Endoscopic antireflux therapy has shown promising potential
in the treatment for gastro-oesophageal reflux disease (GERD). However,
there is currently no universally accepted standard for endoscopic
surgery. Therefore, we introduced antireflux mucosal valvuloplasty (ARMV),
an innovative endoscopic treatment for GERD. We have conducted a cohort
study to assess the association between ARMV and clinical outcomes,
including risks and benefits. The objective of this trail is to compare
the efficacy of ARMV with proton pump inhibitors (PPIs) therapy. Methods
and analysis 74 patients with chronic GERD will be randomised (1:1) to
undergo either ARMV or continue PPI therapy. The primary endpoint is the
GERD health-related quality of life score, measured 6 months
postprocedure. Secondary endpoints include the GERD questionnaire score,
presence of reflux oesophagitis, appearance of the mucosal flap, DeMeester
score, PPI usage and the incidence of adverse events. After 6 months,
crossover is allowed for the PPI group. Assessments will occur at baseline
and at 3, 6, 12, 24 and 36 months postintervention. Ethics and
dissemination The study protocol has been approved by the Institutional
Review Board of Qilu Hospital, Shandong University. Study results will be
disseminated through peer-reviewed journals and presented at scientific
conferences. Trial registration number ClinicalTrials.gov (NCT
06348420). 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 Group.

<22>
Accession Number
2032843855
Title
Valve Thrombosis Following Transcatheter Aortic Valve Replacement:
State-of-the-Art Review.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2025.
Date of Publication: 2025.
Author
Duarte F.; Aguiar-Neves I.; Guerreiro C.E.; Silva M.; Ferreira N.D.;
Fontes-Carvalho R.
Institution
(Duarte) Cardiology Department, Hospital of Divino Espirito Santo, Ponta
Delgada, Portugal
(Aguiar-Neves, Guerreiro, Silva, Ferreira, Fontes-Carvalho) Cardiology
Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de
Gaia, Portugal
(Fontes-Carvalho) Department of Surgery and Physiology, Faculty of
Medicine of the University of Porto, UnIC@RISE, Porto, Portugal
Publisher
John Wiley and Sons Inc
Abstract
Transcatheter aortic valve replacement (TAVR) is a well-established
treatment for severe aortic stenosis, especially in patients over 75 or
those at high surgical risk. While these prosthetic valves have a lower
thrombogenic profile than mechanical heart valves, leaflet thrombosis in
transcatheter aortic valves (TAV) occurs in an estimated 5%-40% of cases.
Most TAV thromboses are subclinical and can be detected via cardiac
computed tomography (CCT), which reveals hypo-attenuating leaflet
thickening and reduced leaflet motion in asymptomatic patients without
elevated transprosthetic gradients on echocardiography. The mechanisms
behind TAV thrombosis involve local mechanical triggers, patient
predisposing factors, and device and procedure-related aspects. The ideal
antithrombotic therapy post-TAVR depends on individual patient
characteristics, balancing bleeding risks with the need for oral
anticoagulants. Data on the optimal management of TAV thrombosis and the
routine use of CT post-TAVR are limited. While anticoagulation effectively
resolves clinically significant prosthesis thrombosis, its benefit in
subclinical cases is unclear. There is an ongoing debate about whether
subclinical leaflet thrombosis precedes clinical valve thrombosis, making
the ideal follow-up after valve implantation uncertain. This article aims
to provide a comprehensive review, summarizing current data on the
incidence of TAVR thrombosis, underlying mechanisms, clinical and imaging
diagnosis, management strategies, preventive measures, and long-term
follow-up. Copyright © 2025 Wiley Periodicals LLC.

<23>
Accession Number
2032812009
Title
Transcatheter Aortic Valve Replacement in Hypertrophic Cardiomyopathy: A
Systematic Review and Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2025.
Date of Publication: 2025.
Author
Ahmed A.; Kaddoura R.; Aggarwal A.; Zinyandu T.; Webber F.; Davila C.;
Zarich S.
Institution
(Ahmed, Aggarwal, Zinyandu, Webber) Department of Internal Medicine,
Bridgeport Hospital, Yale New Haven Health, Bridgeport, CT, United States
(Kaddoura) Department of Pharmacy, Heart Hospital, Hamad Medical
Corporation, Doha, Qatar
(Davila, Zarich) Division of Cardiovascular Diseases, Bridgeport Hospital,
Yale New Haven Health, Bridgeport, CT, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: The co-existence of severe aortic stenosis (AS) and
hypertrophic cardiomyopathy (HCM) is not uncommon. Surgical intervention
is the gold standard management. Patients with high surgical risk might
undergo transcatheter aortic valve replacement (TAVR). However, TAVR
outcomes are unclear in this population. We aimed to investigate the
impact of HCM on the outcomes of TAVR. Aim(s): We aim to investigate
the outcomes of TAVR in patients with HCM. Method(s): We
systematically searched PubMed, EMBASE, and Scopus for studies that
compared outcomes of TAVR procedure between patients with HCM and those
without it. Using the random-effects model, the odds ratios (OR) with 95%
confidence interval (CI) were reported. Result(s): We screened 102
articles and identified three observational cohort studies. Compared to
patients who underwent TAVR without underlying HCM, TAVR for AS co-existed
with HCM was associated with higher rates of mortality (OR 5.79; 95% CI:
3.38; 9.91, p < 0.0001), cardiogenic shock (OR 4.55; 95% CI: 3.40; 6.08, p
< 0.0001), aortic dissection (OR 4.95; 95% CI: 3.17; 7.74, p < 0.0001),
vascular complications (OR 2.10; 95% CI: 1.27; 3.47, p = 0.004), and renal
impairment (OR 1.80; 95% CI: 1.36; 2.40, p < 0.0001). There was no
difference between the comparison groups in terms of complete heart block,
new permanent pacemaker implantation, or bleeding. Conclusion(s): In
patients with severe AS and HCM, TAVR was associated with significantly
higher occurrence of mortality, cardiogenic shock, aortic dissection,
vascular complications, and renal impairment as well as the need for
mechanical ventilation than patients who did not have HCM. Copyright
© 2025 Wiley Periodicals LLC.

<24>
Accession Number
2036876019
Title
A Randomized, Controlled Trial of In-Hospital Use of Virtual Reality to
Reduce Preoperative Anxiety Prior to Cardiac Surgery.
Source
Mayo Clinic Proceedings. (no pagination), 2025. Date of Publication:
2025.
Author
Subramaniam T.; Dearani J.A.; Stulak J.M.; Lahr B.; Lee A.; Miller J.D.
Institution
(Subramaniam, Dearani, Stulak, Miller) Departments of Cardiovascular
Surgery, Mayo Clinic, Rochester, MN, United States
(Lahr, Lee) Quantitative Health Sciences, Mayo Clinic, Rochester, MN,
United States
(Miller) Physiology and Biomedical Engineering, Mayo Clinic, Rochester,
MN, United States
(Miller) Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester,
MN, United States
Publisher
Elsevier Ltd
Abstract
Objective: To study the effectiveness of virtual reality (VR) in reducing
anxiety levels in patients undergoing first-time sternotomy for cardiac
surgery. Patients and Methods: A total of 100 adult patients
scheduled for cardiac surgery at Mayo Clinic in Rochester, Minnesota, USA,
was recruited from April 19, 2022, to October 12, 2022. Before surgery,
patients wore a physiological monitor to record vital signs. On the day of
surgery, patients completed the State-Trait Anxiety Inventory (STAI) and
were randomized into two groups: one receiving a tablet-based intervention
(control) and the other an immersive VR experience in the preoperative
holding area. After the interventions, patients repeated the state anxiety
component of the STAI. Result(s): The results showed that overall
state anxiety scores decreased an average of 2.0 points with tablet
treatment, but this change failed to reach statistical significance.
However, 6 of 20 specific state anxiety features significantly improved
with tablet treatment whereas 1 feature significantly worsened. With the
VR experience, overall state anxiety scores were significantly reduced by
an average of 2.9 points, with improvement in seven state anxiety features
(three of which did not overlap with the tablet intervention). Despite a
greater reduction in the STAI score with the VR experience, there were no
significant differences in the anxiolytic responses between groups.
Physiologically, both tablet and VR treatments slightly but significantly
reduced pulse rate, with no difference between the groups.
 Conclusion(s): Overall, the findings suggest that treatment of older
adults with an immersive VR experience before cardiac surgery can
significantly reduce overall anxiety. Further investigation determining
how such interventions can be optimally implemented in surgical practices
and whether such interventions reduce the need for anxiolytic medications
and improve the overall patient experience is needed. Copyright ©
2024

<25>
Accession Number
2036880984
Title
The impact of white matter lesions and subclinical cerebral ischemia on
postoperative cognitive training outcomes after heart valve surgery: A
randomized clinical trial.
Source
Journal of the Neurological Sciences. 469 (no pagination), 2025. Article
Number: 123370. Date of Publication: 15 Feb 2025.
Author
Butz M.; Gerriets T.; Sammer G.; El-Shazly J.; Braun T.; Sunner L.; Meyer
R.; Tschernatsch M.; Schramm P.; Gerner S.T.; Doeppner T.R.; Mengden T.;
Choi Y.-H.; Schoenburg M.; Juenemann M.
Institution
(Butz, Gerriets, Sammer, Braun, Sunner, Meyer, Tschernatsch, Schramm,
Schoenburg, Juenemann) Heart and Brain Research Group, Kerckhoff Heart and
Thorax Center, Bad Nauheim, Germany
(Butz, Gerriets, Braun, Meyer, Tschernatsch, Schramm, Gerner, Doeppner,
Juenemann) Department of Neurology, University Hospital Giessen and
Marburg, Giessen, Germany
(Butz) Department of Geriatrics, Health Center Wetterau, Schotten, Germany
(Gerriets, Tschernatsch) Die Neurologen, Private Neurology Practice, Bad
Nauheim, Germany
(Sammer) Cognitive Neuroscience at the Center of Psychiatry, Justus-Liebig
University, Giessen, Germany
(Sammer) Department of Psychology, Justus-Liebig University, Giessen,
Germany
(El-Shazly) Department of Psychocardiology, Kerckhoff Heart and Thorax
Center, Bad Nauheim, Germany
(Mengden) Department of Rehabilitation, Kerckhoff Heart and Thorax Center,
Bad Nauheim, Germany
(Choi, Schoenburg) Department of Cardiac Surgery, Kerckhoff Heart and
Thorax Center, Bad Nauheim, Germany
Publisher
Elsevier B.V.
Abstract
Background: White matter lesions and subclinical cerebral ischemia (SCI)
are described as risk factors for postoperative cognitive decline (POCD)
following cardiac surgery. This report aims to investigate the effect of
brain lesions on postoperative cognitive training outcomes.
 Method(s): In a randomized, treatment-as-usual controlled trial,
elderly patients scheduled for elective heart valve surgery participated.
The postoperative cognitive training comprised paper-and-pencil exercises.
Neuropsychological parameters were assessed preoperatively, at discharge
from rehabilitation (immediately post-training), and at the 3-month
follow-up. In addition, depression and anxiety (HADS) as well as
health-related quality of life (SF-36) were evaluated. Brain lesions were
identified using magnetic resonance imaging (training group: n = 18;
control group: n = 21). Specifically, periventricular white matter lesions
(PVWML) and deep white matter lesions (DWML) were assessed using
T2-weighted/FLAIR sequences and categorized according to Fazekas scale.
Volumetric analysis of SCI was conducted using diffusion-weighted imaging.
To statistically control the impact of brain lesions on training outcomes,
we employed analysis of covariance. Result(s): Three-month follow-up
results: When controlling for the independence of SCI on training
outcomes, effects were evident for global cognition (p = 0.022) and SF-36
mental component summary (p = 0.003). Considering the impact of PVWML on
training outcomes, trained participants showed better values in depression
(p = 0.046) and SF-36 mental component summary (p = 0.013). In a subgroup
analysis for patients with PVWML the training group demonstrated superior
performance for language (p = 0.037). After adjusting for DWML, training
effects were noticeable in the SF-36 mental component summary (p = 0.013).
 Conclusion(s): Patients with brain lesions may benefit from cognitive
training after cardiac surgery. Copyright © 2024

<26>
Accession Number
2036849600
Title
Efficacy Of Vasodilators On Hemodynamics For Pulmonary Hypertension
Patients Undergoing Mitral Valve Replacement Surgery: A Systematic Review
And Network Meta-analysis.
Source
Journal of Cardiac Failure. Conference: Heart Failure Society of America's
(HFSA) Annual Scientific Meeting 2024. Atlanta United States. 31(1) (pp
226), 2025. Date of Publication: 01 Jan 2025.
Author
Elrosasy A.; Maher A.; Ramadan A.; Hamam N.G.; Soliman M.; Kamal S.K.;
Milik B.E.; Shahat A.A.; Kamel M.N.; Ali A.A.; Hassan L.A.; Zabady A.;
Zeid M.A.; Nassar S.
Institution
(Elrosasy, Ramadan, Hamam, Soliman, Kamal, Milik, Shahat, Kamel, Hassan)
Cairo University - Faculty of Medicine, Cairo, Egypt
(Maher) Al-Azhar University - Faculty of Medicine, New-Damietta, Egypt
(Ali) Faculty of Medicine, Merit University, Sohag, Sohag, Egypt
(Zabady) Faculty of Science, Damanhour University, Damanhour, Egypt
(Zeid) Faculty of Medicine, Tanta University, Tanta, Egypt
(Nassar) West Virginia University, Morgantown, WV, United States
Publisher
Elsevier B.V.
Abstract
Objective: Pulmonary hypertension (PH) is a progressive hemodynamic
condition associated with significant morbidity and mortality, especially
in patients undergoing cardiac surgery. Despite the availability of
medical therapies targeting essential pathways involved in PH,
perioperative management remains challenging due to limited evidence and
understanding in this area. Therefore, the objective of this network
meta-analysis (NMA) is to compare the efficacy of various pulmonary
vasodilators in perioperative control of PH among patients undergoing
mitral valve replacement (MVR) surgery, aiming to address the existing
knowledge gap and improve perioperative outcomes. Method(s): We
conducted this network metanalysis based on a pre-registered protocol and
PRISMA guidelines. Electronic databases were searched from inception to
August 2023. Only randomized controlled trials (RCTs) evaluating
vasodilators in PH patients undergoing MVR surgery were included. We used
reliable analytical tools (netmeta package in RStudio) and data extraction
sheets to analyze the outcome data. Result(s): Seventeen RCTs
involving 862 patients were analyzed. Prostacyclin, nitric oxide (NO), and
sodium nitroprusside were associated with a statistically significant
reduction in the mean pulmonary arterial pressure with effect sizes (11.9,
[-20.1; -3.8], -8.3, [-16; -0.6], -11.2, [-21.8; -0.7]) respectively.
However, none of the treatment options showed a statistically significant
effect on pulmonary capillary wedge pressure, systolic pulmonary arterial
pressure, or heart rate. Nitroglycerin, NO, and prostacyclin showed a
significant increase in cardiac index with effect sizes of (1 [0.3; 1.7],
1.2 [0.8; 1.6], 1.2 [0.8; 1.6]) respectively. However, this failed to
reach statistical significance. Additionally, NO, prostacyclin, sodium
nitroprusside, and nitroglycerin demonstrated a statistically significant
reduction in systemic vascular resistance (SVR), with effect sizes of.
(-0.5489 [-0.8283; -0.2695], -0.3720 [-0.6517; -0.0923], -0.4700 [-0.7711;
-0.1690], -0.1400 [-0.2426; -0.0374]), respectively. Conclusion(s):
Our network metanalysis highlights prostacyclin, nitroglycerin, NO, and
sodium nitroprusside as consistently effective treatment options in
improving hemodynamics for PH patients undergoing MVR surgery. Our data
provides a valuable insight for surgeons to choose the suitable
vasodilator treatment option during the perioperative period. However,
study limitations and the need for further well-designed randomized trials
are acknowledged. Copyright © 2024

<27>
Accession Number
2036852125
Title
Effects Of Statins On Outcomes After Cardiac Transplantation: A Systematic
Review And Meta-analysis Of Published Studies.
Source
Journal of Cardiac Failure. Conference: Heart Failure Society of America's
(HFSA) Annual Scientific Meeting 2024. Atlanta United States. 31(1) (pp
336), 2025. Date of Publication: 01 Jan 2025.
Author
Ibrahim S.; Addo B.; Allihien S.-M.; Kesiena O.; Ozaeta J.C.; Muppavarapu
R.
Institution
(Ibrahim, Addo, Kesiena) Piedmont Athens Regional Medical Center, Athens,
GA, United States
(Allihien, Ozaeta) AthensGAUnited States
(Muppavarapu) Lambert High School, Suwanee, GA, United States
Publisher
Elsevier B.V.
Abstract
Objective: Statins use post-cardiac transplantation have been suggested to
improve survival and reduce major complications including coronary
allograft vasculopathy. The individual studies that led to this
proposition were small and underpowered. We aimed to perform a systematic
review and meta-analysis to assess the role of statin in mitigating
clinical outcomes including all-cause mortality, major graft rejection,
and coronary allograft vasculopathy in cardiac transplant patients.
 Method(s): Cochrane Central Registry of Controlled Trials, Medline,
Embase, and clinicalTrials.gov were searched for studies published up to
February 2024. The clinical endpoints of interest were all-cause
mortality, major graft rejection, and coronary allograft vasculopathy. The
pooled odds ratio was utilized as the statistical test with a 95%
confidence interval. The fixed-effect model was used for data analysis if
I2 statistics <50%; otherwise, the random-effect model was
used. Sensitivity analysis was performed by alternate removal of a trial
from the study to assess its impact on the result and the interconversion
between fixed-effects and random-effects models. The risk of bias was
assessed using the Cochrane Risk of Bias Assessment Tool for the
randomized trials and ROBIN-I for non-randomized studies. Result(s):
Eleven published studies (5 randomized and 6 non-randomized) that enrolled
2,852 patients satisfied our inclusion criteria. Out of these, 2,119
received statin while 733 received no statin. When compared to no statin,
statin use was associated with a statistically significant reduction in
all-cause mortality by 72% (OR=0.28 [95% CI, 0.21-0.36]; P <0.00001;
I2 = 0%), major graft rejection by 63% (OR= 0.37 [95% CI,
0.21-0.65]; P=0.0005; I2 = 20%), and coronary allograft
vasculopathy by 67% (OR=0.33 ([95% CI, 0.16-0.68]; P =0.003; I2
= 0%). All outcomes remained statistically significant after sensitivity
analysis was run. Meta-regression analysis based on year of trial
publication showed no statistically significant relationship with
all-cause mortality (P=0.77). Conclusion(s): This meta-analysis
suggests that statins may reduce mortality and prevent cardiac allograft
vasculopathy, and severe graft rejection in heart transplant patients.
Larger placebo-controlled studies are still warranted to better
characterize this association. Copyright © 2024

