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<1>
Accession Number
2036026571
Title
Mitral Valve Repair Versus Replacement in Patients Undergoing Concomitant
Aortic Valve Replacement.
Source
Heart Lung and Circulation. 34(1) (pp 3-15), 2025. Date of Publication: 01
Jan 2025.
Author
Zhang Y.; Fu G.; Li G.; Jian B.; Wang R.; Huang Y.; Chu T.; Wu Z.; Zhou
Z.; Liang M.
Institution
(Zhang, Fu, Li, Jian, Huang, Chu, Wu, Zhou, Liang) Department of Cardiac
Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
(Wang) Department of Cardiology, Guangzhou Hospital of Integrated
Traditional and West Medicine, Guangzhou, China
Publisher
Elsevier Ltd
Abstract
Aim: Mitral valve repair (MVr) is associated with more favourable
long-term outcomes than mitral valve replacement (MVR) in cases of
isolated mitral valve disease suitable for repair. However, there is
debate regarding whether the superiority of MVr extends to patients with
concomitant aortic and mitral valve disease. Therefore, this meta-analysis
was conducted to compare the survival benefits between aortic valve
replacement (AVR) plus MVr with a double valve replacement (DVR).
 Method(s): A comprehensive literature search was conducted on PubMed,
EMBASE, and Cochrane until 20 October 2022. Studies comparing MVr and MVR
in patients undergoing concomitant AVR were included. The primary outcome
was long-term survival. The secondary outcomes were early mortality,
mitral valve reoperation, and valve-related adverse events.
 Result(s): Sixteen studies with a total of 140,638 patients were
included in this analysis. Patients undergoing AVR plus MVr exhibited a
favourable trend in long-term survival (HR 0.85; 95% CI 0.71-1.03; p=0.10;
I2=58%). The reconstructed Kaplan-Meier curve revealed that the
long-term survival at 5, 10, and 15 years was higher in the AVR plus MVr
(80.95%, 67.63%, and 51.18%, respectively) than in the DVR group (76.62%,
61.36%, 43.21%, respectively). Aortic valve replacement plus MVr had a
lower risk of early mortality (RR 0.67; 95% CI 0.58-0.79; p<0.001;
I2=77%), thromboembolic events (RR 0.81; 95% CI 0.67-0.98;
p=0.03; I2=5%), and haemorrhagic events (RR 0.87; 95% CI
0.78-0.98; p=0.01; I2=59%). Moreover, both groups displayed
comparable rates of mitral valve reoperation (HR 1.73; 95% CI 0.86-3.48;
p=0.13; I2=60%) and infective endocarditis (RR 1.60; 95% CI
0.65-3.93; p=0.31; I2=0%). However, the rate of reoperation for
AVR plus MVr significantly increased in rheumatic heart disease patients
(HR 3.30, 95% CI 1.66-6.59; p<0.0001). Conclusion(s): Compared with
DVR, AVR plus MVr was associated with favourable long-term survival,
reduced early mortality risk, and a lower incidence of thromboembolic and
haemorrhagic events without increasing the risk of mitral valve
reoperation or infective endocarditis in unselected patients. However,
higher reoperation rates were observed in rheumatic heart disease patients
undergoing AVR plus MVr. Copyright © 2024 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ)

<2>
Accession Number
2032850509
Title
Regular human insulins versus rapid-acting insulin analogues in children
and adolescents with type 1 diabetes: a protocol for a systematic review
with meta-analysis and Trial Sequential Analysis.
Source
Systematic Reviews. 14(1) (no pagination), 2025. Article Number: 5. Date
of Publication: 01 Dec 2025.
Author
Petersen J.J.; Juul S.; Kamp C.B.; Faltermeier P.; Sillassen C.D.B.; Dos
Santos T.J.; Jakobsen J.C.
Institution
(Petersen, Juul, Kamp, Faltermeier, Sillassen, Jakobsen) Centre for
Clinical Intervention Research, Copenhagen Trial Unit, Capital Region of
Denmark, Copenhagen, Denmark
(Petersen) Faculty of Health and Medical Sciences, Copenhagen University,
Copenhagen, Denmark
(Juul) Mental Health Centre Stolpegaard, Mental Health Services in the
Capital Region of Denmark, Gentofte, Denmark
(Juul) Department of Psychology, University of Copenhagen, Copenhagen,
Denmark
(Kamp, Faltermeier, Sillassen, Jakobsen) Department of Regional Health
Research, The Faculty of Health Sciences, University of Southern Denmark,
Odense, Denmark
(Sillassen) Department of Cardiology and Endocrinology, Slagelse Hospital,
Region of Zealand, Slagelse, Denmark
(Dos Santos) Unit of Pediatrics, Hospital Vithas Almeria, Instituto
Hispalense de Pediatria, Andalusia, Almeria, Spain
(Dos Santos) Department of Nursing, Physiotherapy, and Medicine, Faculty
of Health Sciences, University of Almeria, Almeria, Spain
Publisher
BioMed Central Ltd
Abstract
Background: Type 1 diabetes is a serious, chronic disorder with an
increasing incidence among children and adolescents. Glycemic control in
individuals with type 1 diabetes is better managed through a basal-bolus
regimen with either regular human or rapid-acting insulin analogues
administered as a bolus at mealtimes. Rapid-acting insulin analogues have
been hypothesized to cause optimal glycemic control and less risk of
hypoglycemic episodes compared to regular human insulins. However, this
has never been systematically assessed in children and adolescents with
type 1 diabetes. Therefore, this systematic review aims to assess the
beneficial and harmful effects of regular human insulins versus
rapid-acting insulin analogues in children and adolescents.
 Method(s): This is a protocol for a systematic review. A search in
major medical databases (e.g., MEDLINE, EMBASE, CENTRAL) and clinical
trial registries will be performed by a search specialist. We will include
published and unpublished randomized clinical trials comparing regular
human insulins versus rapid-acting insulin analogues (lispro, aspart, or
glulisine). Two review authors will independently extract data and conduct
risk of bias assessments. Primary outcomes will be severe hypoglycemia,
ketoacidosis, and serious adverse events. Secondary outcomes will be
quality of life, HbA1c, and non-serious adverse events. Data will be
analyzed using fixed-effect meta-analyses, random-effects meta-analyses,
and Trial Sequential Analysis. Several subgroup analyses are planned. Risk
of bias will be assessed with the Cochrane Risk of Bias tool-version 2, an
eight-step procedure will be used to assess if the thresholds for clinical
significance are crossed, and the certainty of the evidence will be
assessed by Grading of Recommendations, Assessment, Development and
Evaluations (GRADE). Discussion(s): The beneficial and adverse
effects of regular human insulins versus rapid-acting insulin analogues
have not been systematically assessed in children and adolescents. There
is a need for a comprehensive systematic review of the current evidence.
Systematic review registration: PROSPERO: CRD42024508625. Copyright
© The Author(s) 2025.

<3>
Accession Number
2036821324
Title
A Randomized Comparison of Bioheart Sirolimus-Eluting Bioresorbable
Scaffold and Everolimus-Eluting Stents: The BIOHEART-II Trial.
Source
JACC: Cardiovascular Interventions. 18(1) (pp 15-27), 2025. Date of
Publication: 13 Jan 2025.
Author
Liu S.; Nie S.; Hou Y.; Huang G.; Fu G.; Zhou H.; Wei M.; Lu F.; Zhang F.;
Wang L.; Wang Y.; Wu Y.; Qiao S.
Institution
(Liu, Wu, Qiao) Department of Cardiology, Fu Wai Hospital, National Center
for Cardiovascular Diseases of China, Beijing, China
(Nie) Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Hou) Department of Cardiology, Nanfang Hospital, Southern Medical
University, Guangzhou, China
(Huang) Department of Cardiology, Liaocheng People's Hospital, Liaocheng,
China
(Fu) Department of Cardiology, Sir Run Run Shaw hospital, Zhejiang
University School of Medicine, Zhejiang, China
(Zhou) Department of Cardiology, Shanghai East Hospital, Tongji University
School of Medicine, Shanghai, China
(Wei) Department of Cardiology, Sixth People's Hospital, Shanghai Jiaotong
University, Shanghai, China
(Lu) Department of Cardiology, Tangshan Workers Hospital, Tangshan, China
(Zhang) Department of Cardiology, TEDA International Cardiovascular
Hospital, Tianjin, China
(Wang) Department of Cardiology, Beijing Chaoyang Hospital, Capital
Medical University, Beijing, China
(Wang) Medical Research and Biometrics Center, National Center for
Cardiovascular Diseases of China, Beijing, China
Publisher
Elsevier Inc.
Abstract
Background: First-generation bioresorbable scaffolds (BRS) increased risks
of stent thrombosis and adverse events. The Bioheart scaffold is a new
poly-L-lactic acid-based BRS. Objective(s): This study sought to
evaluate the efficacy and safety of the BRS in patients with coronary
artery disease. Method(s): This was a prospective, multicenter,
randomized, noninferiority trial comparing the Bioheart BRS with a
cobalt-chromium everolimus-eluting stent (CoCr-EES) in patients with
coronary artery disease. Angiography was planned at 12 months in all
patients. The primary endpoint was 12-month in-segment late loss. The key
secondary endpoint was the 12-month proportion of covered struts assessed
on optical coherence tomography. Three-year clinical follow-up was
completed. Result(s): A total of 434 patients from 22 Chinese sites
were included (Bioheart BRS, n =218; CoCr-EES, n = 216). One-year
in-segment late loss was 0.17 +/- 0.38 mm with the Bioheart BRS vs 0.14
+/- 0.24 mm with CoCr-EES; the 1-sided 97.5% upper confidence limit of the
difference was 0.10 mm (P for noninferiority < 0.0001). The proportion of
covered struts was 97.9% in the Bioheart BRS and 98.5% in the CoCr-EES
(difference 0.02%; 95% CI: -0.3% to 0.26%; P for noninferiority < 0.0001;
P for superiority = 0.91). Clinical outcomes at 3 years were similar in
the 2 groups, as were the rates of target lesion failure (5.6% vs 5.2%; P
= 0.84). Conclusion(s): In this multicenter randomized trial, the
Bioheart BRS was noninferior to the CoCr-EES for 1-year in-segment late
loss, and resulted in a comparable 3-year clinical outcome. (Bioheart
Rapamycin Drug-Eluting Bioresorbable Coronary Stent System Clinical Study;
NCT03284255) Copyright © 2025 American College of Cardiology
Foundation

<4>
Accession Number
2034503494
Title
Editor's Choice - Bypass versus Angioplasty in Severe Ischaemia of the Leg
(BASIL)-2 Trial: Analysis of the Timing and Causes of Death in
Participants Randomised to an Infrapopliteal Vein Bypass or Best
Endovascular Treatment First Revascularisation Strategy.
Source
European Journal of Vascular and Endovascular Surgery. 69(1) (pp 102-107),
2025. Date of Publication: 01 Jan 2025.
Author
Bradbury A.W.; Hall J.; Moakes C.A.; Popplewell M.; Meecham L.; Bate G.R.;
Kelly L.; Diamantopoulos A.; Ganeshan A.; Houlind K.; Malmstedt J.; Patel
J.V.; Saratzis A.; Zayed H.
Institution
(Bradbury, Popplewell) College of Medical and Dental Sciences, University
of Birmingham, Birmingham, United Kingdom
(Hall, Moakes) Birmingham Clinical Trials Unit, Institute of Applied
Health Research, University of Birmingham, Birmingham, United Kingdom
(Meecham) University Hospital of Wales, Cardiff, United Kingdom
(Bate, Kelly, Ganeshan) University Hospitals Birmingham NHS Foundation
Trust, Birmingham, United Kingdom
(Diamantopoulos, Zayed) Guys and St. Thomas NHS Foundation Trust, London,
United Kingdom
(Houlind) Lillebaelt Hospital, University of Southern Denmark, Denmark
(Malmstedt) Department of Clinical Science and Education, Karolinska
Institutet, Stockholm, Sweden
(Malmstedt) Division of Vascular Surgery, Department of Surgery,
Sodersjukhuset, Stockholm, Sweden
(Patel) Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
(Saratzis) University of Leicester, Leicester, United Kingdom
Publisher
W.B. Saunders Ltd
Abstract
Objective: The Bypass versus Angioplasty in Severe Ischaemia of the Leg
(BASIL)-2 trial enrolled participants with chronic limb threatening
ischaemia who required an infrapopliteal, with or without a
femoropopliteal, revascularisation procedure to restore limb perfusion.
Participants randomised to a vein bypass (VB) first revascularisation
strategy were over one third more likely than those randomised to a best
endovascular treatment (BET) first revascularisation strategy to die from
any cause during a median follow up of 40.0 (interquartile range 20.9,
60.6) months. The aim of the present study was to describe the timing and
causes of death in BASIL-2 as a first step towards trying to better
understand why randomisation to a VB first revascularisation strategy was
associated with this excess mortality. Method(s): A 10 person
international panel comprising vascular and endovascular surgeons as well
as vascular interventional radiologists, who had all been principal
investigators in BASIL-2, took part in a modified Delphi consensus
exercise to adjudicate the primary cause of death and, in particular,
whether the cause was primarily cardiac or non-cardiac. Result(s): In
151 of 168 deaths (89.9%), the Delphi panel achieved a consensus regarding
the cause of death being probably cardiac or non-cardiac. In the BET
group, 16 of 77 deaths (21%) were classified as probably cardiac compared
with 32 of 91 (35%) in the VB group (unadjusted subdistribution hazard
ratio 2.16, 95% confidence interval [CI] 1.20 - 3.87; unadjusted cause
specific hazard ratio 2.15, 95% CI 1.19 - 3.90). At the point of
randomisation, 64 of 344 (18.6%), 40 of 342 (11.7%), and 37 of 344 (10.8%)
participants had a previous myocardial infarction (MI), percutaneous
coronary intervention (PCI), and coronary artery bypass graft (CABG),
respectively. There was no evidence of varying treatment effects for cause
of death in subgroup analyses of previous PCI, CABG, or MI.
 Conclusion(s): The excess mortality observed in the VB first
revascularisation strategy group in BASIL-2 was largely due to deaths that
were adjudicated by the Delphi panel as probably primarily cardiac. These
excess cardiac deaths were observed throughout follow up and there was no
evidence of non-proportional hazards. Further work is ongoing to try to
better understand the reasons for these findings. Copyright ©
2024 The Authors

<5>
Accession Number
2034109958
Title
Comparison of the treatment strategies for symptomatic chronic internal
carotid artery occlusion.
Source
Journal of Vascular Surgery. 81(2) (pp 494-504.e2), 2025. Date of
Publication: 01 Feb 2025.
Author
Mei F.; Zhang W.; Jiang P.; Tan C.; Cui Y.; Fan J.; Zhang W.W.
Institution
(Mei, Zhang, Jiang, Tan, Cui, Fan) Department of Vascular Surgery, Yichang
Central People's Hospital, The First College of Medical Science, China
Three Gorges University, Hubei, China
(Zhang) Division of Vascular and Endovascular Surgery, Department of
Surgery, University of Washington, Seattle, WA, United States
Publisher
Elsevier Inc.
Abstract
Objective: The best management of symptomatic chronic internal carotid
artery occlusion (CICAO) has been controversial. This systematic review
and meta-analysis were to compare the outcomes of different treatment
strategies for symptomatic CICAO. Method(s): Two independent
researchers conducted a search of articles on the treatment of CICAO
published between January 2000 and October 2023 in PubMed, Web of Science,
Embase, and The Cochrane Library. Twenty-two articles were eligible for
meta-analysis using a random effects model to combine and analyze the data
for the pooled rates of stroke and death, and the rates of procedural
success and significant restenosis/occlusion. Result(s): A total of
1193 patients from 22 publications were included in this study. Six of
them had bilateral internal carotid artery occlusion. The 30-day stroke
and death rates were 1.1% (95% confidence interval [CI], 0%-4.4%) in the
best medical treatment (BMT) group, 4.1% (95% CI, 0.7%-9.3%; I2
= 71.4%) in the extracranial-intracranial (EC-IC) bypass group, 4.4% (95%
CI, 2.4%-6.8%; I2 = 0%) in the carotid artery stenting (CAS)
group, and 1.2% (95% CI, 0%-3.4%; I2 = 0%) in the combined
carotid endarterectomy (CEA) and stenting (CEA + CAS) group. During
follow-up of 16.5 (+/-16.3) months, the stroke and death rates were 19.5%,
1.2%, 6.6%, and 2.4% in the BMT, EC-IC, CAS, and CEA + CAS groups
respectively. The surgical success rate was 99.7% (95% CI, 98.5%-100%;
I2 = 0%) in the EC-IC group, 70.1% (95% CI, 62.3%-77.5%;
I2 = 64%) in the CAS group, and 86.4% (95% CI, 78.8%-92.7%;
I2 = 60%) in the CEA + CAS group. The rate of post-procedural
significant restenosis or occlusion was 3.6% in the EC-IC group, 18.7% in
the CAS group, and 5.7% in the CEA + CSA group. The surgical success rate
was negatively associated by the length of internal carotid artery (ICA)
occlusion. Surgical success rate was significantly higher in the patients
with occlusive lesion within C1 to C4 segments, compared with those with
occlusion distal to C4 segment (odds ratio, 11.3; 95% CI, 5.0-25.53; P <
.001). A proximal stump of ICA is a favorable sign for CAS. The success
rate of CAS was significantly higher in the patients with an ICA stump
than that in the patients without (odds ratio, 11.36; 95% CI, 4.84-26.64;
P < .01). However, the success rate of CEA + CAS was not affected by the
proximal ICA stump. Conclusion(s): For the management of symptomatic
CICAO, BMT alone is associated with the highest risk of mid- and long-term
stroke and death. EC-IC bypass surgery and CEA + CAS should be considered
as the choice of treatment based on operator's expertise and patient's
anatomy. CAS may be employed as an alternative option in high surgical
risk patients, especially when proximal ICA stump exists. Copyright
© 2024 Society for Vascular Surgery

<6>
Accession Number
646071084
Title
Preoperative inspiratory muscle training improves lung function prior to
elective heart valve surgery and reduces postoperative lung function
impairment and pulmonary complications: a randomised trial.
Source
Journal of physiotherapy. 71(1) (pp 27-34), 2025. Date of Publication: 01
Jan 2025.
Author
Yu P.; Luo Z.; Wang Y.; Lin S.; Qin D.; Jones A.Y.; He J.
Institution
(Yu, Luo) Rehabilitation Medicine Centre, West China Hospital, Sichuan
University, Sichuan, China
(Wang) Cardiovascular Surgery Research Laboratory, West China Hospital,
Sichuan University, China
(Lin) Department of Rehabilitation, Fuwai Central China Cardiovascular
Hospital, Zhengzhou, China
(Qin) Department of Rehabilitation Medicine, Tianjin Chest Hospital,
Tianjin, China
(Jones) School of Health and Rehabilitation Sciences, University of
Queensland, Brisbane, Australia
(He) National Clinical Research Centre for Geriatrics, West China
Hospital, Sichuan University, Chengdu, China; Med-X Centre for
Manufacturing, Sichuan University, Chengdu, China
Abstract
QUESTION: What is the effect of 3 days of preoperative inspiratory muscle
training (IMT) on lung function prior to heart valve surgery and on
postoperative lung function and pulmonary complications compared with sham
and no IMT? DESIGN: A three-arm, multicentre, randomised controlled trial
with concealed allocation, intention-to-treat analysis and blinded
assessment of some outcomes. PARTICIPANTS: This study included 228 adults
scheduled for heart valve surgery. INTERVENTIONS: The IMT group received 3
days of IMT at 30% maximal inspiratory pressure, the sham IMT group
received the same but at 10% maximal inspiratory pressure and the control
group received no IMT. OUTCOME MEASURES: Spirometric measures, maximal
inspiratory pressure and maximum voluntary ventilation were measured at
hospital admission, the day before surgery and at discharge. The incidence
of postoperative pulmonary complications (primary outcome) and adverse
events were recorded. RESULT(S): A total of 215 participants
completed surgery as planned and all participants were followed up until
discharge. Spirometric measures, maximal inspiratory pressure and maximum
voluntary ventilation improved in all groups between admission and the day
before surgery, but more so in the IMT group. At discharge, these measures
had deteriorated in all groups, but less so in the IMT group. Preoperative
IMT reduced the total number of participants experiencing a pulmonary
complication in the IMT group compared with the sham IMT group (ARR -0.18,
95% CI -0.33 to -0.03) and compared with the control group (ARR -0.21, 95%
CI -0.35 to -0.05). Very few adverse events occurred in all three groups.
 CONCLUSION(S): Preoperative IMT improved lung function prior to
surgery and at hospital discharge and reduced postoperative pulmonary
complications in adults undergoing elective heart valve surgery.
REGISTRATION: ChiCTR2100054869. Copyright © 2024. Published by
Elsevier B.V.

<7>
Accession Number
2035283773
Title
Impact of Dipyrone Administration on Postoperative Analgesia and Aspirin
Effect in Patients Undergoing Coronary Artery Bypass Grafting: The
Prospective Randomized DipASA Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(1) (pp 121-130),
2025. Date of Publication: 01 Jan 2025.
Author
Petermichl W.; Ellmauer P.-P.; Benning A.; Zeman F.; Schmid C.; Stadlbauer
A.; Heimerl S.; Seyfried T.; Blecha S.
Institution
(Petermichl, Ellmauer, Blecha) Department of Anesthesiology, University
Medical Center Regensburg, Regensburg, Germany
(Benning, Zeman) Center for Clinical Studies, University Medical Center
Regensburg, Regensburg, Germany
(Schmid, Stadlbauer) Department of Cardiothoracic Surgery, University
Medical Center Regensburg, Regensburg, Germany
(Heimerl) Institute of Clinical Chemistry and Laboratory Medicine,
University Medical Center Regensburg, Germany
(Seyfried) Department of Anesthesiology, Hospital Vilshofen, Vilshofen,
Germany
Publisher
W.B. Saunders
Abstract
Objective: The aim of the study was to investigate the impact of dipyrone
administration on postoperative analgesia and acetylsalicylic acid (ASA)
effect in patients undergoing coronary artery bypass grafting (CABG).
 Design(s): A prospective randomized study. Setting(s):
Single-university hospital setting. Participant(s): Ninety-eight
patients who underwent CABG between April 2022 and May 2023.
 Intervention(s): The ASA effect was measured at 6 time points with
impedance aggregometry (Multiplate) and thromboelastography (TEG6s
Platelet Mapping). Patients were randomized to 1 of 3 groups: intravenous
ASA and dipyrone at the same time (group 1), intravenous ASA and dipyrone
with a 2-hour delay (group 2), and intravenous ASA alone (group 3).
Postoperative analgesic effects (numeric rating scale) and the prevalence
of potential ASA non-response (defined as ASPI >40 U and TEG-ASA
inhibition <50%) were recorded. Measurements and Main Results: Of 90
analyzed patients, 80 took ASA preoperatively. All patients received
intravenous ASA 100 mg from postoperative day 1. The effect of ASA did not
significantly differ between the study groups at any time for either
platelet function test. NRS values did not differ between the study groups
at any time (p = 0.469). Patients in group 3 received significantly more
additional co-analgesics than patients who received dipyrone (p = 0.005).
ASA non-response was detected in 38.9% and 67.8% on the seventh
postoperative day, respectively. Conclusion(s): Dipyrone given after
CABG seems safe and did not show any significant effect on platelet
inhibition after ASA administration. Patients taking dipyrone
postoperatively need significantly fewer additional coanalgesics. The ASA
effect on platelet function should be checked at least once after
surgery. Copyright © 2024 The Author(s)

<8>
Accession Number
2036441192
Title
High-Intensity Interval Training in Adults With Congenital Heart Disease:
A Systematic Review.
Source
Heart Lung and Circulation. 34(1) (pp 16-24), 2025. Date of Publication:
01 Jan 2025.
Author
Rocha Conceicao L.S.; Gauthier N.; Andrade Guimaraes A.L.; Gois C.O.;
Oliveira I.K.; Souza D.S.; Carvalho V.O.
Institution
(Rocha Conceicao, Andrade Guimaraes, Gois, Oliveira, Carvalho)
Postgraduate Program in Health Sciences (The GrEAt Group - Grupo de
Estudos em Atividade fisica), Sergipe, Sao Cristovao, Brazil
(Rocha Conceicao, Andrade Guimaraes, Gois, Oliveira, Carvalho) Department
of Physical Therapy, Federal University of Sergipe (UFS), Sergipe, Sao
Cristovao, Brazil
(Gauthier) Department of Pediatrics, Harvard Medical School, Boston, MA,
United States
(Souza) Department of Physiology, Federal University of Sergipe, Aracaju,
Brazil
Publisher
Elsevier Ltd
Abstract
Background & Aim: Individuals with congenital heart disease (CHD) have
reduced cardiorespiratory fitness which is associated with poor prognosis
and quality of life. Evidence shows that exercise is effective in the
management of adults with CHD. However, uncertainties remain about the
safety and efficacy of high-intensity interval training (HIIT) in these
patients. We performed a systematic review to assess the effects of HIIT
on aerobic capacity and quality of life in adults with CHD.
 Method(s): This systematic review followed the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses statement and the Cochrane
Collaboration Handbook. Result(s): As only three studies fitting the
inclusion criteria could be included, with a total of 87 adults with CHD,
we identified a major need for more studies assessing the effect of HIIT.
Although HIIT appeared to improve peak oxygen uptake, other measures were
inconclusive due to limited studies. Conclusion(s): Available
evidence to date suggests that HIIT improves aerobic capacity in adults
with CHD with no serious adverse events. However, these data are too
limited and are to be viewed with caution, identifying an important need
for future studies to determine the direct impact of HIIT and to compare
HIIT with other exercise intensity modalities. Copyright © 2024
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<9>
Accession Number
2032853985
Title
Transcatheter Caval Implantation for Severe Tricuspid Regurgitation.
Source
Current Cardiology Reports. 27(1) (no pagination), 2025. Article Number:
7. Date of Publication: 01 Dec 2025.
Author
Chen V.; Abdul-Jawad Altisent O.; Puri R.
Institution
(Chen, Puri) Department of Cardiovascular Medicine, Heart Vascular &
Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland,
OH, United States
(Abdul-Jawad Altisent) Hospital Clinic Barcelona, Barcelona, Spain
Publisher
Springer
Abstract
Purpose of Review: We describe the evolution of caval valve implantation
(CAVI) as a treatment for severe symptomatic tricuspid regurgitation (TR)
in the high surgical risk patient. Recent Findings: Surgical treatment of
severe TR is often limited by the high surgical risk of the patients who
tend to develop severe secondary TR. Coaptation, annuloplasty, and
orthotopic replacement strategies are all limited by annular and leaflet
geometry, prior valve repair, and the presence of cardiac implantable
device leads. CAVI appears to be a treatment strategy for severe
symptomatic TR that improves functional capacity and quality of life while
also reducing edema and ascites and improving cardiac output. Chronic
kidney disease is a common comorbidity of patients with severe TR;
zero-contrast CAVI has been described. Summary: Severe TR is
undertreated, yet common in the elderly structural heart disease
population. The evolution of CAVI as a viable treatment for severe TR
underscores the deleterious systemic contribution of backwards flow to
morbidity and mortality. There are good safety and efficacy outcomes from
registry data using the TricValve platform. Randomized controlled trials
for CAVI versus medical therapy for severe TR are ongoing. Copyright
© The Author(s) 2024.

<10>
Accession Number
2034585502
Title
Correction notices: A Novel Inflammation-Based Risk Score Predicts
Mortality in Acute Type A Aortic Dissection Surgery: The Additive
Anti-inflammatory Action for Aortopathy and Arteriopathy Score (Mayo
Clinic Proceedings: Innovations, Quality & Outcomes (2022) 6(6) (497-510),
(S2542454822000571), (10.1016/j.mayocpiqo.2022.08.005)).
Source
Mayo Clinic Proceedings: Innovations, Quality and Outcomes. 8(5) (pp 481),
2024. Date of Publication: 01 Oct 2024.
Author
Anonymous
Publisher
Elsevier B.V.
Abstract
Corrigendum to "A Novel Inflammation-Based Risk Score Predicts Mortality
in Acute Type A Aortic Dissection Surgery: The Additive Anti-inflammatory
Action for Aortopathy and Arteriopathy Score" Mayo Clinic Proceedings:
Innovations, Quality & Outcomes, Volume 6, Issue 6, December 2022, Pages
497-510 Hong Liu, MD, PhD; Si-Chong Qian, MD, PhD; Ying-Yuan Zhang, MD;
Ying Wu, MD; Liang Hong, MD; Ji-Nong Yang, MD; Ji-Sheng Zhong, MD; Yu-Qi
Wang, MD; Dong Kai Wu, MD, PhD; Guo-Liang Fan, MD; Jun-Quan Chen, MD, PhD;
Sheng-Qiang Zhang, MD; Xing-Xing Peng, MD; Yong-Feng Shao, MD, PhD;
Hai-Yang Li, MD, PhD; and Hong-Jia Zhang, MD, PhD From the Department of
Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical
University, Nanjing, People's Republic of China (H.L., Y.-F.S.);
Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital
Medical University, Beijing, People's Republic of China (S.-C.Q., H.-Y.L.,
H.-J.Z.); Department of Cardiovascular Surgery, the First Affiliated
Hospital of Guangzhou Medical University, Guangzhou, People's Republic of
China (Y.-Y.Z.); Department of Laboratory, the First Affiliated Hospital
of Shantou University Medical College, Shantou, People's Republic of China
(Y.W.); Department of Cardiovascular Surgery, Nanjing First Hospital,
Nanjing Medical University, Nanjing, People's Republic of China (L.H.);
Department of Cardiovascular Surgery, the Affiliated Hospital of Qingdao
University, Qingdao, People's Republic of China (J.-N.Y.); Department of
Cardiovascular Surgery, Xiamen Cardiovascular Hospital, Xiamen University,
Xiamen, People's Republic of China (J.-S.Z.); Department of Cardiovascular
Surgery, Teda International Cardiovascular Hospital, Chinese Academy of
Medical Sciences, Tianjin, People's Republic of China (Y.-Q.W.);
Department of Cardiovascular Surgery, Xiangya Hospital, Central South
University, Changsha, People's Republic of China (D.K.W.); Department of
Cardiovascular Surgery, Shanghai East Hospital, Tongji University,
Shanghai, People's Republic of China (G.-L.F.); Department of
Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin Medical
University, Tianjin, People's Republic of China (J.-Q.C.); Department of
Cardiovascular Surgery, the First Affiliated Hospital of Bengbu Medical
College, Bengbu, People's Republic of China (S.-Q.Z.); and Department of
Cardiovascular Surgery, the First Affiliated Hospital of Guilin Medical
University, Guilin, People's Republic of China (X.-X.P.). The authors
regret there is a typo in Figure 1 and in Methods section. Figure 1 showed
that "Derivation cohort 3695 patients from Beijing Anzhen Hospital
(2016-2021)," we accidentally made a clerical error, Derivation cohort
3695 patients from Beijing Anzhen Hospital was collected from 2002 to
2021. So, 2016-2021 should be corrected to 2002-2021. Also, Page 501 in
Methods Model Validations, "The new mortality model was internally
validated using data on 571 patients from the same hospitals as the
derivation cohort (2016-2021)," 2016-2021 should be corrected to
2002-2021. The authors would like to apologize for any inconvenience
caused. DOI of original article:
https://doi.org/10.1016/j.mayocpiqo.2022.08.005 Hai-Yang Li, MD, PhD
ocean0203@163.com Copyright © 2024 The Authors

<11>
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.

<12>
Accession Number
2036263688
Title
Advanced Imaging Assessment of the Impact of Tricuspid Regurgitation on
Cardiac Remodeling: The TRILUMINATE Pivotal Imaging Substudy.
Source
Journal of the American College of Cardiology. 85(3) (pp 250-261), 2025.
Date of Publication: 28 Jan 2025.
Author
Cavalcante J.L.; Scherer M.; Fukui M.; Lerakis S.; Harb S.; Pursnani A.;
Schwartz J.G.; Kapadia S.; Ricciardi M.J.; Khalique O.; Kodali S.; Shah
D.; Little S.H.; Sekaran N.; Whisenant B.; Flueckiger P.; Yadav P.;
Emaminia A.; Batchelor W.; Kellman P.; Lin Z.; Trusty P.M.; Hahn R.T.;
Adams D.; Sorajja P.
Institution
(Cavalcante, Sorajja) Allina Health Minneapolis Heart Institute,
Minneapolis, MN, United States
(Cavalcante, Fukui) Minneapolis Heart Institute Foundation Cardiovascular
Imaging Research Center and Core Lab, Minneapolis, MN, United States
(Scherer) Sanger Heart & Vascular Institute, Charlotte, NC, United States
(Lerakis, Adams) Mount Sinai Hospital, New York, NY, United States
(Harb, Kapadia) The Cleveland Clinic Foundation, Cleveland, OH, United
States
(Pursnani, Ricciardi) NorthShore University Health System, Evanston, IL,
United States
(Schwartz) Atrium Health Carolinas Medical Center, Charlotte, NC, United
States
(Khalique, Kodali, Hahn) New York-Presbyterian/Columbia University Medical
Center, New York, NY, United States
(Shah, Little) Houston Methodist Debakey Heart and Vascular Center,
Houston, TX, United States
(Sekaran, Whisenant) Intermountain Medical Center, Murray, UT, United
States
(Flueckiger, Yadav) Piedmont Heart Institute, Atlanta, GA, United States
(Emaminia, Batchelor) Inova Heart and Vascular Institute, Fairfax, VA,
United States
(Kellman) National Institutes of Health, National Heart, Lung, and Blood
Institute, Bethesda, MD, United States
(Lin, Trusty) Abbott Structural Heart, Santa Clara, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: The impact of tricuspid regurgitation (TR) on cardiac
remodeling has not been thoroughly studied in a randomized controlled
trial using advanced imaging. Objective(s): The goal of this analysis
was to provide comparative longitudinal changes in right heart remodeling
using cardiac magnetic resonance and time-resolved functional computed
tomography (4D-CT) in patients with symptomatic severe TR randomized to
TriClip vs medical therapy (control). Method(s): TRILUMINATE Pivotal
(Clinical Trial to Evaluate Cardiovascular Outcomes In Patients Treated
With the Tricuspid Valve Repair System Pivotal) is an international
randomized controlled trial in symptomatic patients with severe TR. A
prospective imaging substudy was performed on TRILUMINATE Pivotal subjects
at 10 sites. Cardiac magnetic resonance and 4D-CT were performed following
dedicated imaging protocols at baseline and at 30 days, and a final 4D-CT
at 1 year (all assessed by an imaging core lab). Result(s):
Sixty-nine randomized subjects (31 TriClip, 38 control) were enrolled. TR
volume significantly decreased with TriClip at 30 days (P < 0.0001; 70%
reduction). A strong association (r = 0.90; P < 0.0001) was observed
between changes in TR volume and right ventricular end-diastolic volume at
30 days. Significant reductions in right ventricular end-diastolic volume
(12% reduction; P < 0.001) and tricuspid annular area (11% reduction; P <
0.0001) were seen at 30 days and sustained through 1 year with TriClip. No
meaningful changes were observed in the control group. Conclusion(s):
Advanced imaging from the TRILUMINATE Pivotal imaging substudy
demonstrated that TriClip effectively reduced TR. Significant cardiac
remodeling was observed at 30 days and sustained at 1 year. With TriClip,
the extent of cardiac remodeling was associated with the degree of TR
reduction. (Clinical Trial to Evaluate Cardiovascular Outcomes In Patients
Treated With the Tricuspid Valve Repair System Pivotal;
NCT03904147) Copyright © 2025 American College of Cardiology
Foundation

<13>
Accession Number
2034370249
Title
The Effect of Stress Ball on Anxiety and Pain Levels in Angiography: A
Randomized Controlled Trial.
Source
Cardiovascular Therapeutics. 2024 (no pagination), 2024. Article Number:
5049092. Date of Publication: 2024.
Author
Yuksel D.; Gunes D.
Institution
(Yuksel) Bingol State Hospital, Bingol, Turkey
(Gunes) Firat University, Faculty of Health Science, Department of
Surgical Nursing, Elazig, Turkey
Publisher
Hindawi Limited
Abstract
Background: Coronary angiography, an invasive diagnostic procedure, often
induces pain and anxiety in patients. Despite the potential for
alleviating discomfort, the use of stress balls as a nonpharmacological
intervention during angiography remains underexplored. Objective(s):
This study is aimed at investigating the impact of stress ball application
on pain and anxiety levels in patients undergoing angiography.
 Method(s): This randomized controlled trial was conducted on adult
patients undergoing angiography at a Cardiovascular Surgery Clinic in
Eastern Turkey between January 2023 and June 2023. A total of 120 patients
were randomly assigned to receive stress ball application in addition to
routine care. Data collection utilized the Numerical Rating Scale (NRS),
Patient Information Form, and State-Trait Anxiety Inventory (STAI).
 Result(s): Analysis revealed a significantly lower increase in mean
NRS posttest scores among patients in the experimental group compared to
the control group (p<0.05). Additionally, the mean STAI posttest score
demonstrated a significant decrease (p<0.05) in the experimental group. A
positive and significant correlation was observed between the mean NRS and
STAI posttest scores among study group patients (p<0.05), indicating a
reduction in anxiety levels with decreasing pain. Conclusion(s): The
application of stress balls during angiography was associated with
decreased anxiety and pain levels in patients. Stress ball intervention
may serve as a beneficial adjunct to pharmacological treatments. This
study underscores the potential of nonpharmacological interventions in
enhancing patient comfort during invasive procedures.Trial Registration:
ClinicalTrials.gov Identifier: NCT06131606
(http://clinicaltrials.gov). Copyright © 2024 Dilan Yuksel and
Dilek Gunes.

<14>
Accession Number
2033186628
Title
Cardiopulmonary Protection of Modified Remote Ischemic Preconditioning in
Mitral Valve Replacement Surgery: A Randomized Controlled Trial.
Source
Cardiovascular Therapeutics. 2024 (no pagination), 2024. Article Number:
9889995. Date of Publication: 2024.
Author
Zhang L.; Zhou K.; Gu T.; Xu J.; Shi M.; Zhu J.; Liu J.
Institution
(Zhang, Zhu) Department of Anesthesiology, The Second Affiliated Hospital
of Soochow University, Jiangsu, Soochow, China
(Zhou, Gu, Xu, Shi, Liu) Jiangsu Province Key Laboratory of
Anesthesiology, Xuzhou Medical University, Jiangsu, Xuzhou, China
(Liu) Department of Anesthesiology, The Affiliated Hospital of Xuzhou
Medical University, Jiangsu, Xuzhou, China
Publisher
Hindawi Limited
Abstract
Background: Remote ischemic preconditioning (RIPC) is reported to have
early-phase and delayed-phase organ-protective effects. Previous studies
have focused on the organ protection of a single RIPC protocol, and the
clinical outcomes remain uncertain. Whether the modified RIPC (mRIPC)
protocol performed repeatedly provides cardiopulmonary protection is still
uncertain. Method(s): In this single-center, randomized, controlled
trial, 86 patients undergoing elective mitral valve replacement (MVR)
surgery were randomized 1:1 to receive either mRIPC or no ischemic
preconditioning (control). Three cycles of 5 min ischemia and 5 min
reperfusion induced by a blood pressure cuff served as the RIPC stimulus.
mRIPC was induced at the following three time points: 24 h, 12 h, and 1 h
before surgery. Blood samples were withdrawn at 10 min after intubation
(T0), at 1 h after aortic declamping (T1), and at 6 h (T2), 12 h (T3), and
24 h (T4) after surgery to measure the serum concentrations of myocardial
enzymes and other biomarkers, including cardiac troponin I (cTnI), which
was the primary endpoint of this study. Creatine kinase isoenzyme (CK-MB),
lactate dehydrogenase (LDH), inotropic score (IS), and inflammatory
mediators were also measured. Blood gas analysis was conducted to
calculate the PaO2/FiO2 ratio and A-aDO2, and the incidence of acute lung
injury (ALI) was also recorded. Result(s): mRIPC significantly
decreased the serum concentrations of cTnI, CK-MB, and LDH at T2, T3, and
T4 (p<0.01), and the IS decreased compared with that in the control group
(12.0+/-1.0 vs. 14.2+/-1.1, p<0.01). In addition, the incidence of ALI in
the mRIPC group was decreased (32.6% vs. 51.2%, p=0.039), and the
PaO2/FiO2 was higher at T4 (p<0.05). Compared with those in the control
group, the levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha
(TNF-alpha) were decreased at T1, T2, T3, and T4 (p<0.05) in the mRIPC
group, and the level of IL-10 increased at the same time.
 Conclusion(s): mRIPC decreased the incidence of myocardial and lung
injury in MVR surgery, providing new evidence for the clinical application
of RIPC in valve surgery.Trial Registration: ClinicalTrials.gov
(NCT01406678). Copyright © 2024 Lianqin Zhang et al.

<15>
Accession Number
2036887472
Title
Finerenone, Obesity, and Heart Failure With Mildly Reduced/Preserved
Ejection Fraction: Prespecified Analysis of FINEARTS-HF.
Source
Journal of the American College of Cardiology. 85(2) (pp 140-155), 2025.
Date of Publication: 21 Jan 2025.
Author
Butt J.H.; Henderson A.D.; Jhund P.S.; Claggett B.L.; Desai A.S.;
Lay-Flurrie J.; Viswanathan P.; Lage A.; Scheerer M.F.; Lam C.S.P.; Senni
M.; Shah S.J.; Voors A.A.; Bauersachs J.; Fonseca C.; Kosiborod M.N.;
Linssen G.C.M.; Petrie M.C.; Schou M.; Verma S.; Zannad F.; Pitt B.;
Vaduganathan M.; Solomon S.D.; McMurray J.J.V.
Institution
(Butt, Henderson, Jhund, Petrie, McMurray) British Heart Foundation
Cardiovascular Research Centre, University of Glasgow, Glasgow, United
Kingdom
(Claggett, Desai, Vaduganathan, Solomon) Cardiovascular Division, Brigham
and Women's Hospital, Harvard Medical School, Boston, MA, United States
(Lay-Flurrie) Bayer PLC, Research & Development, Pharmaceuticals, Reading,
United Kingdom
(Viswanathan) Bayer, Research & Development, Pharmaceuticals, Whippany,
NJ, United States
(Lage) Bayer, Research & Development, Pharmaceuticals, Sao Paolo, Brazil
(Scheerer) Bayer AG, Global Medical Affairs, Berlin, Germany
(Lam) National Heart Centre Singapore & Duke-National University of
Singapore, Singapore
(Senni) University Bicocca Milan, Milan, Italy
(Senni) Papa Giovanni XXIII Hospital, Bergamo, Italy
(Shah) Northwestern University Feinberg School of Medicine, Chicago, IL,
United States
(Voors) University Medical Center Groningen, Groningen, Netherlands
(Bauersachs) Department of Cardiology and Angiology, Hannover Medical
School, Hannover, Germany
(Fonseca) Department of Internal Medicine, Hospital Sao Francisco Xavier,
NOVA MEDICAL School, Universidade Nova de Lisboa, Lisbon, Portugal
(Kosiborod) Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City, MO, United States
(Linssen) Department of Cardiology, Hospital Group Twente, Almelo,
Netherlands
(Schou) Department of Cardiology, Herlev-Gentofte University Hospital,
Hellerup, Denmark
(Verma) Division of Cardiac Surgery, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Zannad) Universite de Lorraine, INSERM Clinical Investigation Centre,
CHU, Nancy, France
(Pitt) University of Michigan, School of Medicine, Ann Arbor, MI, United
States
Publisher
Elsevier Inc.
Abstract
Background: Obesity is associated with excessive adipocyte-derived
aldosterone secretion, independent of the classical
renin-angiotensin-aldosterone cascade, and mineralocorticoid receptor
antagonists may be more effective in patients with heart failure (HF) and
obesity. Objective(s): This study sought to examine the effects of
the nonsteroidal mineralocorticoid receptor antagonist finerenone compared
with placebo, according to body mass index (BMI) in FINEARTS-HF
(FINerenone trial to investigate Efficacy and sAfety superioR to placebo
in paTientS with Heart Failure). Method(s): A total of 6,001 patients
with HF with NYHA functional class II, III, and IV, a left ventricular
ejection fraction of >=40%, evidence of structural heart disease, and
elevated natriuretic peptide levels were randomized to finerenone or
placebo. BMI (kg/m2) was examined using World Health
Organization categories, namely, underweight/normal weight (<25.0
kg/m2; n = 1,306); overweight (25.0-29.9 kg/m2; n =
1,990); obesity class I (30.0-34.9 kg/m2; n = 1,546); obesity
class II (35.0-39.9 kg/m2; n = 751); and obesity class III
(>=40 kg/m2; n = 395). The primary outcome was cardiovascular
death and total worsening HF events. Result(s): Data on baseline BMI
were available for 5,988 patients (median: 29.2 kg/m2; Q1-Q3:
25.5-33.6 kg/m2). Compared with patients who were
underweight/normal weight, those with obesity class II or III had a higher
risk of the primary outcome (underweight/normal weight, reference;
overweight, unadjusted rate ratio: 0.96 [95% CI: 0.81-1.15]; obesity class
I: 1.04 [95% CI: 0.86-1.26]; obesity class II-III: 1.26 [95% CI:
1.03-1.54]). The effect of finerenone on the primary outcome did not vary
by baseline BMI (underweight/normal weight, rate ratio: 0.80 [95% CI:
0.62-1.04]; overweight: 0.91 [95% CI: 0.72-1.15]; obesity class I: 0.92
[95% CI: 0.72-1.19]; obesity class II-III: 0.67 [95% CI: 0.50-0.89];
P<inf>interaction</inf> = 0.32). However, when BMI was examined as a
continuous variable, the beneficial effect of finerenone seemed to be
greater in those with a higher BMI (P<inf>interaction</inf> = 0.005). A
similar pattern was observed for total worsening HF events. Consistent
effects across baseline BMI were observed for cardiovascular and all-cause
death and improvement in the Kansas City Cardiomyopathy Questionnaire
scores. Conclusion(s): In patients with HF with mildly
reduced/preserved ejection fraction, the beneficial effects of finerenone
on clinical events and symptoms were consistent, irrespective of BMI at
baseline, possibly with a greater effect on the primary outcome in
patients with higher BMI. (FINEARTS-HF [FINerenone trial to investigate
Efficacy and sAfety superioR to placebo in paTientS with Heart Failure];
NCT04435626) Copyright © 2025 The Authors

<16>
Accession Number
2032853963
Title
The role of CBT in enhancing health outcomes in coronary artery bypass
graft patients: a systematic review.
Source
BMC Psychiatry. 25(1) (no pagination), 2025. Article Number: 22. Date of
Publication: 01 Dec 2025.
Author
Ibrahim D.; Elkhidir I.H.; Mohammed Z.; Abdalla D.; Mohammed O.A.; Hemmeda
L.; Alrawa S.; Ahmed M.; Abdalla R.; Batran A.; Abdalla Z.; Elhaj N.B.;
Ibrahim B.; Albashir R.B.
Institution
(Ibrahim, Elkhidir, Mohammed, Abdalla, Mohammed, Hemmeda, Alrawa, Ahmed,
Abdalla, Abdalla, Elhaj, Ibrahim) Faculty of Medicine, University of
Khartoum, P.O. Box 11115, Khartoum, Sudan
(Batran) School of Medicine, Ahfad University for Women, Khartoum, Sudan
(Elkhidir, Ahmed) Internal Medicine, Ribat University Hospital, Khartoum,
Sudan
(Albashir) Faculty of Medicine and Health Science, Red Sea University,
Khartoum, Sudan
(Ibrahim) Orthopaedics, University Hospital Kerry, Kerry, Ireland
Publisher
BioMed Central Ltd
Abstract
Background: Coronary artery bypass graft (CABG) is a common intervention
for managing coronary artery disease, which is often accompanied by
postoperative psychological challenges such as anxiety and depression.
This systematic review aims to evaluate the benefits of cognitive
behavioral therapy (CBT) in reducing anxiety and depression symptoms and
improving overall health outcomes in patients' post-coronary artery bypass
graft (CABG) surgery. Method(s): A search of Science Direct,
PsycINFO, PubMed, Google Scholar, VHL, Cochrane, and Scopus databases was
conducted until October 2023. Inclusion criteria encompassed randomized
controlled trials reporting on CBT or CBT-based interventions tailored for
CABG patients, with anxiety and depression symptoms, as well as quality of
life, as primary outcomes. Hospital stay and satisfaction with therapy
were considered secondary outcomes. Result(s): The findings
highlighted that CBT led to improvements in anxiety and depression
symptoms, as well as reduced hospital stays, lowered hopelessness levels,
and increased satisfaction with therapy. The long-term effects of CBT on
CABG patients need to be studied, focusing on larger samples and patient
compliance. Furthermore, assessment of CBT implementation in real-world
clinical settings is important for feasibility, acceptability, and
effectiveness across different regions. Conclusion(s): This review
underscores the positive impact of CBT on mitigating depression and
anxiety symptoms and boosting the quality of life of individuals post-CABG
surgery. Copyright © The Author(s) 2024.

