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<1>
Accession Number
2037643961
Title
Mechanical circulatory support for cardiogenic shock.
Source
The Lancet. 405(10480) (pp 697), 2025. Date of Publication: 01 Mar 2025.
Author
Dalzell J.R.; Cannon J.A.
Institution
(Dalzell, Cannon) Scottish National Advanced Heart Failure Service, Golden
Jubilee National Hospital, Glasgow, United Kingdom
Publisher
Elsevier B.V.

<2>
Accession Number
2037622452
Title
Fractional flow reserve- and intravascular ultrasound-guided strategies
for intermediate coronary stenosis and low lesion complexity in patients
with or without diabetes: A post hoc analysis of the randomised FLAVOUR
trial.
Source
EuroIntervention. 21(3) (pp e183-e192), 2025. Date of Publication: 2025.
Author
Cho S.W.; Kang J.; Zhang J.; Hu X.; Hwang J.-W.; Kwak J.-J.; Hahn J.-Y.;
Nam C.-W.; Lee B.-K.; Kim W.; Huang J.; Jiang F.; Zhou H.; Chen P.; Tang
L.; Jiang W.; Chen X.; He W.; Ahn S.G.; Yoon M.-H.; Kim U.; Lee J.M.;
Hwang D.; Ki Y.-J.; Shin E.-S.; Kim H.-S.; Tahk S.-J.; Wang J.; Koo B.-K.;
Doh J.-H.
Institution
(Cho, Hwang, Kwak, Kim, Doh) Inje University, Ilsan Paik Hospital, Goyang,
South Korea
(Kang, Hwang, Koo) Seoul National University Hospital, Seoul, South Korea
(Zhang, Hu, Wang) The Second Affiliated Hospital Zhejiang University
School of Medicine, Hangzhou, China
(Hahn, Lee) Samsung Medical Center, Sungkyunkwan University School of
Medicine, Seoul, South Korea
(Nam) Keimyung University, Dongsan Medical Center, Daegu, South Korea
(Lee) Kangwon National University Hospital, Chuncheon, South Korea
(Kim) Kyung Hee University Hospital, Seoul, South Korea
(Huang) Affiliated Hangzhou First People's Hospital, Zhejiang University
School of Medicine, Hangzhou, China
(Jiang) Hangzhou Normal University Affiliated Hospital, Hangzhou, China
(Zhou) The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou,
China
(Chen) The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou,
China
(Tang) Zhejiang Hospital, Hangzhou, China
(Jiang) The Third Clinical Institute Affiliated to Wenzhou Medical
University, Wenzhou, China
(Chen) Ningbo First Hospital, Ningbo, China
(He) The Affiliated Hospital of Medical School of Ningbo University,
Ningbo, China
(Ahn) Wonju Severance Christian Hospital, Wonju, South Korea
(Yoon, Tahk) Ajou University Hospital, Suwon, South Korea
(Kim) Yeungnam University Medical Center, Daegu, South Korea
(Ki) Uijeongbu Eulji Medical Center, Uijeongbu, South Korea
(Shin) Ulsan University Hospital, University of Ulsan College of Medicine,
Ulsan, South Korea
Publisher
Europa Group
Abstract
BACKGROUND: A recent randomised trial demonstrated fractional flow reserve
(FFR) guidance for percutaneous coronary intervention (PCI) was
non-inferior to intravascular ultrasound (IVUS) guidance regarding
clinical outcomes, with a lower frequency of PCI. AIMS: We sought to
evaluate the prognosis of FFR versus IVUS guidance for PCI of intermediate
coronary artery stenosis and low lesion complexity in diabetic and
non-diabetic patients. METHOD(S): This study is a prespecified post
hoc analysis from the FLAVOUR trial. The primary outcome was major adverse
cardiac events (MACE) at 24 months, defined as a composite of death,
myocardial infarction or any revascularisation. The secondary outcomes
were target vessel failure (TVF) and each component of MACE and TVF at 24
months. RESULT(S): Among 1,682 randomly assigned patients, 554
(32.9%) had diabetes, and the mean SYNTAX score was 8.64+/-6.03 at
baseline. The FFR group had a lower PCI rate than the IVUS group in both
diabetic (48.2% vs 69.1%; p<0.001) and non-diabetic (42.6% vs 63.3%;
p<0.001) patients. At 24 months, there was no difference in the cumulative
incidence of MACE between the FFR and the IVUS groups in either diabetic
(9.3% vs 8.3%; p=0.90) or non-diabetic (7.5% vs 8.6%; p=0.50) patients.
The cumulative incidence of TVF was also comparable between the FFR and
the IVUS groups regardless of diabetic status. CONCLUSION(S): In
patients with intermediate coronary stenosis and low lesion complexity,
regardless of diabetic status, FFR guidance had no significant differences
in MACE or TVF with a lower frequency of PCI compared with IVUS
guidance. Copyright © Europa Group 2025. All rights reserved.

<3>
Accession Number
2037605769
Title
C-reactive protein levels and outcomes in infarct-related cardiogenic
shock: data from the ECLS-SHOCK trial.
Source
European Heart Journal: Acute Cardiovascular Care. 14(2) (pp 59-70), 2025.
Date of Publication: 01 Feb 2025.
Author
Schupp T.; Thiele H.; Rassaf T.; Mahabadi A.A.; Lehmann R.; Eitel I.;
Skurk C.; Clemmensen P.; Hennersdorf M.; Voigt I.; Linke A.; Tigges E.;
Nordbeck P.; Jung C.; Lauten P.; Feistritzer H.-J.; Buske M.; Poss J.;
Ouarrak T.; Schneider S.; Behnes M.; Duerschmied D.; Desch S.; Freund A.;
Zeymer U.; Akin I.
Institution
(Schupp, Behnes, Duerschmied, Akin) Department of Cardiology, Angiology,
Hemostaseology and Medical Intensive Care, University Medical Center
Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-
Kutzer-Ufer 1-3, Mannheim, Germany
(Thiele, Feistritzer, Buske, Poss, Desch, Freund) Heart Center Leipzig at
Leipzig University and Leipzig Heart Science, Leipzig, Germany
(Rassaf, Mahabadi) Department of Cardiology and Vascular Medicine, West
German Heart and Vascular Center, University Duisburg-Essen, Essen,
Germany
(Lehmann) Asklepios Clinic Langen, Langen, Germany
(Eitel) University Heart Center Lubeck and German Center for
Cardiovascular Research, Partner Site Hamburg-Kiel-Lubeck, Lubeck, Germany
(Skurk) Department of Cardiology, Angiology and Intensive Care Medicine,
Deutsches Herzzentrum der Charite, Campus Benjamin Franklin, Berlin,
Germany
(Clemmensen) Center for Population Health Innovation (POINT) and German
Center for Cardiovascular Research (DZHK), University Heart and Vascular
Center Hamburg, Partner Site Hamburg-Kiel-Lubeck, Hamburg, Germany
(Hennersdorf) SLK Kliniken Heilbronn, Heilbronn, Germany
(Voigt) Contilia Elisabeth-Krankenhaus, Essen, Germany
(Linke) Heart Center, Technische Universitat Dresden, Dresden, Germany
(Tigges) Asklepios Clinic St. Georg, Hamburg, Germany
(Nordbeck) University Hospital Wurzburg, Wurzburg, Germany
(Jung) University Hospital Dusseldorf, Dusseldorf, Germany
(Lauten) Zentralklinik Bad Berka, Bad Berka, Germany
(Ouarrak, Schneider, Zeymer) Institut Fur Herzinfarktforschung and
Klinikum Ludwigshafen, Ludwigshafen, Germany
Publisher
Oxford University Press
Abstract
Aims The impact of systemic inflammation in acute myocardial infarction
complicated by cardiogenic shock (AMI-CS) is still a matter of debate. The
present ECLS-SHOCK sub-study investigates the association of C-reactive
protein (CRP) levels with short-term outcomes in patients with AMI-CS.
Methods and results Patients with AMI-CS enrolled in the multicentre,
randomized ECLS-SHOCK trial between 2019 and 2022 were included. The
prognostic impact of CRP levels on admission, as well as the effect of
extracorporeal life support (ECLS), stratified by CRP levels, was tested
with regard to the primary endpoint of 30-day all-cause mortality. In 371
patients with AMI-CS and available CRP level on baseline, the median CRP
level was 18.0 mg/L. Patients with CRP levels in the highest tertile were
older and less often resuscitated from cardiac arrest. The highest tertile
(i.e. CRP >61.0 mg/L) was associated with an increased risk of 30-day
all-cause mortality compared with patients with lower CRP levels (lowest
tertile: <=5.0 mg/L) [adjusted odds ratio: 3.54; 95% confidence interval
(CI) 1.88-6.68; P = 0.001]. The use of ECLS did not reduce 30-day
all-cause mortality, irrespective of CRP levels on admission. The
additional inclusion of CRP to the IABP-SHOCK II score was associated with
a slight improvement of the prediction of 30-days all-cause mortality
(area under the curve: 0.74; 95% CI 0.68-0.79). Conclusion Higher CRP
levels were independently associated with the risk of 30-day all-cause
mortality in AMI-CS. The additional inclusion of CRP to a validated CS
risk score may further improve the prediction of short-term
prognosis. Copyright © The Author(s) 2024.

<4>
Accession Number
2032057083
Title
Cost-Effectiveness of Three Different New-Generation Drug-Eluting Stents
in the Randomised BIO-RESORT Trial at 3 Years.
Source
PharmacoEconomics - Open. 9(1) (pp 137-145), 2025. Article Number:
e000064. Date of Publication: 01 Jan 2025.
Author
Ploumen E.H.; Wolcherink M.J.O.; Buiten R.A.; Pinxterhuis T.H.; Doggen
C.J.M.; Schotborgh C.E.; Danse P.W.; Scholte M.; van Houwelingen K.G.;
Zocca P.; Pouwels X.G.L.V.; von Birgelen C.
Institution
(Ploumen, Buiten, Pinxterhuis, van Houwelingen, Zocca, von Birgelen)
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente,
Koningsplein 1, Enschede, Netherlands
(Ploumen, Wolcherink, Pinxterhuis, Doggen, Pouwels, von Birgelen)
Department of Health Technology and Services Research, Faculty of
Behavioural, Management and Social Sciences, Technical Medical Centre,
University of Twente, Enschede, Netherlands
(Schotborgh) Department of Cardiology, Haga Hospital, The Hague,
Netherlands
(Danse) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Scholte) Department of Cardiology, Albert Schweitzer Hospital, Dordrecht,
Netherlands
Publisher
Adis
Abstract
Background and Objective: Evidence on health economic outcomes for
percutaneous coronary intervention (PCI) comparing different contemporary
drug-eluting stents (DES) with each other is scarce, as most previous
randomised DES trials did not assess such aspects. This prespecified
health economic evaluation of the Comparison of Biodegradable Polymer and
Durable Polymer Drug-Eluting Stents in an All Comers Population
(BIO-RESORT) trial aimed to compare at 3-year follow-up both health
effects and costs of PCI with one of three new-generation drug-eluting
stents (DES) in patients with obstructive coronary artery disease.
 Method(s): The randomised BIO-RESORT trial assessed in 3514 patients
the ultrathin-strut biodegradable polymer Orsiro sirolimus-eluting stent
(SES) and very-thin-strut Synergy everolimus-eluting (EES) stent versus
the thin-strut durable polymer Resolute Integrity zotarolimus-eluting
stent (ZES). In the current analysis, we used the perspective of a health
insurer in the Netherlands. The main endpoints were quality-adjusted life
years (QALYs), and costs for each treatment strategy. Bootstrapping with
5000 resamples was performed to capture the uncertainty of results.
 Result(s): Mean QALYs for each stent group were 2.566 for the SES,
2.551 for the EES, and 2.550 for the ZES. Mean costs per strategy were
14,670 for the SES, 14,946 for the EES, and 15,069 for the ZES. The SES
had the highest probability of being cost-effective for every
willingness-to-pay threshold up to 100,000 per QALY. Furthermore, in 79%
of modelling scenarios, the SES was more effective and cheaper than ZES.
 Conclusion(s): At 3-year follow-up, PCI with the SES had the highest
probability of being cost-effective due to greater effectiveness and lower
costs compared with the ZES and EES. These findings suggest that, due to
the overall high volume of coronary stenting in clinical practice, use of
this SES could result in substantial cost savings, complemented by slight
additional health benefits. Copyright © The Author(s) 2024.

<5>
Accession Number
2033378299
Title
Guidelines for preoperative pulmonary function assessment in patients with
lung cancer who will undergo surgery (The Japanese Association for Chest
Surgery).
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2025.
Article Number: i3571. Date of Publication: 2025.
Author
Ohde Y.; Ueda K.; Okami J.; Saito H.; Sato T.; Yatsuyanagi E.; Tsuchida
M.; Mimae T.; Adachi H.; Hishida T.; Saji H.; Yoshino I.
Institution
(Ohde) Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka,
Japan
(Ueda) Department of General Thoracic Surgery, Kagoshima University
Graduate School of Medical and Dental Sciences, Kagoshima, Japan
(Okami, Saito) Department of General Thoracic Surgery, Osaka International
Cancer Institute, Osaka, Japan
(Sato) Department of General Thoracic, Breast and Pediatric Surgery,
Fukuoka University School of Medicine, Fukuoka, Japan
(Yatsuyanagi) Department of General Thoracic Surgery, National Hospital
Organization Obihiro Hospital, Hokkaido, Japan
(Tsuchida) Division of Thoracic and Cardiovascular Surgery, Niigata
University Graduate School of Medical and Dental Sciences, Niigata, Japan
(Mimae) Department of Surgical Oncology, Hiroshima University, Hiroshima,
Japan
(Adachi) Department of Surgery, Yokohama City University, Kanagawa, Japan
(Hishida) Division of Thoracic Surgery, Department of Surgery, Keio
University School of Medicine, Tokyo, Japan
(Saji) Department of Chest Surgery, St. Marianna University School of
Medicine, Kanagawa, Japan
(Saji) Committee for Guideline Assessment, The Japanese Association for
Chest Surgery, Kyoto, Japan
(Yoshino) International University of Health and Welfare Narita Hospital,
Narita, Japan
(Yoshino) The Japanese Association for Chest Surgery, Kyoto, Japan
Publisher
Springer
Abstract
This article translates the guidelines for preoperative pulmonary function
assessment in patients with lung cancer who will undergo surgery,
established by the Japanese Association of Chest Surgery on May 17, 2021,
from Japanese to English. The last version of these guidelines was created
on April 5, 2011. Over the past decade, changes in clinical practice have
occurred that do not align with the current guidelines, prompting a
revision in conjunction with the introduction of new evidence this time.
This guideline was developed with reference to the internationally adopted
GRADE (Grading of Recommendations Assessment, Development, and Evaluation)
system. Extraction of evidence, systematic review, and quality assessment
are entrusted to each guideline review committee and the Pulmonary
Function Assessment Working Group. Committee members are also responsible
for determining the selection of evidence and the extraction period, with
a particular emphasis on adopting items considered to be of special
importance. The recommended assessment and management is categorized into
a general overview, pulmonary function assessment, cardiopulmonary
exercise test, pulmonary function assessment for lung cancer with
interstitial pneumonia, preoperative smoking cessation, and pulmonary
rehabilitation. These are described by the strength of recommendation, the
strength of evidence, and the consensus rate. Copyright © The
Author(s), under exclusive licence to The Japanese Association for
Thoracic Surgery 2025.

<6>
Accession Number
2037118808
Title
Medical errors across specialties: A systematic review and meta-analysis
of global incidence and contributing factors.
Source
Medecine et Droit. 2025(190) (pp 14-36), 2025. Date of Publication: 01 Feb
2025.
Author
Hemeda M.S.; Sayed H.Y.; Mostafa A.A.; Salem A.A.; Arafa I.A.R.; Mosa
H.H.A.; Younes M.H.M.; Ahmed S.S.; Saqr Y.M.; Bastawisy A.; Abdalla H.;
Dawood Y.M.A.; Elawamry M.I.; Eid G.; Ibrahim M.M.A.; Ali E.; Abd Elaziz
A.E.S.; Abd Elaziz Alsaid A.; Elhagary A.A.; Ahmed N.; Abu Elfadle A.;
Fayed B.; Elyamany M.I.; Mahmoud W.A.; Abdrabeh H.M.; Ramadan A.; Abdel
Rahman A.R.Z.; Abdelmottaleb H.A.A.; Mohamed M.A.; Hassanein M.M.H.;
Makloph M.; Abouzid M.; Abdelmooty E.A.
Institution
(Hemeda, Sayed, Mostafa) Department of Forensic Medicine and Clinical
Toxicology Faculty of Medicine, Port Said University, Port Said, Egypt
(Salem) Department of Family Medicine, Faculty of Medicine, Port Said
University, Port Said, Egypt
(Arafa, Younes) Department of Obstetrics and Gynecology, Port Said
University, Port Said, Egypt
(Mosa) Department of Cardiology, Faculty of Medicine, Zagazig University,
Zagazig, Egypt
(Ahmed) Department of Community and Occupational Medicine, Faculty of
Medicine, Suez University, Suez, Egypt
(Saqr) Department of Orthopaedic Surgery, Faculty of Medicine, Port Said
University, Port Said, Egypt
(Bastawisy, Fayed) Department of Cardiothoracic Surgery, Faculty of
Medicine, Port Said University, Port Said, Egypt
(Abdalla) Department of Chest Diseases, Faculty of Medicine, Al-Azhar
University, Assiut, Egypt
(Dawood) Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar
University, Cairo, Egypt
(Elawamry) Department of Otorhinolaryngology, Faculty of Medicine,
Al-Azhar University, Assiut, Egypt
(Eid) Department of Orthopaedic Surgery, Faculty of Medicine, Al-Azhar
University, Assiut, Egypt
(Ibrahim) Department of Ophthalmology, Faculty of Medicine, Al-Azhar
University, Cairo, Egypt
(Ali) Department of Urology, Faculty of Medicine, Al-Azhar University,
Assiut, Egypt
(Abd Elaziz) Department of Neurosurgery, Faculty of Medicine, Al-Azhar
University, Assiut, Egypt
(Abd Elaziz Alsaid, Elhagary) Department of Internal Medicine, Faculty of
Medicine, Al-Azhar University, Assiut, Egypt
(Ahmed) Department of Anaesthesia and Surgical Intensive Care, Faculty of
Medicine, Port Said University, Egypt
(Abu Elfadle) Department of Neurosurgery, Faculty of Medicine, Port Said
University, Port Said University, Port Said, Egypt
(Elyamany) Forensic Medicine & Clinical Toxicology, Damietta university,
Damietta, Egypt
(Mahmoud) Department of Dermatology and Andrology, Faculty of Medicine,
Al-Azhar University, Assiut, Egypt
(Abdrabeh, Abdelmooty) Obstetrics and Gynaecology, Faculty of Medicine,
Minia University, Egypt
(Ramadan) Faculty of Medicine, South Valley University, Qena, Egypt
(Abdel Rahman, Abdelmottaleb, Mohamed, Hassanein) Department of Forensic
Medicine & Clinical Toxicology, Faculty of Medicine, Al-Azher University,
Asyut, Egypt
(Makloph) Department of Forensic Medicine and Clinical Toxicology, Fayoum
University, Egypt
(Abouzid) Department of Physical Pharmacy and Pharmacokinetics, Faculty of
Pharmacy, Poznan University of Medical Sciences, Poznan, Egypt
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Medical errors (MEs) refers to the professional negligence or
wrongdoing by healthcare providers that result in harm to patients, it can
vary significantly across different specialities due to variations in
patient populations, diagnostic challenges, treatment complexity, and
procedural risks. Method(s): We conducted an electronic search of
PubMed, Scopus, Web of Science, and Embase databases to identify all
relevant published records till 11th August 2023. The analyses were
carried out in R studio using the meta package. The mean difference (MD)
was used to pool continuous outcomes, while the odds ratio (OR) was used
to pool dichotomous outcomes, both with 95% confidence intervals (CI). We
used the New Castle Ottawa (NOS) Scale for the observational studies.
 Result(s): We included 63 studies encompassing a diverse range of
specialities and involving 376,574 participants. The highest rates of MEs
were found in neurosurgery, orthopaedic surgery, and cardiology. The
lowest rates were seen in dramatology, vascular surgery, gastroenterology,
endocrinology, and rheumatology. There is a huge gap in research
investigations of MEs in Middle Eastern countries. Conclusion(s):
Medical malpractice is a complicated issue that varies by speciality
within the healthcare profession. Errors and neglect can occur in any area
of medicine, including surgery and obstetrics, as well as internal
medicine and family medicine. Copyright © 2024 Elsevier Masson
SAS

<7>
Accession Number
2033335150
Title
A clinical comparison of the effects of six disposable cardiopulmonary
bypass circuits on bleeding and coagulation: a quality assurance project.
Source
Canadian Journal of Anesthesia. (no pagination), 2025. Date of
Publication: 2025.
Author
Takhar S.; Martinez-Perez S.; Beairsto B.; Derman R.; Serrick C.;
Otalora-Esteban M.; Bingley C.; McCluskey S.A.; Karkouti K.; Bartoszko J.
Institution
(Takhar, Beairsto, Serrick) Perfusion Services, University Health Network,
Toronto, ON, Canada
(Martinez-Perez, Derman, Otalora-Esteban, Bingley, McCluskey, Karkouti,
Bartoszko) Department of Anesthesia and Pain Management, Sinai Health
System, Women's College Hospital, University Health Network, Toronto, ON,
Canada
(Martinez-Perez, Derman, Otalora-Esteban, McCluskey, Karkouti, Bartoszko)
Department of Anesthesiology & Pain Medicine, University of Toronto,
Toronto, ON, Canada
(McCluskey, Karkouti, Bartoszko) Peter Munk Cardiac Centre, University
Health Network, Toronto, ON, Canada
(Karkouti) Interdepartmental Division of Critical Care, Department of
Medicine, University of Toronto, Toronto, ON, Canada
(Karkouti) Institute for Health Policy, Management, and Evaluation,
University of Toronto, Toronto, ON, Canada
Publisher
Springer
Abstract
Purpose: Cardiac surgery requiring cardiopulmonary bypass (CPB) is
frequently complicated by excessive bleeding because of coagulopathy.
Contact of blood with the CPB circuit is a major contributor. While
several Health Canada-approved disposable circuits are available for
purchase, there is no existing direct comparative data. Our objective was
to conduct a quality assurance project to provide clinical data on the
bleeding and coagulation effects of six disposable CPB circuits in a
cohort of cardiac surgery patients. Method(s): We compared the
effects of six different circuits on bleeding and coagulation in 872
consecutive patients who underwent various types of cardiac surgery over
12 months at Toronto General Hospital (Toronto, ON, Canada). Generalized
estimating equations accounting for clustering by surgeon were used to
assess the impact of each circuit group on the following: 1) at least
moderate bleeding as defined by the Universal Definition of Perioperative
Bleeding Score after separation from bypass through the first
postoperative day; 2) total allogeneic blood product transfusion within
seven days of surgery; and 3) hemostatic therapy administration within
seven days of surgery. Changes in coagulation tests before and after
bypass were recorded. Result(s): We included 872 patients. There were
no major differences between the six types of circuit in prebypass
compared with postbypass coagulation tests. Nevertheless, when accounting
for surgeon, patient, and procedural characteristics, significant
differences between circuit types emerged for all primary and secondary
outcomes. Conclusion(s): The findings of this quality assurance
project suggest that current Health Canada-approved CPB circuits may have
differential effects on coagulation and bleeding. This should be further
verified in randomized controlled trials. Copyright © Canadian
Anesthesiologists' Society 2025.