<28>
Accession Number
2036876140
Title
Bacterial air contamination and the protective effect of coverage for
sterile surgical goods: A randomized controlled trial.
Source
American Journal of Infection Control. (no pagination), 2025. Date of
Publication: 2025.
Author
Wistrand C.; Soderquist B.; Friberg O.; Sundqvist A.-S.
Institution
(Wistrand, Sundqvist) University Health Care Research Centre, Faculty of
Medicine and Health, Orebro University, Orebro, Sweden
(Wistrand, Friberg) Department of Cardiothoracic and Vascular Surgery,
Orebro University Hospital, Orebro, Sweden
(Soderquist, Friberg) School of Medical Sciences, Faculty of Medicine and
Health, Orebro University, Orebro, Sweden
(Soderquist) Department of Laboratory Medicine, Faculty of Medicine and
Health, Orebro University, Orebro, Sweden
Publisher
Elsevier Inc.
Abstract
Background: There is limited knowledge regarding how long prepared sterile
goods can wait before becoming contaminated. We investigated whether
surgical goods could be prepared the day before surgery and kept sterile
overnight in the operating room, if protected by sterile covers.
 Method(s): Sterile surgical goods for open-heart surgeries (n = 70)
were randomized to preparation on the morning of the operation or on the
previous evening. Exposure time was the total time between preparation and
use. Primary outcome was bacterial growth reported as colony forming units
(cfu), isolated on 840 agar plates. The protocol was registered with
ClinicalTrials.gov (NCT05597072). Result(s): When the agar plates
were protected with sterile covers, exposure time had no impact
(intervention group: 7 cfu, control group: 17 cfu). Without protection,
longer exposure time was associated with more cfu (P = .016). A total of
499 cfu were isolated, displaying 59 different types of bacteria including
13 resistant Staphylococcus epidermidis, 6 (46%) of which were multidrug
resistant. Conclusion(s): Sterile goods could wait in the operating
room for at least 15 hours before use without increased risk of bacterial
air contamination, if protected with sterile covers. However, if the goods
were not covered, bacterial air contamination occurred over
time. Copyright © 2025 The Authors

<29>
Accession Number
2036845914
Title
Guidelines for assessing ventricular pressure-volume relationships in
rodents.
Source
American Journal of Physiology - Heart and Circulatory Physiology. 328(1)
(pp H120-H140), 2025. Date of Publication: 01 Jan 2025.
Author
Wearing O.H.; Chesler N.C.; Colebank M.J.; Hacker T.A.; Lorenz J.N.;
Simpson J.A.; West C.R.
Institution
(Wearing, West) Department of Cellular & Physiological Sciences,
University of British Columbia (UBC), Vancouver, BC, Canada
(Wearing, West) Centre for Chronic Disease Prevention and Management, UBC
Okanagan, Kelowna, BC, Canada
(Wearing, West) Centre for Heart, Lung & Vascular Health, UBC Okanagan,
Kelowna, BC, Canada
(Chesler) Department of Biomedical Engineering, University of California
Irvine, Irvine, CA, United States
(Chesler) Edwards Lifesciences Foundation Cardiovascular Innovation and
Research Center, University of California Irvine, Irvine, CA, United
States
(Colebank) Department of Mathematics, University of South Carolina,
Columbia, SC, United States
(Hacker) Cardiovascular Research Center, University of Wisconsin-Madison,
Madison, WI, United States
(Lorenz) Department of Pharmacology, Physiology, and Neurobiology,
University of Cincinnati, Cincinnati, OH, United States
(Simpson) Department of Human Health and Nutritional Sciences, University
of Guelph, Guelph, ON, Canada
(Simpson) IMPART Investigator Team Canada, Saint John, NB, Canada
Publisher
American Physiological Society
Abstract
Ventricular catheterization with a pressure-volume (PV) catheter is the
gold-standard method for assessing in vivo cardiac function in animal
studies, providing valuable "load-independent" indices of systolic and
diastolic heart performance. PV studies are commonly performed to
elucidate mechanistic insights into cardiovascular disease using surgical
and genetically engineered rat and mouse models, but there is considerable
heterogeneity in how these studies are performed. Wide variation in
protocol design, volume calibration, anesthesia, manipulation of cardiac
loading conditions, how load-independent indices of cardiac function are
derived, as well as in data analysis and reporting is constraining
reliability and reproducibility in the field. The purpose of this
manuscript is to combine our collective expertise in performing open- and
closed-chest left and right ventricle PV studies in rodents to provide
consensus guidelines on how to perform, analyze, and interpret these
studies using either conductance or admittance PV catheters. We first
review recent methodological reporting in rodent PV studies in this
journal and discuss important details required to improve reproducibility
within and across PV studies. We then recommend steps to obtain
high-quality PV data, from volume calibration to choice of anesthetic
agent and acquiring load-independent indices of both systolic and
diastolic function. We also consider between- and within-animal variation
and recommend how to perform data analysis and visualization. We hope that
this consensus paper guides those performing PV studies in rodents and
helps align the field with best practices in surgical/analytical
methodologies and reporting, facilitating better reliability and
reproducibility in the PV field. Copyright © 2025 the American
Physiological Society.

<30>
Accession Number
646147957
Title
The efficacy and safety of Empagliflozin on outcomes of patients with
myocardial infarction undergoing primary PCI: a systematic review and
meta-analysis.
Source
Naunyn-Schmiedeberg's archives of pharmacology. (no pagination), 2024.
Date of Publication: 27 Dec 2024.
Author
Alizadehasl A.; Hakimian H.; Abdolkarimi L.; Afsari Zonooz Y.;
Amini-Salehi E.; Hosseini Jebelli S.F.; Yalameh Aliabadi A.
Institution
(Alizadehasl, Hakimian, Afsari Zonooz, Yalameh Aliabadi) Cardio-Oncology
Research Center, Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Science, Tehran, Iran, Islamic Republic of
(Abdolkarimi) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Science, Tehran, Iran, Islamic Republic of
(Amini-Salehi) Guilan University of Medical Science, Rasht, Iran, Islamic
Republic of
(Hosseini Jebelli) Cardio-Oncology Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Science, Tehran,
Iran, Islamic Republic of
Abstract
Empagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, has
garnered significant interest due to its potential cardiovascular
benefits, particularly in patients experiencing acute myocardial
infarction (AMI) who are undergoing primary percutaneous coronary
intervention (PCI). This systematic review aims to evaluate the
effectiveness of Empagliflozin in improving clinical outcomes in this
patient population. A systematic review of randomized controlled trials
(RCTs) was conducted to assess the effects of Empagliflozin on clinical
outcomes in patients with AMI undergoing primary PCI. Electronic
databases, including PubMed, Scopus, Web of Science, Cochrane, and the
Scientific Information Database, were searched up to July 31, 2024. The
risk of bias in the included studies was evaluated using the Cochrane
Collaboration criteria. Data analysis was performed using Comprehensive
Meta-Analysis software version 3, with outcomes expressed as risk ratios
(RR) and 95% confidence intervals (CI). Seven studies were included in the
meta-analysis. The results demonstrated that Empagliflozin significantly
reduced the risk of heart failure hospitalization compared to placebo,
with a risk ratio of 0.48 (95% CI: 0.23-0.99; P = 0.049), indicating a 52%
reduction in hospitalization risk. However, secondary outcomes showed that
Empagliflozin was associated with a reduction in cardiovascular mortality
(RR = 0.45; 95% CI: 0.06-3.02; P = 0.415) and the need for coronary
revascularization (RR = 0.75; 95% CI: 0.15-3.59; P = 0.717), although
these results did not achieve statistical significance. Empagliflozin is
associated with a significant reduction in heart failure hospitalizations
among patients with AMI undergoing primary PCI, while its effects on
cardiovascular mortality and the necessity for coronary revascularization
were not statistically significant. Despite these secondary outcomes, the
favorable safety profile of Empagliflozin supports its use as a treatment
option for high-risk patients following acute coronary events. Further
research is warranted to investigate the long-term impact of Empagliflozin
on cardiovascular outcomes in this population. Copyright © 2024.
The Author(s), under exclusive licence to Springer-Verlag GmbH Germany,
part of Springer Nature.

<31>
Accession Number
2036787496
Title
Effects of Sedation Medications on Postoperative Delirium and Cognitive
Dysfunction in Cardiac Surgery Patients with Cardiopulmonary Bypass: A
Network Meta-Analysis.
Source
Heart Surgery Forum. 27(12) (pp E1475-E1482), 2024. Date of Publication:
2024.
Author
Zhang Y.-P.; Liu Y.; Han F.-F.; Wang J.; Pan H.-J.
Institution
(Zhang, Pan) Department of Anesthesia, Yuyao Maternity and Child Health
Care Hospital, Yuyao Second People's Hospital, Zhejiang, Yuyao, China
(Liu) Department of Neurosurgery, Ningbo Yinzhou No.2 Hospital, Zhejiang,
Ningbo, China
(Han) Department of Anesthesia, First Hospital of Lanzhou University,
Gansu, Lanzhou, China
(Wang) Department of Anesthesia, Huangyan Hospital of Traditional Chinese
Medicine, Zhejiang, Taizhou, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: Neuropsychological deficits, such as delirium and cognitive
dysfunction, are common consequences of cardiac surgery. The effectiveness
of sedative drugs remains controversial. The purpose of this study was to
collect and summarize the current evidence on the application of sedatives
in randomized trials to prevent delirium and cognitive dysfunction in
adult patients undergoing cardiac surgery with cardiopulmonary bypass
(CPB). Method(s): We searched for relevant studies in the databases
from inception to September 1, 2024. Randomized controlled trials (RCTs)
investigating the effects of sedatives and comparators on postoperative
delirium (POD) and postoperative cognitive dysfunction (POCD) in adults
undergoing cardiac surgery with CPB were included in this research.
Frequentist network meta-analysis (NMA) was utilized for comparing various
interventions. Result(s): Forty-five RCTs were included in the
analysis. For POD, there were statistically significant differences
between the dexmedetomidine group and the control group (odds ratio [OR]:
0.70, 95% CI: 0.50, 0.98, p = 0.038), which was mainly dependent on the
effect of the postoperative application. Ketamine (92%) and esketamine
(91%) also showed higher surface under the cumulative ranking curve
(SUCRA) ranks, and trial sequential analysis also indicated their
potential effectiveness. For the Mini-Mental State Examination (MMSE)
outcome, the results indicated that dexmedetomidine (standardized mean
difference [SMD]: 3.14, 95% CI: 1.12, 5.16, p = 0.002) and remifentanil
(SMD: 4.24, 95% CI: 0.28, 8.20, p = 0.036) resulted in significantly
higher MMSE scores than the control group. Conclusion(s):
Postoperative dexmedetomidine significantly outperformed the control in
terms of POD risk and MMSE score. Esketamine/ketamine also demonstrated
potential efficacy in preventing POD. Further research is required to
validate these findings. Copyright © 2024 The Author(s).

<32>
Accession Number
646134305
Title
Days at Home After Transcatheter Mitral Valve Repair Versus Medical
Therapy Alone in Heart Failure.
Source
Journal of the American Heart Association. (pp e038401), 2024. Date of
Publication: 24 Dec 2024.
Author
Chung M.; Almarzooq Z.I.; Tale A.; Song Y.; Dahabreh I.J.; Kazi D.S.;
Baron S.J.; Yeh R.W.
Institution
(Chung) Department of Anesthesia, Critical Care and Pain Medicine
Massachusetts General Hospital Boston MA USA
(Chung, Almarzooq, Tale, Song, Dahabreh, Kazi, Baron, Yeh) Smith Center
for Outcomes Research in Cardiology, Division of Cardiovascular Medicine,
Department of Medicine Beth Israel Deaconess Medical Center Boston MA USA,
Israel
(Almarzooq) Division of Cardiovascular Medicine, Department of Medicine
Brigham and Women's Hospital Boston MA USA
(Tale, Song, Kazi, Yeh) Division of Cardiovascular Medicine, Department of
Medicine Beth Israel Deaconess Medical Center Boston MA USA, Israel
(Dahabreh) Department of Epidemiology and Department of Biostatistics
Harvard T.H. Chan School of Public Health Boston MA USA
(Baron) Division of Cardiology, Department of Medicine Massachusetts
General Hospital Boston MA USA
Abstract
BACKGROUND: Transcatheter edge-to-edge repair of the mitral valve (mTEER)
reduced a hierarchical end point that included death and heart failure
hospitalization in COAPT (Cardiovascular Outcomes Assessment of the
MitraClip Percutaneous Therapy for Heart Failure Patients With Functional
Mitral Regurgitation Trial). However, the magnitude to which mTEER
increases the number of days a patient spends at home (DAH) in the first
few years after treatment, a patient-centered end point not captured
routinely in clinical trials, has not been evaluated. We compared 1- and
2-year DAH among patients with functional mitral regurgitation and heart
failure randomized to mTEER plus medical therapy versus medical therapy
alone (control) by linking the COAPT trial to comprehensive health care
claims data. METHODS AND RESULTS: We linked data from COAPT trial
participants to Medicare fee-for-service claims. DAH was calculated as the
number of days alive and spent outside a hospital, skilled nursing
facility, inpatient rehabilitation, long-term acute care hospital,
emergency department, or observation stay after randomization. Treatment
groups were compared using quantile regression to calculate the area under
the curve of cumulative distribution functions. We linked 271 patients
(mTEER 136/302, control 135/312) for a 2-year follow-up. Mean+/-SD DAH at
1 year was 312.0+/-95.6 in mTEER and 298.1+/-107.5 in controls with
similar area under the curve (difference 13.9 days [-10.5 to 38.3],
P=0.26). DAH at 2 years was 577.2+/-235.6 in mTEER and 518.2+/-253.0 in
control with a higher area under the curve in mTEER (difference 59.0 days
[0.07 to 117.9], P=0.0497). CONCLUSION(S): In the COAPT trial linked
to Medicare claims, patients randomized to mTEER spent a similar number of
DAH at 1 year but more time at home at 2 years compared with medical
therapy alone.

<33>
Accession Number
646148107
Title
Impact of frailty on outcomes following coronary artery bypass grafting: a
systematic review and meta-analysis.
Source
BMC surgery. 24(1) (pp 419), 2024. Date of Publication: 27 Dec 2024.
Author
Chen S.; Zhang S.; Cai S.; Wang H.
Institution
(Chen, Zhang, Cai) Department of Geriatric Medicine, Wenzhou TCM Hospital
of Zhejiang Chinese Medical University, 9 Jiaowei Road ,Zhejiang Province,
China
(Wang) Department of Geriatric Medicine, Wenzhou TCM Hospital of Zhejiang
Chinese Medical University, 9 Jiaowei Road ,Zhejiang Province, China
Abstract
BACKGROUND: Coronary artery bypass grafting (CABG) remains the preferred
treatment for complex multi-vessel coronary artery disease, offering
substantial long-term benefits. Non-cardiac comorbidities such as frailty
may significantly affect the outcomes of this procedure. However, the
exact impact of frailty on CABG outcomes remains unclear, particularly
given its exclusion from many pivotal revascularization trials. This
systematic review and meta-analysis aimed to consolidate existing data to
evaluate the impact of frailty on short- and long-term outcomes following
CABG. METHOD(S): Searches across PubMed, Cochrane Library, Embase,
and Scopus were done to identify studies that were published up to March
31, 2024, had detailed preoperative frailty assessments and compared frail
versus non-frail adult patients undergoing CABG. Primary outcomes were
all-cause mortality and major adverse cardiac events within one year.
Secondary outcomes included hospital readmission rates and length of stay.
A random-effects model was used to account for heterogeneity. Results were
reported as odds ratios (OR) or mean differences (MD) with 95% confidence
intervals (CI). RESULT(S): Our meta-analysis, involving data from 14
studies, revealed a significant increase in both 30-day (OR 2.52; 95% CI:
2.07 to 3.07) and 1-year mortality (OR 2.58; 95% CI: 1.49 to 4.45) among
frail patients. The risk of acute cardiac and cerebrovascular
complications was comparable in all patients (OR 1.03; 95% CI: 0.89 to
1.19). However, frailty was associated with a significant increase in the
risk of acute kidney injury (OR 2.31; 95% CI: 1.26 to 4.23). Frail
patients were more likely to have longer hospital stays and higher
readmission rates compared to their non-frail counterparts.
 CONCLUSION(S): Our study confirms the critical impact of frailty on
mortality and morbidity in CABG patients and advocates for the integration
of frailty assessments into the preoperative evaluation process.
Addressing frailty can lead to more individualized patient care and better
outcomes, urging a paradigm shift towards comprehensive, patient-centric
management in cardiac surgery. PROSPERO REGISTER:
CRD42024521327. Copyright © 2024. The Author(s).

<34>
Accession Number
2036797252
Title
Cognitive Training for Reduction of Delirium in Patients Undergoing
Cardiac Surgery A Randomized Clinical Trial.
Source
JAMA Network Open. 7(4) (no pagination), 2024. Article Number: e247361.
Date of Publication: 01 Apr 2024.
Author
Jiang Y.; Xie Y.; Fang P.; Shang Z.; Chen L.; Zhou J.; Yang C.; Zhu W.;
Hao X.; Ding J.; Yin P.; Wang Z.; Cao M.; Zhang Y.; Tan Q.; Cheng D.; Kong
S.; Lu X.; Liu X.; Sessler D.I.
Institution
(Jiang, Shang, Zhou, Hao, Ding, Yin, Wang, Cao, Zhang, Lu, Liu) Department
of Anesthesiology, The First Affiliated Hospital of Anhui Medical,
University, Anhui, Hefei, China
(Xie, Yang) Department of Anesthesiology, The First Affiliated Hospital of
University of Science and Technology of China, Anhui, Hefei, China
(Chen, Tan, Cheng) Department of Anesthesiology, Nanjing First Hospital,
Nanjing Medical University, Jiangsu, Nanjing, China
(Zhou, Kong) School of International Pharmaceutical Business, China
Pharmaceutical University, Jiangsu, Nanjing, China
(Sessler) OUTCOMES RESEARCH Consortium, Department of Anesthesiology,
Cleveland Clinic, Cleveland, OH, United States
Publisher
American Medical Association
Abstract
IMPORTANCE Postoperative delirium is a common and impactful
neuropsychiatric complication in patients undergoing coronary artery
bypass grafting surgery. Cognitive training may enhance cognitive reserve,
thereby reducing postoperative delirium. OBJECTIVE To determine whether
preoperative cognitive training reduces the incidence of delirium in
patients undergoing coronary artery bypass grafting. DESIGN, SETTING, AND
PARTICIPANTS This prospective, single-blind, randomized clinical trial was
conducted at 3 university teaching hospitals in southeastern China with
enrollment between April 2022 and May 2023. Eligible participants included
those scheduled for elective coronary artery bypass grafting who consented
and enrolled at least 10 days before surgery. INTERVENTIONS Participating
patients were randomly assigned 1:1, stratified by site, to either routine
care or cognitive training, which included substantial practice with
online tasks designed to enhance cognitive functions including memory,
imagination, reasoning, reaction time, attention, and processing speed.
MAIN OUTCOMES AND MEASURES The primary outcome was occurrence of delirium
during postoperative days 1 to 7 or until hospital discharge, diagnosed
using the Confusion Assessment Method or the Confusion Assessment Method
for Intensive Care Units. Secondary outcomes were postoperative cognitive
dysfunction, delirium characteristics, and all-cause mortality within 30
days following the operation. RESULTS A total of 218 patients were
randomized and 208 (median [IQR] age, 66 [58-70] years; 64 female [30.8%]
and 144 male [69.2%]) were included in final analysis, with 102 randomized
to cognitive training and 106 randomized to routine care. Of all
participants, 95 (45.7%) had only a primary school education and 54
(26.0%) had finished high school. In the cognitive training group, 28
participants (27.5%) developed delirium compared with 46 participants
(43.4%) randomized to routine care. Those receiving cognitive training
were 57% less likely to develop delirium compared with those receiving
routine care (adjusted odds ratio [aOR] 0.43; 95% CI, 0.23-0.77; P =
.007). Significant differences were observed in the incidence of severe
delirium (aOR, 0.46; 95% CI, 0.25-0.82; P = .01), median (IQR) duration of
delirium (0 [0-1] days for cognitive training vs 0 [0-2] days for routine
care; P = .008), and median (IQR) number of delirium-positive days (0
[0-1] days for cognitive training vs 0 [0-2] days for routine care; P =
.007). No other secondary outcomes differed significantly. CONCLUSIONS AND
RELEVANCE In this randomized trial of 208 patients undergoing coronary
artery bypass grafting, preoperative cognitive training reduced the
incidence of postoperative delirium. However, our primary analysis was
based on fewer than 75 events and should therefore be considered
exploratory and a basis for future larger trials. Copyright ©
2024 American Medical Association. All rights reserved.