<17>
Accession Number
2032853629
Title
Prognostic Value of Advanced Echocardiographic Analysis for Transcatheter
Aortic Valve Replacement: A Systematic Review.
Source
Echocardiography. 42(1) (no pagination), 2025. Article Number: e70063.
Date of Publication: 01 Jan 2025.
Author
Angotti D.; Di Pietro G.; Cimino S.; Monosilio S.; Netti L.; Ciuffreda A.;
Improta R.; Tocci M.; Severino P.; Bruno E.; Colantonio R.; Vizza C.D.;
Agati L.; Maestrini V.
Institution
(Angotti, Di Pietro, Cimino, Monosilio, Netti, Ciuffreda, Improta, Tocci,
Severino, Bruno, Colantonio, Vizza, Agati, Maestrini) Department of
Clinical, Anesthesiological and Cardiovascular Sciences, Sapienza
University of Rome, Rome, Italy
Publisher
John Wiley and Sons Inc
Abstract
Transcatheter aortic valve implantation (TAVI) is the main treatment
option for patients with severe aortic stenosis (AS) and older age.
Improved imaging techniques have enabled better patient selection, and the
main role is played by echocardiography. Methods more sensitive than LVEF
in assessing cardiac function, such as global longitudinal strain (GLS)
and myocardial work (MW), have become widespread, and other methods, like
hemodynamic forces (HDFs), might be promising. The aim of this paper is to
systematically review the parameters of GLS, MW, and HDF as predictors of
reverse remodeling and their association with outcomes in patients with AS
undergoing TAVI. In particular, the focus will be on the examination of
the influence of TAVI on left atrial and ventricular function and right
ventricular function. Copyright © 2025 Wiley Periodicals LLC.

<18>
Accession Number
2036263454
Title
Meta-Analysis of Dedicated vs Off-Label Transcatheter Devices for Native
Aortic Regurgitation.
Source
JACC: Cardiovascular Interventions. 18(1) (pp 44-57), 2025. Date of
Publication: 13 Jan 2025.
Author
Samimi S.; Hatab T.; Kharsa C.; Khan S.U.; Bou Chaaya R.G.; Qamar F.; Aoun
J.; Zaid S.; Faza N.; Atkins M.D.; Little S.H.; Zoghbi W.A.; Reardon M.J.;
Kleiman N.S.; Goel S.S.
Institution
(Samimi, Hatab, Kharsa, Khan, Bou Chaaya, Aoun, Faza, Atkins, Little,
Zoghbi, Kleiman, Goel) Houston Methodist DeBakey Heart and Vascular
Center, Houston, TX, United States
(Qamar, Reardon) Department of Cardiovascular Surgery, Houston Methodist
Hospital, Houston, TX, United States
(Zaid) Section of Cardiology, Baylor College of Medicine, Michael E
DeBakey Veterans Affairs Medical Center, Houston, TX, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) for high
surgical risk patients with severe native aortic regurgitation (AR)
presents unique challenges. Dedicated devices such as the JenaValve
(JenaValve Technology) and J-Valve (JC Medical Inc) show promising results
in addressing these challenges. Objective(s): This study compares the
safety and efficacy of dedicated vs off-label devices among high surgical
risk patients with pure native AR. Method(s): We systematically
searched PubMed, EMBASE, and Cochrane Central Register of Controlled
Trials through July 11, 2024, for studies on TAVR among patients with pure
severe native AR. The primary endpoint was 30-day all-cause mortality.
Secondary endpoints were device success, residual AR >= moderate, valve
embolization/migration, pacemaker implantation, reintervention, and
all-cause mortality at 1 year. Summary estimates were constructed using a
random effects model. Result(s): A total of 34 studies encompassing
2,162 patients (mean age 75.4 +/- 0.2 years, 42.8% women) were included in
the meta-analysis. Patients undergoing TAVR with dedicated devices had a
lower all-cause 30-day mortality rate (3% vs 9%; P < 0.01) and higher
device success (93% vs 82%; P < 0.01) compared with off-label devices. The
risk of AR >= moderate (2% vs 5%; P = 0.03), valve embolization/migration
(2% vs 8%; P < 0.01), pacemaker implantation (11% vs 20%; P < 0.01), and
reintervention (4% vs 10%; P < 0.01) at 30 days and all-cause mortality at
1 year (6% vs 24%; P < 0.01) were lower in the dedicated device group.
 Conclusion(s): Dedicated TAVR devices for native AR show superior
device success and reduced mortality, residual AR, and reintervention
rates compared with off-label devices. These findings support the use of
dedicated devices as a safer alternative for high-risk
patients. Copyright © 2025

<19>
Accession Number
2035968342
Title
Comparison of different monitors for measurement of nociception during
general anaesthesia: a network meta-analysis of randomised controlled
trials.
Source
British Journal of Anaesthesia. 134(1) (pp 180-191), 2025. Date of
Publication: 01 Jan 2025.
Author
Snoek M.A.J.; van den Berg V.J.; Dahan A.; Boon M.
Institution
(Snoek, van den Berg, Dahan, Boon) Department of Anesthesiology, Leiden
University Medical Center, Leiden, Netherlands
Publisher
Elsevier Ltd
Abstract
Background: To avoid underdosing or overdosing of analgesic medications, a
variety of nociception monitors that use distinct techniques have been
developed to quantify nociception during general anaesthesia. Although
prior meta-analyses have examined the behaviour of nociception monitors vs
standard care protocols, they did not include the potentially valuable
data for monitor-to-monitor comparisons. In order to capture these data
fully and compare the behaviour of these monitors, we conducted a
systematic search and network meta-analysis. Method(s): We performed
a Bayesian network meta-analysis on data obtained from a systematic search
within PubMed, Embase, Web of Science, Cochrane Library, and EmCare
databases. The search was aimed to detect relevant RCTs on the use of
nociception monitoring versus standard care or versus other nociception
devices(s) during general anaesthesia in adult patients. The primary
endpoint was intraoperative opioid consumption, for which we calculated
the standardised mean difference (SMD) of morphine equivalents (MEs).
Secondary endpoints included postoperative opioid consumption and nausea
or vomiting, extubation time, postoperative pain score, and time to
discharge readiness. The risk of bias was assessed using the revised
Cochrane Risk of Bias tool for randomised trials (RoB 2.0).
 Result(s): Thirty-eight RCTs, including 3412 patients and studying
five different types of nociception monitors, were included in the
analyses: Nociception Level Monitor (NOL), Analgesia Nociception Index
(ANI), Surgical Plethysmographic Index (SPI), Pupillometry (pupillary pain
index [PPI] or pupil dilation reflex [PDR]), and the beat-by-beat
cardiovascular depth of anaesthesia index (CARDEAN). Pupillometry showed a
significant reduction in intraoperative opioid consumption compared with
standard care (SMD -2.44 ME; 95% credible interval [CrI] -4.35 to -0.52),
and compared with SPI (SMD -2.99 ME; 95% CrI -5.15 to -0.81). With respect
to monitors other than pupillometry, no significant differences in opioid
consumption were detected in comparison with standard care or other
monitors. Pupillometry was associated with a longer time to discharge
readiness from the PACU, whereas NOL was associated with shorter
extubation times. No relevant differences in other secondary outcomes were
found. Conclusion(s): Apart from pupillometry, no monitors
demonstrated a significant effect on intraoperative opioid consumption.
Secondary outcomes indicate limited clinical benefit for patients when
using these monitors. Copyright © 2024 The Authors

<20>
Accession Number
2035549873
Title
Effect of exercise prehabilitation on quality of recovery after cardiac
surgery: a single-centre randomised controlled trial.
Source
British Journal of Anaesthesia. 134(1) (pp 45-53), 2025. Date of
Publication: 01 Jan 2025.
Author
Yau D.K.W.; Ng F.F.; Wong M.-K.H.; Underwood M.J.; Wong R.H.L.; Joynt
G.M.; Lee A.
Institution
(Yau, Ng, Joynt, Lee) Department of Anaesthesia and Intensive Care,
Chinese University of Hong Kong, Hong Kong SAR, China
(Wong) Department of Anaesthesia and Intensive Care, Prince of Wales
Hospital, SAR, Hong Kong, China
(Underwood) Cardiovascular Services, Auckland City Hospital, Auckland, New
Zealand
(Wong) Division of Cardiothoracic Surgery, Department of Surgery, Chinese
University of Hong Kong, Hong Kong SAR, China
Publisher
Elsevier Ltd
Abstract
Background: Physical prehabilitation can enhance patient resilience to
surgical stress, but its effects are unclear in vulnerable and frail
patients. We aimed to determine the effect of a structured exercise
prehabilitation programme on the quality of recovery after cardiac surgery
in vulnerable and frail participants. Method(s): This single-blinded,
parallel-arm, superiority, randomised controlled trial recruited patients
with a Clinical Frailty Scale of 4-6 undergoing cardiac surgery. Patients
were randomised to either physical prehabilitation (twice weekly) or
standard care (control); both arms received standard perioperative care.
The primary outcome was Quality of Recovery-15 (QoR-15) score on the third
day after surgery. Secondary outcomes included major adverse cardiac and
cerebrovascular events (MACCE), days alive and at home (DAH<inf>30</inf>),
and the World Health Organization Disability Assessment Schedule (WHODAS)
2.0 metric. Result(s): Of 164 randomised patients, 138 were included
in the primary analysis (median age 64 [interquartile range 60-69] yr; 70%
males). Compliance with the 5-week prehabilitation programme was high
(82%), with no adverse exercise-induced events reported. There were no
between-group differences in QoR-15 scores (median difference -3, 95%
confidence interval [CI] -9 to 3), early and late MACCE, and
DAH<inf>30</inf> (P=0.779). Prehabilitated patients had lower disability
levels than control patients (P=0.022) at 90 days after surgery (mean
difference -9%, 95% CI -17% to -2%). Conclusion(s): A 5-week
programme of physical prehabilitation in predominately prefrail patients
was safe, but it did not enhance quality of recovery scores after surgery.
Prehabilitation resulted in a clinically meaningful decrease in disability
scores at 90 days after surgery. Clinical trial registration:
ChiCTR1800016098. Copyright © 2024 British Journal of Anaesthesia

<21>
Accession Number
2032853950
Title
Paracetamol did not improve the analgesic efficacy with regional block
after video assisted thoracoscopic surgery: a randomized controlled trial.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 11. Date
of Publication: 01 Dec 2025.
Author
Kim S.; Song S.W.; Lee H.; Byun C.S.; Park J.-H.
Institution
(Kim, Song, Lee, Park) Department of Anesthesiology and Pain Medicine,
Wonju College of Medicine, Yonsei University, Wonju, South Korea
(Byun) Department of Thoracic and Cardiovascular Surgery, Wonju College of
Medicine, Yonsei University, Wonju, South Korea
Publisher
BioMed Central Ltd
Abstract
Background: Various analgesic techniques have been applied, the pain after
video assisted thoracic surgery (VATS) is still challenging for
anesthesiologists. Paracetamol provide analgesic efficacy in many
surgeries. However, clinical evidence in the lung surgery with regional
block remain limited. This monocentric double-blind randomized controlled
trial investigates the efficacy of paracetamol after VATS with regional
block. Method(s): A total of 90 patients were randomized to receive
paracetamol (1 g) or normal saline. Erector Spinae Plane Block and
Intercostal Nerve block were applied during the surgery. The Visual
Analogue Scales (VAS) pain score was measured in the PACU as well as 6,
12, 24, and 48 h postoperatively. And the total dose of rescue analgesics
administered to patients in morphine milligram equivalents (MME),
satisfaction score, length of hospital stays, and incidence of nausea and
vomiting were also recorded. Result(s): The VAS pain score at each
time point, the primary endpoint, did not differ between the groups (3.09
+/- 2.14 vs. 2.53 +/- 1.67, p = 0.174 at PACU; 4.56 +/- 2.80 vs. 4.06 +/-
2.46, p = 0.368 at 6 h; 3.07 +/- 1.98 vs. 3.44 +/- 2.48, p = 0.427 at 12
h; 2.10 +/- 2.00 vs. 2.49 +/- 2.07, p = 0.368 at 24 h; and 1.93 +/- 1.76
vs. 2.39 +/- 1.97, p = 0.251 at 48 h postoperatively). Satisfaction scores
(4.37 +/- 0.76 vs. 4.14 +/- 0.88, p = 0.201), nausea (35.6% vs. 37.8%, p =
0.827), hypotension (2.2% vs. 0.0%, p = 0.317), and bradycardia (6.7% vs.
2.2%, p = 0.309) were also reported at similar rates. Conclusion(s):
The analgesic efficacy of one gram of paracetamol with ESPB and ICNB after
VATS was not proven. Thus, caution should be exercised when prescribing
paracetamol for pain control during VATS. Trial registration: this trial
was registered on Clinical Research Information Service (CRIS), Republic
of Korea (KCT0008710). Registration date: 17/08/2023. Copyright ©
The Author(s) 2025.

<22>
Accession Number
2036919639
Title
An automated method of streamlining waiting list by clinical risk
fast-tracking for patients awaiting TAVR: SWIFT TAVR algorithm.
Source
International Journal of Cardiology. 422 (no pagination), 2025. Article
Number: 132952. Date of Publication: 01 Mar 2025.
Author
Khan S.; Demir O.; Mehmood M.; Nabi I.; Kharoud D.; Crawford I.; Smith S.;
Fawaz S.; Sajjad U.; Xue Q.; Singh A.; Karamasis G.V.; Keeble T.; Davies
J.; Kabir A.; Aggarwal R.; Jagathesan R.; Cook C.
Institution
(Khan, Demir, Crawford, Smith, Fawaz, Sajjad, Xue, Singh, Karamasis,
Keeble, Davies, Kabir, Aggarwal, Jagathesan, Cook) Essex Cardiothoracic
Centre, Basildon, Essex, United Kingdom
(Khan, Demir, Mehmood, Nabi, Fawaz, Sajjad, Keeble, Cook) Anglia Ruskin
School of Medicine & MTRC, Anglia Ruskin University, Chelmsford, Essex,
United Kingdom
(Kharoud) Kings College London, Strand, London, United Kingdom
(Karamasis) Attikon University Hospital, National and Kapodistrian
University of Athens, School of Medicine, Athens, Greece
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) is
increasingly in demand for treating severe aortic stenosis in a variety of
surgical risk profiles. This means increasing wait times and elevated
morbidity and mortality on the waitlist. To address this, we developed the
SWIFT TAVR algorithm to prioritize patients based on clinical risk and
reduce wait times. Method(s): The SWIFT algorithm, implemented in
Microsoft Excel, calculates a clinical risk score from three parameters:
left ventricular ejection fraction (LVEF), peak aortic valve gradient, and
syncope. Scores categorize patients into four prioritisation profiles:
high (9-10 points), intermediate (4-8 points), low (2-3 points), and
minimal (0-1 point). The study prospectively applied the SWIFT algorithm
to patients in 2022 (SWIFT group) and retrospectively to a 2021 cohort
(CONTROL group). Outcomes measured were wait times from consultation to
procedure and major adverse cardiac events (MACE) while awaiting TAVR.
 Result(s): A total of 228 patients were included (117 SWIFT, 111
CONTROL). There was no significant difference in baseline characteristics
between groups (p > 0.05). Overall wait times were significantly shorter
in the SWIFT group (21 vs 28 weeks, p < 0.001), particularly for high-risk
patients (12 vs 31 weeks, p < 0.001). MACE rates were similar (9 % vs 10
%, p = 0.722). Discussion(s): The SWIFT algorithm significantly
reduced wait times, particularly for high-risk patients, without
increasing MACE rates. This automated, risk-based prioritisation tool
improves equity and efficiency in TAVR waitlist management and is globally
applicable. Further randomized studies are warranted to validate these
findings. Copyright © 2025 The Authors

<23>
Accession Number
2036756358
Title
Transcatheter versus surgical aortic valve replacement in patients with
aortic stenosis with a small aortic annulus: A meta-analysis with
reconstructed time to event data.
Source
IJC Heart and Vasculature. 56 (no pagination), 2025. Article Number:
101578. Date of Publication: 01 Feb 2025.
Author
Awad A.K.; Otmani Z.; Aly Yassin M.N.; Amin A.M.; Alahmed F.B.; Belabaci
Z.; Hegazy H.A.; Ahmad U.; Abuelazm M.
Institution
(Awad, Hegazy) Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Otmani) Faculty of Medicine, Mouloud Mammeri University, Tizi Ouzou,
Algeria
(Aly Yassin) Faculty of Medicine, Cairo University, Cairo, Egypt
(Amin) Faculty of Medicine, Mansoura University, Mansoura, Egypt
(Alahmed) Faculty of Medicine, Alexandria University, Egypt
(Belabaci) Faculty of Medicine, Djillali Liabes University, Sidi Bel
Abbes, Algeria
(Ahmad) Punjab Medical College, Faisalabad, Pakistan
(Abuelazm) Faculty of Medicine, Tanta University, Tanta, Egypt
Publisher
Elsevier Ireland Ltd
Abstract
Background: Aortic stenosis (AS) remains a prevalent and serious global
health concern, exacerbated by an aging population worldwide. This
valvular disease, when symptomatic and without appropriate intervention,
severe AS can drastically reduce life expectancy. In our systematic review
and meta-analysis, we aim to synthesize available evidence to guide
clinical decision-making by comparing the performance of TAVR and SAVR,
specifically in patients with severe AS and a small aortic annulus.
 Method(s): We searched PubMed, EMBASE, Cochrane, Web of Science, and
Scopus from inception till May 2024. The risk ratio (RR) and mean
difference (MD) with a 95 % confidence interval (CI) are provided as
effect size estimates, with all analyses being conducted using RevMan 5.4.
 Result(s): Eleven studies with 3,670 patients were included. TAVR
significantly increased the risk of 2-year new permanent pacemaker
implantation (PPI) (RR = 2.42; 95 % CI: [1.70-3.44], P < 0.0001) and major
vascular complications (RR = 3.73; 95 % CI: [1.98-6.99], P < 0.0001) than
SAVR. However, TAVR significantly decreased the risk of patient-prosthesis
mismatch (PPM) (RR = 0.56; 95 % CI: [0.48-0.65], P < 0.00001) and
new-onset atrial fibrillation (AF) (RR = 0.31; 95 % CI: [0.23-0.41], P <
0.00001). Also, SAVR reduced the risk of paravalvular leak (PVL) (RR =
3.35; 95 % CI: [1.79-6.27], P = 0.0002). Conclusion(s): TAVR had a
significantly reduced risk of PPM and new-onset AF but with increased PPI
and vascular complications. Also, TAVR significantly improved EOA and
iEOA. Furthermore, SAVR had less risk of PVL, and better LVEF improvement
at predischarge. Therefore, TAVR and SAVR remain valid alternatives, and
decisions should be based on anatomy of the annulus and aortic
root,operative risk, and comorbidities. Copyright © 2024

<24>
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.

<25>
Accession Number
2035038244
Title
Dual ProGlide vs ProGlide and Angio-Seal for Femoral Access Hemostasis
After Transcatheter Aortic Valve Replacement: A Randomised Comparative
Trial.
Source
Canadian Journal of Cardiology. 41(1) (pp 12-20), 2025. Date of
Publication: 01 Jan 2025.
Author
Yeh C.-F.; Kao H.-L.; Ko T.-Y.; Chen C.-K.; Tsai C.-H.; Huang C.-C.; Chen
Y.-H.; Chan C.-Y.; Lin M.-S.
Institution
(Yeh, Kao, Ko, Chen, Tsai, Huang, Chen, Lin) Division of Cardiology,
Department of Internal Medicine and Cardiovascular Centre, National Taiwan
University Hospital, Taipei, Taiwan (Republic of China)
(Ko, Chen) Graduate Institute of Clinical Medicine, Medical College,
National Taiwan University, Taipei, Taiwan (Republic of China)
(Chen) Department of Internal Medicine, National Taiwan University
Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (Republic of China)
(Chan) Division of Cardiovascular Surgery, Department of Surgery and
Cardiovascular Centre, National Taiwan University Hospital, Taipei, Taiwan
(Republic of China)
Publisher
Elsevier Inc.
Abstract
Background: Vascular complications increase morbidity and mortality after
transcatheter aortic valve replacements (TAVR), often related to failures
in vascular closure devices (VCDs). We intended to compare the dual
Perclose ProGlide (PP) strategy and the hybrid combination of PP and
Angio-Seal (AS) for femoral access hemostasis after TAVR. Method(s):
A randomised controlled trial with 257 patients comparing dual PP with 1
PP and 1 AS (AS+PP) for vascular closure after transfemoral TAVR was
conducted. The primary end point was the composite of TAVR access
site-related vascular complications and life-threatening type 2/3 or 1
bleeding according to the Valve Academic Research Consortium 3. Secondary
end points included additional VCD use and significant peripheral ischemia
related to arteriotomy closure within 1 year. Modified VCD failure,
defined as failure to achieve hemostasis within 5 minutes or requiring
additional endovascular manoeuvres, was also recorded. Result(s): The
AS+PP combination yielded lower rates of the primary end point (18.2% vs
29.8%; P = 0.0381), vascular complication (18.2% vs 29.8%; P = 0.0381),
additional VCD use (0.8% vs 19.0%; P < 0.0001), and modified VCD failure
(9.9% vs 33.1%; P < 0.0001) than the dual PP. Bleeding complication rates
were similar between the 2 groups. Three-month follow-up vascular duplex
tests showed similar common femoral artery (CFA) diameters and peak
systolic velocities (PSVs) between the 2 groups, but those with additional
intervention had higher PSVs and smaller CFA diameters than those without.
 Conclusion(s): Combined PP+AS for large-bore femoral access
hemostasis after TAVR promises to be more effective and safer than dual PP
in terms of vascular complications. Moreover, additional intervention for
vascular complications resulted in smaller CFA diameters. Clinical Trial
Registration: NCT05491070 Copyright © 2024 Canadian
Cardiovascular Society

<26>
Accession Number
2034468344
Title
Association of Amiodarone Use Prior to Orthotopic Heart Transplant with
Post-Transplant Graft Dysfunction and All-Cause Mortality: A Systematic
Review and Meta-Analysis.
Source
Journal of Cardiac Failure. 31(1) (pp 149-153), 2025. Date of Publication:
01 Jan 2025.
Author
Ko E.; Ahmed M.; Nudy M.; Bussa R.; Bussa J.; Gonzalez M.; Naccarelli G.;
Soleimani B.; Maheshwari A.
Institution
(Ko, Bussa) Penn State Hershey Medical Center, Department of Internal
Medicine, Hershey, Pennsylvania, United States
(Ahmed, Nudy, Gonzalez, Naccarelli, Soleimani, Maheshwari) Penn State
Hershey Medical Center, Heart and Vascular Institute, Division of
Cardiology, Hershey, Pennsylvania, United States
(Nudy) Penn State Hershey Medical Center, Department of Public Health
Sciences, Hershey, Pennsylvania, United States
(Bussa) University of Massachusetts Amherst, Department of Biochemistry
and Molecular Biology, Amherst, Massachusetts, United States
Publisher
Elsevier B.V.
Abstract
Background: There is conflicting data on the association between
pre-orthotopic heart transplant (OHT) amiodarone use and post-OHT graft
dysfunction (GD) leading to heterogeneity in clinical practice.
 Method(s): We performed a meta-analysis to evaluate whether pre-OHT
amiodarone use was associated with meaningful increases in the incidence
of GD, 30-day mortality, and 1-year mortality. Studies were identified by
searching PubMed and the Cochrane Register of Clinical Trials. The
Mantel-Haenszel method was used to calculate odds ratios (OR) and 95%
confidence intervals (CI<inf>95</inf>) for each endpoint. Result(s):
17 retrospective studies were identified that included 48,782 patients. 14
studies (n = 48,018) reported GD as an outcome. Pre-OHT amiodarone use was
associated with increased odds of GD (OR 1.3, CI<inf>95</inf> 1.2-1.5, p <
0.001). 10 studies (n = 45,875) reported 30-day mortality based on
amiodarone use. Pre-OHT amiodarone use was associated with increased odds
of 30-day mortality (OR 1.4, CI<inf>95</inf> 1.2-1.5, p < 0.001). 5
studies (n = 41,404) reported 1-year mortality based on amiodarone use.
Pre-OHT amiodarone use was associated with increased odds of 1-year
mortality (OR 1.2, CI<inf>95</inf> 1.1-1.4, p < 0.001). The increase in
absolute risk of GD, 30-day mortality, and 1-year mortality for patients
with pre-OHT amiodarone use was 1.3%, 1.2%, and 1.4%, respectively.
 Conclusion(s): Pre-OHT amiodarone exposure was associated with
increased odds of GD, 30-day mortality, and 1-year mortality. The increase
in absolute risk for each endpoint was modest, and it is unclear to what
extent, if any, pre-OHT amiodarone use should influence assessment of OHT
candidacy. Copyright © 2024

<27>
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

<28>
Accession Number
2036882113
Title
Effects of preoperative beta-hydroxy-beta-methylbutyrate, arginine, and
glutamine supplementation on cardiac surgery: A randomized controlled
trial.
Source
Clinical Nutrition. 45 (pp 91-100), 2025. Date of Publication: 01 Feb
2025.
Author
Ogawa M.; Satomi-Kobayashi S.; Yoshida N.; Komaki K.; Hirabayashi T.;
Wakida K.; Saitoh S.; Inoue T.; Yamashita T.; Sakai Y.; Takahashi M.;
Okada K.; Hirata K.-I.
Institution
(Ogawa, Sakai) Division of Rehabilitation Medicine, Kobe University
Graduate School of Medicine, Hyogo, Japan
(Ogawa) Department of Rehabilitation Science, Osaka Health Science
University, Osaka, Japan
(Ogawa) Department of Public Health, Kobe University Graduate School of
Health Sciences, Hyogo, Japan
(Satomi-Kobayashi, Yoshida, Hirata) Division of Cardiovascular Medicine,
Department of Internal Medicine, Kobe University Graduate School of
Medicine, Hyogo, Japan
(Yoshida) Department of Cardiovascular Aging, National Cerebral and
Cardiovascular Center, Osaka, Japan
(Komaki, Hirabayashi) Division of Rehabilitation Medicine, Kobe University
Hospital, Hyogo, Japan
(Wakida, Saitoh, Takahashi) Department of Nutrition, Kobe University
Hospital, Hyogo, Japan
(Inoue) Department of Cardiac Surgery, Hyogo Prefectural Awaji Medical
Center, Hyogo, Japan
(Yamashita) Department of Advanced Medical Science, Kobe University
Graduate School of Science, Technology and Innovation, Hyogo, Japan
(Okada) Division of Cardiovascular Surgery, Department of Surgery, Kobe
University Graduate School of Medicine, Hyogo, Japan
Publisher
Churchill Livingstone
Abstract
Background & aims: In older patients undergoing cardiac surgery, physical
function is a critical determinant of postoperative outcomes.
Beta-hydroxy-beta-methylbutyrate (HMB) supplementation has been shown to
promote muscle protein anabolism and inhibit catabolism, thereby
preventing muscle weakness. However, its efficacy in older patients
undergoing cardiac surgery remains unknown. This study aimed to examine
the effects of preoperative HMB supplementation on postoperative physical
function and complications in this population. Method(s): In this
single-center, open-label, randomized controlled trial, patients aged >=65
years scheduled for cardiac surgery were randomized to receive HMB
supplementation or no nutritional intervention. The HMB group received HMB
1200 mg, L-glutamine 7000 mg, and L-arginine 7000 mg, once or twice daily,
for at least 2 weeks before surgery. Evaluations were performed at
baseline and before and after surgery. The primary outcome was the 6-min
walking distance (6MWD) before and after surgery. Secondary outcomes
included the incidence of complications, muscle mass and strength,
physical performance, and length of hospital stay. Result(s):
Forty-four patients with a mean age of 72.5 years (women, 38 %) were
randomized to the HMB (n = 22) or control (n = 22) group. Compared with
the control group, the HMB group demonstrated a statistically significant
improvement in the 6MWD both at the pre-surgery (448.0 +/- 73.5 m vs.
375.5 +/- 58.8 m; P = 0.01) and post-surgery time points (428.9 +/- 76.4 m
vs. 304.5 +/- 52.3 m; P = 0.001). Muscle strength and physical performance
also showed significant improvements in the HMB group. However, no
significant difference in muscle mass was observed between the groups at
any time point. The HMB group had a shorter hospital length of stay
compared with that of the control group (16.1 +/- 3.8 days vs. 20.4 +/-
7.6 days, P = 0.03), and no adverse events were observed with the
intervention. Conclusion(s): Preoperative HMB supplementation in
older adults undergoing cardiac surgery resulted in significant
improvements in postoperative exercise capacity and physical function,
along with a reduction in the length of hospital stay, without affecting
muscle mass. Registration number of Clinical Trial: UMIN000030490
(UMINhttps://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R00
0034773). Copyright © 2025 The Authors

<29>
Accession Number
2036721358
Title
STRIVE pilot trial: A protocol for a multicentre pragmatic internal pilot
randomised controlled trial of Structured TRaining to Improve fitness in a
Virtual Environment (STRIVE) before surgery.
Source
BMJ Open. 14(11) (no pagination), 2024. Article Number: e093710. Date of
Publication: 07 Nov 2024.
Author
McIsaac D.I.; Tandon P.; Kidd G.; Branje K.; Hladkowicz E.; Hallet J.;
Wijeysundera D.N.; Lee S.; McNeely M.L.; Taljaard M.; Gillis C.; Auer R.;
Chesney T.; Gagne S.; Lalu M.M.; Moloo H.; Thavorn K.; Boland L.; Eskander
A.; Lavallee L.T.; Roberts D.; Van Walraven C.; Breau R.; Fergusson D.;
Martel G.; Scheede-Bergdahl C.; Vogt K.; Bryson G.; Forster A.; Khadaroo
R.; McCartney C.; Serrano P.; Zwarenstein M.; Abdulla K.; Boet S.; Jackson
T.; Joanisse J.; Love C.; Meliambro A.; Nagpal S.; Trottier D.; Yang I.;
Le T.; Sinasac S.; Williams L.; Raiche I.; Vigil H.R.; Farnand M.; Hutton
J.; Barnes K.; Gaudreault J.; Tahasildar B.L.R.; Wang W.; Mansour J.;
Beattie W.S.; Denault A.; Hall R.; Mazer C.D.; McCluskey S.; Sparrow K.;
Spence J.; Turgeon A.; Abdallah F.; Alkadri J.; Al-Nahdi S.; Au S.; Aucoin
S.; Avramescu S.; Baghirzada L.; Bagry H.; Bailey J.; Bainbridge D.; Bak
A.; Baldinii G.; Bamvita J.-M.; Banfield J.; Bartoszko J.; Bautista M.;
Beaubien J.; Beaubien-Souligny W.; Beaudet N.; Beaulieu P.; Belley-Cote
E.; Bertolizio G.; Bousquet-Dion G.; Boyle D.; Brenna C.; Brudney S.;
Buckley N.; Burke N.; Bussieres J.; Cameron M.; Camire D.; Carrier F.M.;
Chagnon F.; Charan N.; Chau A.; Cheng M.; Chiniara G.; Chisholm J.; Chiu
M.; Choi S.; Christodoulou C.; Chui J.; Chung F.; Clarke H.; Couture E.;
Cuthbertson B.; D'Aragon F.; De Jager P.; Deck M.; Decker A.; Deschamps
A.; Dillane D.; Djaiani G.; Dobson G.; Drolet P.; Dubois D.; Duclos C.;
Duggan L.; Dumbarton T.; Shore D.D.; Duttchen K.; Earle D.; Edwards N.;
Flexman A.; Fuller J.; Gagne M.-P.; Gibson N.; Gil A.-F.; Gilron I.;
Girard M.; Glezerson B.; Goldenberg N.; Gondal T.; Gorges M.; Gottesman
D.; Green J.; Gregory A.; Grocott H.; Grunfeld A.; Hare G.; Harrison T.;
Hedlin P.; Hemmerling T.; Heroux J.; Hung O.; Jacka M.; Jerath A.; Jivraj
N.; Karkouti K.; Kaustov L.; Ke J.; Kennedy B.; Kerr B.; Kim J.; Klemmer
M.; Kowalski S.; Ladha K.; Lam W.; Lapierre D.; Law M.; Lebon J.-S.;
Lecluyse V.; Lefebvre A.; Lehmann C.; Leitch J.; Lellouche F.; Li E.; Liu
A.; Mahes N.; McDonald H.; McKay W.; McKeen D.; McMullen S.; McVicar J.;
Milne A.; Missirlis P.; Mizubuti G.; Moliner P.; Monfort C.; Montbriand
J.; Mozel M.; Muneer M.; Munro A.; Mutter T.; Nalla B.; Nates W.;
Neilpovitz D.; Neufeld A.; Nickel C.; O'Brien J.; Orser B.; Ostiguy A.;
Overbeek C.; Gelinas J.P.; Parlow J.; Paul J.; Pierce H.; Plourde G.;
Prabhakar C.; Pridham J.; Raazi M.; Sondekoppam R.; Arellano R.; Ramsay
T.; Rashiq S.; Jayas R.; Taneja R.; Grey R.; Martin R.; El-Gabalawy R.;
Rice T.; Merchant R.N.; Roach D.; Preston R.; DiDonato R.; Ree R.; George
R.; Chun R.; Rosen D.; Hatzakorzian R.; Roy J.-D.; Royer O.; Noppens R.;
Russell S.; Graham R.; McGinn R.; Ramos R.; Saha T.; Sampson S.; Sawchuk
C.; Schmidt M.; Schricker T.; Schwarz S.; Sedighi S.M.; Sehmbi H.; Sellers
D.; Shanthanna H.; Siddiqui F.; Siddiqui N.; Sidhu S.; Singh I.; Sobotie
S.; Soussi S.; Brar S.S.; Sun L.; Sun T.; Suresh V.; Sweet V.; Szabo L.;
Tan E.; Tarshis J.; Thorleifson M.; Todd A.; Tran D.; Tran V.; Trivedi V.;
Uppal V.; Verret M.; Neira V.; Wang D.; Wang G.; Wang L.; Warden G.;
Wasowicz M.; Wong J.; Wong K.; Wourms V.; Wright S.; Yang H.; Yang S.;
Yarnold C.; Yee D.
Institution
(McIsaac) Ottawa Hospital Research Institute Clinical Epidemiology
Programme, Ottawa, ON, Canada
(Tandon) Department of Medicine, University of Alberta, Edmonton, AB,
Canada
(Kidd) The Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Branje) Department of Anaesthesiology and Pain Medicine, University of
Ottawa, Ottawa, ON, Canada
(Branje) The Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Hladkowicz) Departments of Anaesthesiology and Pain Medicine, The Ottawa
Hospital, Ottawa, ON, Canada
(Hallet) Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(Wijeysundera) Department of Anaesthesia, St Michael's Hospital, Toronto,
ON, Canada
(Lee) Department of Anesthesiology, Pharmacology, and Therapeutics, UBC
Faculty of Medicine, Vancouver, BC, Canada
(McNeely) University of Alberta, Edmonton, AB, Canada
(McNeely) Cancer Care Alberta, Edmonton, AB, Canada
(Taljaard) Clinical Epidemiology Programme, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Gillis) School of Human Nutrition, McGill University, Montreal, QC,
Canada
Publisher
BMJ Publishing Group
Abstract
Introduction Home-based, virtually-supported care models may represent the
most efficient and scalable approach to delivering prehabilitation
services. However, virtual approaches to prehabilitation are understudied.
This manuscript describes the protocol for an internal pilot randomised
controlled trial of a virtually-delivered, multimodal prehabilitation
intervention. Methods and analysis We will conduct a pragmatic, individual
patient, internal pilot randomised controlled trial of home-based,
virtually supported, multimodal prehabilitation compared with standard
perioperative care in adults undergoing elective, inpatient thoracic,
abdominal, pelvic and vascular surgery at five Canadian hospitals.
Participants will be partially blinded; clinicians and outcome assessors
will be fully blinded. The intervention consists of 3-12 weeks of a
home-based, multimodal (exercise, nutrition and psychosocial support)
prehabilitation programme supported through an online platform. The
primary feasibility outcomes and their progression targets are (1) monthly
recruitment of>6 participants at each centre, (2) intervention adherence
of>75%, (3) retention of>90% of participants at the patient-reported
primary outcome point of 30-days after surgery and (4) elicitation of
patient, clinician and researcher-identified barriers to our pragmatic
trial. A sample size of 144 participants will be adequate to estimate
recruitment, adherence and retention rates with acceptable precision. All
participants will be followed to either death or up to 1 year. As an
internal pilot, if no substantive changes to the trial or intervention
design are required, pilot participant outcome data will migrate,
unanalysed by allocation, to the future full-scale trial. Ethics and
dissemination Ethical approval has been granted by Clinical Trials Ontario
(Project ID: 4479) and our ethics review board (Protocol Approval
#20230399-01T). Results will be disseminated through presentations at
scientific conferences, peer-reviewed publications, partner organisations
and engagement of social and traditional media. Copyright ©
Author(s) (or their employer(s)) 2024.

<30>
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

<31>
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.

<32>
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.

<33>
Accession Number
2032455189
Title
A Mechanistic Analysis of the Neural Modulation of the Inflammatory System
Through Vagus Nerve Stimulation: A Systematic Review and Meta-analysis.
Source
Neuromodulation. 28(1) (pp 43-53), 2025. Date of Publication: 01 Jan 2025.
Author
de Melo P.S.; Gianlorenco A.C.; Marduy A.; Kim C.K.; Choi H.; Song J.-J.;
Fregni F.
Institution
(de Melo) Medicine, Escola Bahiana de Medicina e Saude Publica, Bahia,
Salvador, Brazil
(de Melo, Gianlorenco, Marduy, Fregni) Neuromodulation Center and Center
for Clinical Research Learning, Spaulding Rehabilitation Hospital and
Massachusetts General Hospital, Harvard Medical School, Boston, MA, United
States
(Gianlorenco) Department of Physical Therapy, Federal University of Sao
Carlos, Brazil
(Marduy) Medicine, Uniao Metropolitana de Ensino e Cultura (UNIME), Bahia,
Salvador, Brazil
(Song) Department of Otorhinolaryngology-Head and Neck Surgery, Korea
University Medical Center, Seoul, South Korea
(Kim) Department of Neurology, Korea University Guro Hospital, Seoul,
South Korea
(Choi) Department of Medical Sciences, of Medicine, Korea University,
Seoul, South Korea
(Choi, Song) Neurive Co, Ltd, Gimhae, South Korea
Publisher
International Neuromodulation Society
Abstract
Objective: We aimed to conduct a systematic review and meta-analysis
assessing the antiinflammatory effects of various VNS methods while
exploring multiple antiinflammatory pathways. Material(s) and
Method(s): We included clinical trials that used electrical stimulation of
the vagus nerve and assessed inflammatory markers up to October 2022. We
excluded studies lacking control groups, those with combined
interventions, or abstracts without full text. We adhered to the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses guidelines and
the Cochrane Handbook for Systematic Reviews. For each inflammatory
marker, a random-effects meta-analysis using the inverse variance method
was performed. Methods used include transcutaneous auricular VNS (taVNS),
transcutaneous cervical VNS (tcVNS), invasive cervical VNS (iVNS), and
electroacupuncture VNS (eaVNS). Main reported outcomes included tumor
necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-1s, C-reactive protein
(CRP), and IL-10. Risk of bias was evaluated using the Cochrane
Collaboration Tool (RoB 2.0). Result(s): This review included 15
studies, involving 597 patients. No statistically significant general VNS
effect was observed on TNF-alpha, IL-6, and IL-1s. However, CRP, IL-10,
and interferon (IFN)-gamma were significantly modulated by VNS across all
methods. Subgroup analysis revealed specific stimulation techniques
producing significant results, such as taVNS effects in IL-1s and IL-10,
and iVNS in IL-6, whereas tcVNS and eaVNS did not convey significant
pooled results individually. Cumulative exposure to VNS, higher risk of
bias, study design, and pulse width were identified as effect size
predictors in our meta-regression models. Conclusion(s): Pooling all
VNS techniques indicated the ability of VNS to modulate inflammatory
markers such as CRP, IL-10, and IFN-gamma. Individually, methods such as
taVNS were effective in modulating IL-1s and IL-10, whereas iVNS modulated
IL-6. However, different VNS techniques should be separately analyzed in
larger, homogeneous, and powerful studies to achieve a clearer and more
consistent understanding of the effect of each VNS method on the
inflammatory system. Copyright © 2024 International
Neuromodulation Society

<34>
Accession Number
2036440193
Title
Tricuspid Transcatheter Edge-to-Edge Repair for Severe Tricuspid
Regurgitation: 1-Year Outcomes From the TRILUMINATE Randomized Cohort.
Source
Journal of the American College of Cardiology. 85(3) (pp 235-246), 2025.
Date of Publication: 28 Jan 2025.
Author
Tang G.H.L.; Hahn R.T.; Whisenant B.K.; Hamid N.; Naik H.; Makkar R.R.;
Tadros P.; Price M.J.; Singh G.D.; Fam N.P.; Kar S.; Mehta S.R.; Bae R.;
Sekaran N.K.; Warner T.; Makar M.; Zorn G.; Benza R.; Jorde U.P.; McCarthy
P.M.; Thourani V.H.; Ren Q.; Trusty P.M.; Sorajja P.; Adams D.H.
Institution
(Tang, Benza, Adams) Mount Sinai Health System, New York, NY, United
States
(Hahn) NewYork-Presbyterian Columbia University Medical Center, New York,
NY, United States
(Whisenant, Sekaran) Intermountain Medical Center, Murray, UT, United
States
(Hamid, Bae, Sorajja) Allina Health Minneapolis Heart Institute at Abbott
Northwestern Hospital, Minneapolis, MN, United States
(Naik, Warner) St Joseph's Hospital and Medical Center Phoenix, AZ, United
States
(Makkar, Makar) Cedars-Sinai Medical Center, Los Angeles, CA, United
States
(Tadros, Zorn) Kansas University Medical Center, Kansas City, KS, United
States
(Price) Scripps Clinic, La Jolla, CA, United States
(Singh) University of California-Davis Medical Center, Sacramento, CA,
United States
(Fam) St Micheal's Hospital, Toronto, ON, Canada
(Kar) Los Robles Regional Medical Center, HCA Healthcare, Thousand Oaks,
CA, United States
(Mehta) Hamilton Health Science, Hamilton, ON, Canada
(Jorde) Montefiore Medical Center, Bronx, NY, United States
(McCarthy) Northwestern University, Chicago, IL, United States
(Thourani) Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA,
United States
(Ren, Trusty) Abbott Structural Heart, Santa Clara, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: Tricuspid regurgitation (TR) is a right-sided valvular disease
independently associated with morbidity and mortality. The TRILUMINATE
Pivotal (Clinical Trial to Evaluate Cardiovascular Outcomes In Patients
Treated With the Tricuspid Valve Repair System Pivotal) is the first
randomized controlled trial assessing the impact of TR reduction with
tricuspid transcatheter edge-to-edge repair (T-TEER). Objective(s):
Outcomes from the full randomized cohort of the TRILUMINATE Pivotal trial
have not been previously reported, and the additional enrollment may
further support the safety and effectiveness of T-TEER through 1 year.
 Method(s): The TRILUMINATE Pivotal trial is an international
randomized controlled trial of T-TEER with the TriClip device in patients
with symptomatic, severe TR. Adaptive trial design allowed enrollment past
the primary analysis population. The primary outcome was a hierarchical
composite of all-cause mortality or tricuspid valve surgery, heart failure
hospitalizations (HFHs), and quality-of-life improvement measured by
Kansas City Cardiomyopathy Questionnaire (KCCQ) at 1 year. Result(s):
Between August 21, 2019, and June 29, 2022, 572 subjects were randomized,
including the primary cohort (n = 350) and subsequent enrollment (n =
222). Subjects were older (78.1 +/- 7.8 years) and predominantly female
(58.9%), with atrial fibrillation (87.8%) and prior HFH (23.8%). The
primary endpoint was met for the full cohort (win ratio = 1.84; P <
0.0001). Freedom from all-cause mortality and tricuspid valve surgery
through 12 months was 90.6% and 89.9% for the device and control groups,
respectively (P = 0.82). Annualized HFH rate was comparable between device
and control subjects (0.17 vs 0.20 events/patient-year; P = 0.40). A
significant treatment effect was observed for change in quality of life
with 52.3% of device subjects achieving a >=15-point KCCQ score
improvement (compared with 23.5% of control subjects; P < 0.0001). All
secondary endpoints favored T-TEER: moderate or less TR at 30 days (88.9%
vs 5.3%; P < 0.0001), KCCQ change at 1 year (13.0 +/- 1.4 points vs -0.5
+/- 1.4 points; P < 0.0001), and 6-minute walk distance change at 1 year
(1.7 +/- 7.5 m vs -27.4 +/- 7.4 m; P < 0.0001). Freedom from major adverse
events was 98.9% for T-TEER (vs performance goal: 90%; P < 0.0001).
 Conclusion(s): TriClip was safe and effective in the full randomized
cohort of TRILUMINATE Pivotal with significant TR reduction and
improvements in 6-minute walk distance and health status. Rates of
all-cause mortality or tricuspid valve surgery and HFH through 1 year were
not reduced by T-TEER. Copyright © 2025 The Authors

<35>
Accession Number
2032445662
Title
Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke Following
Cardiac Interventions: A Systematic Review and Meta-Analysis.
Source
CardioVascular and Interventional Radiology. 48(1) (pp 45-58), 2025.
Article Number: 105851. Date of Publication: 01 Jan 2025.
Author
Jazayeri S.B.; Al-Janabi O.M.; Ghozy S.; Rabinstein A.A.; Kadirvel R.;
Kallmes D.F.
Institution
(Jazayeri) Sina Trauma and Surgery Research Center, Sina Hospital, Tehran
University of Medical Sciences, 11365-3876, Building 7, Hassan-Abad
Square, Tehran, Iran, Islamic Republic of
(Jazayeri, Ghozy, Kadirvel, Kallmes) Department of Radiology, Mayo Clinic,
Rochester, MN, United States
(Al-Janabi) Department of Neurology, Baptist Health, Lexington, KY, United
States
(Ghozy) Department of Neurologic Surgery, Mayo Clinic, Rochester, MN,
United States
(Rabinstein) Department of Neurology, Mayo Clinic, Rochester, United
States
Publisher
Springer
Abstract
Purpose: The purpose of this study is to pool the evidence on the safety
and efficacy of mechanical thrombectomy (MT) in patients who develop acute
ischemic stroke (AIS) due to large vessel occlusion (LVO) following recent
cardiac interventions. Method(s): PubMed, Embase and Scopus were
searched from inception up to February 2024 using a combination of
"cardiac interventions" and "mechanical thrombectomy" as keywords. Studies
that evaluated AIS within 30 days of a recent cardiac intervention who
underwent MT were included. The proportion of mortality, favorable
functional outcome (modified Rankin Scale (mRS) 0-2), successful
reperfusion (TICI >= 2b or TIMI >= 2) and symptomatic intracranial
hemorrhage (sICH) were pooled using generalized linear mixed model.
 Result(s): Thirty-one case reports/series and 11 observational
studies including 195 MT procedures were included. The patients' mean age
was 72 years. The most common cardiac intervention associated with AIS was
transcatheter aortic valve replacement/implantation in 96/192 cases (50%).
The median onset of stoke was 0 (IQR 0-3) days after cardiac intervention.
Rate of successful reperfusion was 79.4% [95%confidence interval (CI)
66.7-88.1%], rate of mRS 0-2 after 90 days was 42.7% [95%CI 32.5-53.6%],
and rate of mortality at 90 days was 30.3% [95%CI 21.7-40.6%]. The rate of
sICH was 11.6% [95%CI 5.9-21.5%]. Conclusion(s): MT to treat AIS due
to LVO after cardiac interventions may result in good rates of functional
recovery, though mortality and sICH may be higher. Regular and repeated
neurological examinations should be performed following cardiac
interventions, with special attention to stroke. If stroke is detected, MT
should be considered as a viable option. Copyright © Springer
Science+Business Media, LLC, part of Springer Nature and the
Cardiovascular and Interventional Radiological Society of Europe (CIRSE)
2024.

<36>
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.