<8>
Accession Number
2032120492
Title
Association of physical function with hospital readmissions among older
adults: A systematic review.
Source
Journal of Hospital Medicine. 20(3) (pp 277-287), 2025. Date of
Publication: 01 Mar 2025.
Author
Thomas E.M.; Smith J.; Curry A.; Salsberry M.; Ridgeway K.; Hunt B.;
Desanto K.; Falvey J.R.
Institution
(Thomas, Salsberry) School of Health and Rehabilitation Sciences, The Ohio
State University, Columbus, OH, United States
(Smith) Kinesiology Department, University of Connecticut, Storrs, CT,
United States
(Curry) Rehabilitation Services Department, Washington Hospital Healthcare
System, Fremont, CA, United States
(Ridgeway) Rehabilitation Therapy Services Department, University of
Colorado Hospital, UCHealth, Aurora, CO, United States
(Ridgeway) Physical Therapy Program, School of Medicine, University of
Colorado Anschutz Medical Campus, Aurora, CO, United States
(Hunt) Rehabilitation Services Department, Intermountain Health, Canyons
Region, Salt Lake, UT, United States
(Desanto) Strauss Health Sciences Library, University of Colorado Anschutz
Medical Campus, Aurora, CO, United States
(Falvey) Department of Physical Therapy and Rehabilitation Science and
Department of Epidemiology and Public Health, University of Maryland
School of Medicine, Baltimore, MD, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Hospital readmissions pose significant burdens on healthcare
systems, particularly among older adults. While efforts to reduce
readmissions have historically focused on medical management, emerging
evidence suggests physical function may also play a role in successful
care transitions. However, there is a limited understanding of the
relationship between functional measures and readmission risk. This
systematic review aims to assess the association between physical function
impairments and hospital readmissions. Objective(s): This systematic
review aims to assess the association between physical function
impairments and hospital readmissions. Method(s): A systematic review
was conducted following PRISMA guidelines, with studies identified through
databases including PubMed, CINAHL, Embase, and others published January
1, 2010-December 31, 2022. Inclusion criteria encompassed observational
studies of adults aged 50 and older in the United States, reporting
readmissions within 90 days of discharge and assessing physical function
across domains of the International Classification of Function model. Data
extraction and risk of bias assessment were independently conducted by two
authors using theScottish Intercollegiate Guidelines Network (SIGN) tool.
 Result(s): Seventeen studies, representing 80,008 participants, were
included in this systematic review. Patient populations included a wide
array of medical populations, including general medical inpatients and
those undergoing cardiac surgery. Across various functional measures
assessed before or during admission, impairments were consistently
associated with increased risk for hospital readmissions up to 90 days
after admission. Measures of participation, including life-space mobility,
were also associated with increased readmission risk. Conclusion(s):
Functional impairments are robust predictors of hospital readmissions in
older adults. Routine assessment of physical function during
hospitalization can improve risk stratification and may support successful
care transitions, particularly in older adults. Copyright © 2024
The Author(s). Journal of Hospital Medicine published by Wiley Periodicals
LLC on behalf of Society of Hospital Medicine.

<9>
Accession Number
2032812009
Title
Transcatheter Aortic Valve Replacement in Hypertrophic Cardiomyopathy: A
Systematic Review and Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. 105(4) (pp 754-760),
2025. Date of Publication: 01 Mar 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.

<10>
Accession Number
645966443
Title
Long-term outcomes with medical therapy, transcatheter repair, or surgery
for isolated tricuspid regurgitation: a systematic review and network
meta-analysis.
Source
Clinical research in cardiology : official journal of the German Cardiac
Society. 114(2) (pp 272-280), 2025. Date of Publication: 01 Feb 2025.
Author
Saito T.; Kuno T.; Aikawa T.; Ueyama H.A.; Kampaktsis P.N.; Kolte D.;
Misumida N.; Takagi H.; Ahmad Y.; Kaneko T.; Zajarias A.; Latib A.
Institution
(Saito) Department of Cardiology, Edogawa Hospital, Tokyo, Japan
(Kuno) Cardiology Division, Massachusetts General Hospital, Harvard
Medical School, 55 Fruit Street ,GRB 800, Boston, MA, United States
(Kuno, Latib) Division of Cardiology, Montefiore Medical Center, Albert
Einstein College of Medicine, Bronx, NY, United States
(Aikawa) Department of Cardiovascular Biology and Medicine, Juntendo
University Graduate School of Medicine, Tokyo, Japan
(Ueyama) Division of Cardiology, Emory University School of Medicine,
Atlanta, GA, United States
(Kampaktsis) Structural and Congenital Center, Hackensack Medical Center,
Hackensack, NJ, United States
(Kolte) Cardiology Division, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, United States
(Misumida) Division of Cardiovascular Medicine, Gill Heart and Vascular
Institute, University of Kentucky, Lexington, KY, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Ahmad) Division of Cardiology, Department of Cardiology, University of
California San Francisco, San Francisco, CA, United States
(Kaneko) Cardiothoracic Surgery Division, Department of Surgery,
Washington University in St Louis School of Medicine, St Louis, MO, United
States
(Zajarias) Cardiovascular Division, Department of Medicine, Washington
University in St Louis School of Medicine, St Louis, MO, United States
Abstract
BACKGROUND: Several transcatheter tricuspid valve (TV) repair devices for
tricuspid regurgitation (TR) have emerged. However, few studies have
compared transcatheter TV repair with medical therapy (MT) alone or
isolated TV surgery. METHOD(S): PubMed and EMBASE were searched in
February 2024. Studies comparing at least any of the following 2 were
included: MT, surgical TV repair, surgical TV replacement, or
transcatheter TV repair. The primary outcome was long-term mortality ( 1
year). The secondary outcomes were short-term mortality (30-day or
in-hospital mortality) and periprocedural complications. We performed a
network meta-analysis using a random effects model. RESULT(S): A
total of 25,831 patients from 22 studies (one randomized trial and 21
observational studies) were included. MT alone was associated with higher
long-term mortality compared to surgical TV repair (HR [95% CI] 1.72
[1.34-2.23]), surgical TV replacement (HR [95% CI] 1.49 [1.14-1.96]), and
transcatheter TV repair (HR [95% CI] 1.52 [1.30-1.78]). Long-term
mortality was comparable between transcatheter and surgical interventions.
Transcatheter TV repair had a lower risk of short-term mortality (versus
surgical TV repair; RR [95% CI] 0.40 [0.22-0.72], versus surgical TV
replacement; RR [95% CI] 0.35 [0.19-0.66]) and lower rates of
periprocedural complications, including new pacemaker implantation, renal
complications, cardiogenic shock than surgical interventions.
 CONCLUSION(S): MT alone for TR was associated with higher long-term
mortality compared to surgical or transcatheter TV interventions.
Transcatheter TV repair had better periprocedural outcomes compared to
surgical interventions with similar long-term mortality. Despite the
possibility of selection bias, transcatheter TV repair appears to be an
attractive option for TR treatment. Copyright © 2024.
Springer-Verlag GmbH Germany, part of Springer Nature.

<11>
Accession Number
2031578196
Title
A Narrative Review of Pain in Pediatric Oncology: The Opioid Option for
Procedural and Surgical Pain.
Source
Pediatric Drugs. 27(1) (pp 19-39), 2025. Article Number: e1719. Date of
Publication: 01 Jan 2025.
Author
Hall E.A.; Shelton C.M.; Hagemann T.M.; Jasmin H.M.; Grey K.; Anghelescu
D.L.
Institution
(Hall, Shelton, Hagemann) Department of Clinical Pharmacy and
Translational Science, University of Tennessee Health Science Center,
Memphis, TN, United States
(Jasmin) Health Sciences Library, University of Tennessee Health Science
Center, Memphis, TN, United States
(Grey) College of Pharmacy, University of Tennessee Health Science Center,
Memphis, TN, United States
(Anghelescu) Department of Global Pediatric Medicine, St. Jude Children's
Research Hospital, Memphis, TN, United States
Publisher
Adis
Abstract
This narrative review examines the evolving role of opioids in managing
procedural and surgical pain in pediatric oncology patients. The review
evaluates studies on opioid use across various oncological surgeries
including thoracic, abdominal, orthopedic, and neurosurgical procedures,
as well as for common painful procedures such as bone marrow aspirations
and lumbar punctures. While opioids remain important for acute procedural
and postoperative pain management in pediatric oncology patients, there is
an increasing emphasis on multimodal, opioid-sparing approaches. The
evidence presented within this review highlights the growing focus on
judicious postoperative opioid prescribing to mitigate risks of adverse
effects and persistent use or potential misuse. The review synthesizes
findings from studies investigating various analgesic regimens, including
the use of regional anesthesia techniques like epidural analgesia and
peripheral nerve blocks, which have shown promise in reducing opioid
requirements. For procedural pain, the review explores the efficacy of
combining opioids with sedatives like midazolam or propofol, as well as
the potential of ketamine as an opioid-sparing alternative. Key findings
indicate that opioid-sparing techniques can effectively reduce overall
opioid consumption without compromising pain control or patient
satisfaction. Several studies demonstrated that regional anesthesia
techniques and non-opioid adjuncts can significantly lower postoperative
opioid requirements across various surgical procedures. For procedural
pain, ketamine-based regimens often showed comparable or superior pain
control to opioid-based approaches, with some studies reporting better
patient satisfaction. This review also addresses the importance of
tailored postoperative opioid prescribing, with some studies presenting
algorithms to predict outpatient opioid needs more accurately. These
approaches aim to ensure adequate pain control while minimizing excess
opioid dispensing. Copyright © The Author(s) 2024.

<12>
Accession Number
2032843855
Title
Valve Thrombosis Following Transcatheter Aortic Valve Replacement:
State-of-the-Art Review.
Source
Catheterization and Cardiovascular Interventions. 105(4) (pp 813-824),
2025. Date of Publication: 01 Mar 2025.
Author
Duarte F.; Aguiar-Neves I.; Guerreiro C.E.; Silva M.; Ferreira N.D.;
Fontes-Carvalho R.
Institution
(Duarte) Cardiology Department, Hospital of Divino Espirito Santo, Ponta
Delgada, Portugal
(Aguiar-Neves, Guerreiro, Silva, Ferreira, Fontes-Carvalho) Cardiology
Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de
Gaia, Portugal
(Fontes-Carvalho) Department of Surgery and Physiology, Faculty of
Medicine of the University of Porto, UnIC@RISE, Porto, Portugal
Publisher
John Wiley and Sons Inc
Abstract
Transcatheter aortic valve replacement (TAVR) is a well-established
treatment for severe aortic stenosis, especially in patients over 75 or
those at high surgical risk. While these prosthetic valves have a lower
thrombogenic profile than mechanical heart valves, leaflet thrombosis in
transcatheter aortic valves (TAV) occurs in an estimated 5%-40% of cases.
Most TAV thromboses are subclinical and can be detected via cardiac
computed tomography (CCT), which reveals hypo-attenuating leaflet
thickening and reduced leaflet motion in asymptomatic patients without
elevated transprosthetic gradients on echocardiography. The mechanisms
behind TAV thrombosis involve local mechanical triggers, patient
predisposing factors, and device and procedure-related aspects. The ideal
antithrombotic therapy post-TAVR depends on individual patient
characteristics, balancing bleeding risks with the need for oral
anticoagulants. Data on the optimal management of TAV thrombosis and the
routine use of CT post-TAVR are limited. While anticoagulation effectively
resolves clinically significant prosthesis thrombosis, its benefit in
subclinical cases is unclear. There is an ongoing debate about whether
subclinical leaflet thrombosis precedes clinical valve thrombosis, making
the ideal follow-up after valve implantation uncertain. This article aims
to provide a comprehensive review, summarizing current data on the
incidence of TAVR thrombosis, underlying mechanisms, clinical and imaging
diagnosis, management strategies, preventive measures, and long-term
follow-up. Copyright © 2025 Wiley Periodicals LLC.

<13>
Accession Number
2033457217
Title
Different extubation protocols for adult cardiac surgery: a systematic
review and pairwise and network meta-analysis.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 104. Date
of Publication: 01 Dec 2025.
Author
Luo R.Y.; Fan Y.Y.; Wang M.T.; Yuan C.Y.; Sun Y.Y.; Huang T.C.; Jing J.Y.
Institution
(Luo, Fan, Wang, Yuan, Sun, Jing) Zhejiang Provincial People'S Hospital,
People'S Hospital of Hangzhou Medical College, No. 158 Shangtang Rd,
Zhejiang, Hangzhou, China
(Luo, Fan) School of Nursing, Zhejiang Chinese Medical University,
Zhejiang, China
(Huang) Intensive Care Unit, the Second Affiliated Hospital, School of
Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
Publisher
BioMed Central Ltd
Abstract
Background: With the advancement of ultra-fast track anesthesia, early
extubation following cardiac surgery has become a prevailing trend. While
there are significant benefits associated with early extubation, its high
failure rate warrants further investigation, and the effectiveness of
various extubation strategies in cardiac surgery still requires
validation. Method(s): An extensive literature search was performed
in the PubMed, Scopus, Embase, and Web of Science databases, encompassing
studies without language restrictions. Eligible studies were those that
compared the outcomes of various extubation strategies. Result(s):
Primary outcome was the success rate of the extubation protocol. Secondary
outcomes were time to extubation, intensive care unit (ICU) length of stay
(LOS), complications and mortality rate. Data from 12 studies, which
included a total of 1454 participants, were included in the analysis. The
pairwise meta-analysis revealed that late extubation was significantly
more effective than immediate extubation strategies (relative risk [RR] =
1.52, 95% confidence interval [CI] = 1.21-1.91, P = 0.0001). In the
network meta-analysis (NMA), the late extubation protocol was associated
with a significantly lower risk of extubation failure compared to early
extubation and extubation on the table (RR = 0.76, 95% CI: 0.5-1.16; RR =
0.22, 95% CI: 0.05-0.91). Furthermore, according to the SUCRA plot, late
extubation was ranked as the most effective strategy for reducing
extubation failure (94%). Conclusion(s): Our findings indicate that a
late extubation strategy, as opposed to early (within a specified time
frame) or immediate extubation, is correlate with a substantially higher
rate of successful extubation. Despite this, the early extubation strategy
seems to offer better cost-effectiveness and safety profiles. The
selection of an appropriate extubation strategy should be personalized,
taking into account the patient's preoperative characteristics and the
circumstances encountered during surgery. Trial registration: The study
protocol adheres to the PRISMA statement and checklist. The protocol was
registered at PROSPERO (CRD42024529051). Copyright © The
Author(s) 2025.

<14>
Accession Number
2032346546
Title
Life-threatening complications in ophthalmic surgery: a systematic review.
Source
Eye (Basingstoke). 39(1) (pp 69-78), 2025. Article Number: 2262502. Date
of Publication: 01 Jan 2025.
Author
Ferrara M.; Romano V.; Longo L.; Rovati M.; Raimondi R.; Semeraro F.;
Aliberti S.; Romano M.R.
Institution
(Ferrara, Romano, Rovati, Semeraro) Department of Medical and Surgical
Specialties, Radiological Sciences, and Public Health, University of
Brescia, Brescia, Italy
(Ferrara, Romano, Semeraro) Eye Unit, ASST Spedali Civili di Brescia,
Brescia, Italy
(Ferrara) School of Medicine, University of Malaga, Malaga, Spain
(Longo, Aliberti, Romano) Department of Biomedical Sciences, Humanitas
University, Milan, Italy
(Raimondi) Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle Upon
Tyne, United Kingdom
(Aliberti) IRCCS Humanitas Research Hospital, Respiratory Unit, Milan,
Italy
(Romano) Department of Ophthalmology, Humanitas Gavazzeni-Castelli,
Bergamo, Italy
Publisher
Springer Nature
Abstract
Ophthalmic surgical procedures are widely acknowledged for their safety
and efficacy. Undoubtedly, advances in ophthalmic surgery, along with the
improvement of anaesthetic techniques, have contributed to the reduction
in the occurrence of these events. However, although uncommon, systemic
severe and life-threatening adverse events can still occur and it is
imperative for an ophthalmologic surgeon to have a comprehensive
understanding of them to act in terms of proactive prevention, prompt
recognition, and optimal treatment, thus maximizing patients' outcomes.
Among life-threatening complication following ophthalmic surgery,
cardiovascular events represent the most common ones, including a range of
different clinical entities: the oculocardiac reflex, potentially leading
to haemodynamic instability and asystole; iatrogenic vascular air
embolism, in form of venous air embolism or "pefluorocarbon syndrome",
which can lead to obstruction of the pulmonary circulation, respiratory
distress and cardiovascular collapse; postoperative venous
thromboembolism, in the context of which the management of perioperative
antiplatelet and anticoagulant therapy has a crucial role. Furthermore,
among infectious complications, that are more commonly limited to the
ocular tissues, necrotizing fasciitis represents a potentially lethal
infection. This review aims to provide an up-to-date, evidence-based
overview of potential life-threatening complications associated with
ophthalmic surgery, exploring pathogenesis, risk factors, signs, symptoms,
and, briefly, management strategies. Copyright © The Author(s),
under exclusive licence to The Royal College of Ophthalmologists 2024.

<15>
Accession Number
2033339788
Title
Myocardial Infarction and All-Cause Mortality Following Percutaneous
Coronary Intervention Versus Conservative Treatment of Chronic Total
Occlusions: A West Denmark Heart Registry Study.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2025.
Date of Publication: 2025.
Author
Sondergaard M.M.; Gunnarstein S.; Christensen M.K.; Christiansen E.H.;
Jensen L.O.; Veien K.T.; Holck E.N.; Kragholm K.; Thuesen L.; Eftekhari A.
Institution
(Sondergaard, Gunnarstein, Christensen, Kragholm, Thuesen, Eftekhari)
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
(Christiansen, Holck) Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark
(Jensen, Veien) Department of Cardiology, Odense University Hospital,
Odense, Denmark
Publisher
John Wiley and Sons Inc
Abstract
Background: Chronic coronary total occlusions (CTO) represent a
therapeutic challenge, and results of randomized clinical trials and
observational studies comparing conservative treatment versus percutaneous
coronary intervention (PCI) are underpowered. Aim(s): To assess
myocardial infarction (MI) and all-cause mortality in consecutive patients
with CTO lesions. Method(s): Using data from the West Denmark Heart
Registry, patients with chronic coronary syndrome and a 100% occluded
vessel by invasive coronary angiography (ICA) were identified. Patients
were stratified according to PCI within 90 days. Five-year risk of MI and
all-cause mortality was calculated using cause-specific Cox-models and
g-formula methods. Subsequently, models were stratified on sex, diabetes,
estimated glomerular filtration rate above 60 mL/min, procedure before
2012, and history of cardiac surgery. The risk was calculated for patients
who did not experience MI or death within 30 days of the initial ICA.
 Result(s): A total of 7675 patients were included in the study, of
whom 3129 patients underwent PCI, and 4546 patients were treated
conservatively. PCI- and conservatively treated patients had comparable
risks of MI (13.1% [95% confidence interval [CI] 12.0%-14.3%] for patients
who underwent PCI vs. 13.4% [95% CI 12.4%-13.4%] for patients who received
conservative treatment). For all-cause mortality, results were 14.4% (95%
CI 13.3%-15.5%) versus 18.9% (95% CI 17.8%-20.0%), respectively. Results
were consistent across subgroups. However, CTO-PCI-treated patients with
previous heart surgery were at higher risk of MI. Conclusion(s):
Patients who underwent CTO-PCI had a comparable 5-year risk of MI and
lower all-cause mortality as compared to conservatively treated
patients. Copyright © 2025 The Author(s). Catheterization and
Cardiovascular Interventions published by Wiley Periodicals LLC.

<16>
Accession Number
2030329892
Title
Impact of Age on the Relationship between Cross-Clamp Time and Mortality
in Cardiac Surgery.
Source
Thoracic and Cardiovascular Surgeon. 72(7) (pp 539-541), 2024. Date of
Publication: 16 Apr 2024.
Author
Mukharyamov M.; Kirov H.; Caldonazo T.; Doenst T.
Institution
(Mukharyamov, Kirov, Caldonazo, Doenst) Department of Cardiothoracic
Surgery, Jena University Hospital, Friedrich Schiller University of Jena,
Jena, Germany
Publisher
Georg Thieme Verlag
Abstract
Age is an independent risk factor for mortality even when all known
comorbidities are considered. Thus, other factors may additionally
contribute to the age-associated risk. We performed a systematic
literature search and identified 161 manuscripts, of which 32 studies
(18,256 patients) were analyzed. Cross-clamp time correlated with observed
mortality. The increase in mortality risk with cross-clamp time was much
greater in older patients than in younger patients. The log odds ratio
(OR) for age and cross-clamp time was 0.07 and 0.01, respectively, which
was highly significant for both independent risk factors. Age accelerates
the increase in mortality risk with increasing aortic cross-clamp
times. Copyright © 2024. Thieme. All rights reserved.

<17>
Accession Number
2032037538
Title
Pooled comparative analysis of transcatheter aortic valve replacement
versus surgical aortic valve replacement in patients with left ventricular
assist device.
Source
General Thoracic and Cardiovascular Surgery. 73(2) (pp 125-129), 2025.
Article Number: n71. Date of Publication: 01 Feb 2025.
Author
Magouliotis D.E.; Giamouzis G.; Athanasiou T.; Spiliopoulos K.; Briasoulis
A.; Skoularigis J.; Triposkiadis F.; Xanthopoulos A.
Institution
(Magouliotis) Department of Cardiac Surgery Research, Lankenau Institute
for Medical Research, Main Line Health, Wynnewood, PA, United States
(Magouliotis, Spiliopoulos) Unit of Quality Improvement, Department of
Cardiothoracic Surgery, University of Thessaly, Larissa, Greece
(Giamouzis, Skoularigis, Triposkiadis, Xanthopoulos) Department of
Cardiology, University Hospital of Larissa, Larissa, Greece
(Athanasiou) Department of Surgery and Cancer, Imperial College London,
London, United Kingdom
(Briasoulis) Department of Clinical Therapeutics, Faculty of Medicine,
Alexandra Hospital, National and Kapodistrian University of Athens,
Athens, Greece
Publisher
Springer
Abstract
A thorough literature search was conducted on patients with Left
Ventricular Assist Device (LVAD) and aortic insufficiency undergoing
transcatheter aortic valve replacement (TAVR). We identified all original
research studies that compared the long-term outcomes of surgical
transcatheter aortic valve replacement (SAVR) versus TAVR for patients
with LVAD, published between 1990 and 2023. The primary endpoint was the
composite of in-hospital mortality, stroke, transient ischemic attack,
myocardial infarction (MI), pacemaker implantation, vascular complications
and cardiac tamponade. Secondary endpoints were the median overall
survival (OS), the incidence of acute kidney injury (AKI), any bleeding
needing transfusions or reintervention and cost. A total of fourteen
studies and 358 patients were included (TAVR: 242; SAVR: 116). The
composite outcome, the incidence of AKI, the bleeding needing transfusion,
along with cost were significantly higher in the SAVR group. In addition,
there was no significant difference between TAVR and SAVR in terms of
median OS. The median OS in the TAVR group was 18 months. Finally, the
most common causes of death were progression of heart failure and
pneumonia. The present meta-analysis indicates that TAVR is associated
with enhanced outcomes compared to SAVR for patients with LVAD presenting
aortic insufficiency. Further well-designed original studies with greater
sample sizes are necessary to validate our findings. Copyright ©
The Author(s), under exclusive licence to The Japanese Association for
Thoracic Surgery 2024.

<18>
Accession Number
2030617613
Title
Meta-analysis of BITA versus SITA grafting in diabetic patients: evidence
from propensity score-matched studies.
Source
General Thoracic and Cardiovascular Surgery. 73(2) (pp 80-87), 2025. Date
of Publication: 01 Feb 2025.
Author
Nolan J.; Wijaya A.R.; Harta I.K.A.P.
Institution
(Nolan, Wijaya) Faculty of Medicine, Udayana University, Denpasar,
Indonesia
(Harta) Cardiothoracic and Vascular Surgery Department, Prof IGNG Ngoerah
General Hospital, Denpasar, Indonesia
Publisher
Springer
Abstract
Background: It has been demonstrated that the use of bilateral internal
thoracic artery (BITA) grafting in coronary artery bypass grafting (CABG)
improves long-term survival in comparison to the use of a single internal
thoracic artery (SITA) graft. However, the optimal transplantation
technique for diabetic patients remains undetermined. The purpose of this
meta-analysis was to compare the effectiveness and safety of BITA and SITA
CABG in diabetic patients. Method(s): A comprehensive search of
Google Scholar, Science Direct, and PubMed was conducted for studies with
propensity score-matched comparing between BITA and SITA grafting in
diabetic patients. The main goal was to know mid- to long-term mortality,
and the supplementary results included incidence of deep sternal wound
infection, 30-day mortality, and incidence of reoperation due to
hemorrhage. Result(s): The meta-analysis included 11 studies
involving 3762 diabetic patients with matched propensity scores. Compared
to SITA grafting, BITA grafting was associated with a significant
reduction in long-term mortality (HR 0.78; 95% CI 0.67-0.91), P = 0.03,
I2 = 54%. There were no significant differences between the two
groups in terms of 30-day mortality, reoperation for bleeding,
cerebrovascular accident, or renal failure. Conclusion(s): BITA
grafting appears to provide better overall survival than SITA grafting in
patients with diabetes. However, using BITA grafting is associated with a
greater risk of deep sternal wound infection. These findings may help
guide the choice of grafting technique in diabetic patients undergoing
CABG. Copyright © The Author(s), under exclusive licence to The
Japanese Association for Thoracic Surgery 2024.