<35>
Accession Number
646134786
Title
Ischemic Stroke Prevention in Patients Atrial Fibrillation and a Recent
Ischemic Stroke, TIA, or Intracranial Hemorrhage; a World Stroke
Organisation (WSO) Scientific Statement.
Source
International journal of stroke : official journal of the International
Stroke Society. (pp 17474930241312649), 2024. Date of Publication: 24 Dec
2024.
Author
Sposato L.A.; Cameron A.; Johansen M.C.; Katan M.; Murthy S.B.; Schachter
M.; Sur N.; Yaghi S.; Aspberg S.; Caso V.; Hsieh C.-Y.; Hilz M.; Nucera
A.; Seiffge D.J.; Sheppard M.; Martins S.O.; Bahit M.C.; Scheitz J.F.;
Shoamanesh A.
Institution
(Sposato) Department of Clinical Neurological Sciences, Department of
Epidemiology & Biostatistics, Department of Anatomy and Cell Biology,
Heart & Brain Lab, Robarts Research Institute, Western University, London,
ON, Canada
(Cameron) School of Cardiovascular and Metabolic Health, University of
Glasgow, Glasgow, United Kingdom
(Johansen) Department of Neurology, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
(Katan) Department of Neurology, Stroke Center, University and University
Hospital of Basel, Basel, Switzerland
(Murthy) Clinical and Translational Neuroscience Unit, Department of
Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell
Medicine, New York, NY, USA
(Schachter) Neurocritical Care, Piedmont Healthcare, Atlanta, GA, United
States
(Sur) Department of Neurology, Stroke Division, University of Miami Miller
School of Medicine, Miami, FL, United States
(Yaghi) Department of Neurology, Brown University, Providence, RI, United
States
(Aspberg) Division of Cardiovascular Medicine, Department of Clinical
Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
(Caso) Stroke Unit, Santa Maria Della Misericordia Hospital-University of
Perugia, Perugia, Italy
(Hsieh) Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
(Republic of China)
(Hilz) Department of Neurology, University of Erlangen-Nuremberg,
Erlangen, Germany and Icahn School of Medicine at Mount Sinai, New York,
NY, USA
(Nucera) Neurovascular Treatment Unit, Spaziani Hospital, Frosinone, Italy
(Seiffge) Department of Neurology, Inselspital University Hospital and
University of Bern, Bern, Switzerland
(Sheppard) Cardiovascular and Genetics Research Institute, University of
London, St George's University, St George's, London, United Kingdom
(Martins) Neurology Department, Hospital Moinhos de Vento, Porto Alegre,
Brazil
(Bahit) INECO Neurociencias, Rosario, Argentina
(Scheitz) Department of Neurology and Center for Stroke Research, Charite
Universitatsmedizin, Berlin, Germany
(Shoamanesh) Division of Neurology, McMaster University, Hamilton, ON,
Canada
Abstract
BACKGROUND: Secondary stroke prevention in patients with atrial
fibrillation (AF) is one of the fastest growing areas in the field of
cerebrovascular diseases. This Scientific statement from the World Stroke
Organization Brain & Heart Task Force provides a critical analysis of the
strength of current evidence this topic, highlights areas of current
controversy, identifies knowledge gaps, and proposes priorities for future
research. METHOD(S): We select topics with the highest clinical
relevance and perform a systematic search to answer specific practical
questions. Based on the strength of available evidence and knowledge gaps,
we identify topics that need to be prioritized in future research. For
this purpose, we adopt a novel classification of evidence strength based
on the availability of publications in which the primary population is
patients with recent (<6 months) cerebrovascular events, whether the
primary study endpoint is a recurrent ischemic stroke, and the quality of
the studies (e.g., observational vs. randomized controlled trial).
SUMMARY: Priority areas include AF screening, molecular biomarkers, AF
subtype classification, anticoagulation in device-detected AF, timing of
anticoagulation initiation, effective management of breakthrough strokes
on existing anticoagulant therapy, the role of left atrial appendage
closure, novel approaches, and antithrombotic therapy post-intracranial
hemorrhage. Strength of currently available evidence varies across the
selected topics, with early anticoagulation being the one showing more
consistent data. CONCLUSION(S): Several knowledge gaps persist in
most areas related to secondary stroke prevention in AF. Prioritizing
research in this field is crucial to advance current knowledge and improve
clinical care.

<36>
Accession Number
2036785948
Title
Hybrid coronary revascularization in multivessel disease: Long-term
clinical outcomes of a prospective randomized study.
Source
Kardiologia Polska. 82(12) (pp 1278-1280), 2024. Date of Publication:
2024.
Author
Tajstra M.; Zembala M.O.; Gierlotka M.; Filipiak K.; Gasior M.; Hrapkowicz
T.
Institution
(Tajstra, Gasior) Department of Cardiology, SMDZ in Zabrze, Medical
University of Silesia, Katowice, Poland
(Zembala) Department of Cardiac Surgery, Faculty of Medicine, Catholic
University of Lublin, Lublin, Poland
(Gierlotka) Department of Cardiology, University Hospital, Institute of
Medial Sciences, University of Opole, Opole, Poland
(Filipiak, Hrapkowicz) Department of Cardiac, Vascular and Endovascular
Surgery and Transplantology, Silesian Center for Heart Diseases, Medical
University of Silesia, Zabrze, Poland
Publisher
Via Medica

<37>
Accession Number
2032803742
Title
Is There an Association Between Living in a Rural Area and the Incidence
of Postoperative Complications or Hospital Readmissions Following Left
Ventricular Assist Device (LVAD) Implantation, Compared to Urban Lvad
Recipients? A Systematic Review.
Source
Clinical Cardiology. 48(1) (no pagination), 2025. Article Number: e70068.
Date of Publication: 01 Jan 2025.
Author
Gollapudi S.; Gollapudi A.; Banala S.; Singh S.; Tadi K.
Institution
(Gollapudi, Banala) Department of Medicine, Rowan School of Osteopathic
Medicine, Stratford, NJ, United States
(Gollapudi, Singh, Tadi) Department of Research, Future Forwards Research
Institute, Piscataway, NJ, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Left ventricular assist devices (LVADs) are utilized as a
therapeutic option for patients with end-stage heart failure. While LVAD
implantation can enhance survival rates and quality of life, the procedure
has its risks, and postoperative complications are common. This review
aims to investigate whether there is an association between living in a
rural area and the incidence of postoperative complications or hospital
readmissions following LVAD implantation, compared to urban LVAD
recipients. Method(s): A comprehensive literature review examined
studies that compared postoperative outcomes between rural and urban LVAD
recipients. Data on adverse events, hospitalizations, and mortality rates
were extracted, focusing on the impact of geographic location on these
outcomes. Result(s): The review found that rural LVAD recipients may
be at a higher risk for certain complications, including gastrointestinal
bleeding, ventricular arrhythmias, LVAD complications, and stroke. Rural
patients also exhibited higher instances of emergency department visits
and hospital readmissions. Despite these challenges, survival rates and
heart transplantation outcomes at 1 year were similar between rural and
urban recipients. However, rural patients exhibited a higher driveline
infection rate at 1 year. Conclusion(s): The findings of this review
suggest that rural residency may be associated with an increased risk of
certain postoperative complications and hospital readmissions following
LVAD implantation. These results highlight the need for healthcare
strategies to address the challenges faced by rural LVAD recipients.
Further research is necessary to understand the relationship between
geographic location and LVAD outcomes and to develop interventions that
can improve postoperative care for this vulnerable
population. Copyright © 2024 The Author(s). Clinical Cardiology
published by Wiley Periodicals LLC.

<38>
Accession Number
2036804401
Title
The long-term success of cardiovascular surgery in Takayasu arteritis: 48
years of experience in Mexico, beyond forefront techniques.
Source
Journal of Thoracic Disease. 16(12) (pp 8482-8492), 2024. Date of
Publication: 31 Dec 2024.
Author
Soto M.E.; Gomez-Savinon V.G.; Vasquez-Jimenez C.; Barragan-Garcia R.;
Hernandez-Mejia I.; Koretzky S.G.; Guarner-Lans V.; Perez-Torres I.;
Martinez-Hernandez H.J.; Herrera-Alarcon V.
Institution
(Soto) Research Direction, Instituto Nacional de Cardiologia Ignacio
Chavez, Mexico City, Mexico
(Soto) Cardiovascular Line, Department of Centro Medico American British
Cowdray (ABC), Mexico City, Mexico
(Gomez-Savinon, Barragan-Garcia, Hernandez-Mejia, Martinez-Hernandez,
Herrera-Alarcon) Department of Cardiothoracic Surgery, Instituto Nacional
de Cardiologia Ignacio Chavez, Mexico City, Mexico
(Vasquez-Jimenez, Barragan-Garcia) Cardiovascular Surgery Service,
Department of Mexicali Cardiological Center, Mexico City, Mexico
(Koretzky) Department of Editorial, Instituto Nacional de Cardiologia
Ignacio Chavez, Mexico City, Mexico
(Koretzky) Department of Clinical Research, Mexico's Children Hospital
"Federico Gomez", Mexico City, Mexico
(Guarner-Lans) Department of Physiology, Instituto Nacional de Cardiologia
Ignacio Chavez, Mexico City, Mexico
(Perez-Torres) Department of Cardiovascular Biomedicine, Instituto
Nacional de Cardiologia, Mexico City, Mexico
Publisher
AME Publishing Company
Abstract
Background: Takayasu arteritis (TA) affects medium and large caliber
arteries causing stenosis, occlusion, or aneurysms. It has great
predilection for the aortic arch, subclavian and extracranial arteries.
The global prevalence is of 1% to 2% per million inhabitants, which varies
by geographical region. The main cause of death in TA of cardiovascular
origin and includes ischemic cardiomyopathy and valvular disease. The aim
of this study was to evaluate the surgical experience according to the
type of surgery in subjects with TA and with and without long-term
inflammatory activity. Method(s): This was a retrospective and
descriptive, cross-sectional study, between 1969 and 2017. Patients with
TA with more than 3 classification criteria according to the American
College of Rheumatology were included. The type of surgery was classified
as: organ preservation, cardiac, bypass, exclusion, and replacement.
Inflammatory activity was evaluated. Result(s): A total of 41
patients were included, out of which 31 (76%) were women. The age at
diagnosis was 29+/-10 years. The long-term survival rate according to the
surgical procedure was in cardiac surgery of 15 years in 90% of cases, in
organ preservation surgery of 35 years in 90%. Bypass, replacement,
exclusion and other surgeries had a 100% survival at a follow-up of 48
years. Conclusion(s): There are different types of surgical
approaches to treat the complexity of each TA patient. The surgical
technique well selected by experts in cardiothoracic surgery offers an
excellent long-term prognosis. Interventional management successfully
resolves some arterial occlusive aspects. It is necessary to evaluate the
appropriate use of surgical, interventional, and hybrid management through
randomized clinical trials to evaluate their comparison with
transparency. Copyright © 2024 AME Publishing Company. All rights
reserved.

<39>
Accession Number
2036804519
Title
Lung resection and new postoperative home oxygen requirement: a systematic
review.
Source
Journal of Thoracic Disease. 16(12) (pp 8796-8806), 2024. Date of
Publication: 31 Dec 2024.
Author
Oslock W.M.; Xie R.; Donahue J.; Wei B.
Institution
(Oslock, Xie, Donahue, Wei) Department of Surgery, University of Alabama
Birmingham, Birmingham, AL, United States
(Oslock) Department of Quality, Birmingham Veterans Affairs Medical
Center, Birmingham, AL, United States
(Wei) Department of Surgery, Birmingham Veterans Affairs Medical Center,
Birmingham, AL, United States
Publisher
AME Publishing Company
Abstract
Background: While patients are assessed for their ability to tolerate
surgery through physiologic evaluations such as pulmonary function tests,
ventilation-perfusion scans, and exercising testing, some patients still
require home oxygen therapy after pulmonary resection. It is not well
understood what the associated risk factors are, how long patients need
supplemental oxygen, and if this requirement is associated with worse
long-term outcomes. Given these knowledge gaps, we sought to conduct a
systematic review of pulmonary resections and new postoperative home
oxygen requirement. Method(s): A comprehensive search of PubMed was
conducted from inception to August 2023 for studies reporting new home
oxygen requirement in adults after pulmonary resection. If all
participants were already on home oxygen, if no patients required home
oxygen after surgery, or full text was not available in English the study
was excluded. Odds ratios from available studies were statistically
combined using a meta-analytic approach into a forest plot, allowing for a
more precise estimate of the effect size than any single study.
 Result(s): A total of 17 studies capturing 26,093 patients, 3,796 of
whom were discharged on home oxygen, were included in the review. The
majority of studies focused on patients undergoing resection for malignant
etiologies. Female sex, White race, obesity, and non-adenocarcinoma
histology were most commonly found to be associated with increased risk
for home oxygen. Tobacco use and pulmonary function studies [e.g., forced
expiratory volume in one second (FEV1) and diffusing capacity of the lungs
for carbon monoxide (DLCO)] lost significance on multivariable analysis.
While few of the studies captured duration and outcomes associated with
home oxygen, the ones that did found that nearly 50% of patients were
still on home oxygen after 6 months and that the need for home oxygen even
during the first month was associated with increased risk for mortality.
 Conclusion(s): Requiring home oxygen after surgery may be associated
with worse outcomes. Additional studies on the factors associated with
requiring postoperative home oxygen are needed. This would allow for more
accurate preoperative counseling as well as target modifiable risk factors
for optimization. Copyright © 2024 AME Publishing Company. All
rights reserved.

<40>
Accession Number
2036787566
Title
Efficacy of Nursing Intervention Management in the Operating Room for
Patients Undergoing Cardiac Surgery: A Systematic Review and
Meta-Analysis.
Source
Heart Surgery Forum. 27(12) (pp E1465-E1474), 2024. Date of Publication:
2024.
Author
Shi H.; Li X.; Li J.; Xu Z.; Mao L.
Institution
(Shi, Li, Li, Xu) Operating Room Department, Taizhou Hospital of Zhejiang
Province affiliated to Wenzhou Medical University, Zhejiang, Taizhou,
China
(Mao) Nursing Department, Taizhou Hospital of Zhejiang Province affiliated
to Wenzhou Medical University, Zhejiang, Taizhou, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: Cardiac surgery is a complex, high-risk procedure that
necessitates specialized nursing care in the operating room (OR). Nursing
intervention management is vital in ensuring patient safety and optimizing
outcomes. This meta-analysis aims to assess the effectiveness of nursing
intervention management in the OR for patients undergoing cardiac surgery.
 Method(s): A systematic search was conducted on PubMed, Web of
Science, China National Knowledge Internet, and Wanfang databases to
identify relevant studies published from January 1998 to March 2023. The
inclusion criteria were studies that were randomized controlled trials
(RCTs) or quasi-RCTs and compared the efficacy of nursing intervention
management in the OR for patients undergoing cardiac surgery. The primary
outcome was postoperative adverse events. The secondary outcome was length
of hospital stays. intraoperative blood loss; ICU length of stay; duration
of surgery. Result(s): This systematic review and meta-analysis
showed that operating room nursing can reduce the occurrence of
postoperative adverse events in patients undergoing cardiac surgery [risk
ratio (RR) = 0.30, 95% CI: (0.20, 0.45)]. At the same time, it could
reduce the length of hospital stays of patients [Mean Deviation (MD) =
-5.32, 95% CI: (-6.03, -4.60)]; intraoperative blood loss [MD= -179.70,
95% CI:(-211.02, -148.39)]; ICU length of stay [MD = -5.85, 95% CI:
(-10.39, -1.31)]; duration of surgery [MD= -19.77, 95% CI: (-22.73,
-16.81)]. Conclusion(s): Nursing intervention management in the OR is
effective in improving outcomes and patient satisfaction for individuals
undergoing cardiac surgery. Copyright: © 2024 The Author(s).

<41>
Accession Number
2036812652
Title
Financial burden of complications following lung resection: a scoping
review protocol.
Source
BMJ Open. 14(12) (no pagination), 2024. Article Number: e083015. Date of
Publication: 20 Dec 2024.
Author
Flinkier A.; Chu F.; Berman J.; Slifirski H.; Barnett S.; Caragata R.;
Weinberg L.
Institution
(Flinkier, Chu, Caragata, Weinberg) Department of Anaesthesia, Austin
Health, Heidelberg, VIC, Australia
(Berman) Department of Surgery, Monash Health, Clayton, VIC, Australia
(Slifirski) Austin Health, Heidelberg, VIC, Australia
(Barnett) Department of Thoracic Surgery, Austin Health, Heidelberg, VIC,
Australia
(Barnett) Department of Surgery, The University of Melbourne, Melbourne,
VIC, Australia
(Weinberg) Department of Critical Care, The University of Melbourne,
Parkville Campus, Melbourne, VIC, Australia
Publisher
BMJ Publishing Group
Abstract
Introduction Global healthcare expenditures are rising, driven largely by
increased spending in both high- and low-income countries with
hospitalisation as a primary contributor. Respiratory diseases,
particularly lung cancer, pose significant public health and economic
challenges with thoracic surgery as the standard curative treatment.
Complications post resection, such as arrhythmias, infections and
respiratory failure, result in substantial healthcare costs and resource
demands. Although studies have explored the economic impact of surgeries,
there is a limited comprehensive analysis of the financial burden of
postoperative complications after lung resection surgery. To address this
gap, this scoping review aims to map existing literature on lung resection
complications and associated costs, providing insights for future research
and healthcare policy. Methods and analysis This scoping review will be
conducting according to the Preferred Reporting Items for Systematic
Review and Meta-Analysis Extension for Scoping Reviews standards. Eligible
peer-reviewed articles and grey literature will be identified across
Medical Literature Analysis and Retrieval System Online, Excerpta Medica
Database and Cochrane Central Register of Controlled Trials. Cost data
will be converted into US dollars as per the Federal Reserve Bank of St
Louis and adjusted for inflation as per the US Bureau of Labor Statistics
Consumer Price Index inflation calculator. Ethics and dissemination Ethics
approval was not required. The results will be communicated through
established professional networks, conference presentations and
publication in peer-reviewed journals. 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 Group.

<42>
Accession Number
646131614
Title
Prehabilitation in lung cancer surgery: A review and meta-analysis of RCT
studies.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2023. Milan Italy. 62(Supplement 67) (pp
PA3773), 2023. Date of Publication: 01 Sep 2023.
Author
Athanassiadi K.; Magouliotis D.; Chatzimichali E.; Liverakou E.; Katsandri
A.; Kalomenidis I.; Katsaounou P.
Institution
(Athanassiadi, Magouliotis, Chatzimichali, Liverakou) Dept of Thoracic
Surgery, General Hospital 'EVANGELISMOS', Athens, Greece
(Katsandri) Dept of Internal Medicine, General Hospital 'EVANGELISMOS',
Athens, Greece
(Kalomenidis) Dept of Intensive Care Unit and Respiratory Insufficiency,
General Hospital, Greece
(Katsaounou) EVANGELISMOS, Athens, Greece
Publisher
European Respiratory Society
Abstract
Prehabilitation to maximize exercise capacity before lung cancer surgery
has the potential to improve operative tolerability and patient outcomes.
Although prehabilitation becomes popular in cancer surgery, it is not
common in thoracic surgery in clinical practice. MATERIAL and METHOD: We
conducted a systematic literature search through PubMed/Medline covering
completed trials from 2010 to 2021 and included randomised controlled
trials (RCTs) in which they studied participants who were scheduled to
undergo lung resection for NSCLC and were allocated to receive either
prehabilitation or no. The data was collected and analyzed by 2 review
authors independently who screened the studies and selected those for
inclusion. We analyzed the duration of prehabilition and the benefits for
the patients perioperatively in comparison to those who did not receive
exercise training preoperatively. Result(s): Preoperative exercise
training may reduce the risk of developing a postoperative pulmonary
complication, postoperative need for pain analgesia and length of hospital
stay. It also might improve both exercise capacity and FVC in people
undergoing lung resection for NSCLC. Conclusion(s): Although our
findings should be interpreted very carefully due to the differences of
the RCT's studies we included, one should admit that prehabilitation
should be included as rule in lung cancer surgery. At a time when
healthcare is under pressure to provide patientcentered value-based care,
prehabilitation provides a potentially cost-effective opportunity to to
reduce complications after surgery and significantly reduce healthcare
expenditure.