<37>
Accession Number
2032837570
Title
Correction: Thoracic and cardiovascular surgeries in Japan during 2020:
Annual report by the Japanese Association for Thoracic Surgery(General
Thoracic and Cardiovascular Surgery, (2024), 72, (61-94),
10.1007/s11748-023-01979-8).
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2025. Date
of Publication: 2025.
Author
Matsumiya G.; Sato Y.; Takeuchi H.; Abe T.; Endo S.; Hirata Y.; Ishida M.;
Iwata H.; Kamei T.; Kawaharada N.; Kawamoto S.; Kohno K.; Kumamaru H.;
Minatoya K.; Motomura N.; Nakahara R.; Okada M.; Saji H.; Saito A.;
Shimizu H.; Suzuki K.; Takemura H.; Taketani T.; Toh Y.; Tatsuishi W.;
Yamamoto H.; Yasuda T.; Watanabe M.; Yoshimura N.; Tsuchida M.; Sawa Y.
Institution
(Matsumiya) Department of Cardiovascular Surgery, Chiba University
Graduate School of Medicine, Chiba, Japan
(Sato) Department of Thoracic Surgery, University of Tsukuba, Tsukuba,
Japan
(Takeuchi) Department of Surgery, Hamamatsu University School of Medicine,
Shizuoka, Japan
(Abe, Tatsuishi) Division of Cardiovascular Surgery, Department of General
Surgical Science, Gunma University, Maebashi, Japan
(Endo) Thoracic Surgery, Jichi Medical University Saitama Medical Center,
Omiya, Japan
(Hirata) Department of Cardiac Surgery, The University of Tokyo Hospital,
Tokyo, Japan
(Ishida) Cardiac Surgery, Handa City Hospita, Aichi, Japan
(Iwata) Department of General Thoracic Surgery, Gifu University Hospital,
Gifu, Japan
(Kamei) Department of Surgery, Graduate School of Medicine, Tohoku
University, Sendai, Japan
(Kawaharada) Department of Cardiovascular Surgery, Sapporo Medical
University School of Medicine, Sapporo, Japan
(Kawamoto) Department of Cardiovascular Surgery, Tohoku Medical and
Pharmaceutical University Hospital, Sendai, Japan
(Kohno) Department of Gastrointestinal Tract Surgery, Fukushima Medical
University, Fukushima, Japan
(Kumamaru, Yamamoto) Department of Healthcare Quality Assessment, Graduate
School of Medicine, The University of Tokyo, Kagoshima, Tokyo, Japan
(Minatoya) Department of Cardiovascular Surgery, Graduate School of
Medicine, Kyoto University, Kyoto, Japan
(Motomura) Department of Cardiovascular Surgery, Toho University Sakura
Medical Center, Chiba, Japan
(Nakahara) Division of Thoracic Surgery, Tochigi Cancer Center, Toshigi,
Japan
(Okada) Surgical Oncology, Hiroshima University, Hiroshima, Japan
(Saji) Department of Chest Surgery, St. Marianna University School of
Medicine, Kawasaki, Japan
(Saito) Department of Surgery, Yokohama City University, Graduate School
of Medicine, Yokohama, Japan
(Shimizu) Department of Cardiovascular Surgery, Keio University, Tokyo,
Japan
(Suzuki) Department of General Thoracic Surgery, Juntendo University
School of Medicine, Tokyo, Japan
(Takemura) Department of Cardiovascular Surgery, Kanazawa University,
Kanazawa, Japan
(Taketani) Department of Cardiovascular Surgery, Mitsui Memorial Hospital,
Tokyo, Japan
(Toh) Department of Gastroenterological Surgery, National Hospital
Organization Kyushu Cancer Center, Fukuoka, Japan
(Yasuda) Department of Surgery, Kindai University Faculty of Medicine,
Osaka, Japan
(Watanabe) Department of Gastroenterological Surgery, Cancer Institute
Hospital, Tokyo, Japan
(Yoshimura) Department of Thoracic and Cardiovascular Surgery, University
of Toyama, Graduate School of Medicine, Toyama, Japan
(Tsuchida) Division of Thoracic and Cardiovascular Surgery, Niigata
University Graduate School of Medical and Dental Sciences, Niigata, Japan
(Sawa) Osaka University, Graduate School of Medicine, Osaka Police
Hospital, Osaka, Japan
Publisher
Springer
Abstract
In the original publication of the article [1], the number of 30-day
hospital mortality and 30-day hospital mortality rate for the Stanford
type A acute aortic dissections in "Table 3 (1) Dissection" were published
incorrectly. The corrected part of the table is given in this Correction.
The corrected number of 30-day hospital mortality was 493, and hospital
mortality rate was 8.0%, respectively. (Table presented.) Thoracic aortic
aneurysm (total; 22,540) (1) Dissection (total; 10,855) Stanford type
Acute Chronic Concomitant operation A B A B Replaced site Cases 30-day
mortality Hospital mortality Cases 30-day mortality Hospital mortality
Cases 30-day mortality Hospital mortality Cases 30-day mortality Hospital
mortality AVP AVR MVP MVR CABG Others Hospital After discharge Hospital
After discharge Hospital After discharge Hospital After discharge
Ascending Ao 2071 146 (7.0) 1 (0.05) 189 (9.1) 1 0 0 0 187 6 (3.2) 0 8
(4.3) 1 0 0 0 61 137 22 8 110 32 Aortic Root 191 35 (18.3) 0 36 (18.8) 0 0
0 0 80 4 (5.0) 0 5 (6.3) 3 0 0 0 32 194 6 2 65 7 Arch 1954 135 (6.9) 1
(0.05) 174 (8.9) 31 0 0 0 355 9 (2.5) 0 13 (3.7) 172 5 (2.9) 0 6 (3.5) 54
113 10 5 118 25 Aortic root + asc. Ao. + Arch 167 23 (13.8) 0 26 (15.6) 0
0 0 0 47 1 (2.1) 0 3 (6.4) 6 0 0 0 23 143 2 0 35 2 Descending Ao 35 4
(11.4) 0 4 (11.4) 28 2 (7.1) 0 2 (7.1) 56 1 (1.8) 0 1 (1.8) 220 9 (4.1) 0
10 (4.5) 2 4 0 0 4 0 Thoracoabdominal 1 1 (100.0) 0 1 (100.0) 11 1 (9.1) 0
1 (9.1) 46 5 (10.9) 0 5 (10.9) 182 11 (6.0) 1 (0.5) 13 (7.1) 0 0 0 0 1 0
Simple TEVAR 101 9 (8.9) 0 11 (10.9) 442 30 (6.8) 0 34 (7.7) 264 2 (0.8) 0
3 (1.1) 1171 7 (0.6) 0 8 (0.7) 1 2 0 0 2 2 Open SG with BR 1213 101 (8.3)
2 (0.16) 133 (11.0) 62 3 (4.8) 0 3 (4.8) 207 8 (3.9) 0 11 (5.3) 237 4
(1.7) 0 7 (3.0) 61 115 10 2 104 16 Open SG without BR 435 32 (7.4) 0 45
(10.3) 28 2 (7.1) 0 3 (10.7) 52 2 (3.8) 0 4 (7.7) 82 3 (3.7) 0 3 (3.7) 20
45 1 0 30 2 Arch TEVAR with BR 14 1 (7.1) 0 1 (7.1) 123 6 (4.9) 0 10 (8.1)
73 2 (2.7) 0 2 (2.7) 364 7 (1.9) 0 8 (2.2) 1 0 0 0 0 0 Thoracoabdominal
TEVAR with BR 0 0 0 0 11 0 0 0 6 0 0 1 (16.7) 33 2 (6.1) 0 4 (12.1) 0 0 0
0 0 0 Other 18 6 (33.3) 0 6 (33.3) 13 3 (23.1) 0 3 (23.1) 10 0 0 0 51 2
(3.9) 0 2 (3.9) 0 2 0 0 1 1 Total 6200 493 (8.0) 4 (0.06) 626 (10.1) 750
47 (6.3) 0 56 (7.5) 1383 40 (2.9) 0 56 (4.0) 2522 50 (2.0) 1 (0.0) 61
(2.4) 255 755 51 17 470 87 (), % mortality Ao aorta, AVP aortic valve
repair, AVR aortic valve replacement, MVP mitral valve repair, MVR mitral
valve replacement, CABG coronary artery bypass grafting, TEVAR thoracic
endovascular aortic (aneurysm) repair Acute, within 2 weeks from the
onset Copyright © The Author(s) 2025.

<38>
Accession Number
2036440906
Title
Radiofrequency and Cryoablation as Energy Sources in the Cox-Maze
Procedure: A Meta-Analysis of Rhythm Outcomes.
Source
Heart Lung and Circulation. 34(1) (pp 25-33), 2025. Date of Publication:
01 Jan 2025.
Author
Baudo M.; Rosati F.; D'Alonzo M.; Benussi S.; Muneretto C.; Di Bacco L.
Institution
(Baudo, Rosati, D'Alonzo, Benussi, Muneretto, Di Bacco) Department of
Cardiac Surgery, Spedali Civili di Brescia, University of Brescia,
Brescia, Italy
Publisher
Elsevier Ltd
Abstract
Aim: Cox-maze IV is the most effective surgical procedure for atrial
fibrillation (AF) treatment to date; however, few studies have compared
the outcomes of the different energy sources applied to achieve
transmurality. This study aimed to analyse the impact of the different
energy sources on Cox-maze IV results in terms of sinus rhythm
restoration. Method(s): A systematic review and meta-analysis was
conducted by including studies reporting rhythm outcomes on biatrial
Cox-maze AF ablation with bipolar radio-frequency (BRF), cryoenergy
(Cryo), or both (BRF+Cryo). The primary endpoints were the early and late
rhythm outcomes of AF ablation using the different energy sources. Late AF
recurrences were evaluated through timepoint analysis, and freedom from AF
from Kaplan-derived data. Sixty articles including 8,293 patients were
selected (3,364 patients Cryo, 1,937 BRF, and 2,992 BRF+Cryo).
 Result(s): At 6 months, AF incidence was significantly lower in the
Cryo group at 6.73%; it was 25.52% in the BRF and 16.79% in the BRF+Cryo
groups (p=0.0112). At the 4-year timepoint, AF incidence was lower in the
Cryo group compared with the BRF and BRF+Cryo: 6.14% vs 51.59% vs 16.09%,
respectively (p=0.0392). Freedom from AF was 76.7%+/-2.2%, 60.9%+/-2.2%,
and 66.3%+/-1.6% for Cryo, BRF, and BRF+Cryo at 4 years, respectively
(p<0.001). At meta-regression, mean left atrial diameter was positively
associated with higher AF recurrences (OR 1.04, 95% CI 1.01-1.08;
p=0.0159). Conclusion(s): When performing this procedure,
cryoablation seems to be associated with improved rhythm outcomes when
compared with bipolar radiofrequency ablation. Copyright © 2024
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<39>
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. 39(1) (pp 151-161),
2025. Date of Publication: 01 Jan 2025.
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
(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.

<40>
Accession Number
2036026839
Title
Combined left atrial appendage occlusion and catheter ablation for atrial
fibrillation versus isolated left atrial appendage occlusion: A systematic
review and meta-analysis.
Source
International Journal of Cardiology. 421 (no pagination), 2025. Article
Number: 132597. Date of Publication: 15 Feb 2025.
Author
Clemente M.R.C.; Navalha D.D.P.; Bittar V.; Costa T.A.; Fernandes G.P.;
Silva L.T.M.
Institution
(Clemente) Petropolis School of Medicine, Petropolis, Brazil
(Navalha) Department of Medicine, University of Nebraska Medical Center,
Omaha, NE, United States
(Bittar) University Centre of Associated Colleges for Education, Sao Joao
da Boa Vista, Brazil
(Costa) Department of Medicine, University of Colorado School of Medicine,
Aurora, CO, United States
(Fernandes) University Center of the State of Para, Para, Brazil
(Silva) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
Publisher
Elsevier Ireland Ltd
Abstract
Background: Data on the effects of combined left atrial appendage
occlusion (LAAO) and catheter ablation (CA) for atrial fibrillation (AF)
remain limited. We aimed to perform a systematic review and meta-analysis
comparing LAAO and CA versus isolated LAAO. Method(s): We
systematically searched PubMed, Embase, and Cochrane Library for studies
comparing combined LAAO and CA versus isolated LAAO in patients with
atrial fibrillation. Statistical analyses were performed using R software
version 4.3.1. We pooled odds ratios (OR) with 95 % confidence intervals
(CI) for binary outcomes. Result(s): We included eight studies
comprising 51,802 patients, of whom 1375 (2.6 %) underwent combined LAAO
and CA. There were no significant differences between combined LAAO and CA
versus isolated LAAO in terms of major bleeding (OR 0.55; 95 % CI 0.09,
3.41; p = 0.52; I2 = 0 %), major adverse cardiovascular events
(OR 0.88; 95 % CI 0.40, 1.93; p = 0.74; I2 = 0 %), stroke (OR
1.03; 95 % CI 0.35, 3.00; p = 0.96; I2 = 0 %), thromboembolism
(OR 0.60; 95 % CI 0.18, 1.98; p = 0.40; I2 = 0 %), minor
bleeding (OR 1.32; 95 % CI 0.63, 2.80; p = 0.46; I2 = 0 %), or
pericardial effusion (OR 1.18; 95 % CI 0.60, 2.33; p = 0.63; I2
= 24 %). Conclusion(s): In this meta-analysis of observational
studies, combined LAAO and CA for AF was similar to isolated LAAO in terms
of efficacy and safety. Further large randomized controlled trials are
needed to explore the long-term effects of combining these
procedures. Copyright © 2024 Elsevier B.V.

<41>
Accession Number
2031711785
Title
Incidence of aortic valve reintervention in patients with aortic stenosis
undergoing transcatheter aortic valve implantation versus surgical aortic
valve replacement: a systematic review and updated meta-analysis of
randomized studies.
Source
General Thoracic and Cardiovascular Surgery. 73(1) (pp 12-22), 2025.
Article Number: n71. Date of Publication: 01 Jan 2025.
Author
Groberio J.G.; Reginato P.H.; Streit R.E.; Rocha A.V.; Udoma-Udofa O.C.;
de Mesquita C.F.; Rivera A.; Ulbrich A.Z.; Farias F.R.; Gomes W.F.
Institution
(Groberio) Faculty of Medicine, Vila Velha University, Espirito Santo,
Vila Velha, Brazil
(Reginato, Streit, Rocha, Ulbrich, Farias) Faculty of Medicine, Federal
University of Parana, Parana, Curitiba, Brazil
(Udoma-Udofa) Faculty of Medicine, Federal University of Juiz de Fora,
Minas Gerais, Juiz de Fora, Brazil
(de Mesquita) School for Medical Sciences, Federal University of
Pernambuco, Pernambuco, Recife, Brazil
(Rivera) Faculty of Medicine, Nove de Julho University, Sao Paulo, Sao
Bernardo do Campo, Brazil
(Gomes) INC Hospital, Rua Jeremias Maciel Perretto, 300, Campo Comprido,
Parana, Curitiba, Brazil
Publisher
Springer
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) and surgical
aortic valve replacement (SAVR) are established interventions for
alleviating symptoms and enhancing survival in individuals with severe
aortic stenosis (AS). However, the long-term outcomes and incidence of
reintervention associated with TAVI and SAVR remain uncertain.
 Method(s): We conducted a systematic review and meta-analysis to
compare the incidence of reintervention in TAVI versus SAVR. PubMed,
Embase, and Cochrane databases were searched for randomized controlled
trials (RCTs). Risk ratios (RR) and 95% confidence intervals (CI) were
pooled with a random-effects model. A p-value < 0.05 was considered
statistically significant. Result(s): Nine RCTs were included, with
5144 (50.9%) patients randomized to TAVI. Compared with SAVR, TAVI
increased reinterventions (RR 1.89; 95% CI 1.29-2.76; p < 0.01) and the
need for pacemakers (RR 1.91; 95% CI 1.49-2.45; p < 0.01). In addition,
TAVI significantly reduced the incidence of new-onset atrial fibrillation
(RR 0.43; 95% CI 0.32- 0.59; p < 0.01). There were no significant
differences in all-cause mortality (RR 1.04; 95% CI 0.92-1.16; p = 0.55),
cardiovascular mortality (RR 1.04; 95% CI 0.94-1.17; p = 0.44), stroke (RR
0.97; 95% CI 0.80-1.17; p = 0.76), endocarditis (RR 0.96; 95% CI
0.70-1.33; p = 0.82), and myocardial infarction (RR 1.06; 95% CI
0.79-1.41; p = 0.72) between groups. Conclusion(s): In patients with
severe AS, TAVI significantly increased the incidence of reinterventions
and the need for pacemakers as compared with SAVR. Copyright ©
The Author(s), under exclusive licence to The Japanese Association for
Thoracic Surgery 2024.

<42>
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.

<43>
Accession Number
2035605185
Title
Comparison of Inhalational and Intravenous Anesthesia Induction on
Electroencephalogram and Cerebral Perfusion in Children With Congenital
Heart Disease: A Secondary Analysis of a Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(1) (pp 162-167),
2025. Date of Publication: 01 Jan 2025.
Author
Han D.; Xie S.; Pan S.; Ou Y.
Institution
(Han, Xie, Pan, Ou) Anesthesia Department, Children's Hospital affiliated
to Capital Institute of Pediatrics, Beijing, China
(Ou) Anesthesia Center, Beijing Anzhen Hospital affiliated to Capital
Medical University, Beijing, China
Publisher
W.B. Saunders
Abstract
Objectives: The effects of anesthetics on electroencephalograms and
cerebral perfusion remain understudied in children with congenital heart
disease. With regard to this, we compared inhalational anesthesia
induction and intravenous anesthesia induction. Design(s): A
randomized controlled trial. Setting(s): Operating room in 2 tertiary
hospitals. Participant(s): A cohort of 116 pediatrics patients
undergoing cardiac surgery. Measurements and Main Results: The
patients were randomly assigned to either the intravenous group (n = 58)
or the inhalational group (n = 58). The inhalational group received
anesthesia induction with 4% to 6% sevoflurane and a bolus of pipecuronium
0.2 mg/kg, whereas the intravenous group received anesthesia induction
with intravenous midazolam 0.2 mg/kg, pipecuronium 0.2 mg/kg, and
sufentanil 1 mug/kg. Ten minutes after tracheal intubation, the following
parameters were measured: spectral edge frequency, burst suppression
event, patient state index, middle cerebral artery blood flow velocity,
cerebral oxygen saturation, and hemodynamic parameters. In comparison with
the intravenous group, the inhalational group exhibited significant
increases in 95% spectral edge frequency, ratio of burst suppression
event, blood flow velocity in the middle cerebral artery, and cerebral
oxygen saturation (p < 0.05 for all), as well as decreases in systolic
pressure, diastolic pressure, cardiac index, and the maximal slope of
systolic upstroke (p < 0.05 for all). Conclusion(s): The
administration of sevoflurane for anesthesia induction results in more
burst suppression, while also demonstrating superior cerebral perfusion
when compared with the use of intravenous medications for anesthesia
induction. Trial registration: Chinese Clinical Trial Registry
(ChiCTR1800015946). Copyright © 2024 Elsevier Inc.

<44>
Accession Number
2031764556
Title
Cerebral Embolic Protection: Is There a Benefit for Left Atrial and Mitral
Valve Procedures?.
Source
Current Cardiology Reports. 26(12) (pp 1341-1346), 2024. Date of
Publication: 01 Dec 2024.
Author
Besir B.; Kapadia S.R.
Institution
(Besir, Kapadia) Department of Cardiovascular Medicine, Heart, Vascular
and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3,
Cleveland, OH, United States
Publisher
Springer
Abstract
Purpose of Review: This review aims to highlight the current evidence on
the use of cerebral embolic protection devices (CEPD) in left atrial and
transcatheter mitral valve procedures. It also aims to summarize the
antithrombotic management of patients undergoing such procedures. Recent
Findings: Ischemic stroke is one of the most devastating complications of
structural heart procedures. The manifestation of periprocedural stroke
can range from asymptomatic and detectable only through brain imaging to
major stroke with neurological deficits. CEP devices were initially
developed to mitigate the risk of stroke associated with transcatheter
aortic valve replacement (TAVR). However, the efficacy of such devices
during different cardiac interventions is yet to be fully demonstrated,
especially in left atrial appendage closure (LAAO), and mitral valve
interventions. Few studies demonstrated that the risk of periprocedural
strokes after LAAO and mitral valve interventions is not negligible and is
highest during the periprocedural period and then falls. The majority of
patients undergoing those procedures have cerebral ischemic injuries
detected on diffusion-weighted magnetic resonance imaging (DW-MRI).
Moreover, a reasonable number of those patients had debris embolization on
the filters of the CEPD. Pharmacological therapy with antithrombotic
agents before, during, or after structural heart interventions is crucial
and should be tailored to each patient's risk of bleeding and ischemia.
Close monitoring that includes a full neurological assessment and frequent
follow-up visits with cardiac echocardiography are important.
 Summary: The risk of periprocedural stroke in left atrial and
transcatheter mitral valve procedures is not negligible. Pharmacological
therapy with antithrombotic agents before, during, or after structural
heart interventions is important to mitigate the risk of stroke,
especially the long-term risk. More prospective studies are needed to
assess the efficacy of CEPD in such procedures. Copyright © The
Author(s) 2024.

<45>
Accession Number
646062390
Title
Effect of Continuous Erector Spinae Plane Block on Postoperative Recovery
in Patients Undergoing Minimally Invasive Cardiac Surgery: A Prospective,
Randomized Controlled Clinical Trial.
Source
Current medical science. 44(6) (pp 1103-1112), 2024. Date of Publication:
01 Dec 2024.
Author
Jin L.; Yu Y.; Miao P.; Huang Y.-H.; Yu S.-Q.; Guo K.-F.
Institution
(Jin, Yu, Miao, Huang, Yu, Guo) Department of Anesthesia, Zhongshan
Hospital, Fudan University, Shanghai, China
Abstract
OBJECTIVE: To investigate whether continuous erector spinae plane block
(ESPB) improves the quality of recovery (QoR) and decreases postoperative
acute and chronic pain in patients undergoing minimally invasive cardiac
surgery. METHOD(S): This was a single-center, double-blind,
prospective, randomized, placebo-controlled trial. A total of 120 patients
were randomized to groups at a 1:1 ratio. They received general
anaesthesia and an ESP catheter (ropivacaine or normal saline) before
surgery, and received patient-controlled intravenous analgesia with
sufentanil and continuous ESPB with a pulse injection of 8 mL (ropivacaine
or normal saline) per h after 20 mL of the experimental drug was
administered at the end of surgery. The primary outcome was the 15-item
quality of recovery scale (QoR-15) score at 24 h after surgery. The
secondary outcomes included the severity of pain, sufentanil consumption,
incidence of rescue analgesia, and proportion of patients with chronic
pain. RESULT(S): The QoR-15 score was greater in the ESPB group than
in the control group at 24 h after surgery [112 (108-118) vs. 109
(101-114), P=0.023]. ESPB was associated with a lower cough visual
analogue scale (VAS) score (44 vs. 47, P=0.001), resting VAS score (28 vs.
35.5, P=0.003), sufentanil consumption (104.8 microg vs. 145.5 microg,
P=0.000), and incidence of rescue analgesia (20.0% vs. 43.3%, P=0.006).
 CONCLUSION(S): Continuous ESPB mildly improved the QoR-15 score in
patients undergoing minimally invasive cardiac surgery and reduced
postoperative pain scores, opioid consumption, and the incidence of rescue
analgesia. Copyright © 2024. Huazhong University of Science and
Technology.

<46>
Accession Number
2032696733
Title
Randomized Trial of Pulsatile and Nonpulsatile Flow in Cyanotic and
Acyanotic Congenital Heart Surgery.
Source
World Journal for Pediatric and Congenital Heart Surgery. (no
pagination), 2024. Date of Publication: 2024.
Author
Patel K.; Lin T.K.; Clark J.B.; Ceneviva G.D.; Imundo J.R.; Spear D.;
Kunselman A.R.; Thomas N.J.; Myers J.L.; Undar A.
Institution
(Patel, Lin, Clark, Ceneviva, Imundo, Spear, Kunselman, Thomas, Myers,
Undar) Penn State Hershey Pediatric Cardiovascular Research Center, Penn
State College of Medicine, Hershey, PA, United States
(Patel, Clark, Imundo, Myers, Undar) Division of Pediatric Cardiology,
Department of Pediatrics, Penn State College of Medicine, Hershey, PA,
United States
(Patel, Clark, Myers, Undar) Department of Surgery, Penn State College of
Medicine, Hershey, PA, United States
(Lin) Division of Pediatric Critical Care Medicine, Department of
Pediatrics, University of Virginia Children's Hospital, Charlottesville,
VA, United States
(Ceneviva, Spear, Thomas) Division of Pediatric Critical Care Medicine,
Department of Pediatrics, Penn State College of Medicine, Hershey, PA,
United States
(Kunselman, Thomas) Department of Public Health Sciences, Penn State
College of Medicine, Hershey, PA, United States
(Undar) Department of Biomedical Engineering, College of Engineering, The
Pennsylvania State University, University Park, PA, United States
Publisher
SAGE Publications Inc.
Abstract
Background: The study objective was to determine the impact of
cardiopulmonary bypass perfusion modalities on cerebral hemodynamics and
clinical outcomes in congenital cardiac surgery patients stratified by
acyanotic versus cyanotic heart disease. Method(s): A total of 159
pediatric (age <18 years) cardiac surgery patients were prospectively
randomized to pulsatile or nonpulsatile cardiopulmonary bypass and
stratified by type of congenital heart disease: acyanotic versus cyanotic.
Intraoperative cerebral gaseous microemboli counts and middle cerebral
artery pulsatility index were assessed. Organ injury was quantified by
Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score at 24, 48, and 72 h
postoperatively. Additional outcomes included Pediatric Risk of
Mortality-3 score, vasoactive-inotropic score, duration of mechanical
ventilation, intensive care and hospital length of stay, and 180-day
mortality. Heterogenous variance linear models (ie, ANOVA and mixed
models) and chi2 tests were used to compare groups for
continuous and categorical variables, respectively. Result(s): Within
congenital heart disease subgroups, patients randomized to nonpulsatile
versus pulsatile bypass had similar preoperative and operative
characteristics. While the intraoperative pulsatility index was higher in
the pulsatile subset of both acyanotic and cyanotic groups (P <.05),
regional cerebral oxygen saturation, mean arterial pressure, and gaseous
microemboli counts were similar. Postoperative PELOD-2 scores decreased at
similar rates in the acyanotic and cyanotic subgroups regardless of the
perfusion modality utilized. There were also no significant between-group
differences in the additional postoperative outcomes by perfusion modality
in either acyanotic or cyanotic groups. Conclusion(s): Despite
patients undergoing pulsatile cardiopulmonary bypass experiencing a more
physiologic pulsatility index in both acyanotic and cyanotic groups, no
significant differences in cerebral hemodynamics or clinical outcomes were
appreciated. Copyright © The Author(s) 2024.

<47>
Accession Number
646209311
Title
Heparin rebound in patients undergoing off-pump coronary artery bypass
grafting surgery: a single-center retrospective study.
Source
Journal of cardiothoracic surgery. 20(1) (pp 18), 2025. Date of
Publication: 04 Jan 2025.
Author
Jiang F.; Xu Y.; Hu S.-S.; Wang J.-Q.; Yao Y.-T.
Institution
(Jiang) Department of Anesthesiology, Xiangyang Central Hospital,
Affiliated Hospital of Hubei University of Arts and Science, Xiangyang,
China
(Jiang, Hu, Wang, Yao) Department of Anesthesiology, Fuwai Hospital,
National Center for Cardiovascular Diseases, Peking Union Medical College
and Chinese Academy of Medical Sciences, No. 167, Beilishi Road, Xicheng
District, China
(Xu) Department of Pain, Xiangyang Central Hospital, Affiliated Hospital
of Hubei University of Arts and Science, No. 136 Jingzhou Street,
Xiangyang, China
(Hu) Department of Anesthesiology, Gansu Province Maternity and Child
Health Care Hospital (Gansu Province Central Hospital), 143 North Road,
Lanzhou, China
(Wang) Department of Anesthesiology, Lu'an Affiliated Hospital of Anhui
Medical University, No.21 West Wanxi Road, China
Abstract
BACKGROUND: Heparin, an anticoagulant used in cardiac surgery, can result
in heparin rebound (HR), where it returns postoperatively despite being
neutralized with protamine. This study was designed to investigate the
prevalence of HR in patients undergoing off-pump coronary artery bypass
grafting (OPCAB) and evaluate the impact of HR on their short-term
outcomes. METHOD(S): HR was defined by a 10% increase in activated
coagulation time (ACT) following two hours of heparin neutralization with
protamine, bleeding over 200 mL/h, and abnormal laboratory coagulation
examination results. We analyzed 503 OPCAB patients aged 31-80 years from
September 2019 to June 2022, who were categorized into HR (n = 56) and
Non-HR (n = 447) groups. The primary outcome was postoperative bleeding
volume. Secondary outcomes included the incidence of postoperative
reoperation for bleeding, allogenic blood transfusion incidences and
volumes, and laboratory variables. RESULT(S): Significant differences
were observed in preoperative platelet counts (P < 0.001) and the ACT
measured 2 h post-heparin neutralization (P = 0.012). The group HR
exhibited higher 24-hour bleeding volumes, increased reoperation rates,
and greater total bleeding volumes (all P < 0.001). CONCLUSION(S):
Postoperative HR was found to be prevalent in OPCAB patients and increased
bleeding risks. These findings indicate the need for future randomized
controlled trials to confirm the impact of HR and guide patient blood
management. Copyright © 2024. The Author(s).

<48>
Accession Number
2036925499
Title
Comparative evaluation of high-flow nasal cannula (HFNC) and conventional
oxygen therapy (COT) in infants after non-cardiac surgery: Study protocol
of a randomized controlled trial.
Source
PLoS ONE. 20(1) (no pagination), 2025. Article Number: e0314782. Date of
Publication: 01 Jan 2025.
Author
Zhang D.; Gong T.; Huang Q.; Zhang Q.; Liu K.; Li J.; Yu H.; Cui Y.
Institution
(Zhang, Gong, Huang, Zhang, Liu, Li, Cui) Department of Anesthesiology,
Chengdu Women's and Children's Central Hospital, School of Medicine,
University of Electronic Science and Technology of China, Chengdu, China
(Yu) Department of Anesthesiology, West China Hospital, Sichuan
University, Chengdu, China
Publisher
Public Library of Science
Abstract
Background Literature regarding the advantages of HFNC in infants for
ensuring oxygen supply after non-cardiac surgery is insufficient. The
purpose of our study is to compare COT vs. HFNC on postoperative outcomes
in infants undergoing non-cardiac surgery. We hypothesize that
prophylactic use of HFNC after non-cardiac surgery in infants would reduce
the incidence of post-anesthesia hypoxemia and could also be adapted as
first-line oxygen therapy after non-cardiac surgery. Methods This is a
superior, single-blind, randomized controlled study. A total of 394
infants undergoing general anesthesia will be randomly assigned to accept
COT or HFNC in a 1:1 ratio. The primary outcome is the rate of
desaturation post-extubation. Secondary outcomes include the rate of mild
upper airway obstruction, the rate of severe respiratory depression, the
rate of transfer to PICU, duration of oxygen therapy, length of PACU stay,
the time to reach full enteral feeding, and postoperative adverse events,
including nasal injury, agitation, vomiting, and unplanned secondary
surgery related to the initial surgery. Discussion This is the first
randomized controlled trial to explore the advantages of HFNC in infants
to ensure oxygen supply after non-cardiac surgery. If favorable evidence
is obtained, HFNC could be adopted as first-line oxygen therapy for
infants following non-cardiac surgery. Copyright © 2025 Zhang et
al. This is an open access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author
and source are credited.

<49>
[Use Link to view the full text]
Accession Number
2036870096
Title
Takotsubo Syndrome Following Catheter Ablation for Atrial Fibrillation A
Systematic Review and Metasummary of Case Reports/Series.
Source
Cardiology in Review. (no pagination), 2024. Article Number:
10.1097/CRD.0000000000000845. Date of Publication: 2024.
Author
Desai R.; Gudiwada M.C.V.B.; Jasti J.R.; Jitta S.R.; Guddeti A.V.;
Vuddandam D.K.; Gujjari M.; Varala S.; Janga C.; Ganipineni V.D.P.; Merugu
B.; Bandaru R.R.; Puli S.; Venkata V.S.
Institution
(Desai) Independent Researcher, Atlanta, GA, United States
(Gudiwada) Department of Cardiology, University of Nebraska Medical
Center, Omaha, NE, United States
(Jasti) Department of Cardiology, Tower Health, Philadelphia, PA, United
States
(Jitta) Department of Internal Medicine, Mercy Hospital, Saint Louis, MO,
United States
(Guddeti) Department of Medicine, Mediciti Institute of Medical Science,
Hyderabad, India
(Vuddandam, Gujjari, Varala) Department of Medicine, Osmania General
Hospital, Hyderabad, India
(Janga) Department of Internal Medicine, Jefferson Abington Hospital,
Abington, PA, United States
(Ganipineni) Department of Internal Medicine, Thomas Hospital, Fairhope,
AL, United States
(Merugu) Department of Medicine, Vydehi Institute of Medical Sciences and
Research Center, Bengaluru, India
(Bandaru) Department of Internal Medicine, East Carolina University,
Greenville, NC, United States
(Puli, Venkata) Department of Hospital Medicine, Cheshire Medical Center,
Dartmouth Health Keene, NH, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Atrial fibrillation (AF) catheter ablation is safe and effective, though
rare cases of takotsubo syndrome (TTS) have been observed without proven
causation. This review synthesizes TTS following AF ablation case reports
and series. Until October 2024, PubMed/Medline, SCOPUS, and Google Scholar
were searched for AF ablation and TTS case reports and series. This study
examines TTS incidence, clinical features, and prognosis after AF catheter
ablation. Thirteen articles detailing 18 patients were included in the
review. The study population had a mean age of 65 +/- 9.18 years and
77.77% were female. Of the 18 patients, 6 patients (33.3%) underwent
radiofrequency catheter ablation and 5 patients (27.7%) underwent
cryoablation. All the patients developed TTS within 4 days of the
procedure. Heart palpitations and breathlessness are predominant symptoms.
Eight patients had T-wave inversion. Dyskinesia was the most prevalent
echocardiography finding among the reported cases. Left ventricular
ejection fraction was moderately reduced in 5 cases (35.7%) and severely
reduced (left ventricular ejection fraction <30%) in 6 cases (42.8%). Of
the 15 patients in whom a pattern of ballooning was reported, 13 patients
had apical ballooning and 2 had atypical ballooning pattern. Of the 8
cases (44.44%) with complications, 1 had ventricular fibrillation and 2
patients had pulseless electrical activity. Left ventricular function is
completely recovered among 17 patients whereas one patient died due to
numerous cardiac electromechanical dissociation events. This systematic
investigation highlights the need for TTS vigilance after AF ablation,
especially in postmenopausal women having catheter ablation. More research
is required to fully understand the prevalence, etiology, and risk factors
of TTS after AF ablation. Copyright © 2024 Wolters Kluwer Health,
Inc. All rights reserved.

<50>
Accession Number
646209085
Title
Single versus Dual Antiplatelet Therapy after Left Atrial Appendage
Closure: a Propensity Score Matching Analysis.
Source
Heart rhythm. (no pagination), 2024. Date of Publication: 11 Dec 2024.
Author
Galea R.; Krsnik J.P.; Bini T.; Chalkou K.; Gasys A.; Brugger N.; Madhkour
R.; Seiffge D.J.; Roten L.; Siontis G.C.M.; Raber L.
Institution
(Galea) Department of Cardiology, Bern University Hospital, University of
Bern, Bern, Switzerland; Department of Cardiology, Hospital Centre of
Biel, Biel, Switzerland
(Krsnik, Bini, Gasys, Brugger, Madhkour, Roten, Siontis, Raber) Department
of Cardiology, Bern University Hospital, University of Bern, Bern,
Switzerland
(Chalkou) Department of Clinical Research, University of Bern, Bern,
Switzerland
(Seiffge) Department of Neurology, Bern University Hospital, University of
Bern, Bern, Switzerland
Abstract
BACKGROUND: Either dual antiplatelet therapy or oral anticoagulation in
combination with aspirin represent recommended treatment regimens
following left atrial appendage closure (LAAC). As the majority of
patients receiving LAAC have high bleeding risk, less aggressive
antithrombotic treatments are needed, such as single antiplatelet therapy.
 OBJECTIVE(S): To compare both ischemic and bleeding outcomes in
patients receiving single (SAPT) or dual antiplatelet therapy (DAPT) after
successful LAAC. METHOD(S): Data on consecutive patients undergoing
percutaneous LAAC between 2009 and 2023 were prospectively collected
including one-year follow-up. A propensity score matching was performed
among patients discharged under SAPT and DAPT. The primary endpoint was
the one-year composite of cardiovascular death, stroke, systemic embolism
or device related thrombosis (DRT). The secondary endpoints included major
bleeding and DRT. RESULT(S): Among 1033 patients discharged with
antiplatelet therapy, 154 patients receiving SAPT were compared to 230
matched patients receiving DAPT. The primary endpoint was similar between
the two study groups (SAPT 11.0% vs. DAPT 8.3%; Rate Ratio [RR]: 1.14; 95%
Confidence Interval [CI]: 0.83-1.55; p=0.420). Consistently, we found no
difference in terms of both major bleedings (SAPT 9.7% vs. DAPT 12.6%;
Hazard Ratio: [HR]: 0.77; 95% CI: 0.43-1.39; p=0.387) and DRT (2.6% vs.
1.1%; RR:1.47; 95% CI: 0.89-2.43; p=0.130) between SAPT and DAPT groups.
 CONCLUSION(S): In this propensity score analysis of a single-center
LAAC cohort, both ischemic and bleeding outcomes did not differ at 1 year
between patients discharged with SAPT or DAPT. These results have to be
confirmed in an adequately powered randomized clinical
trial. Copyright © 2024. Published by Elsevier Inc.

<51>
Accession Number
646205476
Title
Effect Of PCI On QTd And QT Interval Compared To Control/other Treatments
For Myocardial Infarction.
Source
Circulation Research. Conference: American Heart Association's Basic
Cardiovascular Sciences Scientific Sessions 2023: Innovations and
Discovery in Cardiovascular Science. Philadelphia, PA United States.
133(Supplement 1) (no pagination), 2023. Date of Publication: 01 Aug 2023.
Author
Vasavada A.; Jain M.; Sundaram D.M.; Gudi T.R.; Mahfooz K.; Kotak R.;
Singh G.
Institution
(Vasavada) M.P. Shah Med College, Jamnagar, India
(Jain) Shri Bhausaheb Hire Government Med College, Thane, India
(Sundaram) Employees' State Insurance Corp (ESIC), Med College and Post
Graduate Institute of Med Science and Rsch (PGIMSR), Chennai, India
(Gudi) Merit Health River Region, Vicksburg, MS, United States
(Mahfooz) Lincoln Med Cntr, Bronx, NY, United States
(Kotak) Padmashri DY Patil Univ, Sch of Medicine, Navi Mumbai, India
(Singh) Shri Guru Ram Das Institute of Med Sciences and Rsch, Amritsar,
India
Publisher
Lippincott Williams and Wilkins
Abstract
Background: QT dispersion measurement is a potential risk stratification
tool but is a conflict in the literature on how PCI and other procedures
affect it. We aimed to compare PCI with other procedures like
Streptokinase, PCI plus thrombectomy, and coronary artery bypass graft
(CABG) on QT interval. Method(s): We conducted a systematic review
and meta-analysis on the association between PCI and QTd through a
literature search in three electronic databases, Science Direct, PubMed,
and Google Scholar, for empirical studies published in English. Random
effects model was used. Result(s): Eleven studies were found in
total. We found significant differences in QTc between pre and post PCI
and a significant reduction in QTc across all the studies (SMD 2.57, 95%
CI 1.22 to 3.92; p<0.05). Five studies compared the efficacy of PCI and
control (other procedures) in reducing QTd after 24 hours of treatment
procedures. The mean change from baseline in QTd is more significant in
the PCI group (post-PCI) compared to the control group, although there is
no statistically significant difference between the two groups (SMD -0.30,
95% CI -1.25 to 0.65; I2 = 96%). A significant reduction in QTd
corresponding to a statistically significant difference between QTd prior
and post-PCI intervention for QTd at 2hrs, 24hrs, and 2-7 days, was found.
The estimated overall effect measure reveals statistical significance (SMD
1.18, 95% CI 0.70 to 1.65; P < 0.05). Conclusion(s): QTd difference
was significant post-PCI. Future studies on evaluating it as a predictor
to various outcomes could illustrate it's benefit in clinical practise.

<52>
Accession Number
2036972888
Title
Evaluation of the effect of crocin on prevention of atrial fibrillation
after coronary artery bypass grafting or heart valve replacement: A
double-blind, randomized, placebo-controlled trial.
Source
Avicenna Journal of Phytomedicine. 12(6) (pp 589-601), 2022. Date of
Publication: 01 Nov 2022.
Author
Shahri S.H.H.; Soltani G.; Teshnizi M.A.; Moeinipour A.; Tayyebi M.; Bayaz
R.J.D.; Abedi F.; Ghavami V.; Amini S.; Mohammadpour A.H.
Institution
(Shahri, Abedi, Mohammadpour) Department of Clinical pharmacy, School of
Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Soltani, Amini) Department of Anesthesia, School of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Teshnizi, Moeinipour) Cardiac Surgeon, Department of Cardiac Surgery,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Tayyebi) Vascular and Endovascular Surgery Research Center, Faculty of
Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Bayaz) Cardiovascular Research Center, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Ghavami) Department of Biostatistics, Social Determinants of Health
Research Center, Mashhad University of Medical Sciences, Mashhad, Iran,
Islamic Republic of
Publisher
Mashhad University of Medical Sciences
Abstract
Objective: The aim of this study was to evaluate the effect of crocin on
the prevention of atrial fibrillation after coronary artery bypass
grafting (CABG) and heart valve replacement. Material(s) and
Method(s): 100 patients who were scheduled for CABG or heart valve
replacement surgeries were randomly assigned into two groups of treatment
and placebo. In the treatment group, patients received crocin tablets from
three days prior to surgery and on the first three postoperative days (for
a total of six days). During the first three days after surgery,
postoperative atrial fibrillation (POAF) was assessed by electrocardiogram
monitoring. Prooxidant-antioxidant balance (PAB) and c-reactive protein
(CRP) levels were also assessed. Result(s): POAF developed in 7
patients in the treatment group versus 18 patients in the control
(p=0.02). PAB levels were significantly lower in the crocin group
(p<0.001), while differences in CRP levels were insignificant (p=0.39).
 Conclusion(s): It seems that prophylactic use of crocin is effective
in reducing the incidence of POAF in patients undergoing heart
surgeries. Copyright © 2022 Mashhad University of Medical
Sciences. All rights reserved.

<53>
Accession Number
2036961339
Title
Comparison of percutaneous coronary intervention vs coronary artery bypass
graft for left main coronary artery disease in patients with prior
cerebrovascular disease: A systematic review, meta-analysis and
meta-regression.
Source
International Journal of Cardiology: Cardiovascular Risk and Prevention.
24 (no pagination), 2025. Article Number: 200370. Date of Publication: 01
Mar 2025.
Author
Shuja M.H.; Shakil F.; Ali S.H.; Uddin Q.S.; Noman A.; Iqbal J.; Ahmed M.;
Sajid F.; Ansari H.W.; Farhan S.A.; Ansari H.U.H.; Farhan S.H.; Nasir
M.M.; Qazi S.; Majid M.
Institution
(Shuja, Shakil, Ali, Uddin, Noman, Ahmed, Farhan, Ansari, Farhan, Nasir,
Qazi) Department of Internal Medicine, Dow University of Health Sciences,
Pakistan
(Iqbal) Nursing Department Communicable Diseases Centre Hamad Medical
Corporation, Doha, Qatar
(Sajid, Ansari) Department of Medicine, Liaquat National Hospital and
Medical College, Pakistan
(Majid) Department of Internal Medicine, AdventHealth Sebring, Sebring,
FL, United States
Publisher
Elsevier B.V.
Abstract
Background: Previous studies suggest similar cardiovascular (CV) benefits
for either percutaneous coronary intervention (PCI) or coronary artery
bypass graft (CABG) in patients with left main coronary artery disease
(LMCAD). However, limited data exist on the influence of prior
cerebrovascular disease (CEVD). Thus, we aim to compare the CV outcomes in
patients with LMCAD and prior CEVD, undergoing either PCI or CABG.
 Method(s): A comprehensive search from (January 2000 to August 2024)
identified three relevant studies. Outcomes analyzed included all-cause
mortality, major adverse cardiac and cerebrovascular events (MACCE),
myocardial infarction (MI), and risk of stroke in patients undergoing
either PCI or CABG for LMCAD. Data analysis employed a random effects
model and presented hazard ratios (HR) along with their 95 % confidence
intervals (CI). Result(s): Three studies involving 760 patients (361
PCI, 399 CABG) were included. PCI was associated with a significantly
higher risk of MACCE (HR = 2.56; 95 % CI = 1.23-5.37; p = 0.01;
I2 = 86 %) and MI (HR = 2.97; 95 % CI = 1.72-5.13; p < 0.0001;
I2 = 0 %) compared to CABG. No significant differences were
observed in all-cause mortality (HR = 1.35; 95 % CI = 0.92-1.98; p = 0.12;
I2 = 0 %) or recurrent stroke (HR = 0.83; 95 % CI = 0.40-1.70;
p = 0.60; I2 = 1 %). The risk of repeat revascularization was
higher in PCI, though not statistically significant (HR = 3.44; 95 % CI =
0.50-23.60; p = 0.21; I2 = 70 %). Conclusion(s): PCI
significantly elevates the risk of MACCE and MI in patients with LMCAD and
prior CEVD compared to CABG. However, risks of all-cause mortality, repeat
stroke, and revascularization were non-significant. Comorbidities may
drive the elevated risk, underscoring the need for tailored strategies in
this population. Copyright © 2025

<54>
Accession Number
2036902408
Title
Definitions of clinical study outcome measures for cardiovascular
diseases: The European Unified Registries for Heart Care Evaluation and
Randomized Trials (EuroHeart).
Source
European Heart Journal. 46(2) (pp 190-214), 2025. Date of Publication: 07
Jan 2025.
Author
Wilkinson C.; Bhatty A.; Batra G.; Aktaa S.; Smith A.B.; Dwight J.;
Rucinski M.; Chappell S.; Alfredsson J.; Erlinge D.; Ferreira J.;
Gudmundsdottir I.J.; Hrafnkelsdottir P.J.; Ingimarsdottir I.J.; Irs A.;
Janosi A.; Jarai Z.; Oliveira-Santos M.; Popescu B.A.; Vasko P.; Vinereanu
D.; Yap J.; Bugiardini R.; Cenko E.; Nadarajah R.; Sydes M.R.; James S.;
Maggioni A.P.; Wallentin L.; Casadei B.; Gale C.P.; Aboyans V.; Almeida
A.G.; Atar D.; Bayes-Genis A.; Biondi-Zoccai G.; Bonaca M.P.; Bonaros N.;
Brundel B.J.J.M.; Campo G.; Casado-Arroyo R.; Ceconi C.; Chioncel O.;
Ciccarelli M.; Coats L.; Collet J.-P.; Dan G.-A.; Delgado V.; Dilaveris
P.; Dobrev D.; Donal E.; Duncker D.; Elgamal S.M.; Ezekowitz J.A.; Fonarow
G.; Fraser A.G.; Giannakoulas G.; Gigante B.; Gnecchi M.;
Gollmann-Tepekoylu C.; Greene S.J.; Heijman J.; Howes J.; Iung B.; Jensen
M.T.; Kunadian V.; Lelonek M.; Leonardi S.; Grove E.L.; Liberale L.; Liga
R.; Lincoff A.M.; Lorusso R.; Mamas M.; Manfrini O.; Mangiacapra F.;
Marsan N.A.; Martin-Fernandez M.; Merino J.L.; Metra M.; Parolari A.;
Perrino C.; Raber L.; Rahmani B.; Rainer P.P.; Rosano G.M.C.; Rossi A.;
Rubboli A.; Rudolph T.; Sandner S.; Savarese G.; Siller-Matula J.;
Sossalla S.; Spadaccio C.; Stabile E.; Tanne D.; Ten Berg J.; Thielmann
M.; Treskes R.W.; Uchmanowicz I.; Udell J.A.; Van Kimmenade R.R.J.;
Zdravkovic M.
Institution
(Wilkinson) Hull York Medical School, University of York, York, United
Kingdom
(Wilkinson) Academic Cardiovascular Unit, South Tees NHS Foundation Trust,
James Cook University Hospital, Middlesbrough, United Kingdom
(Bhatty, Aktaa, Smith, Chappell, Nadarajah, Gale) Leeds Institute of
Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United
Kingdom
(Bhatty, Aktaa, Smith, Chappell, Nadarajah, Gale) Leeds Institute for Data
Analytics, University of Leeds, Leeds, United Kingdom
(Bhatty, Aktaa, Nadarajah, Gale) Department of Cardiology, Leeds Teaching
Hospitals NHS Trust, Leeds, United Kingdom
(Batra, James, Wallentin) Department of Medical Sciences, Cardiology and
Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
(Dwight, Rucinski) European Society of Cardiology Patient Forum, Sweden
(Alfredsson, Vasko) Department of Cardiology, Linkoping University
Hospital, Linkoping, Sweden
(Erlinge) Department of Clinical Sciences, Lund University, Lund, Sweden
(Ferreira) Department of Cardiology, Hospital de Santa Cruz, Centro
Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
(Gumundsdottir, Hrafnkelsdottir, Ingimarsdottir) Department of Cardiology,
Landspitali University Hospital, Reykjavik, Iceland
(Ingimarsdottir) Department of Health Sciences, Faculty of Medicine,
University of Iceland, Reykjavik, Iceland
(Irs) Heart Clinic, Tartu University Hospital, Tartu, Estonia
(Janosi) Gyorgy Gottsegen National Cardiovascular Institute, Budapest,
Hungary
(Jarai) Department of Cardiology, South Buda Center Hospital, Szent Imre
Teaching Hospital, Budapest, Hungary
(Oliveira-Santos, Vinereanu) Cardiology Department, Unidade Local de Saude
de Coimbra, Coimbra, Portugal
(Popescu) Cardiology Clinic, University of Medicine and Pharmacy Carol
Davila, Emergency Institute for Cardiovascular Diseases Prof Dr C C
Iliescu, Bucharest, Romania
(Vinereanu) Cardiology and Cardiovascular Surgery, University and
Emergency Hospital, Bucharest, Romania
(Yap) Department of Cardiology, National Heart Centre Singapore, Singapore
(Bugiardini, Cenko) Department of Experimental, Diagnostic and Specialty
Medicine, Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy
(Sydes) BHF Data Science Centre, HDR UK, London, United Kingdom
(Sydes) MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and
Methodology, UCL, London, United Kingdom
(Maggioni) ANMCO Research Centre, Heart Care Foundation, Florence, Italy
(Casadei) Division of Cardiovascular Medicine, NIHR Oxford Biomedical
Research Centre, University of Oxford, Oxford, United Kingdom
Publisher
Oxford University Press
Abstract
Background and Aims: Standardized definitions for outcome measures in
randomized clinical trials and observational studies are essential for
robust and valid evaluation of medical products, interventions, care, and
outcomes. The European Unified Registries for Heart Care Evaluation and
Randomised Trials (EuroHeart) project of the European Society of
Cardiology aimed to create international data standards for cardiovascular
clinical study outcome measures. Method(s): The EuroHeart methods for
data standard development were used. From a Global Cardiovascular Outcomes
Consortium of 82 experts, five Working Groups were formed to identify and
define key outcome measures for: cardiovascular disease (generic
outcomes), acute coronary syndrome and percutaneous coronary intervention
(ACS/PCI), atrial fibrillation (AF), heart failure (HF) and transcatheter
aortic valve implantation (TAVI). A systematic review of the literature
informed a modified Delphi method to reach consensus on a final set of
variables. For each variable, the Working Group provided a definition and
categorized the variable as mandatory (Level 1) or optional (Level 2)
based on its clinical importance and feasibility. Result(s): Across
the five domains, 24 Level 1 (generic: 5, ACS/PCI: 8, AF: 2; HF: 5, TAVI:
4) and 48 Level 2 (generic: 18, ACS-PCI: 7, AF: 6, HF: 2, TAVI: 15)
outcome measures were defined. Conclusion(s): Internationally derived
and endorsed definitions for outcome measures for a range of common
cardiovascular diseases and interventions are presented. These may be used
for data alignment to enable high-quality observational and randomized
clinical research, audit, and quality improvement for patient
benefit. Copyright © 2024 The Author(s).