<19>
Accession Number
2031288567
Title
Off-pump vs. on-pump coronary artery bypass grafting in patients with
chronic kidney disease: an updated systematic review and meta-analysis.
Source
International Urology and Nephrology. 57(2) (pp 463-477), 2025. Article
Number: 750828. Date of Publication: 01 Feb 2025.
Author
Ahmed M.; Majeed K.; Ali H.; Syed H.; Batool A.
Institution
(Ahmed, Majeed, Ali, Syed, Batool) Department of Internal Medicine,
Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
Publisher
Springer Science and Business Media B.V.
Abstract
Background: In patients with chronic kidney disease (CKD), cardiovascular
disease is found to be the primary cause of mortality, and after coronary
artery bypass grafting (CABG), their prognosis deteriorates.
 Method(s): We conducted a meta-analysis comparing off-pump CABG
versus on-pump CABG in CKD patients. We searched electronic databases,
including PubMed, Cochrane, and Google Scholar, using relevant keywords.
We included studies comparing off-pump CABG with on-pump CABG in patients
with chronic kidney disease, which was defined as an estimated glomerular
filtration rate (eGFR) < 60 ml/min per 1.73 m2. Effect
estimates were synthesized using a random-effects model and expressed as
risk ratios (RR) for dichotomous outcomes and mean difference (MD) for
continuous outcomes, with corresponding 95% confidence intervals (CIs).
Our primary outcome was short-term mortality. Result(s): A total of
25 studies, of which 23 were observational and 2 were RCTs, were included
in this meta-analysis, comprising 234,585 patients (66,591 in the off-pump
group and 167,994 in the on-pump group). Our meta-analysis showed that
there was a significantly higher mortality rate in the on-pump CABG group
as compared to the off-pump CABG group (RR: 0.73, 95% CI [0.61, 0.88]; P =
0.0006, I2 = 60%). Conclusion(s): Compared with OPCAB,
short-term mortality was significantly higher in ONCAB. Copyright
© The Author(s), under exclusive licence to Springer Nature B.V.
2024.

<20>
Accession Number
2037567062
Title
COMPARATIVE STUDY OF THE EFFICACY OF INTRAVENOUS ESMOLOL, DILTIAZEM, AND
LIGNOCAINE IN ATTENUATING THE PRESSURE RESPONSE TO LARYNGOSCOPY AND
TRACHEAL INTUBATION.
Source
International Journal of Academic Medicine and Pharmacy. 7(1) (pp
360-365), 2025. Date of Publication: 2025.
Author
Sharma A.D.; Garg R.; Sharan A.; Zeliang E.; Kumar P.
Institution
(Sharma) NIIMS, Uttar Pradesh, India
(Garg, Kumar) NCRIMS, Uttar Pradesh, Meerut, India
(Sharan) Rama Medical College Hospital and Research Centre, Uttar Pradesh,
Hapur, India
(Zeliang) CIHSR, Chumoukedima, Nagaland, India
Publisher
Society for Healthcare and Research Development
Abstract
Background: Laryngoscopy and tracheal intubation often lead to significant
hemodynamic disturbances due to sympathetic nervous system activation.
This study compares the efficacy of intravenous Esmolol, Diltiazem, and
Lignocaine in reducing the pressor response to laryngoscopy and
intubation. Material(s) and Method(s): This randomized controlled
trial included 90 ASA I and II adult patients scheduled for elective
non-cardiac surgery under general anaesthesia. Patients were randomly
allocated into three groups (n=30 each): Group EG (Esmolol 1 mg/kg IV),
Group DG (Diltiazem 0.3 mg/kg IV), and Group LG (Lignocaine 1.5 mg/kg IV).
Hemodynamic parameters-systolic arterial pressure (SAP), diastolic
arterial pressure (DAP), heart rate (HR), and mean arterial pressure
(MAP)-were recorded at baseline, immediately post-intubation (0 min), and
at 1, 3, 5, and 10 minutes post-intubation. Adverse effects were also
documented. Result(s): Diltiazem demonstrated the most effective
control of SAP, DAP, and MAP at all time points (p<0.05). Esmolol was
superior in controlling HR (p<0.001). Lignocaine exhibited the least
impact on hemodynamic stability but effectively reduced airway reflexes.
Side effects included mild bradycardia (10%) in Group EG, headache (6.7%)
in Group DG, and injection site discomfort (13.3%) in Group LG.
 Conclusion(s): Diltiazem is recommended for patients at risk of
hypertension, while Esmolol is preferred for tachycardia control.
Lignocaine had limited hemodynamic benefits. Further studies are needed to
establish optimal perioperative management strategies. Copyright
© 2025 Society for Healthcare and Research Development. All rights
reserved.

<21>
Accession Number
2037546492
Title
Patient and family engagement interventions for enhancing patient safety
in the perioperative journey: A scoping review.
Source
BMJ Open Quality. 14(1) (no pagination), 2025. Article Number: e002986.
Date of Publication: 17 Feb 2025.
Author
Seyfulayeva A.; Fonte B.F.; Alho A.M.; Shaikh A.; Nunes A.B.; Casaca
P.G.C.; Leite A.; Taha A.; Dhingra-Kumar N.; Sousa P.
Institution
(Seyfulayeva, Fonte, Shaikh, Nunes, Casaca, Leite, Sousa) NOVA University,
Lisbon National School of Public Health, Lisbon, Portugal
(Seyfulayeva, Fonte, Sousa) Collaborating Centre for Education, Research
and Evaluation of Safety and Quality in Healthcare, WHO, Lisbon, Portugal
(Alho, Nunes, Casaca, Leite, Sousa) Public Health Research Centre,
Comprehensive Health Research Center, CHRC, REAL, CCAL, NOVA University,
Lisbon National School of Public Health, Lisbon, Portugal
(Alho) ULS Santa Maria, Public Health Unit Francisco George, Lisbon,
Portugal
(Shaikh) The Aga Khan University, Sindh, Karachi, Pakistan
(Leite) Departamento de Epidemiologia, Instituto Nacional de Saude Doutor
Ricardo Jorge, Lisbon, Portugal
(Taha) Patient Safety and Quality of Care, World Health Organization,
Geneva, Switzerland
(Dhingra-Kumar) Patient Safety Flagship Unit, World Health Organisation,
Geneva, Switzerland
Publisher
BMJ Publishing Group
Abstract
Background Surgical procedures present intricate challenges within
healthcare delivery, often associated with higher risks of adverse events
compared with non-surgical contexts. Patient and family engagement (PFE)
throughout the perioperative journey is a possibility to enhance care
quality, safety and patient-centredness. However, literature addressing
PFE across the entirety of the perioperative journey remains sparse.
Objective The current scoping review aims to comprehensively map the
existing interventions with PFE approach focused on improving patient
safety across various types of surgical procedures throughout the
perioperative journey. In addition, the review aims to understand the
level and type of PFE approach adopted in this context. Eligibility
criteria Articles published in indexed peer-reviewed journals from 2003 to
2023, written in English, Portuguese or Spanish, that report on
interventions with PFE approach targeting adult surgical patients, their
families, caregivers, patient advocates and patient champions. The review
includes articles reporting on both inpatient and ambulatory surgical
patients. Methods Following Joanna Briggs Institute guidelines and the
Preferred Reporting Items for Systematic reviews and Meta-Analyses
extension for Scoping Reviews framework, this review systematically
searched PubMed, Web of Science, SCOPUS, CINAHL, and PsycINFO for relevant
articles. Eligible interventions were categorised using PFE framework
regarding the level of engagement and mapped according to the WHO Global
Patient Safety Action Plan 2021-2030. Results Out of 765 records initially
identified, 32 met the eligibility criteria for data extraction and
analysis, of which 40% originated from the USA, followed by the UK (18%)
and Canada (12%). 47% of the interventions targeted multiple/all types'
of procedures, 19% focused on cardiothoracic surgeries and 9% on
gynaecological procedures or organ transplant. The majority of the
interventions (88%) focused on PFE at the direct care level, predominantly
adopting a consultation-based approach. Furthermore, 81% of eligible
interventions emphasised patient information and education, 16% addressed
codevelopment of policy and 3% of interventions focused on patient
advocacy. Conclusion The findings show a predominant focus on PFE
interventions targeting patient safety at the direct care level,
particularly in the provision of patient information and education.
However, interventions at organisational and policy-making levels are
notably scarce. Further investment is required to promote interventions
engaging patients and families at broader organisational and policy-making
levels. Copyright © 2025 BMJ Publishing Group. All rights
reserved.

<22>
Accession Number
646516193
Title
Glucagon-like peptide 1 (GLP-1) receptor agonists for people with chronic
kidney disease and diabetes.
Source
Cochrane Database of Systematic Reviews. 2025(2) (no pagination), 2025.
Article Number: CD015849. Date of Publication: 18 Feb 2025.
Author
Natale P.; Green S.C.; Tunnicliffe D.J.; Pellegrino G.; Toyama T.;
Strippoli G.F.M.
Institution
(Natale, Tunnicliffe) Sydney School of Public Health, The University of
Sydney, Sydney, Australia
(Natale, Pellegrino, Strippoli) Department of Precision and Regenerative
Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari,
Italy
(Green) Department of Medicine, University of Otago Christchurch,
Christchurch, New Zealand
(Toyama) Department of Nephrology, Kanazawa University, Kanazawa, Japan
(Toyama) Innovative Clinical Research Center, Kanazawa University,
Kanazawa, Japan
(Strippoli) Nephrology, Dialysis and Transplantation Unit, Department of
Medical and Surgical Sciences, University of Foggia, Foggia, Italy
(Strippoli) Cochrane Kidney and Transplant, Centre for Kidney Research,
The Children's Hospital at Westmead, Westmead, Australia
Publisher
John Wiley and Sons Ltd
Abstract
Background: Approximately 40% of people with diabetes develop kidney
failure and experience an accelerated risk of cardiovascular
complications. Glucagon-like peptide 1 (GLP-1) receptor agonists are
glucose-lowering agents that manage glucose and weight control.
 Objective(s): We assessed the benefits and harms of GLP-1 receptor
agonists in people with chronic kidney disease (CKD) and diabetes.
 Search Method(s): The Cochrane Kidney and Transplant Register of
Studies was searched to 10 September 2024 through contact with the
Information Specialist using search terms relevant to this review. Studies
in the Register are identified through searches of CENTRAL, MEDLINE, and
EMBASE, conference proceedings, the International Clinical Trials Registry
Platform (ICTRP) Search Portal, and ClinicalTrials.gov. Selection
Criteria: Randomised controlled studies were eligible if participants with
diabetes and CKD were randomly allocated to a GLP-1 receptor agonist,
placebo, standard care or a second glucose-lowering agent. CKD included
all stages (from 1 to 5). Data Collection and Analysis: Three authors
independently extracted data and assessed the risk of bias using the risk
of bias assessment tool 2. Pooled analyses using summary estimates of
effects were obtained using a random-effects model, and results were
expressed as risk ratios (RR) and/or hazard ratio (HR) and their 95%
confidence intervals (CI) for dichotomous outcomes and mean difference
(MD) and 95% CI for continuous outcomes. The primary outcomes included
death (all-cause and cardiovascular), 3- and 4-point major adverse
cardiovascular events (MACE), kidney failure, composite kidney outcome,
and severe hypoglycaemia. The secondary outcomes included non-fatal or
fatal myocardial infarction (MI) or stroke, non-fatal peripheral arterial
events, heart failure, hospitalisation due to heart failure, estimated
glomerular filtration rate or creatinine clearance, doubling of serum
creatinine, urine albumin-to-creatinine ratio, albuminuria progression,
vascular access outcomes, body weight, body mass index, fatigue, life
participation, peritoneal dialysis infection, peritoneal dialysis failure,
adverse events, serious adverse events, withdrawal due to adverse events,
HbA1c, sudden death, acute MI, ischaemic stroke, and coronary
revascularisation. Confidence in the evidence was assessed using the
Grading of Recommendations Assessment, Development and Evaluation (GRADE)
approach. Main Result(s): Forty-two studies involving 48,148
participants were included. All studies were conducted on people with type
2 diabetes, and no studies were carried out on children. The median study
age was 66 years. The median study follow-up was 26 weeks. Six studies
were conducted in people with CKD stages 1-2, 11 studies in people with
CKD stages 3-5, one study in people on dialysis, and the remaining studies
included people with both CKD stages 1-2 and 3-5. Risks of bias in the
included studies for all the primary outcomes in studies that compared
GLP-1 receptor agonists to placebo were low in most methodological
domains, except one study that was assessed at high risk of bias due to
missing outcome data for death (all-cause and cardiovascular). The overall
risk of bias for all-cause and cardiovascular death in studies that
reported the treatment effects of GLP-1 receptor agonists compared to
standard care, dipeptidyl peptidase-4 (DPP-4) inhibitors or sodium-glucose
cotransporter 2 (SGLT2) inhibitors were assessed as unclear or at high
risk of bias due to deviations from intended interventions or missing
data. For GLP-1 receptor agonists compared to insulin or another GLP-1
receptor agonist, the risk of bias for all-cause and cardiovascular death
was low or unclear. Compared to placebo, GLP-1 receptor agonists probably
reduced the risk of all-cause death (RR 0.85, 95% CI 0.74 to 0.98;
I2 = 23%; 8 studies, 17,861 participants; moderate-certainty
evidence), but may have little or no effect on cardiovascular death (RR
0.84, 95% CI 0.68 to 1.05; I2 = 42%; 7 studies, 17,801
participants; low-certainty evidence). Compared to placebo, GLP-1 receptor
agonists probably decreased 3-point MACE (RR 0.84, 95% CI 0.73 to 0.98; I2
= 65%; 4 studies, 19,825 participants; moderate-certainty evidence), and
4-point MACE compared to placebo (RR 0.77, 95% CI 0.67 to 0.89; 1 study,
2,158 participants; moderate-certainty evidence). Based on absolute risks
of clinical outcomes, it is likely that GLP-1 receptor agonists prevent
all-cause death in 52 people with CKD stages 1-2 and 116 in CKD stages
3-5, cardiovascular death in 34 people with CKD stages 1-2 and 71 in CKD
stages 3-5, while 95 CKD stages 1-2 and 153 in CKD stages 3-5 might
experience a major cardiovascular event for every 1000 people treated over
1 year. Compared to placebo, GLP-1 receptor agonists probably had little
or no effect on kidney failure, defined as starting dialysis or kidney
transplant (RR 0.86, 95% CI 0.66 to 1.13; I2 = 0%; 3 studies,
4,134 participants; moderate-certainty evidence), or on composite kidney
outcomes (RR 0.89, 95% CI 0.78 to 1.02; I2 = 0%; 2 studies,
16,849 participants; moderate-certainty evidence). Compared to placebo,
GLP-1 receptor agonists may have little or no effect on the risk of severe
hypoglycaemia (RR 0.82, 95% CI 0.54 to 1.25; I2 = 44%; 4
studies, 6,292 participants; low-certainty evidence). The effects of GLP-1
receptor agonists compared to standard care or other hypoglycaemic agents
were uncertain. No studies evaluated treatment on risks of fatigue, life
participation, amputation or fracture. Authors' conclusions: GLP-1
receptor agonists probably reduced all-cause death but may have little or
no effect on cardiovascular death in people with CKD and diabetes. GLP-1
receptor agonists probably lower major cardiovascular events, probably
have little or no effect on kidney failure and composite kidney outcomes,
and may have little or no effect on the risk of severe hypoglycaemia in
people with CKD and diabetes. Copyright © 2025 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<23>
Accession Number
2033335079
Title
Balloon-versus self-expandable transcatheter aortic valve implantation in
small aortic annuli: a meta-analysis of randomized and propensity studies.
Source
Cardiovascular Intervention and Therapeutics. (no pagination), 2025.
Article Number: e012873. Date of Publication: 2025.
Author
Baudo M.; Sicouri S.; Yamashita Y.; Magouliotis D.; Cabrucci F.; Carnila
S.; Ramlawi B.
Institution
(Baudo, Sicouri, Yamashita, Magouliotis, Cabrucci, Carnila, Ramlawi)
Department of Cardiac Surgery Research, Lankenau Institute for Medical
Research, Main Line Health, 100 E Lancaster Avenue, Wynnewood, PA, United
States
(Yamashita, Ramlawi) Department of Cardiac Surgery, Lankenau Heart
Institute, Main Line Health, Wynnewood, PA, United States
Publisher
Springer
Abstract
The hemodynamic and clinical differences between balloon- (BEV) and
self-expandable valves (SEV) are critical for patients with a small aortic
annulus (SAA). This meta-analysis aims to evaluate the clinical and
hemodynamic performance of these two systems in patients with severe
aortic stenosis and SAA. A systematic review was conducted from inception
to June 2024 for randomized and propensity-score studies comparing BEV and
SEV outcomes in patients with a SAA. Reconstructed individual patient data
(IPD) from Kaplan Meier curves was pooled for overall survival and
rehospitalization for heart failure. Nine studies with 2856 patients met
our inclusion criteria: 1427 in the BEV group and 1429 in the SEV group.
SEV demonstrated superior hemodynamic performance, including improved iEOA
(Standardized Mead Difference [SMD]: 0.52, p = 0.0012), lower mean
gradients (SMD: - 0.89, p < 0.0001), and reduced PPM (Odds Ratio [OR]:
0.38, p < 0.0001) compared to BEV. BEV presented lower new pacemaker rates
compared to SEV (OR: 1.52, p = 0.0447). There were no significant
differences between SEV and BEV in terms of rates of > mild paravalvular
leaks, early stroke, and Valve Academic Research Consortium-defined
outcomes. Reconstructed IPD showed no significant differences in overall
survival (Hazard Ratio [HR]: 0.95, p = 0.584) and rehospitalization for
heart failure (HR: 1.05, p = 0.828) during follow-up. In patients with SAA
undergoing TAVI the use of BEV was associated with higher frequency of PPM
and/or pressure gradients. Similar early stroke, survival and
rehospitalization rates were reported. Pacemaker rates were higher with
SEV. Long-term follow-up studies are required, especially with
newer-generation devices. Copyright © The Author(s) under
exclusive licence to Japanese Association of Cardiovascular Intervention
and Therapeutics 2025.

<24>
Accession Number
2033318173
Title
Thymus transplantation for DiGeorge Syndrome: a systematic review.
Source
Pediatric Surgery International. 41(1) (no pagination), 2025. Article
Number: 82. Date of Publication: 01 Dec 2025.
Author
Ahmed H.S.; Dias A.F.; Pulkurthi S.R.
Institution
(Ahmed) Bangalore Medical College and Research Institute, K.R Road,
Karnataka, Bangalore, India
(Dias, Pulkurthi) M S Ramaiah Medical College, M S Ramaiah Nagar,
Karnataka, Bangalore, India
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: DiGeorge syndrome (DGS) is a condition typically associated
with athymia, parathyroid hypoplasia or aplasia, and congenital heart
defects. Athymia in these patients causes severe immunodeficiency, causing
high mortality and morbidity, often requiring thymic tissue
transplantation. The present systematic review aims to consolidate the
present evidence on thymus transplantation in DGS. Method(s): An
electronic literature search of five databases (PubMed, Medline, Scopus,
EBSCOhost, and CINAHL) was performed from inception till September 2024.
Relevant articles were selected, and data was extracted by two independent
reviewers. Result(s): A total of 16 articles were included from an
initial set of 1227 articles. Patients diagnosed with DGS in the included
studies were predominantly male, and the age at which thymus
transplantation was done typically varied from 0.8 to 26 months. Several
patients had chromosome 22q11 hemizygosity. Thymic tissue was taken from
tissues of pediatric patients undergoing cardiothoracic surgery.
Pre-transplant medication included immunosuppressants with rabbit
anti-thymocyte globulin (RATGAM) being frequently used alongside steroids
and tacrolimus. This tissue was cultured and transplanted into the
quadriceps muscle of the patients under general anesthesia. Thymopoiesis
was well described in most patients with graft failures and rejections
occurring rarely. Naive T-cell development was noted in almost all
patients with clearance of infections in many cases. Common postoperative
complications include sepsis, haemorrhage, gastrointestinal disturbances,
among others. Mortality was uncommon but often associated with
intracerebral hemorrhages and sepsis. Conclusion(s): Thymus
transplantation is a relatively safe and effective procedure in patients
with DGS with athymia. Future research should explore the addition of
allogenic parathyroid gland transplantation along with thymic
tissue. Copyright © The Author(s), under exclusive licence to
Springer-Verlag GmbH Germany, part of Springer Nature 2025.

<25>
Accession Number
2035705829
Title
Prevalence of Myocardial Infarction With Obstructive and Non-Obstructive
Coronary Arteries in a Middle-Aged Population With Chronic Airflow
Limitation: A Cross-Sectional Study.
Source
International Journal of COPD. 20 (pp 303-312), 2025. Date of Publication:
2025.
Author
Sundh J.; Ekstrom M.; Blomberg A.; Lindberg E.; Malinovschi A.; Olin
A.-C.; Skold C.M.; Toren K.; Wollmer P.; Ostgren C.J.; Jernberg T.
Institution
(Sundh) Department of Respiratory Medicine, Faculty of Medicine and
Health, Orebro University, Orebro, Sweden
(Ekstrom) Lund University, Faculty of Medicine, Department of Clinical
Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine,
Lund, Sweden
(Blomberg) Department of Public Health and Clinical Medicine, Umea
University, Umea, Sweden
(Lindberg) Department of Medical Sciences, Respiratory, Allergy and Sleep
Research, Uppsala University, Uppsala, Sweden
(Malinovschi) Department of Medical Sciences, Clinical Physiology, Uppsala
University, Uppsala, Sweden
(Olin, Toren, Wollmer) Occupational and Environmental Medicine, School of
Public Health and Community Medicine, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden
(Skold) Respiratory Medicine Unit, Department of Medicine Solna and Center
for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
(Skold) Department of Respiratory Medicine and Allergy, Karolinska
University Hospital, Stockholm, Sweden
(Ostgren) Department of Translational Medicine, Lund University, Malmo,
Sweden
(Ostgren) Centre of Medical Image Science and Visualization (CMIV),
Linkoping University, Linkoping, Sweden
(Jernberg) Department of Health, Medicine and Caring Sciences, Linkoping
University, Linkoping, Sweden
(Jernberg) Department of Clinical Sciences, Danderyd Hospital, Karolinska
Institutet, Stockholm, Sweden
Publisher
Dove Medical Press Ltd
Abstract
Purpose: Myocardial infarctions (MIs) can occur in underlying obstructive
coronary artery disease (MI-CAD) or in non-obstructive coronary arteries
(MINOCA). The primary objectives of the study were to investigate the
prevalence of MI-CAD and MINOCA in people with CAL, and to explore if CAL
is an independent risk factor for MI-CAD and MINOCA. Secondary objectives
were to explore these research questions stratified by sex and by smoking
history. Patients and Methods: Cross-sectional analysis of the
population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) of people
aged 50-64 years. CAL was defined as a post-bronchodilator ratio of forced
expiratory volume in one second and forced vital capacity below 0.70.
MI-CAD was defined as a self-reported MI with coronary computed tomography
angiography findings of previous revascularization or at least one
significant coronary stenosis (>50%), and MINOCA as self-reported MI with
no previous revascularization and no significant coronary stenosis.
 Result(s): In total, 1735 (8.3%) of 20,882 included participants had
CAL. MI-CAD was more common than MINOCA both in people with (2.8 vs 0.6%)
and without CAL (1.2 vs 0.3%). Compared with those without CAL, people
with CAL had an almost doubled independent risk of both MI-CAD ([adjusted
OR] 1.72; [95% CI] 1.22-2.42) and MINOCA (1.99; 1.02-3.86). In men, CAL
was associated with increased risk of MINOCA (2.63; 1.23-5.64), and in
women with increased risk for MI-CAD (3.43; 1.68-1.26).
 Conclusion(s): Middle-aged people with CAL have an almost doubled
risk of both MI-CAD and MINOCA, compared with people without CAL. In
contrast to people without CAL, the risk of MINOCA is increased in men and
the risk of MI-CAD is increased in women. In a clinical context, both MI
types should be considered in CAL. Copyright © 2025 Sundh et al.