<43>
Accession Number
646126379
Title
Late Breaking Abstract - Post-removal pneumothorax with and without chest
tube clamping in patients with pleural disease: a randomized controlled
trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2023. Milan Italy. 62(Supplement 67) (pp
OA2590), 2023. Date of Publication: 01 Sep 2023.
Author
Llamazares S.R.; Melendez P.O.; Padilla I.A.O.; Hernandez L.J.A.; Menindez
M.D.; Bastidas F.G.M.; Riestra P.V.; Valdes E.G.
Institution
(Llamazares, Melendez, Padilla, Hernandez, Menindez, Bastidas, Riestra,
Valdes) National Institute of Respiratory Diseases (INER), Mexico City,
Mexico
Publisher
European Respiratory Society
Abstract
Introduction: There is an ongoing discussion about whether clamping a
chest tube (ChT) before its removal is the ideal way to avoid
complications. As a pending research question recently posed by the BTS in
a Public Consultation Draft, and as the first prospective study and first
randomized controlled trial (RCT) to ever answer this question, this study
aimed to compare the incidence of 24-hour post-removal pneumothorax with
and without ChT clamping in patients with pleural disease. Method(s):
Adult patients hospitalized in a single centre requiring a ChT because of
pleural effusion, pneumothorax or thoracic surgery were block-randomized
into two arms: 6 hours clamping vs. not clamping before ChT removal. The
primary outcome was the appearance of pneumothorax within the first 24
hours as seen in a chest X-ray. Result(s): A total of 93 patients
were included, of which 41 patients had ChT clamping (44%) while 52 (56%)
had not. ChT insertion diagnosis was pleural effusion in 43 patients
(46%), pneumothorax in 35 patients (38%) and surgery in 15 patients (16%).
Only 4 patients in each group developed post-removal pneumothorax in the
first 24 hours (7.7% vs. 9.8%) with no differences between them (p=0.72)
and only 1 patient required ChT reinsertion. No differences were observed
in days with a ChT between both groups (p=0.44), nor in the days of
hospital stay after its withdrawal (p=0.86). A subgroup analysis according
to ChT insertion diagnosis also revealed no differences in post-removal
pneumothorax between clamping and nonclamping arms. Conclusion(s):
There were no differences in the incidence of 24-hour postremoval
pneumothorax between both techniques in this RCT.

<44>
Accession Number
2036793403
Title
Quality of life measured by EQ-5D at different treatment time points for
coronary artery disease: protocol for a systematic review and
meta-analysis.
Source
BMJ Open. 10(7) (no pagination), 2020. Article Number: e039311. Date of
Publication: 29 Jul 2020.
Author
Lum E.; McCreanor V.; Luo N.; Graves N.
Institution
(Lum, Graves) Health Services & Systems Research, Duke-NUS Medical School,
Singapore
(Lum) School of Clinical Sciences, Queensland University of Technology,
Brisbane, QLD, Australia
(McCreanor) Jamieson Trauma Institute, Royal Brisbane and Women's
Hospital, Metro North Hospital and Health Service, Brisbane, QLD,
Australia
(McCreanor) Australian Centre for Health Services Innovation, Queensland
University of Technology, Brisbane, QLD, Australia
(Luo) Saw Swee Hock School of Public Health, National University of
Singapore, Singapore
Publisher
BMJ Publishing Group
Abstract
Introduction Cardiovascular disease is estimated to affect 423 million
people globally. It caused 18 million deaths in 2017 and is projected to
cost US$1 trillion by 2030 worldwide. Coronary artery disease (CAD) is the
most common type of cardiovascular disease; CAD treatments can affect
patients' quality of life. Valuations of quality of life or health
utilities are important for economic evaluations to ascertain relative
health benefit when comparing treatments, and can be expected to change
for individuals over time. The purpose of this systematic review is to
estimate the quality of life of patients with CAD reported through the
EuroQol 5 Dimension (EQ-5D) questionnaire, from short to longer term time
points following different treatments. Methods and analysis PubMed,
Embase, Web of Science, the Cochrane Database of Systematic Reviews and
the EuroQol website will be systematically searched from January
2003-March 2020. Published, peer-reviewed, English language studies
assessing quality of life of patients with CAD using the EQ-5D will be
included. One researcher will conduct the search; two researchers will
independently screen titles and abstracts for potential inclusion. Full
texts of potentially eligible studies will be retrieved for a second round
of independent screening against inclusion and exclusion criteria by two
researchers. The final list of included studies will be assessed for risk
of bias using the RoB 2 and Risk Of Bias In Non-randomized Studies - of
Interventions (ROBINS-I) tools for randomised and non-randomised studies,
respectively. Data extraction will be done by one researcher, with data
extraction for a random 10% of included studies checked by a second
researcher. Mean utility weights for individual studies will be combined
using random effects model meta-analyses. A model will be run separately
for each time point and treatment. Treatment time points of interest
include baseline, 30 days, 6 months, 12-24 months and more than 24 months.
Subgroup analysis of patients with diabetes who received interventional
treatments-coronary artery bypass graft or percutaneous coronary
intervention with or without stents, will be conducted for the same
selected time points. Ethics and dissemination Ethics approval is not
required for systematic reviews. Results of the review will be
disseminated via publication in a peer-reviewed journal. Copyright
© Author(s) (or their employer(s)) 2020.

<45>
Accession Number
2036721683
Title
Metoprolol for prophylaxis of postoperative atrial fibrillation in cardiac
surgery patients: Systematic review and meta-analysis.
Source
BMJ Open. 10(10) (no pagination), 2020. Article Number: e038364. Date of
Publication: 31 Oct 2020.
Author
Norhayati M.N.; Shaiful Bahari I.; Zaharah S.; Nik Hazlina N.H.; Mohammad
Aimanazrul Z.; Irfan M.
Institution
(Norhayati, Shaiful Bahari, Mohammad Aimanazrul) Department of Family
Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health
Campus, Kubang Kerian, Malaysia
(Zaharah, Nik Hazlina, Irfan) Women's Health Development Unit, School of
Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian,
Malaysia
(Irfan) Department of Zoology, Pir Mehr Ali Shah, Arid Agriculture
University, Rawalpindi, Pakistan
Publisher
BMJ Publishing Group
Abstract
Purpose Postoperative atrial fibrillation (POAF) is a potentially lethal
and morbid complication after open heart surgery. This systematic review
and meta-analysis aimed to investigate metoprolol compared with other
treatments for prophylaxis against POAF. Methods We searched CENTRAL,
MEDLINE, EMBASE and trial registries for randomised controlled trials that
evaluated metoprolol for preventing the occurrence of POAF after surgery
against other treatments or placebo. Random-effects model was used for
estimating the risk ratios (RRs) and mean differences with 95% CIs.
Results Nine trials involving 1570 patients showed metoprolol reduced POAF
compared with placebo (416 patients; RR 0.46, 95% CI 0.33 to 0.66;
I2=21%; risk difference (RD) -0.19, 95% CI -0.28 to -0.10).
However, metoprolol increased the risk of POAF compared with carvedilol
(159 patients; RR 1.59, 95% CI 1.20 to 2.12; I2=4%; RD 0.13,
95% CI 0.06 to 0.20). There was no difference when compared with sotalol
or amiodarone. The occurrence of cardiovascular conditions after drugs
administration or death between the groups was not different. The overall
quality of evidence was moderate to high. Subgroup analysis and funnel
plot were not performed. Conclusions Metoprolol is effective in preventing
POAF compared with placebo and showed no difference with class III
antiarrhythmic drugs. Death and thromboembolism are associated with open
heart surgery, but not significant in relation to the use of
metoprolol. Copyright © Author(s) (or their employer(s)) 2020.

<46>
Accession Number
2036793841
Title
Safety and efficacy of perioperative benzodiazepine administration: study
protocol for a systematic review and meta-analysis.
Source
BMJ Open. 9(12) (no pagination), 2019. Article Number: e031895. Date of
Publication: 11 Dec 2019.
Author
Spence J.; Young J.; Alhazzani W.; Whitlock R.; D'Aragon F.; Um K.; Mazer
D.; Beaver C.; Jacobsohn E.; Belley-Cote E.
Institution
(Spence) Departments of Anesthesia and Critical Care and Health Research
Methods,, Evaluation, and Impact (HEI), Population Health Research
Institute, McMaster University, Hamilton, ON, Canada
(Young) Health Sciences Library, McMaster University, Hamilton, ON, Canada
(Alhazzani) Departments of Critical Care, Medicine (Gastroenterology), and
Health Research Methods, Evaluation, and Impact (HEI), McMaster
University, Hamilton, ON, Canada
(Whitlock) Departments of Surgery (Cardiac Surgery) and Health Research
Methods, Evaluation and Impact (HEI), Population Health Research Institute
(PHRI), McMaster University, Hamilton, ON, Canada
(D'Aragon) Department d'anesthesiologie, Faculte de medecine et des
sciences de la sante, Universite de Sherbrooke, Sherbrooke, QC, Canada
(Um) Population Health Research Institute, McMaster University, Hamilton,
ON, Canada
(Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Beaver) Sheridan College, Oakville, ON, Canada
(Jacobsohn) Rady Faculty of Health Sciences, Max Rady College of Medicine,
University of Manitoba, Winnipeg, MB, Canada
(Belley-Cote) Departments of Critical Care and Medicine (Cardiology),
Population Health Research Institute (PHRI), McMaster University,
Hamilton, ON, Canada
Publisher
BMJ Publishing Group
Abstract
Introduction Perioperative benzodiazepines are used because of their
anxiolytic, sedative and amnestic effects. Evidence has demonstrated an
association of benzodiazepines with adverse neuropsychiatric effects.
Nonetheless, because of their potential benefits, perioperative
benzodiazepines continue to be used routinely. We seek to evaluate the
body of evidence of the risks and benefits of benzodiazepine use during
the perioperative period. Methods and analysis We will search Cochrane
CENTRAL, MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Science from
inception to March 2019 for randomised controlled trials (RCTs) and
observational studies evaluating the administration of benzodiazepine
medications as compared with all other medications (or nothing) in
patients undergoing cardiac and non-cardiac surgery. We will exclude
studies assessing the use of benzodiazepines for procedural sedation or
day surgery. We will examine the impact of giving these medications
before, during and after surgery. Outcomes of interest include the
incidence of delirium, duration of delirium, postprocedure cognitive
change, the incidence of intraoperative awareness, patient
satisfaction/quality of life/quality of recovery, length-of-stay (LOS) in
the intensive care unit (ICU), hospital LOS and in-hospital mortality.
Reviewers will screen references and assess eligibility using predefined
criteria independently and in duplicate. Two reviewers will independently
collect data using prepiloted forms. We will present results separately
for RCTs and observational studies. We will pool data using a random
effect model and present results as relative risk with 95% CIs for
dichotomous outcomes and mean difference with 95% CI for continuous
outcomes. We will pool adjusted ORs for observational studies. We will
assess risk of bias for individual studies using the Cochrane
Collaboration tool for RCTs. For observational studies, we will use tools
designed by the Clinical Advances through Research and Information
Translation group. Quality of evidence for each outcome will be assessed
using the Grading of Recommendations Assessment, Development and
Evaluation approach. Copyright © Author(s) (or their employer(s))
2019.

<47>
Accession Number
2032798264
Title
Coronary CTA and CT-FFR in trans-catheter aortic valve implantation
candidates: a systematic review and meta-analysis.
Source
European Radiology. (no pagination), 2025. Article Number: 210. Date of
Publication: 2025.
Author
Becker L.M.; Peper J.; van Ginkel D.-J.; Overduin D.C.; van Es H.W.;
Rensing B.J.M.W.; Timmers L.; ten Berg J.M.; Mohamed Hoesein F.A.A.;
Leiner T.; Swaans M.J.
Institution
(Becker, Peper, van Ginkel, Overduin, Rensing, Timmers, ten Berg, Swaans)
Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
(Becker, Mohamed Hoesein, Leiner) Department of Radiology, University
Medical Center Utrecht, Utrecht, Netherlands
(van Es) Department of Radiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(ten Berg) Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, Netherlands
(Leiner) Department of Radiology, Mayo Clinics, Rochester, MN, United
States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objectives: Screening for obstructive coronary artery disease (CAD) with
coronary computed tomography angiography (CCTA) could prevent unnecessary
invasive coronary angiography (ICA) procedures during work-up for
trans-catheter aortic valve implantation (TAVI). CT-derived fractional
flow reserve (CT-FFR) improves CCTA accuracy in chest pain patients.
However, its reliability in the TAVI population is unknown. This
systematic review and meta-analysis assesses CCTA and CT-FFR in TAVI
candidates. Method(s): PubMed, Embase and Web of Science were
searched for studies regarding CCTA and/or CT-FFR in TAVI candidates.
Primary endpoint was correct identification and rule-out of obstructive
CAD. Results were pooled in a meta-analysis. Result(s): Thirty-four
articles were part of the meta-analysis, reporting results for CCTA and
CT-FFR in 7235 and 1269 patients, respectively. Reference standard was
mostly anatomical severity of CAD. At patient level, pooled CCTA
sensitivity was 94.0% and specificity 72.4%. CT-FFR sensitivity was 93.2%
and specificity 70.3% with substantial variation between studies. However,
in studies that compared both, CT-FFR performed better than CCTA.
Sensitivity of CCTA versus CT-FFR was 74.9% versus 83.9%, and specificity
was 65.5% versus 89.8%. Conclusion(s): Negative CCTA accurately rules
out CAD in the TAVI population. CCTA could lead to significant reduction
in pre-TAVI ICA, but false positives remain high. Diagnostic accuracy of
CT-FFR was comparable to that of CCTA in our meta-analyses, but in studies
performing a direct comparison, CT-FFR performed better than CCTA.
However, as most studies were small and used CT-FFR software exclusively
available for research, a large study on CT-FFR in TAVI work-up using
commercially available CT-FFR software would be appropriate before
considering routine implementation. Key Points: Question Coronary artery
disease (CAD) screening with invasive coronary angiography before
trans-catheter aortic valve implantation (TAVI) is often retrospectively
unnecessary, revealing no obstructive CAD. Findings Coronary CTA ruled out
CAD in approximately half of TAVI candidates. CT-derived fractional flow
reserve (CT-FFR) performed similarly overall but better than coronary CTA
in direct comparison. Clinical relevance Addition of coronary CTA to TAVI
planning-CT to screen for obstructive CAD could reduce negative invasive
coronary angiographies in TAVI work-up. CT-FFR could reduce false-positive
coronary CTA results, improving its gatekeeper function in this
population, but more data is necessary. Copyright © The
Author(s), under exclusive licence to European Society of Radiology 2024.

<48>
Accession Number
2036724240
Title
Impact of Bifurcation Lesions on Outcomes after FFR-Guided PCI or CABG.
Source
Circulation: Cardiovascular Interventions. (no pagination), 2024. Article
Number: e014610. Date of Publication: 2024.
Author
Dillen D.M.M.; Otsuki H.; Takahashi K.; Kobayashi Y.; Piroth Z.; Noiseux
N.; Nakadi B.E.; Kalinauskas G.; Szekely L.; Davidavicius G.; Teeuwen K.;
Tonino P.A.L.; Pijls N.H.J.; De Bruyne B.; Fearon W.F.; Zimmermann F.M.
Institution
(Dillen, Teeuwen, Tonino, Pijls, Zimmermann) Department of Cardiology,
Catharina Hospital, Eindhoven, Netherlands
(Otsuki, Takahashi, Fearon) Division of Cardiovascular Medicine, Stanford
University School of Medicine, Stanford Cardiovascular Institute, Stanford
University, CA, United States
(Kobayashi) New York Presbyterian Brooklyn Methodist, Weill Cornell
Medical College, United States
(Piroth) Gottsegen National Cardiovascular Center, Budapest, Hungary
(Noiseux) Department of Cardiothoracic Surgery, Centre Hospitalier de
l'Universite de Montreal, QC, Canada
(Nakadi) Department of Cardiothoracic Surgery, Centre Hospitalier
Universitaire de Charleroi, Belgium
(Kalinauskas) Department of Cardiothoracic Surgery, Vilnius University
Hospital Santaros Klinikos, Lithuania
(Szekely) Department of Cardiothoracic Surgery, Gottsegen National
Cardiovascular Center, Budapest, Hungary
(Davidavicius) Clinic of Cardiac and Vascular Diseases, Institute of
Clinical Medicine, Vilnius University, Lithuania
(Tonino) Department of Biomedical Engineering, Technical University
Eindhoven, Netherlands
(De Bruyne) Cardiovascular Center Aalst, OLV Clinic, Belgium
(Zimmermann) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: In the era of first-generation drug-eluting stents and
angiography-guided percutaneous coronary intervention (PCI), the presence
of a bifurcation lesion was associated with adverse outcomes after PCI. In
contrast, the presence of a bifurcation lesion had no impact on outcomes
following coronary artery bypass grafting (CABG). Therefore, the presence
of a coronary bifurcation lesion requires special attention when choosing
between CABG and PCI. The aim of this study is to assess whether the
presence of a bifurcation lesion still influences clinical outcomes after
contemporary PCI using second-generation drug-eluting stent and fractional
flow reserve (FFR) guidance versus CABG. METHOD(S): The randomized
FAME 3 trial (Fractional Flow Reserve Versus Angiography for Multivessel
Evaluation) compared FFR-guided PCI using current drug-eluting stents with
CABG in patients with 3-vessel coronary artery disease. The prespecified
key end point at 3-year follow-up was the composite of death, myocardial
infarction, or stroke. In this substudy, the impact of bifurcation lesions
on outcomes after FFR-guided PCI and CABG was investigated.
 RESULT(S): The FAME 3 trial enrolled 1500 patients and 653 (45.2%)
patients had at least 1 true bifurcation lesion. There was no difference
in the composite of death, myocardial infarction, or stroke at the 3-year
follow-up between patients with or without at least 1 true bifurcation
lesion (11.6% versus 10.0%; hazard ratio, 1.17 [95% CI, 0.86-1.61];
P=0.32), regardless of revascularization strategy. The composite end point
was not statistically different between FFR-guided PCI and CABG in
patients with at least 1 true bifurcation lesion (hazard ratio, 1.27 [95%
CI, 0.80-2.00]) or without a true bifurcation lesion (hazard ratio, 1.36
[95% CI, 0.87-2.12]), with no significant interaction (Pinteraction=0.81).
 CONCLUSION(S): In patients with 3-vessel coronary artery disease, the
presence of a true bifurcation lesion was not associated with a different
treatment effect after FFR-guided PCI with contemporary drug-eluting stent
versus CABG. Copyright © 2024 American Heart Association, Inc.