<55>
Accession Number
646191587
Title
Coronary revascularisation deferral based on quantitative flow ratio or
fractional flow reserve: a post hoc analysis of the FAVOR III Europe
trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
(no pagination), 2025. Date of Publication: 02 Jan 2025.
Author
Andersen B.K.; Holm N.R.; Mogensen L.J.H.; Maillard L.; Ramunddal T.;
Erriquez A.; Christiansen E.H.; Escaned J.; Of The Favor Iii Europe Study
Team O.B.
Institution
(Andersen, Holm, Mogensen, Christiansen) Department of Cardiology, Aarhus
University Hospital, Aarhus, Denmark
(Maillard) GCS ES Axium Rambot, Clinique Axium, Aix-en-Provence, France
(Ramunddal) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Erriquez) Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara,
Ferrara, Italy
(Escaned) Hospital Clinico San Carlos IDISSC, Complutense University of
Madrid, Spain and Centro de Investigacion Biomedica en Red - Enfermedades
Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
Abstract
BACKGROUND: Safe deferral of revascularisation is a key aspect of
physiology-guided percutaneous coronary intervention (PCI). While recent
evidence gathered in the FAVOR III Europe trial showed that quantitative
flow ratio (QFR) guidance did not meet non-inferiority to fractional flow
reserve (FFR) guidance, it remains unknown if QFR might have a specific
value in revascularisation deferral. AIMS: We aimed to evaluate the safety
of coronary revascularisation deferral based on QFR as compared with FFR.
 METHOD(S): Patients randomised in the FAVOR III trial in whom PCI was
deferred in at least one coronary artery, based on QFR or FFR>0.80, were
included in the present substudy. The primary outcome was the 1-year rate
of major adverse cardiac events (MACE), with results reported for two
subsets of deferred patients: (1) any study lesion deferral and (2)
complete study lesion deferral. RESULT(S): A total of 523 patients
(55.2%) in the QFR group and 599 patients (65.3%) in the FFR group had at
least one coronary revascularisation deferral. Of these, 433 patients
(82.8%) and 511 (85.3%) patients, respectively, had complete study lesion
deferral. In the "complete study lesion deferral" patient group, the
occurrence of MACE was significantly higher in QFR-deferred patients as
compared with FFR-deferred patients (24 [5.6%] vs 14 [2.8%], adjusted
hazard ratio [HR] 2.07, 95% confidence interval [CI]: 1.07-4.03; p=0.03).
In the subgroup of "any study lesion deferral", the MACE rate was 5.6% vs
3.6% (QFR vs FFR), adjusted HR 1.55, 95% CI: 0.88-2.73; p=0.13.
 CONCLUSION(S): QFR-based deferral of coronary artery
revascularisation resulted in a higher incidence of 1-year MACE as
compared with FFR-based deferral.

<56>
Accession Number
2036985444
Title
Red Blood Cell Transfusion in Critically Ill Adults: An American College
of Chest Physicians Clinical Practice Guideline.
Source
Chest. (no pagination), 2025. Date of Publication: 2025.
Author
Coz Yataco A.O.; Soghier I.; Hebert P.C.; Belley-Cote E.; Disselkamp M.;
Flynn D.; Halvorson K.; Iaccarino J.M.; Lim W.; Lindenmeyer C.C.; Miller
P.J.; O'Neil K.; Pendleton K.M.; Vande Vusse L.; Ouellette D.R.
Institution
(Coz Yataco) Critical Care Medicine Division and Pulmonary Medicine
Division, Integrated Hospital-Care Institute, Cleveland, OH, United States
(Lindenmeyer) Department of Gastroenterology, Hepatology and Nutrition,
Cleveland Clinic, Cleveland, OH, United States
(Coz Yataco) Cleveland Clinic Lerner College of Medicine of Case Western
Reserve University, Cleveland, OH, United States
(Soghier) Division of Pulmonary and Critical Care Medicine, Department of
Medicine, Salem Hospital/Massachusetts General Brigham, Salem, MA, United
States
(Flynn) Boston University Chobanian & Avedisian School of Medicine,
Boston, MA, United States
(Soghier, Iaccarino) American College of Chest Physicians, Glenview, IL,
United States
(Disselkamp) Department of Critical Care and Pulmonary Medicine, Lexington
Veterans Affairs Healthcare System, Lexington, KY, United States
(Halvorson) Department of Medicine, John A. Burns School of Medicine,
University of Hawaii, Honolulu, HI, United States
(Miller) Section of Pulmonary, Critical Care, Allergy and Immunologic
Disease, Section on Hematology and Oncology, Department of Medicine,
Section on Critical Care Medicine, Department of Anesthesiology, Wake
Forest School of Medicine, Winston-Salem, NC, United States
(O'Neil) Wilmington Health and MICU, Novant New Hanover Regional Medical
Center, Wilmington, NC, United States
(Pendleton) Division of Pulmonary, Allergy, Critical Care and Sleep
Medicine, Department of Medicine, University of Minnesota, Minneapolis,
MN, United States
(Vande Vusse) Division of Pulmonary, Critical Care and Sleep Medicine,
Department of Medicine, University of Washington, Seattle, WA, United
States
(Ouellette) Division of Pulmonary and Critical Care Medicine, Henry Ford
Hospital, Detroit, MI, United States
(Hebert) Bruyere Research Institute, University of Ottawa, Ottawa, ON,
Canada
(Belley-Cote) Population Health Research Institute, Hamilton, ON, Canada
(Lim) Department of Medicine, McMaster University, Hamilton, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: Blood products frequently are administered to critically ill
patients. Considering recent trials and practice variability, a
comprehensive review of current evidence was deemed essential to offer
pertinent guidance to critical care practitioners. This American College
of Chest Physicians (CHEST) guidelines panel examined the literature on
RBC transfusions among critically ill patients overall and specific
subgroups, including patients with gastrointestinal bleeding, acute
coronary syndrome (ACS), cardiac surgery, isolated troponin elevation, and
septic shock, to provide evidence-based recommendations. Study Design and
Methods: A panel of experts developed six Population, Intervention,
Comparator, and Outcome questions addressing RBC transfusions in
critically ill patients and performed a comprehensive evidence review. The
panel applied the Grading of Recommendations, Assessment, Development, and
Evaluations approach to assess the certainty of evidence and to formulate
and grade recommendations. A modified Delphi technique was used to reach
consensus on the recommendations. Result(s): The initial search
identified a total of 3,082 studies, and after the initial screening, 38
articles were reviewed. Among them, 23 studies met inclusion criteria,
comprising 22 randomized controlled trials and one cohort study. Based on
the analysis of these studies, the panel formulated two strong and four
conditional recommendations. The overall quality of evidence for
recommendations ranged from very low to moderate. Conclusion(s): In
most critically ill patients, a restrictive strategy was preferable to a
permissive approach because it does not increase the risk of death or
complications, but does decrease RBC use significantly. Data from
critically ill subpopulations also supported a restrictive approach,
except in patients with ACS, for whom favoring a restrictive approach
could increase adverse outcomes. Copyright © 2024 The Author(s)

<57>
Accession Number
2032858073
Title
Real-time continuous glucose monitoring improves postoperative glucose
control in people with type 2 diabetes mellitus undergoing coronary artery
bypass grafting: A randomized clinical trial.
Source
Diabetes, Obesity and Metabolism. (no pagination), 2025. Date of
Publication: 2025.
Author
Son H.; Sohn S.H.; Kim H.A.; Choe H.J.; Lee H.; Jung H.S.; Cho Y.M.; Park
K.S.; Hwang H.Y.; Kwak S.H.
Institution
(Son, Jung, Cho, Park, Kwak) Division of Endocrinology and Metabolism,
Department of Internal Medicine, Seoul National University Hospital,
Seoul, South Korea
(Sohn, Hwang) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Kim) Division of Endocrinology, Department of Internal Medicine, Veteran
Health Service Medical Center, Seoul, South Korea
(Choe) Division of Endocrinology and Metabolism, Department of Internal
Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South
Korea
(Lee) Department of Internal Medicine, Seoul National University Hospital,
Seoul, South Korea
(Lee) Department of Translational Medicine, Seoul National University
College of Medicine, Seoul, South Korea
(Lee) Genomic Medicine Institute, Medical Research Center, Seoul National
University College of Medicine, Seoul, South Korea
(Cho, Park, Kwak) Divison of Endocrinology and Metabolism, Department of
Internal Medicine, Seoul National University College of Medicine, Seoul,
South Korea
(Kwak) Innovative Medical Technology Research Institute, Seoul National
University Hospital, Seoul, South Korea
Publisher
John Wiley and Sons Inc
Abstract
Background: Effective glycaemic control following cardiac surgery improves
clinical outcomes, and continuous glucose monitoring (CGM) might be a
valuable tool in achieving this objective. We investigated the effect of
real-time CGM and telemonitoring on postoperative glycaemic control in
people with type 2 diabetes (T2D) after coronary artery bypass grafting
(CABG). Method(s): In this randomized clinical trial (RCT), adults
with T2D undergoing CABG were assigned to either a test group utilizing
real-time CGM (Dexcom G6) and telemetry for glycaemic control, or a
control group with blinded CGM measures, relying on point-of-care
measures. The primary outcome was the percentage of time in range (TIR) of
blood glucose between 70 and 180 mg/dL (3.9-10.0 mmol/L), measured by CGM.
 Result(s): Among 91 subjects, 48 were in the test group and 43 were
in the control group. The least squares (LS) mean +/- standard error of
TIR was 60.3 +/- 2.7%, 50.3 +/- 2.9% in the test and control group,
respectively. The test group had significantly higher TIR when adjusted
with age, sex, body mass index, baseline fasting blood glucose and
baseline glycated haemoglobin (LS mean difference, 10.0%; 95% confidence
interval, 2.1-18.0; p = 0.014). The test group also had lower time above
range and mean glucose levels, with no differences in time below range or
hypoglycaemic events. Conclusion(s): In this RCT, real-time CGM and
telemonitoring improved glycaemic control during postoperative period
without increasing hypoglycaemia risk. Given the benefits of effective
glycaemic control on perioperative outcomes, CGM may be helpful in
managing T2D after CABG. Copyright © 2025 John Wiley & Sons Ltd.

<58>
Accession Number
2036913748
Title
Stress Reduction in Perioperative Care: Feasibility Randomized Controlled
Trial.
Source
Journal of Medical Internet Research. 27 (no pagination), 2025. Article
Number: e54049. Date of Publication: 2025.
Author
Kondylakis H.; Giglioli I.A.C.; Katehakis D.; Aldemir H.; Zikas P.;
Papagiannakis G.; Hors-Fraile S.; Gonzalez-Sanz P.L.; Apostolakis K.;
Stephanidis C.; Nunez-Benjumea F.J.; Banos-Rivera R.M.; Fernandez-Luque
L.; Kouroubali A.
Institution
(Kondylakis, Katehakis, Papagiannakis, Apostolakis, Stephanidis,
Kouroubali) FORTH-ICS, Heraklion, Greece
(Giglioli, Aldemir, Hors-Fraile, Gonzalez-Sanz, Fernandez-Luque) Adhera
Therapeutics (United States), Wake Forest, NC, United States
(Zikas) ORamaVR SA, Heraklion, Greece
(Nunez-Benjumea) Innovation & Data Analysis Unit, Institute of Biomedicine
of Seville, IBiS/Virgen Macarena University Hospital, CSIC, University of
Seville, Seville, Spain
(Banos-Rivera) Polibienestar Institute, University of Valencia, Valencia,
Spain
Publisher
JMIR Publications Inc.
Abstract
Background: Patients undergoing surgery often experience stress and
anxiety, which can increase complications and hinder recovery. Effective
management of these psychological factors is key to improving outcomes.
Preoperative anxiety is inversely correlated with the amount of
information patients receive, but accessible, personalized support remains
limited, especially in preoperative settings. Face-to-face education is
often impractical due to resource constraints. Digital health (DH)
interventions offer a promising alternative, enhancing patient engagement
and empowerment. However, most current tools focus on providing
information, overlooking the importance of personalization and
psychological support. Objective(s): This study aimed to assess the
viability of a DH intervention known as the Adhera CARINAE DH Program.
This program is specifically designed to offer evidence-based and
personalized stress- and anxiety-management techniques. It achieves this
by using a comprehensive digital ecosystem that incorporates wearable
devices, mobile apps, and virtual reality technologies. The intervention
program also makes use of advanced data-driven techniques to deliver
tailored patient education and lifestyle support. Method(s): A total
of 74 patients scheduled for surgery across 4 hospitals in 3 European
countries were enrolled in this study from September 2021 to March 2022.
Surgeries included cardiopulmonary and coronary artery bypass surgeries,
cardiac valve replacements, prostate or bladder cancer surgeries, hip and
knee replacements, maxillofacial surgery, and scoliosis procedures. After
assessment for eligibility, participants were randomized into 2 groups:
the intervention group (n=23) received the Adhera CARINAE DH intervention
in addition to standard care, while the control group (n=27) received
standard care alone. Psychological metrics such as self-efficacy,
self-management, and mental well-being were assessed before and after the
intervention, alongside physiological markers of stress. Result(s):
The intervention group demonstrated significant improvements across
several psychological outcomes. For example, Visual Analogue Scale Stress
at the hospital improved at admission by 5% and at hospital discharge by
11.1% and Visual Analogue Scale Pain at admission improved by 31.2%. In
addition, Hospital Anxiety and Depression Scale Anxiety after surgery
improved by 15.6%, and Positive and Negative Affect Scale-Negative at
hospital admission improved by 17.5%. Overall, patients in the
intervention study spent 17.12% less days in the hospital. Besides these
individual scores, the intervention group shows more positive
relationships among the psychological dimensions of self-efficacy,
self-management, and mental well-being, suggesting that the CARINAE
solution could have a positive effect and impact on the reduction of
stress and negative emotions. Conclusion(s): Our results provide an
important first step toward a deeper understanding of optimizing DH
solutions to support patients undergoing surgery and for potential
applications in remote patient monitoring and communication. Copyright
© 2025 JMIR Publications Inc.. All rights reserved.

<59>
Accession Number
2036984973
Title
The Efficacy and Safety of Angiotensin II for Treatment of Vasoplegia in
Critically Ill Patients: A Systematic Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Kotani Y.; Lezzi M.; Murru C.P.; Khanna A.K.; Zarbock A.; Bellomo R.;
Landoni G.
Institution
(Kotani) Department of Intensive Care Medicine, Kameda Medical Center,
Kamogawa, Japan
(Lezzi, Murru, Landoni) Department of Anesthesia and Intensive Care, IRCCS
San Raffaele Scientific Institute, Milan, Italy
(Khanna) Section on Critical Care Medicine, Department of Anesthesiology,
Wake Forest University School of Medicine, Winston-Salem, NC, United
States
(Khanna) Perioperative Outcomes and Informatics Collaborative, Wake Forest
University School of Medicine, Medical Center Boulevard, Winston-Salem,
NC, United States
(Khanna) Outcomes Research Consortium, Houston, TX, United States
(Zarbock) Department of Anesthesiology, Intensive Care Medicine and Pain
Therapy, University Hospital Muenster, Muenster, Germany
(Bellomo) Department of Intensive Care, Austin Hospital, Melbourne,
Australia
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Monash University, Melbourne, Australia
(Bellomo) Department of Critical Care, Melbourne Medical School, The
University of Melbourne, Melbourne, Australia
(Landoni) School of Medicine, Vita-Salute San Raffaele University, Milan,
Italy
Publisher
W.B. Saunders
Abstract
Objectives: To summarize evidence regarding intravenous angiotensin II
administration in critical illness and provide an updated understanding of
its effects on various organ dysfunction and renin-angiotensin system
(RAS) biomarkers. Design(s): A systematic review. Setting(s): A
search of PubMed, Embase, and the Cochrane Library from inception to May
3, 2024. Randomized controlled trials (RCTs), nonrandomized trials,
quasi-randomized trials, observational studies, case reports, and case
series were included. Comparative studies (RCTs and observational studies
with comparator) were used for the main analysis. Participant(s):
Critically ill adults and children. Intervention(s): Intravenous
angiotensin II administration. Measurements and Main Results:
Fifty-nine studies with a total of 2,918 participants (5 RCTs, 15
observational studies, and 39 case reports or case series) were analyzed.
Septic shock and cardiac surgery were the most common clinical conditions
(14 studies for each). In 14 comparative studies (5 RCTs and 9
observational studies), mortality was not different from that in controls,
except in 1 observational study. Several studies reported decreased renal
replacement therapy use, improved oxygenation and blood pressure response,
and decreased rate of myocardial injury with angiotensin II therapy. There
was no increase in thrombotic events or adverse events. Angiotensin II
therapy reduced renin and angiotensin I levels without affecting other RAS
biomarkers. Conclusion(s): Intravenous angiotensin II has been
reported in almost 3000 critically ill patients with diverse types of
shock. Despite unclear mortality impacts, angiotensin II seems to confer
beneficial effects on several organ systems and RAS derangements, without
increasing adverse events. Copyright © 2024 Elsevier Inc.

<60>
Accession Number
646192760
Title
Hypotension after induction of anesthesia with remimazolam or etomidate: a
non-inferiority randomized controlled trial in patients undergoing
coronary artery bypass grafting.
Source
Korean journal of anesthesiology. (no pagination), 2025. Date of
Publication: 03 Jan 2025.
Author
Min J.-J.; Oh E.J.; Hwang H.J.; Jo S.; Cho H.; Kim C.; Lee J.-H.
Institution
(Min, Hwang, Jo, Cho, Kim, Lee) Department of Anaesthesiology and Pain
Medicine, Samsung Medical Centre, Sungkyukwan University School of
Medicine, Seoul, South Korea
(Oh) Anaesthesiology and Pain Medicine, Chung-Ang University College of
Medicine, Chung-Ang University Gwangmyeong Hospital, South Korea
Abstract
Background: Remimazolam is a novel ultra-short-acting benzodiazepine known
for its hemodynamic stability over propofol. However, its hemodynamic
effects compared to those of etomidate are not well established. This
study aimed to determine whether the use of remimazolam is non-inferior to
etomidate with regard to the occurrence of post-induction hypotension in
patients undergoing coronary arterial bypass grafting. Method(s):
Patients were randomly assigned to either the remimazolam group (6 m/kg/h)
or the etomidate group (0.3 mg/kg) for induction of anesthesia. Anesthetic
depth was adjusted based on the bispectral index (BIS). Primary outcome
was the incidence of post-induction hypotension, defined as a mean
arterial pressure (MAP) less than 65 mmHg within 15 min after endotracheal
intubation, with a non-inferiority margin of 12%. Result(s): A total
of 144 patients were finally analyzed. Incidence of post-induction
hypotension was 36 / 71 (50.7%) in the remimazolam group and 25 / 73
(34.2%) in the etomidate group, with a rate difference of 16.5% (95% CI,
3.0-32.6) between the two groups that was beyond the prespecified
non-inferiority margin of 12.0%. The number of patients who needed
vasopressors was similar in the two groups. Conclusion(s): In this
non-inferiority trial, remimazolam failed to show non-inferiority to
etomidate in terms of post-induction hypotension when used as an induction
drug for general anesthesia in patients undergoing coronary arterial
bypass grafting. However, different doses or infusion techniques of
remimazolam must be compared with etomidate in various patient groups to
fully assess its hemodynamic non-inferiority during induction of
anesthesia.

<61>
Accession Number
2036903069
Title
Effect of different intraoperative blood pressure regulation levels on
postoperative myocardial injury in patients undergoing radical mastectomy
for breast cancer after receiving neoadjuvant chemotherapy: a study
protocol for a randomised controlled trial.
Source
BMJ Open. 15(1) (no pagination), 2025. Article Number: e088559. Date of
Publication: 06 Jan 2025.
Author
Zhou Z.; Liu H.; Wang X.; Sang X.; Zhang Y.; Liu Y.; Zhang X.
Institution
(Zhou, Wang, Sang, Zhang) Department of Anesthesiology, The Affiliated
Lianyungang Hospital of Xuzhou Medical University, Jiangsu, Lianyungang,
China
(Liu) Department of Anesthesiology, Guanyun Clinical College, Medical
School of Yangzhou University, Jiangsu, Lianyungang, China
(Zhang) Deapartment of Anesthesiology, The Affiliated Suzhou Hospital of
Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
(Liu) Department of Anesthesiology, Lianyungang Clinical College of
Nanjing Medical University, Jiangsu, Lianyungang, China
(Zhang) Department of Anesthesiology, The First Affiliated Hospital of
Kangda College of Nanjing Medical University, Jiangsu, Lianyungang, China
Publisher
BMJ Publishing Group
Abstract
Introduction For patients with breast cancer receiving preoperative
neoadjuvant chemotherapy with anthracyclines, there is an increased risk
of postoperative myocardial injury due to the cardiotoxicity of the
chemotherapeutic agents. The optimal intraoperative blood pressure
regulation regimen for these patients is unclear. This study is being
conducted to determine whether targeting mean arterial pressure (MAP) to
100%-120% of the patient's baseline blood pressure reduces the incidence
of myocardial injury after non-cardiac surgery (MINS) compared with
targeting MAP to 80%-100%. MINS is defined as elevated cardiac troponin
levels within 30 days after non-cardiac surgery with or without clinical
and electrocardiographic signs of cardiac ischaemia. Methods and analysis
The study is a single-centre, single-blind, prospective randomised
controlled trial. It is expected to enrol 166 subjects receiving
neoadjuvant chemotherapy with anthracyclines, between the ages of 40 and
75 years, scheduled for radical mastectomy. Participants will be
randomised 1:1 to a lower-level group:intraoperative MAP control at
80%-100% of baseline values or a higher-level group:intraoperative MAP
control at 100%-120% of baseline values. The primary outcome is defined by
the incidence of MINS at 6-8 hours, 24 hours and 48 hours postoperatively.
The secondary outcomes are heart-type free fatty acid-binding protein
values at 1-2 hours, 6-8 hours and 24 hours postoperatively; the incidence
of acute kidney injury within 48 hours postoperatively; the Quality of
Recovery-15 score at 24 hours, 48 hours postoperatively; post-anaesthesia
care unit length of stay; other postoperative cardiovascular
complications; the number of times rescue analgesia and antiemetics are
required; the time to first ambulation and length of postoperative
hospitalisation. Ethics and dissemination This study involves the
participation of human subjects and has received approval from the
Clinical Trial Ethics Committee at The Affiliated Lianyungang Hospital of
Xuzhou Medical University (approval number: KY-20230915001). Study results
will be presented at scientific meetings and in scientific publications.
Trial registration number ChiCTR2300077675. Copyright © Author(s)
(or their employer(s)) 2025. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ Group.

<62>
Accession Number
646195500
Title
Individualised acute normovolaemic haemodilution for non-cardiac surgery
with anticipated high-dose red cell transfusion: study protocol for a
randomised controlled trial in West China Hospital of Sichuan University.
Source
BMJ open. 15(1) (pp e088326), 2025. Date of Publication: 02 Jan 2025.
Author
Liao C.; Tan J.; An J.; Zhong J.; Lai X.; Tian L.; Liao R.
Institution
(Liao, An, Zhong, Lai, Tian, Liao) Department of Anesthesia and Operation
Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
(Liao, Zhong, Lai, Liao) Chinese Academy of Medical Sciences (2018RU012),
Chengdu, Sichuan, China
(Tan) Department of Blood Transfusion, West China Hospital of Sichuan
University, Chengdu, Sichuan, China
Abstract
INTRODUCTION: Acute normovolaemic haemodilution (ANH) is a perioperative
blood management technique involving the removal of whole blood and
simultaneous infusion of colloids or crystalloids to achieve haemodilution
while maintaining normovolaemia. However, its efficacy in reducing the
requirement for perioperative allogeneic blood transfusion remains
controversial due to inconsistent findings in the literature. An
individualised red cell transfusion strategy, guided by the West China
Liu's Score, has demonstrated effectiveness in reducing the need for
allogeneic red cell transfusion. Building on this evidence, we propose an
individualised ANH approach and hypothesise that individualised ANH,
guided by the West China Liu's Score, can reduce the requirement for
allogeneic red cells during the perioperative period. METHODS AND
ANALYSIS: This is a single centre, prospective, randomised controlled
trial designed to evaluate the superiority of the individualised ANH,
based on the West China Liu's Score, in reducing perioperative red cell
requirements compared with current clinical practice. Adult patients
undergoing elective non-cardiac surgery with an anticipated red cell
transfusion volume exceeding eight units (or 1600 mL) will be enrolled and
randomly allocated to either the 'ANH group' or the 'Control group' in a
1:1 ratio. The primary outcome is the perioperative consumption of the
allogeneic red blood cells. Data analysis will adhere to the
intent-to-treat principle. ETHICS AND DISSEMINATION: The study protocol
(V.1.0) has been approved by the Biological Medical Ethical Committee of
the West China Hospital of Sichuan University, with approval No. 2024(595)
on 17 April 2024. The results of this trial will be disseminated by
publication in peer-reviewed journals and academic conference
presentations. TRIAL REGISTRATION NUMBER: National Institutes of Health
Clinical Trials Registry, NCT06399536. 2 May 2024. Copyright ©
Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ Group.

<63>
Accession Number
2032868972
Title
Sex and gender in perioperative cardiovascular research: protocol for a
scoping review.
Source
Systematic Reviews. 14(1) (no pagination), 2025. Article Number: 6. Date
of Publication: 01 Dec 2025.
Author
Sjaus A.; Fakhory N.
Institution
(Sjaus) Department of Anesthesia, Pain Management and Perioperative
Medicine, Dalhousie University, IWK Health Centre, 5850 University Avenue,
Halifax, NS, Canada
(Sjaus) Department of Women's and Obstetric Anesthesia, IWK Health Centre,
Halifax, NS, Canada
(Fakhory) Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
Publisher
BioMed Central Ltd
Abstract
Background: The inadequate inclusion of sex and gender in medical research
has resulted in biased clinical guidance and disparities in knowledge and
patient outcomes. Despite efforts by regulatory and funding agencies,
opportunities to generate sex-specific knowledge are frequently
overlooked. While certain disciplines in cardiovascular medicine have made
notable progress, these advances have yet to permeate the literature on
perioperative cardiovascular complications in non-cardiac surgery.
Prompted by the recent findings on sex-specific perioperative
cardiovascular outcomes, this review aims to scope the literature in this
field and categorize methodological approaches used to incorporate sex and
gender in studies of this patient population. Method(s): Joanna
Briggs Institute (JBI) methodology for scoping reviews will be followed in
stages elaborated by Levac (2010). A comprehensive search strategy will be
used to identify relevant primary research published since 2010. Screening
will be performed by independent reviewers using predefined inclusion and
exclusion criteria. Data will be extracted from full text and
supplementary materials of selected articles. Results will be presented as
proportions of studies reporting sex and gender, the assigned purpose of
these variables in analysis, and where they are reported in the article.
In addition, articles will be mapped to the source, country of origin, and
year of publication. Narrative summaries will be provided to outline key
findings and assess the depth of the literature within each of the major
topics (risk assessment/prediction, diagnosis, treatment, prognosis, and
outcomes). Discussion(s): Increasing recognition of the profound and
complex implications of sex and gender in medicine has fuelled calls for
greater attention to participation equity, sex-specific analysis and
reporting. Focusing on perioperative cardiovascular complications, this
review has the potential to identify knowledge gaps for future research,
as well as areas of strength that could support formal knowledge synthesis
or secondary analysis of data from past research. Scoping review
registration: Submitted on August 15th, 2023 (Web of Science
osf.io/u25sf). Copyright © The Author(s) 2025.

<64>
Accession Number
646188800
Title
A meta-analysis of the efficacy and safety of exercise-based cardiac
rehabilitation in patients with left ventricular assist devices.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Abuelazm M.; Ibrahim A.; Amin A.; Khan U.; Rezq H.; Elbenawi H.; Abdelnabi
M.; Shaban M.; Abouzid M.; Abdelazeem B.
Institution
(Abuelazm) Tanta University, Faculty of Medicine, Tanta, Egypt
(Ibrahim) Faculty of Medicine, Menoufia University, Menoufia, Egypt
(Amin) Mansoura University, Faculty of Medicine, Mansoura, Egypt
(Khan) University of Maryland, School of Medicine, Baltimore, United
States
(Rezq) Al-Azhar University, Faculty of Medicine, Cairo, Egypt
(Elbenawi) Mayo Clinic, Cardiovascular Surgery, Rochester, United States
(Abdelnabi) University of Michigan, Ann Arbor, United States
(Shaban) Ain Shams University, Faculty of Medicine, Cairo, Egypt
(Abouzid) Poznan University of Medical Sciences, Poznan, Poland
(Abdelazeem) West Virginia University Hospital, Morgantown, United States
Publisher
Oxford University Press
Abstract
Background: Left Ventricular Assist Devices (LVADs) and heart
transplantation stand out as the two well-established and effective
therapeutic approaches for managing patients with advanced heart failure.
Exercise-based cardiac rehabilitation (EBCR) has been demonstrated to
improve functional capacity in patients with LVAD. Purpose(s): We aim
to assess the efficacy and safety of EBCR in patients with LVAD. Also, to
compare high-intensity (HIT) versus moderate-intensity (MIT) EBCR regimens
in patients with LVAD. Method(s): A systematic review and
meta-analysis synthesizing evidence from randomized controlled trials
(RCTs) studies obtained from PubMed, Embase Cochrane, Scopus, and WOS
until January 2024. We used the fixed-effects model to report dichotomous
outcomes using risk ratio (RR) and continuous outcomes using standardized
mean difference (SMD) with a 95% confidence interval (CI). Result(s):
Six RCTs with 160 patients were included. There was no significant
difference between EBCR and standard care regarding peak VO2 change [SMD:
0.24 with 95% CI (-0.14, 0.62), P= 0.21] and six-minute walk distance
(6-MWD) change [SMD: 0.28 with 95% CI (-0.11, 0.66), P= 0.16]. Also, there
was no significant difference between HIT and MIT exercise regarding peak
VO2 change [SMD: 0.20 with 95% CI (-0.41, 0.82), P= 0.52] and 6-MWD change
[SMD: 0.07 with 95% CI (-0.54, 0.69), P= 0.81]. Moreover, EBCR was
associated with a significant decrease in the incidence of any adverse
events when compared to usual care with [RR: 0.80 with 95% CI (0.65,
0.99), P= 0.04], while there was no significant difference between HIT and
MIT exercise regarding the incidence of any adverse events [RR: 0.38 with
95% CI (0.02, 9.22), P= 0.55]. Conclusion(s): EBCR did not improve
functional capacity in patients with LVAD, with no significant effect on
peak VO2 or 6-MWD. (Figure Presented).

<65>
Accession Number
646186633
Title
Outcomes of CT- or CMR-guided TAVR according to sex: a secondary analysis
of the randomized TAVR-CMR trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Oberhollenzer F.; Lechner I.; Reindl M.; Tiller C.; Holzknecht M.; Von Der
Emde S.; Binder R.K.; Klug G.; Bauer A.; Mayr A.; Reinstadler S.J.;
Metzler B.
Institution
(Oberhollenzer, Lechner, Reindl, Tiller, Holzknecht, Von Der Emde, Bauer,
Mayr, Reinstadler, Metzler) Medical University of Innsbruck, Innsbruck,
Austria
(Binder) Klinikum Wels-Grieskirchen, Department of Internal Medicine II,
Cardiology and Intensive Care, Wels, Austria
(Klug) General Hospital, Department of Internal Medicine, Bruck an der
Mur, Austria
Publisher
Oxford University Press
Abstract
Background: Previous studies have reported sex differences in
pre-procedural imaging characteristics of patients undergoing
transcatheter aortic valve replacement (TAVR) evaluation. Whether these
differences affect the outcome of computed tomography (CT)-guided or
cardiac magnetic resonance (CMR)-guided TAVR has not been studied.
 Objective(s): This analysis aimed to evaluate sex-based differences
in imaging findings and outcomes in patients undergoing TAVR for severe
aortic valve stenosis. Method(s): This was a secondary analysis of
the TAVR-CMR trial, a randomized clinical trial comparing TAVR planning by
CT or CMR. Outcomes (based on the Valve Academic Research Consortium
(VARC)-2 definition) with each imaging strategy were compared according to
sex. Result(s): Of 380 patient randomized into the TAVR-CMR trial,
194 (51.1%) were female and 186 (48.9%) were male. Of these, 267 patients
eventually underwent TAVR (133 women (49.8%) and 134 men (50.2%),
p=0.457). Imaging findings differed between the sexes for both imaging
modalities. The comparison between CT and CMR to assess the access route
and landing zone showed no difference in both women and men (all p>0.05).
Implantation success was not significantly different between imaging
strategies for both women (84.7% (CT group) vs. 93.2% (CMR group), p=0.11)
and men (95.7% (CT group) vs. 93.8% (CMR group), p=0.61). All-cause
mortality at 6 months was not significantly different between imaging
strategies for both women (10.2% (CT group) vs. 8.1% (CMR group), p=0.68)
and men (4.3% (CT group) vs. 9.4% (CMR group), p=0.24).
 Conclusion(s): This secondary analysis has confirmed sex-related
differences in pre-procedural imaging characteristics, with no influence
of the imaging modality used. Similar outcomes were observed in both
female and male patients when the TAVR was guided by either a CMR or a CT
scan.

<66>
Accession Number
646186120
Title
Surgery versus thrombolytic therapy for the management of left-sided
prosthetic valve thrombosis without hemodynamic compromise: a systematic
review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Chopard R.; Vidoni C.; Besutti M.; Ismail M.; Ecarnot F.; Favoulet B.;
Badoz M.; Schiele F.; Perrotti A.; Meneveau N.
Institution
(Chopard, Vidoni, Besutti, Ismail, Ecarnot, Favoulet, Badoz, Schiele,
Perrotti, Meneveau) Regional University Hospital Jean Minjoz, Service de
Pharmacologie - Toxicologie, Besancon, France
Publisher
Oxford University Press
Abstract
Background: The optimal strategy in prosthetic heart valve thrombosis
(PVT) remains controversial, with no randomized trials and conflicting
observational data. Objective(s): To perform a systematic review and
meta-analysis of evidence comparing systemic thrombolysis and cardiac
surgery in PVT. Method(s): We searched for studies on treatment
strategies in patients with left-sided PVT since 2000 in PubMed, Cochrane
and Embase. Primary outcome was mortality, secondary outcomes were major
bleeding, and thrombo-embolism during follow-up. Result(s): We
identified 2,298 studies, of which 16 were included, comprising 1,389
patients with PVT (mean age, 50.4+/-9.3 years, 60.0% were women). Among
them, 67.2% were New York Heart Association Stage III/IV at admission.
Overall, 48.1% were treated with systemic thrombolysis, and 51.9% with
cardiac surgery. Mortality was 10.8% in the thrombolysis group, and 15.3%
in the surgery group (Figure 1). The pooled OR for mortality with systemic
thrombolysis was 0.66 (95% CI, 0.46-0.96; I2 = 36.6%; tau2, 0.428; p =
0.03) versus cardiac surgery. Rates of both transient ischemic attack and
non-central nervous system embolism were higher in the thrombolysis group
(p=0.002 and p=0.02, respectively). Treatment success, major bleeding and
stroke were similar between groups. Sensitivity analysis including studies
that used low dose and/or slow infusion thrombolysis showed that mortality
was lower, and treatment success was higher in patients referred to
systemic thrombolysis, with similar rates of other secondary outcomes.
 Conclusion(s): Thrombolysis seems to be the preferred option for the
management of PVT without cardiogenic shock, pending future RCTs or larger
observational studies.

<67>
Accession Number
646187476
Title
Concomitant left atrial appendage occlusion and transcatheter aortic valve
replacement among patients with atrial fibrillation: an updated systematic
review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Andrade N.; Cumming H.S.; Katsuyama E.S.; Fernandes J.M.; Pinheiro R.P.S.;
Pereira V.J.; Gomes W.F.
Institution
(Andrade, Cumming) Bahiana School of Medicine and Public Health, Salvador,
Brazil
(Katsuyama) Faculdade de Medicina do ABC, Sao Paulo, Brazil
(Fernandes) Albert Einstein Israelite Faculty of Health Sciences, Sao
Paulo, Brazil
(Pinheiro) Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro,
Brazil
(Pereira) Austral University Hospital, Pilar, Argentina
(Gomes) Hospital INC, Interventional Cardiology, Curitiba, Brazil
Publisher
Oxford University Press
Abstract
Background: Atrial fibrillation (AF) is a prevalent arrhythmia in patients
undergoing transcatheter aortic valve replacement (TAVR). Left atrial
appendage occlusion (LAAO) has emerged as a viable strategy to prevent
stroke in selected patients with AF. While both devices can be implanted
simultaneously during a single procedure, the safety and efficacy of this
approach remain uncertain. Purpose(s): This study aims to evaluate
the efficacy and safety of concomitant LAAO in patients with AF and aortic
valve disease undergoing TAVR. Method(s): We conducted a systematic
review and meta-analysis of randomized controlled trials and observational
studies that compared concomitant TAVR and LAAO with isolated TAVR. The
study's primary outcomes were all-cause mortality, stroke or transient
ischemic attack (TIA), and major bleeding. We established a minimum
follow-up time of six months. Result(s): Three studies met our
eligibility criteria, including one randomized controlled trial and two
observational studies. The meta-analysis included 570 patients, 249 (44%)
who underwent LAAO and TAVR, with a mean follow-up of 16.3 months. In the
overall population, there was no significant difference between the groups
in all-cause mortality (relative risk [RR] 0.95; 95% confidence interval
[CI] 0.67-1.35; p = 0.78; figure 1A), major bleeding (RR 1.15; 95% CI
0.75-1.77; p = 0.51; 1B), and stroke or TIA (RR 0.70; 95% CI 0.33-1.45; p
= 0.33; figure 1C). Conclusion(s): In conclusion, concomitant LAAO
and TAVR did not demonstrate discernible clinical differences compared to
isolated TAVR in patients with AF and aortic valve disease. We recommend
that this therapeutic approach be individualized until more robust data
become available.

<68>
Accession Number
646186566
Title
Survival penalty in patients undergoing transcatheter versus surgical
aortic valve replacement: is it just a question of frailty? Insights from
a large cohort with demographic matching.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Boute M.; De Terwangne C.; De Azevedo D.; Gerber B.; Pasquet A.; Pouleur
A.C.; Pierard S.; Maes F.; Kefer J.; De Kerchove L.; Vancraeynest D.
Institution
(Boute, De Azevedo, Gerber, Pasquet, Pouleur, Pierard, Maes, Kefer,
Vancraeynest) Cliniques Saint-Luc UCL, Department of Cardiology, Brussels,
Belgium
(De Terwangne) Cliniques Saint-Luc UCL, Department of Geriatrics,
Brussels, Belgium
(De Kerchove) Cliniques universitaires Saint-Luc, Department of
Cardiovascular and Thoracic Surgery, Brussels, Belgium
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve replacement (TAVR) and surgical
aortic valve replacement (SAVR) are the reference treatments for aortic
stenosis. Conflicting data exist on late survival results of these two
techniques. While randomised controlled trials (with highly selected
patients) assert the non-inferiority of TAVR, real-world data from large
registries (with potential uncorrected confounders) suggest the opposite.
Comparing the survival rates of SAVR and TAVR with those of a matched
reference population could help circumvent potential biases of direct
procedural comparisons and quantify the impact of frailty on
post-operative survival. Purpose(s): Our study aims to compare the
5-year overall survival rates of SAVR, non-frail TAVR, and frail TAVR
patients with the survival of their demographically matched reference
population. Method(s): This study included all consecutive patients
undergoing either SAVR or TAVR at a tertiary hospital between January 2010
and December 2021. Each patient underwent a comprehensive geriatric
assessment by an experienced geriatric team, from which a Clinical Frailty
Scale (CFS) was derived using a validated classification tree. Frailty was
defined as a CFS >= 6, in accordance with ESC guidelines. The patients
were stratified into 3 subgroups: SAVR, non-frail TAVR, and frail TAVR
patients. For each subgroup, a corresponding reference population was
generated using national actuarial tables to ensure individual-level
matching based on age, gender, and year of observation. Survival of each
subgroup was then compared to its corresponding reference population over
a 5-year period using standardized mortality ratios (SMR) and one-sample
logrank tests. Result(s): Our cohort included 1183 SAVR, 254
non-frail TAVR, and 151 frail TAVR patients, with mean ages of 74.1, 85.4,
and 85.7 years, and median EuroSCORE II of 2.0%, 4.2%, and 5.4%,
respectively. Survival of SAVR patients was equivalent to the reference
population (80.1 vs 80.9% survival; SMR = 1.06 [0.89 - 1.25]; p = 0.454;
Figure 1A). Similarly, non-frail TAVR patients also achieved survival
rates comparable to those of the reference population (50.9 vs 54.0%
survival; SMR = 0.94 [0.76 - 1.18]; p = 0.549; Figure 1B). However, frail
TAVR patients faced a significantly reduced survival rate (41.7% vs 54.0%
survival; SMR = 1.48 [1.15 - 1.90]; p < 0.001; Figure 1C). The frailty of
this subgroup could therefore explain a 48% increase in mortality risk
compared with their reference population after 5 years.
 Conclusion(s): Treating non-frail patients with aortic stenosis
through TAVR or SAVR restores life expectancy to levels comparable with
their reference population, challenging results from other real-world
registries. In contrast, TAVR in frail patients is associated with worse
survival, raising the question of treatment futility in this specific
subgroup. Refining the selection of frail patients who may benefit from
TAVR remains an important clinical challenge.

<69>
Accession Number
646187420
Title
Right ventricular global longitudinal strain by cardiac magnetic resonance
feature tracking is associated with outcome in patients with a systemic
right ventricle.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Wustmann K.; Valsangiacomo Buechel E.; Ruperti-Repilado J.; Greutmann M.;
Schwerzmann M.; Bouchardy J.; Rutz T.; Tobler D.; Gabriel H.; Stambach D.;
Schwitter J.; Burkhardt B.
Institution
(Wustmann) German Heart Center Muenchen Technical University of Munich,
Munich, Germany
(Valsangiacomo Buechel, Burkhardt) Children's Hospital Zurich, Zurich,
Switzerland
(Ruperti-Repilado, Tobler) University Hospital Basel, Department of
Cardiology, Basel, Switzerland
(Greutmann) University Hospital Zurich, Zurich, Switzerland
(Schwerzmann) University of Ottawa Heart Institute, Ottawa, Canada
(Bouchardy) University Hospital of Geneva, Geneva, Switzerland
(Rutz, Schwitter) University Hospital Centre Vaudois (CHUV), Lausanne,
Switzerland
(Gabriel) Medical University of Vienna AKH, Vienna, Austria
(Stambach) Cantonal Hospital St. Gallen, St. Gallen, Switzerland
Publisher
Oxford University Press
Abstract
Introduction: It is well known, that patients with a systemic (sub-aortic)
right ventricle (sRV) for congenitally-corrected transposition of the
great arteries (TGA) or with complete TGA after atrial switch operation
are more threatened to develop RV dysfunction, relevant supra- and
ventricular tachycardia and have a reduced life expectancy. While the
randomized, placebo-controlled, double-blinded, multi-centre SERVE trial
to investigate the effect of phosphodiesterase-5 inhibitor tadalafil in
sRV patients showed negative results on the primary end-point RV
endsystolic volume (RVESV), aim of this sub-analysis was to evaluate RV
global longitudinal strain (GLS), a more sensitive measure of RV function,
by cardiac magnetic resonance (CMR) feature tracking (FT) over time, for
treatment effect and to investigate whether RV GLS predicts clinical
outcome in sRV patients. Method(s): CMR volumetric RV and FT
parameters were analysed (blinded for patient and assessment time and
treatment) at baseline and compared to follow-up (FU) after 3 years, or
after 1 year in case of withdrawal of the study drug. FT was performed
using appropriate software. Treatment effect was analysed using ANCOVA
with baseline values and FU-time as covariates. Values of > 4th quartile
of RV GLS were used as cut-off for Kaplan-Meier analysis on the primary
outcome, defined as a composite of all-cause death, clinically relevant
arrhythmias and hospitalisation for heart failure. Result(s): CMR
exams were available for 78 patients at baseline (40+/-11 years, 33%
females) and for 71 patients at FU. No treatment effect of tadalafil
compared to the placebo was discovered for RV GLS (p=0.26), RVESVi
(p=0.63) and RV ejection fraction (RVEF, p=0.6). Over a 3 years FU-time,
RV GLS mildly increased (p=0.0023, figure 1). During FU, 14 patients
experienced a clinical outcome: 1 death, 4 hospitalisations for heart
failure, and 12 clinically relevant arrhythmic events. An RV GLS > -13.4%
was associated with adverse clinical outcome (p=0.003, figure 2).
 Conclusion(s): In patients with a systemic RV, treatment with
Tadalafil had no effect on CMR-derived RV global longitudinal strain
compared to placebo. RV GLS changed significantly over the 3 years
FU-time. A RV GLS value of > -13.4% is associated with adverse clinical
outcome in these patients.

<70>
Accession Number
646188722
Title
Persistent angina following revascularization for chronic coronary
syndromes: a systematic review and meta-analysis of randomized controlled
trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Singh A.; Brown D.L.
Institution
(Singh) Keck School of Medicine of USC, Los Angeles, United States
(Brown) Keck School of Medicine of USC, Division of Cardiovascular
Medicine, Los Angeles, United States
Publisher
Oxford University Press
Abstract
Introduction: Recent randomized clinical trials (RCTs) have demonstrated
that revascularization plus optimal medical therapy for patients with
chronic coronary syndromes (CCS) results in greater reduction in angina
than medical therapy alone. However, the frequency of persistent angina
following revascularization for CCS is not well understood.
 Purpose(s): To quantify the frequency of persistent angina following
revascularization in contemporary RCTs of revascularization plus medical
therapy vs. medical therapy alone among patients with CCS. Method(s):
A literature search through January of 2024 was conducted in PubMed and
Cochrane Central Register of Controlled Trials for contemporary RCTs
reporting angina frequency following randomization to revascularization
plus medical therapy vs. medical therapy alone. The primary outcome of
interest was the frequency of persistent angina in the revascularization
arms of these studies at early (3-12 months) and late (3-5 years) time
points. A random effects model was used to combine results from individual
studies. Result(s): From a total of 5287 citations, the search
yielded 7 RCTs that met inclusion criteria. These studies randomized 5719
patients to an invasive or revascularization strategy. Revascularization
was exclusively by percutaneous coronary intervention (PCI) in 4 studies
and by coronary artery bypass grafting or PCI in 3 studies. At the early
time point, the combined frequency of persistent angina was 39.6% (95% CI:
30.6-49.4). For the two blinded, sham-controlled studies, the rate of
persistent angina was significantly greater at 67.2% (95%CI: 54.9-77.4)
compared to 30.5% (95% CI: 23.1-39) in the unblinded studies (P<0.001). In
the 5 studies with 3-5 years of follow-up, the frequency of persistent
angina was 33.3% (95% CI: 19.2-51.2). Conclusion(s): Persistent
angina is common after revascularization for CCS and suggests alternative
causes and treatments of residual angina should be considered.

<71>
Accession Number
646189300
Title
Association of PCI with outcomes in stable coronary artery disease.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Price J.; Tao M.; Gupta S.; Gier C.; Pastena P.; Ibtida I.; Sharma A.;
Mann N.
Institution
(Price, Tao, Gupta, Gier, Pastena, Ibtida, Sharma, Mann) Stony Brook
University Hospital, Stony Brook, United States
Publisher
Oxford University Press
Abstract
Background: The utility of percutaneous coronary intervention (PCI) in
patients with stable symptomatic coronary artery disease (CAD) remains
unclear. Although there has been recent literature to suggest that PCI may
improve anginal symptoms, studies evaluating the association of PCI with
clinical outcomes compared to optimal medical therapy (OMT) has yielded
conflicting results. Purpose(s): We performed a systematic review and
meta-analysis evaluating the association of PCI compared to OMT with
adverse cardiovascular outcomes in patients with stable CAD.
 Method(s): A literature search was performed using the databases Ovid
MEDLINE, Embase, and Web of Science, identifying studies that evaluated
the association of PCI with clinical endpoints in patients with
symptomatic stable CAD. The primary endpoint was all-cause mortality.
Secondary endpoints were recurrent acute myocardial infarction (AMI),
cerebrovascular accident (CVA), and unplanned coronary revascularization.
The search was not restricted to time or publication status.
 Result(s): A total of 17 studies with 20,389 patients (11,294 PCI,
9095 OMT) met inclusion criteria. Mean follow-up duration was 3.98 years
(ranging from 1 year to 6.5 years), mean age was 63.8, mean ejection
fraction was 59%. All patients had symptomatic CAD with lesion severity
>50%. Compared to OMT, PCI was associated with lower risk of mortality on
short-term (<=1 year) but not long-term (>1 year) follow-up (OR 0.5, 95%
CI 0.29-0.86; p=0.01; OR 0.68; 95% CI 0.42-1.12; p=0.88). PCI was not
associated with lower risk of AMI or need for unplanned coronary
revascularization (OR 1.02; 95% CI 0.73-1.44; p=0.90; OR 0.87; 95% CI
0.51-1.49; p=0.61). There was a trend toward lower risk of CVA in patients
treated with OMT compared to PCI, however this was not statistically
significant (OR 1.46; 95% CI 0.96-2.22; p=0.07). Conclusion(s): The
use of PCI in patients with stable CAD is associated with lower risk of
all-cause mortality on short-term follow-up, however this association was
not seen on long-term follow-up >1 year. PCI was not associated with lower
risk of AMI or unplanned revascularization and may be associated with
increased risk of CVA compared to OMT. Additional high-quality studies are
needed to further associate the utility of PCI in this patient population.