<26>
[Use Link to view the full text]
Accession Number
2035905643
Title
Effect of a Machine Learning-Derived Early Warning Tool with Treatment
Protocol on Hypotension during Cardiac Surgery and ICU Stay: The
Hypotension Prediction 2 (HYPE-2) Randomized Clinical Trial.
Source
Critical Care Medicine. 53(2) (pp e328-e340), 2025. Date of Publication:
01 Feb 2025.
Author
Schuurmans J.; Rellum S.R.; Schenk J.; Van Der Ster B.J.P.; Van Der Ven
W.H.; Geerts B.F.; Hollmann M.W.; Cherpanath T.G.V.; Lagrand W.K.;
Wynandts P.R.; Paulus F.; Driessen A.H.G.; Terwindt L.E.; Eberl S.;
Hermanns H.; Veelo D.P.; Vlaar A.P.J.
Institution
(Schuurmans, Rellum, Schenk, Van Der Ster, Van Der Ven, Hollmann,
Wynandts, Terwindt, Eberl, Hermanns, Veelo) Department of Anesthesiology,
Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences,
Amsterdam, Netherlands
(Schuurmans, Rellum, Schenk, Cherpanath, Lagrand, Paulus, Terwindt, Vlaar)
Department of Intensive Care, Amsterdam UMC, University of Amsterdam,
Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
(Schenk) Department of Epidemiology and Data Science, Amsterdam UMC,
University of Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands
(Geerts) Medical Affairs, Healthplus.ai B.V., Amsterdam, Netherlands
(Wynandts) Laboratory of Experimental Intensive Care and Anesthesiology,
Amsterdam UMC, Location AMC, Amsterdam, Netherlands
(Driessen) Department of Cardiothoracic Surgery, Amsterdam UMC, University
of Amsterdam, Heart Center, Amsterdam, Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVES: Cardiac surgery is associated with perioperative
complications, some of which might be attributable to hypotension. The
Hypotension Prediction Index (HPI), a machine-learning-derived early
warning tool for hypotension, has only been evaluated in noncardiac
surgery. We investigated whether using HPI with diagnostic guidance
reduced hypotension during cardiac surgery and in the ICU. DESIGN:
Randomized clinical trial conducted between May 2021 and February 2023.
SETTING: Single-center study conducted in an academic hospital in the
Netherlands. PATIENTS: Adults undergoing elective on-pump coronary artery
bypass grafting, with or without single heart valve surgery, were enrolled
if a mean arterial pressure (MAP) greater than or equal to 65 mm Hg was
targeted during the surgical off-pump phases and ICU stay. After
eligibility assessment, 142 of 162 patients approached gave informed
consent for participation. INTERVENTIONS: Patients randomized 1:1 received
either diagnostic guidance in addition to standard care if HPI reached
greater than or equal to 75 (n = 72) or standard care alone (n = 70).
MEASUREMENTS AND MAIN RESULTS: The primary outcome was the severity of
hypotension, measured as time-weighted average (TWA) of MAP less than 65
mm Hg. Secondary outcomes encompassed hypertension severity and
intervention disparities. Of 142 patients randomized, 130 were included in
the primary analysis. The HPI group showed 63% reduction in median TWA of
hypotension compared with the standard care group, with a median of
differences of -0.40 mm Hg (95% CI, -0.65 to -0.27; p < 0.001). In the HPI
group, patients spent a median 28 minutes (95% CI, 17-44 min) less in
hypotension, with a measurement duration of 322 minutes in the HPI group
and 333 minutes in the standard care group. No significant differences
were observed in hypertension severity, treatment choice, or fluid,
vasopressors, and inotrope amounts. CONCLUSION(S): Using HPI combined
with diagnostic guidance on top of standard care significantly decreased
hypotension severity in elective cardiac surgery patients compared with
standard care. Copyright © 2024 by the Society of Critical Care
Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

<27>
Accession Number
2037600640
Title
Non-intubated video-assisted thoracoscopy: a narrative review.
Source
Acta Anaesthesiologica Belgica. 75 (pp 125-136), 2024. Date of
Publication: 01 Dec 2024.
Author
Ushakova V.; Coppens S.
Institution
(Ushakova) Department of Anaesthesiology, University Hospitals of Leuven,
Herestraat 49, Leuven, Belgium
(Coppens) Department of Anaesthesiology, University Hospitals of Leuven,
Department of Cardiovascular Sciences, Biomedical Sciences Group,
University of Leuven, Herestraat 49, Leuven, Belgium
Publisher
BeSARPP
Abstract
Non-intubated video-assisted thoracoscopic surgery (NIVATS) is an emerging
technique in thoracic surgery that avoids the use of general anaesthesia
and mechanical ventilation. The evolution from traditional VATS to NIVATS
has shown significant potential in reducing postoperative complications,
shortening hospital stays, and improving patient satisfaction. By allowing
spontaneous breathing, NIVATS minimizes the invasiveness of thoracic
procedures and reduces the risks associated with tracheal intubation and
general anaesthesia. A comprehensive literature search was conducted
across multiple databases, including the Cochrane Library, Embase, Medline
(Ovid), PubMed, and Scopus, focusing on studies published between 2013 and
2023. Keywords included terms related to NIVATS, spontaneous breathing,
and one-lung ventilation. The search yielded 56 relevant studies selected
for inclusion in our review. This narrative review explores the
physiological aspects and clinical implications induced by the respiratory
management in thoracoscopic surgery. It also examines equipment and
techniques for lung isolation, emphasizing the importance of optimizing
perioperative management. In conclusion, both VATS and NIVATS offer
significant advantages over traditional open thoracotomy. NIVATS, in
particular, shows promise in enhancing patient outcomes through reduced
complications and faster recovery. We present our current protocol for
NIVATS at the University Hospitals in Leuven, although further studies
areneeded to confirm these benefits and refine protocols for broader
clinical adoption. Copyright © 2024 BeSARPP. All rights reserved.

<28>
Accession Number
2033273337
Title
Risk and benefit analysis of single-shot nerve block for postoperative
analgesia for uniportal video-assisted thoracic surgery (uVATS): a
randomized controlled trial.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 68. Date
of Publication: 01 Dec 2025.
Author
Wang L.F.; Qi F.; Feng H.X.; Shi Y.H.; Li Y.; Zheng M.T.; Bu T.; Li W.X.;
Zhang Z.R.
Institution
(Wang, Zheng) Department of Anesthesiology, China-Japan Friendship
Hospital, Beijing, China
(Qi, Feng, Shi, Li, Li, Zhang) Department of Thoracic Surgery, China-Japan
Friendship Hospital, Beijing, China
(Bu) Department of Anesthesiology, Peking University First Hospital,
Beijing, China
Publisher
BioMed Central Ltd
Abstract
Background: There is lack of the clinical evidence of optimized
perioperative analgesic protocol for uniportal video-assisted
thoracoscopic surgery (uVATS). Method(s): We performed a RCT
enrolling participants scheduled for uVATS (Trial registration:
NCT06016777; registration date: Aug 28, 2023). Participants were
randomized for thoracic paravertebral block combined with
patient-controlled intravenous analgesia (PVB + PCIA), erector spinae
block combined with PCIA (ESPB + PCIA), or PCIA group. Participants were
followed-up till 6 months. Primary outcome was total opioid consumption.
Secondary outcomes included postoperative rest and cough pain scores,
ambulation time, chest tube duration, length of stay, anaesthesia expense
and adverse events. Result(s): We enrolled 108 participants between
October 16th, 2023 to April 14th, 2024. Neural block did not reduce opioid
consumption. Postoperative rest and cough pain scores did not differ among
the groups at all the follow-up time points. None of the participants
experienced chronic pain. The ambulation time, duration of chest tube
maintenance and length of stay did not differ among groups. Duration of
anaesthesia procedure was significantly prolonged in both neural blockade
groups compared to PCIA group (p = 0.033). Anaesthesia expenses were
significantly higher in both nerve block groups than in the PCIA group (p
< 0.001). Adverse events related to neural blockade occurred in 17.9% in
PVB + PCIA group and 2.9% in ESPB + PCIA group (p = 0.010), including
local haemorrhage and block failure. Adverse events related to opioid use
did not differ among groups. Conclusion(s): Both PVB and ESPB did not
exhibit analgesic advantage for uVATS. Neural block may carry the risk of
haemorrhage and block failure, prolonged the anaesthesia procedure and
increased the anaesthesia expenses. Trial registration: Clinical Trial
Number was NCT06016777, trial registration date was Aug 28th,
2023. Copyright © The Author(s) 2025.

<29>
Accession Number
2035694679
Title
Prevalence of Hearing Loss After Open-Heart Surgery: A Systematic Review.
Source
Brazilian Journal of Cardiovascular Surgery. 40(1) (no pagination), 2025.
Article Number: e20230197. Date of Publication: 2025.
Author
Emamzadehashemi K.R.; Paryad E.; Salari A.; Noveiri M.J.S.
Institution
(Emamzadehashemi) Department of Neurosurgery, Faculty of Medicine, Imam
Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran,
Islamic Republic of
(Paryad, Noveiri) Cardiovascular Diseases Research Center, Department of
Cardiology, Heshmat Hospital, Department of Nursing, School of Nursing and
Midwifery, Guilan University of Medical Sciences, Rasht, Iran, Islamic
Republic of
(Salari) Cardiovascular Diseases Research Center, Department of
Cardiology, Heshmat Hospital, School of Medicine, Guilan University of
Medical Sciences, Rasht, Iran, Islamic Republic of
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: Today, due to the increase in the incidence of heart
problems in people, we see an increase in the number of heart surgeries
worldwide. Hearing disorders in the form of hearing loss have been
reported as one of the side effects of this kind of surgery in some
studies. Considering the evidence of the effect of open-heart surgery on
patients' hearing loss, this systematic review study was conducted to
determine the frequency of hearing loss after open-heart surgery.
 Method(s): To carry out this systematic review, studies that
investigated hearing loss after open-heart surgery in Iran and the rest of
world, published in Persian or English, and various international
electronic databases including PubMed, Web of Science, Scopus, and
authentic Persian sources (e.g., Irandoc and Scientific Information
Database) until the end of 2021 have been indexed. Result(s): In the
initial review, 46 of the 2230 initially searched articles had the
conditions for further review. After checking the articles' title and
abstract and the working method of the studies and removing duplicates and
incomplete articles, a total of 16 articles were included in the study.
Then, their results were analyzed as the frequency of hearing loss after
open-heart surgery by age and sex. Conclusion(s): The review of
various studies confirms the fact that after open-heart surgery, the
existence of evidence of hearing changes is not far from
expected. Copyright © 2025, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<30>
Accession Number
2035694686
Title
The Ticking Surgical Clock: Outcome, Predictor, or a Bit of Both?.
Source
Brazilian Journal of Cardiovascular Surgery. 40(1) (no pagination), 2025.
Article Number: e20240084. Date of Publication: 2025.
Author
Magoon R.; Kalaiselvan J.; Jose J.
Institution
(Magoon, Kalaiselvan) Department of Cardiac Anaesthesia, Atal Bihari
Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia
Hospital, New Delhi, India
(Jose) Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of
Cardiovascular Sciences and Research, Karnataka, Bengaluru, India
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular

<31>
Accession Number
2037442936
Title
Perioperative goal-directed therapy with artificial intelligence to reduce
the incidence of intraoperative hypotension and renal failure in patients
undergoing lung surgery: A pilot study.
Source
Journal of Clinical Anesthesia. 102 (no pagination), 2025. Article Number:
111777. Date of Publication: 01 Mar 2025.
Author
Habicher M.; Denn S.M.; Schneck E.; Akbari A.A.; Schmidt G.; Markmann M.;
Alkoudmani I.; Koch C.; Sander M.
Institution
(Habicher, Denn, Schneck, Akbari, Schmidt, Markmann, Koch, Sander)
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy,
Justus Liebig University of Giessen, Rudolf-Buchheim-Street 7, Giessen,
Germany
(Alkoudmani) Department of General, Visceral, Thoracic, Transplant and
Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Street
7, Giessen, Germany
Publisher
Elsevier Inc.
Abstract
Study objective: The aim of this study was to investigate whether
goal-directed treatment using artificial intelligence, compared to
standard care, can reduce the frequency, duration, and severity of
intraoperative hypotension in patients undergoing single lung ventilation,
with a potential reduction of postoperative acute kidney injury (AKI).
 Design(s): single center, single-blinded randomized controlled trial.
 Setting(s): University hospital operating room. Patient(s): 150
patients undergoing lung surgery with single lung ventilation were
included. Intervention(s): Patients were randomly assigned to two
groups: the Intervention group, where a goal-directed therapy based on the
Hypotension Prediction Index (HPI) was implemented; the Control group,
without a specific hemodynamic protocol. Measurements: The primary outcome
measures include the frequency, duration of intraoperative hypotension,
furthermore the Area under MAP 65 and the time-weighted average (TWA) of
MAP of 65. Other outcome parameters are the incidence of AKI and
myocardial injury after non-cardiac surgery (MINS). Main Result(s):
The number of hypotensive episodes was lower in the intervention group
compared to the control group (0 [0-1] vs. 1 [0-2]; p = 0.01), the
duration of hypotension was shorter in the intervention group (0 min
[0-3.17] vs. 2.33 min [0-7.42]; p = 0.01). The area under the MAP of 65 (0
mmHg * min [0-12] vs. 10.67 mmHg * min [0-44.16]; p < 0.01) and the TWA of
MAP of 65 (0 mmHg [0-0.08] vs. 0.07 mmHg [0-0.25]; p < 0.01) were lower in
the intervention group. The incidence of postoperative AKI showed no
differences between the groups (6.7 % vs.4.2 %; p = 0.72). There was a
trend to lower incidence of MINS in the intervention group (17.1 % vs.
31.8 %; p = 0.07). A tendency towards reduced postoperative infection was
seen in the intervention group (16.0 % vs. 26.8 %; p = 0.16).
 Conclusion(s): The implementation of a treatment algorithm based on
HPI allowed us to decrease the duration and severity of hypotension in
patients undergoing lung surgery. It did not result in a significant
reduction in the incidence of AKI, however we observed a tendency towards
lower incidence of MINS in the intervention group, along with a slight
reduction in postoperative infections. Copyright © 2025

<32>
Accession Number
2033273131
Title
Tissue infarction secondary to brucellosis: a systematic review of case
reports and case series.
Source
BMC Infectious Diseases. 25(1) (no pagination), 2025. Article Number: 203.
Date of Publication: 01 Dec 2025.
Author
Keyvanfar A.; Najafiarab H.; Mohammadi Z.; Falah Tafti M.; Talebian N.;
Tehrani S.; Yadegarynia D.
Institution
(Keyvanfar, Tehrani, Yadegarynia) Infectious Diseases and Tropical
Medicine Research Center, Shahid Beheshti University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Najafiarab, Talebian) Preventative Gynecology Research Center, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Mohammadi) School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Falah Tafti, Talebian) Student Research Committee, School of Medicine,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
BioMed Central Ltd
Abstract
Background: Tissue infarction is a rare but serious life-threatening
complication of brucellosis. In this systematic review, we investigated
manifestations, diagnostic and therapeutic measures, and causes of tissue
infarction in patients with brucellosis. Method(s): Pubmed/Medline,
Embase, Scopus, and Web of Science were systematically searched for case
reports or case series that detail tissue infarction secondary to
brucellosis up to October 20, 2024. Baseline characteristics, clinical and
paraclinical findings, infarcted tissue details, treatments, and outcomes
of the patients were independently extracted by two reviewers.
 Result(s): A total of 34 articles were included, reporting on 36
brucellosis patients with tissue infarction in the central nervous system
(CNS) (n = 24), spleen (n = 6), heart (n = 3), kidney (n = 1), bowel (n =
1), and three organs-spleen-bowel-kidney- (n = 1). These patients
primarily presented with flu-like symptoms and organ-specific
manifestations resulting from tissue infarction. Laboratory findings were
predominantly suggestive of brucellosis. Furthermore, tissue infarctions
were confirmed by imaging in all cases. Most patients indicated
improvement with medications and surgical interventions.
 Conclusion(s): Tissue infarction in patients with brucellosis can
impact various organs, particularly the brain, spleen, and heart, with
symptoms differing based on the specific organ involved. As patients with
brucellosis exhibit symptoms of tissue infarction, healthcare providers
should be aware of this complication. Prompt diagnosis can be achieved
through laboratory and imaging investigations. Appropriate medical and
surgical treatments should be provided for these cases. Trial
registration: The study protocol was registered in the international
prospective registry of systematic reviews known as PROSPERO (Protocol
number: CRD42024595263). Copyright © The Author(s) 2025.

<33>
Accession Number
2033295562
Title
Vitamin D for the Prevention of Disease: An Endocrine Society Clinical
Practice Guideline.
Source
Journal of Clinical Endocrinology and Metabolism. 109(8) (pp 1907-1947),
2024. Date of Publication: 01 Aug 2024.
Author
Demay M.B.; Pittas A.G.; Bikle D.D.; Diab D.L.; Kiely M.E.;
Lazaretti-Castro M.; Lips P.; Mitchell D.M.; Murad M.H.; Powers S.; Rao
S.D.; Scragg R.; Tayek J.A.; Valent A.M.; Walsh J.M.E.; McCartney C.R.
Institution
(Demay) Department of Medicine, Endocrine Unit, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, United States
(Pittas) Division of Endocrinology, Diabetes and Metabolism, Department of
Medicine, Tufts Medical Center, Boston, MA, United States
(Bikle) Departments of Medicine and Dermatology, University of California
San Francisco, San Francisco VA Medical Center, San Francisco, CA, United
States
(Diab) Department of Internal Medicine, Division of Endocrinology,
Diabetes and Metabolism, University of Cincinnati, Cincinnati, OH, United
States
(Kiely) Cork Centre for Vitamin D and Nutrition Research, School of Food
and Nutritional Sciences, INFANT Research Centre, University College Cork,
Cork, Ireland
(Lazaretti-Castro) Department of Internal Medicine, Division of
Endocrinology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
(Lips) Endocrine Section, Amsterdam University Medical Center, Internal
Medicine, Amsterdam, Netherlands
(Mitchell) Pediatric Endocrine Unit, Massachusetts General Hospital,
Harvard Medical School, Boston, MA, United States
(Murad) Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, United
States
(Powers) Bone Health and Osteoporosis Foundation, Los Gatos, CA, United
States
(Rao) Division of Endocrinology, Diabetes and Bone & Mineral Disorders,
Henry Ford Health, Detroit, MI, United States
(Rao) College of Human Medicine, Michigan State University, Lansing, MI,
United States
(Scragg) School of Population Health, The University of Auckland,
Auckland, New Zealand
(Tayek) Department of Internal Medicine, Harbor-UCLA Medical Center,
Torrance, CA, United States
(Tayek) The Lundquist Institute, Torrance, CA, United States
(Valent) Department of Obstetrics & Gynecology, Oregon Health & Science
University, Portland, OR, United States
(Walsh) Division of General Internal Medicine, Department of Medicine,
University of California San Francisco, San Francisco, CA, United States
(McCartney) Department of Medicine, University of Virginia,
Charlottesville, VA, United States
(McCartney) Department of Medicine, West Virginia University, Morgantown,
WV, United States
Publisher
Endocrine Society
Abstract
Background: Numerous studies demonstrate associations between serum
concentrations of 25-hydroxyvitamin D (25[OH]D) and a variety of common
disorders, including musculoskeletal, metabolic, cardiovascular,
malignant, autoimmune, and infectious diseases. Although a causal link
between serum 25(OH)D concentrations and many disorders has not been
clearly established, these associations have led to widespread
supplementation with vitamin D and increased laboratory testing for
25(OH)D in the general population. The benefit-risk ratio of this increase
in vitamin D use is not clear, and the optimal vitamin D intake and the
role of testing for 25(OH)D for disease prevention remain uncertain.
 Objective(s): To develop clinical guidelines for the use of vitamin D
(cholecalciferol [vitamin D3] or ergocalciferol [vitamin D2]) to lower the
risk of disease in individuals without established indications for vitamin
D treatment or 25(OH)D testing. Method(s): A multidisciplinary panel
of clinical experts, along with experts in guideline methodology and
systematic literature review, identified and prioritized 14 clinically
relevant questions related to the use of vitamin D and 25(OH)D testing to
lower the risk of disease. The panel prioritized randomized
placebo-controlled trials in general populations (without an established
indication for vitamin D treatment or 25[OH]D testing), evaluating the
effects of empiric vitamin D administration throughout the lifespan, as
well as in select conditions (pregnancy and prediabetes). The panel
defined "empiric supplementation" as vitamin D intake that (a) exceeds the
Dietary Reference Intakes (DRI) and (b) is implemented without testing for
25(OH)D. Systematic reviews queried electronic databases for publications
related to these 14 clinical questions. The Grading of Recommendations,
Assessment, Development, and Evaluation (GRADE) methodology was used to
assess the certainty of evidence and guide recommendations. The approach
incorporated perspectives from a patient representative and considered
patient values, costs and resources required, acceptability and
feasibility, and impact on health equity of the proposed recommendations.
The process to develop this clinical guideline did not use a risk
assessment framework and was not designed to replace current DRI for
vitamin D. Result(s): The panel suggests empiric vitamin D
supplementation for children and adolescents aged 1 to 18 years to prevent
nutritional rickets and because of its potential to lower the risk of
respiratory tract infections; for those aged 75 years and older because of
its potential to lower the risk of mortality; for those who are pregnant
because of its potential to lower the risk of preeclampsia, intra-uterine
mortality, preterm birth, small-for-gestational-age birth, and neonatal
mortality; and for those with high-risk prediabetes because of its
potential to reduce progression to diabetes. Because the vitamin D doses
in the included clinical trials varied considerably and many trial
participants were allowed to continue their own vitamin D-containing
supplements, the optimal doses for empiric vitamin D supplementation
remain unclear for the populations considered. For nonpregnant people
older than 50 years for whom vitamin D is indicated, the panel suggests
supplementation via daily administration of vitamin D, rather than
intermittent use of high doses. The panel suggests against empiric vitamin
D supplementation above the current DRI to lower the risk of disease in
healthy adults younger than 75 years. No clinical trial evidence was found
to support routine screening for 25(OH)D in the general population, nor in
those with obesity or dark complexion, and there was no clear evidence
defining the optimal target level of 25(OH)D required for disease
prevention in the populations considered; thus, the panel suggests against
routine 25(OH)D testing in all populations considered. The panel judged
that, in most situations, empiric vitamin D supplementation is
inexpensive, feasible, acceptable to both healthy individuals and health
care professionals, and has no negative effect on health equity.
 Conclusion(s): The panel suggests empiric vitamin D for those aged 1
to 18 years and adults over 75 years of age, those who are pregnant, and
those with high-risk prediabetes. Due to the scarcity of natural food
sources rich in vitamin D, empiric supplementation can be achieved through
a combination of fortified foods and supplements that contain vitamin D.
Based on the absence of supportive clinical trial evidence, the panel
suggests against routine 25(OH)D testing in the absence of established
indications. These recommendations are not meant to replace the current
DRIs for vitamin D, nor do they apply to people with established
indications for vitamin D treatment or 25(OH)D testing. Further research
is needed to determine optimal 25(OH)D levels for specific health
benefits. Copyright © The Author(s) 2024. Published by Oxford
University Press on behalf of the Endocrine Society. All rights reserved.

<34>
Accession Number
2031765064
Title
Effects and mechanisms of supramaximal high-intensity interval training on
extrapulmonary manifestations in people with and without chronic
obstructive pulmonary disease (COPD-HIIT): study protocol for a
multi-centre, randomized controlled trial.
Source
Trials. 25(1) (no pagination), 2024. Article Number: 664. Date of
Publication: 01 Dec 2024.
Author
Jakobsson J.; Burtin C.; Hedlund M.; Boraxbekk C.-J.; Westman J.; Karalija
N.; Stal P.; Sandstrom T.; Ruttens D.; Gosker H.R.; De Brandt J.; Nyberg
A.
Institution
(Jakobsson, Hedlund, Westman, De Brandt, Nyberg) Section of Physiotherapy,
Department of Community Medicine and Rehabilitation, Umea University,
Umea, Sweden
(Burtin) REVAL - Rehabilitation Research Center, BIOMED - Biomedical
Research Institute, Hasselt University, Diepenbeek, Belgium
(Boraxbekk, Karalija) Umea Centre for Functional Brain Imaging (UFBI),
Umea University, Umea, Sweden
(Boraxbekk) Diagnostic Radiology, Department of Radiation Sciences, Umea
University, Umea, Sweden
(Boraxbekk) Institute of Sports Medicine Copenhagen (ISMC) and Department
of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen,
Denmark
(Boraxbekk) Institute for Clinical Medicine, Faculty of Medical and Health
Sciences, University of Copenhagen, Copenhagen, Denmark
(Ruttens) Department of Respiratory Medicine, Ziekenhuis Oost-Limburg,
Genk, Belgium
(Ruttens) Faculty of Medicine and Life Sciences, Hasselt University,
Diepenbeek, Belgium
(Karalija, Stal) Department of Medical and Translational Biology, Umea
University, Umea, Sweden
(Sandstrom) Department of Public Health and Clinical Medicine, Umea
University, Umea, Sweden
(Gosker) Department of Respiratory Medicine, NUTRIM School of Nutrition
and Translational Research in Metabolism, Maastricht University Medical
Center+, Maastricht, Netherlands
Publisher
BioMed Central Ltd
Abstract
Background: Beyond being a pulmonary disease, chronic obstructive
pulmonary disease (COPD) presents with extrapulmonary manifestations
including reduced cognitive, cardiovascular, and muscle function. While
exercise training is the cornerstone in the non-pharmacological treatment
of COPD, there is a need for new exercise training methods due to
suboptimal adaptations when following traditional exercise guidelines,
often applying moderate-intensity continuous training (MICT). In people
with COPD, short-duration high-intensity interval training (HIIT) holds
the potential to induce a more optimal stimulus for training adaptations
while circumventing the ventilatory burden often associated with MICT in
people with COPD. We aim to determine the effects of supramaximal HIIT and
MICT on extrapulmonary manifestations in people with COPD compared to
matched healthy controls. Method(s): COPD-HIIT is a prospective,
multi-centre, randomized, controlled trial with blinded assessors and data
analysts, employing a parallel-group designed trial. In phase 1, we will
investigate the effects and mechanisms of a 12-week intervention of
supramaximal HIIT compared to MICT in people with COPD (n = 92) and
matched healthy controls (n = 70). Participants will perform watt-based
cycling two to three times weekly. In phase 2, we will determine how
exercise training and inflammation impact the trajectories of
neurodegeneration, in people with COPD, over 24 months. In addition to the
92 participants with COPD performing HIIT or MICT, a usual care group (n =
46) is included in phase 2. In both phases, the primary outcomes are a
change from baseline in cognitive function, cardiorespiratory fitness, and
muscle power. Key secondary outcomes include change from baseline exercise
tolerance, brain structure, and function measured by MRI,
neuroinflammation measured by PET/CT, systemic inflammation, and
intramuscular adaptations. Feasibility of the interventions will be
comprehensively investigated. Discussion(s): The COPD-HIIT trial will
determine the effects of supramaximal HIIT compared to MICT in people with
COPD and healthy controls. We will provide evidence for a novel exercise
modality that might overcome the barriers associated with MICT in people
with COPD. We will also shed light on the impact of exercise at different
intensities to reduce neurodegeneration. The goal of the COPD-HIIT trial
is to improve the treatment of extrapulmonary manifestations of the
disease. Trial registration: Clinicaltrials.gov: NCT06068322.
Prospectively registered on 2023-09-28. Copyright © The Author(s)
2024.