<49>
Accession Number
2035403114
Title
The Value of Biomarkers in Major Cardiovascular Surgery Necessitating
Cardiopulmonary Bypass.
Source
Reviews in Cardiovascular Medicine. 25(10) (no pagination), 2024. Article
Number: 355. Date of Publication: 2024.
Author
Stef A.; Bodolea C.; Bocsan I.C.; Cainap S.S.; Achim A.; Serban A.;
Solomonean A.G.; Tintiuc N.; Buzoianu A.D.
Institution
(Stef, Solomonean, Tintiuc) Clinical Department of Anesthesia and
Intensive Care, Heart Institute "Niculae Stancioiu", "Iuliu Hatieganu"
University of Medicine and Pharmacy, Cluj-Napoca, Romania
(Stef, Bodolea) Anesthesia and Intensive Care 2 Discipline, "Iuliu
Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
(Bocsan, Buzoianu) Department of Pharmacology, Toxicology and Clinical
Pharmacology, "Iuliu Hatieganu" University of Medicine and Pharmacy,
Cluj-Napoca, Romania
(Cainap) Department of Mother and Child, 2nd Pediatric Discipline, "Iuliu
Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
(Achim, Serban) Cardiology Department, Heart Institute "Niculae
Stancioiu", "Iuliu Hatieganu" University of Medicine and Pharmacy,
Cluj-Napoca, Romania
Publisher
IMR Press Limited
Abstract
The use of biomarkers in cardiovascular surgery is an evolving field with
promising potential; however, current research remains largely limited,
requiring further validation for routine clinical application. This review
explores the application of biomarkers in cardiovascular surgery, focusing
on heart failure, cardiac ischemia, and organ dysfunction, including
renal, cerebral, pulmonary, and splanchnic impairments. Additionally, it
examines the significance of biomarkers in assessing the inflammatory
state and oxidative stress during the perioperative period, particularly
in the context of major surgical trauma and cardiopulmonary bypass (CPB).
From January 2018 to June 2024, we reviewed 133 studies and four
systematic reviews and meta-analyses using the Medline, Embase, and
Central databases, screening for pre- or postoperative biomarker levels in
patients undergoing cardiac surgery. Outcomes of interest were
postoperative mortality, nonfatal myocardial infarction, stroke,
congestive heart failure, and major adverse cardiovascular events (MACEs).
Studies reporting multivariable-adjusted risk estimates were included. The
findings revealed that cardiac troponins (cTns) and creatine kinase
isoenzyme MB (CK-MB) remain the most widely utilized biomarkers for
assessing myocardial injury post-surgery. These elevated biomarker levels
were consistently associated with an increased risk of postoperative
complications, including low cardiac output syndrome, prolonged
ventilation, and mortality. Emerging biomarkers, such as heart-type fatty
acid-binding protein (h-FABP) and high-sensitivity C-reactive protein
(hs-CRP), demonstrated promising early detection and risk stratification
results. In particular, h-FABP increased rapidly within one hour of
myocardial injury, peaking at 4-6 hours and returning to baseline within
24 hours. This rapid clearance makes h-FABP a valuable tool for early
myocardial injury detection, potentially allowing for timely
interventions. Inflammatory biomarkers, including hs-CRP and pentraxin 3
(PTX3), were found to be associated with poor outcomes, such as increased
morbidity and mortality. Elevated preoperative levels of these markers
were indicative of a heightened inflammatory response, correlating with
worse postoperative recovery and higher rates of complications.
Furthermore, the neutrophil-to-lymphocyte ratio (NLR) emerged as a
cost-effective and easily accessible predictor of postoperative outcomes.
Elevated NLR values were linked to an increased risk of adverse events,
including prolonged ventilation, low cardiac output syndrome, and overall
mortality. Further, the practicality of measuring NLR through routine
blood tests makes it viable for widespread clinical use. In conclusion,
integrating biomarkers in cardiovascular surgery significantly advances
predicting postoperative outcomes for cardiac surgery patients. Therefore,
it is essential to categorize these biomarkers into two distinct groups in
the future, inflammatory and non-inflammatory (related to organ damage),
to improve understanding and enhance their clinical applicability. Future
research should focus on standardizing the use of these biomarkers and
exploring their combined predictive power to enhance risk stratification
and improve patient prognosis. Copyright © 2024 The Author(s).

<50>
Accession Number
2032794388
Title
Non-adrenergic vasopressors for vasodilatory shock or perioperative
vasoplegia: a meta-analysis of randomized controlled trials.
Source
Critical Care. 28(1) (no pagination), 2024. Article Number: 439. Date of
Publication: 01 Dec 2024.
Author
Kotani Y.; Belletti A.; D'Amico F.; Bonaccorso A.; Wieruszewski P.M.;
Fujii T.; Khanna A.K.; Landoni G.; Bellomo R.
Institution
(Kotani) Department of Intensive Care Medicine, Kameda Medical Center, 929
Higashi-Cho, Kamogawa, Japan
(Belletti, D'Amico, Bonaccorso, Landoni) Department of Anesthesia and
Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
(Wieruszewski) Department of Anesthesiology, Mayo Clinic, Rochester, MN,
United States
(Wieruszewski) Department of Pharmacy, Mayo Clinic, Rochester, MN, United
States
(Fujii) Department of Intensive Care, Jikei University Hospital, Tokyo,
Japan
(Khanna) Department of Anesthesiology, Section On Critical Care Medicine,
Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical
Center, Winston-Salem, NC, United States
(Khanna) Outcomes Research Consortium, Houston, TX, United States
(Landoni) School of Medicine, Vita-Salute San Raffaele University, Milan,
Italy
(Bellomo) Australian and New Zealand Intensive Care Research Centre
(ANZIC-RC), School of Public Health and Preventive Medicine, Monash
University, Melbourne, Australia
(Bellomo) Department of Critical Care, University of Melbourne, Melbourne,
Australia
(Bellomo) Data Analytics Research and Evaluation Centre, Austin Hospital,
Melbourne, Australia
(Bellomo) Department of Intensive Care, Austin Hospital, Heidelberg,
Melbourne, VIC, Australia
(Bellomo) Department of Intensive Care, Royal Melbourne Hospital,
Melbourne, Australia
(Bellomo) Data Analytics Research and Evaluation, Austin Hospital,
Heidelberg, Melbourne, VIC, Australia
Publisher
BioMed Central Ltd
Abstract
Background: Excessive exposure to adrenergic vasopressors may be harmful.
Non-adrenergic vasopressors may spare adrenergic agents and potentially
improve outcomes. We aimed to conduct a systematic review and
meta-analysis of randomized controlled trials (RCTs) to evaluate the
efficacy of non-adrenergic vasopressors in adult patients receiving
vasopressor therapy for vasodilatory shock or perioperative vasoplegia.
 Method(s): We searched PubMed, Embase, and Cochrane Library for RCTs
comparing non-adrenergic vasopressors with adrenergic vasopressors alone
or placebo in critically ill or perioperative patients. Each eligible
study was categorized into septic shock, cardiac surgery, or non-cardiac
surgery. Non-adrenergic vasopressors included vasopressin, terlipressin,
selepressin, angiotensin II, methylene blue, and hydroxocobalamin. The
primary outcome was mortality at longest follow-up. We conducted a
random-effects meta-analysis. We registered the protocol in PROSPERO
International Prospective Register of Systematic Reviews (CRD42024505039).
 Result(s): Among 51 eligible RCTs totaling 5715 patients, the
predominant population was septic shock in 30 studies, cardiac surgery in
11 studies, and non-cardiac surgery in 10 studies. Cochrane risk-of-bias
tool for randomized trials version 2 identified 17 studies as low risk of
bias. In septic shock, mortality was significantly lower in the
non-adrenergic group (960/2232 [43%] vs. 898/1890 [48%]; risk ratio [RR],
0.92; 95% confidence interval [95% CI], 0.86-0.97; P = 0.03; I2
= 0%), with none of the individual non-adrenergic vasopressors showing
significant survival benefits. No significant mortality difference was
observed in patients undergoing cardiac surgery (34/410 [8.3%] vs. 47/412
[11%]; RR, 0.82; 95% CI, 0.55-1.22; P = 0.32; I2 = 12%) or
those undergoing non-cardiac surgery (9/388 [2.3%] vs. 18/383 [4.7%]; RR,
0.66; 95% CI, 0.31-1.41; P = 0.28; I2 = 0%).
 Conclusion(s): Administration of non-adrenergic vasopressors was
significantly associated with reduced mortality in patients with septic
shock. However, no single agent achieved statistical significance in
separate analyses. Although the pooled effects of non-adrenergic
vasopressors on survival did not reach statistical significance in
patients undergoing cardiac or non-cardiac surgery, the confidence
intervals included the possibility of both no effect and a clinically
important benefit from non-adrenergic agents. These findings justify the
conduct of further RCTs comparing non-adrenergic vasopressors to usual
care based on noradrenaline alone. Copyright © The Author(s)
2024.

<51>
Accession Number
2036731279
Title
Efficacy and safety of remimazolam tosylate for patients undergoing
off-pump coronary artery bypass grafting: a study protocol for a
non-inferiority randomised controlled trial in China.
Source
BMJ Open. 14(11) (no pagination), 2024. Article Number: e085519. Date of
Publication: 14 Nov 2024.
Author
Wang D.; Cui M.; Wu X.; Niu M.; Yu T.; Zhang Y.; Yue Y.; Wang Q.; Xu B.;
Feng N.; Si J.
Institution
(Wang, Xu) School of Anaesthesiology, Shandong Second Medical University,
Shandong, Weifang, China
(Cui) Department of Anaesthesiology, Zibo Maternal and Child Health
Hospital, Shandong, Zibo, China
(Wu, Niu, Zhang, Yue, Wang, Feng, Si) Department of Anaesthesiology, Zibo
Central Hospital, Shandong, Zibo, China
(Yu) Department of Anaesthesiology, Binzhou Medical University, Shandong,
Binzhou, China
Publisher
BMJ Publishing Group
Abstract
Introduction Maintaining haemodynamic stability is crucial but challenging
during the induction and maintenance of general anaesthesia (GA) in
patients undergoing off-pump coronary artery bypass grafting (OPCABG).
Remimazolam tosylate is a novel ultra-short-acting benzodiazepine with
minimal cardiovascular depression. Currently, non-inferior studies
comparing the haemodynamic changes induced by remimazolam and etomidate
are limited. This study aims to assess the efficacy and safety of
remimazolam tosylate for the induction and maintenance of GA in patients
undergoing OPCABG. Method and analysis This two-armed non-inferiority
randomised controlled trial will include 88 patients aged 18-75 years who
are scheduled for OPCABG. Patients will be randomly assigned in a 1:1
ratio to receive either remimazolam tosylate or etomidate and propofol for
anaesthesia induction and maintenance. The primary outcome will be the
fluctuation of mean artery pressure during anaesthesia induction.
Secondary outcomes will include adverse events, adverse drug reactions,
the cumulative dosage of vasoactive drugs, vital signs and bispectral
index values at different time points, lengths of postoperative mechanical
ventilation and tracheal intubation, lengths of intensive care unit stay
and hospital stay and hospital mortality. Analyses will be conducted using
both the intention-to-treat approach and the per-protocol approach. Ethics
and dissemination This study was approved by the Ethics Committee of Zibo
Central Hospital (No. 2024001). The trial results will be submitted to an
international peer-reviewed journal. 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.

<52>
Accession Number
2035465271
Title
The influence of the American Association for Thoracic Surgery on clinical
trial development by cardiothoracic surgeons.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2024.
Date of Publication: 2024.
Author
Narahari A.K.; Horgan T.M.; Chandrabhatla A.S.; Kareddy A.; Gikandi A.;
Zenati M.A.; Harpole D.; Jones D.; Yarboro L.T.; Burt B.; Krupnick A.S.;
Mehaffey J.H.
Institution
(Narahari, Horgan, Chandrabhatla, Kareddy, Yarboro) Division of
Cardiothoracic Surgery, Department of Surgery, University of Virginia
Health, Charlottesville, VA, United States
(Gikandi) Harvard Medical School, Boston, Mass, United States
(Zenati) Division of Cardiac Surgery, Brigham and Women's Hospital and
Harvard Medical School, Boston, Mass, United States
(Harpole) Division of Cardiovascular and Thoracic Surgery, Department of
Surgery, Duke University School of Medicine, Durham, NC, United States
(Jones) Thoracic Service, Department of Surgery, Memorial Sloan Kettering
Cancer Center, New York, NY, United States
(Burt) Division of Thoracic Surgery, Department of Surgery, Baylor College
of Medicine, Houston, Tex, United States
(Krupnick) Division of Thoracic Surgery, Department of Surgery, University
of Maryland School of Medicine, Baltimore, Md, United States
(Mehaffey) Division of Cardiac Surgery, Department of Cardiovascular and
Thoracic Surgery, West Virginia University School of Medicine, Morgantown,
WVa, United States
Publisher
Elsevier Inc.
Abstract
Objective: Clinical trials play a critical role in the rapidly evolving
field of cardiothoracic surgery and the American Association for Thoracic
Surgery Clinical Trials Methods Course has provided a biannual symposium
led by preeminent surgeons with vast experience in planning, conducting,
and analyzing surgical clinical trials. This study hypothesizes that
participation in the course is associated with future success in clinical
trial leadership. Method(s): A list of course attendees (2014-2022)
was queried in ClinicalTrials.gov, a database of clinical trials funded by
the US Department of Health and Human Services and the National Institutes
of Health. The type of clinical trial and publications from the trial were
collected. Demographic information about the participants was collected
from faculty pages. Result(s): A total of 107 participants from
various professional backgrounds attended the American Association for
Thoracic Surgery Clinical Trials Methods course and led 91 clinical
trials. The average time to starting a clinical trial after attending the
workshop was 3.04 years for participants who had not already been involved
with a trial. Of the 107 participants, 36 (33.6%) were either the
principal investigator or a subinvestigator for 91 clinical trials.
 Conclusion(s): The American Association for Thoracic Surgery Clinical
Trials Methods course provides participants the tools for successfully
leading surgical clinical trials. Although participation has been limited,
those who attend the course and lead a clinical trial do so within
approximately 3 years. The Clinical Trials Methods Course provides an
excellent return on investment and the American Association for Thoracic
Surgery should continue sponsorship of this program because it supports
the develop of future leaders in cardiothoracic surgery. Copyright
© 2024 The American Association for Thoracic Surgery

<53>
Accession Number
2036756605
Title
A comparative study between ultrasound guided thoracic paravertebral block
vs ultrasound guided serratus anterior muscle block in video-assisted
thoracoscopic surgeries.
Source
Anaesthesia, Pain and Intensive Care. 28(6) (pp 996-1003), 2024. Date of
Publication: 01 Dec 2024.
Author
Maamoon R.M.H.; Afifi G.A.S.; Elshantory S.F.E.; Mohie A.G.M.; Salem
M.M.H.
Institution
(Maamoon) Department of Anesthesia, ICU & Pain Management, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
(Afifi, Elshantory, Mohie, Salem) Faculty of Medicine, Ain Shams
University, Cairo, Egypt
Publisher
Faculty of Anaesthesia, Pain and Intensive Care, AFMS
Abstract
Background & Objective: Video-assisted thoracoscopic (VATS) procedures,
are becoming increasingly popular. It is recommended to utilize
loco-regional analgesia for reducing post-surgical pain because it
encourages early postoperative recovery and provides opioid sparing.
Various regional analgesic methods, such as paravertebral, intercostal,
and serratus plane blocks, may be utilized to alleviate pain after
thoracic surgery. This study compares serratus anterior muscle blocks
(SAPB) and thoracic paravertebral blocks (TPVB) in providing postoperative
pain alleviation following VATS using ultrasound. Methodology: In this
randomized prospective comparative trial, 80 patients scheduled for VATS
were allocated at random to one of two equal groups; group A received USG-
TPVB, and group B received USG-guided SAPB. The postoperative VAS score,
time of rescue analgesia, and postoperative nalbuphine consumption were
documented throughout a 24-hour period. We also documented the onset of
ambulation and any nerve block consequences. Result(s): VAS was
considerably lower in the TPVB group at 12 and 24 h compared to SABP with
P value (< 0.001 & 0.029) respectively; also, patients in the TPVB group
took longer to request rescue analgesia (10.77 +/- 2.28) vs (6.12 +/-
1.43) in SABP group with P < 0.001. Also, TPVB group consumed fewer
nalbuphine doses (5.56 +/- 1.56) than patients in the SAPB group (9.5 +/-
3.49) with P < 0.001. Conclusion(s): When compared to SAPB block,
TBVP block was more successful in lowering postoperative pain scores and
lowering the overall 24-h postoperative opioid intake following VATS
procedures performed under general anesthesia. Copyright © 2024
Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights
reserved.

<54>
Accession Number
2036731342
Title
Effect of acupuncture on quality of life in atrial fibrillation: study
protocol for a randomised controlled trial.
Source
BMJ Open. 14(11) (no pagination), 2024. Article Number: e087460. Date of
Publication: 14 Nov 2024.
Author
Li M.-T.; Shi G.-X.; Wang Y.; Wu B.-Q.; Zhang Z.-H.; Zhao Q.-Y.; Wang X.;
Li X.-B.; Guo W.-H.; He L.; Zhang H.-L.; Wang L.; Wang X.-W.; Tu J.-F.;
Wang H.-Y.; Yan S.-Y.; Lin Y.; Li H.-W.; Liu C.-Z.; Wang L.-Q.
Institution
(Li, Shi, Wang, Tu, Yan, Lin, Li, Liu, Wang) International Acupuncture and
Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and
Tuina, Beijing University of Chinese Medicine, Beijing, China
(Wu) The First Teaching Hospital of Tianjin University of Traditional
Chinese Medicine, Tianjin, China
(Zhang, Wang) Jiangsu Provincial People's Hospital, Nanjing, China
(Zhao, Wang) Renmin Hospital of Wuhan University, Wuhan, China
(Wang, Guo, Wang) Dongzhimen Hospital Affiliated to Beijing University of
Chinese Medicine, Beijing, China
(Li) Peking University People's Hospital, Beijing, China
(He) The First Affiliated Hospital of Hebei University of Chinese
Medicine, Hebei, China
(Zhang) Peking University Third Hospital, Haidian District, Beijing, China
Publisher
BMJ Publishing Group
Abstract
Introduction Atrial fibrillation (AF) is the prevalent cardiac arrhythmia
and can significantly impair the quality of life (QoL). Although catheter
ablation (CA) is an established treatment for AF,post-procedural
complications or perceived inadequate control of AF may diminish the QoL
for some patients, potentially even to levels lower than pre-procedure.
Preliminary findings from our previous pilot trial indicate that
acupuncture may positively influence QoL in AF patients post-CA. This
study aims to increase the sample size to evaluate the efficacy of
acupuncture as an adjunctive treatment to conventional medical therapy in
improving QoL of patients with AF after CA. Methods and design This
multicentre randomised clinical trial will be conducted in China. A total
of 146 eligible patients will be randomly assigned in a 1:1 ratio to
either the acupuncture group or the sham acupuncture group. All patients
will receive standard postablation care and undergo 18 sessions of
acupuncture/sham acupuncture within 12 weeks following CA, followed by a
9-month follow-up period. The primary outcome is the change in the Atrial
Fibrillation Effect on Quality-of-Life (AFEQT) summary score from baseline
to months 6 after CA. Secondary outcomes include the changes in the AFEQT
subscale scores at months 6, the AFEQT summary and subscale score at
months 3 and 12, AF burden, AF recurrence, heart rate variability, number
of cardioversions, repeat CA procedures, European Heart Rhythm Association
score, number of arrhythmia-related hospitalisations, average heart rate,
use of Six-Dimensional Health State Short Form to assess health status,
costs incurred by disease treatment, Credibility/Expectancy Questionnaire
and blinded assessments. Adverse events will also be meticulously recorded
throughout the trial. Ethics and dissemination Ethics approval has been
granted by the Ethics Committee of Beijing University of Traditional
Chinese Medicine (approval no: 2020BZYLL0802) and seven other subcentres.
The findings of the study results will be disseminated through
presentations at scientific conferences or publications in peer-reviewed
journals. 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.