<72>
Accession Number
646187023
Title
Percutaneous coronary intervention versus coronary arterial bypass
grafting in patients with left main coronary artery disease and chronic
kidney disease: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Gialamas I.; Kalogeras K.; Pantelidis P.; Lysandrou A.; Zakynthinos G.;
Lytra T.; Gounaridi M.; Katsarou O.; Roubelakis A.; Oikonomou E.; Siasos
G.; Vavouranakis M.
Institution
(Gialamas, Kalogeras, Pantelidis, Lysandrou, Zakynthinos, Lytra,
Gounaridi, Katsarou, Oikonomou, Siasos, Vavouranakis) National and
Kapodistrian University of Athens Medical School, Third Department of
Cardiology, Athens, Greece
(Roubelakis) Athens Medical center, Department of Cardiothoracic Surgery,
Athens, Greece
Publisher
Oxford University Press
Abstract
Background: Left main coronary artery disease (LMCAD), defined as a
stenosis of >50%, is a potentially lethal condition that should be treated
intensively by either percutaneous coronary intervention (PCI) or coronary
artery bypass grafting (CABG) depending on the anatomy. The presence of
chronic kidney disease (CKD) complicates LMCAD, acting as a potential
worsening factor for this group of patients, as well as impairing the
effectiveness and outcomes of both revascularization treatments.
 Purpose(s): This systematic review and meta-analysis aims to
comprehensively compare the outcomes of PCI and CABG in patients with
LMCAD and CKD. Method(s): A systematic search of the available
literature was conducted in PubMed, Embase, and CENTRAL. Studies that
compared PCI versus CABG in patients with LMCAD and CKD were included. The
primary endpoints comprised major adverse cardiac and cerebrovascular
events (MACCE) and all-cause death, while secondary endpoints included
components of MACCE, such as myocardial infarction (MI), stroke and new
revascularization events. The results were qualitatively and
quantitatively synthesized and pooled hazard ratios (HR) were calculated.
The statistical analysis was conducted in R. Result(s): A total of
767 titles were initially retrieved, with five studies finally included in
the analysis (n = 2,337 patients). The pooled analysis revealed that
patients treated with PCI experienced more MACCE (HR: 1.50, 95% CI:
1.26-1.78, p < 0.001), an outcome primarily driven by MI (HR: 1.75, 95%
CI: 1.17-2.62, p = 0.01) and revascularization rates (Hazard Ratio: 3.66,
95% CI: 1.84-7.30, p < 0.001), while no significant difference was shown
in stroke rates (HR: 0.70, 95% CI: 0.40-1.22, p = 0.21). A trend towards
increased all-cause death was observed for the PCI group, although this
outcome slightly failed to reach statistical significance (HR: 1.30, 95%
CI: 1.00-1.68, p = 0.05). Conclusion(s): The present systematic
review and meta-analysis indicated that PCI appears inferior to CABG in
patients with LMCAD and CKD, with respect to most long-term outcomes. This
includes higher rates of MACCE, and particularly MI and new events of
revascularization for patients undergoing PCI, while all-cause death was
marginally higher for this group. Further randomized controlled trials are
needed to provide more robust evidence for guiding revascularization
strategies in this high-risk population.

<73>
Accession Number
646186088
Title
Association of cardiac amyloidosis with cardiovascular outcomes after
aortic valve replacement in patients with severe aortic stenosis: a
systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Figueira T.; Tao M.; Masson R.; Ibtida I.; Kim P.; Pastena P.; Dusi S.;
Petrancosta J.; Raven M.; Rahman T.; Parikh P.; Mann N.
Institution
(Figueira, Tao, Masson, Ibtida, Kim, Dusi, Petrancosta, Raven, Rahman,
Parikh, Mann) Stony Brook University Hospital, Stony Brook, United States
(Pastena) Harvard Medical School, Boston, United States
Publisher
Oxford University Press
Abstract
Introduction: Aortic stenosis (AS) and cardiac amyloidosis (CA) frequently
coexist and is commonly observed in older individuals referred for aortic
valve replacement (AVR). However, the association of CA with adverse
outcomes after AVR has not been well established. Purpose(s): This
meta-analysis aimed to evaluate the association of CA with adverse
cardiovascular outcomes in patients with severe AS after undergoing AVR.
 Method(s): A literature search was performed for studies evaluating
patients with severe AS undergoing AVR, comparing clinical endpoints on
follow-up for patients with and without CA. The clinical endpoints
included all-cause mortality and heart failure (HF) hospitalization.
Databases searched included Ovid MEDLINE, Embase, and Web of Science.
Subgroup analysis was performed for short term (<30 days) and long term
(>30 days) mortality. The search was not restricted to time or publication
status. Result(s): Five studies including 1,105 patients with severe
AS (111 with concurrent CA, 904 without CA) met inclusion criteria. The
mean follow-up duration was 24.6 months, mean age was 81.2 years and 55.4%
were men. Mean echocardiographic aortic valve parameters included valve
area of 0.715cm2, mean gradient of 41.8 mmHg, and peak velocity of 4.2m/s.
The mean left ventricular ejection fraction was 58%. All except 1 study
included only patients with ATTR CA while excluding other causes of CA.
There was no statistically significant difference in all-cause mortality
between patients with and without CA following AVR, both in short-term (OR
0.94; 95% CI 0.17-5.31; p=0.95) and long-term (OR 1.72; 95% CI 0.75-3.91;
p=0.20) follow-up. However, patients without CA demonstrated a
significantly lower risk of heart failure hospitalization post-AVR
compared to those with CA (OR 2.49; 95% CI 1.18-5.23; p = 0.02).
 Conclusion(s): In the context of patients with severe AS undergoing
AVR, the presence of CA does not appear to significantly impact short-term
or long-term all-cause mortality. Notably, patients without CA exhibited a
lower risk of heart failure hospitalization following AVR. These findings
underscore the importance of considering cardiac amyloidosis in the
clinical management of severe AS and highlight potential differences in
outcomes based on its presence or absence. Additional studies are needed
to elucidate outcome differences for CA patients who undergo surgical
versus transcatheter AVR.

<74>
Accession Number
646187663
Title
Baseline right ventricular-pulmonary artery uncoupling and mortality
following transcatheter aortic valve replacement: a meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Theofilis P.; Mantzouranis E.; Vlachakis P.K.; Sakalidis A.;
Soulaidopoulos S.; Tsioufis K.
Institution
(Theofilis, Mantzouranis, Vlachakis, Sakalidis, Soulaidopoulos, Tsioufis)
Hippokration General Hospital, Athens, Greece
Publisher
Oxford University Press
Abstract
Background: In severe aortic stenosis (AS) patients, elevated left-sided
filling pressures can lead to pulmonary hypertension and right ventricular
(RV) systolic dysfunction. These conditions signal advanced disease and
predict poor outcomes in transcatheter aortic valve replacement (TAVR)
cases. However, recent studies indicate potential recovery post-TAVR, with
improved prognosis. The newly recognized index, RV to pulmonary artery
(RV-PA) coupling, reflects the RV's ability to handle pulmonary afterload
and is associated with adverse outcomes. Purpose(s): This study aimed
to delineate the prognostic role of baseline RV-PA uncoupling in patients
undergoing TAVR. Method(s): We conducted a systematic literature
search for studies assessing RV-PA coupling indices at baseline in
patients undergoing TAVR. We recorded the year of publication, method of
RV-PA assessment, the proposed cutoffs, patients' age-sex, and follow-up
duration. The primary outcome of interest was all-cause mortality at
maximal follow-up and the adjusted hazard ratios of RV-PA uncoupling for
all-cause mortality were extracted. Pooling of the hazard ratios was
conducted according to a random effects model. I2 was chosen as the
measure of between-study heterogeneity, with values exceeding 50% being
significant. Result(s): We identified a total of 316 studies, of
which 5 were ultimately selected for data extraction and inclusion in the
meta-analysis after screening of title/abstract/full-text. All but one
study utilized the Tricuspid Annular Plane Systolic Excursion/Pulmonary
artery systolic pressure (TAPSE/PASP) as the method of RV-PA assessment.
The mean age of the participants across the studies was approximately 81
years old, with a balanced male:female ratio. The median follow-up
duration was 23 months (range: 6-40 months). According to the results of
the meta-analysis, the presence of baseline RV-PA uncoupling was
associated with a 2.8-fold increased risk of all-cause mortality at
maximal follow-up (Figure). Significant between-study heterogeneity was
detected. An asymmetric funnel plot was inspected, indicative of
publication bias (Egger's test intercept: 6.76, 95% confidence interval
5.07-8.44, p=0.004). The results, although attenuated, remained
significant even after a trim-and-fill analysis (3 studies added, hazard
ratio: 1.27, 95% confidence interval: 0.03-2.51, p=0.04). Furthermore, the
results were unaffected following a sensitivity analysis with the
leave-one-out method. Conclusion(s): This meta-analysis suggests that
baseline RV-PA uncoupling prior to TAVR is associated with all-cause
mortality and it could serve as an imaging biomarker of prognosis in this
patient population.

<75>
Accession Number
646186651
Title
Mortality rates in patients undergoing urgent versus elective
transcatheter aortic valve replacement: a systematic review and
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Apostolos A.; Ktenopoulos N.; Chlorogiannis D.-D.; Konstantinou K.;
Katsaros O.; Drakopoulou M.; Tsalamandris S.; Karanasos A.; Latsios G.;
Synetos A.; Aggeli C.; Panoulas V.; Tsioufis C.; Toutouzas K.
Institution
(Apostolos, Ktenopoulos, Katsaros, Drakopoulou, Tsalamandris, Latsios,
Synetos, Aggeli, Tsioufis, Toutouzas) National and Kapodistrian University
of Athens Medical School, Athens, Greece
(Chlorogiannis) Massachusetts General Hospital, Harvard Medical School,
Department of Interventional Radiology, Boston, United States
(Konstantinou, Panoulas) Royal Brompton and Harefield NHS Foundation
Trust, Greater London, United Kingdom
(Karanasos) University Hospital of Patras, Rio-Patras, Greece
Publisher
Oxford University Press
Abstract
Background: Patients with severe aortic stenosis (AoS) often present with
acute heart failure and compensation, leading frequently to cardiogenic
shock. Transcatheter Aortic Valve Replacement (TAVR) has been recently
performed as a bailout treatment in such patients. The aim of our
meta-analysis is to compare urgent TAVR to elective procedures.
 Method(s): We systematically screened three databases searching for
studies comparing urgent versus elective TAVR. Primary endpoint is the
30-days mortality. Secondary endpoints included in-hospital mortality,
device success, periprocedural vascular complications, 30-day stroke,
30-day acute kidney injury (AKI), permanent pacemaker implantation (PPM),
moderate or severe paravalvular leakage and 30-day bleedings.
 Result(s): Seventeen studies were included, with a total of 84,495
patients. Urgent TAVR was associated with an increased risk for 30-days
mortality (RR: 2.53, 95% CI: 1.81 - 3.54), in-hospital mortality (RR:
2.67, 95% CI: 1.94 - 3.68), periprocedural vascular complications (RR:
1.91, 95% CI: 1.28 - 2.85) and AKI (RR: 2.83, 95% CI: 1.93 - 4.14),
compared to elective procedure. No differences were observed in the rest
secondary endpoints. Conclusion(s): Urgent TAVR was associated with
higher in-hospital and 30-day mortality, possibly driven by the increased
incidence of AKI and vascular complications in urgent TAVR. The results
highlight the importance of early TAVR in stable AoS patients.

<76>
Accession Number
646189021
Title
A randomized, double-blind, placebo-controlled, mechanistic trial on the
safety, tolerability and pharmacodynamics of ninerafaxstat in patients
with angina and chronic coronary syndrome.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Knuuti J.; Nielsen R.R.; Bax J.J.; Gormsen L.C.; Flachskampf F.; Jensen
R.V.; Jespersen C.W.; Johnston N.; Dehbi H.M.; Chamberlin P.; Pryds K.;
Sorensen J.; Held C.; Loimaala A.; Saraste A.
Institution
(Knuuti, Saraste) Turku University Hospital, Turku PET Centre, University
of Turku, Turku, Finland
(Nielsen) Department of Cardiology, Aarhus, United States
(Bax) Leiden University Medical Center, Department of Cardiology, Leiden,
Netherlands
(Gormsen) Aarhus University Hospital, Department of Nuclear Medicine and
PET, Aarhus, Denmark
(Flachskampf) Uppsala University, Uppsala, Sweden
(Jensen, Pryds) Aarhus University Hospital, Department of Cardiology,
Aarhus, Denmark
(Jespersen) Aarhus University Hospital, Aarhus N, Denmark
(Johnston) Uppsala University, Department of Medical Sciences, Uppsala,
Sweden
(Dehbi) University College London, Comprehensive Clinical Trials Unit,
London, United Kingdom
(Chamberlin) Imbria Pharmaceuticals, Boston, United States
(Sorensen) Uppsala University, Department of Surgical Sciences, Nuclear
Medicine and PET, Uppsala, Sweden
(Held) Uppsala University, Uppsala Clinical Research Centre, Uppsala,
Sweden
(Loimaala) Helsinki University Hospital, Department of Cardiology, Heart
and Lung Center, Helsinki, Finland
Publisher
Oxford University Press
Abstract
Background/Introduction: Symptoms of angina resulting from reversible
myocardial ischemia in chronic coronary syndromes have a negative impact
on quality of life. Metabolic alterations are a key feature of ischemia,
including reduced ATP generation by mitochondrial oxidative
phosphorylation, NAD+ depletion, anaerobic glycolysis, proton & lactate
accumulation leading to contractile dysfunction. Ninerafaxstat is a novel
cardiac mitotrope that shifts metabolism from fatty acids towards glucose
utilization, optimizing myocardial energy production during ischemia.
 Purpose(s): We aimed to investigate the safety, tolerability, impact
on myocardial glucose utilization and preliminary anti-ischemic efficacy
of ninerafaxstat administered for 8 weeks to patients with symptomatic
chronic stable angina who were on anti-anginal therapy and had evidence of
myocardial stress hypoperfusion using 15O-H2O PET imaging. Method(s):
IMPROVE-Ischemia was an international, randomized, double-blind,
placebo-controlled mechanistic trial comparing ninerafaxstat vs. placebo
in patients with symptomatic chronic coronary syndrome. The primary
endpoint was the safety and tolerability of ninerafaxstat. Key efficacy
evaluations were undertaken at baseline and end-of-treatment (Week 8)
including imaging core laboratory assessments of 15O-H2O PET perfusion
rest and stress imaging to quantify absolute myocardial blood flow (MBF),
dobutamine stress echo with contrast for evaluation of LV contractile
response during demand stress using the wall motion score index (WMSI)
and, in a subgroup of subjects, 18F-FDG-PET imaging of myocardial glucose
metabolism. Result(s): The study randomized 58 subjects (mean age
68.6+/-7.1 years) with symptomatic stable angina and inducible
hypoperfusion from 4 sites across 3 countries (Denmark, Finland, Sweden).
22% had type 2 diabetes and 50% had undergone percutaneous and/or surgical
coronary revascularization. The majority (68%) were on >=2 (up to 4)
regular anti-anginals. Ninerafaxstat was well tolerated without impact on
systemic hemodynamics. At Week 8, ninerafaxstat significantly increased
myocardial glucose utilization and, in those with dobutamine-induced
deterioration in wall motion at baseline assessment (n=25, pre-specified
subgroup), resulted in a ~50% improvement in mean and peak stress WMSI,
without altering rest or hyperemic stress MBF (Table 1). Conclusion(s):
Treatment with ninerafaxstat was well-tolerated and showed a neutral
hemodynamic profile. Ninerafaxstat significantly increased myocardial
glucose utilization consistent with its mechanism of action and improved
myocardial contractile response to dobutamine stress in subjects with
baseline stress inducible deterioration of wall motion. These findings
support a direct, metabolically-mediated, anti-ischemic effect of
ninerafaxstat on top of existing anti-anginal agents, supporting its
further development in cardiac pathologies characterised by ischemia.

<77>
Accession Number
646186249
Title
Association of cardiac amyloidosis with periprocedural complications in
patients with severe aortic stenosis undergoing transcatheter aortic valve
replacement: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Figueira T.; Tao M.; Ibtida I.; Masson R.; Zhang D.; Sharma A.; Kim P.;
Pastena P.; Gavalas M.; Goldschmidt M.; Tam E.
Institution
(Figueira, Tao, Ibtida, Masson, Zhang, Sharma, Kim, Gavalas, Goldschmidt,
Tam) Stony Brook University Hospital, Stony Brook, United States
(Pastena) Harvard Medical School, Boston, United States
Publisher
Oxford University Press
Abstract
Introduction: Cardiac amyloidosis (CA) has been frequently observed in
patients with aortic stenosis (AS). While transcatheter aortic valve
replacement (TAVR) may be an option, the association of CA with risk of
periprocedural complications has not been well evaluated. Purpose(s):
This study aimed to evaluate the association of CA with periprocedural
complications after TAVR in patients with severe AS. Method(s): A
literature search was performed for studies evaluating patients with
severe AS undergoing AVR, comparing periprocedural safety endpoints for
patients with and without CA. The primary endpoints were vascular
complications and bradyarrhythmias post-TAVR requiring permanent pacemaker
(PPM) implantation. Secondary endpoints included periprocedural acute
kidney injury (AKI), cerebrovascular accidents (CVA), and major bleeding
events. Endpoints were defined using the Valve Academic Research
Consortium-2 criteria. The search was not restricted to time or
publication status. Result(s): 6 studies with 1,138 patients with
severe AS (150 with CA, 988 without CA) met inclusion criteria. Mean age
was 82 years, 52.4% were men, all except 1 study assessed only patients
with ATTR CA. Echocardiographic mean aortic valve parameters included
valve area of 0.718 cm2, mean gradient of 40.8, and peak velocity of 4.13
m/s. The mean left ventricular ejection fraction was 55.2%. The presence
of CA was not associated with an increased risk of periprocedural vascular
complications (OR 0.69, 95% CI 0.25-1.88; p=0.47). While a trend toward
higher risk of periprocedural PPM implantation was observed in patients
with CA, this finding did not reach statistical significance (OR 1.51; 95%
CI 0.77-2.94; p=0.23). The presence of CA was not associated with
increased risk of periprocedural AKI, CVA, or major bleeding (OR 1.3, 95%
CI 0.32-5.3; p=0.72, OR 0.65, 95% CI 0.17-2.41; p=0.52; OR 0.55, 95% CI
0.16-1.87; p=0.34). Conclusion(s): In the context of patients with
severe AS undergoing TAVR, the presence of cardiac amyloidosis did not
increase the risk of periprocedural complications, including vascular
complications, AKI, CVA, or major bleeding. Although a trend toward a
higher risk of bradyarrhythmias requiring PPM implantation was noted in
patients with CA, further studies are warranted to confirm this
observation. Overall, these findings contribute valuable insight into the
safety profile of TAVR in the patients with CA.

<78>
Accession Number
646186677
Title
Rotational atherectomy versus orbital atherectomy for the treatment of
calcified coronary lesions: a systematic review and meta-analysis of
81,873 patients.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Altobaishat O.; Abuelazm M.; Amin A.M.; Tanashat M.; Turkmani M.; Manasrah
A.; Sharaf I.; Abouzid M.
Institution
(Altobaishat) Jordan University of Science and Technology, Faculty of
Medicine, Irbid, Jordan
(Abuelazm, Sharaf) Tanta University, Faculty of Medicine, Tanta, Egypt
(Amin) Mansoura University, Faculty of Medicine, Mansoura, Egypt
(Tanashat) Yarmouk University, Faculty of Medicine, Irbid, Jordan
(Turkmani) Michigan State University, Internal Medicine, East Lansing,
United States
(Manasrah) Mayo Clinic, Rochester, United States
(Abouzid) Poznan University of Medical Sciences, Department of Physical
Pharmacy and Pharmacokinetics, Poznan, Poland
Publisher
Oxford University Press
Abstract
Background: Previous studies have suggested that pre-treatment of coronary
artery calcification with rotational atherectomy (RA) prior to stent
deployment can enhance procedural success, but this does not necessarily
translate into improved clinical outcomes. Recently, the Orbital
Atherectomy (OA) system has been introduced into clinical practice to
enhance lesion preparation. Purpose(s): Our study aims to evaluate
the safety and efficacy of both RA and OA as pre-treatment strategies
before stent deployment in patients with coronary artery calcification.
 Method(s): We conducted a comprehensive systematic review and
meta-analysis of randomized controlled trials (RCTs) and observational
studies. These were identified through systematic PubMed, Web of Science,
Scopus, Embase, and Cochrane searches until January 2024. Dichotomous data
were pooled using risk ratio (RR), and continuous data were pooled using
mean difference (MD), both with a 95% confidence interval (CI), using
Stata version 17. Result(s): Our analysis included eleven studies
encompassing 81,873 patients. No significant difference was observed
between RA and OA in terms of major adverse cardiovascular events (MACE)
(RR: 0.81 with 95% CI [0.64, 1.02], P= 0.07). However, OA was
significantly associated with a decreased incidence of all-cause mortality
(RR: 0.60 with 95% CI [0.52, 0.70], P< 0.01), target vessel
revascularization (TVR) (RR: 0.43 with 95% CI [0.22, 0.82], P= 0.01),
coronary artery bypass grafting (CABG) (RR: 0.78 with 95% CI [0.62, 0.97],
P= 0.03), and fluoroscopy time (MD: -3.93 with 95% CI [-7.39, -0.48], P=
0.03). There was no significant difference between RA and OA in cardiac
death (RR: 2.65 with 95% CI [0.94, 7.51], P= 0.07), target lesion
revascularization (TLR) (RR: 0.57 with 95% CI [0.23, 1.41], P= 0.22),
myocardial infarction (RR: 0.79 with 95% CI [0.62, 1.01], P= 0.06), stent
thrombosis (RR: 0.33 with 95% CI [0.09, 1.23], P= 0.10), stroke (RR: 0.76
with 95% CI [0.57, 1.01], P= 0.06), re-admission (RR: 0.76 with 95% CI
[0.48, 1.19], P= 0.23), vessel closure (RR: 0.78 with 95% CI [0.18, 3.33],
P= 0.74), procedural duration (MD: -5.43 with 95% CI [-21.71, 10.84], P=
0.51), length of hospital stay (MD: 0.21 with 95% CI [-0.47, 0.90], P=
0.54), and contrast amount (MD: -3.68 with 95% CI [-9.37, 2.01], P= 0.21).
 Conclusion(s): Both RA and OA as pre-treatment strategies before
stent deployment demonstrate similar outcomes for numerous cardiovascular
events. However, OA is associated with lower rates of all-cause mortality,
TVR, CABG, and fluoroscopy time.

<79>
Accession Number
646188585
Title
Long-term survival after coronary artery bypass grafting comparing
bilateral versus single internal mammary artery in a women cohort.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Sousa I.; Cerqueira R.; Diaz S.; Ferreira A.F.; Amorim M.J.; Pinho P.;
Lourenco A.P.; Barros A.S.; Saraiva F.; Leite-Moreira A.
Institution
(Sousa, Diaz, Ferreira, Barros, Saraiva) Faculty of Medicine University of
Porto, UnIC RISE, Department of Surgery and Physiology, Porto, Portugal
(Cerqueira, Leite-Moreira) Faculty of Medicine, University of Porto,
Department of Cardiothoracic Surgery, Porto, Portugal
(Amorim, Pinho) Sao Joao University Hospital Centre, Department of
Cardiothoracic Surgery, Porto, Portugal
(Lourenco) Faculty of Medicine, University of Porto, UnICatRISE/Department
of Anaesthesiology, Porto, Portugal
Publisher
Oxford University Press
Abstract
Introduction: Although neutral results from the ART randomized controlled
trial, observational studies have been supporting better survival after
bilateral internal mammary artery (BIMA) vs single internal mammary artery
(SIMA) coronary artery bypass grafting (CABG). However, for some specific
subgroups, like women patients, more doubts remain about BIMA benefits.
 Aim(s): To compare long-term survival and early results in women
after SIMA vs BIMA. Method(s): Longitudinal, retrospective,
single-center study including consecutive women with at least 2
left-coronary system (LCS) vessel disease who underwent primary isolated
CABG with at least 1 internal mammary artery (IMA) conduit and a minimum
of 2 conduits targeting the LCS, between 2004-2014. Emergent or salvage
surgeries, on-pump beating-heart, BIMA in which 1 IMA targeted the right
coronary artery territory were excluded. The primary outcome was
all-causes mortality (checked on February 2023). Time-to-event outcomes
were studied using Kaplan-Meier Curves, Log-Rank test and multivariable
Cox Regression. Median follow-up was 11 years, maximum of 19 years.
 Result(s): From 539 women selected for this study, BIMA CABG was
performed in 30%. SIMA patient's were older (mean age 68.95+/-8.39 vs
62.75+/-9.82 years, p<0.001), but the prevalence of cardiovascular risk
factors were similar between groups (arterial hypertension, p=0.693;
dyslipidemia, p=0.111; diabetes mellitus, p=0.462 and obesity, p=0.109).
Peripheral artery disease (p=0.707), left ventricular dysfunction
(p=0.727), cerebrovascular disease (p=0.730), active smoking habits
(p=0.05) and chronic obstrutive pulmonary disease (p=0.537) were also
similar. Severe chronic kidney disease (27% vs 14%, p<0.001) and Canadian
Coronary Society - grade IV (74% vs 63%, p=0.011) were more frequent in
SIMA group. In the univariable survival analysis, SIMA had worse survival
results than BIMA (Log Rank test p<0.01). At 5-, 10- and 15- years of
follow-up, cumulative survival for SIMA vs BIMA were 88% vs 90%, 68% vs
75%, 42% vs 58%, respectively. However, the multivariable Cox regression
showed that BIMA was not associated with long-term survival (HR [95%CI]:
1.09 [0.75-1.59], p=0.6). Most of post-operative outcomes were similar
between groups, with the exception of atrial fibrilation (25% vs 16%,
p=0.031) and time to discharge (median days [min-max]: 7 [4-128] vs 7
[4-59]) that were higher in SIMA. No differences were found in immediate
reexploration of thorax (sternal infection - 0.3% SIMA vs 1.2% BIMA,
p=0.219; bleeding- 1.6% SIMA vs 0.6% BIMA, p=0.681). Redo CABG occurred in
1 SIMA and 1 BIMA women, at 41 and 84 months of follow-up, respectively.
 Conclusion(s): In this study, revascularization with BIMA seems to be
safe in women and provides similar results than SIMA. More studies in
women are needed to establish the better approach for this specific
subgroup. (Figure Presented).

<80>
Accession Number
646187715
Title
Intracardiac vs transesophageal echocardiography for percutaneous LAA
occlusion: a meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Beneki E.; Dimitriadis K.; Soulaidopoulos S.; Pyrpyris N.; Dri E.; Iliakis
P.; Sakalidis A.; Koutsopoulos G.; Tsioufis P.; Kostakis P.; Theofilis P.;
Aznaouridis K.; Aggeli K.; Tsioufis K.
Institution
(Beneki, Dimitriadis, Soulaidopoulos, Pyrpyris, Dri, Iliakis, Sakalidis,
Koutsopoulos, Tsioufis, Kostakis, Theofilis, Aznaouridis, Aggeli,
Tsioufis) Hippokration General Hospital, Athens, Greece
Publisher
Oxford University Press
Abstract
Background: Percutaneous left atrial appendage occlusion (LAAO) is
typically performed under the guidance of transesophageal echocardiography
(TEE) and fluoroscopy. Intracardiac echocardiography (ICE) appears to be a
potential alternative to guide implantation. Purpose(s): We sought to
perform a meta-analysis comparing ICE and TEE for endocardial LAAO.
 Method(s): A comprehensive literature search was performed in PubMed
and Google Scholar regarding published abstracts and manuscripts on July
1, 2023. Studies reporting clinical outcomes comparing ICE vs TEE for
endocardial LAAO were included. Result(s): A total of 16 studies with
123,444 patients (ICE-5,122 patients and TEE-122,667 patients) (mean age
75+/-4 years, 59%male) fulfilled the criteria. Five included Watchman,
four included the Amplatzer Cardiac Plug/ Amulet device, and seven
included both devices. There was no significant difference in CHA2DS2VASC
or HAS-BLED scores between both groups. Outcomes assessed including
procedural success between ICE vs TEE (risk ratio [RR], 1.01; 95% CI,
1.00-1.01), fluoroscopy time (mean difference [MD], 1.25 minutes; 95% CI,
-1.63- 4.14) and total procedure time (MD, -3.74 minutes; 95% CI, -
13.42-5.94) were found to be similar between both groups. There was also
no significant difference in complications including vascular
complications, bleeding events, device embolization, and stroke between
both groups. Of note, patients undergoing LAA closure under ICE guidance
had higher risk for pericardial effusion and/or cardiac tamponade compared
to those in the TEE group (RR 1.72; 95% CI, 1.32-2.23).
 Conclusion(s): Although TEE is the gold standard for perioperative
guidance of LAAO, imaging with ICE is a feasible alternative associated
with similar efficacy outcomes in LAAO procedures. However, further
studies needed to clarify safety of ICE as an alternative perioperative
imaging technique.

<81>
Accession Number
646188144
Title
LV reverse remodeling after SAVR in patients with severe symptomatic
aortic stenosis: impact on the clinical outcome.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Lima M.R.L.; Abecasis J.A.; Reis Santos R.R.S.; Maltes S.M.; Guerreiro
S.G.; Freitas P.F.; Ferreira A.F.; Ribeiras R.R.; Andrade M.J.A.; Madeira
M.M.; Ramos S.R.; Sousa Uva M.S.U.; Adragao P.A.
Institution
(Lima, Abecasis, Reis Santos, Maltes, Guerreiro, Freitas, Ferreira,
Ribeiras, Andrade, Madeira, Ramos, Sousa Uva, Adragao) Hospital Santa
Cruz, Lisbon, Portugal
Publisher
Oxford University Press
Abstract
Introduction: Surgical aortic valve replacement (SAVR) is the treatment of
choice for young patients with severe aortic stenosis (AS) and low
surgical risk. Left ventricular (LV) reverse remodeling (RR) after surgery
is expected to occur. However, this is not always the case following
afterload relief, and this may impact the prognosis. We aimed to assess
the prognostic effect of distinct definitions of LV RR after SAVR in the
long-term outcome of patients with severe AS. Method(s):
Single-centre prospective study including patients referred for SAVR due
to severe symptomatic AS, with no previous history of ischemic
cardiomyopathy. Both pre- and post-operative transthoracic
echocardiographic (TTE) and cardiac magnetic resonance (CMR) study (at the
3rd to 6th month after SAVR) were performed. LV RR was defined when in
presence of at least one of the imaging criteria: >15% decrease in
end-diastolic volume (EDV) by CMR; >15% decrease in LV indexed mass (LVM)
by CMR; >10% decrease in geometric remodeling (LV mass/EDV ratio) by CMR;
>10% increase in LV ejection fraction (LVEF) by CMR; >50% increase on
global longitudinal strain (GLS) by TTE. We assess the prognostic value of
RR definitions for the outcome after SAVR using Cox regression and
Kaplan-Meier analysis. The primary endpoint was defined as all-cause
mortality, heart failure (HF) hospitalization or worsening HF.
 Result(s): We enrolled 140 patients - mean age 71+/-9 years-old, 49%
male, predominantly high-gradient-normal flow AS (mean gradient 65
+/-18mmHg, aortic valve area 0.7+/-0.2cm2, index stroke volume
47+/-11mL/m2) submitted to SAVR. At a mean follow-up (FUP) of 34+/-12
months, 23 (16%) patients met the primary endpoint: 4% (5 patients) died
immediately after surgery; three patients died at the FUP (overall
mortality rate of 6%). 12 patients (9%) were admitted for HF and 7 (5%)
had at least one episode of worsening HF. 118 patients had complete pre
and post-surgery imaging study (mean FUP: 36+/-10 months): 103 patients
(87%) had at least one RR parameter (Table 1). Post-operative RR was not
independently associated with the clinical outcome (Figure 1A). LVM was
the sole independent predictor of the outcome at univariate analysis
(Figure 1B-F). Conclusion(s): LV RR after SAVR is highly prevalent in
a cohort of patients with classical severe symptomatic AS. However, only
LVM regression independently predicts the clinical outcome after surgery.
This may stand the greater importance of structural reverse remodeling,
rather than LV functional improvement, after pressure overload relief.

<82>
Accession Number
646185884
Title
Unlocking the future: machine learning models for predicting in-hospital
mortality after transcatheter aortic valve replacement: a single-arm
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Ahmed H.; Mahmoud Ismayl M.I.; Manvir Mangat M.M.; Anirudh Palicherla
A.P.; Rama Ellauzi R.E.; Ruth Ann Kalathil R.K.; Suma Pusapati S.P.; Jalal
Dufani J.D.; Ahmed Aboeata A.A.; Nandan Anavekar N.A.; Andrew Goldsweig
A.G.
Institution
(Ahmed, Anirudh Palicherla, Ruth Ann Kalathil, Suma Pusapati, Jalal
Dufani, Ahmed Aboeata) Creighton University Medical Centre, Omaha, United
States
(Mahmoud Ismayl, Nandan Anavekar) Mayo Clinic, Department of
Cardiovascular Medicine, Rochester, United States
(Manvir Mangat) Trinity School of Medicine, Warner Robbins, United States
(Rama Ellauzi) Henry Ford Hospital, Detroit, United States
(Andrew Goldsweig) Baystate Medical Center, Springfield, United States
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve replacement (TAVR) continues to be
increasingly performed. While machine learning has demonstrated utility in
predicting adverse outcomes in various cardiovascular procedures, its
effectiveness in predicting in-hospital mortality in TAVR remains
uncertain. Purpose(s): We aimed to examine the accuracy of machine
learning in predicting in-hospital mortality in TAVR. Method(s): We
searched PubMed and Cochrane databases up to February 2024 for
observational studies assessing the diagnostic accuracy of machine
learning for predicting in-hospital mortality in TAVR. Extracted data
included study characteristics, patient demographics, type of predictive
model used, and area under the receiver operating characteristic curves
(AUC). Predictive accuracy was assessed by pooling AUC of machine-learning
models across studies. AUC values ranging from 0.80 to 0.90, 0.70 to 0.80,
0.60 to 0.70, and 0.50 to 0.60 corresponded to excellent, good, fair, and
poor discrimination ability, respectively (1). We used a random effects
model to estimate the overall effect size with a 95% confidence interval
(CI). Heterogeneity was evaluated with the I2 test.We conducted subgroup
analyses based on the type of machine-learning model utilized to assess
for any potential differences in predictive accuracy. Result(s): A
total of three studies were identified, comprising a study population of
70,714 patients. Across studies, eight machine learning models were
utilized, consisting of three artificial neural network models, one
logistic regression model, one naive Bayes model, two random forest
models, and one support vector machine model. Pooled AUC showed excellent
accuracy of machine learning in predicting in-hospital mortality in TAVR
(0.92; 95% CI 0.90 - 0.95). Subgroup analyses revealed similar yet
excellent accuracy across all types of machine learning models utilized:
artificial neural network (0.92; 95% CI 0.86-0.99), logistic regression
(0.92; 95% CI 0.89-0.95), naive Bayes (0.90; 95% CI 0.88-0.92), random
forest (0.94; 95% CI 0.87-1.00), and support vector machine (0.94; 95% CI
0.91-0.96). Conclusion(s): Our study suggests that utilizing machine
learning can accurately predict in-hospital mortality in TAVR. Operators
of TAVR procedures may benefit from incorporating machine learning
prediction models in their clinical practice. Further exploration of
machine learning on outcomes in TAVR is needed to verify our findings.

<83>
Accession Number
646185620
Title
Transcatheter aortic valve implantation in failed bioprosthetic or native
valves: a systematic review and meta analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Kaddoura R.; Dakhil Z.; Ahmed A.; Al-Hijji M.
Institution
(Kaddoura, Al-Hijji) Hamad Medical Corporation Heart Hospital, Doha, Qatar
(Dakhil) Ibn Al-Bitar Hospital Specialized Cardiac Surgery Center,
Baghdad, Iraq
(Ahmed) Yale New Haven Health Bridgeport Hospital, Internal Medicine,
Bridgeport, United States
Publisher
Oxford University Press
Abstract
Background and purpose: Currently, there is no comparative assessment of
pooled clinical outcomes between valve-in-valve (ViV) transcatheter aortic
valve implantation (TAVI) for either failed transcatheter or surgical
bioprosthetic aortic valves (TAV or SAV) and native aortic valve TAVI
(NV-TAVI) for aortic stenosis. Thus, this systematic review investigated
the clinical outcomes of ViV-TAVI compared with NV-TAVI. Method(s): A
meta-analysis was conducted according to Cochrane Handbook and the PRISMA
statement. A systematic literature search was performed, using EMBASE and
MEDLINE from inspection to December 25, 2023, to explore the comparative
outcomes between ViV-TAVI and NV-TAVI. RStudio software was used to
calculate pooled odds ratio (OR) with 95% confidence intervals (CI).
Random-effects model was used to allow a more conservative assessment.
 Result(s): Eighteen cohort studies (n=65,350) met eligibility
criteria. Studies were categorized into 2 groups according to initially
implanted bioprosthetic valve: TAV-in-TAV (5 studies, n=14490) and
TAV-in-SAV implantation (13 studies, n=50860). Each ViV-TAVI group was
compared with NV-TAVI. TAV-in-TAV implantation: There were no significant
differences in all-cause mortality or stroke rates at >= 12 months between
groups. The follow-up period was 12 months in all studies except in one
(i.e., 24 months). Sensitivity analyses, by removing that study, did not
show difference for both outcomes [(OR=1.25, 95%CI: 0.72-2.18) and
(OR=1.14, 95%CI: 0.59-2.20), respectively]. TAV-in-TAV implantation was
associated with higher rates of permanent pacemaker (PPM) insertion
(OR=1.78, 95%CI: 1.10-2.88) within 30-day of follow-up. PPM insertion rate
remained higher by 34% (OR=1.34, 95%CI: 1.02-1.76) even after removing the
study that reported PPM insertion during index admission. Early conversion
to open heart surgery and coronary occlusion (OR=3.75, 95%CI: 0.99-1417)
did not differ between groups. TAV-in-SAV implantation: TAV-in-SAV
implantation did not significantly reduce the risk of all-cause mortality,
but stroke risk was reduced by 19% at >= 12 months follow-up. Sensitivity
analyses by removing the studies with 24 months follow-up yielded
comparable results [(OR=0.88, 95%CI: 0.64-1.21) and (OR=0.81, 95%CI:
0.70-0.94), respectively]. TAV-in-SAV implantation was associated with
lower rates of PPM insertion compared with NV-TAVI (OR=0.33, 95%CI:
0.17-0.62) within 30-day of follow-up. The risk remained significantly
lower by 69% (OR=0.31, 95%CI: 0.10-0.92) upon removing the studies that
reported PPM insertion during the index admission. Early conversion to
open heart surgery and coronary occlusion (OR=1.88, 95%CI: 0.82-4.32) did
not differ between groups. Conclusion(s): In comparison with NV-TAVI,
TAV-in-TAV implantation was associated with higher PPM insertion rates,
whereas, TAV-in-SAV implantation was associated with lower stroke and PPM
insertion rates without an impact on mortality.

<84>
Accession Number
646185524
Title
Safety and efficacy of transcatheter aortic valve implantation (TAVI) in
patients with previous TAVI; a systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Ktenopoulos N.; Apostolos A.; Karanasos A.; Drakopoulou M.; Katsaros O.;
Simopoulou C.; Oikonomou G.; Kachrimanidis I.; Koliastasis L.; Benetos G.;
Tsalamandris S.; Synetos A.; Latsios G.; Tsioufis C.; Toutouzas K.
Institution
(Ktenopoulos, Apostolos, Drakopoulou, Katsaros, Simopoulou, Oikonomou,
Kachrimanidis, Koliastasis, Benetos, Tsalamandris, Synetos, Latsios,
Tsioufis, Toutouzas) Ippokrateio General Hospital of Athens, First
Department of Cardiology, Athens, Greece
(Karanasos) General University Hospital of Patras, Department of
Cardiology, University of Patras, Patra, Greece
Publisher
Oxford University Press
Abstract
Background: Transcatheter Aortic Valve Implantation (TAVI) has gained
ground in the management of severe aortic stenosis, even in low-surgical
risk patients. However, TAVI prostheses, like bioprostheses, have a finite
lifetime; thus, TAVI in patients with previous TAVI (TAVI-in-TAVI) rates
are radically increased. Although data regarding TAVI indicate low
mortality and stroke rates within the first year, TAVI-in-TAVI is less
studied. Purpose(s): The aim of the study is to systematically review
and summarize available data regarding the safety and the outcomes of
TAVI-in-TAVI. Method(s): This study was conducted according to the
PRISMA guidelines. We systematically searched PubMed, SCOPUS, and Cochrane
databases from their inception to February 10, 2024, for studies assessing
the characteristics and outcomes of patients undergoing TAVI-in-TAVI.
Primary endpoint of our systematic review and meta-analysis is the
in-hospital, 30-days and 1-year mortality rates. Secondary endpoints
comprised in-hospital, 30-days and 1-year stroke rates, in-hospital
vascular complications, conversion to surgery, coronary compression or
obstruction, and perforation with or without tamponade, and in-hospital
and 30-days permanent pacemaker implantation (PPM) implantation. Endpoint
definitions followed the Valve Academic Research Consortium 3 criteria.
The cumulative incidence of primary and secondary endpoints and the
corresponding 95% confidence intervals (CI) were estimated. A random
effects model (DerSimonian-Laird) was used to account for heterogeneity
among the included studies. Result(s): Our meta-analysis included a
total of 5 studies and 2,145 patients undergoing TAVI-in-TAVI, 72.9%
(N=1,564) of whom were treated with a balloon-expandable valve. Our
analysis showed that patients undergoing TAVI-in-TAVI had 3.7% (95% CI:
1.6%-5.9%), 3.9% (95% CI: 3%-4.7%) and 12.5% (95% CI: 11%-14%)
in-hospital, 30-days and 1-year all-cause mortality, while stroke occurred
in 1.8% (95% CI: 1.2%-2.4%), 2.1% (95% CI: 1.4%-2.9%) and 3% (95% CI:
2.3%-3.8%) of the patients in-hospital, 30-days and 1-year, respectively.
Notalby, conversion to surgery, coronary compression/obstruction and
perforation with or without tamponade occurred in <1% of the patients,
while 6.1% (95% CI: 2.2%-9.9%) of the patients had vascular complications
during the procedure. Considering the PPM implantation rates, patients had
a 1.8% (95% CI: 1.2%-2.4%) for in-hospital and a 6.8% (95% CI: 5.2%-8.3%)
for 30-days incidence. Conclusion(s): Our systematic review and
meta-analysis is the first to present that TAVI-in-TAVI has an acceptable
safety profile with relatively low in-hospital, 30-days and 1-year
mortality and stroke rates, comparable to the native-valve-TAVI. Taking
into consideration that TAVI-in-TAVI might be the only therapeutic
approach for an increasing number of patients, further studies are
warranted to further assess its safety and efficacy and to provide
additional procedural techniques.

<85>
Accession Number
646185945
Title
Coronary CTA and CT-FFR in trans-catheter aortic valve implantation
candidates: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Becker L.; 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, Van Es, Rensing, Timmers, Ten Berg,
Swaans) St Antonius Hospital, Nieuwegein, Netherlands
(Mohamed Hoesein) University Medical Center Utrecht, Utrecht, Netherlands
(Leiner) Mayo Clinic, Rochester, United States
Publisher
Oxford University Press
Abstract
Objectives: To perform a systematic review and meta-analysis on diagnostic
accuracy and other outcomes of coronary computed tomography angiography
(CCTA) and CT-derived fractional flow reserve (CT-FFR) in candidates for
trans-catheter aortic valve implantation (TAVI). Background(s):
Screening for obstructive coronary artery disease (CAD) with CCTA during
TAVI work-up could prevent unnecessary invasive coronary angiography
(ICA). This becomes increasingly relevant as the TAVI-population grows.
CT-FFR improves CCTA accuracy in chest pain patients, but its reliability
is unknown in the TAVI-population. 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): Twenty-four of the 29 included articles were part of the
meta-analysis, reporting results for CCTA and CT-FFR in 3.494 and 797
patients respectively. Reference standard was anatomical severity of CAD
in most studies. At patient-level, pooled CCTA sensitivity was 94.3% and
specificity 74.8%. CT-FFR sensitivity was 91.5% and specificity 60.3% with
strong variation between studies. CCTA correctly ruled out CAD in 52% of
all patients, but 42% of positive CCTAs were false positives. CT-FFR
correctly ruled out CAD in 47% of all patients included in this
meta-analysis, but showed better accuracy than CCTA in studies that
compared both. In these studies, sensitivity of CCTA versus CT-FFR was
70.7% versus 79.0% and specificity was 64.4% versus 92.9%.
 Conclusion(s): Negative CCTA effectively rules-out CAD in the
TAVI-population. Adding CCTA to TAVI work-up could lead to significant
reduction in pre-TAVI ICA procedures, but the proportion of
false-positives remains high. In studies performing a direct comparison,
CT-FFR performed better than CCTA. This is not reflected in the CT-FFR
meta-analysis. Therefore, diagnostic accuracy of CT-FFR and added value
over CCTA in the TAVI-population remains unclear. Further research
regarding validation and reliability is warranted.

<86>
Accession Number
646189259
Title
Rationale and study design of the international randomized control trial
MYocarditis THerapy with Steroids: the MYTHS trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Ammirati E.; Conti N.; Frea S.; Uribarri A.; Grosu A.; Loffredo F.; Corsi
D.; Tomasoni D.; Cappelli F.; Marini M.; Garascia A.; Van De Heyning C.M.;
Crespo-Leiro M.; Adler E.D.; Potena L.
Institution
(Ammirati, Conti, Garascia) ASST Great Metropolitan Niguarda, De Gasperis
Cardio Center, Milan, Italy
(Frea) Hospital Citta Della Salute e della Scienza di Torino,
Cardiovascular and Thoracic Department, Turin, Italy
(Uribarri) University Hospital Vall d'Hebron, Barcelona, Spain
(Grosu) ASST Papa Giovanni XXIII Bergamo, Cardiovascular Department,
Bergamo, Italy
(Loffredo) University of Campania Luigi Vanvitelli, Naples, Italy
(Corsi) Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
(Tomasoni) ASST Spedali Civili, Brescia, Italy
(Cappelli) Careggi University Hospital, Florence, Italy
(Marini) University Hospital Riuniti of Ancona, Cardiovascular Department,
Ancona, Italy
(Van De Heyning) University Hospital Antwerp, Antwerp, Belgium
(Crespo-Leiro) CHUAC, A Coruna, Spain
(Adler) UC San Diego Health, Department of Medicine, La Jolla, United
States
(Potena) S. Orsola-Malpighi Policlinic, Cardiovascular and Thoracic
Department, Bologna, Italy
Publisher
Oxford University Press
Abstract
Background: Immunosuppression is generally suggested in patients with
specific subtypes of acute myocarditis, such as eosinophilic myocarditis
or giant cell myocarditis or associated with systemic autoimmune
disorders. In contrast, no specific treatment for most acute myocarditis
complicated by acute heart failure (HF) or cardiogenic shock is
recommended beyond the management of acute HF and supportive therapy.
Nevertheless, large registries commonly reported using corticosteroids in
severe forms without data supporting this strategy. Purpose(s): To
assess the safety and efficacy of high-dose pulse intravenous (IV)
corticosteroid therapy to treat patients with complicated/ fulminant acute
myocarditis based on clinical suspicion. Method(s): An international
pragmatic investigator-initiated single-blinded randomized controlled
trial that screens patients between 18 and 70 years admitted to the
hospital for suspected acute myocarditis (cardiac symptoms onset within
three weeks) complicated by acute HF/ cardiogenic shock and left
ventricular (LV) ejection fraction<41% without significant LV dilation is
ongoing. Patients are randomized in a 1:1 ratio to pulsed IV
methylprednisolone (1 g) in saline solution (250 mL) daily for three days
or placebo (saline without methylprednisolone) on top of standard therapy
and maximal supportive care. A final diagnosis of myocarditis is confirmed
by histology or cardiac magnetic resonance imaging. A population of 288
patients has been planned to assess a reduction in the probability of
reaching the primary endpoint from 25% in the placebo arm to 12% in the
methylprednisolone arm with a power of 0.80 (Figure). The main analysis
will be conducted on an intention-to-treat basis. Result(s): The
primary efficacy endpoint of the trial is defined as the time from
randomization to the first event occurring within 6 months, including
all-cause death, heart transplantation, or long-term LV assist device
implant, or need for an upgrading of the temporary mechanical circulatory
support (t-MCS), or ventricular tachycardia (VT)/fibrillation (VF) treated
with direct current (DC) shock, or first rehospitalization due to HF or
VT/VF, or advanced atrioventricular block. The safety endpoints include a
composite of potential complications that can occur, including serious
infections, acute gastrointestinal bleeding, and other complications that
can be related to corticosteroid therapy or prolonged stay on t-MCS. There
are 32 active centers, and 48 patients have been randomized since December
2021. The trial is expected to be completed by the end of 2028.
 Conclusion(s): The results of the MYTHS trial can define the role of
IV methylprednisolone in the initial treatment of patients with
complicated forms of acute myocarditis that currently have an unacceptably
high mortality rate.