<35>
Accession Number
2032706462
Title
LANDMARK comparison of early outcomes of newer-generation Myval
transcatheter heart valve series with contemporary valves (Sapien and
Evolut) in real-world individuals with severe symptomatic native aortic
stenosis: a randomised non-inferiority trial.
Source
The Lancet. 403(10445) (pp 2695-2708), 2024. Date of Publication: 22 Jun
2024.
Author
Baumbach A.; van Royen N.; Amat-Santos I.J.; Hudec M.; Bunc M.;
Ijsselmuiden A.; Laanmets P.; Unic D.; Merkely B.; Hermanides R.S.; Ninios
V.; Protasiewicz M.; Rensing B.J.W.M.; Martin P.L.; Feres F.; De Sousa
Almeida M.; van Belle E.; Linke A.; Ielasi A.; Montorfano M.; Webster M.;
Toutouzas K.; Teiger E.; Bedogni F.; Voskuil M.; Pan M.; Angeras O.; Kim
W.-K.; Rothe J.; Kristic I.; Peral V.; Garg S.; Elzomor H.; Tobe A.;
Morice M.-C.; Onuma Y.; Soliman O.; Serruys P.W.; Siqueira D.; Pinto I.;
Cervone A.; Assef J.; Vilela A.; Paladino A.; Ramos A.; Rezende M.;
Ghorayeb S.; Braga Silva T.R.; Gjorgjievska S.; Hadzibegovic I.; Jurin I.;
Sipic T.; Pavlovic N.; Rudez I.; Manola S.; Gallet De Saint-Aurin R.;
Boukantar M.; Nicolas E.; Ennezat P.V.; Urien J.M.; Vincent F.; Delhaye
C.; Denimal T.; Cosenza A.; Pamart T.; Porouchani S.; Pontana F.;
Montaigne D.; Balmette V.; Bechiri M.; Chen E.; Janah D.; Renker M.;
Westermann D.; Valina C.; Ferenc M.; Loffelhardt N.; Rahimi F.; Breitbart
P.; Franke K.; Czerny M.; Diab N.; Sick P.; Adeishvili M.; Mangner N.;
Haussig S.; Sveric K.; Crusius L.; Roehlig M.; Koliastasis L.; Drakopoulou
M.; Katsaros O.; Ktenopoulos N.; Ioanniadis A.; Evangelou S.; Ninios I.;
Molnar L.; Papp R.; Arnold-Bela F.; Demeterne Kiss O.; Nagy A.; Czimbalmos
C.; Pellegrinni D.; Montonati C.; Pellicano M.; Guagliumi G.; Tespili M.;
Barbara B.; Filippo R.; Marco A.; Ciro V.; Luca F.; Eustachio A.; Giacomo
I.; Cannone G.; Brambilla N.; Testa L.; Avondo S.; Valvo R.; Clarke R.;
Fish M.; Kosowski M.; Krawczyk M.; Kubler P.; Kotwica T.; Teles R.;
Goncalves P.; Raposo L.; Brito J.; Leal S.; Freitas P.; Ribeiras R.;
Poliacikova P.; Mihailovic P.M.; Terseglav S.; Steblovnik K.; Cercek M.;
Vitez L.; Sustersic M.; Kovac A.; Kogoj P.; Dimitrovska L.; Arana J.R.D.;
Martinez S.S.; Dieguez A.R.; Barrero A.; Gonzalez-Bartol E.; Aristizabal
C.; Frutos A.S.; Luna J.P.S.; Gomez M.G.; Gabella T.R.; Nelson V.Q.;
Medina J.N.; Ojeda S.; de Lezo J.S.; Romero M.; Gonzalez-Manzanares R.;
Alvarado M.; Mesa D.; Perea J.; Petursson P.; Alchay M.; Andreen S.;
Gameren M.V.; Heijer P.D.; Meuwissen M.; Cheng J.M.; Vos J.; Scholzel
B.E.; Simsek C.; Hubbers S.; Van den Branden B.J.L.; Stens N.A.; Versteeg
G.A.A.; Rooijakkers M.J.P.; Gehlmann H.R.; Verkroost M.W.A.; Geuzebroek
G.S.C.; Van Wely M.H.; Van Geuns R.J.; van Nunen L.X.; van Garsse
L.A.F.M.; Timmers L.; ten Berg J.; Kraaijeveld A.O.; Dickinson M.G.;
Dessing T.C.; Mokhles M.M.
Institution
(Baumbach) Centre for Cardiovascular Medicine and Devices, William Harvey
Research Institute, Queen Mary University of London and Barts Heart
Centre, London, United Kingdom
(Baumbach) Cleveland Clinic, London, United Kingdom
(van Royen) Department of Cardiology, Radboud University Hospital,
Nijmegen, Netherlands
(Amat-Santos) CIVERCV, Centro de Investigacion Biomedica en red -
Enfermedades Cardiovasculares, University Clinical Hospital of Valladolid,
Valladolid, Spain
(Amat-Santos) Department of Cardiology, University Clinical Hospital of
Valladolid, Valladolid, Spain
(Hudec) Department of Acute Cardiology, Middle-Slovak Institute Of
Cardiovascular Diseases, Banska Bystrica, Slovakia
(Bunc) Department of Cardiology, University Medical Centre Ljubljana,
Ljubljana, Slovenia
(Ijsselmuiden) Department of Cardiology, Amphia Hospital, Breda,
Netherlands
(Ijsselmuiden) Department of Interventional Cardiology, Maastricht
University Medical Center, Maastricht, Netherlands
(Ijsselmuiden) Zuyderland Hospital, Limburg, Netherlands
(Laanmets) Department of Invasive Cardiology, North Estonia Medical
Centre, Tallinn, Estonia
(Unic) Department of Cardiac and Transplant Surgery, University Hospital
Dubrava, Zagreb, Croatia
(Merkely) Heart and Vascular Centre, Semmelweis University Heart and
Vascular Centre, Budapest, Hungary
(Hermanides) Department of Cardiology, Isala Hospital, Zwolle, Netherlands
(Ninios) Department of Cardiology, European Interbalkan Medical Center,
Thessaloniki, Greece
(Protasiewicz) Department of Cardiology, Institute of Heart Diseases,
Wroclaw Medical University, Wroclaw, Poland
(Rensing) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Netherlands
(Martin) Department of Interventional Cardiology, University Hospital of
Gran Canaria Dr Negrin, Las Palmas, Spain
(Feres) Department of Invasive Cardiology, Instituto Dante Pazzanese, Sao
Paulo, Brazil
(De Sousa Almeida) CHRC, NOVA Medical School, NOVA University Lisbon,
Lisbon, Portugal
(van Belle) Department of Interventional Cardiology, Lille University,
Lille, France
(Linke) Department of Internal Medicine and Cardiology, University Clinic,
Heart Center Dresden, University of Technology Dresden, Dresden, Germany
(Ielasi) Department of Interventional Cardiology, IRCCS Galeazzi
Sant'Ambrogio Hospital, Milan, Italy
(Montorfano) School of Medicine, Vita-Salute San Raffaele University,
Milan, Italy
(Montorfano) Interventional Cardiology Unit IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Webster) Department of Cardiology, Auckland City Hospital, Auckland, New
Zealand
(Toutouzas) Department of Cardiology, Hippokration Hospital, Athens,
Greece
(Teiger) Department of Medico-surgical Cardiovascular and Anaesthesiology,
Henri-Mondor University Hospital, Creteil, France
(Bedogni) Department of Clinical Cardiology, San Donato Hospital, Milan,
Italy
(Voskuil) Department of Interventional Cardiology, University Medical
Center Utrecht, Utrecht, Netherlands
(Pan) Department of Cardiology, University Hospital Reina Sofia,
University of Cordoba, Cordoba, Spain
(Angeras) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Angeras) Department of Clinical and Molecular Medicine, Gothenburg
University, Gothenburg, Sweden
(Kim) Department of Cardiology and Angiology, University of Giessen and
Marburg, Giessen, Germany
(Kim) Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim,
Germany
(Rothe) Department of Cardiology and Angiology, University Heart Center
Freiburg Bad Krozingen, University Medical Center Freiburg, Freiburg,
Germany
(Rothe) Department of Cardiology and Angiology, Faculty of Medicine,
University of Freiburg, Freiburg, Germany
(Kristic) Department of Cardiology, University Hospital of Split, Split,
Croatia
(Peral) Department of Cardiology, Son Espases University Hospital, Palma,
Spain
(Garg) Department of Cardiology, Royal Blackburn Hospital, Blackburn,
United Kingdom
(Elzomor, Tobe, Onuma, Soliman, Serruys) Department of Cardiology, School
of Medicine, University of Galway, Galway, Ireland
(Morice) Cardiovascular European Research Center, Paris, France
Publisher
Elsevier B.V.
Abstract
Background: Transcatheter aortic valve implantation is an established,
guideline-endorsed treatment for severe aortic stenosis. Precise sizing of
the balloon-expandable Myval transcatheter heart valve (THV) series with
the aortic annulus is facilitated by increasing its diameter in 1.5 mm
increments, compared with the usual 3 mm increments in valve size. The
LANDMARK trial aimed to show non-inferiority of the Myval THV series
compared with the contemporary THVs Sapien Series (Edwards Lifesciences,
Irvine, CA, USA) or Evolut Series (Medtronic, Minneapolis, MN, USA).
 Method(s): In this prospective, multinational, randomised,
open-label, non-inferiority trial across 31 hospitals in 16 countries
(Germany, France, Sweden, the Netherlands, Italy, Spain, New Zealand,
Portugal, Greece, Hungary, Poland, Slovakia, Slovenia, Croatia, Estonia,
and Brazil), 768 participants with severe symptomatic native aortic
stenosis were randomly assigned (1:1) to the Myval THV or a contemporary
THV. Eligibility was primarily decided by the heart team in accordance
with 2021 European Society of Cardiology guidelines. As per the criteria
of the third Valve Academic Research Consortium, the primary endpoint at
30 days was a composite of all-cause mortality, all stroke, bleeding
(types 3 and 4), acute kidney injury (stages 2-4), major vascular
complications, moderate or severe prosthetic valve regurgitation, and
conduction system disturbances resulting in a permanent pacemaker
implantation. Non-inferiority of the study device was tested in the
intention-to-treat population using a non-inferiority margin of 10.44% and
assuming an event rate of 26.10%. This trial is registered with
ClinicalTrials.gov, NCT04275726, and EudraCT, 2020-000137-40, and is
closed to new participants. Finding(s): Between Jan 6, 2021, and Dec
5, 2023, 768 participants with severe symptomatic native aortic stenosis
were randomly assigned, 384 to the Myval THV and 384 to a contemporary
THV. 369 (48%) participants had their sex recorded as female, and 399
(52%) as male. The mean age of participants was 80.0 years (SD 5.7) for
those treated with the Myval THV and 80.4 years (5.4) for those treated
with a contemporary THV. Median Society of Thoracic Surgeons scores were
the same in both groups (Myval 2.6% [IQR 1.7-4.0] vs contemporary 2.6%
[1.7-4.0]). The primary endpoint showed non-inferiority of the Myval (25%)
compared with contemporary THV (27%), with a risk difference of -2.3%
(one-sided upper 95% CI 3.8, p<inf>non-inferiority</inf><0.0001). No
significant difference was seen in individual components of the primary
composite endpoint. Interpretation(s): In individuals with severe
symptomatic native aortic stenosis, the Myval THV met its primary endpoint
at 30 days. Funding(s): Meril Life Sciences. Copyright ©
2024 Elsevier Ltd

<36>
Accession Number
2033259470
Title
Tricuspid regurgitation after heart transplantation: where innovation and
intervention are in hibernation.
Source
Heart Failure Reviews. (no pagination), 2025. Article Number: e1452. Date
of Publication: 2025.
Author
Alyaydin E.; Gotschy A.; Parianos D.; Nagele M.P.; Tudorache I.; Flammer
A.J.; Stehli J.
Institution
(Alyaydin, Gotschy, Parianos, Nagele, Flammer, Stehli) Department of
Cardiology, University Hospital Zurich, Zurich, Switzerland
(Gotschy) Institute of Diagnostic and Interventional Radiology, University
Hospital Zurich, Zurich, Switzerland
(Gotschy) Institute for Biomedical Engineering, University and ETH Zurich,
Zurich, Switzerland
(Tudorache) Clinic for Cardiac Surgery, University Heart Center Zurich,
Zurich, Switzerland
(Alyaydin) Department of Cardiology, St. Johannes Hospital, Dortmund,
Germany
Publisher
Springer
Abstract
Tricuspid regurgitation (TR) is a common valvular dysfunction following
heart transplantation (HT), with reported prevalence rates ranging from 19
to 84%, primarily depending on the duration of follow-up. Its etiology is
multifactorial and includes surgical technique, ischemic time, primary
graft dysfunction, pulmonary hypertension, pacemaker leads, and
endomyocardial biopsies. Severe TR can significantly impair graft
function, exercise capacity, and patient survival. This mini-review
explores current management strategies, including surgical techniques such
as annuloplasty and tricuspid valve replacement. HT patients are often
high-risk surgical candidates due to factors such as immunosuppressive
therapy, prior surgeries, and various comorbidities. Therefore, we
primarily focus on the evidence regarding emerging interventional methods,
such as transcatheter edge-to-edge repair. Although these interventions
show promising early results, they remain relatively novel in HT
recipients, and the current evidence is based on case reports and small
studies. Further research is essential to evaluate the long-term efficacy
and safety of these management strategies to enhance outcomes for HT
recipients with TR. Copyright © The Author(s) 2025.

<37>
Accession Number
2037440672
Title
Commentator Discussion: A randomized study of cryoablation of intercostal
nerves in patients undergoing minimally invasive thoracic surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2025.
Date of Publication: 2025.
Author
Anonymous
Publisher
Elsevier Inc.

<38>
Accession Number
2037619821
Title
Design and rationale of the multicenter randomized clinical trial
(REVERSE): Efficacy and safety of rivaroxaban in the early postoperative
period for patients with bioprosthetic valve replacement or valve repair.
Source
International Journal of Cardiology. 425 (no pagination), 2025. Article
Number: 133023. Date of Publication: 15 Apr 2025.
Author
Wang X.; Zhang C.; Pan M.-M.; Lin H.-W.; Xue S.; Xie B.; Gu Z.-C.
Institution
(Wang, Zhang, Gu) Department of Pharmacy, Punan Branch of Renji Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
(Wang, Zhang, Pan, Lin, Gu) Department of Pharmacy, Ren Ji Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
(Wang, Zhang, Pan, Lin, Gu) College of Clinical Pharmacy, Shanghai Jiao
Tong University School of Medicine, Shanghai, China
(Zhang) School of Medicine, Tongji University, Shanghai, China
(Xue, Xie) Department of Cardiovascular Surgery, Ren Ji Hospital, Shanghai
Jiao Tong University School of Medicine, Shanghai, China
Publisher
Elsevier Ireland Ltd
Abstract
Background: Rivaroxaban, a Non-vitamin K oral anticoagulant (NOAC), is
extensively employed for patients at heightened risk of thrombosis,
including those with non-valvular atrial fibrillation (NVAF) and venous
thromboembolism (VTE). However, to date, there is a lack of robust
clinical data to explore the efficacy and safety of rivaroxaban in
thromboprophylaxis during the early postoperative period (<6 months) in
patients following surgical bioprosthetic valve (BPV). Method(s): The
REVERSE trial is a prospective, multicenter, non-inferior, randomized
controlled trial enrolling a planned 250 patients in China. Patients are
randomly assigned 1:1 to receive rivaroxaban (20 mg once daily) or
dose-adjusted warfarin (target international normalized ratio 2.0-3.0) for
6 months. The primary outcome is defined as the composite of all-cause
death, major cardiovascular events, or major bleeding. The safety outcome
is all bleeding events defined by the International Society on Thrombosis
and Haemostasis (ISTH). Conclusion(s): The REVERSE trial stands as
the inaugural multicenter study dedicated to evaluating the efficacy and
safety of rivaroxaban for early postoperative anticoagulation in BPV
surgery patients. Its findings are anticipated to contribute pivotal
evidence regarding the clinical advantages of NOACs. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT06476301. Copyright © 2025 Elsevier B.V.

<39>
Accession Number
2037428651
Title
Early Versus Bail-Out Left Ventricular Unloading During Venoarterial
Extracorporeal Membrane Oxygenation: A Systematic Review And
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Picado-Loaiza S.; Ayala R.; Ferreira R.O.M.; Zeledon F.; Almeidinha L.;
Clemente M.; Bittar de Pontes V.; Lee E.C.
Institution
(Picado-Loaiza, Zeledon) Cardiovascular Surgery Department, Caja
Costarricense del Seguro Social, San Jose, Costa Rica
(Ayala) Cardiovascular Surgery Department, Robert Bosch Hospital,
Stuttgart, Germany
(Ferreira) Federal University of Santa Catarina, Florianopolis, Brazil
(Almeidinha) Rochester General Hospital, Rochester, NY, United States
(Clemente) Petropolis School of Medicine, Petropolis, Brazil
(Bittar de Pontes) University Centre of Associated Colleges of Education,
Sao Joao da Boa Vista, Sao Paulo, Brazil
(Lee) Sands Constellation Heart Institute, Rochester, NY, United States
Publisher
W.B. Saunders
Abstract
Left ventricular (LV) unloading has demonstrated favorable outcomes in
patients undergoing venoarterial extracorporeal membrane oxygenation
(VA-ECMO). However, the optimal timing for LV unloading during VA-ECMO
remains controversial. PubMed, Embase, and Cochrane were searched for
studies comparing early versus bail-out LV unloading in patients
undergoing VA-ECMO. We computed mean differences (MD) for continuous
outcomes and risk ratios (RR) for binary outcomes, with 95% confidence
intervals (95%CIs). Heterogeneity was assessed using I2 statistics.
Statistical analyses were performed using R version 4.2.3. Six studies
comprising 1,556 participants were included in the meta-analysis, of whom
936 (60%) were referred to early LV unloading. There were no significant
differences between groups in weaning from VA-ECMO (MD 1.07; 95% CI 0.86 -
1.33; p = 0.55; I2 = 26%), in-hospital mortality (RR 0.95; 95% CI 0.86 -
1.05; p = 0.28; I2 = 0%), 30-day mortality (RR 0.75; 95% CI 0.52 - 1.10; p
= 0.14; I2 = 64%), or duration of VA-ECMO (MD 0.37; 95% CI -1.57 - 2.32; p
= 0.71; I2 = 20%). Sepsis (RR 0.84; 95% CI 0.63 - 1.11; p = 0.22; I2 =
0%), stroke (RR 0.90; 95% CI 0.52 - 1.56; p = 0.70; I2 = 48%), and bridge
to heart transplantation or left ventricular assist device (RR 1.20; 95%
CI 0.90 - 1.62; p = 0.22; I2 = 0%) also did not differ significantly
between the groups. In patients undergoing VA-ECMO, early LV unloading was
not associated with improved efficacy and safety outcomes when compared to
the bail-out strategy for LV unloading. Copyright © 2025 Elsevier
Inc.

<40>
Accession Number
2037601051
Title
The modified heart team protocol facilitated the revascularization
decision-making quality in complex coronary artery disease.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. 40(2) (no
pagination), 2025. Article Number: ivaf023. Date of Publication: 01 Feb
2025.
Author
Ma H.; Lin S.; Li X.; Wang Y.; Ling Y.; Zhang L.; Chen Y.; Liu C.; Ma Y.;
Liu G.; Gao C.; Cheng Z.; Shao F.; Sun Y.; Qi D.; An S.; Hu J.; Zhao Z.;
Dou K.; Wu Y.; Liu R.; Song W.; Zhao J.; Yang W.; Yin D.; Song L.; Zhao
H.; Hu F.; Gao L.; Qian J.; Cui B.; Yang Y.; Luo X.; Gao G.; Cui J.; Wang
X.; Hu X.; Liu S.; Zheng Z.; Wei L.; Lin Y.; Sun X.; Xia L.; Yang J.; Xie
N.; Dong H.; Gong Y.; Sheng L.; Yu B.; Yang S.; Xing L.; Yang G.; Chen T.;
Ma Q.; Chen L.; Pan H.; Cheng X.; Dong N.; Li M.; Li F.; Liu J.; Bai M.;
Zhu Y.; Chen X.; Huang F.; Qiu Z.; Pu J.; Jin S.; Du Y.; Han L.; Tang Y.;
Zhang G.; Song X.; Dong R.; Tu C.; Zhang M.; Zhao Y.; Zheng J.; Song Y.;
He Y.; Liu Z.; Lu W.; Zhang J.; Wang Z.; Wang L.; Yang D.; Li J.; Jin Z.;
Meng S.; Jia R.; Zhang Q.; You J.; Luo Y.; Tao L.; Feng X.; Yu H.; Li Y.;
Guo W.; Zhang D.; Xue Y.; Jiang J.; Wang H.; Liu T.; Xu S.; Yang Z.
Institution
(Ma, Lin, Li, Yang, Dou, Liu, Zheng) National Clinical Research Center for
Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing,
China
(Lin, Liu) Department of Cardiovascular Surgery, Chinese Academy of
Medical Sciences and Peking Union Medical College, National Center for
Cardiovascular Diseases, Fuwai Hospital, Beijing, China
(Li) Central China Subcenter of National Center for Cardiovascular
Diseases, Zhengzhou, China
(Wang) Medical Research and Biometrics Center, Chinese Academy of Medical
Sciences and Peking Union Medical College, Fuwai Hospital, National Center
for Cardiovascular Diseases, Beijing, China
(Yang, Dou) Department of Cardiology, Chinese Academy of Medical Sciences
and Peking Union Medical College, Fuwai Hospital, National Center for
Cardiovascular Diseases, Beijing, China
(Zheng) National Health Commission Key Laboratory of Cardiovascular
Regenerative Medicine, Central China Subcenter of National Center for
Cardiovascular Diseases, Fuwai Central China Cardiovascular Hospital,
Zhengzhou, China
Publisher
Oxford University Press
Abstract
OBJECTIVES: A lack of standardization in heart team implementation
potentially leads to suboptimal decision-making quality, and we previously
established a modified heart team protocol to improve the decision-making
quality. The present trial was to validate the effect of the modified
heart team implementation protocol on improving the decision-making
quality versus the conventional protocol in complex coronary artery
disease (CAD). METHOD(S): Eligible interventional cardiologists,
cardiac surgeons and non-interventional cardiologists were randomly
allocated to the intervention or control arm and established 12 heart
teams in each arm. The 12 heart teams in each arm were randomly divided
into 6 pairs, and 480 historic cases with complex CAD into 6 sets of 80
cases. In each arm, each set of 80 cases was discussed independently by
one pair of heart teams, with each case finally receiving two heart team
decisions (a pairwise decisions'). The intervention arm conducted heart
team decision-making according to the previously established protocol and
the control arm based on guideline recommendations. The primary outcome
was the overall percent agreement of the inter-team pairwise decisions.
Decision-making appropriateness was further analysed. RESULT(S): A
total of 36 cardiac surgeons, 36 interventional cardiologists and 12
non-interventional cardiologists from 26 centres were enrolled. The
overall percent agreement was significantly higher in the intervention arm
than the control arm (72.1% vs 65.8%, P=0.04; kappa 0.51 vs 0.37). Both
team-level (19.4% vs 33.0%; P0.001) and specialist-level (interventional
cardiologists, 19.8% vs 37.7%, P0.001; cardiac surgeons, 19.8% vs 28.7%,
P0.001) inappropriateness rate of decision-making was significantly lower
in the intervention arm than the control arm. CONCLUSION(S): The
modified heart team implementation protocol improved the decision-making
quality and appropriateness compared with the guideline-based
protocol. Copyright © 2025 The Author(s).