<55>
Accession Number
2035416229
Title
Levosimendan in Patients with Low Cardiac Output Syndrome After Cardiac
Surgery: A Substudy of the Multicenter Randomized CHEETAH Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2024.
Date of Publication: 2024.
Author
Boboshko V.; Lomivorotov V.; Ruzankin P.; Khrushchev S.; Lomivorotova L.;
Monaco F.; Calabro M.G.; Comis M.; Bove T.; Pisano A.; Belletti A.
Institution
(Boboshko, Lomivorotova) Department of Anesthesiology and Intensive Care,
E. Meshalkin National Medical Research Center, Novosibirsk, Russian
Federation
(Lomivorotov) Department of Anesthesiology and Perioperative Medicine,
Penn State College of Medicine, Penn State Milton S. Hershey Medical
Center, Hershey, PA, United States
(Ruzankin) Department of Mathematics and Mechanics, Novosibirsk State
University, Novosibirsk, Russian Federation
(Ruzankin, Khrushchev) Sobolev Institute of Mathematics, Novosibirsk,
Russian Federation
(Monaco, Calabro, Belletti) Department of Anesthesia and Intensive Care,
IRCCS San Raffaele Scientific Institute, Milan, Italy
(Comis) Cardiac and Vascular Department, Ospedale Mauriziano Umberto I,
Torino, Italy
(Bove) Department of Medicine (DMED), University of Udine, Italy
(Bove) Department of Emergency "Santa Maria della Misericordia", Azienda
Sanitaria Universitaria Friuli Centrale (ASUFC), Udine University
Hospital, Udine, Italy
(Pisano) Cardiac Anesthesia and ICU, AORN "Dei Colli", Monaldi Hospital,
Naples, Italy
Publisher
W.B. Saunders
Abstract
Objective: To test the hypothesis that levosimendan administration in
patients with low cardiac output syndrome after cardiac surgery is
associated with improved long-term (5-year follow-up) outcomes.
 Design(s): Single-center subanalysis of the multicenter randomized
CHEETAH trial. Setting(s): Cardiac surgery department of a tertiary
hospital. Participant(s): A total of 134 adult patients requiring
hemodynamic support for a cardiac index <2.5 L/min/m2 after
cardiac surgery with cardiopulmonary bypass (CPB). Intervention(s):
Patients were randomized (1:1 ratio) to receive levosimendan (continuous
infusion with a starting dose of 0.05 mug/kg/min) or placebo, in addition
to standard inotropic care. Measurements and Main Results: The
primary endpoint was long-term mortality (1-5 years) after randomization.
Secondary outcomes were hemodynamic parameters, need for inotropic
support, acute kidney injury (AKI), need for renal replacement therapy,
duration of mechanical ventilation, intensive care unit (ICU) and hospital
stay, and 30-day mortality. No significant between-group difference in
long-term mortality (5 years) was observed (hazard ratio, 1.59; 95%
confidence interval, 0.81 to 3.11; p = 0.17). There were no significant
differences in secondary outcomes, except for the difference in the mean
pulmonary artery pressure at 4 to 6 hours after randomization, which was
lower in the levosimendan group compared to the placebo group (median, 24
[interquartile range (IQR), 21.8-28] mmHg vs 26 [IQR, 22.2-33] mmHg; p =
0.019). Conclusion(s): Among patients requiring hemodynamic support
after cardiac surgery with CPB, perioperative levosimendan infusion did
not affect long-term survival (1-5 years) compared with placebo.
Levosimendan also had no effect on major clinical outcomes such as AKI,
ICU stay, hospital stay, and 30-day mortality. Copyright © 2024
Elsevier Inc.

<56>
Accession Number
2036731383
Title
Effect of different durations of preoperative computerised cognitive
training on postoperative delirium in older patients undergoing cardiac
surgery: a study protocol for a prospective, randomised controlled trial.
Source
BMJ Open. 14(11) (no pagination), 2024. Article Number: e088163. Date of
Publication: 14 Nov 2024.
Author
Qiu X.; Wang L.; Wen X.; Meng Q.; Qi J.; Li C.; Yin H.; Ling F.; Yuhan Q.;
Zhang W.; Zhang Y.
Institution
(Qiu, Wang, Wen, Meng, Qi, Li, Yin, Ling, Yuhan, Zhang, Zhang) Department
of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University,
Jiangsu, Xuzhou, China
Publisher
BMJ Publishing Group
Abstract
Introduction Postoperative delirium (POD) is a common neurological
complication after surgery among older patients, characterised by acute
disturbances in consciousness, attention and cognition, usually occurring
within 24-72 hours after surgery. POD has a significant impact on the
prognosis of older patients undergoing major cardiovascular surgery,
including increased length of hospital stay, hospital costs and
readmission rates, with an incidence rate as high as 26%-52%. Computerised
cognitive training (CCT) refers to difficulty-adaptive training in
cognitive domains such as attention, memory and logical reasoning, using
systematically designed tasks. Existing studies have shown that CCT has
reduced the risk of delirium in non-cardiac surgery patients with at least
minimal compliance. The purpose of this study is to investigate the
effects of preoperative CCT on the incidence of POD in older patients
undergoing elective cardiac surgery, to clarify the dose-effect
relationship between different training time of preoperative CCT and POD
and to explore the minimum effective time target that can significantly
lower the incidence of POD. Methods and analysis This is a prospective,
single-blind, randomised controlled trial that aims to enrol 261 older
patients scheduled for elective cardiac surgery at the Affiliated Hospital
of Xuzhou Medical University. The patients will be randomised into three
groups: group C will be the routine care group (no CCT prior to surgery);
group L will be the low-dose time group (with a total of 5 hours of CCT
prior to surgery) and group H will be the high-dose time group (with a
total of 10 hours of CCT prior to surgery). The primary outcome is the
incidence of delirium within 7 days after surgery. Secondary outcomes
include postoperative mild neurocognitive disorder (NCD) and postoperative
major NCD (30 days up to 1 year), time of onset and duration and severity
of delirium, and all-cause mortality within 1 year after surgery. The
results of this study are of significant importance for establishing
effective, patient-centred and low-risk prevention strategies for
POD/postoperative NCD. Ethics and dissemination This study protocol has
been approved by the Ethics Committee of the Affiliated Hospital of Xuzhou
Medical University (Ethics Number: XYFY2023-KL149-01). All participants
will provide written informed consent, and the results of the study will
be published in international peer-reviewed academic journals and
presented at academic conferences. 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.

<57>
Accession Number
2032790215
Title
Safety and efficacy of cerebral embolic protection systems in
transcatheter aortic valve replacement: a systematic review and
meta-analysis.
Source
Expert Review of Cardiovascular Therapy. 22(12) (pp 681-688), 2024. Date
of Publication: 2024.
Author
Kheyrbek M.; Alsabti S.; Niroula S.; Ahmad E.; Choucair M.; Bhatia U.;
Wernette A.; Chhabra K.; Strubchevska K.; Hanson I.; Halalau A.
Institution
(Kheyrbek, Alsabti, Niroula, Ahmad, Choucair, Bhatia, Wernette, Chhabra,
Strubchevska, Halalau) Department of Internal Medicine, Corewell Health
William Beaumont University Hospital, Royal Oak, MI, United States
(Hanson) Department of Cardiovascular Medicine, Corewell Health William
Beaumont University Hospital, Royal Oak, MI, United States
(Hanson, Halalau) Oakland University William Beaumont School of Medicine,
Rochester, MI, United States
Publisher
Taylor and Francis Ltd.
Abstract
Background: Stroke is a potential complication of Transcatheter Aortic
Valve Replacement (TAVR). Recent trials evaluating Cerebral Embolic
Protection Systems (CEPS) to reduce the incidence of stroke after TAVR
have been conflicting. Method(s): Multiple databases were searched
for studies comparing TAVR with or without CEPS and that reported on the
primary outcome of periprocedural stroke. Two authors individually
screened the titles, the abstracts and the full texts using Covidence.
Risk of bias was assessed using Cochrane's ROB-2 and ROBINS-I tools.
 Result(s): A total of 15 studies (3 randomized controlled trials, 7
national registries, and 5 cohort studies) met the eligibility criteria
and were included in our review. CEPS was associated with lower rates of
periprocedural stroke [OR 0.71 (95% CI 0.55, 0.93) p = 0.012], as well as
lower rates of mortality [OR 0.60 (95% CI 0.49, 0.74) p < 0.001]. There
was no significant difference between the two groups in the incidence of
acute kidney injury [OR 0.91 (95% CI 0.82, 1.01) p = 0.087], major
vascular complications [OR 0.97 (95% CI 0.83, 1.14) p = 0.734], and major
life-threatening bleeding [OR 0.89 (95% CI 0.73, 1.07) p = 0.222].
 Conclusion(s): Our findings suggest that the use of CEPS in TAVR is
associated with a lower risk of periprocedural stroke and mortality.
Registration: The PROSPERO identification number is
CRD42022374055. Copyright © 2024 The Author(s). Published by
Informa UK Limited, trading as Taylor & Francis Group.

<58>
Accession Number
2036734183
Title
Effects of paravertebral block on postoperative analgesia in children
undergoing unilateral thoracotomy cardiac surgery with cardiopulmonary
bypass: protocol for a randomised controlled trial.
Source
BMJ Open. 14(11) (no pagination), 2024. Article Number: e086462. Date of
Publication: 07 Nov 2024.
Author
Guo J.; Tian L.; Kang W.; Jia Y.; Yuan S.
Institution
(Guo, Tian, Kang, Jia, Yuan) Department of Anestheisiology, Fuwai Hospital
State Key Laboratory of Cardiovascular Disease, Beijing, China
Publisher
BMJ Publishing Group
Abstract
Introduction This study aims to determine whether paravertebral block
(PVB) provides better postoperative analgesia, lower incidence of
complications and faster recovery compared with local anaesthetic wound
infiltration for school-aged children undergoing cardiac surgery with
cardiopulmonary bypass via thoracotomy. Method and analysis This is a
single-centre, randomised controlled trial. We will enrol 100 children
aged 6-14 years with atrial or ventricular septal defects scheduled for
thoracotomy cardiac surgery with cardiopulmonary bypass. The patients will
be randomly assigned to the PVB group and the control group in a ratio of
1:1. After the surgery, we will conduct unilateral PVB with ropivacaine
for patients in the PVB group, and local anaesthetic wound infiltration
for patients in the control group. We will use the double-dummy design to
ensure blinding. The patients will not be administered analgesics after
returning to the PICU(paediatric intensive care unit). Their bedside nurse
will monitor their pain condition. When the Faces Pain Scale-Revised
(FPS-R) Pain Score is >=4, sufentanil infusion will be started. The
primary outcome will be total opioid consumption within 24 hours after
surgery. Secondary outcomes will be (1) FPS-R Scores at 6 hours, 12 hours,
18 hours and 24 hours after surgery; (2) The rate of opioid treatment for
remedial analgesia; (3) The first time of FPS-R Score is >=4
postoperatively. Exploratory outcomes will be: (1) Length of postoperative
mechanical ventilation, ICU stay and hospital stay; (2) The rate of
postoperative nausea and vomiting and respiratory depression 24 hours
after surgery. Ethics and dissemination This study was approved by the
Ethics Committee of the Chinese Academy of Medical Sciences, Fuwai
Hospital (No 2023-2135) and PUMC. Written informed consent will be
obtained from each patient or their legal representatives before
enrolment. The results of this trial will be published in an international
peer-reviewed scientific journal. 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.

<59>
Accession Number
2032781275
Title
Stroke Prevention in Patients With Atrial Fibrillation Receiving Dialysis:
A Systematic Review.
Source
Canadian Journal of Kidney Health and Disease. 11 (no pagination), 2024.
Date of Publication: 01 Jan 2024.
Author
Masse O.; Dallaire G.; Maurice N.; Hong Y.; Mercurio C.M.; Tremblay C.;
Dugre N.; Bernier-Jean A.
Institution
(Masse, Dallaire, Maurice, Hong, Mercurio, Tremblay, Dugre) Department of
Pharmacy, CIUSSS du Nord-de-l'Ile-de-Montreal, QC, Canada
(Masse, Maurice, Hong, Mercurio, Tremblay, Dugre) Faculty of Pharmacy,
University of Montreal, QC, Canada
(Bernier-Jean) Division of Nephrology, Department of Medicine, CIUSSS du
Nord-de-l'Ile-de-Montreal, QC, Canada
(Bernier-Jean) Faculty of Medicine, University of Montreal, QC, Canada
Publisher
SAGE Publications Ltd
Abstract
Background: Despite atrial fibrillation affecting nearly 25% of patients
receiving dialysis, conflicting study findings and guideline
recommendations continue to make individual treatment decisions
challenging. Objective(s): The objective was to examine the efficacy
and safety of stroke-prevention interventions in patients with atrial
fibrillation receiving dialysis. Design(s): A systematic review of
randomized controlled trials and observational studies. Patient(s):
Adult patients with non-valvular atrial fibrillation receiving any type of
dialysis. Measurements: Ischemic strokes or systemic embolism, major
bleeding, and all-cause mortality. Method(s): We searched Medline,
Embase, Cochrane Central Register of Controlled Trials, and the gray
literature from inception to February 16, 2023. We selected all studies
comparing antiplatelet, anticoagulant agents or left atrial appendage
closure to placebo, no treatment, or an active comparator (most often
vitamin K antagonists). Two reviewers independently screened and included
the studies, extracted the data and assessed the risk of bias using the
Cochrane Risk of Bias tool (version 1) and the Newcastle-Ottawa Scale.
When randomized controlled trials were available, we pooled the risk
ratios using fixed-effect meta-analyses. Results from observational
studies were described narratively. We appraised the certainty of evidence
(CoE) of the findings using GRADE. Result(s): Of the 8526 citations
identified, we included 50 studies (4 randomized controlled trials and 46
observational studies) involving 155 058 participants. Our meta-analysis
of 4 randomized controlled trials of direct oral anticoagulants (apixaban
or rivaroxaban) compared with vitamin K antagonists (486 participants)
suggested that the effect of direct oral anticoagulants on ischemic
strokes or systemic embolism is very uncertain (risk ratio [RR] = 0.52;
95% confidence interval [CI] = 0.22-1.20; very low CoE). Direct oral
anticoagulants may decrease major bleeding (RR = 0.67; 95% CI = 0.44-1.03;
low CoE) and may result in little to no difference in mortality (RR =
0.89; 95% CI = 0.70-1.13; low CoE). Our narrative review of the
observational evidence suggests that, compared with no treatment, vitamin
K antagonists may decrease ischemic strokes or systemic embolism (18
studies, low CoE) and likely increase major bleeding (12 studies, moderate
CoE), whereas their effect on mortality is very uncertain (16 studies,
very low CoE). Compared with no treatment, the effect of direct oral
anticoagulants on all outcomes is very uncertain (2 studies, very low
CoE). We also found that the effect of antiplatelet agents, left atrial
appendage closure, and heparin-related therapies is very uncertain on all
outcomes (very low CoE), except for antiplatelet agents that may increase
major bleeding (1 study, low CoE) compared with no treatment.
 Limitation(s): Most of the included studies were observational and
retrospective, resulting in low or very low certainty for nearly all of
the outcomes. The included interventions were highly heterogeneous, which
precluded meta-analysis of the results in all cases except for direct oral
anticoagulants. Conclusion(s): In patients with atrial fibrillation
receiving dialysis, vitamin K antagonists may decrease ischemic strokes or
systemic embolism compared with no treatment at the cost of an increased
risk of major bleeding. Direct oral anticoagulants (apixaban or
rivaroxaban) may also lead to less major bleeding than vitamin K
antagonists. The overall low to very low certainty of the evidence
emphasizes the importance of engaging in shared decision-making when
selecting a strategy for stroke prevention for atrial fibrillation in
people receiving maintenance dialysis. PROSPERO registration ID:
CRD42022307009. Copyright © The Author(s) 2024.

<60>
Accession Number
2036732496
Title
Use of dexmedetomidine during light versus deep anaesthesia on
postoperative delirium among elderly patients undergoing major non-cardiac
surgery: protocol for a multicentre randomised factorial trial.
Source
BMJ Open. 14(10) (no pagination), 2024. Article Number: e083312. Date of
Publication: 01 Nov 2024.
Author
Shi H.-J.; Zhuang M.-Y.; Hu J.-H.; Long Y.-Q.; Gao Y.-P.; Zheng Z.; Feng
X.-M.; Ji F.-H.; Peng K.
Institution
(Shi, Zhuang, Hu, Long, Ji, Peng) Department of Anaesthesiology, First
Affiliated Hospital of Soochow University, Jiangsu, Suzhou, China
(Shi, Zhuang, Hu, Long, Ji, Peng) Institute of Anaesthesiology, Soochow
University, Jiangsu, Suzhou, China
(Gao) Department of Anaesthesiology, Zhangjiagang First People's Hospital,
Jiangsu, Zhangjiagang, China
(Zheng) Department of Anaesthesiology, First Peoples of Hospital of
Taicang, Jiangsu, Taicang, China
(Feng) Department of Anaesthesiology, University of Utah Health, Salt Lake
City, UT, United States
Publisher
BMJ Publishing Group
Abstract
Introduction Elderly patients are at a high risk of postoperative delirium
(POD), leading to increased postoperative morbidity and mortality. The use
of dexmedetomidine and depth of anaesthesia may influence POD. This study
aims to determine the effects of dexmedetomidine infusion versus normal
saline placebo during light versus deep anaesthesia on POD among elderly
patients undergoing major non-cardiac surgery. Methods and analysis This
prospective, multicentre, randomised, controlled, factorial trial will be
conducted at three tertiary hospitals in Jiangsu, China. We will recruit a
total of 420 patients who are at least 60 years old and undergoing major
non-cardiac surgery (thoracic, abdominal, urology, orthopaedic and spine
surgery) under general anaesthesia. Patients will be randomised (1:1:1:1)
to receive one of four anaesthesia regimens: (1) dexmedetomidine and light
anaesthesia, (2) dexmedetomidine and deep anaesthesia, (3) placebo and
light anaesthesia or (4) placebo and deep anaesthesia. Dexmedetomidine
will be infused at 0.5 mug/kg/h throughout surgery, and intraoperative
bispectral index target will be 55 for light anaesthesia and 40 for deep
anaesthesia. The primary outcome is the occurrence of POD during the first
7 days postoperatively or until hospital discharge, assessed using the
3-min Confusion Assessment Method two times per day. The secondary
outcomes include days with POD, type of POD, pain scores at rest and on
movement at 24 and 48 hours postoperatively, patient-controlled
intravenous fentanyl consumption during 0-24 and 24-48 hours
postoperatively, hypotension, bradycardia, postoperative nausea and
vomiting, non-delirium complications, length of postoperative hospital
stay, 30-day cognitive function and 30-day mortality. Data will be
analysed on a modified intention-to-treat basis. Ethics and dissemination
This trial was approved by the Ethics Committee of the First Affiliated
Hospital of Soochow University and each participating centre. The trial
results will be published in a peer-reviewed journal. 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.