<87>
Accession Number
646186718
Title
Prognostic impact of intravascular imaging in percutaneous coronary
intervention according to atherothrombotic risk.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Ha J.; Hong D.; Lee J.M.; Park T.K.; Choi K.H.; Hahn J.Y.; Song Y.B.; Lee
S.H.; Lee J.Y.; Shin D.S.; Lee S.Y.; Gwon H.C.; Choi S.H.; Yang J.H.; Kim
S.M.
Institution
(Ha, Hong, Lee, Park, Choi, Hahn, Song, Gwon, Choi, Yang) Samsung Medical
Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
(Lee) Chonnam National University Hospital, Gwangju, South Korea
(Lee, Lee) Kangbuk Samsung Hospital, Seoul, South Korea
(Shin) St. Francis Hospital, Roslyn, United States
(Kim) Chungbuk National University Hospital, Cheongju, South Korea
Publisher
Oxford University Press
Abstract
Background: Recent randomized controlled trials support intravascular
imaging-guided PCI to improve patient prognosis, however, future risk of
clinical events in patient with coronary artery disease is not solely
determined by lesion characteristics or how these lesions are treated.
 Objective(s): Current study investigated whether the effects of
intravascular imaging in complex percutaneous coronary invention (PCI)
would differ according to atherothrombotic risks. Method(s): This
study was post-hoc analysis of the RENOVATE-COMPLEX-PCI trial that
compared intravascular imaging-guided PCI with angiography-guided PCI in
patients with complex coronary artery lesions. Study population was
stratified according to atherothrombotic risk assessed by Thrombolysis In
Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P) (a sum
of age>=75 years, diabetes mellitus, hypertension, smoking, peripheral
arterial disease, stroke, coronary artery bypass grafting, heart failure,
and renal dysfunction) into low-risk (TRS-2P<3) or high-risk (TRS-2P>=3)
groups. The primary endpoint was target vessel failure (TVF), a composite
of cardiac death, target vessel related myocardial infarction, or
clinically driven target vessel revascularization. Result(s): Among
the total patients, 1,247 were low-risk and 392 were high-risk. The risk
of TVF was significantly higher in the high-risk group than the low-risk
group (15.5% vs. 7.2%; hazard ratio [HR], 2.13; 95% confidence interval
[CI], 1.51-3.00; P<0.001). The benefits of intravascular imaging-guided
PCI over angiography-guided PCI did not differ between the low-risk group
(5.6% vs. 10.4%; HR, 0.56; 95% CI, 0.36-0.86) and the high-risk group
(14.1% vs. 18.5%; HR, 0.71; 95% CI, 0.41-1.24) without significant
interaction (interaction P=0.496). Conclusion(s): Although patients
with high atherothrombotic risk had significantly worse clinical outcome
than those with low atherothrombotic risk, the prognostic impact of
intravascular imaging-guided PCI compared with angiography-guided PCI was
similarly observed in both low and high future atherothrombotic risk
groups. Structured Graphical Abstract.

<88>
Accession Number
646188450
Title
Peer support interventions improve disease self-management after coronary
heart disease diagnosis: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Weddell J.; Shi W.; Redfern J.; Buckley T.; Gallagher R.
Institution
(Weddell, Shi, Redfern, Buckley, Gallagher) University of Sydney, Charles
Perkins Centre, Sydney, Australia
Publisher
Oxford University Press
Abstract
Background: Patients with coronary heart disease (CHD) diagnoses often
experience impacts on patient-reported outcomes (quality of life,
depression, disease self-management and self-efficacy) at a time when
secondary prevention is required. Peer support has proven benefits for
these issues in many chronic conditions but synthesis of the evidence in
CHD populations has not been undertaken. Purpose(s): In this
systematic review and meta-analysis, we aimed to explore the impact of
peer support interventions on health-related quality of life, depression,
anxiety, self-management and self-efficacy in CHD. Method(s):
Electronic databases were searched from inception to November 2023
(MEDLINE, Embase, PsycINFO, CINAHL, Scopus, PubMed [non-MEDLINE], Web of
Science, and the Cochrane Central Register of Controlled Trials).
Randomised controlled trials (RCTs) evaluating peer support interventions
(that enable experience sharing and/or support by others with the same
condition) in populations with diagnosed CHD were eligible for inclusion.
Risk of bias was assessed using the Cochrane risk of bias tool.
Meta-analyses were undertaken in RevMan Version: 7.4.0 using the inverse
variance method and a random effects model. Result(s): In total, 16
papers reporting 14 unique RCTs were included. The total sample (n=1793)
was 65% male with a mean age of 54.5+/-13.0 years. The diagnosis of the
samples varied between studies, including coronary artery bypass graft(s),
first time or newly diagnosed myocardial infarction and percutaneous
coronary intervention. By 6-months follow-up, peer support interventions
demonstrated no statistically significant improvements in health-related
quality of life (SMD -0.38, 95% CI -1.84, 1.08), depression (SMD -0.09,
95% CI -0.26, 0.08) and anxiety (SMD -0.85, 95% CI -1.83, 0.14). Whereas,
improvements occurred in disease self-management (SMD 1.49, 95% CI 0.66,
2.32) and self-efficacy in both short term (by 6-months, SMD 0.57, 95% CI
0.37, 0.77) and longer term (6-12 months, SMD 0.67, 95% CI 0.29, 1.05).
Peer support interventions varied widely in format and several studies
were of poor quality. Conclusion(s): Peer support interventions
benefit patient-reported outcomes of disease self-management and
self-efficacy up to 6 and 12 months, but not for other patient reported
outcomes after CHD diagnosis. More exploration is needed of content,
delivery and focus of peer support interventions to maximise effectiveness
for CHD secondary prevention.

<89>
Accession Number
646188235
Title
Impact of inpatient cardiac rehabilitation on hospital-associated
disability for older patients undergoing transcatheter aortic valve
implantation: insight from the JROAD/ JROAD-DPC database.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Katano S.; Kono Y.; Yano T.; Kanaoka K.; Sawamura A.; Motokawa T.;
Miyamoto Y.; Ohya Y.; Miura S.; Fukuma N.; Makita S.; Izawa H.
Institution
(Katano) Sapporo Medical University Hospital, Sapporo, Japan
(Kono) Fujita Health University Hospital, Department of Rehabilitation,
Toyoake, Japan
(Yano) Sapporo Medical University, Department of Cardiovascular, Renal and
Metabolic Medicine, Sapporo, Japan
(Kanaoka, Miyamoto) National Cerebral and Cardiovascular Center,
Department of Medical and Health Information Management, Suita, Japan
(Sawamura) Ichinomiya Municipal Hospital, Department of Cardiology,
Ichinomiya, Japan
(Motokawa) Nagasaki University Hospital, Department of Cardiology,
Nagasaki, Japan
(Ohya) Ryukyu University, Department of Cardiology, Okinawa, Japan
(Miura) Fukuoka University, School of Medicine, Department of Cardiology,
Fukuoka, Japan
(Fukuma) Nippon Medical School, Department of Cardiovascular Medicine,
Tokyo, Japan
(Makita) Saitama Medical University, International Medical Center,
Department of Rehabilitation, Hidaka, Japan
(Izawa) Fujita Health University, School of Medicine, Department of
Cardiology, Toyoake, Japan
Publisher
Oxford University Press
Abstract
Background: Hospital-associated disability (HAD), a decline in the ability
to perform activities of daily living (ADL) during hospitalization, is a
modifiable target in the integrated care for older adults. Inpatient
rehabilitation during the perioperative period is a part of a
comprehensive cardiac rehabilitation (CR) program and plays a pivotal role
in functional recovery and smooth reintegration into the home, community,
and workplace after surgery. Prior research, including meta-analyses, have
shown that outpatient CR participation after discharge of patients who
underwent transcatheter aortic valve implantation (TAVI) and surgical
aortic valve replacement is associated with a significant improvement in
exercise capacity and indexes of ADL. However, the impact of inpatient CR
on the occurrence of HAD remains unexplored. Purpose(s): Using a
large real-world nationwide database in Japan, the aim of this study was
to determine the prevalence of HAD and the impact of inpatient CR
participation on the development of HAD in older patients undergoing TAVI.
 Method(s): Older patients undergoing TAVI were extracted from the
Japanese nationwide database (JROAD-DPC) from April 2014 to March 2021 and
were divided into patients receiving inpatient CR (CR group) and non-CR
group. HAD was defined as a decrease in the Barthel Index score >= 5
points at discharge relative to admission. Result(s): Of 19,789
eligible patients, 17,066 (86%) underwent inpatient CR (average age, 84.3
+/- 4.9 years; Woman, 65%). The overall prevalence of HAD was 9.6%, with a
lower incidence in the CR group than those in the non-CR group (8.8% vs.
14.2%, p < 0.01). Participation in inpatient CR was associated with a
significantly lower odds ratio (OR) of HAD in multivariate logistic
regression analysis (adjusted OR, 0.62; 95% confidence interval [CI],
0.54-0.70; p < 0.01) and in inverse probability of treatment
weighting-adjusted logistic regression analyses (adjusted OR, 0.82; 95%
CI, 0.77-0.88; p < 0.01; Table). Analyses in subgroups of interest showed
heterogeneity of the effects of inpatient CR with possible loss in
patients with a body mass index of less than 18.5 kg/m2 or BI
score of less than 60 points at admission (Figure). Conclusion(s): A
substantial number of older patients undergoing TAVI developed HAD during
perioperative period. Participation in inpatient CR was associated with a
lower likelihood of HAD in TAVI recipients, but the benefit of inpatient
CR for development of HAD was possibly lost in patients with a low BMI and
low a BI score at admission, indicating the necessity of HAD-targeted
multidisciplinary CR for lean patients with ADL disability before TAVI.
(Figure Presented).

<90>
Accession Number
646186905
Title
Prognostic implications of p2y12 inhibitor pre-treatment in non-st segment
elevation acute coronary syndromes undergoing late invasive strategy - a
national registry analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Fonseca Vazao A.; Goncalves C.; Martins A.; Cabral M.; Carvalho M.;
Carvalho J.; Pernencar S.; Morais J.
Institution
(Fonseca Vazao, Goncalves, Martins, Cabral, Carvalho, Carvalho, Pernencar,
Morais) Leiria Hospital Centre, Leiria, Portugal
Publisher
Oxford University Press
Abstract
Background: Current guidelines recommend considering P2Y12 pre-treatment
(PreT) in patients (pts) with non-ST segment elevation acute coronary
syndrome (NSTE-ACS) expected to undergo a late invasive strategy, based on
individual bleeding risk. Purpose(s): Investigate in-hospital
morbidity and mortality in NSTE-ACS pts undergoing a late invasive
strategy (coronary angiography (CAG) performed >24h post-admission)
comparing those receiving P2Y12 inhibitors (P2Y12i) PreT with those who
did not. Method(s): Retrospective multicenter analysis of NSTE-ACS
pts from the Portuguese Registry on Acute Coronary Syndromes (ProACS)
undergoing a late invasive strategy from October 2010 to October 2023.
Exclusion criteria: previous treatment with P2Y12i or anticoagulants;
atrial fibrillation. Two cohorts were defined: pts receiving PreT with
P2Y12i before undergoing CAG (group 1) and pts without PreT (group 2).
Comparative analyses included baseline characteristics, clinical findings,
CAG findings and treatment. Primary outcome was in-hospital major adverse
cardiovascular events (MACE), a composite of all-cause mortality,
re-infarction, stroke and congestive heart failure. The secondary outcome
included individual events and major bleeding. Result(s): 3776 pts
were included (mean age:66+/-12 yrs,29% female), 1530 in group 1 and 2246
in group 2. Group 1 had lower prevalence of dyslipidemia (60 vs 66%,
p<0.001), prior stroke (7 vs 5%, p=0.003), myocardial infarction (16 vs
21%) and percutaneous coronary intervention (12 vs 15%) (both p=0.001). On
admission, there were no differences regarding Killip-Kimball class (class
I - 90 vs 90%,p=0.501) and pts in group 1 less frequently had left
ventricular disfunction (left ventricular ejection fraction <50% - 20 vs
24%,p=0.032). Group 1 had higher incidence of obstructive CAD (84 vs
77%,p<0.001), more frequently required more than 1 CAG during admission (8
vs 4%,p<0.001), but multivessel disease did not significantly differ (52
vs 52%,p=0.667). Coronary angioplasty was more frequent in group 1 (63 vs
60%,p=0.019) as was coronary artery bypass graft (13 vs 10%,p=0.002).
Regarding anti-thrombotics, group 1 had higher prescription rates of
clopidogrel (68 vs 56%), aspirin (99 vs 81%), unfractionated heparin (21
vs 8%), enoxaparin (80 vs 56%), but lower of fondaparinux (12 vs 41%) (all
p<0.001). There were no differences in the primary outcome (9 vs
9%,p=0.906) and secondary outcomes: in-hospital mortality (1 vs 1%),
re-infarction (1 vs 1%), ischemic stroke (1% vs 0,4%) and congestive heart
failure (7% vs 8%) (all p>0.05). Group 1 had higher rates of major
bleeding (0.8 vs 0.2%, OR 3.48, CI 95% 1.22-9.89, p=0.013).
 Conclusion(s): In patients with NSTE-ACS undergoing a late invasive
strategy, PreT with P2Y12i showed no statistically significant differences
in MACE, despite association with higher rates of major bleeding.

<91>
Accession Number
646186792
Title
Temporal trends in antithrombotic therapy following transcatheter aortic
valve implantation in denmark.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Vistisen H.; Graversen P.L.; Havers-Borgersen E.; Strange J.E.;
Oestergaard L.; Butt J.H.; Dahl J.S.; Povlsen J.A.; Terkelsen C.J.;
Freeman P.; Nissen H.; Koeber L.; De Backer O.; Fosboel E.L.
Institution
(Vistisen, Graversen, Havers-Borgersen, Strange, Oestergaard, Butt,
Koeber, De Backer, Fosboel) Rigshospitalet - Copenhagen University
Hospital, Copenhagen, Denmark
(Dahl, Nissen) Odense University Hospital, Department of Cardiology,
Odense, Denmark
(Povlsen, Terkelsen) Aarhus University Hospital, Department of Cardiology,
Aarhus, Denmark
(Freeman) Aalborg University Hospital, Department of Cardiology, Aalborg,
Denmark
Publisher
Oxford University Press
Abstract
Background: A number of randomized clinical trials have examined the use
of antithrombotic therapy after transcatheter aortic valve implantation
(TAVI), and guidelines have changed over time. Yet, data from clinical
practise patterns are lacking and it is important to evaluate adherence to
guideline recommendations over time. Purpose(s): This study aims to
evaluate the temporal use of antithrombotic therapy after TAVI in Denmark.
 Method(s): A nationwide Danish cohort of patients undergoing
first-time TAVI from 2008 to 2017 were identified from Danish nationwide
registries. Patients were categorized into four groups according to data
on prescription filling of antithrombotic therapy within a three-months
period post-TAVI: i) No antithrombotic therapy, ii) single antiplatelet
therapy (SAPT), iii) dual antiplatelet therapy (DAPT), or iv)
anticoagulant therapy. The use of antithrombotic therapy post-TAVI was
examined for each year from 2008 to 2017. Result(s): We identified
3187 patients undergoing first-time TAVI, among whom 120 (3.8%) did not
receive any antithrombotic therapy, 715 (22.4%) were prescribed SAPT, 1244
(39.0%) were on DAPT, and 1108 (34.8%) were treated with anticoagulant
therapy at three months post-TAVI. Patients without antithrombotic therapy
were more often men (64.2%) and were more likely to have a history of
malignancy (23.3%) compared with the other treatment groups. Patients who
received oral anticoagulation had a higher burden of atrial fibrillation
(75.7%). The proportion of patients with atrial fibrillation remained
stable over time. During the first decade of TAVI, there was a shift in
the antithrombotic treatment pattern: no therapy was ranging from 1.1% to
6.6%, SAPT from 19.1% to 29.4%, while DAPT decreased from 51.0% to 31.2%
and anticoagulant therapy increased from 21.6% to 39.8% (Figure 1).
 Conclusion(s): During the first decade of TAVI, antithrombotic
therapy patterns post-TAVI changed substantially, such that the use of
dual antiplatelet therapy decreased over time, while the use of
anticoagulant therapy increased. Since atrial fibrillation remained stable
over time, the increase in anticoagulant therapy is most likely due to
changes in guidelines for management of atrial fibrillation in 2010. These
findings show the evolving treatment patterns in the first decade of TAVI,
which reflects the recommendations from clinical trials and guidelines for
the management of antithrombotic therapy for patients with TAVI.

<92>
Accession Number
646186954
Title
Incidence of aortic valve reintervention in patients with aortic stenosis
undergoing TAVI vs SAVR: A systematic review and meta-analysis of
randomised controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Groberio J.; Reginato P.H.; Streit R.E.; Rocha A.; Florencio De Mesquita
C.; Udoma-Udofa O.C.; Ulbrich A.; Farias F.; Gomes W.
Institution
(Groberio) Vila Velha University, Vitoria, Brazil
(Reginato, Streit, Rocha, Ulbrich, Farias) Federal University of Parana,
Curitiba, Brazil
(Florencio De Mesquita) Federal University of Pernambuco, Recife, Brazil
(Udoma-Udofa) Federal University of Juiz de Fora, Juiz De Fora, Brazil
(Gomes) INC, Curitiba, Brazil
Publisher
Oxford University Press
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) and surgical
aortic valve replacement (SAVR) are two established treatments for severe
aortic stenosis (AS). The relative comparison between TAVI and SAVR for
recurrent aortic valve interventions is not well defined. Purpose(s):
We aimed to perform a systematic review and meta-analysis comparing the
incidence of aortic valve reintervention in patients undergoing TAVI
versus SAVR. Method(s): MEDLINE, Embase and Cochrane databases were
searched for randomised controlled trials (RCT) that compared TAVI with
SAVR for the treatment of AS reporting the occurrence of aortic valve
reinterventions. We also performed a subgroup analysis of different types
of TAVI prosthesis. We performed a meta-regression to evaluate the effect
of age and Society of Thoracic Surgeons (STS) risk score in the outcome of
interest. Statistical analysis was performed using RevMan 5.4.1 and
RStudio 2023.12.1. Heterogeneity was assessed with I2 statistics.
 Result(s): We included 8 RCTs with 8,698 patients, of whom 4,443
(51%) underwent TAVI. Mean follow-up ranged from 1 to 10 years. Aortic
valve reintervention was significantly more common in patients treated
with TAVI compared with SAVR (RR 1.89; 95%CI 1.24-2.88; p = 0.003). In a
subgroup analysis stratified by balloon-expandable or self-expandable
valves, there were no significant subgroup differences in their respective
comparisons with TAVR (p = 0.20). In meta-regression analysis, older age
(p = 0.008) and higher STS score (p = 0.009) were significantly associated
with a higher incidence of aortic valve reinterventions with TAVI relative
to SAVR. Conclusion(s): In patients who undergo aortic valve
replacement, TAVI is associated with a significantly higher incidence of
aortic valve reinterventions relative to SAVR, particularly in populations
with older age or higher STS score.

<93>
Accession Number
646185991
Title
Transcatheter versus surgical aortic valve replacement in lower-risk
patients: an updated meta-analysis of randomised controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Reddy R.K.; Howard J.P.; Reardon M.J.; Thyregod H.G.H.; Jorgensen T.H.;
Toff W.D.; Forrest J.K.; Leon M.B.; Ahmad Y.
Institution
(Reddy, Howard) National Heart and Lung Institute Imperial College,
London, United Kingdom
(Reardon) Methodist Hospital, DeBakey Heart and Vascular Center, Houston,
United States
(Thyregod, Jorgensen) Rigshospitalet - Copenhagen University Hospital,
Heart Centre, Copenhagen, Denmark
(Toff) University of Leicester, Department of Cardiovascular Sciences,
Leicester, United Kingdom
(Forrest, Ahmad) Yale School of Medicine, Section of Cardiovascular
Medicine, New Haven, United States
(Leon) Columbia University, Irving Medical Centre, New York, United States
Publisher
Oxford University Press
Abstract
Background: Long-term clinical outcomes after transcatheter [TAVI] and
surgical [SAVR] aortic valve replacement are of utmost importance in
lower-risk patients. Event rates are diminished in lower-risk patients,
therefore individual trials may be separately underpowered to assess
low-frequency outcomes. New randomised data has emerged, including 4, 5
and 10-year follow-up from the Evolut Low Risk, PARTNER-3 and NOTION
trials, respectively. Purpose(s): To perform a systematic review and
meta-analysis of randomised trials studying long-term outcomes in patients
with severe aortic stenosis at low-surgical risk undergoing TAVI versus
SAVR. Method(s): Trials randomising patients at lower surgical risk
in trials comparing TAVI with SAVR were systematically identified. The
prespecified primary endpoint was all-cause death. Key secondary endpoints
included stroke, death or disabling stroke, cardiac death, new permanent
pacemaker, aortic valve reintervention, and new-onset atrial fibrillation.
Reconstructed individual patient data [IPD] was obtained via digitisation
of Kaplan-Meier survival curves. Using these data, Cox proportional
hazards regression was performed using frailty models on the primary
outcome of all-cause death. To assess total lifetime lost, the restricted
mean survival time [RMST] was calculated. Conventional pairwise random
effects meta-analyses were also performed. This analysis was prospectively
registered [CRD42023484976]. Result(s): 4 eligible trials contributed
data from 3557 patients with a weighted mean follow-up duration of
approximately 4 years (47.6 months). In the reconstructed IPD pooled
analyses, there was no significant difference in the hazard of death
[hazard ratio 1.15, 95% CI 0.93 to 1.41, p=0.20] or RMST [DELTA-0.8
months, p=0.09] (Figure 1). In pairwise meta-analyses, there was no
difference between TAVI and SAVR in all-cause death [relative risk (RR)
0.94, 95% confidence interval (CI) 0.78 to 1.13, p=0.51] (Figure 2). There
was also no significant difference for stroke [RR 0.94, 95% CI 0.59 to
1.50, p=0.80], or a composite of death or disabling stroke [RR 0.92, 95%
CI 0.70 to 1.22, p=0.57]. There was an increase in new pacemaker
implantation with TAVI [RR 2.15, 95% CI 1.50 to 3.07, p<0.001], and a
reduction in new AF with TAVI [RR 0.43, 95% CI 0.26 to 0.70, p<0.001];
there was no significant difference in any other endpoint (Figure 2).
 Conclusion(s): The present analysis demonstrates no difference in
major clinical outcomes with TAVI or SAVR in lower-risk patients at
4-years follow-up. These results were consistent when analysed using
pooled reconstructed IPD or conventional meta-analyses and there were no
differences in RMST. These data are informative for lower-risk patients
and clinicians, but longer-term follow-up is required to confirm whether
equivalence is maintained. Kaplan-Meier plot comparing TAVI vs SAVR.

<94>
Accession Number
646187746
Title
Effects of nicorandil, isosorbide mononitrate or diltiazem on radial
artery grafts after coronary artery bypass grafting: the randomized
ASRAB-pilot trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Zhu Y.; Zhang W.; Qin K.; Liu Y.; Zhao Q.
Institution
(Zhu, Qin, Liu, Zhao) Rui Jin Hospital, Shanghai Jiaotong University,
School of Medicine,Cardiovascular Surgery, Shanghai, China
(Zhang) Fudan University, Shanghai, China
Publisher
Oxford University Press
Abstract
Background: The optimal chronic oral antispastic medication after coronary
artery bypass grafting (CABG) using radial artery (RA) grafts is
controversial. Purpose(s): This pilot trial aimed to preliminarily
compare the efficacy and safety of nicorandil, isosorbide mononitrate, or
diltiazem in patients who underwent CABG using RA grafts. Method(s):
This was a single-center, randomized, open-label, parallel-group pilot
trial. Eligible patients who underwent CABG using RA grafts within 3 days
were randomized in a 1:1:1 ratio to receive oral doses of nicorandil (15
mg daily), isosorbide mononitrate (50 mg daily), or diltiazem (180 mg
daily) for 24 weeks post-CABG. The primary outcomes were RA grafts failure
(defined as modified FitzGibbon Grade B, S, or O) at 1- and 24-weeks,
assessed by coronary computed tomography angiography (CCTA). The secondary
outcomes include major adverse cardiovascular event (MACE, a composite of
all-cause death, myocardial infarction, stroke, and unplanned
revascularization) and angina recurrence. Result(s): Among 150
randomized participants, 149 patients (full analysis set, mean age 56.8
years, 13.4% females, 83.9% with acute coronary syndrome, 49.7% with
diabetes) with 177 RA grafts completed at least once CCTA assessment,
including 50 patients with 64 RA grafts in the nicorandil group, 50
patients with 57 RA grafts in the isosorbide mononitrate group, and 49
patients with 56 RA grafts in the diltiazem group, respectively. (Figure
1). At 1-week post-CABG, the RA graft failure rates were numerically lower
with nicorandil vs. diltiazem (19.4% vs. 25.0%, difference: -5.6% [95% CI
-20.6% to 9.3%]; P = 0.49) and isosorbide mononitrate vs. diltiazem (18.2%
vs. 25.0%, difference: -6.8% [95% CI -21.8% to 8.6%]; P =0.41). Nicorandil
vs. isosorbide mononitrate showed similar rates (19.4% vs 18.2%,
difference: 1.2% [95% CI -13.3% to 15.2%]; P =0.88). At 24 weeks, a
numerically trend indicating a larger reduction in RA graft failure rates
between nicorandil vs. diltiazem (16.1% vs 27.8%, difference: -11.7% [95%
CI -26.6% to 3.4%]; P =0.17), and isosorbide mononitrate vs. diltiazem
(12.5% vs 27.8%, difference: -15.3% [95% CI -29.8% to -0.2%]; P =0.06).
Nicorandil vs. isosorbide mononitrate remained similar (16.1% vs 12.5%,
difference: 3.6% [95% CI -9.6% to 16.4%]; P =0.59). Per-protocol set
analysis results were consistent with full analysis set analysis (Table
1). During the follow-up, 6 patients with MACEs and 7 with angina
recurrence were observed (MACE: 2 in nicorandil, 2 in isosorbide
mononitrate, and 2 in diltiazem; angina recurrence: 1, 3, and 3 in the
respective groups). Conclusion(s): In this underpowered pilot trial,
treatment with nicorandil or isosorbide mononitrate showed a numerically
considerable but not statistically significant benefit on RA grafts
outcome compared to diltiazem up to 24-week post-CABG. Larger hypothesis
testing trial is warranted.

<95>
Accession Number
646187505
Title
Efficacy of specific drug class therapy in pulmonary arterial hypertension
associated with HIV, portal hypertension or both: a single Center
experience.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Dardi F.; Cennerazzo F.; Guarino D.; Ballerini A.; Magnani I.; Salvi M.;
Donato F.; Bertozzi R.; Manes A.; Palazzini M.; Galie N.
Institution
(Dardi, Cennerazzo, Guarino, Ballerini, Magnani, Salvi, Donato, Bertozzi,
Manes, Palazzini, Galie) University Hospital of Bologna S. Orsola-Malpighi
Polyclinic, Bologna, Italy
Publisher
Oxford University Press
Abstract
Background: Pulmonary arterial hypertension (PAH) is a rare complication
of both HIV infection (HIV-PAH) and portal hypertension (Po-PAH); it can
occur in patients with both diseases (HIV/Po-PAH). The use of the
PAH-specific drug classes (prostanoids, endothelin-1 receptor antagonists
[ERA] and phosphodiesterase-5 inhibitors [PDE5-i]) is largely justified by
retrospective and observational case reports since, to date, there are no
randomized clinical trials except for the PORTICO trial which demonstrated
the efficacy of macitentan in Po-PAH. Purpose(s): the aim of the
study was to evaluate the efficacy of PAH-specific drugs, both monotherapy
and dual oral upfront therapy (ERA + PDE5i started within 1 month apart),
in patients with Po-PAH, HIV/Po-PAH and HIV-PAH. Method(s): Between
1998 and 2023 we enrolled patients with Po-PAH, HIV-PAH and HIV/Po-PAH
referred to our Center and undergoing monotherapy with prostanoid, ERA and
PDE5-I or dual upfront oral therapy. The efficacy of the drugs was
assessed by comparing clinical parameters (NYHA functional class),
exercise capacity (six-minute walking test) and hemodynamic parameters at
baseline and after a treatment period of 3-6 months. The data are
expressed as mean and standard deviation and were compared with Student's
t-test for paired data. Result(s): 128 patients were enrolled (83
Po-PAH, 23 HIV/Po-PAH and 22 HIV-PAH). 20 were treated with ERA
monotherapy, 90 with PDE5-I, 13 with prostanoids and 5 treated with dual
oral upfront therapy. Conclusion(s): Prostanoids, ERAs and PDE5-Is,
both in monotherapy and as dual upfront oral therapy, are associated with
a significant improvement in functional class, exercise capacity and
hemodynamic parameters. The effect of such drugs is similar to patients
suffering from other forms of PAH.

<96>
Accession Number
646188580
Title
A prehabilitation programme is feasible and acceptable for
mild-to-moderately frail patients undergoing cardiac surgeries.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Li P.W.C.; Yu D.S.F.
Institution
(Li, Yu) University of Hong Kong, Hong Kong, Hong Kong
Publisher
Oxford University Press
Abstract
Background: Preoperative frailty is a strong prognostication in cardiac
surgical patients to predict poorer health outcomes. Intervening at the
preoperative stage through prehabilitation is gaining increasing research
attention. Previous studies tested a single frailty-reversing strategy,
either nutritional or exercise, the exercise protocols were mainly
aerobic-focused, which deviates from the exercise prescription principles
suggested for frailty management, rendering an effective prehabilitation
intervention is yet to be developed in cardiac surgical patients.
 Purpose(s): This study aimed to examine the preliminary effects and
explore the feasibility of a multi-component frailty-specific
prehabilitation programme for mild-to-moderately frail patients undergoing
cardiac surgeries/procedures. We hypothesised that compared with patients
who receive usual care, patients awaiting cardiac surgeries who
participate in the prehabilitation programme would have improved
functional capacity, frailty status, quality of life and psychological
outcomes, increased serum albumin and reduced C-reactive protein.
 Method(s): This study adopted a mixed-method design comprising a
pilot randomised controlled trial and a qualitative study. Adult patients
with a Clinical Frailty Scale score between 4 and 6, waiting for coronary
artery bypass grafting surgery and/or valve repair/replacement, with at
least 5 weeks of procedural waiting time and without contraindications for
exercise were recruited. They were randomized in a 1:1 ratio to receive
the prehabilitation programme or usual care. The programme comprised a
structured preoperative education, nutritional optimization, stress
management; and a multi-component exercise training with 3 sessions/week
and 60 minutes/session. The exercise training lasted at least 4 weeks and
maintained throughout the preoperative period. Result(s): Twenty
participants were randomized into the intervention (n = 11) or control (n
= 9) group. The programme was feasible, acceptable and no severe adverse
events were recorded. The lost to follow-up rate was 7.9%, and the overall
attendance was 96%. The intervention group showed significantly greater
improvement in functional capacity, frailty status and psychological
outcomes than the control group at post-intervention. Participants gave
positive comments about the programme and its delivery mode. They
expressed that the one-on-one home-based practice enabled them greater
confidence to overcome kinesiophobia. Two participants voiced out the
preference for exclusive home-based training, rather than having
hospital-based training in the first two weeks. Conclusion(s): The
prehabilitation programme is feasible and acceptable for patients waiting
for cardiac surgeries. It improves the functional performance, frailty
status and psychological outcomes in these patients. A full-scale
randomised controlled trial is warranted to investigate its longer-term
and clinical effects.

<97>
Accession Number
646188979
Title
Is chronic kidney disease predictive of coronary artery bypass grafting
after acute coronary syndrome? A systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Scott J.; Letts M.; Hajee-Adam W.; Chau C.; Bailey P.; Johnson T.; Caskey
F.J.; Selman L.E.; Ben-Shlomo Y.
Institution
(Scott, Letts, Bailey, Johnson, Caskey, Selman, Ben-Shlomo) University of
Bristol, Bristol, United Kingdom
(Hajee-Adam) Barts Health NHS Trust, London, United Kingdom
(Chau) Royal United Hospital Bath NHS Trust, Bath, United Kingdom
Publisher
Oxford University Press
Abstract
Background: Coronary artery bypass grafting (CABG) provides superior
long-term outcomes to percutaneous coronary intervention (PCI) for
multi-vessel coronary artery disease. People with chronic kidney disease
(CKD) are at increased risk of multi-vessel coronary artery disease, and
experience greater morbidity and mortality following acute coronary
syndrome (ACS). Purpose(s): To determine whether CKD affects choice
of revascularisation strategy after ACS. Method(s): We searched
EMBASE, MEDLINE, SCOPUS, CENTRAL and the NIHR's website of funded studies
to identify articles referring to ACS and invasive coronary management in
high-income countries over the past 12 years until 29th September 2023.
Full text articles were included if data on rates of CABG were reported in
people with and without CKD who were revascularised following ACS. CKD was
defined as one or more recording of an estimated glomerular filtration
rate (eGFR) <60mls/min/1.73m2, however proxies for this were accepted.
Risk of bias was assessed via ROBINS-E. Random effect meta-analyses
estimated the odds ratios for CKD and CABG, stratified by ACS type and
receipt of dialysis. Certainty of evidence was assessed according to
GRADE. Result(s): Initial searches generated 15,138 articles, of
which 13 observational studies were included in this review (8,021,743
participants). Amongst people revascularised following ACS, those with CKD
were more likely to receive CABG than those without kidney disease (OR for
the average exposure effect 1.47 (95% CI 1.30-1.66)). The likelihood of
CABG in people with CKD receiving dialysis and those with CKD not
receiving dialysis were similar as the 95% confidence intervals
demonstrate (ORs 1.25 (95% CI 1.00-1.57) and 1.41 (1.19-1.67)
respectively). The effect of CKD on increased likelihood of CABG appeared
greater following ST-elevation myocardial infarction (STEMI) than non-ST
elevation ACS (NSTE-ACS) (OR 1.53 (95% CI 1.27-1.83) versus 1.10
(0.98-1.25) respectively, p=0.003). Certainty of the evidence was low for
receipt of CABG in people with CKD not receiving dialysis, and moderate
for all other outcomes. Conclusion(s): In high-income countries, CKD
is associated with increased receipt of CABG amongst people revascularised
following ACS. This finding is likely explained by the greater prevalence
of multi-vessel coronary artery disease in this population. It is however
unclear why the association between CKD and receipt of CABG is stronger in
those with STEMI compared to NSTE-ACS, and whether this accurately
reflects differential need between the two groups. (Figure Presented).

<98>
Accession Number
646188422
Title
A meta-analysis of the safety and efficacy of pulsed-field versus
conventional thermal ablation for atrial fibrillation.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Amin A.M.; Abuelazm M.; Nazir A.; Ibrahim A.A.; Elbenawi H.; Aboutaleb A.;
Ellabban M.; Arnaout M.; Abouzid M.; Abdelazeem B.
Institution
(Amin) Mansoura University, Faculty of Medicine, Mansoura, Egypt
(Abuelazm) Tanta University, Faculty of Medicine, Tanta, Egypt
(Nazir) King Edward Medical University, Faculty of Medicine, Lahore,
Pakistan
(Ibrahim) Menofia University, Faculty of Medicine, Menoufia, Egypt
(Elbenawi) Mayo Clinic, Cardiovascular Surgery, Rochester, United States
(Aboutaleb) Zagazig University, Faculty of Medicine, Zagazig, Egypt
(Ellabban) Al-Azhar University, Faculty of Medicine, Cairo, Egypt
(Arnaout) Aleppo University, Faculty of Medicine, Aleppo, Syrian Arab
Republic
(Abouzid) Poznan University of Medical Sciences, Department of Physical
Pharmacy and Pharmacokinetics, Poznan, Poland
(Abdelazeem) West Virginia University Hospital, Cardiology Department,
Morgantown, United States
Publisher
Oxford University Press
Abstract
Background: Since pulsed-field ablation (PFA) specifically targets
myocardial tissue, it has become a cutting-edge substitute for
radiofrequency (RF) and cryoablation. Purpose(s): We aim to compare
the safety and efficacy of PFA vs thermal ablation for AF ablation.
 Method(s): We conducted a systematic review and meta-analysis
synthesizing randomized controlled trials (RCTs) and observational
comparative studies, which were retrieved by systematically searching:
PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane through September
2023. RevMan version 5.4 software was used to pool dichotomous data using
risk ratio (RR) and continuous data using mean difference (MD) with a 95%
confidence interval (CI). Result(s): Seventeen studies with a total
of 2,255 patients were included. PFA was significantly associated with a
decreased AF recurrence (RR: 0.65, 95% CI [0.51, 0.84], P= 0.0010) but not
any arrhythmia recurrence (RR: 0.87, 95% CI [0.69, 1.09], P= 0.22). Also,
PFA was significantly associated with decreased total procedure time (MD:
-15.15, 95% CI [-20.23, -10.07], P< 0.00001) and heart rate (MD: -7.56,
95% CI [-12.78, -2.34], P= 0.005); however, there was no significant
difference between PFA and thermal ablation in fluoroscopy time (MD: 2.83,
95% CI [-0.38, 6.04], P= 0.08). PFA decreased phrenic nerve palsy (RR:
0.38, 95% CI [0.15, 0.98], P= 0.05) and esophageal lesions (RR: 0.09, 95%
CI [0.01, 0.69], P= 0.02); however, PFA was significantly associated with
increased pericardial tamponade (RR: 6.14 with 95% CI [1.43, 26.33], P=
0.01). Conclusion(s): PFA was significantly associated with decreased
AF recurrence, heart rate, total procedure time, phrenic nerve palsy,
esophageal lesion, and increased incidence of pericardial tamponade
compared with thermal ablation. However, current evidence is mainly
weighted by observational studies, requiring further large-scale
randomized trials.

<99>
Accession Number
646188802
Title
Correlation between short-term quality of life improvement and clinical
outcomes - a post-hoc ISCHEMIA trial analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Caldonazo T.; Kim J.K.; Heise R.H.; Rahouma M.R.; Harik L.H.; Redfors
B.R.; Sandner S.S.; Gaudino M.G.
Institution
(Caldonazo) Jena University Hospital, Jena, Germany
(Kim, Heise, Rahouma, Harik, Gaudino) Weill Cornell Medicine, New York,
United States
(Redfors) Sahlgrenska University Hospital, Gothenburg, Sweden
(Sandner) Medical University of Vienna, Center for Biomedical research,
Vienna, Austria
Publisher
Oxford University Press
Abstract
Background: Patients with symptomatic coronary artery disease (CAD)
exhibit improvement in quality of life (QoL) after invasive management
(percutaneous coronary intervention [PCI] and coronary artery bypass
grafting [CABG]). However, it is not clear how QoL improvements after
intervention are related to clinical outcomes. Purpose(s): Using the
International Study of Comparative Health Effectiveness With Medical and
Invasive Approaches (ISCHEMIA) population, we sought to assess the
relationship between short-term QoL improvement and long-term clinical
outcomes. Method(s): All participants in the ISCHEMIA trial who were
randomized to the invasive arm and who had QoL scores available were
included in the analysis. QoL improvement was calculated using the
difference between the Seattle Angina Questionnaire (SAQ) score at
baseline and at six months regarding randomization. The primary outcome
was the trial-defined composite outcome (cardiovascular death, myocardial
infarction, cardiac arrest or hospitalization for unstable angina/heart
failure) and all-cause death. The secondary outcome was all-cause
mortality. Median follow-up was 3.3 years. Cox proportional hazards models
included clinically relevant demographic and angiographic covariates.
 Result(s): After the exclusion of the conservative treatment arm and
patients without QoL follow-up or covariate data, 1,577 patients were
selected for the final analysis (Fig.1). The median baseline SAQ score was
74 (interquartile range, IQR: 60-88), the change in score at six months
was 14 (IQR: 2-26), and 76.1% of patients experienced improvement in QoL.
Six-month QoL improvement was not associated with a lower risk of the
primary outcome (hazard ratio [HR]: 0.961, 95% confidence interval [CI],
0.920-1.005, p=0.081 - Table 1), but was associated with all-cause
mortality (HR: 0.919, 95% CI, 0.859-0.982, p=0.013 - Table 1). In this
population, increased age (HR: 2.370, 95% CI, 1.710-3.287, p<0.001, per 10
years) was also associated with higher risk of all-cause mortality.
 Conclusion(s): Among invasive treated patients in ISCHEMIA trial,
six-month QoL improvement was associated with a lower risk of long-term
all-cause mortality, but not with a lower risk of major adverse events.

<100>
Accession Number
646189043
Title
Colchicine in patients with coronary disease undergoing coronary artery
bypass surgery: a meta-analysis of randomized controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Kirov H.; Caldonazo T.; Festerling L.; Medin D.; Mukharyamov M.; Fischer
J.; Runkel A.; Doenst T.
Institution
(Kirov, Caldonazo, Festerling, Medin, Mukharyamov, Fischer, Runkel,
Doenst) University hospital Jena, Jena, Germany
Publisher
Oxford University Press
Abstract
Background: Recent randomized evidence has shown that low dose colchicine
lowers the risk of cardiovascular events in patients with chronic coronary
artery disease (CAD). Colchicine has also been used in coronary artery
bypass grafting (CABG) with individual studies suggesting protective
effects for postoperative atrial fibrillation (POAF). We performed a
meta-analysis of studies assessing the effect of colchicine on outcomes in
CABG surgery. Purpose(s): To determine the potential of colchicine
for reducing post-operative atrial fibrillation or other adverse events in
patients undergoing CABG. Method(s): We systematically searched three
libraries (MEDLINE, Web of Science and The Cochrane Library) selecting all
randomized control trials (RCT) including patients who underwent CABG and
were randomized for pre- or perioperative administration of colchicine
versus standard of care. Primary outcome was incidence of POAF. Inverse
variance method (DerSimonian&Laird) and random effects model were
performed. The leave-one-out analysis was carried out as a sensitivity
analysis to address possible outliers. Result(s): From 205 screened
studies, five met the inclusion criteria and were selected. The data from
839 patients were included in the final analysis. Included studies were
published between 2014 and 2022. The perioperative administration of
colchicine was associated with reduction of POAF rates after CABG when
compared to standard of care (relative risk; RR= 0.54, 95% confidence
interval; CI, 0.40-0.73, p<0.01 - Fig. 1). The leave-one-out analysis
confirmed the robustness of the analysis, with minimal variations of the
confidence interval (Fig. 2). Conclusion(s): This meta-analysis of
randomized studies suggests that the perioperative administration of
colchicine is associated with significant reduction of POAF rates after
CABG. Forest plot Leave-one-out analysis.

<101>
Accession Number
646186748
Title
Comic-based consenting on patient-reported experience and outcome measures
for transfemoral aortic valve implantation.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Thevathasan T.; Reitz F.; Hornig C.; Leistner D.; Dreger H.; Suendermann
S.; Unbehaun A.; Haghikia A.; Stangl K.; Falk V.; Landmesser U.; Hindricks
G.; Skurk C.; Stangl V.; Brand A.
Institution
(Thevathasan, Reitz, Hornig, Dreger, Suendermann, Unbehaun, Stangl, Falk,
Landmesser, Hindricks, Skurk, Stangl, Brand) Deutsches Herzzentrum der
Charite, Department of Cardiology, Angiology and Intensive Care Medicine,
Berlin, Germany
(Leistner) University Hospital Frankfurt, Department of Neurology,
Frankfurt, Germany
(Haghikia) Catholic Hospital Bochum, Bochum, Germany
Publisher
Oxford University Press
Abstract
Background: The impact of an improved patient informed consent (IC) before
transcatheter aortic valve implantation (TAVI) on patient-reported
experience and outcome measures (PREMs and PROMs) as well as on clinical
outcomes remains unclear. Purpose(s): To investigate patient
satisfaction, PREMs, PROMs and clinical outcomes in patients receiving
additional illustrative graphic-based IC (comic group) compared to
conventional IC (control group) for TAVI at two tertiary care centers as
part of a randomised controlled trial ('TAVI-COMIC study').
 Method(s): Adult patients undergoing elective TAVI were enrolled.
Patient satisfaction and PREMs were assessed after providing IC, PROMs at
90 days after TAVI and clinical safety outcomes within 7 days after TAVI
(Figure). Result(s): Only 48 (32%) of all patients read the official
usual patient information sheet. Of 299 patients undergoing TAVI,
comic-based IC was performed in 152 (51%) patients. Patient satisfaction
was significantly higher (29 [23-32] vs 25 [22-30] of a maximum of 32
points in the validated Client Satisfaction Questionnaire [CSQ], p<0.001)
and anxiety was lower (34 [25-51] vs 39 [29-55], p<0.001 in the validated
Spielberger State-Trait-Anxiety Inventory [STAI]) in the comic group. 92
(61%) patients in the comic group felt 'relaxed' prior to the procedure
compared to only 44 (30%) patients receiving conventional IC (p<0.001). 91
(60%) were 'very satisfied' with the delivered patient IC compared to 28
(19%) patients in the control group (p<0.001). PROMs at 90 days were
assessed in a subgroup of 198 (66% of total cohort) patients: The comic
group had similar PROMs as the control group (e.g. general health
condition, walking ability and rate of dizziness, syncope, helplessness,
depression, dyspnea or angina). Clinical outcomes, such as bleeding,
pneumonia, stroke, delirium, or TAVI unit and hospital length of stay,
were similar in both groups. Conclusion(s): Use of an alternative IC
approach, such as medical graphic narratives, might significantly improve
patient satisfaction and PREMs, while facilitating similar PROMs and
procedural safety as conventional treatment strategies.

<102>
Accession Number
646185572
Title
Safety and efficacy of transcatheter aortic valve implantation (TAVI) for
pure aortic regurgitation; a systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Ktenopoulos N.; Apostolos A.; Karanasos A.; Drakopoulou M.; Katsaros O.;
Simopoulou C.; Oikonomou G.; Kachrimanidis I.; Koliastasis L.; Benetos G.;
Tsalamandris S.; Synetos A.; Latsios G.; Tsioufis C.; Toutouzas K.
Institution
(Ktenopoulos, Apostolos, Drakopoulou, Katsaros, Simopoulou, Oikonomou,
Kachrimanidis, Koliastasis, Benetos, Tsalamandris, Synetos, Latsios,
Tsioufis, Toutouzas) Ippokrateio General Hospital of Athens, First
Department of Cardiology, Athens, Greece
(Karanasos) General University Hospital of Patras, Department of
Cardiology, University of Patras, Patra, Greece
Publisher
Oxford University Press
Abstract
Background: Although Transcatheter Aortic Valve Implantation (TAVI) has
gained ground in the management of severe aortic stenosis (AS), evidence
about its safety and efficacy for patients with pure native aortic
regurgitation (AR) remains limited. Purpose(s): The aim of the study
is to systematically review and summarize available data regarding the
safety and the outcomes of TAVI in pure AR. Method(s): This study was
conducted according to the PRISMA guidelines. We systematically searched
PubMed, SCOPUS, and Cochrane databases from their inception to February 1,
2024, for studies assessing the characteristics and outcomes of patients
undergoing TAVI for pure AR. Primary endpoint of our systematic review and
meta-analysis is the in-hospital, 30-days and 1-year mortality rates.
Secondary endpoints comprised in-hospital stroke, major bleeding, and
permanent pacemaker implantation (PPM) implantation. Endpoint definitions
followed the Valve Academic Research Consortium 2 criteria. The cumulative
incidence of primary and secondary endpoints and the corresponding 95%
confidence intervals (CI) were estimated. A random effects model
(DerSimonian-Laird) was used to account for heterogeneity among the
included studies. Result(s): Our meta-analysis included a total of 22
studies and 6,710 patients undergoing TAVI for pure-AR. Our analysis
showed that patients undergoing TAVI for pure AR had 3.4% (95% CI:
2%-4.7%), 7.9% (95% CI: 5.2%-10.6%) and 15.5% (95% CI: 9.9%-21.2%)
in-hospital, 30-days and 1-year all-cause mortality. In-hospital stroke
occurred in 1.9% (95% CI: 1.5%-2.2%) of the patients, while 4.9% (95% CI:
3.3%-6.6%) of the patients suffered from major bleeding events. Finally,
considering the PPM implantation rates, patients had a 10.7% (95% CI:
7.4%-13.9%) in-hospital incidence. Conclusion(s): Our systematic
review and meta-analysis shows a promising safety profile for TAVI
treating pure AR. It demonstrated relatively low in-hospital, 30-days and
1-year mortality incidence, comparable to the TAVI treating severe AS,
according to the existing literature. Taking into consideration that TAVI
for pure-AR might be the only therapeutic option for an increasing number
of patients, further studies are needed to further assess the safety and
efficacy of the procedure.