<41>
Accession Number
2033416636
Title
Comparing cross-over stenting and focal ostial stenting for ostial left
anterior descending coronary artery lesions: a systematic review and
meta-analysis.
Source
BMC Cardiovascular Disorders. 25(1) (no pagination), 2025. Article Number:
131. Date of Publication: 01 Dec 2025.
Author
Khairy A.M.; Hafez A.H.; Elshahat A.; Emara A.; Aboueisha H.; Fahmy M.I.;
Abdelaziz A.; Yasseen I.
Institution
(Khairy, Hafez, Yasseen) Cardiology Department, Faculty of Medicine,
Al-Azhar University, Cairo, Egypt
(Khairy, Hafez, Elshahat, Emara, Aboueisha, Fahmy, Abdelaziz) Medical
Research Group of Egypt (MRGE), Cairo, Egypt
(Elshahat, Emara, Abdelaziz) Faculty of Medicine, Al-Azhar University,
Cairo, Egypt
(Aboueisha) Faculty of Medicine, Suez Canal University, Ismailia, Egypt
(Fahmy) Faculty of Medicine, Mansoura University, Mansoura, Egypt
Publisher
BioMed Central Ltd
Abstract
Background: The ideal revascularization approach for ostial left anterior
descending coronary artery (L.A.D.) lesions continues to be a matter of
debate. Two primary stenting strategies are often contemplated for
managing these lesions: focal ostial stenting (F.O.S.) and the provisional
strategy, alternatively termed cross-over stenting (C.O.S.) from the LM to
the L.A.D. artery. Aim(s): Our objective is to assess the efficacy of
C.O.S. vs. F.O.S. techniques in patients with ostial L.A.D. lesions who
underwent percutaneous coronary intervention (P.C.I.). Method(s): We
systematically searched five electronic databases to identify relevant
studies. The data was pooled as odds ratio (O.R.) with its 95% confidence
interval (C.I.) using the DerSimonian-Laird random effect model in STATA
17 MP. Significance was determined by a p-value > 0.05 between
intervention subgroups. Result(s): Nine articles with a total of 1492
patients were included in the meta-analysis. The pooled O.R. for Major
Adverse Cardiovascular Events (MACE) was 0.88 (95% C.I. [0.39, 1.99], P =
0.76), indicating comparable rates between F.O.S. and C.O.S. For all-cause
death, the O.R. was 1.46 (95% C.I. [0.53, 4.02], P = 0.46), with no
significant differences between the compared techniques. Cardiovascular
death showed no preference between treatments (O.R.=0.99, 95% C.I. [0.30,
3.31], P = 0.99), and similarly for myocardial infarction (O.R.=0.74, 95%
C.I. [0.38, 1.44], P = 0.37). Conclusion(s): Our meta-analysis
comparing C.O.S. and F.O.S. for L.A.D. lesions revealed similar efficacy
in clinical and angiographic outcomes. Copyright © The Author(s)
2024.

<42>
Accession Number
2037565578
Title
Contemporary Incidence of Cognitive Impairment or Dementia in Patients
Undergoing Coronary Artery Bypass Grafting: A Systematic Review and
Meta-Analysis.
Source
Dementia and Geriatric Cognitive Disorders. 54(1) (pp 52-66), 2025. Date
of Publication: 01 Feb 2025.
Author
Lo H.Z.; Wee C.F.; Low C.E.; Teo Y.H.; Teo Y.N.; Yun C.Y.; Syn N.L.; Tan
B.Y.Q.; Chai P.; Yeo L.L.L.; Yeo T.-C.; Chong Y.F.; Poh K.-K.; Kong
W.K.F.; Wong R.C.C.; Chan M.Y.; Sia C.-H.
Institution
(Lo) School of Medicine, Faculty of Medicine, Nursing and Health Sciences,
Monash University, Melbourne, VIC, Australia
(Wee, Low, Teo, Teo, Tan, Chai, Yeo, Yeo, Chong, Poh, Kong, Wong, Chan,
Sia) Department of Medicine, Yong Loo Lin School of Medicine,, National
University of Singapore, Singapore, Singapore
(Yun, Chai, Yeo, Poh, Kong, Wong, Chan, Sia) Department of Cardiology,
National University Heart Centre Singapore, Singapore, Singapore
(Syn) Department of Surgery, Yong Loo Lin School of Medicine,, National
University of Singapore, Singapore, Singapore
(Tan, Yeo, Chong) Division of Neurology, Department of Medicine, National
University Hospital, Singapore, Singapore
Publisher
S. Karger AG
Abstract
Introduction: Despite the high prevalence of cognitive impairment or
dementia post-coronary artery bypass grafting (CABG), the incidence of
cognitive impairment or dementia post-CABG in contemporary practice is
currently unclear. Therefore, this paper aims to investigate the incidence
and associated risk factors of cognitive impairment or dementia in
patients' post-CABG. Method(s): A systematic search across three
databases (PubMed, SCOPUS, and Embase) was conducted for studies published
in or after 2013 that reported cognitive impairment or dementia post-CABG.
Subgroup analyses and metaregression by risk factors were performed to
determine their influence on the results. Result(s): This analysis
included 23 studies with a total of 2,620 patients. The incidence of
cognitive impairment or dementia less than 1 month, 2 to 6 months, and
more than 12 months post- CABG was 35.96% (95% confidence interval [CI]:
28.22-44.51, I2 = 87%), 21.33% (95% CI: 13.44-32.15, I2 = 88%), and 39.13%
(95% CI: 21.72-58.84, I2 = 84%), respectively. Meta-regression revealed
that studies with more than 80% of the cohort diagnosed with hypertension
were significantly associated with incidence of cognitive impairment or
dementia less than 1 month post- CABG. Conclusion(s): This
meta-analysis demonstrates a high incidence of cognitive impairment or
dementia in patients' post-CABG in contemporary practice, particularly
less than 1 month post-CABG and more than 12 months post-CABG. We found
that hypertension was a significant risk factor in the short-term (less
than 1 month) follow-up period for cognitive impairment or dementia
post-CABG. Future research should be done to assess strategies to reduce
cognitive impairment post-CABG. Copyright © 2024 The Author(s).

<43>
Accession Number
2037523460
Title
Alterations in the intestinal microbiome and immune dysregulation in
infants with CHD undergoing cardiopulmonary bypass: A scoping review.
Source
Cardiology in the Young. (no pagination), 2025. Date of Publication:
2025.
Author
Prout A.J.; Meert K.L.; Al-Ahmadi M.; Dickson R.P.
Institution
(Prout, Meert) Department of Pediatrics, Central Michigan University,
College of Medicine, Mt. Pleasant, MI, United States
(Prout, Meert) Division of Pediatric Critical Care Medicine, Department of
Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
(Al-Ahmadi) Division of Pediatric Cardiovascular Surgery, Department of
Surgery, Children's Hospital of Michigan, Detroit, MI, United States
(Dickson) Division of Pulmonary and Critical Care Medicine, Department of
Internal Medicine, University of Michigan Medical School, Ann Arbor, MI,
United States
(Dickson) Department of Microbiology and Immunology, University of
Michigan Medical School, Ann Arbor, MI, United States
(Dickson) Weil Institute for Critical Care Research & Innovation, Ann
Arbor, MI, United States
Publisher
Cambridge University Press
Abstract
Background: Infants who require cardiopulmonary bypass for surgical repair
of CHD are at high risk for secondary infections, which cause significant
death and disability. The risk of secondary infection is increased by
immune dysfunction. The intestinal microbiome calibrates immune function.
Infants with CHD have substantial changes in their intestinal microbiome.
We performed this scoping review to describe the current understanding of
the relationship between the intestinal microbiome and immune function
after pediatric cardiac surgery with cardiopulmonary bypass.
 Method(s): We searched the PubMed, Cumulative Index to Nursing and
Allied Health Literature, Cochrane, and Scopus databases with the
assistance of a medical librarian. We included trials that analysed
intestinal microbiome composition and immune function after cardiac
surgery with cardiopulmonary bypass in infants. Result(s): We found
two observational cohorts and two interventional trials describing
composition of intestinal microbiome and some measures of immune function
after heart surgery with cardiopulmonary bypass in infants. A total of 114
children were analysed. Three trials were exclusively in infants, and one
was in older children and infants. All trials found a differential
composition of the intestinal microbiome in infants with CHD compared to
those without CHD, and one described a robust correlation between
composition of the intestinal microbiome with cytokine profile and adverse
outcomes. Conclusion(s): Despite robust preclinical data and data
from other disease states, there is minimal data about the correlation
between immune function and intestinal microbiome composition in infants
with CHD after cardiopulmonary bypass. Copyright © The Author(s),
2025. Published by Cambridge University Press.

<44>
Accession Number
2037560054
Title
Improving atrial fibrillation or flutter detection and management by
smartphone-based photoplethysmography rhythm monitoring following cardiac
surgery: a pragmatic randomized trial.
Source
Europace. 27(2) (no pagination), 2025. Article Number: euaf015. Date of
Publication: 01 Feb 2025.
Author
Gruwez H.; De Melio N.; Vermunicht P.; Van Langenhoven L.; Desteghe L.;
Lamberigts M.; Nuyens D.; Van Herendael H.; Rodrigus I.; Van Kerrebroeck
C.; Vandervoort P.; Heidbuchel H.; Pison L.; Rega F.; Haemers P.
Institution
(Gruwez, Lamberigts, Rega, Haemers) Department of Cardiovascular Sciences,
UZ Leuven, Herestraat 49, Leuven, Belgium
(Gruwez, Nuyens, Van Herendael, Van Kerrebroeck, Vandervoort, Pison)
Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
(Gruwez, De Melio) Limburg Clinical Research Center, Faculty of Medicine
and Life Sciences, Hasselt University, Hasselt, Belgium
(Vermunicht, Desteghe, Rodrigus, Heidbuchel) Department of Cardiology,
Antwerp University Hospital, Antwerp, Belgium
(Van Langenhoven) KU Leuven - University of Leuven, Leuven Biostatistics
and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
Publisher
Oxford University Press
Abstract
Aims Atrial fibrillation (AF) and atrial flutter (AFL) after cardiac
surgery are common and associated with adverse outcomes. The increased
risk related to AF or AFL may extend beyond discharge. This study aims to
determine whether photoplethysmography (PPG)-based smartphone monitoring
to detect AF or AFL after hospital discharge following cardiac surgery
improves AF management. Methods and results The intervention group
performed 1 min rhythm checks three times daily using a smartphone-based
PPG application during 6 weeks after hospitalization for cardiac surgery.
The primary outcome involved AF management interventions by independent
physicians, including initiation of oral anticoagulation (OAC), direct
cardioversion, and up-titration or initiation of antiarrhythmic drugs. The
study included 450 patients [mean (SD) age, 64.1 (9.2) years; 96 women
(21.3%); 130 patients with AF history (28.9%); median (IQR) CHA2DS2-VASc
score, 2 (1-3)], of whom 238 were randomized to PPG-based monitoring and
212 to usual care. AF/AFL was detected with PPG or electrocardiography in
44 patients (18.5%) in the monitoring group and 4 patients (1.9%) in the
usual care group (OR 11.8; 95% CI, 4.2-33.3; P < 0.001); these were new
detections in, respectively, 22 patients (9.2%) and 1 patient (0.5%) (OR
21.3; 95% CI, 2.9-166.7; P = 0.003). AF management interventions occurred
in 24 patients (10.1%) in the monitoring group compared to 5 patients
(2.4%) in the usual care group [odds ratio (OR), 5.1; 95% CI, 1.8-14.4; P
= 0.002]. Conclusion In unselected patients discharged home following
cardiac surgery, PPG-based smartphone monitoring revealed significantly
more AF/AFL which led to significantly more optimization of AF
management. Copyright © The Author(s) 2025. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<45>
Accession Number
2037511583
Title
Outcomes of aortic stenosis in patients with cardiac amyloidosis: A
systematic review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2025. Date of
Publication: 2025.
Author
Ahmad S.; Ahsan M.J.; Newlun M.; Sand M.; Rmilah A.A.; Yousaf A.; Shabbir
M.A.; Malik S.A.; Goldsweig A.M.
Institution
(Ahmad, Shabbir, Malik, Goldsweig) Division of Cardiovascular Medicine,
University of Nebraska Medical Center, Omaha, NE, United States
(Ahsan) Department of Cardiovascular Medicine, Baylor University Medical
Center, Dallas, TX, United States
(Newlun, Sand) Department of Medicine, University of Nebraska Medical
Center, Omaha, NE, United States
(Rmilah) Department of Medicine, Magnolia Regional Health Center, Corinth,
MS, United States
(Yousaf) Department of Medicine, McLaren Flint-Michigan State University,
Flint, MI, United States
(Goldsweig) Department of Cardiovascular Medicine, Baystate Medical Center
and University of Massachusetts-Baystate, Springfield, MA, United States
Publisher
Elsevier Inc.
Abstract
Background: Cardiac amyloidosis (CA) results from the deposition of
abnormally folded protein fibrils, leading to restrictive cardiomyopathy,
valvular heart disease, and arrhythmias. Up to 15 % of patients with
severe aortic stenosis (AS) have concomitant CA (AS-CA). We conducted this
systematic review and meta-analysis to compare medical management,
transcatheter aortic valve replacement (TAVR), and surgical AVR (SAVR) in
AS-CA. Method(s): A comprehensive literature search was conducted for
relevant studies from inception through January 20, 2024. Studies
exploring outcomes in adult AS patients with and without CA receiving
medical therapy, TAVR, or SAVR were included in this analysis.
 Result(s): Fifteen studies including 253,334 patients (AS-CA 6704; AS
alone 246,630) were identified. AS-CA patients had significantly higher
all-cause mortality (RR = 2.60, 95 % CI 1.48-4.57, P = 0.0009) compared to
AS alone. Among patients with AS-CA, TAVR was associated with lower
all-cause mortality compared to both medical therapy (RR = 0.50, 95 % CI
0.29-0.89, P = 0.02) and SAVR (RR = 0.41, 95 % CI 0.22-0.78, P = 0.007).
AS-CA patients undergoing TAVR were more likely to have paradoxical
low-flow, low-gradient AS (RR = 1.56, 95 % CI 1.15-2.12, P = 0.04) at
baseline and had a higher risk of post-TAVR acute kidney injury (RR =
1.95, 95 % CI 1.35-2.80, P = 0.0003) compared to patients undergoing TAVR
for AS alone. There were similar risks of other post-TAVR complications,
including major bleeding, vascular complications, stroke, and new
pacemaker implantation between AS-CA and AS alone. Conclusion(s): CA
is associated with a higher mortality in patients with severe AS. In
patients with concomitant AS and CA, TAVR is safe and associated with
better survival than medical therapy or SAVR. Social media abstract:
#Meta-Analysis: Cardiac amyloidosis is associated with increased mortality
in severe AS. #TAVR is safe in amyloidosis & improves survival more than
medical therapy or SAVR. Copyright © 2025 Elsevier Inc.

<46>
Accession Number
2037515516
Title
Effect of Enhanced Recovery After Surgery (ERAS) Programs on Perioperative
Outcomes in Patients Undergoing Cardiac Surgery: A Systematic Review and
Meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Diz-Ferreira E.; Diaz-Vidal P.; Fernandez-Vazquez U.; Gil-Casado C.;
Luna-Rojas P.; Diz J.C.
Institution
(Diz-Ferreira) Well-Move Research Group, University of Vigo, School of
Medicine, University of Santiago de Compostela, Spain
(Diaz-Vidal, Fernandez-Vazquez, Gil-Casado, Luna-Rojas) School of
Medicine, University of Santiago de Compostela, Spain
(Diz) Department of Anesthesia and Postoperative Critical Care, Hospital
Alvaro Cunqueiro, Vigo, Department of Functional Biology and Health
Sciences, Well-Move Research Group, University of Vigo, Spain
Publisher
W.B. Saunders
Abstract
Background: Enhanced recovery after surgery (ERAS) programs emerged as a
strategy to reduce perioperative morbidity; however, there is currently
limited evidence of their clinical efficacy. The objective of this study
was to assess the impact of ERAS programs in cardiac surgery on hospital
length of stay, mortality, atrial fibrillation, and quality of life.
 Method(s): A systematic review and meta-analysis were conducted in
accordance with the Preferred Reporting Items for Systematic reviews and
Meta-Analyses statement, encompassing studies on ERAS programs in adult
patients undergoing elective cardiac surgery. The effect size and 95%
confidence interval (CI) were estimated with a random-effects model. The
protocol was preregistered on Open Science Framework. Result(s):
Eighteen studies (published between 2016 and 2023) comprising 4,469
patients were included in the analysis, of which only one was a randomized
controlled trial. The implementation of ERAS was associated with a
reduction in hospital stay of 1.24 days (95% CI: -1.67, -0.82, p < 0.001,
I2 = 83%). No differences were observed between the groups in
mortality (odds ratio: 0.65, 95% CI: 0.28, 1.48, p = 0.3, I2 =
0%), nor in the incidence of atrial fibrillation (odds ratio: 0.77, 95%
CI: 0.57, 1.03, p = 0.08, I2 = 17%). A meta-analysis of quality
of life was not feasible due to a lack of sufficient data.
 Conclusion(s): Although ERAS programs were associated with a
reduction in hospital stay and no differences in mortality or atrial
fibrillation, the quality of the evidence was very low. To recommend the
implementation of ERAS programs in cardiac surgery, it is necessary to
have randomized studies providing evidence of its efficacy, and studies
including quality of life and other patient-centered recovery criteria
outcomes. Copyright © 2025 Elsevier Inc.

<47>
Accession Number
2037110178
Title
Preoperative anxiety and its impact on surgical outcomes: A systematic
review and meta-analysis.
Source
Journal of Clinical and Translational Science. 9(1) (no pagination), 2025.
Article Number: e33. Date of Publication: 17 Jan 2025.
Author
Shebl M.A.; Toraih E.; Shebl M.; Tolba A.M.; Ahmed P.; Banga H.S.; Orz M.;
Tammam M.; Saadalla K.; Elsayed M.; Kamal M.; Abdulla M.; Eldessouky A.I.;
Moustafa Y.T.; Mohamed O.A.; Aiash H.
Institution
(Shebl, Saadalla, Mohamed) Faculty of Medicine, Cairo University, Kasr
Al-Ainy, Cairo, Egypt
(Toraih) Tulane University, School of Medicine, New Orleans, LA, United
States
(Toraih, Kamal, Eldessouky, Aiash) Faculty of Medicine, Suez Canal
University, Ismailia, Egypt
(Toraih, Banga, Aiash) Upstate Medical University, Syracuse, United States
(Shebl) Faculty of Medicine, Modern University for Technology and
Information, Cairo, Egypt
(Tolba, Orz, Tammam, Abdulla, Moustafa) Faculty of Medicine, Alexandria
University, Alexandria, Egypt
(Ahmed) Virginia Commonwealth University, Richmond, United States
(Elsayed) Dnipropetrovsk Medical Institute of Conventional and Alternative
Medicine, Dnipropetrovsk, Ukraine
Publisher
Cambridge University Press
Abstract
Background: Preoperative anxiety is a common phenomenon affecting 60-80%
of surgical patients, with potential implications for surgical outcomes.
Despite its prevalence, there remains a lack of consensus on its precise
effects and optimal management strategies. Objective(s): This
meta-analysis aimed to synthesize current evidence on the impact of
preoperative anxiety on various surgical outcomes, including anesthetic
and analgesic requirements, delirium, recovery times, and pain.
 Method(s): We conducted a comprehensive literature search and
meta-analysis of studies examining the relationship between preoperative
anxiety and surgical outcomes. Standardized mean differences (SMD),
correlation (COR), and odds ratios (OR) with 95% confidence intervals were
calculated. Result(s): Our analysis revealed significant associations
between preoperative anxiety and increased anesthetic requirements (SMD =
0.67, 95% CI: 0.32-1.01) and analgesic requirements (SMD = 0.89, 95% CI:
0.65-1.12). Preoperative anxiety was associated with postoperative
delirium in adults (OR = 1.90, 95% CI: 1.11-3.26), unlike the pediatric
population. Preoperative anxiety was associated with prolonged time to
reach Modified Aldrete Score of 9 (SMD = 0.79, 95% CI: 0.50-1.07) and
extubation time (SMD = 0.89, 95% CI: 0.58-1.21). Preoperative anxiety was
positively correlated with propofol consumption (STAI-S COR = 0.35, 95%CI:
0.15-0.55). No significant association between preoperative anxiety and
postoperative pain was found. Conclusion(s): This meta-analysis
provides evidence for the wide-ranging effects of preoperative anxiety on
surgical outcomes. The findings emphasize the need for routine
preoperative anxiety screening and the development of targeted
interventions. Future research should focus on long-term impacts and the
effectiveness of various anxiety management strategies. Copyright
© The Author(s), 2025.

<48>
Accession Number
2033259545
Title
The association of right ventricular function with outcomes after cardiac
surgery: a systematic review.
Source
Canadian Journal of Anesthesia. (no pagination), 2025. Article Number:
n71. Date of Publication: 2025.
Author
Alavi N.; Van Klei W.; Agyei K.; Zabida A.; Abraha M.; Salvatori M.;
Mashari A.; Bartoszko J.
Institution
(Alavi, Van Klei, Zabida, Salvatori, Mashari, Bartoszko) Department of
Anesthesia and Pain Management, Sinai Health System, Women's College
Hospital, University Health Network, Toronto, ON, Canada
(Alavi, Van Klei, Bartoszko) Institute of Medical Science, University of
Toronto, Temerty Faculty of Medicine, University of Toronto, Toronto, ON,
Canada
(Van Klei, Salvatori, Mashari, Bartoszko) Department of Anesthesiology &
Pain Medicine, University of Toronto, Toronto, ON, Canada
(Van Klei, Bartoszko) Peter Munk Cardiac Centre, University Health
Network, Toronto, ON, Canada
(Van Klei, Agyei, Abraha, Bartoszko) Temerty Faculty of Medicine,
University of Toronto, Toronto, ON, Canada
(Van Klei) Division of Anesthesiology, Intensive Care and Emergency
Medicine, University Medical Center Utrecht, Utrecht, Netherlands
(Bartoszko) Department of Anaesthesia and Pain Management, Toronto General
Hospital, 200 Elizabeth Street, 3EN-464, Toronto, ON, Canada
Publisher
Springer
Abstract
Purpose: Assessment of right ventricular (RV) function is recommended as
part of a comprehensive echocardiography exam, including before and after
cardiac surgery. Nevertheless, the prognostic implications of various
measures of RV function in patients undergoing cardiac surgery are not
well characterized. Our goal was to conduct a focused systematic review to
assess the association of quantitative parameters of RV function with
postoperative outcomes in patients undergoing cardiac surgery.
 Method(s): We conducted a systematic review of randomized controlled
trials or observational studies in adult (>= 18 yr) patients undergoing
cardiac surgery with a reported echocardiogram within six months of
surgery, intraoperatively, or shortly after surgery. We excluded case
reports and case series. Databases included PubMed and MEDLINE, and papers
published from 1 January 1990 to 22 April 2024 were searched for. The
primary predictors of interest were quantitative RV function parameters.
The primary outcome of interest was postoperative mortality up to five
years. The secondary outcome was all major adverse cardiac events (MACE).
 Result(s): We identified 7,187 potentially relevant studies, 27 of
which were included; all of these were observational studies. Right
ventricular fractional area change (RVFAC) was the most commonly reported
parameter, but was inconsistently associated with mortality and MACE.
Tricuspid annular plane systolic excursion (TAPSE) and strain were
consistently associated with mortality. The most consistent predictor of
MACE was RV myocardial performance index (MPI) across studies.
 Conclusion(s): Pre- and perioperative assessment of RV function using
at least two quantitative echocardiographic parameters may offer
prognostic information in patients undergoing cardiac surgery. Right
ventricular FAC, TAPSE, strain, and RV MPI have been frequently studied;
however, further research is needed to delineate the role of
echocardiographic RV quantification for perioperative prognostication.
Study registration: PROSPERO (CRD42023387383); first submitted 23 December
2022. Copyright © Canadian Anesthesiologists' Society 2025.