<61>
Accession Number
2036791379
Title
Sex Differences in Patients Undergoing FFR-Guided PCI or CABG in the FAME
3 Trial.
Source
JACC: Cardiovascular Interventions. (no pagination), 2025. Date of
Publication: 2025.
Author
Takahashi K.; Otsuki H.; Zimmermann F.M.; Ding V.Y.; Oldroyd K.G.; Wendler
O.; Reardon M.J.; Woo Y.J.; Yeung A.C.; Pijls N.H.J.; De Bruyne B.; Fearon
W.F.
Institution
(Takahashi, Otsuki, Ding, Yeung, Fearon) Stanford University School of
Medicine and Stanford Cardiovascular Institute, Stanford University,
Stanford, CA, United States
(Zimmermann, Pijls) Department of Cardiology, Catharina Hospital,
Eindhoven, Netherlands
(Zimmermann) St. Antonius Hospital, Nieuwegein, Netherlands
(Oldroyd) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Wendler) Cleveland Clinic London, London, United Kingdom
(Reardon) Houston Methodist Debakey Heart & Vascular Center, Houston, TX,
United States
(Woo) Department of Cardiothoracic Surgery, Division of Cardiovascular
Medicine and Stanford Cardiovascular Institute, Stanford University,
Stanford, CA, United States
(De Bruyne) Cardiovascular Center Aalst, Belgium
(Fearon) VA Palo Alto Medical Systems, Palo Alto, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: Outcomes in women after fractional flow reserve (FFR)-guided
percutaneous coronary intervention (PCI) using current-generation
drug-eluting stents (DES) compared with coronary artery bypass grafting
(CABG) are unknown. Objective(s): This study sought to evaluate
differences in clinical outcomes according to sex after FFR-guided PCI
with current generation DES compared with CABG. Method(s): The FAME 3
trial was an investigator-initiated, randomized controlled trial,
comparing FFR-guided PCI with current generation DES or CABG in patients
with 3-vessel coronary artery disease. This prespecified subgroup analysis
compared the incidence of major adverse cardiac and cerebrovascular events
(MACCE) according to sex, defined as the composite of all-cause death,
myocardial infarction, stroke, or repeat revascularization at 3 years.
 Result(s): Of 1,500 patients included in the FAME 3 trial, 265
(17.7%) were women. Women had a significantly higher risk of MACCE at 3
years compared with men after CABG (18.1% vs 11.7%; adjusted HR: 2.07; 95%
CI: 1.19-3.60), whereas women had a similar risk of MACCE at 3 years
compared with men after PCI (18.2% vs 19.1%; adjusted HR: 1.27; 95% CI:
0.79-2.03). Regarding treatment effects by sex, women undergoing PCI had a
similar risk of MACCE at 3 years compared with CABG (adjusted HR: 1.15;
95% CI: 0.62-2.11). By contrast, men undergoing PCI had a higher risk of
MACCE at 3 years compared with CABG (adjusted HR: 1.68; 95% CI: 1.25-2.25;
P<inf>interaction</inf> = 0.142), which was mainly driven by a higher risk
of myocardial infarction (adjusted HR: 2.11; 95% CI: 1.26-3.56;
P<inf>interaction</inf> = 0.102) and repeat revascularization (adjusted
HR: 2.26; 95% CI: 1.47-3.47; P<inf>interaction</inf> = 0.071).
 Conclusion(s): In the FAME 3 trial, at 3 years, women had similar
outcomes with FFR-guided PCI compared with CABG, whereas men had improved
outcomes with CABG. (A Comparison of Fractional Flow Reserve-Guided
Percutaneous Coronary Intervention and Coronary Artery Bypass Graft
Surgery in Patients With Multivessel Coronary Artery Disease [FAME 3];
NCT02100722) Copyright © 2024 American College of Cardiology
Foundation

<62>
Accession Number
2036791908
Title
The Prognostic Relevance of a New Bundle Branch Block After Transcatheter
Aortic Valve Implantation: A Systematic Review and Meta-Analysis.
Source
Structural Heart. (no pagination), 2025. Article Number: 100392. Date of
Publication: 2025.
Author
Rao K.; Ahmed M.; Brieger D.; Baer A.; Hansen P.; Bhindi R.
Institution
(Rao, Brieger, Hansen, Bhindi) Royal North Shore Hospital, Sydney,
Australia
(Rao, Baer, Hansen, Bhindi) North Shore Private Hospital, Sydney,
Australia
(Rao, Ahmed, Bhindi) University of Sydney, Australia
Publisher
Cardiovascular Research Foundation
Abstract
Background: Interference with the cardiac conduction system is common
after transcatheter aortic valve implantation (TAVI), manifesting as
atrioventricular block, or more commonly, new-onset persistent left bundle
branch block (NOP-LBBB). Bundle branch block results in ventricular
dyssynchrony and reduced cardiac output and may be associated with a
poorer prognosis. This systematic review and meta-analysis evaluates the
prognostic impact of a left or right bundle branch block after TAVI.
 Method(s): A systematic review was performed of the following online
databases: PubMed, Medline, Scopus, and Web of Science, including English
language studies from 2014 to 2024. Two separate searches for conducted
for NOP-LBBB and new-onset persistent right bundle branch block
(NOP-RBBB). The Newcastle-Ottawa Scale was used to evaluate risk of bias.
 Result(s): Twenty-three studies totaling 18875 patients were included
for NOP-LBBB, whilst 5 studies with a total of 3525 patients were included
for NOP-RBBB. NOP-LBBB was associated with higher all-cause mortality at 1
year (risk ratio [RR] 1.41 [95% CI 1.12-1.78], I2 = 49%, p <
0.01), cardiovascular mortality (RR 1.34 [95% CI 1.02-1.75], I2
= 60%, p = 0.02), heart failure-related rehospitalization (RR 1.56 [95% CI
1.31-1.84], I2 = 47%, p < 0.01), and permanent pacemaker
implantation at 1 year (RR 3.05 [95% CI 2.39-3.89], I2 = 14%, p
< 0.01). NOP-RBBB was not associated with higher all-cause mortality at 1
year (RR 1.74 [95% CI 0.88-3.46], I2 = 93%, p = 0.11), however
increased the risk of pacemaker implantation at 1 year (RR 4.68 [95% CI
3.60-6.08], I2 = 67%, p < 0.01). Conclusion(s): NOP-LBBB
is associated with higher mortality and heart failure rehospitalization
after TAVI, whilst both NOP-LBBB and NOP-RBBB increase the risk of
permanent pacemaker implantation at 1 year after TAVI. Copyright
© 2024 The Authors

<63>
Accession Number
2036759845
Title
Routine stress testing in diabetic patients after coronary intervention: a
systematic review and meta-analysis.
Source
Current Problems in Cardiology. 50(3) (no pagination), 2025. Article
Number: 102972. Date of Publication: 01 Mar 2025.
Author
de Oliveira J.P.; da Rocha F.R.; Huntermann R.; de Oliveira R.P.; Bacca
C.O.F.
Institution
(de Oliveira, da Rocha, Huntermann, de Oliveira, Bacca) Medical Sciences
Research Center, University Center for the Development of Alto Vale - Rio
do Sul -, Brazil
(Bacca) Regional Hospital of Alto Vale - HRAV, Rio do Sul, Santa Catarina,
Brazil
Publisher
Elsevier Inc.
Abstract
Background: Stress testing is a widely used non-invasive tool in patients
with angina, but its role in diabetic patients after coronary intervention
remains uncertain. This review evaluates its impact in this population.
Goals: We aimed to perform a systematic review and meta-analysis of
studies assessing death, MACE, ischemia and repeated revascularization in
diabetic patients post-coronary intervention. Method(s): We searched
PubMed, Embase, and Cochrane for RCTs and cohort studies on diabetic
patients post-revascularization reporting MI and cardiovascular death,
ischemia, repeat revascularization, and pooled hazard ratios for mortality
or MI. Statistical analysis used RStudio and RevMan, with heterogeneity
assessed via I2 statistics. Result(s): We included 14,461 patients
from 15 studies (14 observational cohorts, 1 RCT), all with diabetes and
prior revascularization. Follow-up ranged from 1 to 5.2 years, with a mean
age of 60.8 +/- 9.5 years, and 75 % male. MI and cardiovascular death
occurred in 11.24 % (95 % CI: 7.35-15.79 %; p < 0.01, Figure 2), ischemia
in 36.07 % (95 % CI: 30.26-42.08 %; p < 0.01, Figure 3), and repeated
revascularization in 15.65 % (95 % CI: 6.65-27.64 %; p < 0.01, Figure 4).
For mortality or MI, the pooled hazard ratio was 1.28 (95 % CI: 1.02-1.61,
Figure 5), suggesting a modest benefit of standard care over routine
stress testing. Conclusion(s): Routine stress testing in diabetic
patients after coronary intervention may not significantly impact
outcomes. Further controlled studies are needed to clarify its clinical
benefit. Copyright © 2024

<64>
Accession Number
646114597
Title
Safety and efficacy of cerebral embolic protection systems in
transcatheter aortic valve replacement: a systematic review and
meta-analysis.
Source
Expert review of cardiovascular therapy. (no pagination), 2024. Date of
Publication: 20 Dec 2024.
Author
Kheyrbek M.; Alsabti S.; Niroula S.; Ahmad E.; Choucair M.; Bhatia U.;
Wernette A.; Chhabra K.; Strubchevska K.; Hanson I.; Halalau A.
Institution
(Kheyrbek, Alsabti, Niroula, Ahmad, Choucair, Bhatia, Wernette, Chhabra,
Strubchevska, Halalau) Department of Internal Medicine, Corewell Health
William Beaumont University Hospital, Royal Oak, MI, United States
(Hanson) Department of Cardiovascular Medicine, Corewell Health William
Beaumont University Hospital, Royal Oak, MI, United States
(Hanson, Halalau) Oakland University William Beaumont School of Medicine,
Rochester, MI, United States
Abstract
BACKGROUND: Stroke is a potentialcomplication of Transcatheter Aortic
Valve Replacement (TAVR). Recent trials evaluating Cerebral Embolic
ProtectionSystems(CEPS) to reduce the incidence of stroke after TAVR have
been conflicting. METHOD(S): Multiple databaseswere searched for
studies comparing TAVR with or without CEPS and that reportedon the
primary outcome of periprocedural stroke. Two authors individuallyscreened
the titles, the abstracts and the full texts using Covidence. Risk ofbias
was assessed using Cochrane's ROB-2 and ROBINS-I tools. RESULT(S): 15
studies (3 randomized controlled trials, 7 national registries, and
5cohort studies) met the eligibility criteria and were included in our
review. CEPS was associatedwith lower rates of periprocedural stroke [OR
0.71 (95% CI 0.55, 0.93)p = 0.012], as well as lower rates of mortality
[OR 0.60 (95% CI 0.49, 0.74)p < 0.001]. There was no significant
difference between the two groups in theincidence of acute kidney injury
[OR 0.91 (95% CI 0.82, 1.01) p = 0.087], majorvascular complications [OR
0.97 (95% CI 0.83, 1.14) p = 0.734], and major life-threateningbleeding
[OR 0.89 (95% CI 0.73, 1.07) p = 0.222]. CONCLUSION(S): Our findings
suggest that the use of CEPS in TAVR is associated with alower risk of
periprocedural stroke and mortality. REGISTRATION: The PROSPERO
identification number is CRD42022374055.

<65>
Accession Number
646115897
Title
Comparison of thoracoscopic-guided intercostal nerve block and
ultrasound-guided intercostal nerve block in postoperative analgesia of
uniportal video-assisted lobectomy: a pilot randomized controlled trial.
Source
International journal of surgery (London, England). (no pagination),
2024. Date of Publication: 20 Dec 2024.
Author
Li Y.; Wei L.; Du J.-H.; He J.-X.; Xu X.; Hu L.-H.
Institution
(Li, Wei, Du, Xu, Hu) Department of Anesthesiology
(He) Department of Thoracic Surgery, affiliated Lihuili Hospital of Ningbo
University, Ningbo, China
Abstract
BACKGROUND: Ultrasound-guided intercostal nerve block (UINB) and
thoracoscopic-guided intercostal nerve block (TINB) are often used for
analgesia after thoracic surgery. Herein, we compared the application of
TINB and UINB for analgesia after uniportal video-assisted lobectomy.
 METHOD(S): Sixty patients were randomly allocated into two groups:
UINB and TINB. The surgical time of intercostal nerve block (INB), the
success rate of the first needle, visual analog scale (VAS) scores, the
time of the first patient-controlled intravenous analgesia (PCIA) press,
the time for removing the thoracic drainage tube, consumption of
sufentanil and the number of PCIA presses within 24 hours postoperatively,
and adverse reactions (ARs) were compared between the two groups.
 RESULT(S): The surgical time of INB was significantly shorter in the
TINB group than in the UINB group (P < 0.001). The time of the first press
of PCIA was significantly earlier in the TINB group than in the UINB group
(P < 0.001). The success rate of the first needle was significantly higher
in the TINB group than in the UINB group (P < 0.001). No significant
differences were observed between the two groups regarding VAS scores,
time for removing the thoracic drainage tube, the consumption of
sufentanil, the number of PCIA presses within 24 hours postoperatively,
and ARs. CONCLUSION(S): TINB and UINB have similar analgesic effects
after uniportal video-assisted lobectomy. However, TINB demonstrates
shorter surgical time and a higher success rate than UINB. Copyright
© 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

<66>
Accession Number
2032775895
Title
Contemporary Review of Minimally Invasive Mitral Valve Surgery: Current
Considerations and Innovations.
Source
Journal of Cardiovascular Development and Disease. 11(12) (no pagination),
2024. Article Number: 404. Date of Publication: 01 Dec 2024.
Author
Alsheebani S.; Goubran D.; de Varennes B.; Chan V.
Institution
(Alsheebani, de Varennes) Department of Surgery, McGill University,
Montreal, QC, Canada
(Goubran, Chan) Department of Surgery, University of Ottawa Heart
Institute, Ottawa, ON, Canada
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Minimally invasive mitral valve surgery (MIMVS) has become a
well-established alternative to traditional median sternotomy at
high-volume surgical centers. Advancements in surgical instruments have
led to further refinement of MIMVS. However, MIMVS remains limited to
select patients in select settings. In this review, we provide a brief
overview of the evolution of MIMVS, as well as a technical description of
the most relevant aspects of minimally invasive mitral valve
surgery. Copyright © 2024 by the authors.

<67>
Accession Number
646118414
Title
Effects of continuous pecto-intercostal fascial block for management of
post-sternotomy pain in patients undergoing cardiac surgery: a randomized
controlled trial.
Source
International journal of surgery (London, England). (no pagination),
2024. Date of Publication: 20 Dec 2024.
Author
Zhao Y.; He D.; Zhou W.; Chen C.; Liu Z.; Xia P.; Ye Z.; Li C.
Institution
(Zhao, He, Zhou, Chen, Liu, Xia, Ye, Li) Department of Anesthesiology,
Xiangya Hospital of Central South University, Hunan Province, Changsha,
China
(Liu, Xia, Ye, Li) National Clinical Research Center for Geriatric
Disorders, Central South University, Hunan Province, Changsha, China
Abstract
BACKGROUND: Managing postoperative pain following median sternotomy has
long been a notable challenge for anesthesiologists. The administration of
postoperative analgesia traditionally relies on intravenous pumps for the
delivery of opioids. With the development of regional block techniques and
postoperative multimodal analgesia, pecto-intercostal fascial block (PIFB)
has gained widespread utilization due to its distinctive advantages.
However, its application is limited to a single block. This study aimed to
indicate whether continuous PIFB analgesia in cardiac surgery via
sternotomy could possess clinical advantages compared with intravenous
analgesia in terms of postoperative pain management. If continuous PIFB
analgesia was the priority, the secondary objective would involve
determining the most effective administration method, making it a critical
area of exploration. METHOD(S): Totally, 114 patients were randomly
allocated to three groups: the PCIA group, receiving intravenous opioid
infusion exclusively via pump, and the C-PIFB and I-PIFB groups, where
ultrasound-guided PIFB with a nerve blocking pump was administered. The
C-PIFB group received a constant basal infusion, while programmed
intermittent boluses were administered in the I-PIFB group. The primary
endpoint was postoperative visual analogue scale (VAS) scores, and
secondary outcomes included intraoperative sufentanil consumption, time to
extubation, mobilization, length of stay in intensive care unit (ICU) and
hospital, and the incidence of postoperative complications.
 RESULT(S): The VAS scores at rest and during coughing were noticeably
diminished in the two block groups relative to the intravenous pump group
at 12, 24, 48, and 72 h postoperatively. Notably, intraoperative
sufentanil consumption was significantly reduced in the C-PIFB group (3.12
[0.93] ug.kg-1) and the I-PIFB group (3.42 [0.77] ug.kg-1) compared with
the PCIA group (4.66 [1.02] ug.kg-1, P < 0.001). Time to extubation,
mobilization, length of stay in ICU and hospital, and use of rescue
analgesics did not exhibit statistically significant differences among the
three groups. However, the postoperative complication rates were markedly
lower in the C-PIFB group (42.11%) and I-PIFB group (36.84%) relative to
the PCIA group (81.58%, P < 0.001). There were no significant differences
between C-PIFB and I-PIFB groups regarding VAS score, secondary outcomes,
and postoperative complications. CONCLUSION(S): Continuous PIFB can
provide satisfactory postoperative analgesia while reducing perioperative
opioid consumption, diminishing the risk of postoperative complications,
and accelerating postoperative recovery for patients undergoing median
sternotomy in cardiac surgery. The constant basal infusion method may be
the optimal approach for administering continuous PIFB. Copyright
© 2024. Published by Wolters Kluwer Health, Inc.

<68>
Accession Number
646115432
Title
Efficacy of the intravenous formulation of fentanyl citrate administered
orally as premedication in paediatric patients undergoing open cardiac
surgery.
Source
Journal of perioperative practice. (pp 17504589241301311), 2024. Date of
Publication: 19 Dec 2024.
Author
Elbardan I.M.; Shehab A.S.; Yacout A.G.; Mabrouk I.M.
Institution
(Elbardan, Shehab, Yacout, Mabrouk) Department of Anesthesia and Surgical
Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
Abstract
BACKGROUND: Recently, fentanyl has become prevalent as a sedative
premedication. METHOD(S): A non-inferiority parallel design
quadruple-blinded randomised controlled trial of 1- to 7-year-old children
scheduled for elective cardiac surgery was conducted. Participants were
assigned a 1:1 allocation ratio to a control group (n = 50) given a
parenteral formulation of midazolam 0.5 mg/kg and an intervention group (n
= 50) given a parenteral formulation of fentanyl 10 mug/kg 30 min before
admission to the operating room. RESULT(S): Fentanyl was shown to be
inferior when compared to midazolam during inhalational induction but not
in the 'after premedication' and 'during separation' periods. A lower
percentage of children disliked the medication in the fentanyl group.
 CONCLUSION(S): A parenteral formulation of fentanyl can be a
satisfactory alternative when given orally as a sedative pre-anaesthetic
medication in paediatric cardiac surgery before admission to the operating
room.

<69>
Accession Number
646115381
Title
Efficacy of Cerebral Oxygen Saturation Monitoring for Perioperative
Neurocognitive Disorder in Adult Non-cardiac Surgical Patients: A
Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Source
World neurosurgery. (pp 123570), 2024. Date of Publication: 17 Dec 2024.
Author
Qiu L.; Ma Y.; Ge L.; Zhou H.; Jia W.
Institution
(Qiu, Ma, Ge, Zhou, Jia) Department of Anesthesiology, Gansu Provincial
Hospital, Gansu Province, Lanzhou, China
Abstract
BACKGROUND: Perioperative neurocognitive disorders (PND) are common
perioperative complications associated with various poor outcomes.
Regional cerebral oxygen saturation (rSO2) monitoring is a non-invasive
technique based on near-infrared spectroscopy detection. Due to the
considerable controversy among currently published studies on the
application of intraoperative rSO2 monitoring in adult patients undergoing
elective non-cardiac surgery, this study aims to conduct a systematic
review and meta-analysis to provide more comprehensive and robust evidence
to support clinical decision-making. MATERIALS AND METHODS: This study
conducted a systematic literature search of databases including PubMed,
Embase, CENTRAL, and Web of Science, from their inception to May 1, 2024.
The eligible randomized controlled trials included adult patients
undergoing elective non-cardiac surgery under general anesthesia who
received optimized anesthesia management guided by rSO2 monitoring and
those in the control group who received routine anesthesia management
under standard monitoring or blinded rSO2 monitoring. The primary outcomes
were the incidence of PND, including postoperative delirium (POD) and
postoperative cognitive dysfunction (POCD), and Mini-Mental State
Examination (MMSE) scores. Secondary outcomes included the incidence of
intraoperative cerebral desaturation and length of hospital stay (LOS).
 RESULT(S): The pooled results showed that compared to the control
group, optimized anesthesia management guided by intraoperative rSO2
monitoring significantly reduced the incidence of POCD within 7 days
postoperatively and may reduce the incidence of POCD at 3 months and
longer periods postoperatively. However, it may not reduce the incidence
of POD within 7 days or longer periods postoperatively, improve MMSE
scores, reduce the incidence of intraoperative cerebral desaturation, or
shorten LOS. Given the substantial heterogeneity in the pooled results for
MMSE scores within 7 days postoperatively and LOS, and the limited number
of studies reporting the incidence of POD, POCD, and MMSE scores after 7
days postoperatively, the related results should be interpreted with
caution. CONCLUSION(S): Despite the presence of heterogeneity and the
inclusion of a limited number of studies for some outcomes, it is still
recommended that clinical anesthesiologists routinely perform
intraoperative rSO2 monitoring and optimize intraoperative anesthesia
management based on the monitoring results to maximize rSO2 and improve
cerebral perfusion, thereby improving patients' neurocognitive outcomes.
Further large-scale high-quality studies are needed to confirm the
conclusions of this study. Copyright © 2024. Published by
Elsevier Inc.