<103>
Accession Number
646187821
Title
Generalizability of SELECT to a contemporary cohort of cardiac surgical
patients: analysis of the TRICS III Randomized Trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Dhingra N.; Verma R.; Mazer C.D.; Verma S.
Institution
(Dhingra, Mazer, Verma) St. Michael's Hospital, Toronto, Canada
(Verma) Royal College of Surgeons in Ireland, Dublin, Ireland
Publisher
Oxford University Press
Abstract
Background: The SELECT trial reported a significant reduction in
cardiovascular (CV) outcomes with semaglutide amongst patients without
diabetes who had pre-existing CV disease and a body-mass index (BMI) of 27
or greater. Patients undergoing cardiac surgery represent a high-risk
subset of those with established CV disease, and may benefit from
treatment with semaglutide. Purpose(s): This study evaluated the
generalizability of SELECT to a contemporary international cohort of
cardiac surgical patients, and assessed whether differences between
SELECT-eligible and non-eligible patients translated to altered risks of
CV outcomes. Method(s): Present data was gathered from the TRICS III
trial, a multicentre, randomized trial of restrictive versus liberal
red-cell transfusion thresholds amongst 5243 cardiac surgical patients
with a EuroSCORE I of >=6. The proportion of cardiac surgical patients
eligible for SELECT was determined by applying its selection criteria to
the TRICS III cohort. Finally, baseline characteristics and outcomes
stratified by SELECT eligibility were compared. Result(s): A total of
4887 patients from the TRICS III cohort had available data for analysis,
of which 452 (9.2%) were deemed to have been eligible for the SELECT
trial. A comparison of baseline characteristics between SELECT-eligible
and non-eligible patients are presented in Table 1; while SELECT-eligible
patients were more likely to have preserved left ventricular function
(71.7% vs. 61.0%), EuroSCORE I values were comparable between the two
groups (7.8+/-2.1 vs. 7.9+/-1.9). The rate of a 3-point MACCE of Death, MI
or stroke in the present cohort of SELECT-eligible patients undergoing
cardiac surgery (16.6%) was numerically higher than those enrolled in
SELECT receiving semaglutide (8.1%) or placebo (10.0%), despite the
shorter follow-up (6 months vs. 39.8 months). Six month outcomes following
cardiac surgery were similar regardless of SELECT eligibility (Figure 1);
no difference in risk of outcomes was documented for the 3-point MACCE
[SELECT Eligible vs. Non-eligible - 16.6% vs. 14.5%; OR 1.17 (0.9-1.53);
P=0.24] and the TRICS III primary composite of Death, MI, Stroke, or
New-Onset Renal Failure with Dialysis [17.0% vs. 17.0%; OR 1.0
(0.77-1.29); P=0.98]. There was a trend towards higher rates of MI at 6
months amongst SELECT-eligible patients, but this difference failed to
reach statistical significance [8.5% vs. 6.3%; OR 2.0 (0.96-1.39);
P=0.08). Conclusion(s): In this large international cohort of
contemporary cardiac surgical patients, nearly 10% would have met
eligibility for SELECT. SELECT-eligible patients undergoing cardiac
surgery in TRICS III had a numerically higher rate of MACCE than those
enrolled in SELECT, highlighting the high risk nature of this patient
subgroup. However, amongst SELECT-eligible and non-eligible patients
undergoing cardiac surgery, no significant difference in CV outcomes was
uncovered.

<104>
Accession Number
646189073
Title
Moderate-intensity statin combined with ezetimibe versus high-intensity
statin monotherapy for secondary cardiovascular risk reduction: a
systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Cani A.; Ayyalu T.; Klaassen J.; Turch H.; Loyola J.; Huang E.; Gewehr D.;
Kritya M.; Martignoni F.
Institution
(Cani) Fidia Farmaceutici, Padua, Italy
(Ayyalu) Lenox Hill Hospital, New York, United States
(Klaassen) Univeristy of Wyoming, Laramie, United States
(Turch) Abbott Northwestern Hospital, Minneapolis, United States
(Loyola) Hospital Nove de Julho, Sao Paulo, Brazil
(Huang) National Taiwan University, Taipei, Taiwan (Republic of China)
(Gewehr) Curitiba Heart Institute, Curitiba, Brazil
(Kritya) Inamdar Multispecialty Hospital, Pune, India
(Martignoni) Minneapolis Heart Institute Foundation, Minneapolis, United
States
Publisher
Oxford University Press
Abstract
Introduction: Intensive lowering of LDL cholesterol levels is recommended
for patients with atherosclerotic cardiovascular disease (ASCVD) [1].
Statins are the first-line therapy for secondary prevention [1]. Recent
studies such as the RACING trial suggest that the combination of
moderate-intensity statins and ezetimibe (MIS+EZE) may achieve a greater
LDL cholesterol reduction and a lower adverse event rate than
high-intensity statins alone (HIS) [2]. Purpose(s): The aim of this
systematic review and meta-analysis is to assess cardiovascular outcomes
and clinical safety of MIS+EZE versus HIS in patients with ASCVD.
 Method(s): We searched PubMed, Cochrane and Embase for studies that
compared MIS+EZE to HIS in patients with ASCVD and included studies
reporting cardiovascular mortality, all cause mortality, non-fatal stroke,
non-fatal myocardial infarction, unstable angina, coronary
revascularization, heart failure, and LDL-C <= 70mg/dL. Studies with the
same statin dose in both treatment groups and studies with overlapping
populations were excluded. Treatment effects for binary endpoints were
compared using pooled risk-ratios (RR) with 95% confidence intervals.
 Result(s): Out of 6238 studies, we included 6 RCTs and 2
retrospective cohort studies with 40,236 patients of whom 10,254 were
treated with MIS+EZE (25,5%). Mean follow-up ranged from 90 days to 3
years. Cardiovascular mortality (RR 0.83; CI95% 0.73-0.94; p=0.003),
all-cause mortality (RR 0.90; CI95% 0.82-0.98; p=0.02) and non-fatal
stroke (RR 0.83; CI95% 0.73-0.93; p=0.002) were significantly lower in
patients treated with MIS+EZE compared to those treated with HIS. A
significantly higher proportion of patients in the MIS+EZE group reached
an LDL-C <= 70mg/dL (RR 1.26; CI95% 1.19-1.34; p<0.00001). No
statistically significant difference was found for non-fatal myocardial
infarction (RR 0.87; CI95% 0.64-1.17; p=0.36), coronary revascularization
(RR 1.03; CI95% 0.78-1.35; p=0.83), heart failure (RR 0.95; CI95%
0.86-1.06; p=0.38) and unstable angina (RR 1.52; CI95% 0.62-3.75; p=0.36).
A RCT sub-analysis was feasible for cardiovascular mortality and showed no
statistically significant difference between the two groups (RR 1.01;
CI95% 0.42-2.42; p=0.98). Regarding safety endpoints, the risk of adverse
events (RR 0.84; CI95% 0.74-0.95; p=0.004) and the risk of muscle-related
adverse events (RR 0.67; CI95% 0.49-0.92; p=0.01) were significantly lower
in MIS+EZE group. The significant reduction in muscle-related adverse
events was maintained in the RCT sub-analysis (RR 0.61; CI95% 0.41-0.91;
p=0.02). There was no difference between groups in the risk of
liver-related adverse events (RR 0.63; CI95% 0.29-1.41; p=0.26) or
new-onset malignancy (RR 0.99; CI95% 0.87-1.12; p=0.85).
 Conclusion(s): The combination of moderate-intensity statins and
ezetimibe may be considered as an alternative therapeutic strategy to
reduce secondary cardiovascular risk with lower rates of drug intolerance.

<105>
Accession Number
646188592
Title
Systematic review and meta-analysis on the effects of physical
activity-based interventions on frailty status and clinical outcomes in
adults with long-term cardiac conditions.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Sze S.; Waterhouse H.; Singh S.; Squire I.B.
Institution
(Sze, Squire) Cardiovascular Research Unit of Leicester, Leicester, United
Kingdom
(Waterhouse, Singh) University of Leicester, Leicester, United Kingdom
Publisher
Oxford University Press
Abstract
Introduction: Frailty is common in patients with long-term cardiac
conditions and is associated with poor clinical outcomes, but limited
treatment options are available. Previous studies investigating
interventions for frailty have shown positive results with physical
activity interventions, however, these studies were largely based on
general elderly populations. Aim(s): To assess the impact of physical
activity-based interventions on frailty and clinical outcomes in frail
patients with long-term cardiac conditions. Method(s): A systematic
review and meta-analysis was conducted based on the PRISMA guideline,
using Medline, Embase, CENTRAL, PEDro, CINAHL electronic databases for
articles published between 2000 and 2023. Studies which recruited adults
>18 years with long-term cardiac conditions (including angina, acute
coronary syndrome (ACS), valve disease, heart failure (HF), atrial
fibrillation, cardiac surgery and congenital heart disease) who underwent
physical activity-based interventions were included. The primary outcome
was change in frailty (measured using a validated tool) post intervention.
We also assessed the effect of interventions on mortality and
hospitalisation. Result(s): We screened 2697 records and reviewed 91
full-text articles; 12 studies (14 articles) were included, involving 1394
patients. Median age of participants ranged from 64 to 82 years. Five
studies recruited participants with HF, 3 evaluated participants post
transaortic valve implantation, 3 recruited cardiac surgical patients and
1 study evaluated participants post ACS. Physical activity-based
interventions were multi-domain, including a mixture of aerobic, strength,
balance, endurance and respiratory muscle training; the majority (N=10)
had individualised exercise prescription. Meta-analysis of 8 randomised
controlled trials (RCTs) showed statistically significant improvement in
frailty associated with physical activity-based interventions compared to
controls [pooled standardised mean difference (95% CI) = -0.34 (-0.59 to
-0.08), p = 0.01, I2 = 48%]. Seven RCTs evaluated change in frailty by
short physical performance battery (SPPB). Meta-analysis of these studies
showed a statistically significant improvement in SPPB associated with
physical activity-based interventions compared to controls [pooled mean
difference (95% CI) = 0.83 (0.31-1.34), p = 0.002, I2 = 49%]. (Figure) The
magnitude of improvement in SPPB exceeded the minimally clinically
significant improvement of 0.5. Three studies evaluated the effect of
physical activity-based intervention on clinical outcomes, all of which
showed neutral effect on mortality and hospitalisation.
 Conclusion(s): Physical activity-based interventions in patients with
frailty and long-term cardiac conditions were associated with significant
improvement in frailty status, with neutral effect on mortality and
hospitalisation. (Figure Presented).

<106>
Accession Number
646186116
Title
Emergency interventional treatment of cardiogenic shock due to
decompensated aortic stenosis: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Kuehne S.G.; Raake P.W.J.; Chiarito M.; Bongiovanni D.
Institution
(Kuehne, Raake, Bongiovanni) University Hospital Augsburg, Departement of
Cardiology, Augsburg, Germany
(Chiarito) IRCCS Ospedale San Raffaele, Universita Vita-Salute San
Raffaele, Milano, Italy
Publisher
Oxford University Press
Abstract
Introduction: Cardiogenic shock (CS) induced by severe aortic stenosis
(AS) represents a critical condition with a high mortality rate. Its
optimal treatment is still unclear due to the recent advances in
interventions and supportive therapies. Emergency transcatheter aortic
valve implantation (eTAVI) as definitive therapy and emergency balloon
aortic valvuloplasty (eBAV) as bridge to intervention are viable
therapeutic options, but it is still unclear which strategy provides the
best outcomes. Purpose/Objective: This meta-analysis aimed to investigate
the effectiveness and safety of eTAVI versus eBAV in patients with
cardiogenic shock due to severe aortic stenosis. The primary endpoint was
mortality at 30-day. Secondary outcomes were 1-year mortality and vascular
and bleeding complications as well as incidence of pacemaker implantation.
 Method(s): We performed a systematic literature review to identify
relevant studies reporting outcomes of patients undergoing eBAV or eTAVI
due to CS. Studies conducting eTAVI or eBAV in patients with cardiogenic
shock due to severe aortic stenosis were included. Data extraction and
analysis were performed to evaluate mortality rates at 30 days and 1 year,
as well as secondary endpoints including procedural complications.
 Result(s): 15 studies were included in the meta-analysis (6 for
eTAVI, 10 for eBAV, one study comparing the two strategies) with a total
of 2702 patients. The pooled estimated rate for mortality at 30 days was
19% (I2= 11.4%; CI 0.16, 0.22) for eTAVI and 40%
(I2= 56%; CI 0.31, 0.49) for eBAV while the pooled estimated
rate for mortality at one year were 66% (I2= 27.1%; CI 0.57,
0.75) and 45% (I2= 82.8%; CI 0.21, 0.69) for eBAV and eTAVI
respectively. Pooled estimated rate for any bleeding was 11%
(I2= 54.3%; CI 0.02, 0.21) for eBAV and 11% (I2=
88.3%; CI 0.02, 0.20) for eTAVI, while for major vascular complications
were 6% (I2= 72.7%; CI 0.00, 0.13) and 7% (I2=
52.1%; CI 0.03, 0.11) for eBAV and eTAVI respectively. As expected, pooled
estimates for pacemaker implantation was high for eTAVI 9 %(I2=
0%; CI 0.08, 0.10) while 1% (I2= 9.5%;CI 0.0, 0.05) for eBAV.
 Conclusion(s): Using the totality of existing evidence, this study
synthesizes the current evidence to elucidate the benefits and risks
associated with eTAVI and eBAV in patients with CS due to AS. eTAVI
procedure has beneficial survival rates, while it is associated with
higher pacemaker implantations. While these findings are hypothesis
generating only, as selection bias and other confounders cannot be
excluded, they provide valuable insights to guide clinical decision-making
in CS patients.

<107>
Accession Number
646188428
Title
Multimodal analgesics after adult cardiac surgery; a systematic review.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Wynne R.; Jedwab R.; Gjeilo K.H.; Magboo R.; Goudarzi M.; Okeefe Mccarthy
S.; Keeping Burke L.; Murfin J.; Killackey T.; Bruneau J.; Phillips E.;
Bowden T.; Fredericks S.; Sanders J.; Lie I.
Institution
(Wynne) Western Health, Melbourne, Australia
(Jedwab) Monash Health, Melbourne, Australia
(Gjeilo) St Olavs Hospital (Trondheim university hospital), Trondheim,
Norway
(Magboo, Sanders) St Bartholomews and Queen Mary University, London,
United Kingdom
(Goudarzi) Peter Munk Cardiac Centre, Toronto, Canada
(Okeefe Mccarthy) Brock University, Centre for Health and Wellbeing, ON,
Canada
(Keeping Burke) University of New Brunswick, NB, Canada
(Murfin) University of Southampton NHS Foundation Trust, South Hampton,
United Kingdom
(Killackey) Hospital for Sick Children, Toronto, Canada
(Bruneau) Memorial University, NL, Canada
(Phillips) University of Manitoba, Manitoba, Canada
(Bowden) University of London, St Bartholomews, London, United Kingdom
(Fredericks) Ryerson University, Toronto, Canada
(Lie) Oslo University Hospital, Gjovik, Norway
Publisher
Oxford University Press
Abstract
Background: Moderate to severe pain is frequently reported during the
acute recovery phase following adult cardiac surgery. Multimodal
analgesics are recommended for adult patients post cardiac surgery, but
the optimal combination of multimodal analgesics is unknown.
 Purpose(s): To synthesise the best available evidence about the
effectiveness of multimodal analgesics on pain after adult cardiac
surgery. Method(s): A systematic review was conducted according to
the PRISMA-P statement and the published review protocol. Inclusion
criteria were full-text papers or abstracts with adequate reporting, in
any language, of randomised controlled trials (RCTs) in adult patients
undergoing cardiac surgery that investigated the effect of multimodal
postoperative analgesic regimens, compared to a control group. The highest
mean level of patient self-reported pain intensity at rest, captured using
a validated pain assessment tool, was the primary outcome measure.
 Result(s): Of 3754 citations identified in the initial search to the
12th of December 2022, there were 1605 duplicates leaving 2149 citations
for title and abstract screening, of which 2027 were irrelevant. There
were 122 full-text papers assessed and 29 included in the review. Data
were independently extracted by 2 reviewers in Covidence. Participants (N
= 2360), aged 59.5 + 8.2 years, were primarily male (N = 1561, 66.1%),
weighing 78.1 +9.2 kilograms. Risk of bias was high and reporting quality
was poor. Pain at rest reported in 18 (62%) studies was 3.5 (SD 1.2) in
the control and 2.7 (SD 0.9) in the intervention groups respectively.
Nurse-led versus patient-controlled analgesic administration was tested in
14 (48.3%) trials. All trials tested different analgesic combinations,
none of which compared a combination of non-opioids, opioid
agonist-antagonist agents, or full opioid agonists. Conclusion(s):
Poorly managed pain is associated with postoperative complications,
unplanned readmissions, and the development of chronic pain. Robust RCTs
are urgently needed to inform optimal combinations of multimodal
analgesics to optimise patient recovery after adult cardiac surgery.
(Figure Presented).

<108>
Accession Number
646189068
Title
Safety of beta-blocker discontinuation in patients after acute coronary
syndromes and preserved left ventricular ejection fraction: long-term
clinical outcomes from the SPUM-ACS cohort.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Johner N.; Branca M.; Carballo D.; Baggio S.; Nanchen D.; Tessitore E.;
Raber L.; Luscher T.F.; Matter C.; Windecker S.; Rodondi N.; Mach F.;
Gencer B.
Institution
(Johner, Carballo, Tessitore, Mach, Gencer) Geneva University Hospitals,
Cardiology Division, Geneva, Switzerland
(Branca) University of Bern, CTU Bern, Bern, Switzerland
(Baggio, Rodondi) University of Bern, Institute of Primary Healthcare
(BIHAM), Bern, Switzerland
(Nanchen) University of Lausanne, Center for Primary Care and Public
Health (Unisante), Lausanne, Switzerland
(Raber, Windecker) Bern University Hospital, Inselspital, Department of
Cardiology, Bern, Switzerland
(Luscher) University of Zurich, Center for Molecular Cardiology, Zurich,
Switzerland
(Matter) University Hospital Zurich, Department of Cardiology, Zurich,
Switzerland
Publisher
Oxford University Press
Abstract
Background: While beta-blockers have been shown to improve outcomes after
acute coronary syndromes (ACS), most trials predate the advent of
reperfusion therapy and modern secondary prevention. Recent trial data in
the reperfusion era found no all-cause or cardiovascular mortality benefit
in patients with a left ventricular ejection fraction (LVEF) >40%, while
myocardial infarction and angina were reduced. We hypothesized that, in
patients who receive optimal contemporary treatment following ACS and who
have an LVEF >40%, beta-blocker discontinuation within 1 year after ACS is
safe and non-inferior to beta-blocker continuation in terms of the 5-year
incidence of major adverse cardiovascular events (MACE). Purpose(s):
We assessed the safety of beta-blocker discontinuation within 12 months
following ACS in patients with an LVEF >40% at discharge, compared to
continued long-term beta-blocker therapy, with respect to the 5-year
incidence of MACE. Method(s): Data was derived from the Swiss Special
Program University Medicine - Inflammation in ACS (SPUM-ACS) cohort
(N=3,762), a multicenter prospective cohort of patients hospitalized for
invasive management of ACS between 2009-2017. We included patients with an
LVEF >40%, beta-blockers at discharge, and who completed the 5-year
follow-up. Patients who continued beta-blockers at one year were compared
with those who discontinued beta-blockers at any time throughout the first
year after ACS using a target trial emulation design. Adjusted hazard
ratios (aHR) were obtained with a Cox model using an inverse probability
weighting adjustment for baseline characteristics including demographic
parameters, comorbidities, and concomitant medication. The primary
endpoint was 5-year MACE (cardiovascular death, myocardial infarction,
stroke or transient ischemic attack, unplanned coronary revascularization,
and hospitalization for unstable angina). Result(s): Of 2,077
patients with an LVEF >40% and beta-blockers at discharge, 1,758 (85%)
continued beta-blockers and 319 (15%) had discontinued beta-blocker
therapy at one year. The 5-year risk between the discontinuation and
continuation group was similar for the primary endpoint (14.5% vs 14.3%,
respectively, aHR 1.00, 95%CI 0.73-1.36, p=0.98). All-cause mortality (aHR
1.08, 95%CI, 0.64-1.81, p=0.79) did not differ between both groups. In a
subgroup analysis, there was no effect modification by LVEF, but some
evidence for a higher risk of primary endpoint with beta-blocker
discontinuation in STEMI (aHR 1.50, 95%CI 1.02-2.21) compared with NSTEMI
(aHR 0.69, 95%CI 0.40-1.19, P interaction = 0.022). Conclusion(s):
Beta-blocker discontinuation within 12 months following ACS in patients
with an LVEF >40% was not associated with an increased risk of MACE at 5
years, compared to long-term continuation of beta-blocker therapy. In the
absence of a dedicated randomized controlled trial, beta-blocker
discontinuation may be safe, especially after NSTEMI. Kaplan-Meier plot:
probability of MACE.

<109>
Accession Number
646187690
Title
Coronary access after Transcatheter Aortic Valve Replacement (TAVR): a
systematic review and meta-analysis of observational studies.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Giacobbe F.; Morena A.; Bruno F.; Di Pietro G.; Nebiolo M.; Odeh Y.; De
Filippo O.; Conrotto F.; Omede P.; D'ascenzo F.; De Ferrari G.M.
Institution
(Giacobbe, Morena, Bruno, Nebiolo, Odeh, De Filippo, Conrotto, Omede,
D'ascenzo, De Ferrari) Hospital Citta Della Salute e della Scienza di
Torino, Turin, Italy
(Di Pietro) Sapienza University of Rome, Cardiac Department, Rome, Italy
Publisher
Oxford University Press
Abstract
Introduction: Over the past two decades, transcatheter aortic valve
replacement (TAVR) has transformed the management of aortic stenosis,
initially for high-risk surgical candidates and subsequently for low-risk
patients. However, with the expanding indications for TAVR to younger,
lower-risk patients, it is crucial to assess not only the short-term
clinical outcomes but also the long-term considerations for future
interventions. The prevalence of coronary artery disease (CAD) in TAVR
patients is relevant, and the optimal timing of percutaneous coronary
intervention (PCI) remains a question, given the technical challenges
associated with coronary access in TAVR patients. Method(s): We
conducted a systematic literature review and meta-analysis according to
Cochrane Collaborations and PRISMA guidelines. We included 19 eligible
trials involving 1533 patients who underwent coronary angiography after
TAVR. The primary endpoint was the incidence of successful selective
coronary re-access. Secondary endpoints included semi-selective and
non-selective access rates. The analysis was stratified by
balloon-expandable (BEVs) and self-expandable valve (SEVs) types.
 Result(s): Successful coronary access after TAVR was feasible in the
majority of patients, with a higher success rate observed for the left
main coronary artery (LM) compared to the right coronary artery (RCA).
Balloon-expandable valves demonstrated the highest success rates in
coronary ostia cannulation, achieving nearly 100% success for both LM and
RCA. Among self-expandable valves, the Evolut R/PRO showed superior
success rates in selective coronary access (76,85% (95%CI 53,34-100%) for
LM and 57,27% (95%CI 32,8-81,74%) for RCA) compared to the CoreValve
(45,62% (95%CI 0-92,78%) for LM and 49,19% (95%CI 0-100%) for RCA).
Notably, the majority of coronary angiograms were performed due to acute
coronary syndrome, primarily non-ST-segment elevation myocardial
infarction (NSTEMI) and unstable angina (UA), 26,5% for NSTEMI and 23,4%
for UA, respectively. Conclusion(s): Selective coronary engagement
after TAVR is generally achievable, with BEVs demonstrating superior
success rates compared to SEVs. Among self-expandable valves, the Evolut
R/PRO showed better outcomes than the CoreValve. These findings provide
valuable insights into post-TAVR coronary access feasibility, reducing
concerns about valve selection based on this criterion.

<110>
Accession Number
646189309
Title
A randomized controlled trial of an eight-week cardiac rehabilitation home
verse hospital exercise programme for post coronary cardiac bypass
patients.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Taktoni M.; Morg Thow M.T.; Seenan C.S.
Institution
(Taktoni) King Faisal Specialist Hospital and Research Centre, Riyadh,
Saudi Arabia
(Morg Thow, Seenan) Glasgow Caledonian University, Health and life
Science, Glasgow, United Kingdom
Publisher
Oxford University Press
Abstract
Background: The prevalence and morbidity and mortality rates of coronary
heart disease (CHD) continue to increase towards epidemic proportions in
the Kingdom of Saudi Arabia (KSA). Despite the advances in Cardiac
surgery, currently there are no established out-patient phase program of
Cardiac Rehabilitation (CR) for CHD participants in KSA. Aim of the study:
To evaluate the effectiveness of a home-based CR (Home CR) program using
individualized exercise (Physiotools-R) and out-patient phase of CR
(Hospital CR) program compared to standard care of home instructions on
physical function, physiological and psychological status, body
composition and the quality of life of the CHD participants post Coronary
Artery Bypass Graft (CABG) surgery. Method(s): 73 participants
post-CABG surgery were randomly assigned to one of three groups: Hospital
CR group (n=25), Home CR group (n=24) and Control group (n=24). Outcome
measures include Incremental Shuttle Walk Test (ISWT), Metabolic
Equivalent Tasks (METs), Psychosocial outcomes and body composition were
recorded at baseline, eight weeks of CR intervention, and after four weeks
of observation follow up. Intervention(s): Hospital CR program
comprised of group based Aerobic Circuit Training, home based structured
individualized exercise program. Each programme had 2 hours' sessions, 3
times a week for 8 weeks, followed by four weeks of observation follow-up.
The control group followed standard care comprised usual advice on
post-operation precautions. Result(s): Post intervention, there was
an increase in mean ISWT score from baseline in both the home-based
cardiac rehabilitation and outpatient-based cardiac rehabilitation groups
(66 [0.58] m and 71 [9.19] m, respectively). No difference was observed in
the control group. At the 4-week follow-up, both intervention groups
showed statistically significant improvements in all outcome measures
(ISWT, metabolic equivalence tasks, HADS-A, HADS-D, and Short Form-36)
compared with baseline (all P < .001). The home-based cardiac
rehabilitation group showed statistically continuous improvement compared
with the outpatient-based cardiac rehabilitation group. The control group
did not show any significant changes across time in outcome measures
 Conclusion(s): Home-based CR is as effective as hospital-based CR at
improving exercise capacity in patients following CABG surgery. Home-based
CR appears to be more effective at maintaining these improvements with no
further input in the longer term.

<111>
Accession Number
646186115
Title
Multi-dimensional assessment of long-term outcomes in patients treated
with extracorporeal cardiopulmonary resuscitation during refractory
cardiac arrest.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Thevathasan T.; Voss F.; Wahl V.; Kenny M.A.; Selzer S.; Al Harbi A.S.;
Boettel J.; Paul J.; Dorsch E.M.; Audebert H.; Landmesser U.; Westenfeld
R.; Skurk C.
Institution
(Thevathasan, Wahl, Kenny, Selzer, Al Harbi, Boettel, Paul, Landmesser,
Skurk) Deutsches Herzzentrum der Charite, Department of Cardiology,
Angiology and Intensive Care Medicine, Berlin, Germany
(Voss, Westenfeld) University Hospital Duesseldorf, Duesseldorf, Germany
(Dorsch, Audebert) Charite - Universitatsmedizin Berlin, Berlin, Germany
Publisher
Oxford University Press
Abstract
Background: Recent randomised controlled trials showed short-term survival
benefits with extracorporeal cardiopulmonary resuscitation (ECPR) compared
to standard cardiac arrest treatment in selected patients with refractory
cardiac arrest. Only limited data exist on multi-dimensional long-term
outcomes after ECPR. Purpose(s): To investigate multi-dimensional
long-term outcomes of ECPR survivors, that is general health status, as
well as cardiac, cognitive and psychological functions. Method(s):
This is a multicenter, mixed-method clinical study conducted by
cardiologists, neurologists and psychologists between May 2021 and
December 2023. Adult patients who survived ECPR with veno-arterial
extracorporeal membrane oxygenation (VA-ECMO) or 'ECMELLA' (i.e., VA-ECMO
plus percutaneous left-ventricular assist device) in two German tertiary
care centers were included. A comprehensive set of functional outcomes
across multiple dimensions were assessed at approximately 18 months after
the index cardiac arrest event (see Figure for stations A to E and
explanation of abbreviations). Result(s): Long-term outcomes were
assessed in 32 ECPR survivors, out of whom 15 patients (46%) had received
VA-ECMO and 18 (54%) ECMELLA treatment. 23 patients (70%) were male and
the average age was 55 years (+/-13). Vital signs and laboratory markers
were unremarkable. Most patients denied heart failure symptoms although
the average EQ-5D-5L score was 52 (+/-8). The left-ventricular ejection
fraction was 51% (+/-9), which improved by 14% (+/-11) in the ECMO group
and 31% (+/-15) in the ECMELLA group since the index cardiac arrest event.
Bicycle exercise (on average 6 minutes duration with a power of up to 100
Watts) and 6-minute walk test (average distance of 394 meters +/-145)
revealed physical impairments. 29 patients (88%) had a good cerebral
performance (i.e., Cerebral Performance Category scale of 1) and the
average mental status was good (mini-mental state examination score 29
+/-1). 22 patients (56%) perceived (partial) impairments in activities of
daily living although the average Barthel index was 100 (+/-5) and
modified Rankin scale was 1 (+/-1). 12 patients (36%) were unable to
return to their jobs. Remarkably, 17 (51%) and 4 (12%) patients reported
depressive symptoms and suicidal thoughts, respectively.
 Conclusion(s): Although ECPR remains a highly complex procedure,
cardiac and neurologic functions in survivors have almost recovered, while
physical and psychological impairments still persisted at 18 months after
cardiac arrest. Physical rehabilitation and psychological care appear to
be important measures for ECPR survivors.

<112>
Accession Number
646188351
Title
Ultrasound-guided versus palpation-guided techniques for vessel
catheterization in children undergoing cardiac surgery. A systematic
review and meta-analysis of randomized controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Ibrahim A.; Allam A.R.; Amin A.M.; Abuelazm M.; Rakab M.S.; Alhadeethi A.;
Hageen A.W.; Mahmoud A.; Abouzid M.; Abdelazeem B.
Institution
(Ibrahim, Allam) Menoufiya University, Faculty of Medicine, Shebeen
El-Kom, Egypt
(Amin, Rakab) Mansoura University, Faculty of Medicine, Mansoura, Egypt
(Abuelazm, Hageen) Tanta University Hospital, Faculty of Medicine, Tanta,
Egypt
(Alhadeethi) Al-Salam Teaching Hospital, Department of General Medicine,
Nineveh, Iraq
(Mahmoud) El-Minya University Hospital, Faculty of Medicine, El-Minya,
Egypt
(Abouzid) Poznan University of Medical Sciences, Department of Physical
Pharmacy and Pharmacokinetics, Poznan, Poland
(Abdelazeem) West Virginia University Hospital, Cardiology Department,
Morgantown, United States
Publisher
Oxford University Press
Abstract
Background: Pediatric heart surgery is the first treatment option for
congenital heart disease, which is the leading cause of death in Children.
Arterial cannulation (AC) and Central venous catheter (CVC) are required
in pediatric cardiac surgery for continuous monitoring of the central
venous pressure (CVP), replacement of fluid and blood products, close
hemodynamic monitoring, and frequent sampling for arterial blood gases
(ABG). Purpose(s): We aim to assess the efficacy and safety of the
ultra-sound guided technique compared to the traditional palpation-guided
technique for vessel catheterization in children undergoing cardiac
surgery. Method(s): A systematic review and meta-analysis
synthesizing evidence from randomized controlled trials (RCTs) studies
obtained from PubMed, Embase Cochrane, Scopus, and WOS until February
2024. We used the fixed-effects model to report dichotomous outcomes using
risk ratio (RR) and continuous outcomes using mean difference (MD) with a
95% confidence interval (CI). Result(s): Thirteen RCTs with 1060
children were included. Regarding arterial cannulation, ultrasound-guided
technique was associated with a statistically significant increase in
successful cannulation [RR: 1.31 with 95% CI (1.10, 1.56), P< 0.0001], and
first-attempt success [RR: 1.88 with 95% CI (1.35, 2.63), P< 0.0001];
however, it was not associated with any statistically significant
difference in venous cannulation in both outcomes with [RR: 1.13 with 95%
CI (0.98, 1.30), P= 0.10], [RR: 1.53 with 95% CI (0.86, 2.71), P= 0.15]
respectively. Moreover, ultrasound-guided technique was associated with a
statistically significant decrease in the number of attempts either in
arterial cannulation with [MD: -0.73 with 95% CI (-1.00, -0.46), P<
0.0001] or in venous cannulation with [MD: -1.34 with 95% CI (-2.55,
-0.12), P= 0.03], and the time of attempted cannulation also either in
arterial cannulation with [MD: -2.27 with 95% CI (-3.38, -1.16), P<
0.0001] or in venous cannulation with [MD: -4.13 with 95% CI (-7.06,
-1.19), P< 0.0001]. Finally, ultrasound-guided technique was associated
with a statistically significant decrease in the incidence of any
complications either in arterial cannulation with [RR: 0.36 with 95% CI
(0.18, 0.71), P< 0.001] or in venous cannulation with [RR: 0.30 with 95%
CI (0.11, 0.84), P= 0.02]. Conclusion(s): Ultrasound-guided arterial
catheterization increases the number of successful catheterizations and
first-attempt success rate; however, there was no significant difference
in venous cannulation, while both arterial and venous cannulation were
associated with decreased number of attempts, reduced overall procedure
time, and decreased incidence of complications. (Figure Presented).

<113>
Accession Number
646189163
Title
Invasive assessment of coronary microvascular dysfunction with MACEs: a
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Sakalidis A.; Dimitriadis K.; Iliakis P.; Soulaidopoulos S.; Mantzouranis
E.; Doundoulakis I.; Argyriou N.; Kostakis P.; Pyrpiris N.; Adamopoulou
E.; Aznaouridis K.; Tsiachris D.; Aggeli K.; Tsioufis K.
Institution
(Sakalidis, Dimitriadis, Iliakis, Soulaidopoulos, Mantzouranis,
Doundoulakis, Argyriou, Kostakis, Pyrpiris, Adamopoulou, Aznaouridis,
Tsiachris, Aggeli, Tsioufis) Ippokrateio General Hospital of Athens,
Athens, Greece
Publisher
Oxford University Press
Abstract
Aims: Although obstructive coronary artery disease (CAD) is considered a
prerequisite for myocardial ischemia, it is established that abnormalities
of coronary microcirculation may restrict myocardial perfusion in the
absense of CAD. Coronary microvascular dysfunction (CMD) is likely
associated with elevated risk for MACEs. We performed a meta-analysis of
randomized controlled trials to determine the prognostic value of CMD,
assessed by invasive techniques, in predicting cardiovascular endpoints in
patients without epicardial CAD. Methods and Results: We identified
all studies between 1 January 2000 and 1 December 2023, where coronary
flow was invasively measured and clinical outcomes were reported. We
included RCTs and all prospective and retrospective studies with a control
group, which measured coronary flow reserve (CFR) and/or index of
microcirculatory resistance (IMR), as assessed invasively. The endpoints
were all-cause mortality and MACEs, including cardiovascular death,
myocardial infarction, hospitalization for heart failure (HF) and coronary
revascularization. Twenty-five articles enrolling a total of 9.800
subjects (mean age: 55.5+/-10.6 years) were included with a mean follow-up
period of 37 months were eventually deemed eligible for our final
analysis. Of these, 3.421 (34,9%) patients had CFR<2.5 and/or IMR>25,
indicating CMD, while 6.379 (65,1%) subjects were found without CMD. The
analysis of the pooled results demonstrated that the presence of CMD
depicted by abnormal CFR and/or IMR was associated with a substantially
higher risk for all-cause mortality during a median follow-up period of
3.2 years. The odds ratio for all-cause mortality in patients with CMD
compared with those without CMD was 2.31 (95% CI: 1.62 - 2.54, p<0.01). A
similar effect of abnormal CFR and IMR was also observed for
cardiovascular morality (HR 2.47, 95% CI: 1.81 - 3.38, p<0.01). In
addition, the composite of revascularization was also assessed in the
total of the selected studies. In particular, the pooled analysis
demonstrated a positive association of CMD with a higher future risk for
revascularization (HR 1.87, 95% CI: 1.33 - 2.62, p<0.01). The composite of
hospitalization for heart failure was also assessed. In addition, the
pooled analysis demonstrated a positive association between CMD and
hospitalization for HF (HR 2.50, 95% CI: 1.63 - 3.85, p<0.01).A similar
effect of abnormal CMD was also observed for myocardial infraction (HR
1.73, 95% CI: 1.33 - 2.24). Elevated IMR (>40) seems to be to be
prognostically more relevant than abnormal CFR in the setting of acute
myocardial infarction. Conclusion(s): CMD is associated with a nearly
3-fold increase in mortality and a 2-fold increase in major adverse
cardiac events. Impaired coronary flow is strongly associated with
increased risk of all-cause mortality and MACEs. Future studies and
randomized controlled trials are needed to identify strategies to diagnose
and treat CMD.

<114>
Accession Number
646187341
Title
A meta-analysis of the effects of sacubitril-valsartan on surrogate
markers of systemic right ventricular dysfunction in congenital heart
disease.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Braganca B.; Pinho A.I.; Azevedo J.; Andrade A.; Rodrigues R.A.; Cruz C.
Institution
(Braganca, Azevedo, Andrade) CH Tamega e Sousa - Penafiel, Guilhufe,
Portugal
(Pinho, Rodrigues, Cruz) Sao Joao University Hospital Centre, Cardiology,
Porto, Portugal
Publisher
Oxford University Press
Abstract
Introduction: Dysfunction of systemic right ventricle (sRV) in adult
congenital heart disease (ACHD) patients is expectable and often
associated with heart failure and other dismal cardiovascular events.
Despite limited evidence, several neurohormonal modulators approved for
heart failure with reduced ejection fraction (HFrEF) have been used
off-label in patients with RV dysfunction1. Sacubitril-valsartan (ARNI)
effects on sRV remains poorly studied, with current evidence being limited
to small cohorts. Purpose(s): Review and summarize current evidence
about the effects of ARNI in ACHD patients with sRV. Method(s): We
performed a systematic review on MEDLINE, EMBASE, COCHRANE, and SCOPUS for
articles that included 'systemic right ventricle' and 'sacubitril
valsartan' until January 2024. Two investigators screened the literature
and extracted data. Treatment effects were measured by Cohen's d
effect-size (EZ) pre and post-ARNI, with a 95% confidence interval (CI),
using a restricted maximum likelihood model. Result(s): From 197
publications screened, five studies fulfilled our criteria, comprising a
total of 135 patients. Follow-up after ARNI therapy ranged from 12 to 27
months. No randomized clinical trials were found, and only two studies had
a prospective design. Dextro-transposition of the great arteries (D-TGA)
after atrial switch operation was the most common type of congenital heart
disease with sRV (n=95; 70%). Meta-analysis demonstrates that ARNI reduced
NT-proBNP levels during follow-up (EZ= -0.34, CI -0.59 to 0.08; p=0.01;
I2=4.0%). Regarding RV function, ARNI improved RV fractional area change
(RVFAC) (EZ= 0.75, CI 0.01 to 1.50; p= 0.048; I2=85.0%). A trend for RV
global longitudinal strain improvement was also observed with ARNI (EZ=
1.74, CI -0.05 to 3.54; p=0.06; I2=95.9%) but not for tricuspid annular
plane systolic excursion (EZ= -0.07, CI -0.33 to 0.20; p=0.62; I2=0.0%).
RV diastolic diameter did not change significantly with ARNI (EZ= 0.07, CI
-0.43 to 0.56; p=0.79; I2=68.2%). A trend for improvement on the 6-minute
walk test was observed (EZ= 1.89, CI -0.13 to 3.91; p=0.07; I2=96.3%), but
no effect on exercise oxygen consumption (VO2) (EZ= -0.09, CI -1.32 to
1.15; p=0.89; I2=91.4%). During follow-up ARNI did not change
significantly systolic blood pressure (EZ= -0.32, CI -0.74 to 0.11;
p=0.15; I2=58.4%) or serum creatinine (EZ= 0.23, CI -0.04 to 0.49; p=0.09;
I2=0.0%). Conclusion(s): Despite heterogeneity among these studies,
this meta-analysis demonstrates that ARNI might improve NT-proBNP levels
and RV function. ARNI seems safe and well tolerated, with no significant
effect on blood pressure and renal function. More well-powered studies are
needed to confirm the beneficial effects of ARNI in ACHD with sRV.

<115>
Accession Number
646186555
Title
Utility of polygenic risk score for prediction of dilated cardiomyopathy
and modulation of severity of LV dysfunction among cases.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Kramarenko D.R.; Jurgens S.J.; Ramo J.T.; Van Orsouw C.A.; Hottenga J.J.;
Charron P.; Meder B.; Palotie A.; Daly M.; Ellinor P.T.; Pinto Y.M.;
Aragam K.G.; Van Der Crabben S.N.; Amin A.S.; Bezzina C.R.
Institution
(Kramarenko, Jurgens, Pinto, Bezzina) Amsterdam UMC - Location Academic
Medical Center, Department of Experimental Cardiology, Amsterdam,
Netherlands
(Ramo, Palotie, Daly) Institute for Molecular Medicine Finland (FIMM),
Helsinki, Finland
(Van Orsouw) Amsterdam University Medical Centre, Amsterdam, Netherlands
(Hottenga) Vrije Universiteit Medical Centre (VUMC), Department of
Biological Psychology, Amsterdam, Netherlands
(Charron) Institute of Cardiometabolism and Nutrition - ICAN, Paris,
France
(Meder) University Hospital Heidelberg, Department of Medicine III,
Heidelberg, Germany
(Ellinor, Aragam) Broad Institute, Cardiovascular Disease Initiative,
Cambridge, United States
(Van Der Crabben, Amin) Amsterdam UMC - Location Academic Medical Center,
Department of Clinical Genetics, Amsterdam, Netherlands
Publisher
Oxford University Press
Abstract
Background: Dilated cardiomyopathy (DCM) is a predominant cause of heart
failure and a leading indication for cardiac transplantation. While rare
genetic variants are established as causative factors in familial forms of
the disease, recent genome-wide association studies (GWAS) have also
underscored the significant contribution of common genetic variation to
DCM. Polygenic scores (PGS) constructed from GWAS have demonstrated
promise in risk stratification for a range of common diseases and may
similarly have value for risk prediction in DCM. However, data regarding
the clinical utility of PGS in DCM remains sparse. Purpose(s): We
aimed to evaluate the utility of PGS for prediction of DCM and its
association with left ventricular ejection fraction (LVEF) and family
history. We further aimed to assess the contribution of PGS in DCM
patients with established causative rare variants (genotype-positive) and
those without (genotype-negative). Method(s): We used a
previously-constructed PGS, which was developed from a GWAS meta-analysis
(8387 DCM cases and 939161 controls) and multi-trait analysis (MTAG) with
cardiac MRI traits. In the present analysis, we calculated PGS for a newly
assembled cohort of 978 DCM cases from a major university medical centre
and 7207 controls from a national register. To evaluate the clinical
utility of PGS, we built logistic regression models and assessed the
association between PGS and DCM status. Subsequently, we performed
subgroup analyses, including: i) individuals of European ancestry, ii)
non-European ancestry, iii) males, iv) females, v) genotype-positive
participants(n=193), and vi) genotype-negative participants (n=294). We
then used linear and logistic regression models, respectively, to assess
the associations of PGS with LVEF and documented family history of DCM.
 Result(s): PGS demonstrated a significant enrichment among DCM cases
compared to controls (OR per SD 1.93, P = 9.47E-68). This association
persisted with consistent effect estimates - ranging from OR 1.5 to 2.2 -
across all examined subgroups and demonstrated sufficient statistical
significance (all P<1.58E-06) (Figure 1). Genotype-negative cases had a
significantly higher PGS compared to genotype-positive individuals (P =
0.0015), although PGS was significantly enriched in both groups as
compared to controls. Furthermore, among DCM cases, higher PGS was
significantly associated with lower LVEF at first presentation (P=0.03,
beta=-0.5% per SD) (Figure 2). There was no significant association found
between PGS and family history. Conclusion(s): PGS is strongly
associated with risk of DCM, and may modulate the severity of LV
dysfunction among DCM cases. Polygenic burden contributes to DCM risk in
both genotype-positive and negative cases, although the contribution is
stronger in patients without known causative rare variants. Overall, our
results suggest a potential clinical applicability for PGS in DCM risk
stratification.

<116>
Accession Number
646189519
Title
Echocardiographic evaluation of right ventricle to pulmonary artery
coupling in patients undergoing transcatheter aortic valve implantation: a
systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Ananta M.; Wijaya A.D.; Pragitara C.F.; Almutairi A.A.
Institution
(Ananta) Cempaka Putih Jakarta Islamic Hospital, Jakarta, Indonesia
(Wijaya, Almutairi) University College London, London, United Kingdom
(Pragitara) Berkah Regional General Hospital, Pandeglang, Indonesia
Publisher
Oxford University Press
Abstract
Background: Right Ventricle to Pulmonary Artery (RV/PA) uncoupling, which
depicts the inability of RV contractility to match the increasing RV
afterload, has recently gained recognition as a simple echocardiography
parameter to aid prognosis judgment in patients with RV dysfunction. In
Aortic Stenosis (AS) patients, the extent of RV dysfunction and Pulmonary
Hypertension (PH) has been linked with poor outcomes, but the prognostic
value of RV/PA uncoupling in AS patients undergoing TAVI has not been
well-defined. Purpose(s): To investigate the prognostic value of
RV/PA uncoupling and its association with echocardiographic parameters in
AS patients undergoing TAVI. Method(s): We conducted a systematic
search through Pubmed and Embase to include studies up to February 2024.
Studies were eligible if they evaluated the prognostic performance of
RV/PA uncoupling in AS patients undergoing TAVI. Random-effects model were
employed to pool the adjusted Hazard Ratio (aHR) with inverse-variance
weighting method or Relative Risk (RR) with 95% Confidence Interval (95%
CI) using Mantel-Haenszel test for categorical outcomes or Weighted Mean
Difference (WMD) for numerical outcomes. Risk of bias assessment was
conducted using the Newcastle Ottawa Scale (NOS). Result(s): Thirteen
studies were included. Out of 4,146 patients, 55.21% were reported to have
RV-PA uncoupling prior to TAVI. RV/PA uncoupling was customarily assessed
with TAPSE/PASP ratio, with threshold for uncoupling ranging between
<0.31-<0.63 mm/mmHg. Follow-up period ranged between 6-65 months. Patients
with baseline RV/PA uncoupling had lower LVEF (WMD -9.94% [-4.36-
-15.53%]; I2 = 78%), lower TAPSE (WMD -4.98 mm [95% CI -1.15- -8.80]; I2 =
95%), and higher PASP (WMD 19.77 [95% CI 17.02-22.51]; I2 = 0%) compared
to patients with RV/PA coupling at baseline. Baseline RV-PA uncoupling was
an independent predictor of all-cause mortality (pooled aHR = 2.26 (95% CI
1.36-3.76); I2 = 77%) and composite endpoint of mortality and adverse
cardiac or cerebrovascular events (pooled aHR = 2.07 (1.30-3.29); I2 =
24%). However, RV/PA uncoupling was not significantly associated with a
higher risk of permanent pacemaker implantation after TAVI (pooled Risk
Ratio 1.02 [0.70-1.47]; I2 = 0%). Conclusion(s): Pre-procedural RV/PA
uncoupling emerges as an independent predictor of worse prognosis in AS
patients undergoing TAVI, contributing to a better understanding of the
impact of this parameter on patient outcomes.

<117>
Accession Number
2036937178
Title
Futility in TAVI: A scoping review of definitions, predictive criteria,
and medical predictive models.
Source
PLoS ONE. 20(1 January) (no pagination), 2025. Article Number: e0313399.
Date of Publication: 01 Jan 2025.
Author
Ferry C.; Fiery-Fraillon J.; Togni M.; Cook S.
Institution
(Ferry, Togni, Cook) Department of Cardiology, University & Hospital
Fribourg, Fribourg, Switzerland
(Fiery-Fraillon) Institute of Higher Education and Research in Healthcare,
IUFRS, Lausanne, Switzerland
Publisher
Public Library of Science
Abstract
Background Transcatheter Aortic Valve Implantation (TAVI) procedures are
rapidly expanding, necessitating a more extensive stratification of
patients with aortic stenosis. Especially in the high-risk group, some
patients fail to derive optimal or any benefits from TAVI, leading to the
risk of futile interventions. Despite consensus among several experts
regarding the importance of recognizing and anticipating such
interventions, the definition, and predictive criteria for futility in
TAVI remain ambiguous. Aim The purpose of this study is to explore the
literature addressing the definition, predictive criteria, and medical
predictive models for futility in cases of TAVI. Design A scoping review
was conducted by two researchers and reported in accordance with the
PRISMA-ScR guidelines. Eligibility criteria Studies addressing futility in
TAVI, including definitions, predictive variables, and models, were
included without restrictions on study design but were excluded study only
on surgical valve replacement, valve in valve or aortic stenosis causes by
other pathology than calcification. Information sources We identified 129
studies from five key sources: CINAHL, PUBMED, the Cochrane Library,
ClinicalTrials.gov, and EMBASE. The literature search was conducted in two
rounds-first in February 2024 and again in October 2024-using no
restrictions on the year of publication or the language of the studies.
Additional references were included through cross-referencing. Results The
definition of futility is not unanimous, although most researchers agreed
on 1-year survival as a cutoff. The majority of studies focused on single
variables that can predict 1-year survival, employing either prospective
or retrospective designs. Frailty was the major concept studied. Numerous
predictive models have been identified, but no consensus was found.
Conclusion Futility concepts generate interest in the TAVI procedure. In
this review, numerous articles state that 1-year mortality serves as a
cutoff to define futile procedures. Some variables, cardiac or otherwise,
are independent predictors of 1-year mortality. Medical predictive models
showed moderate sensitivity and specificity, except for machine learning,
which shows promise for the future. However, few articles delve deeply
into non-quantifiable parameters such as patient goals and objectives or
ethical questions. More studies should focus on these
parameters. Copyright © 2025 Ferry et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<118>
Accession Number
2032916042
Title
Glycated Haemoglobin (HbA<inf>1C</inf>) in Cardiac Surgery: A Narrative
Review.
Source
Journal of Clinical Medicine. 14(1) (no pagination), 2025. Article Number:
23. Date of Publication: 01 Jan 2025.
Author
Luthra S.; Viola L.; Navaratnarajah M.; Thirukumaran D.; Velissaris T.
Institution
(Luthra, Viola, Navaratnarajah, Thirukumaran, Velissaris) Wessex
Cardiothoracic Centre, Division of Cardiac Surgery, University Hospital
Southampton NHS Foundation Trust, Southampton, United Kingdom
(Luthra) Academic Unit of Human Development and Health, Faculty of
Medicine, University of Southampton, Southampton, United Kingdom
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Perioperative dysglycaemia in cardiac surgery is associated
with poor outcomes. Glycaemic variability rather than glucose levels is a
predictor of the length of an ICU stay, a rise in creatinine and acute
kidney injury after cardiac surgery. Glycated haemoglobin
(HbA<inf>1C</inf>) values correspond closely to average blood glucose
levels and cut-off values can be used to define a diabetic and
pre-diabetic status. These have been correlated with perioperative events.
 Method(s): In this narrative review, MEDLINE (via PubMed) and the
Cochrane Library were used to search for the effects of different
preoperative HbA<inf>1C</inf> levels on the postoperative outcomes after
cardiac surgery. HbA<inf>1C</inf> values correspond closely with average
blood glucose levels and cut-off values can be used to define a diabetic
and pre-diabetic status; these have been correlated with perioperative
events. This narrative review discusses the role of HbA<inf>1C</inf> in
cardiac surgery. Discussion(s): The scientific data show
controversial results: some systematic reviews and randomised control
trials demonstrated that a high level of HbA<inf>1C</inf> seems to be an
indicator for postoperative complications in cardiac surgery; other
studies dissented and reported that mortality and morbidity cannot be
directly attributed to HbA<inf>1c</inf> levels. Conclusion(s): The
scientific community seems to be in general agreement that high levels of
HbA<inf>1C</inf> are prognostic markers of adverse outcomes post cardiac
surgery, but it has also been proved that there could be multiple
underlying factors contributing to them. Copyright © 2024 by the
authors.