<49>
Accession Number
2037541325
Title
Monitoring Hemostatic Function during Cardiac Surgery with Point-of-Care
Viscoelastic Assays: A Narrative Review.
Source
Seminars in Thrombosis and Hemostasis. (no pagination), 2025. Date of
Publication: 2025.
Author
Ong B.J.A.; See Tow H.X.; Fong A.T.W.; Ling R.R.; Shekar K.; Teoh K.; Ti
L.K.; Maclaren G.; Fan B.E.; Ramanathan K.
Institution
(Ong, See Tow, Fong, Ling, Teoh, Ti, Maclaren, Fan, Ramanathan) Yong Loo
Lin School of Medicine, National University of Singapore, National
University Health System, Singapore, Singapore
(Ling) Australia and New Zealand Intensive Care Research Centre, School of
Preventive Medicine and Public Health, Monash University, Melbourne, VIC,
Australia
(Ling, Ti) Department of Anaesthesia, National University Hospital,
National University Health System, Singapore, Singapore
(Shekar) Intensive Care Unit, Caboolture Hospital, Brisbane, QLD,
Australia
(Shekar) Adult Intensive Care Services, The Prince Charles Hospital,
Brisbane, QLD, Australia
(Shekar) Faculty of Health Sciences & Medicine, Bond University, Gold
Coast, QLD, Australia
(Shekar) Faculty of Health, Queensland University of Technology,
University of Queensland, Brisbane, QLD, Australia
(Teoh) Faculty of Medicine, University of Queensland, Brisbane, QLD,
Australia
(Teoh) Division of Adult Cardiac Surgery, Department of Cardiac, Thoracic
and Vascular Surgery, National University Heart Centre, National
University Health System, Singapore, Singapore
(Maclaren, Ramanathan) Cardiothoracic Intensive Care Unit, Department of
Cardiac, Thoracic and Vascular Surgery, National University Heart Centre,
National University Health System, Singapore, Singapore
(Fan) Lee Kong Chian School of Medicine, Nanyang Technological University,
Singapore, Singapore
(Fan) Department of Hematology, Tan Tock Seng Hospital, Singapore,
Singapore
Publisher
Thieme Medical Publishers, Inc.
Abstract
Bleeding is a well-known and severe complication of cardiac surgery.
Cardiopulmonary bypass, along with heparinization and hemodilution, is
thought to affect all pathways of the hemostatic process, leading to
excessive bleeding and worsened morbidity and mortality. The traditionally
used standard laboratory tests (SLTs) were not designed for the surgical
setting, have long turnaround times, and are poor predictors of bleeding.
This review aims to give an overview of viscoelastic assays (VEAs),
compare VEAs to conventional testing methods, and summarize the evidence
for VEAs in cardiac surgery. A search of Medline via Pubmed, Scopus, and
Embase yielded 2,868 papers, which we reviewed and summarized the key
findings. VEAs such as rotational thromboelastometry and
thromboelastography provide a quick turnaround, graphical, global
impression of hemostasis in whole blood. VEAs allow for the analysis of
specific contributors to the coagulation process and may facilitate
cause-oriented hemostatic treatment and the development of treatment
algorithms. VEAs have been found to have a high specificity and high
negative predictive value for coagulopathic bleeding. Patients treated
with VEA-based algorithms have been shown to have lower rates of bleeding,
transfusion requirements, and exposure to allogeneic blood products.
However, VEA-based algorithms have not demonstrated a mortality benefit
and evidence for outcomes such as surgical re-exploration and hospital
length of stay remains equivocal. In conclusion, VEAs have been shown to
be comparable if not superior to SLTs in cardiac surgery. Further
large-scale studies are needed to better evaluate the impact of VEAs on
clinical outcomes. Copyright © 2025. Thieme. All rights reserved.

<50>
Accession Number
2037606155
Title
Clinical and hemodynamic outcomes of self-expanding and balloon-expandable
valves for valve-in-valve transcatheter aortic valve implantation
(ViV-TAVI): An updated systematic review and meta-analysis.
Source
IJC Heart and Vasculature. 57 (no pagination), 2025. Article Number:
101627. Date of Publication: 01 Apr 2025.
Author
Yasmin F.; Moeed A.; Iqbal K.; Ali A.; Kumar A.; Basit J.; Hamza M.; Dani
S.S.; Kalra A.
Institution
(Yasmin) Yale University School of Medicine, New Haven, CT, United States
(Moeed, Iqbal, Ali) Dow Medical College, Dow University of Health
Sciences, Karachi, Pakistan
(Kumar) Cleveland Clinic Akron General, Akron General Avenue, Akron Ohio,
OH, United States
(Basit) Rawalpindi Medical College, Rawalpindi, Karachi, Pakistan
(Hamza) Guthrie Medical Group, Cortland, NY, United States
(Dani) Department of Cardiology, Beth Israel Lahey Health, Burlington, MA,
United States
(Kalra) Franciscan Health, Lafayette, IN, United States
(Kalra) Krannert Cardiovascular Research Center, Indiana University School
of Medicine, Indianapolis, IN, United States
Publisher
Elsevier Ireland Ltd
Abstract
Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) has
emerged as a feasible alternative to reoperative surgery in patients with
degenerated surgical bio-prosthesis. However, data regarding the choice of
valve type in ViV-TAVI remain inconclusive. This meta-analysis compares
the procedural and clinical outcomes of self-expanding (SE) vs.
balloon-expandable (BE) valves in ViV-TAVI. MEDLINE and Scopus were
queried to identify studies reporting outcomes of ViV-TAVI by SE/BE valve
type or comparing outcomes between SE or BE valves for ViV-TAVI. The
primary outcome was incidence of all-cause mortality at 30 days. Data were
presented as incidence of outcomes, analyzed via random effects model
using inverse variance method with 95 % confidence intervals. Further
incidence rates of primary and secondary outcomes were presented as
subgroups of BE and SE, with comparison in incidence rates between the
subgroups made using p-interaction of proportions. 27 studies with 13,182
patients (SE: 7346; BE: 5836) were included. There were no significant
differences between the BE vs. SE valves in 30-day mortality (BE 4 % vs.
SE 3 %, p = 0.44), 1-year mortality (BE 12 % vs. SE 10 %, p = 0.60), and
moderate-to-severe AR at 1 year (BE 1 % vs. SE 3 %, p = 0.36). However,
patients with SE valves had higher rates of new permanent pacemaker
insertion (BE 4 % vs. SE 9 %, p = 0.0019). There were no significant
differences in the incidence of 30-day safety outcomes, including stroke,
AKI, coronary obstruction, major bleeding, and major vascular
complications. Both BE and SE valve types showed comparable mortality and
safety outcomes in ViV-TAVI, except pacemaker insertion, which was higher
in SE compared with BE valves. Copyright © 2025 The Authors

<51>
Accession Number
2037559938
Title
Minimally invasive lung surgery with an intraoperative completely or
partially tubeless protocol: randomized clinical trial.
Source
BJS Open. 9(1) (no pagination), 2025. Article Number: zrae132. Date of
Publication: 01 Feb 2025.
Author
Zhao Y.; Shan L.; Zhang W.; Li P.; Li N.; Zhang H.; Peng C.; Cong B.; Zhao
X.
Institution
(Zhao, Shan, Zhang, Li, Li, Zhang, Peng, Cong, Zhao) Department of
Thoracic Surgery, The Second Hospital of Shandong University, Shandong
Province, Jinan, China
Publisher
Oxford University Press
Abstract
Background: Thoracic surgery is an invasive procedure and there has been a
move towards minimally invasive approaches. This includes video-assisted
thoracoscopic surgery. Non-intubated video-assisted thoracoscopic surgery
without endotracheal intubation has been developed with a view to avoiding
complications associated with intubation including tracheal injury, vocal
cord injury and lung impairment due to mechanical ventilation. This study
aims to compare outcomes from non-intubated 'completely tubeless' versus
intubated 'partially tubeless' minimally invasive thoracic surgery.
 Method(s): A single-institution, prospective randomized clinical
trial was conducted comparing patients who underwent minimally invasive
lung completely tubeless versus partially tubeless surgery, both with
enhanced recovery. The primary outcome was the short-term postoperative
complication rate. Binary logistic regression analysis was performed to
determine the significant predictors of severe mediastinal shift and
receiver operating characteristic (ROC) curve plots were drawn.
 Result(s): Among the 348 patients, 174 patients were assigned to the
completely tubeless group and 174 patients were assigned to the partially
tubeless group. There was no difference in postoperative complications
including pulmonary complications, supraventricular arrhythmia, acute
myocardial infarction, acute cerebral stroke, venous thromboembolism and
urinary retention. The completely tubeless protocol was associated with a
higher proportion of early mobilization (66.7% versus 55.7%, P = 0.047), a
shorter median duration of drainage (1.0 versus 2.0 days, P = 0.002), and
a shorter median duration of postoperative hospital stay (2.0 versus 3.0
days, P = 0.001). The completely tubeless group had less of a difference
in white blood cell count before and after the operation (P = 0.042).
Binary logistic regression analysis revealed that weight was a significant
predictor of mediastinal shift in the completely tubeless group.
 Conclusion(s): Under enhanced recovery after surgery protocols, there
is no difference in postoperative complications in patients undergoing
completely or partially tubeless surgery. However, patients having
completely tubeless surgery have shorter durations of postoperative
drainage, shorter durations of hospital stay, milder systemic inflammatory
reactions, and better immune protection than patients who undergo lung
resection with a partially tubeless protocol. The severity of mediastinal
shift may be mainly related to body-weight. Copyright © The
Author(s) 2025. Published by Oxford University Press on behalf of BJS
Foundation Ltd.

<52>
Accession Number
2037387635
Title
Characterizing pre-discharge interventions to reduce length of stay for
older adults: A scoping review.
Source
PLoS ONE. 20(2 February) (no pagination), 2025. Article Number: e0318233.
Date of Publication: 01 Feb 2025.
Author
Garcia E.; Hass Z.J.
Institution
(Garcia, Hass) School of Industrial Engineering, Purdue University, West
Lafayette, IN, United States
(Garcia, Hass) Regenstrief Center for Healthcare Engineering, Purdue
University, West Lafayette, IN, United States
(Hass) School of Nursing, Purdue University, West Lafayette, IN, United
States
Publisher
Public Library of Science
Abstract
Background Hospital pre-discharge interventions are becoming one of the
leading strategies to promote early discharge. For older adult patients,
it remains unclear what these interventions are and how they affect
discharge outcomes. Objective This scoping review categorizes
pre-discharge interventions promoting early acute care hospital
discharging or total hospital length of stay reductions among older
adults, synthesizes contextual factors (e.g., cost, staffing) driving
implementation, and assesses the perceived intervention's impact. Design
The review followed the five states of the Arksey and O'Malley framework
and the PRISMA-ScR extension. The PubMed, Embase, and Scopus databases
were searched from 1983 to 2020 for pre-discharge interventions designed
or adapted to discharge older adults earlier in their stay from acute care
hospitals. Potentially relevant articles were screened against eligibility
criteria. Findings were extracted and collated in data charting forms
followed by brief thematic analyses. Results The search yielded 5,455
articles of which 91 articles were included. Eight pre-discharge
intervention categories were identified: clinical management,
diagnostic/risk assessment tools, staffing enhancements, drug
administration, length of stay protocols, nutrition planning, and
communication improvements. Leading motivations for intervention
implementation included the nationwide drive to reduce care costs and
hospitals' need to increase hospital profitability, improve quality of
care, or optimize resource utilization. Discharge outcomes reported
included hospitalization costs, readmission rates, mortality rates,
resource utilization rates and costs, and length of stay. Mixed results
were found regarding the effectiveness of early discharge interventions on
discharge outcomes based on expressed author sentiment. Conclusions The
drive for pre-discharge interventions that reduce older adult hospital
stays and associated costs continues to stem primarily from economic and
governmental policies. Follow-up studies may be required to emphasize
patient perspectives and care trajectories to avoid unintentional costly
and health-deteriorating consequences. Copyright © 2025 Garcia,
Hass. 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.

<53>
Accession Number
2037534866
Title
Comparison of strategies for vascular ACCESS closure after Transcatheter
Aortic Valve Implantation: the ACCESS-TAVI randomized trial.
Source
European Heart Journal. 46(7) (pp 635-645), 2025. Date of Publication: 14
Feb 2025.
Author
Rheude T.; Ruge H.; Altaner N.; Pellegrini C.; Covarrubias H.A.; Mayr P.;
Cassese S.; Kufner S.; Taniguchi Y.; Thilo C.; Klos M.; Erlebach M.;
Schneider S.; Jurisic M.; Laugwitz K.-L.; Lange R.; Schunkert H.; Kastrati
A.; Krane M.; Xhepa E.; Joner M.
Institution
(Rheude, Altaner, Pellegrini, Covarrubias, Cassese, Kufner, Taniguchi,
Jurisic, Schunkert, Kastrati, Xhepa, Joner) Department of Cardiovascular
Diseases, German Heart Center Munich, Technical University Munich
University Hospital, Lazarettstrasse 36, Munich, Germany
(Ruge, Erlebach, Lange, Krane) Department of Cardiovascular Surgery,
Institute Insure, German Heart Center Munich, School of Medicine & Health,
Technical University of Munich, Lazarettstrasse 36, Munich, Germany
(Covarrubias) Hospital de Cardiologia, Centro Medico Nacional Siglo XXI,
IMSS, Ciudad de Mexico, Mexico
(Mayr) Institute of Anaesthesiology, German Heart Center Munich, Technical
University Munich University Hospital, Munich, Germany
(Kufner, Laugwitz, Schunkert, Kastrati, Krane, Joner) DZHK (German Center
for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich,
Germany
(Thilo) Department of Internal Medicine I, RoMed Klinikum Rosenheim,
Rosenheim, Germany
(Klos) Medicum Tegernsee, Rottach-Weissach, Germany
(Schneider) Department of Cardiology, Benedictus Krankenhaus Tutzing,
Tutzing, Germany
(Laugwitz) Department of Internal Medicine I, Technical University Munich
University Hospital, Munich, Germany
Publisher
Oxford University Press
Abstract
Background and Data from randomized trials investigating different access
closure strategies after transfemoral transcatheter aortic valve Aims
implantation (TF-TAVI) remain scarce. In this study, two vascular closure
device (VCD) strategies to achieve haemostasis after TF-TAVI were
compared. Methods The ACCESS-TAVI (Comparison of Strategies for Vascular
ACCESS Closure after Transcatheter Aortic Valve Implantation) is a
prospective, multicentre trial in which patients undergoing TF-TAVI were
randomly assigned to a strategy with a combined suture-/plug-based VCD
strategy (suture/plug group) using one ProGlideTM/ProStyleTM (Abbott
Vascular) and one Angio-Seal (Terumo) vs. a suture-based VCD strategy
(suture-only group) using two ProGlidesTM/ProStylesTM. The primary
endpoint was a composite of major or minor access site-related vascular
complications during index hospitalization according to Valve Academic
Research Consortium 3 criteria. Key secondary endpoints included time to
haemostasis, bleeding type >= 2, and all-cause mortality over 30 days.
Results Between September 2022 and April 2024, 454 patients were
randomized. The primary endpoint occurred in 27% (62/230) in the
suture/plug group and 54% (121/224) in the suture-only group [relative
risk .55 (95% confidence interval: .44, .68); P < .001]. Time to
haemostasis was significantly shorter in the suture/plug group compared
with the suture-only group (108 +/- 208 s vs. 206 +/- 171 s; P < .001). At
30 days, bleeding type >= 2 occurred less often in the suture/plug group
compared with the suture-only group [6.2% vs. 12.1%, relative risk .66
(.43, 1.02); P = .032], with no significant difference in mortality.
Conclusions With regard to the composite of major or minor access
site-related vascular complications, a combined suture-/plug-based VCD
strategy was superior to a suture-based VCD strategy for vascular access
closure in patients undergoing TF-TAVI. Copyright © The Author(s)
2024. Published by Oxford University Press on behalf of the European
Society of Cardiology. All rights reserved.

<54>
Accession Number
2037534875
Title
Plugging the gap: vascular access closure after transfemoral transcatheter
aortic valve implantation.
Source
European Heart Journal. 46(7) (pp 646-648), 2025. Date of Publication: 14
Feb 2025.
Author
Ang D.T.Y.; Mitchell Lindsay M.
Institution
(Ang, Mitchell Lindsay) Department of Cardiology, Golden Jubilee National
Hospital, Agamemnon St, Clydebank, United Kingdom
Publisher
Oxford University Press

<55>
Accession Number
2037564994
Title
Effects of high-intensity interval training versus moderate-intensity
continuous training on cardiorespiratory and exercise capacity in patients
with coronary artery disease: A systematic review and meta-analysis.
Source
PLoS ONE. 20(2 February) (no pagination), 2025. Article Number: e0314134.
Date of Publication: 01 Feb 2025.
Author
Gao C.; Yue Y.; Wu D.; Zhang J.; Zhu S.
Institution
(Gao, Zhang, Zhu) Chengdu University of Traditional Chinese Medicine,
School of Nursing Chengdu, Sichuan, Chengdu, China
(Yue, Wu) Chengdu Fourth People's Hospital, Sichuan, Chengdu, China
Publisher
Public Library of Science
Abstract
Background With the increasing utilization of cardiac rehabilitation in
clinical treatment and prognosis for patients with cardiovascular
diseases, exercise training has become a crucial component. High-intensity
interval training (HIIT) and moderate-intensity continuous training (MICT)
are commonly employed in rehabilitating patients with cardiovascular
diseases. However, further investigation is required to determine whether
HIIT and MICT can effectively enhance the prognosis of patients with
coronary artery disease. Therefore, this study aims to assess the
effectiveness of HIIT and MICT interventions, optimal intervention
duration for different intensity levels of training, as well as effective
training modalities that improve cardiorespiratory function and exercise
capacity among patients. Methods We conducted a comprehensive search of
the Cochrane Library, PubMed, EMbase, Web of Science, and CINAHL databases
for randomized controlled trials (RCTs) pertaining to high-intensity
interval training (HIIT) and moderate-intensity continuous training (MICT)
interventions in patients with coronary artery disease from inception
until publication on September 26, 2024. Two independent researchers
assessed articles that met the inclusion criteria and analyzed the results
using Sata 17.0 software. Forest plots were employed to evaluate the
impact of HIIT and MICT on outcome indicators. Sensitivity analysis and
funnel plot assessment were performed to examine publication bias.
Subgroup analysis was conducted to determine optimal intervention duration
and training methods. Results A total of 22 studies with 1364 patients
were included in the study, including the HIIT group (n = 685) and the
MICT group (n = 679). The results showed that compared to MICT, HIIT
significantly increased PeakVO<inf>2</inf>(Peak oxygen uptake)[WMD =
1.42mL /kg/min 95%CI (0.87, 1.98), P = 0.870, I2 = 0%],
6MWT(6-minute walk test)[WMD = 18.60m 95%CI (2.29, 34.92), P = 0.789,
I2 = 0%], PHR(Peak heart rate)[WMD = 4.21bpm 95%CI (1.07,
7.36), P = 0.865, I2 = 0%], DBP(diastolic blood pressure)[WMD =
3.43mmHg 95%CI (1.09, 5.76), P = 0.004, I2 = 60.2%]. However,
in LVEF(left- ventricular ejection fraction)[WMD = 0.32mL 95%CI (-1.83,
2.46), P = 0.699, I2 = 0%], LVEDV(left ventricular
end-diastolic volume)[WMD = 0.91 ml 95%CI (-1.83, 2.46), P = 0.995,
I2 = 0%] and SBP(systolic blood pressure)[WMD = 1.85mmHg 95%CI
(-0.23, 3.93),P = 0.266, I2 = 18.2%], there was no significant
difference between HIIT and MICT. Conclusion Based on the findings of this
systematic review, HIIT demonstrates superior efficacy compared to MICT in
enhancing PeakVO<inf>2</inf>, PHR, 6MWT and DBP. However, no significant
differences were observed in LVEF, LVEDV, and SBP. In summary, HIIT
exhibits potential for improving cardiopulmonary function and exercise
capacity among patients with coronary artery disease. Copyright ©
2025 Gao 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.

<56>
Accession Number
2037585172
Title
Transcatheter vs Surgical Aortic Valve Replacement in Lower-Risk Patients:
An Updated Meta-Analysis of Randomized Controlled Trials.
Source
Journal of the American College of Cardiology. 85(9) (pp 926-940), 2025.
Date of Publication: 11 Mar 2025.
Author
Reddy R.K.; Howard J.P.; Mack M.J.; Reardon M.J.; Jorgensen T.H.; Horsted
Thyregod H.G.; Toff W.D.; Van Mieghem N.M.; Vora A.N.; Makkar R.R.;
Kapadia S.; Forrest J.K.; Leon M.B.; Ahmad Y.
Institution
(Reddy, Howard) National Heart and Lung Institute, Imperial College
London, London, United Kingdom
(Reddy) Nuffield Department of Population Health, University of Oxford,
Oxford, United Kingdom
(Mack) Department of Cardiovascular Disease, Baylor Scott and White
Health, Plano, TX, United States
(Reardon) Houston Methodist DeBakey Heart and Vascular Center, Houston,
TX, United States
(Jorgensen, Horsted Thyregod) The Heart Centre, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
(Toff) Department of Cardiovascular Sciences, University of Leicester and
NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester,
United Kingdom
(Van Mieghem) Department of Interventional Cardiology, Thoraxcenter,
Erasmus University Medical Center, Rotterdam, Netherlands
(Vora, Forrest) Section of Cardiovascular Medicine, Yale University School
of Medicine, New Haven, CT, United States
(Makkar) Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Leon) Division of Cardiology, Columbia University Irving Medical Center,
NewYork-Presbyterian Hospital, New York, NY, United States
(Leon) The Cardiovascular Research Foundation, New York, NY, United States
(Ahmad) Division of Cardiology, University of California, San Francisco,
San Francisco, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: Longer-term outcomes are especially important for lower-risk
patients with severe aortic stenosis undergoing transcatheter aortic valve
replacement (TAVR) or surgical aortic valve replacement (SAVR). Additional
randomized data comparing TAVR and SAVR have recently become available.
 Objective(s): The purpose of this study was to perform an updated
systematic review with conventional pairwise meta-analyses and pooled
survival analyses using reconstructed time-to-event individual participant
data (IPD) including the totality of randomized evidence comparing
longer-term clinical outcomes after TAVR and SAVR in lower-risk patients.
 Method(s): The prespecified primary endpoint was all-cause death. Key
secondary endpoints included stroke and the composite of death or
disabling stroke. Cox proportional hazards frailty regression and
restricted mean survival time models were fitted using reconstructed
time-to-event IPD. In sensitivity analyses, proportional odds models were
fitted with frailty terms. Conventional pairwise meta-analyses were
performed under random and fixed effects assumptions. Result(s): Six
trials enrolling 5,341 lower-risk patients were included with 2,717
randomized to TAVR and 2,624 randomized to SAVR (weighted mean follow-up
of 35.7 months). At 5 years in the pooled survival analyses of
reconstructed time-to-event IPD, TAVR was associated with a 20% reduction
in the hazard of all-cause death (HR: 0.80; 95% CI: 0.66-0.97; P = 0.02)
and a 19% reduction in the hazard of all-cause death or disabling stroke
(HR: 0.81; 95% CI: 0.68-0.96; P = 0.01) compared with SAVR. There was no
difference in stroke (HR: 0.97; 95% CI: 0.74-1.26; P = 0.80).
 Conclusion(s): In lower-risk patients, TAVR was associated with a
reduced hazard of death and death or disabling stroke compared with SAVR,
while rates of stroke were equivalent. Most patients have not yet
undergone 5-year follow-up, and so these findings may change as further
longer-term data become available. The present data are informative for
lower-risk patients and treating clinicians, but further randomized trials
and longer-term follow-up are required, particularly in younger
patients. Copyright © 2025 American College of Cardiology
Foundation