<70>
Accession Number
646121324
Title
Transcatheter tricuspid valve intervention versus medical therapy for
symptomatic tricuspid regurgitation: a meta-analysis of reconstructed
time-to-event data.
Source
International journal of surgery (London, England). 110(10) (pp
6800-6809), 2024. Date of Publication: 01 Oct 2024.
Author
Fu G.; Zhu J.; Song W.; Bagaber G.; Wang C.; Chen J.; Wei L.
Institution
(Fu, Song, Wang, Chen, Wei) Department of Cardiovascular Surgery,
Zhongshan Hospital, Fudan University, Shanghai, China
(Zhu) Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital,
Fudan University, Shanghai, China
(Bagaber) Shanghai Medical College, Fudan University, Shanghai, China
(Wang, Chen, Wei) Department of Cardiovascular Surgery, Shanghai Geriatric
Medical Center, Shanghai, China
Abstract
BACKGROUND: Transcatheter tricuspid valve intervention (TTVI) has
demonstrated safety and efficacy in treating high-risk patients with
tricuspid regurgitation (TR). The authors aimed to perform a meta-analysis
based on reconstructed time-to-event data to compare the clinical benefit
of TTVI with medical therapy (MED). METHOD(S): A systematic
literature search was conducted in major databases, including PubMed,
Embase, and the Cochrane Library, until 20 October 2023. All studies
comparing the outcomes between TTVI and MED were included. The primary
outcome was all-cause mortality. The secondary outcomes included heart
failure (HF) hospitalization and the composite outcome of all-cause
mortality and HF hospitalization. RESULT(S): Five studies covering
3826 patients (1146 received TTVI and 2680 received MED) were identified.
At 1-year follow-up, TTVI significantly reduced the risk of all-cause
mortality compared with MED [hazard ratio (HR) 0.54, 95% CI: 0.39-0.74,
P=0.0001]. There was a trend in favor of TTVI in HF hospitalization,
although without significant difference (HR 0.70, 95% CI: 0.42-1.18,
P=0.18). TTVI was also associated with a decreased risk of composite
outcome (HR 0.57, 95% CI: 0.38-0.86, P=0.007). Reconstructed Kaplan-Meier
curves illustrated a 1-year overall survival rate of 83.1% in the TTVI
group and 68.8% in the MED group. The subgroup analysis of device types
yielded consistent results. CONCLUSION(S): Compared with MED, TTVI
was associated with greater 1-year benefits for patients with symptomatic
moderate or greater TR from the aspects of all-cause mortality and HF
hospitalization. Copyright © 2024 The Author(s). Published by
Wolters Kluwer Health, Inc.

<71>
Accession Number
2032796689
Title
Efficacy of preoperative prophylactic application of betamethasone on
postoperative nausea and vomiting in patients undergoing total knee
arthroplasty: a prospective randomized controlled trial.
Source
Frontiers in Medicine. 11 (no pagination), 2024. Article Number: 1487818.
Date of Publication: 2024.
Author
Sun X.; Dou Q.; Li B.; Bai G.; Qin K.; Ma J.; Yao F.; Huang Y.
Institution
(Sun, Li, Bai, Qin, Ma, Huang) Department of Knee Joint Surgery, Honghui
Hospital, Xi'an Jiaotong University, Shaanxi, Xi'an, China
(Sun, Dou, Bai, Qin) The First Clinical Medical College, Shaanxi
University of Chinese Medicine, Xianyang, China
(Yao) Department of Orthopedics, Baoji Central Hospital, Shaanxi, Baoji,
China
Publisher
Frontiers Media SA
Abstract
Background: The demand for total knee arthroplasty (TKA) is increasing,
yet postoperative nausea and vomiting (PONV) significantly hinder patient
recovery. Preoperative prophylactic administration of glucocorticoids can
alleviate PONV, with betamethasone showing promising results in breast and
cardiac surgeries. However, its efficacy in TKA patients remains unclear.
This study evaluates the efficacy and safety of preoperative betamethasone
for PONV in TKA patients through a prospective randomized controlled trial
(RCT). Material(s) and Method(s): In this trial, 124 patients were
randomly assigned to receive either 2 mL of normal saline (control group)
or 2 mL of betamethasone sodium phosphate (10.52 mg total dose;
experimental group) 10 min before anesthesia induction. Primary outcomes
included nausea severity, vomiting frequency, and antiemetic use, while
secondary outcomes were pain scores, knee range of motion, blood glucose,
IL-6, CRP, ESR, and adverse reactions. Result(s): Results showed the
experimental group had significantly lower nausea severity at 2, 4, 6, 12,
and 24 h post-surgery compared to controls. The average frequency of
vomiting in the experimental group (0.060 +/- 0.307) was lower than that
in the control group (0.390 +/- 0.662), with a statistical difference (P <
0.001). The postoperative use of metoclopramide in the experimental group
(0.480 +/- 2.163) was lower than that in the control group (4.520 +/-
6.447), and there was a statistical difference between the two groups (P <
0.001). CRP in the experimental group on the second day after surgery
(45.741 +/- 47.044) was lower than that in the control group (65.235 +/-
50.970), with a statistical difference (P = 0.014). IL-6 in the
experimental group was lower on the first (51.853 +/- 67.202) and second
postoperative days (25.143 +/- 31.912) than that in the control group on
the first (79.477 +/- 97.441) and second postoperative days (38.618 +/-
36.282), with statistical differences (P = 0.039, P = 0.006). There was no
significant difference in postoperative knee pain, knee range of motion,
blood glucose, ESR, and adverse reactions between the two groups.
 Conclusion(s): Our prospective RCT demonstrates that preoperative
betamethasone is effective and safe for reducing PONV in TKA patients,
suggesting a new clinical approach for prophylactic treatment of PONV
post-TKA. Copyright © 2024 Sun, Dou, Li, Bai, Qin, Ma, Yao and
Huang.

<72>
Accession Number
646114766
Title
A Systematic Review of Multimodal Analgesic Effectiveness on Acute
Postoperative Pain After Adult Cardiac Surgery.
Source
Journal of advanced nursing. (no pagination), 2024. Date of Publication:
20 Dec 2024.
Author
Wynne R.; Jedwab R.M.; Gjeilo K.H.; Fredericks S.; Magboo R.; Phillips
E.K.; Goudarzi Rad M.; O'Keefe-Mccarthy S.; Keeping-Burke L.; Murfin J.;
Killackey T.; Bruneau J.; Matthews S.; Bowden T.; Sanders J.; Lie I.
Institution
(Wynne, Matthews) School of Nursing & Midwifery, Centre for Quality &
Patient Safety in the Institute for Health Transformation, Deakin
University, Geelong, VIC, Australia
(Wynne) Western Health, St Albans, VIC, Australia
(Jedwab) EMR & Informatics Program, Monash Health, Clayton, VIC, Australia
(Gjeilo) Department of Public Health and Nursing, Faculty of Medicine and
Health, NTNU - Norwegian University of Science and Technology, Trondheim,
Norway
(Gjeilo) Department of Cardiology, St. Olav's Hospital, Trondheim, Norway
(Fredericks) Daphne Cockwell School of Nursing, Ryerson University,
Toronto, Canada
(Magboo) Adult Critical Care Unit, St. Bartholomew's Hospital, London,
United Kingdom
(Magboo) Queen Mary University of London, London, United Kingdom
(Phillips) Cardiac Sciences, Winnipeg Regional Health Authority, Winnipeg,
MB, Canada
(Phillips) Applied Health Sciences, University of Manitoba, Winnipeg, MB,
Canada
(Goudarzi Rad, Killackey) Lawrence S Bloomberg Faculty of Nursing,
University of Toronto, Toronto, ON, Canada
(Goudarzi Rad, Killackey) Peter Munk Cardiac Centre, University Health
Network, Toronto, ON, Canada
(O'Keefe-Mccarthy) Department of Nursing, Brock University, St.
Catharines, ON, Canada
(Keeping-Burke) Department of Nursing & Health Sciences, University of New
Brunswick, Saint John, New Brunswick, Canada
(Murfin) Cardiac Surgery, University of Southampton NHS Foundation Trust,
Southampton, United Kingdom
(Bruneau) Memorial University of Newfoundland, St John's ,Newfoundland and
Labrador, Canada
(Matthews) Heart Foundation, Global Cardiovascular Research Funders Forum,
Melbourne, VIC, Australia
(Bowden) School of Health & Psychological Sciences, Nursing Department,
University of London, London, United Kingdom
(Sanders) Faculty of Nursing, King's College London, London, United
Kingdom
(Sanders) Barts Health NHS Trust, St Bartholomew's Hospital, London,
United Kingdom
(Sanders) William Harvey Research Institute, London, United Kingdom
(Lie) Centre for Patient-Centred Heart & Lung Research, Department of
Cardiothoracic Surgery, Division of Cardiovascular & Pulmonary Disease,
Oslo University Hospital, Oslo, Norway
(Lie) Department of Health Sciences in Gjovik, Faculty of Medicine &
Health Sciences, Norwegian University of Science & Technology, Norway
Abstract
AIM: To synthesise the best available empirical evidence about the
effectiveness of multimodal analgesics on pain after adult cardiac
surgery. DESIGN: A systematic review with meta-analysis. METHOD(S):
Indexed full-text papers or abstracts, in any language, of randomised
controlled trials of adult patients undergoing cardiac surgery
investigating multimodal postoperative analgesic regimen effect on mean
level of patient-reported pain intensity at rest. DATA SOURCES: Eight
databases, via two platforms and three trial registries were searched from
1 January 1995 to 1 June 2024 returning 3823 citations. RESULT(S): Of
the 123 full-text papers assessed, 29 were eligible for inclusion. Data
were independently extracted by a minimum of two reviewers in Covidence.
There were 2195 participants, aged 60.4 +/- 6.6 (range 40-79) years, who
were primarily male (n = 1522, 76.1%), randomised in the included studies.
Risk of bias was high and reporting quality was poor. Patient-reported
pain was measured at rest in 28 (96.6%) trials. Data were suitable for
pooled analysis from 10 (34.5%) of these trials with an average rest pain
intensity of 3.3 (SD 1.5) in the control and 2.7 (SD 1.9) in the
intervention groups, respectively. No trials compared combinations of
nonopioid, opioid-agonist-antagonist, partial opioid agonists or full
opioid agonists. Most trials (n = 11, 37.9%) compared two different full
opioid options for less than 72 h (n = 24, 82.7%). CONCLUSION(S):
Robust trials are needed to determine which multimodal analgesic
combination will optimise patient recovery after adult cardiac surgery.
There is an urgent need to test and refine high-quality end-point
measures. IMPLICATIONS FOR PATIENT CARE: Adequate assessment precedes
ideal pain treatment. The findings from this review reveal neither are
sufficient, and the impact of suboptimal pain management on postoperative
recovery is grossly underinvestigated. IMPACT: The optimal combination of
multimodal analgesics is unknown despite being recommended in best
practice guidelines for enhanced recovery after cardiac surgery. Almost
30% of adults continue to experience ongoing pain up to a year after
cardiac surgery, and findings from this review reveal a dearth of robust
empirical evidence for optimal pain management, and heterogeneity in the
way pain is assessed, measured and managed. This review provides a premise
for robust trials focused on acute postoperative recovery in cardiac
surgery and beyond. REPORTING METHOD: This review was conducted in
accordance with the PRISMA-P statement. PATIENT OR PUBLIC CONTRIBUTION:
There was no patient or public contribution. PROTOCOL REGISTRATION:
PROSPERO: CRD42022355834. Copyright © 2024 John Wiley & Sons Ltd.

<73>
Accession Number
2035403478
Title
Ultrasound-Guided Continuous Rhomboid Intercostal and Sub-Serratus Plane
Block Comparison of Thoracoscopic Intercostal Nerve Block After
Thoracoscopic Surgery: A Prospective Randomized Controlled Study.
Source
Journal of Pain Research. 17 (pp 4471-4481), 2024. Date of Publication:
2024.
Author
Wang S.; Wang H.; Chen X.; Li M.; Xu D.
Institution
(Wang, Wang, Chen, Li, Xu) Department of Anesthesiology, Affiliated
Hospital of Chifeng University, Chifeng, China
Publisher
Dove Medical Press Ltd
Abstract
Purpose: Thoracic surgery is among the most painful surgeries,
postoperative pain can lead to a poor prognosis. This study aimed to
explore the analgesic effect of ultrasound-guided continuous rhomboid
intercostal and sub-serratus (RISS) plane block Comparison of
thoracoscopic intercostal nerve block (ICNB) on postoperative pain
management and recovery in patients who underwent Video-Assisted Thoracic
Surgery (VATS) Lobectomy. Method(s): This prospective randomized
controlled study enrolled patients after VATS Lobectomy who received
ultrasound-guided continuous RISS plane block (RISS group) or ICNB
(Control group) for postoperative pain. The primary outcome was the visual
analogue scale (VAS) score. The secondary outcomes included non-invasive
blood pressure (NIBP), heart rate (HR), the time to ambulation after
surgery, the timing of drain removal, and the duration of postoperative
hospitalization. Result(s): A total of 98 participants were collected
(53.08 +/- 13.63; 43 (43.88%) males); each group included 49 patients. The
RISS group displayed significantly lower visual analogue scale (VAS)
scores during rest and when coughing at postoperative 12, 24, and 48h
compared to the Control group (P < 0.001). The total consumption of
sufentanil and remifentanil was smaller in the RISS group than in the
control group. The NIBP,HR in the RISS group were significantly lower than
in the Control group at immediately after skin incision (T1), upon
entering the thoracic cavity (T2), 5 min after entering the thoracic
cavity (T3) (P < 0.001). The patients in the RISS group were more likely
to exhibit a shorter time to the first postoperative ambulation compared
to the Control group (8.84 +/- 2.87,15.43 +/- 4.50, P < 0.001).
 Conclusion(s): Continuous RISS may be a safe and effective strategy
for postoperative pain management after thoracoscopic
surgery. Copyright © 2024 Wang et al.

<74>
Accession Number
2032772704
Title
Benefits from Implementing Low- to High-Intensity Inspiratory Muscle
Training in Patients Undergoing Cardiac Surgery: A Systematic Review.
Source
Journal of Cardiovascular Development and Disease. 11(12) (no pagination),
2024. Article Number: 380. Date of Publication: 01 Dec 2024.
Author
Evangelodimou A.; Patsaki I.; Andrikopoulos A.; Chatzivasiloglou F.;
Dimopoulos S.
Institution
(Evangelodimou, Patsaki) Laboratory of Advanced Physiotherapy,
Physiotherapy Department, School of Health & Care Sciences, University of
West Attica, Athens, Greece
(Andrikopoulos, Dimopoulos) Clinical Ergospirometry, Exercise and
Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos
Hospital, School of Medicine, National and Kapodistrian University of
Athens, Athens, Greece
(Chatzivasiloglou) Intensive Care Unit, Bristol Royal Infirmary University
Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
(Dimopoulos) Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Athens,
Kallithea, Greece
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Cardiac surgery procedures are among the main treatments for people with
cardiovascular disease, with physiotherapy playing a vital part.
Respiratory complications are common and associated with prolonged
Intensive Care Unit (ICU) and hospital stay, as well as increased
mortality. Inspiratory muscle training has been found to be beneficial in
improving respiratory muscle function in critically ill patients and
patients with heart failure. The purpose of this review is to present the
results of implementing inspiratory muscle training (IMT) programs in
patients before and/or after cardiac surgery. The PubMed, Embase and
Science Direct databases were searched from January 2012 to August 2023.
In the present review, randomized controlled clinical trials (RCTs),
clinical trials and quasi-experimental studies conducted in adult patients
pre and/or post cardiac surgery were included. Fifteen studies were
considered eligible for inclusion in the review. The results revealed that
the IMT programs varied in intensity, repetitions, and duration in all
included studies. Most studies implemented the IMT after the surgery.
Statistical significance between groups was noted in Maximal Inspiratory
Pressure and the 6-Minute Walk Distance Test. Preoperative and
postoperative programs could improve inspiratory muscle strength,
pulmonary function, and functional capacity as well as decrease the length
of hospital stay in patients undergoing cardiac surgery. No clear evidence
emerged favoring low or higher IMT intensities. The combination of IMT
with other forms of exercise might be beneficial in patients undergoing
cardiac surgery. However, further RCTs are required to provide confirming
evidence. Copyright © 2024 by the authors.

<75>
Accession Number
646112784
Title
Evaluating the impact of Benson's relaxation technique on anxiety and
delirium among coronary artery bypass graft surgery patients.
Source
Journal of cardiothoracic surgery. 19(1) (pp 657), 2024. Date of
Publication: 19 Dec 2024.
Author
Golchoubi A.; Miri K.; Vagheei S.; Hajiabadi F.; Kahrom M.; Behnam Vashani
H.R.
Institution
(Golchoubi) Department of Medical- Surgical Nursing, School of Nursing and
Midwifery (MSC Student), Mashhad University of Medical Sciences, Mashhad,
Iran, Islamic Republic of
(Miri) Department of Nursing, School of Nursing and Midwifery, Torbat
Heydariyeh University of Medical Sciences, Iran, Islamic Republic of
(Vagheei, Hajiabadi) Nursing and Midwifery Care Research Center, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Hajiabadi) Department of Medical Surgical Nursing, School of Nursing and
Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Kahrom) Department of Cardiovascular Surgery, Faculty of Medicine,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Behnam Vashani) Nursing and Midwifery Care Research Centre, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Abstract
BACKGROUND: Anxiety and delirium are prevalent complications in cardiac
patients undergoing invasive procedures like coronary artery bypass
surgery, with untreated symptoms potentially leading to enduring physical
and psychological consequences. Benson's relaxation technique, a method of
attention focusing, has demonstrated efficacy in alleviating various
symptoms, although findings are conflicting. Thus, this study aimed to
assess the influence of Benson's relaxation on anxiety and delirium
severity in open-heart surgery candidates. METHOD(S): Conducted in
2022 at Qaem Hospital in Mashhad, this randomized controlled trial
involved 60 patients. The intervention group received Benson's relaxation
training pre-surgery and practiced it twice daily for 72 h post-admission.
Standard care was provided to controls. Anxiety and delirium were assessed
using standardized scales before and after the intervention.
 RESULT(S): The demographic characteristics of both groups were
comparable with no significant differences. Benson's relaxation
significantly reduced delirium scores on the first and second days
post-surgery (P < 0.001). However, the difference in delirium scores
between the groups was not significant on the third day (P = 0.129). While
the intervention led to a significant reduction in anxiety within the
intervention group, no significant difference in anxiety reduction was
observed between the intervention and control groups (P = 0.579).
 CONCLUSION(S): Incorporating Benson's relaxation technique, which
showed significant effects in reducing early postoperative delirium, into
postoperative care plans for open-heart surgery patients warrants
consideration. However, given the lack of a significant effect on anxiety
reduction compared to routine care, further research is necessary to
evaluate its long-term effectiveness and broader impact on psychological
outcomes. TRIAL REGISTRATION: This study was registered in the Iranian
Registry of Clinical Trials (no. c IRCT20210903052365N1) on
2022-01-28. Copyright © 2024. The Author(s).

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