<119>
Accession Number
2036940956
Title
Current Status of Tricuspid Valve Interventions in Asia Pacific Region.
Source
JACC: Asia. (no pagination), 2025. Date of Publication: 2025.
Author
So K.C.-Y.; Xu J.; Kam K.K.-H.; Sung S.-H.; Meemook K.; Wang D.D.; Tang
G.H.L.; Lee A.P.-W.; Lam Y.-Y.
Institution
(So, Kam, Lee) Department of Medicine and Therapeutics, Prince of Wales
Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
(Xu) Department of Cardiology, Tianjin First Central Hospital, Tianjin,
China
(Sung) Institute of Emergency and Critical Care Medicine, National Yang
Ming Chiao Tung University, Taipei, Taiwan (Republic of China)
(Meemook) Department of Medicine, Faculty of Medicine at Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand
(Wang) Wayne State University School of Medicine, Detroit, MI, United
States
(Tang) Department of Cardiovascular Surgery, Mount Sinai Health System,
New York, NY, United States
(Lee) Laboratory of Cardiac Imaging and 3D Printing, Li Ka Shing Institute
of Health Sciences, Shatin, New Territtories, Hong Kong SAR, China
(Lam) Central Medical, Hong Kong SAR, China
Publisher
Elsevier Inc.
Abstract
Transcatheter tricuspid interventions are becoming increasingly more
common in Asia Pacific. In the past decade, clinicians in Asia Pacific
have worked with a multitude of new transcatheter tricuspid technologies.
A standardized clinical algorithm to diagnose symptomatic tricuspid
regurgitation to increase patient access to novel right heart therapies
has not yet been identified. Anatomic diversity in the Asia Pacific
patient population; disease prevalence patterns; and socioeconomic,
cultural, and local health structures represent unique challenges in the
treatment of these patients with right heart failure. As advancements are
made in right heart failure and transcatheter tricuspid technologies,
hopefully more patients can be treated not just in Asia Pacific, but
across the entire world. Copyright © 2024 The Authors

<120>
Accession Number
2036867852
Title
Left atrial appendage occlusion in patients with atrial fibrillation and
intracerebral haemorrhage associated with cerebral amyloid angiopathy: a
multicentre observational study and pooled analysis of published studies.
Source
Journal of Neurology, Neurosurgery and Psychiatry. (no pagination), 2024.
Article Number: jnnp-2024-334718. Date of Publication: 2024.
Author
Thiankhaw K.; Best J.; Srivastava S.; Prachee I.; Agarwal S.; Tan S.;
Calvert P.A.; Chughtai A.; Ang R.; Segal O.R.; Werring D.J.
Institution
(Thiankhaw, Best, Srivastava, Werring) Stroke Research Centre, Department
of Brain Repair and Rehabilitation, UCL Queen Square Institute of
Neurology, London, United Kingdom
(Thiankhaw) Department of Internal Medicine, Chiang Mai University, Chiang
Mai, Thailand
(Prachee, Ang, Segal) Department of Cardiac Electrophysiology, Saint
Bartholomew's Hospital Barts Heart Centre, London, United Kingdom
(Agarwal, Tan) Department of Stroke Medicine, Clinical Neurosciences,
Addenbrooke's Hospital, Cambridge, United Kingdom
(Calvert, Chughtai) Department of Cardiology, Royal Papworth Hospital,
Cambridge, United Kingdom
(Calvert) University of Cambridge, Cambridge, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Background Cerebral amyloid angiopathy (CAA) is a common cause of
intracerebral haemorrhage (ICH) with a high recurrence risk. Left atrial
appendage occlusion (LAAO) is a method for ischaemic stroke prevention in
patients with atrial fibrillation (AF), potentially reducing the risk of
intracranial bleeding in CAA-associated ICH. We aimed to determine the
outcomes of patients with AF with CAA-associated ICH undergoing LAAO.
Methods We conducted a multicentre study of patients with CAA-associated
ICH who underwent LAAO for stroke prevention. We pooled our findings with
data from a systematic review of relevant published studies of LAAO for AF
in ICH survivors reporting CAA diagnosis. Results We included data from
two published studies (n=65) with CAA-specific data and our cohort study
(n=37), providing a total of 102 participants (mean age 76.2+/-8.0 years,
74.6% male) with CAA-related symptomatic ICH and AF treated with LAAO. The
median follow-up period was 9.4 months (IQR 4.2-20.6). Postprocedural
antithrombotic regimens varied between single (73.0%) or dual antiplatelet
therapy (16.2%), or direct oral anticoagulant (DOAC) (10.8%), with a
median duration of 42 days (IQR 35-74). Postprocedural complications were
uncommon, but included transient arrhythmias (2.1%) and
non-life-threatening tamponade (2.1%). Pooled incidence rates of ischaemic
stroke and ICH during follow-up were 5.16 (95% CI 1.36 to 17.48) and 2.73
(95% CI 0.41 to 13.94) per 100 patient years, respectively. Conclusions
LAAO followed by short-term antithrombotic therapy might be a safe and
effective ischaemic stroke preventive strategy in people with
CAA-associated ICH and AF. However, randomised controlled trials are
needed to determine how LAAO compares with long-term DOAC in this
population. Copyright © Author(s) (or their employer(s)) 2024.

<121>
Accession Number
2036812316
Title
Effect of desflurane, sevoflurane or propofol on the incidence of
postoperative delirium in older adults undergoing moderate- to high-risk
major non-cardiac surgery: study protocol for a prospective, randomised,
observer-blinded, clinical trial (RAPID-II trial).
Source
BMJ Open. 14(11) (no pagination), 2024. Article Number: e092611. Date of
Publication: 27 Nov 2024.
Author
Adamowitsch N.; Emler D.; Fleischmann E.; Fraunschiel M.; Graf A.;
Hantakova N.; Hochreiter B.; Horl K.M.; Horvath K.; Kabon B.; Langthaler
H.; List M.; Reiterer C.; Rossi B.; Schallmeiner S.; Stiefsohn M.;
Taschner A.; Zanvettor G.; Zenz F.W.; Zotti O.; Eckhardt C.; Emshoff I.;
Geiger C.; Innerhofer N.; Kofler M.; Rajsic S.; Reyer B.; Sinner B.;
Trubsbach S.; Widmann M.
Institution
(Taschner, Fleischmann, Kabon, Horvath, Adamowitsch, Hantakova,
Hochreiter, Zotti, Reiterer) Department of Anaesthesia, Intensive Care
Medicine and Pain Medicine, Division of General Anaesthesia and Intensive
Care Medicine, Medical University of Vienna, Vienna, Vienna, Austria
(Sinner, Eckhardt) Department of Anaesthesia and Intensive Care, Medical
University Innsbruck, Tirol, Innsbruck, Austria
(Fraunschiel) IT Services and Strategic Information Management, Medical
University of Vienna, Vienna, Vienna, Austria
(Graf) Institute of Medical Statistics, Centre for Medical Data Science,
Medical University of Vienna, Vienna, Vienna, Austria
(Adamowitsch, Emler, Fleischmann, Fraunschiel, Graf, Hantakova,
Hochreiter, Horl, Horvath, Kabon, Langthaler, List, Reiterer, Rossi,
Schallmeiner, Stiefsohn, Taschner, Zanvettor, Zenz, Zotti) Medical
University of Vienna, Austria
(Eckhardt, Emshoff, Geiger, Innerhofer, Kofler, Rajsic, Reyer, Sinner,
Trubsbach, Widmann) Medical University of Innsbruck, Austria
Publisher
BMJ Publishing Group
Abstract
Introduction The effect of different anaesthetics on the incidence of
postoperative delirium is still not entirely clear. Therefore, we will
evaluate the effect of desflurane versus sevoflurane versus propofol for
the maintenance of anaesthesia on the incidence of postoperative delirium
in older adults undergoing moderate- to high-risk major noncardiac
surgery. We will further compare the incidences of delayed neurocognitive
recovery, long-term postoperative neurocognitive disorder, postoperative
nausea and vomiting between the groups. Methods and analysis In this
multicentre, prospective, observer-blinded, randomised controlled clinical
trial, we will include 1332 patients >=65 years of age undergoing
moderate- to high-risk major non-cardiac surgery lasting at least 2 hours.
Patients will be randomly 1:1:1 assigned to receive desflurane,
sevoflurane or propofol for anaesthesia. Maintenance of anaesthesia will
be performed in a goal-directed manner using processed
electroencephalography with an intraoperative goal of bispectral index
40-60. Our primary outcome will be the incidence of postoperative delirium
within the first five postoperative days. Postoperative delirium will be
assessed using the three-dimensional-confusion assessment method (3D-CAM)
or CAM-intensive care unit (ICU) in the morning and evening of the first
five postoperative days by blinded study personnel. The primary outcome,
the incidence of postoperative delirium, will be compared between the
three study groups using a chi2 test. Furthermore, a logistic
regression model for the incidence of postoperative delirium will be
performed, accounting for randomised groups as well as other predefined
confounding factors. Ethics and dissemination This clinical trial has been
approved by the ethics committee and the Federal Office for Safety in
Healthcare as the competent authority for clinical trials in Austria. The
results of this trial will be published in a peer-reviewed
journal. Copyright © Author(s) (or their employer(s)) 2024.

<122>
Accession Number
2032838175
Title
The Emerging Role of Multimodality Imaging in the Diagnosis and Management
of Post Pericardiotomy Syndrome.
Source
Current Cardiology Reports. 27(1) (no pagination), 2025. Article Number:
1. Date of Publication: 01 Dec 2025.
Author
Alqahtani M.; Mardigyan V.; Chetrit M.
Institution
(Alqahtani, Chetrit) Division of Cardiology, McGill University Health
Centre, 845 Rue Sherbrooke O, Montreal, QC, Canada
(Mardigyan) Division of Cardiology, Jewish General Hospital, 3755 Chem. de
la Cote-Sainte- Catherine, Montreal, QC, Canada
Publisher
Springer
Abstract
Purpose of Review: This review aims to evaluate current diagnostic and
therapeutic strategies for postpericardiotomy syndrome (PPS), with a focus
on the evolving role of multimodality imaging, including echocardiography,
cardiac computed tomography (CCT), and cardiac magnetic resonance imaging
(CMR). The review also explores the potential benefits of advanced imaging
in improving the accuracy and management of PPS. Recent Findings: PPS, a
common complication following cardiac surgery, presents with pleuritic
chest pain, fever, and pericardial or pleural effusion. Traditional
diagnostic methods like echocardiography and X-ray are increasingly
supplemented by advanced imaging modalities such as CCT and CMR. These
tools allow for better visualization of pericardial inflammation and
effusion, aiding in diagnosis and guiding treatment. Colchicine and NSAIDs
remain the most effective treatments for PPS, while the role of
corticosteroids remains uncertain. Biological treatments have shown
promising results in managing recurrent pericarditis. This review presents
a proposed algorithm for the diagnosis and management of PPS, drawing on
our institutional experience. Summary: Multimodality imaging is
emerging as an essential tool in diagnosing and managing PPS. It enhances
diagnostic precision, informs treatment strategies, and provides
prognostic insights. As imaging technology advances, integrating these
modalities into PPS care has the potential to improve patient
outcomes. Copyright © The Author(s), under exclusive licence to
Springer Science+Business Media, LLC, part of Springer Nature 2025.

<123>
Accession Number
2032912234
Title
Recent Advances in Perioperative Analgesia in Thoracic Surgery: A
Narrative Review.
Source
Journal of Clinical Medicine. 14(1) (no pagination), 2025. Article Number:
38. Date of Publication: 01 Jan 2025.
Author
Mitchell J.; Couvreur C.; Forget P.
Institution
(Mitchell) Department of Anesthesiology, Catholic University of Louvain,
University Hospital CHU UCL Namur, Yvoir, Mont-Godinne, Belgium
(Mitchell) Medecins Sans Frontieres (MSF), Operational Centre Brussels
(OCB), Brussels, Belgium
(Couvreur) Department of Emergency Medicine, Catholic University of
Louvain, University Hospital CHU UCL Namur, Yvoir, Mont-Godinne, Belgium
(Forget) Aberdeen Centre for Arthritis and Musculoskeletal Health
(Epidemiology Group), Institute of Applied Health Sciences, School of
Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom
(Forget) Anaesthesia Department, NHS Grampian, Aberdeen, United Kingdom
(Forget) IMAGINE UR UM 103, Anesthesia Critical Care, Emergency and Pain
Medicine Division, Nimes University Hospital, Montpellier University,
Nimes, France
(Forget) Pain and Opioids after Surgery (PANDOS) European Society of
Anaesthesiology and Intensive Care (ID ESAIC_RG_PAND) Research Group,
Brussels, Belgium
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Thoracic surgery is associated with significant postoperative pain, which
can hinder recovery and elevate morbidity risks. Traditionally, epidural
anesthesia has been the cornerstone for pain management, but its drawbacks
including technical challenges, side effects, and complications
necessitate exploring alternative methods. This narrative review examined
recent advances in perioperative analgesic strategies in thoracic surgery,
focusing on regional anesthetic techniques like paravertebral blocks
(PVBs), erector spinae plane blocks (ESPBs), intercostal blocks, and
serratus anterior blocks. Each approach was evaluated for efficacy,
safety, and impact on patient outcomes. PVB can provide effective
unilateral analgesia with fewer systemic complications compared to
epidurals. ESPB provides analgesia through a superficial,
ultrasound-guided approach, minimizing risks and offering an alternative
for various thoracic procedures. Intercostal blocks are effective but are
limited by the need for multiple injections, increasing the complication
risks. Serratus anterior blocks, targeting intercostal and thoracic
nerves, show promise in managing lateral thoracic wall pain with a low
complication rate. Advancements in surgical techniques including minimally
invasive approaches further optimize pain control and recovery. A
multimodal analgesic approach combining regional anesthesia and systemic
therapies enhances outcomes by addressing somatic and visceral pain
components. Despite the efficacy of epidural analgesia, alternative
regional techniques offer comparable pain relief with fewer complications,
suggesting their growing role in thoracic surgery. Collaborative efforts
between surgical, anesthetic, and emergency teams are crucial for
tailoring pain management strategies to individual patients, improving
recovery and reducing long-term morbidity. Future research should continue
exploring these methods to refine their application and broaden their
accessibility. Copyright © 2024 by the authors.

<124>
Accession Number
2032853926
Title
Balancing Anesthetic Agents in Acute Trauma Care for Induction and
Maintenance of Anesthesia.
Source
Current Anesthesiology Reports. 15(1) (no pagination), 2025. Article
Number: 20. Date of Publication: 01 Dec 2025.
Author
Chen J.L.; Diesch C.; Moon T.S.
Institution
(Chen, Diesch, Moon) UT Southwestern Medical Center, Department of
Anesthesiology, 5323 Harry Hines Blvd, Dallas, TX, United States
Publisher
Springer
Abstract
Purpose of Review: Traumatic injuries are a leading cause of morbidity and
mortality in the United States and globally. Many injured patients require
surgery and anesthesia, though the ideal choice and dosing of anesthetic
induction and maintenance agents to optimize patient outcomes is not
widely agreed upon. Sedative agents can lead to or worsen intraoperative
hypotension (IOH) in trauma patients who are already prone to hemodynamic
instability, potentially exacerbating existing injuries. The goal of this
review is to summarize the existing data on commonly used anesthetic
agents in trauma patients and identify any gaps in knowledge. Recent
Findings: It is well-established that IOH worsens patient outcomes in the
non-cardiac surgical population, which includes trauma patients. Commonly
used induction and maintenance agents can contribute to worsened outcomes
by exacerbating hypotension and reducing organ perfusion. Studies are
conflicting on whether propofol increases the risk of post-intubation
hypotension (PIH), hospital length-of-stay (LOS), and mortality, though
some centers advocate for the use of shock-index based reduction in
dosing, particularly in neurologically injured patients, to prevent
worsening of hypotension. It is generally accepted that etomidate does not
increase the risk of post-intubation hypotension compared to other
commonly used sedatives including ketamine, but may increase the risk of
adrenal suppression with resultant infectious or organ dysfunction
complications. Ketamine increases cerebral perfusion pressure (CPP)
without appreciable increases in intracranial pressure (ICP) and can be
used in neurologically injured patients, assuming the absence of
cerebrospinal fluid-obstructing lesions. Regarding volatile anesthetics
for maintenance of anesthesia, there has yet to be convincing evidence
demonstrating a difference in neurologic outcome, other morbidity, or
mortality between sevoflurane, desflurane, and isoflurane. There is no
experimental or clinical data that clearly supports the use of one
intravenous or volatile agent over any other for maintenance of anesthesia
in trauma patients. Injured animal and cellular experiments have shown
that dexmedetomidine may have neuroprotective effects as well as
anti-inflammatory, lung and gut protective effects when injected
intraperitoneally. Summary: Propofol, etomidate, and ketamine are all
commonly used for induction and intubation of the traumatically injured
patient. There is no clear evidence to support the use of one agent over
another, as the reduction in blood pressure with propofol can be mitigated
with dose reduction or concomitant vasopressor administration. It is
important to be aware that selection bias is likely present in existing
studies, and the sicker, more hemodynamically unstable patients were
probably less likely to receive propofol versus another induction agent
such as etomidate or ketamine. Large-scale, multicenter, randomized,
controlled, and blinded studies directly comparing all three agents are
necessary to determine if anesthesiologists should choose one agent over
the others. For maintenance of anesthesia, high-quality human studies
evaluating volatile anesthetics agents and total intravenous anesthesia
(TIVA) and their effects on morbidity and mortality are lacking and no
ideal agent has been identified. Again, multicenter, randomized,
controlled, and blinded studies are needed to determine a significant
difference in patient outcomes amongst these agents. Copyright ©
The Author(s), under exclusive licence to Springer Science+Business Media,
LLC, part of Springer Nature 2025.

<125>
Accession Number
2032838085
Title
Efficacy of Transversus Thoracic Plane Block for Pain Management in
Cardiac Surgeries.
Source
Current Pain and Headache Reports. 29(1) (no pagination), 2025. Article
Number: 8. Date of Publication: 01 Dec 2025.
Author
Kaye A.D.; Sampognaro C.M.; Shah S.S.; Duplechin D.P.; Curry G.C.;
Rodriguez V.A.; Ahmadzadeh S.; Mathew J.; Palowsky Z.R.; Shekoohi S.
Institution
(Kaye) Departments of Anesthesiology and Pharmacology, Toxicology, and
Neurosciences, Louisiana State University Health Sciences Center
Shreveport, Shreveport, LA, United States
(Sampognaro, Shah, Duplechin, Curry, Rodriguez) School of Medicine,
Louisiana State University Health Sciences Center at Shreveport,
Shreveport, LA, United States
(Ahmadzadeh, Mathew, Palowsky, Shekoohi) Department of Anesthesiology,
Louisiana State University Health Sciences Center Shreveport, Shreveport,
LA, United States
Publisher
Springer
Abstract
Purpose of Review: Effective pain management in cardiac surgery presents
as a continuous challenge related to the intensity of postoperative pain
and reliance on opioid therapy. The dependance of opioid-based therapies
is concerning, as these therapies carry risk future addiction and
potential severe side effects. The transversus thoracic plane block (TTPB)
has emerged as a promising regional anesthesia technique that blocks the
anterior branches of the intercostal nerves in the chest wall, potentially
providing improved analgesia for cardiac surgery patients. The present
investigation evaluates the efficacy of TTPB in reducing opioid
consumption, decreasing postoperative pain scores, and enhancing recovery
outcomes in patients undergoing cardiac surgeries. Recent Findings: Data
from randomized controlled trials revealed that TTPB significantly reduced
24-hour opioid consumption, increased the time to first rescue analgesic,
and lowered Visual Analog Scale (VAS) pain scores both at rest and with
movement, particularly in the first 12 h post-surgery. Additional benefits
include fewer opioid-related side effects, such as nausea and pruritus,
and reductions in intensive care unit (ICU) length of stay. Studies also
suggested that TTPB can support earlier extubation and accelerated
recovery, contributing to higher patient satisfaction and overall improved
postoperative outcomes. Conclusion(s): Despite these promising
results, challenges in technique standardization and limited long-term
data are still obstacles that prevent widespread adoption. Achieving
consistent TTPB efficacy requires technical precision in ultrasound
guidance, and there is little research on its effectiveness across diverse
populations, such as pediatric and high-risk cardiac patients. Addressing
these gaps through multi-center, long-term studies could help establish
TTPB as a prominent pain management strategy in cardiac surgery to
minimize opioid dependence and enhance patient comfort and
recovery. Copyright © The Author(s), under exclusive licence to
Springer Science+Business Media, LLC, part of Springer Nature 2024.

<126>
Accession Number
646186114
Title
Combination of moderate-intensity statins and ezetimibe versus
high-intensity statins alone for primary prevention of cardiovascular
events.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Godoy L.C.; Kiflen M.; Alonzo R.; Chu A.; Austin P.C.; Fang J.; Basque S.;
Lawler P.R.; Nunes J.T.; Jackevicius C.A.; Ko D.T.; Lee D.S.; Goodman
S.G.; Farkouh M.E.; Udell J.A.
Institution
(Godoy, Kiflen, Nunes, Lee, Goodman) Peter Munk Cardiac Centre, Toronto,
Canada
(Alonzo, Chu, Austin, Fang, Basque) ICES, Toronto, Canada
(Lawler) McGill University Health Centre, Montreal, Canada
(Jackevicius) VA Greater Los Angeles Healthcare System, Los Angeles,
United States
(Ko) Sunnybrook Health Sciences Centre, Toronto, Canada
(Farkouh) Cedars-Sinai Heart Institute, Los Angeles, United States
(Udell) University of Toronto, Toronto, Canada
Publisher
Oxford University Press
Abstract
Background: Combination of a moderate-intensity statin with ezetimibe can
lead to similar reductions in cardiovascular events as monotherapy with a
high-intensity statin in patients with established atherosclerotic
cardiovascular disease (ASCVD). The comparative effectiveness of these two
cholesterol-lowering strategies in the primary prevention setting is
unknown. Purpose(s): To compare incident ASCVD events associated with
a combination of moderate-intensity statin and ezetimibe versus
monotherapy with a high-intensity statin in adults without prior history
of cardiovascular disease. Method(s): We conducted a new-user active
comparator retrospective population-based cohort study in Canada. We
included all adults aged >= 67 years (eligible for drug coverage) with a
first prescription of either a combination of moderate-intensity statin
with ezetimibe ('combination therapy') or high-intensity statin alone
between January 2010 and December 2022. Patients were excluded if they had
not received any prior lipid lowering therapies or had a history of
myocardial infarction (MI), stroke, heart failure, peripheral vascular
disease or prior coronary revascularisation at any time before or within 3
months of treatment initiation. The primary outcome was a composite of
all-cause death, hospitalization for MI or stroke, or coronary
revascularization. An inverse probability of treatment weighting
propensity score was used to account for confounding (demographics,
comorbidities, laboratory tests, other medications). Result(s): Among
67,884 patients (mean age: 74.0+/-5.5y; 53% females), 8,798 (13%)
initiated combination therapy and 59,086 (87%) initiated a high-intensity
statin. At 1 year, after weighting, the mean achieved LDL-C was ~1.9
mmol/L in both groups. The median follow-up was 6.5 years. The cumulative
incidence of the primary outcome at 10 years in the weighted cohort was
32.7% in the combination therapy group and 36.1% in the high-intensity
statin group (HR: 0.87; 95% CI: 0.82 to 0.92; p<0.001; absolute risk
reduction: 3.5%; 95% CI: 0.8 to 6.1; Figure 1). This result was primarily
driven by a lower risk of all-cause death (HR: 0.85; 95% CI: 0.80 to 0.91;
p<0.001; Figure 2) and stroke (cause-specific [cs] HR: 0.86; 95% CI 0.74
to 0.99; p=0.04), whereas no differences were observed in the risk of MI
(csHR: 0.97; 95% CI: 0.82 to 1.15) or coronary revascularization (csHR:
0.97; 95% CI 0.85 to 1.11). Conclusion(s): The combination of
moderate-intensity statins with ezetimibe was associated with a lower risk
of incident ASCVD compared with high-intensity statins alone among primary
prevention patients in a real-world setting. These results were driven by
a lower risk of all-cause death and stroke, but not coronary events. The
influence of statin intolerance on the allocated strategy and adherence to
therapy cannot be addressed in this analysis, which, along with verifying
these estimates, may be best determined in a prospective randomized trial.

<127>
Accession Number
646185967
Title
Strategy optimization for the combined procedure of left atrial appendage
occlusion plus catheter ablation in patients with atrial fibrillation
(COMBINATION): a multi-center, randomized study.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Du X.F.; Chu H.M.; Yang B.; Zhong J.Q.; Ruan Z.B.; Chen Q.; Tao S.M.; Lai
H.L.; Liang J.Q.; Xie R.Q.; Ye P.; Zhou X.H.; Li Y.D.; Li J.P.; Zhao Y.J.
Institution
(Du, Chu) First Affiliated Hospital of Ningbo University, Ningbo, China
(Yang) Shanghai East Hospital, Cardiology, Shanghai, China
(Zhong) Qilu Hospital of Shandong University, Cardiology, Shandong, China
(Ruan) Jiangsu Taizhou People's Hospital, Cardiology, Taizhou, China
(Chen) Second Affiliated Hospital of Nanchang University, Cardiology,
Nanchang, China
(Tao) Second People's Hospital of Yunnan Province, Cardiology, Kunming,
China
(Lai) Jiangxi Provincial People's Hospital, Cardiology, Nanchang, China
(Liang) Second People's Hospital of Foshan, Cardiology, Foshan, China
(Xie) Second Hospital of Hebei Medical University, Cardiology,
Shijiazhuang, China
(Ye) Central Hospital of Wuhan, Cardiology, Wuhan, China
(Zhou, Li) First Affiliated Hospital of Xinjiang Medical University,
Cardiology, Urumchi, China
(Li) Yantai Yuhuangding Hospital, Cardiology, Yantai, China
(Zhao) Seventh People's Hospital of Zhengzhou, Cardiology, Zhengzhou,
China
Publisher
Oxford University Press
Abstract
Background: The long-term efficacy and safety of combining left atrial
appendage closure (LAAC) plus catheter ablation (CA) in patients with
atrial fibrillation (AF) in a single procedure have been established.
However, the optimal combining strategy has not been well elucidated.
 Objective(s): To determine the impact of different combining
strategies on long-term clinical outcomes. Method(s): In this
prospective multicenter study, patients with non-valvular AF referred for
the combining procedure were randomly assigned to the ablation-first or
occlusion-first groups at a 1:1 ratio. We evaluated the outcomes of LAAC
with a Watchman device and CA using a contact-force sensing catheter
during long-term follow-up. Result(s): Of the 202 randomized
patients, 194(96.0%) completed the trial with 97 patients in each group.
Baseline characteristics were comparable between groups. All procedures
were accomplished with acute successful LAAC and restoration of sinus
rhythm. Incidences of periprocedural complications were similar. Higher
chronic peri-device leak (PDL, 15.5% vs 5.2%, P=0.031) and device-related
thrombus (DRT, 8.2% vs 1.0%, P=0.035) rates were observed in the
ablation-first group. The event-free survival rate of the primary endpoint
(composite of stroke/transient ischemic attack, thromboembolism,
clinically-relevant bleeding, cardiovascular rehospitalization/death) was
significantly higher in the occlusion-first group (83.5% vs 71.1%,
log-rank P=0.036, HR 0.53, 95%CI 0.29-0.95) during a median 2.5-year
follow-up. Patients with male gender and higher CHA2DS2-VASc score were at
lower risk in the subgroup analysis. Long-term freedoms from AF (77.3% vs
63.5%, log-rank P=0.039) and atrial tachyarrhythmias (70.1% vs 55.7%,
log-rank P=0.044) were higher in the occlusion-first group, respectively.
 Conclusion(s): The occlusion-first approach is recommended for
combined procedures where a plug-like device is implanted due to its
superior long-term clinical benefits.

<128>
Accession Number
646186992
Title
Comparative efficacy of colchicine and intensive LDL-C lowering in
patients with ASCVD receiving statins: a network meta-analysis of
randomised controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Ou Z.; Wang F.; Chen Y.; Liu X.; Ran B.; Yin Y.; Cui K.
Institution
(Ou, Wang, Ran, Cui) Chongqing General Hospital, Chongqing University,
Chongqing, China
(Chen, Yin) Second Affiliated Hospital, Chongqing Medical University,
Department of Cardiology, Chongqing, China
(Liu) Keio University, School of Medicine, Tokyo, Japan
Publisher
Oxford University Press
Abstract
Background: Adding intensive low-density lipoprotein cholesterol (LDL-C)
lowering treatments or colchicine to statins resulted in additional
cardiovascular benefits. However, the relative efficacy and priority of
these agents are unclear. Purpose(s): We aimed to compare the effects
of these supplementary agents on cardiovascular outcomes in patients with
atherosclerotic cardiovascular diseases (ASCVD) receiving statins.
 Method(s): We performed a systematic review and frequentist network
meta-analysis on randomized controlled trials. The primary efficacy
endpoint was the main adverse cardiovascular event (MACE), and the
secondary efficacy endpoints were myocardial infarct, stroke, coronary
revascularization, cardiovascular death and all-cause mortality. The
safety endpoints were treatment discontinuation and non-cardiovascular
death. Colchicine was used as reference treatment. Random-effects model
was used in case of high heterogeneity, the fixed-effects model was
preferred otherwise. We ranked the comparative effects of all drugs with
surface under the cumulative ranking (SUCRA) probabilities.
 Result(s): 17 trials totaling 85823 participants treated with
colchicine, proprotein convertase subtilisin/kexin type 9 (PCSK9)
inhibitor, Niemann-Pick C1-like 1 protein (NPC1L1) inhibitor and ATP
citrate lyase (ACL) inhibitor were included. Compared with colchicine,
NPC1L1 inhibitor was associated with increased risk of MACE (risk ratio
[RR]: 1.39, 1.21-1.59), stroke (RR: 1.81, 1.09-3.00) and coronary
revascularization (RR: 1.36, 1.11-1.68), and PCSK9 inhibitor was
associated with increased risk of MACE (RR: 1.27, 1.10-1.46). However,
NPC1L1 inhibitor (RR: 0.68, 0.48-0.96) and PCSK9 inhibitor (RR: 0.64,
0.44-0.93) were associated with reduced risk of non-cardiovascular death
in comparison to colchicine. PCSK9 inhibitors had a lower risk of MACE
(RR: 0.91, 95% CI: 0.85-0.98) and coronary revascularization (RR: 0.89,
95% CI: 0.81-0.97) compared with NPC1L1 inhibitor. Although no regimen
prolonged survival, colchicine had the lowest rank at non-cardiovascular
death and the worse performance on all-cause mortality.
 Conclusion(s): In patients with ASCVD receiving statins,
inflammation-inhibiting with colchicine seems to be superior to intensive
LDL-C lowering therapy with PCSK9 inhibitor or NPC1L1 inhibitor in
cardiovascular prevention. However, using colchicine as an alternative to
intensive lipid-lowering therapy may need to be weighed against the
greater cardiovascular benefits and the potential harms of higher
non-cardiovascular death. Given the worse performance of colchicine on
survival based on current evidence, colchicine may be more appropriate for
patients who have been treated with intensive LDL-C-lowering agents but
still have recurrent cardiovascular events. Forest plots of included
agents.

<129>
Accession Number
646185842
Title
Statin use before acute coronary syndrome and coronary risk factors,
clinical presentation, interventions, and outcomes: ACC-NCDR-CathPCI
Registry in India.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Gupta R.; Gupta J.B.; Sharma K.K.; Sharma S.K.; Makkar J.S.; Khedar R.S.;
Bana A.; Sharma S.; Guptha S.
Institution
(Gupta, Gupta, Sharma, Makkar, Khedar, Bana) Eternal Heart Care Center and
Research Institute, Jaipur, India
(Sharma) Rajasthan University of Health Sciences, Jaipur, India
(Sharma) Icahn School of Medicine at Mount Sinai, New York, United States
(Guptha) H-Care LLC, San Diego, United States
Publisher
Oxford University Press
Abstract
Background: Statins are used for coronary artery disease (CAD) primary and
secondary prevention. Limited studies on the association of statin use
before acute coronary syndrome (ACS) with clinical presentation and
outcomes are available. Purpose(s): We compared statin-user and
statin-naive ACS patients for clinical and angiographic findings and
in-hospital and 3-year outcomes following percutaneous coronary
intervention (PCI). Method(s): Successive patients with ACS who
underwent PCI from Sep'17 to Dec'23 were enrolled in the ACC-NCDR-CathPCI
registry in India. Details of risk factors, clinical presentation,
coronary angiography, interventions and in-hospital were recorded.
Follow-up data in a sub-cohort recruited from Apr'19 to Mar'22 were
obtained for incident major cardiovascular events (MCE) (cardiovascular
deaths, recurrent ACS, PCI and bypass surgery). Result(s): 8296 ACS
patients were enrolled; prior statin use was in 3149 (38%) and statin
naive were 5147 (62%). Statin-user vs statin-naive patients were older
(61.6+10 vs 59.7+11y), with more hypertension (60.1 vs 48.6%), diabetes
(35.8 vs 31.8%), pre-existing CAD (PCI 20.9 vs 9.1%; CABG 5.0 vs 2.3%) and
lower mean total, LDL, and NHDL cholesterol (p<0.001). Statin users had
less ST-elevation myocardial infarction (STEMI) (28.4% vs 45.2%), more
non-STEMI (65.2 vs 50.8%), better LVEF (46.3+10 vs 44.5+10%), >2 coronary
stents (35.5 vs 29.5%), lower mechanical circulatory support (2.2 vs 3.9%)
and lower median hospitalization (66.1 vs 68.5h) (p<0.001). In
statin-users incidence of in-hospital CAD deaths was 29 (0.92%) vs 78
(1.52%) (odds ratio, OR 0.61, 95% confidence intervals 0.39-0.93) and
all-cause deaths 33 (1.05) vs 91(1.77%) (OR 0.59, 95%CI 0.39-0.88)
(p<0.01). ORs attenuated following multivariate adjustments for risk
factors, clinical presentation and interventions. In the follow up cohort
(n=3813, high-intensity statins 99.6%), among baseline statin-users
incident MCE was 98 (6.9%) vs 214 (8.9%) (hazard ratio, HR 0.76, 95%CI
0.59-0.97) and CVD deaths were in 46 (3.2%) vs 113 (4.7%) (HR 0.68, 95%CI
0.48-0.96) with attenuation following adjustment for baseline clinical
variables and interventions. Conclusion(s): Acute coronary syndrome
patients taking pre-admission statins have significantly lower in-hospital
and long-term cardiovascular and all-cause mortality following PCI.

<130>
Accession Number
646187055
Title
Red cell distribution width as a predictor of cardiovascular events in
high-risk patients with statin intolerance: post-hoc analysis of the CLEAR
Outcomes trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no
pagination), 2024. Date of Publication: 01 Oct 2024.
Author
Safarova M.; Li N.; Lincoff A.M.; Powell H.A.; Nissen S.E.; Nicholls S.J.;
Moriarty P.M.
Institution
(Safarova) Medical College of Wisconsin, Cardiovascular Medicine,
Milwaukee, United States
(Li, Powell) Esperion Therapeutics, Inc, Ann Arbor, MI, United States
(Lincoff, Nissen) Cleveland Clinic, Cleveland, United States
(Nicholls) Monash University, VIC, Australia
(Moriarty) University of Kansas Medical Center, Kansas City, United States
Publisher
Oxford University Press
Abstract
Background: Despite optimal lipid-lowering therapy there is up to 70%
residual risk of recurrent atherosclerotic cardiovascular disease (ASCVD)
events, motivating further testing of alternative risk factors and disease
pathways. Red cell distribution width (RDW) is a simple and reproducible
marker of heterogeneity of cell size in the peripheral blood. High RDW is
associated with an increased risk of ASCVD and death, independent of
established risk factors. Recent data suggest no significant impact of
PCSK9 inhibitors on hsCRP or RDW. In CLEAR Outcomes, baseline hsCRP
predicted risk for future cardiovascular (CV) events and death more
strongly than elevated LDL-C. It has been shown that bempedoic acid (BA)
reduces hsCRP, but its effects on RDW are unknown. Purpose(s): To
analyze the effect of BA on a 4-component composite of incident myocardial
infarction, stroke, coronary revascularization, or cardiovascular death
(MACE-4) and for CV death by baseline RDW, and to confirm the association
of increased RDW with elevated risk of MACE. Method(s): A total of
13,970 individuals with statin intolerance, with or at high risk for
ASCVD, were randomized in the multinational CLEAR Outcomes trial with a
median follow up of 3.4 years. Compared to placebo, BA reduced mean LDL-C
by 21% and median hsCRP by 22% at 6 months. Quartiles of increasing
baseline RDW were assessed as predictors of future adverse events after
adjustment for traditional risk factors, hsCRP, and randomized treatment
assignment. Result(s): Compared to placebo, BA reduced mean RDW by
0.28% at 6 months and 0.13% at 36 months (p<0.0001). There was a weak
positive correlation between hsCRP and RDW at baseline (Figure 1). In the
placebo group, higher baseline RDW was associated with an increase in the
likelihood of MACE-4 and CV death, and the hazard ratios (HR) associated
with a 1%increase in RDW after adjusting for covariates and hsCRP were
1.06 (95% CI 1.02-1.11) and 1.22 (1.15-1.29), respectively. When grouped
by quartiles of baseline RDW, compared with a reference group with lowest
RDW (<13.7%), there was a notable increase in the risk of MACE-4 and CV
death among the higher quartiles in the placebo group (Table 1). Those in
the 4th quartile demonstrated a 3-fold increase in the risk of CV death
(HR, 3.03, 2.00-4.60). The adjusted HRs (95% CI) for BA vs placebo for
MACE-4 were generally lower in individuals with elevated baseline RDW than
in those in the first quartile [Q1: RDW<=13.7%; 0.96 (0.79-1.17), Q2: RDW
13.7%-14.4%; 0.81 (0.67-0.97), Q3: RDW 14.4%-15.2%; 0.90 (0.75-1.09), and
Q4: RDW>15.2%; 0.84 (0.7-1.01)]. Conclusion(s): In a large randomized
controlled clinical trial setting, we confirmed an association between
elevated RDW and MACE-4. Compared with placebo, BA demonstrated efficacy
in reducing CV risk in patients with moderately increased RDW.

<131>
Accession Number
2036827720
Title
Ultrasound-assisted middle thoracic epidural catheter placement utilizing
the most dorsal sites of bilateral transverse process roots as anatomical
landmarks: A cadaveric observational study and a clinical randomized
controlled trial.
Source
Journal of Clinical Anesthesia. 101 (no pagination), 2025. Article Number:
111740. Date of Publication: 01 Feb 2025.
Author
Kunigo T.; Yoshikawa Y.; Niki S.; Ohtani M.; Muraki M.; Nitta A.; Ohsaki
Y.; Nagaishi K.; Yamakage M.
Institution
(Kunigo, Yoshikawa, Niki, Ohtani, Muraki, Nitta, Yamakage) Department of
Anesthesiology, Sapporo Medical University School of Medicine, 291 South 1
West 16, Chuo-ku, Hokkaido, Sapporo-shi, Japan
(Ohsaki) Department of Anatomy (I), Sapporo Medical University School of
Medicine, 291 South 1 West 17, Chuo-ku, Hokkaido, Sapporo-shi, Japan
(Nagaishi) Department of Anatomy (II), Sapporo Medical University School
of Medicine, 291 South 1 West 17, Chuo-ku, Hokkaido, Sapporo-shi, Japan
Publisher
Elsevier Inc.
Abstract
Study objective: We developed an innovative method for ultrasound-assisted
thoracic epidural catheter placement and assessed its potential to reduce
procedural duration for trainees. Design(s): A cadaveric
observational study and a clinical randomized controlled trial.
 Setting(s): Sapporo Medical University Hospital. Patient(s): A
total of 52 adult patients scheduled for thoracic or abdominal surgery and
four cadavers. Intervention(s): Patients were randomly assigned to
either group receiving conventional palpation (conventional group) or
combination of the ultrasound examination and conventional palpation
(ultrasound group). Measurements: The primary outcome was total procedure
time (sum of skin marking time and needling time) by trainees. The
secondary outcomes were (1) skin marking time, (2) needling time, (3)
multiple skin punctures, (4) needle redirection, (5) complications, and
(6) failed cases. Main Result(s): Through dissection of four
cadavers, the most dorsal site of the transverse process root was
identifiable by ultrasound and the reliable indicator of the interlaminar
space. We devised ultrasound-assisted middle thoracic epidural catheter
placement utilizing the most dorsal sites of bilateral transverse process
roots as anatomical landmarks. Trainees in the ultrasound group had
significantly longer skin marking time and significantly shorter needling
time than those in the conventional group (107 [87-158] vs 46 s [34-54] s,
p < 0.001 and 197 [156-328] vs 341 [303-488] s, p = 0.003). Consequently,
there was no significant difference between the two groups in total
procedure time (326 [263-467] s vs 391 [354-533] s, p = 0.167). Moreover,
the probability of trainee failure in epidural anesthesia was
significantly lower in the ultrasound group (2/26 [17.7 %] vs 10/26 [38.5
%], p = 0.019). Conclusion(s): Our novel technique for thoracic
epidural catheter placement resulted in expedited needling and enhanced
success rates among trainees, although there was no significant difference
between total procedure time when using ultrasound guidance and that when
using conventional palpation. Copyright © 2024

<132>
Accession Number
2036789235
Title
Intravenous Amino-acid Infusion to Prevent Acute Kidney Injury after
Cardiac Surgery: A Review of the Evidence.
Source
Annals of Thoracic Surgery. (no pagination), 2025. Date of Publication:
2025.
Author
Losiggio R.; Redaelli M.B.; Landoni G.; Bellomo R.
Institution
(Losiggio, Redaelli, Landoni) Department of Anesthesia and Intensive Care,
IRCCS San Raffaele Scientific Institute, Milan, Italy
(Landoni) School of Medicine, Vita-Salute San Raffaele University, Milan,
Italy
(Bellomo) Department of Critical Care, The University of Melbourne,
Melbourne, Australia
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Monash University, Melbourne, Australia
(Bellomo) Data Analytics Research and Evaluation Centre, Austin Hospital,
Melbourne, Australia
(Bellomo) Department of Intensive Care, Austin Hospital, Melbourne,
Australia
(Bellomo) Centre for Clinical Informatics, Royal Melbourne Hospital,
Melbourne, Australia
(Bellomo) Department of Intensive Care, Royal Melbourne Hospital,
Melbourne, Australia
Publisher
Elsevier Inc.
Abstract
Background: Acute kidney injury (AKI) is a frequent and important
complication of cardiac surgery. Decreased perfusion is a key mechanism.
This decreased perfusion may be attenuated by intravenous amino acids
(AAs) through recruitment of renal functional reserve. Method(s): The
study investigators performed a PubMed search of all articles published
from 1980 to August 30, 2024, with combined search criteria of "renal
functional reserve," "amino acids," "cardiac surgery," and
"cardiopulmonary bypass" by using MEDLINE (PubMed), Embase, and the
Cochrane Central Register of Clinical Trials. Included were studies
describing the effect of AAs on renal functional reserve and studies of
adult cardiac surgery patients with information on renal function. A
narrative review was developed. Result(s): Multiple experimental and
human studies over >40 years have recurrently and consistently shown that
the administration of an oral protein load or intravenous AAs increase
renal blood flow and glomerular filtration rate by >30%. Moreover, several
pilot investigations in cardiac surgery with cardiopulmonary bypass
consistently showed renal benefits with intravenous AAs. Finally, a
pivotal trial of 3511 cardiac surgery patients (the PROTECTION trial)
recently confirmed such beneficial effects in a double-blind multicenter
international setting. Conclusion(s): Intravenous AAs consistently
recruit renal functional reserve and improve kidney function in cardiac
surgery patients. These findings have been confirmed by the PROTECTION
(Intravenous Amino Acid Therapy for Kidney Protection in Cardiac Surgery)
trial. Intravenous AA therapy is the only proven treatment to prevent
and/or attenuate the severity of cardiac surgery-associated
AKI. Copyright © 2024 The Society of Thoracic Surgeons

<133>
Accession Number
646165249
Title
The Society of Thoracic Surgeons Expert Consensus Statements on a
Framework for a Standardized National Robotic Curriculum for Thoracic
Surgery Trainees.
Source
The Annals of thoracic surgery. (no pagination), 2024. Date of
Publication: 18 Dec 2024.
Author
Kim S.S.; Schumacher L.; Cooke D.T.; Servais E.; Rice D.; Sarkaria I.;
Yang S.; Abbas A.; Sanchetti M.; Long J.; Kotova S.; Park B.J.; D'Souza
D.; Shah-Jadeja M.; Ajouz H.; Godoy L.; Bahatyrevich N.; Hayanga J.; Lazar
J.
Institution
(Kim) Canning Thoracic Institute, Northwestern University Feinberg School
of Medicine, Northwestern Memorial Hospital, Chicago, IL, United States
(Schumacher) Division of General Thoracic Surgery, Tufts University School
of Medicine, Boston, MA, United States
(Cooke, Godoy, Bahatyrevich) Division of General Thoracic Surgery,
University of California, Davis Health, Sacramento, CA, United States
(Servais) Division of Thoracic Surgery, Lahey Hospital and Medical Center,
UMass Chan Medical School, Burlington, MA, United States
(Rice) Division of Thoracic Surgery, MD Anderson Cancer Center, Houston,
TX, United States
(Sarkaria) Division of Thoracic Surgery, University of Texas Southwestern
Medical Center, Dallas, TX, United States
(Yang) Division of Thoracic Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, Liberia
(Abbas, Ajouz) Division of Thoracic Surgery, Brown University School of
Medicine, Providence, RI, United States
(Sanchetti) Division of Thoracic Surgery, Emory School of Medicine,
Atlanta, GA, United States
(Long) Division of Cardiothoracic Surgery, University of North Carolina at
Chapel Hill School of Medicine, Chapel Hill, NC, United States
(Kotova) Division of Thoracic Surgery, Oregon Health and Science
University School of Medicine, Portland, OR
(Park) Thoracic Service, Department of Surgery, Memorial Sloan-Kettering
Cancer Center, New York, NY
(D'Souza) Division of Thoracic Surgery, Ohio State University, Columbus,
OH, United States
(Shah-Jadeja) Division of Thoracic Surgery, University of Kentucky,
Lexington, KY, United States
(Hayanga) Department of Cardiothoracic and Vascular Surgery, West Virginia
University Medicine, Morgantown, WV, United States
(Lazar) Ascension Saint Thomas Hospital, University of Tennessee Health
Science Center, Division of Thoracic Surgery, Nashville, TN, United States
Abstract
OBJECTIVE: With robotic technology's rapid growth and integration, an
urgent need to bridge the educational gap in thoracic surgical training
has emerged. This document, a result of consensus among a group of experts
in the practice and training of robotic surgery from the Society of
Thoracic Surgeons (STS), aims to provide a framework for a standardized
national robotic curriculum for thoracic surgery trainees. METHOD(S):
The STS Task Force on Robotic Thoracic Surgery and Workforce on E-learning
and Educational Innovation assembled an expert group with the input of the
Thoracic Surgery Director's Association (TSDA). A focused literature
review was performed, and expert consensus statements were developed using
a modified Delphi process to address three major themes: (1) Program
expectations, (2) Components of training, and (3) Assessment and feedback.
 RESULT(S): A consensus was reached on 12 recommendations. These
consensus statements reflect updated insights on developing a standardized
robotics curriculum based on the latest literature and current educational
experience, focusing on program expectations and educational guidelines to
develop an optimal training curriculum. CONCLUSION(S): The expert
panel provides several key recommendations to provide a framework for
developing a standardized national robotic thoracic curriculum, which
would improve resident education and abridge any educational disparity
that may exist among programs. Copyright © 2024. Published by
Elsevier Inc.

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