<57>
[Use Link to view the full text]
Accession Number
646115897
Title
Comparison of thoracoscopic-guided intercostal nerve block and
ultrasound-guided intercostal nerve block in postoperative analgesia of
uniportal video-assisted lobectomy: a pilot randomized controlled trial.
Source
International journal of surgery (London, England). 111(2) (pp 1995-2001),
2025. Date of Publication: 01 Feb 2025.
Author
Li Y.; Wei L.; Du J.-H.; He J.-X.; Xu X.; Hu L.-H.
Institution
(Li, Wei, Du, Xu, Hu) Department of Anesthesiology
(He) Department of Thoracic Surgery, affiliated Lihuili Hospital of Ningbo
University, Ningbo, China
Abstract
BACKGROUND: Ultrasound-guided intercostal nerve block (UINB) and
thoracoscopic-guided intercostal nerve block (TINB) are often used for
analgesia after thoracic surgery. Herein, we compared the application of
TINB and UINB for analgesia after uniportal video-assisted lobectomy.
 METHOD(S): Sixty patients were randomly allocated into two groups:
UINB and TINB. The surgical time of intercostal nerve block (INB), the
success rate of the first needle, visual analog scale (VAS) scores, the
time of the first patient-controlled intravenous analgesia (PCIA) press,
the time for removing the thoracic drainage tube, consumption of
sufentanil and the number of PCIA presses within 24 hours postoperatively,
and adverse reactions (ARs) were compared between the two groups.
 RESULT(S): The surgical time of INB was significantly shorter in the
TINB group than in the UINB group ( P < 0.001). The time of the first
press of PCIA was significantly earlier in the TINB group than in the UINB
group ( P < 0.001). The success rate of the first needle was significantly
higher in the TINB group than in the UINB group ( P < 0.001). No
significant differences were observed between the two groups regarding VAS
scores, time for removing the thoracic drainage tube, the consumption of
sufentanil, the number of PCIA presses within 24 hours postoperatively,
and ARs. CONCLUSION(S): TINB and UINB have similar analgesic effects
after uniportal video-assisted lobectomy. However, TINB demonstrates
shorter surgical time and a higher success rate than UINB. Copyright
© 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

<58>
Accession Number
2037427144
Title
Characterization of ischemic etiology in heart failure with reduced
ejection fraction randomized clinical trials: A systematic review and
meta-analysis.
Source
European Journal of Internal Medicine. (no pagination), 2025. Date of
Publication: 2025.
Author
Canepa M.; Anastasia G.; Ameri P.; Vergallo R.; O'Connor C.M.; Sinagra G.;
Porto I.
Institution
(Canepa, Anastasia, Ameri, Vergallo, Porto) Cardiovascular Unit,
Department of Internal Medicine, University of Genova, Italy
(Canepa, Ameri, Vergallo, Porto) Cardiovascular Unit, IRCCS Ospedale
Policlinico San Martino, Genoa, Italy
(O'Connor) Inova Heart and Vascular Institute, Falls Church, VA, United
States
(O'Connor) Division of Cardiology, Duke University Medical Center, Durham,
NC, United States
(Sinagra) Cardiovascular Department, Azienda Sanitaria Universitaria
Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
Publisher
Elsevier B.V.
Abstract
Aims: We investigated how ischemic etiology has been assigned in heart
failure with a reduced ejection fraction (HFrEF) randomized controlled
trials (RCTs). Methods and Results: We performed a systematic review
and meta-analysis of definitions, rates of ischemic etiology and of each
ischemic definition component: i) coronary artery disease (CAD), ii)
myocardial infarction (MI), iii) coronary revascularization, and iv)
prior/current angina. A total of 145 HFrEF RCTs were selected, of which
133 (91.7 %) enrolling both ischemic and non-ischemic patients (629
patients/study on average, median age 64.8 years and ejection fraction
28.2 %). The majority of these RCTs (84.2 %) lacked of clear ischemic
etiology definition. Rate of ischemic etiology was 57.8 % (122 RCTs,
169,855 patients), of CAD 53.8 % (25 RCTs, 18,756 patients), of prior MI
46.7 % (57 RCTs, 80,582 patients), of prior revascularization 39.9 % (32
RCTs, 30,730 patients), and of prior/current angina 25.5 % (22 RCTs,
25,572 patients). In studies presenting both variables, prior MI showed
the strongest correlations with assigned ischemic etiology (beta = 0.84, p
< 0.0001, 49 RCTs), followed by prior/current angina (beta = 0.84, p <
0.0001, 20 RCTs), prior revascularization (beta = 0.30, p = 0.006, 28
RCTs), whereas CAD had no significant correlation (beta = 0.29, p = 0.162,
from 17 RCTs). Rate of prior MI decreased over time (1986-2007: 51.4 +/-
11.6 %; 2008-2016: 48.2 +/- 8.8 %; 2017-2023: 41.4 +/- 16.6 %; p = 0.057),
whereas the one of prior revascularization increased (28.3 +/- 11.2 %;
40.7 +/- 19.6 %; 49.3 +/- 19.4 %; p = 0.048). Conclusion(s): An
accurate definition of ischemic etiology is mostly lacking in HFrEF RCTs,
and primarily assigned based on investigators clinical judgment, sometimes
in the presence of a prior MI, although the rate of this component showed
a decline over time. Copyright © 2025 The Authors

<59>
[Use Link to view the full text]
Accession Number
646118414
Title
Effects of continuous pecto-intercostal fascial block for management of
post-sternotomy pain in patients undergoing cardiac surgery: a randomized
controlled trial.
Source
International journal of surgery (London, England). 111(2) (pp 2037-2045),
2025. Date of Publication: 01 Feb 2025.
Author
Zhao Y.; He D.; Zhou W.; Chen C.; Liu Z.; Xia P.; Ye Z.; Li C.
Institution
(Zhao, He, Zhou, Chen, Liu, Xia, Ye, Li) Department of Anesthesiology,
Xiangya Hospital of Central South University, Hunan Province, Changsha,
China
(Liu, Xia, Ye, Li) National Clinical Research Center for Geriatric
Disorders, Central South University, Hunan Province, Changsha, China
Abstract
BACKGROUND: Managing postoperative pain following median sternotomy has
long been a notable challenge for anesthesiologists. The administration of
postoperative analgesia traditionally relies on intravenous pumps for the
delivery of opioids. With the development of regional block techniques and
postoperative multimodal analgesia, pecto-intercostal fascial block (PIFB)
has gained widespread utilization due to its distinctive advantages.
However, its application is limited to a single block. This study aimed to
indicate whether continuous PIFB analgesia in cardiac surgery via
sternotomy could possess clinical advantages compared with intravenous
analgesia in terms of postoperative pain management. If continuous PIFB
analgesia was the priority, the secondary objective would involve
determining the most effective administration method, making it a critical
area of exploration. METHOD(S): Totally, 114 patients were randomly
allocated to three groups: the patient-controlled intravenous analgesia
(PCIA) group, receiving intravenous opioid infusion exclusively via pump,
and the constant infusion pecto-intercostal fascial block (C-PIFB) and
intermittent infusion pecto-intercostal fascial block (I-PIFB) groups,
where ultrasound-guided PIFB with a nerve-blocking pump was administered.
The C-PIFB group received a constant basal infusion, while programmed
intermittent boluses were administered in the I-PIFB group. The primary
end point was postoperative visual analog scale (VAS) scores, and
secondary outcomes included intraoperative sufentanil consumption, time to
extubation, mobilization, length of stay in the intensive care unit (ICU)
and hospital, and the incidence of postoperative complications.
 RESULT(S): The VAS scores at rest and during coughing were noticeably
diminished in the two block groups relative to the intravenous pump group
at 12, 24, 48, and 72 h postoperatively. Notably, intraoperative
sufentanil consumption was significantly reduced in the C-PIFB group [3.12
(0.93) microg kg -1 ] and the I-PIFB group [3.42 (0.77) microg kg -1 ]
compared with the PCIA group [4.66 (1.02) microg kg -1 , P < 0.001]. Time
to extubation, mobilization, length of stay in ICU and hospital, and use
of rescue analgesics did not exhibit statistically significant differences
among the three groups. However, the postoperative complication rates were
markedly lower in the C-PIFB group (42.11%) and I-PIFB group (36.84%)
relative to the PCIA group (81.58%, P < 0.001). There were no significant
differences between C-PIFB and I-PIFB groups regarding VAS score,
secondary outcomes, and postoperative complications. CONCLUSION(S):
Continuous PIFB can provide satisfactory postoperative analgesia while
reducing perioperative opioid consumption, diminishing the risk of
postoperative complications, and accelerating postoperative recovery for
patients undergoing median sternotomy in cardiac surgery. The constant
basal infusion method may be the optimal approach for administering
continuous PIFB. Copyright © 2025 The Author(s). Published by
Wolters Kluwer Health, Inc.

<60>
Accession Number
2033387983
Title
Effectiveness of perioperative remimazolam in preventing postoperative
delirium: a systematic review and meta-analysis.
Source
European Journal of Medical Research. 30(1) (no pagination), 2025. Article
Number: 122. Date of Publication: 01 Dec 2025.
Author
Wang M.; Liu J.; Liu W.; Zhang X.; Zhang G.; Sun L.; Bi Y.; Wang H.; Dong
R.
Institution
(Wang) School of Anesthesiology, Shandong Second Medical University, No. 5
Donghai Middle Road, Qingdao, China
(Wang, Liu, Liu, Zhang, Sun, Bi, Dong) Department of Anesthesiology,
Qingdao Hospital, University of Health and Rehabilitation Sciences
(Qingdao Municipal Hospital), Qingdao, China
(Zhang) Department of Anesthesiology, Dezhou Third People'S Hospital,
Dezhou, China
(Wang) Department of Pediatrics, Qingdao Women and Children'S Hospital,
Qingdao University, No. 217 Liaoyang West Road, Qingdao, China
(Dong) Key Laboratory of Anesthesiology and Resuscitation, Huazhong
University of Science and Technology), Ministry of Education, Wuhan, China
Publisher
BioMed Central Ltd
Abstract
Background: To compare the POD rates in patients undergoing non-cardiac
surgery who received remimazolam perioperatively versus placebo or other
sedatives. Method(s): We systematically searched four major databases
(Cochrane Central Register of Controlled Trials, Web of Science, Embase,
and PubMed) for relevant randomized controlled trials (RCTs) up to July
11, 2024. Literature quality evaluation was used the bias risk table in
Review Manager 5.4. The primary outcome of interest was POD, and secondary
outcomes were the hypotension risk, bradycardia and, nausea and vomiting.
 Result(s): Across 11 trials involving 1985 participants, we recorded
309 cases of POD during follow-up. In trials where the control group
received saline, remimazolam decrease the risk of POD significantly by 70%
(RR 0.30, 95% CI [0.19, 0.46]; p < 0.00001). Statistical analysis did not
show significant difference in the risk of POD between the remimazolam
group and the groups receiving either dexmedetomidine (RR 1.23 [0.64,
2.37]; p = 0.53) or propofol (RR 0.83 [0.60, 1.16]; p = 0.28). Regarding
adverse events, remimazolam significantly reduces the morbidity of
hypotension compared to dexmedetomidine (RR 0.25 [0.10, 0.65]; p = 0.004)
and propofol (RR 0.45 [0.33, 0.60]; p < 0.00001). In addition, there were
no significant differences in the incidence of bradycardia (RR 0.85; 95%
CI [0.34-2.12], p = 0.72) and nausea and vomiting (RR 1.06; 95% CI
[0.74-1.51], p = 0.77) between remimazolam and the control group.
 Conclusion(s): During the perioperative period, using remimazolam can
lower POD risk after surgery for patients who had non-cardiac surgery, but
remimazolam does not work better than dexmedetomidine or propofol.
Compared with the dexmedetomidine and propofol, remimazolam also has
apparent advantages in preventing intraoperative
hypotension. Copyright © The Author(s) 2025.

<61>
Accession Number
2035829836
Title
Transcatheter Aortic Valve Replacement in Patients With Systolic Heart
Failure and Moderate Aortic Stenosis: TAVR UNLOAD.
Source
Journal of the American College of Cardiology. 85(9) (pp 878-890), 2025.
Date of Publication: 11 Mar 2025.
Author
Van Mieghem N.M.; Elmariah S.; Spitzer E.; Pibarot P.; Nazif T.M.; Bax
J.J.; Hahn R.T.; Popma A.; Ben-Yehuda O.; Kallel F.; Redfors B.; Chuang
M.L.; Alu M.C.; Lindeboom W.; Kolte D.; Zahr F.E.; Kodali S.K.; Strote
J.A.; Hermanides R.S.; Cohen D.J.; Tijssen J.G.P.; Leon M.B.
Institution
(Van Mieghem, Spitzer) Department of Cardiology, Thoraxcenter,
Cardiovascular Institute, Erasmus University Medical Center, Rotterdam,
Netherlands
(Elmariah) Division of Cardiology, University of San Francisco, San
Francisco, CA, United States
(Spitzer, Lindeboom, Tijssen) Cardialysis, Rotterdam, Netherlands
(Pibarot) Department of Medicine, Quebec Heart and Lung Institute, Laval
University, Quebec City, QC, Canada
(Nazif, Hahn, Alu, Kodali, Leon) Division of Cardiology,
NewYork-Presbyterian Hospital/Columbia University Irving Medical Center,
New York, NY, United States
(Bax) Department of Cardiology, Leiden University Medical Center, Leiden,
Netherlands
(Hahn, Popma, Redfors, Chuang, Alu, Cohen, Leon) Cardiovascular Research
Foundation, New York, NY, United States
(Ben-Yehuda) Division of Cardiovascular Medicine, University of California
San Diego, San Diego, CA, United States
(Kallel) Edwards Lifesciences, Irvine, CA, United States
(Redfors) Department of Population Health Sciences, Weill Cornell
Medicine, New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Redfors) Wallenberg Laboratory, Institute of Medicine, University of
Gothenburg, Gothenburg, Sweden
(Kolte) Cardiology Division, Massachusetts General Hospital, Boston, MA,
United States
(Kolte) Harvard Medical School, Boston, MA, United States
(Zahr) Oregon Health and Science University, Portland, OR, United States
(Strote) Medical Center of the Rockies, Loveland, CO, United States
(Hermanides) Department of Cardiology, Isala Heart Center, Zwolle,
Netherlands
(Cohen) St Francis Hospital, Roslyn, NY, United States
(Tijssen) Department of Cardiology, Amsterdam UMC, University of
Amsterdam, Amsterdam, Netherlands
Publisher
Elsevier Inc.
Abstract
Background: Neurohormonal modulation and afterload reduction are key for
treatment of heart failure with reduced ejection fraction (HFrEF). In
HFrEF patients with concomitant moderate aortic stenosis (AS), treatment
with transcatheter aortic valve replacement (TAVR) may be complementary to
guideline-directed medical therapy (GDMT). Objective(s): This study
sought to determine whether TAVR for moderate AS provides clinical benefit
in patients with HFrEF on top of GDMT. Method(s): We performed an
investigator-initiated, international, randomized controlled trial in
patients with HFrEF on GDMT with moderate AS who were suitable for
transfemoral TAVR with a balloon-expandable valve. Patients were
randomized 1:1 to TAVR or clinical aortic stenosis surveillance (CASS)
with aortic valve replacement upon progression to severe AS. The primary
endpoint was the hierarchical occurrence of: 1) all-cause death; 2)
disabling stroke; 3) disease-related hospitalizations and heart failure
equivalents; and 4) change from baseline in the Kansas City Cardiomyopathy
Questionnaire Overall Summary Score analyzed using the win ratio.
 Result(s): From January 2017 to December 2022, 178 patients were
randomized to TAVR (n = 89) or AS surveillance (n = 89). The mean age was
77 years, 20.8% were female, and 55.6% were in NYHA functional class III
or IV. The median follow-up duration was 23 months (Q1-Q3: 12-33 months).
A total of 38 (43%) patients in the CASS group (of whom 35 had progressed
to severe AS) underwent TAVR at a median of 12 months postrandomization.
TAVR was associated with wins in 47.6% of pairs, compared with 36.6% in
the CASS group, resulting in a win ratio of 1.31 (95% CI: 0.91-1.88; P =
0.14). At 1 year, TAVR resulted in a greater improvement in the Kansas
City Cardiomyopathy Questionnaire Overall Summary Score compared with the
CASS group (12.8 +/- 21.9 points vs 3.2 +/- 22.8 points; P = 0.018).
 Conclusion(s): TAVR was not superior to AS surveillance for the
primary hierarchical composite endpoint in patients with moderate AS and
HFrEF on GDMT. Preemptive TAVR for moderate AS was safe and may provide
clinically meaningful quality-of-life benefits. Copyright © 2025
American College of Cardiology Foundation

<62>
Accession Number
2033170953
Title
The efficacy and safety of bivalirudin and heparin in patients with acute
coronary syndrome: a systematic review and meta-analysis.
Source
Systematic Reviews. 14(1) (no pagination), 2025. Article Number: 39. Date
of Publication: 01 Dec 2025.
Author
Zhai Y.; Shang H.; Li Y.; Zhang N.; Zhang J.; Wu S.
Institution
(Zhai, Shang) Key Laboratory of Chinese Internal Medicine of Ministry of
Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese
Medicine, Haiyuncang Lane 5, Dongcheng District, Beijing, China
(Zhai, Li, Zhang, Zhang) Henan University of Chinese Medicine, No. 156
Jinshui Road, Henan, Zhengzhou, China
(Wu) The First Affiliated Hospital of Henan University of Chinese
Medicine, No. 19 Renmin Road, Henan, Zhengzhou, China
Publisher
BioMed Central Ltd
Abstract
Background: Patients with acute coronary syndrome (ACS) undergoing
percutaneous coronary intervention (PCI) are at high risk of thrombosis.
However, bleeding-related complications during antithrombotic therapy
remain a major barrier to effective treatment and can often lead to
adverse outcomes. This meta-analysis aimed to determine the efficacy and
safety of bivalirudin and heparin in patients with ACS after PCI.
 Method(s): Randomized controlled trials (RCTs) on the efficacy and
safety of bivalirudin versus heparin in patients with ACS after PCI were
identified from the PubMed, Embase, Cochrane Library, CBM, CNKI, WanFang,
and VIP database until August 2024. The outcomes included all-cause
mortality, major adverse cardiovascular events (MACEs), incidence of
recurrent myocardial infarction, stent thrombosis, short-term bleeding,
revascularization, and retransfusion. Meta-analysis was performed using
RevMan 5.3 and Stata 12.0 softwares. The included studies were assessed
for risk of bias using the Cochrane risk-of-bias assessment tool.
 Result(s): A total of 70,199 patients from 27 randomized controlled
trials (RCTs) were analyzed in this review. There were no significant
differences between the bivalirudin and heparin groups in terms of
all-cause mortality, major adverse cardiovascular events (MACEs),
recurrent myocardial infarction, stent thrombosis within 30 days, or
subacute stent thrombosis. Specifically, the incidence of short-term
bleeding (P = 0.001) and retransfusion (P = 0.001) was significantly lower
in the bivalirudin group compared to the heparin group. Conversely, the
incidence of acute stent thrombosis (P < 0.0001) and revascularization (P
= 0.009) was significantly higher in the bivalirudin group.
 Conclusion(s): Compared with heparin, bivalirudin has definite
anticoagulant effect in patients with acute myocardial infarction after
PCI, and the risk of bleeding and the incidence of retransfusion were
lower in the bivalirudin group. This review helps doctors in PCI
management choose bivalirudin or heparin more precisely based on patients'
conditions for better treatment and fewer adverse events. Copyright
© The Author(s) 2025.

<63>
Accession Number
2037362637
Title
The effect of Neurokinin-1 receptor antagonists on postoperative pain: A
meta-analysis of randomized controlled trials.
Source
Journal of Clinical Anesthesia. 102 (no pagination), 2025. Article Number:
111772. Date of Publication: 01 Mar 2025.
Author
D'Amico F.; Kelleher E.; D'Andria Ursoleo J.; Yavorovskiy A.G.; Turi S.;
Zaffaroni S.; Agosta V.T.; Ajello S.; Landoni G.
Institution
(D'Amico, D'Andria Ursoleo, Turi, Zaffaroni, Agosta, Ajello, Landoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Kelleher) Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, United Kingdom
(Yavorovskiy) Sechenov First Moscow State Medical University of the
Ministry of Health of the Russian, Moscow, Russian Federation
(Landoni) School of Medicine, Vita-Salute San Raffaele University, Milan,
Italy
Publisher
Elsevier Inc.
Abstract
Study objective: Substance P is a neuropeptide with a pivotal role in pain
transmission and modulation. Preclinical studies suggest that targeting
substance P and inhibiting its receptor, neurokinin 1 (NK-1), is a
potential avenue for pain relief. When translated into clinical settings,
these preliminary findings yielded mixed results. This meta-analysis of
randomized controlled trials (RCTs) aims to investigate whether a
preemptive administration of NK-1 antagonists may reduce postoperative
pain. Design(s): We searched PubMed, Cochrane and EMBASE from
inception to January 3, 2025, for studies comparing NK-1 antagonists
versus placebo or standard care that reported data on postoperative pain.
The primary outcome was pain at two hours after surgery measured through a
0-10 numeric scale. Secondary outcomes were postoperative pain at 24 and
at 48 h and postoperative morphine equivalent consumption.
 Setting(s): Hospitals. Main Result(s): The search strategies
identified 13 RCTs with a total of 1959 patients. All studies reported a
single preoperative administration of NK-1 antagonists. NK-1 antagonists
reduced postoperative pain two hours (n = 8; MD -0.62; 95 % CI: -0.91,
-0.32; P < 0.001; I2 = 0 %) and at 24 h (n = 9; MD -0.65; 95 % CI: -1.22,
-0.09; P = 0.02; I2 = 86 %) but not 48 h after surgery. Morphine
equivalent consumption was similar in the two groups. Conclusion(s):
Preoperative single-administration of NK-1 antagonists reduces
postoperative pain. The observed pain reduction pattern is consistent with
the pharmacokinetics (half-life 9-12 h) of these inhibitors and with data
from preclinical studies. Copyright © 2025 Elsevier Inc.

<64>
Accession Number
2036120458
Title
Aortic Valve Replacement vs Clinical Surveillance in Asymptomatic Severe
Aortic Stenosis: A Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. 85(9) (pp 912-922), 2025.
Date of Publication: 11 Mar 2025.
Author
Genereux P.; Banovic M.; Kang D.-H.; Giustino G.; Prendergast B.D.;
Lindman B.R.; Newby D.E.; Pibarot P.; Redfors B.; Craig N.J.; Bartunek J.;
Schwartz A.; Seyedin R.; Cohen D.J.; Iung B.; Leon M.B.; Dweck M.R.
Institution
(Genereux, Giustino) Gagnon Cardiovascular Institute, Morristown Medical
Center, Morristown, NJ, United States
(Banovic) Belgrade Medical School, University of Belgrade, Belgrade,
Serbia
(Banovic) Cardiology Department, University Clinical Center of Serbia,
Belgrade, Serbia
(Kang) Asan Medical Center, College of Medicine, University of Ulsan,
Seoul, South Korea
(Prendergast) Department of Cardiology, Guys and St Thomas' NHS Foundation
Trust Hospital London, London, United Kingdom
(Prendergast) Heart, Vascular and Thoracic Institute, Cleveland Clinic
London, London, United Kingdom
(Lindman) Structural Heart and Valve Center, Vanderbilt University Medical
Center, Nashville, TN, United States
(Newby, Dweck) British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Edinburgh, United Kingdom
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec City,
QC, Canada
(Redfors) Department of Molecular and Clinical Medicine, Institute of
Medicine, Gothenburg University, Gothenburg, Sweden
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Redfors) Department of Population Health Sciences, Weill Cornell
Medicine, New York, NY, United States
(Craig) Centre for Cardiovascular Sciences, University of Edinburgh,
Edinburgh, United Kingdom
(Bartunek) Clinical Trial Service Unit and Epidemiological Studies Unit,
Nuffield Department of Population Health, University of Oxford, Oxford,
United Kingdom
(Schwartz, Leon) Columbia University Medical Center/NewYork-Presbyterian
Hospital, New York, NY, United States
(Seyedin) Edwards Lifesciences, Irvine, CA, United States
(Cohen) St. Francis Hospital and Heart Center, Roslyn, NY, United States
(Cohen, Leon) Cardiovascular Research Foundation, New York, NY, United
States
(Iung) Bichat Hospital, Assistance Publique-Hopitaux de Paris, and INSERM
LVTS 1148, Universite Paris-Cite, Paris, France
Publisher
Elsevier Inc.
Abstract
Background: Current guidelines recommend a strategy of clinical
surveillance (CS) for patients with asymptomatic severe aortic stenosis
(AS) and a normal left ventricular ejection fraction. Objective(s):
The aim of this study was to conduct a study-level meta-analysis of
randomized controlled trials (RCTs) evaluating the effect of early aortic
valve replacement (AVR) compared with CS in patients with asymptomatic
severe AS. Method(s): Studies were quantitatively assessed in a
meta-analysis using random-effects modeling. Prespecified outcomes
included all-cause and cardiovascular mortality, unplanned cardiovascular
or heart failure (HF) hospitalization, and stroke. The meta-analysis is
registered at the International Platform of Registered Systematic Review
and Meta-Analysis Protocols (INPLASY202490002). Result(s): Four RCTs
were identified, including a total of 1,427 patients (719 in the early AVR
group and 708 in the CS group). At an average follow-up time of 4.1 years,
early AVR was associated with a significant reduction in unplanned
cardiovascular or HF hospitalization (pooled rate 14.6% vs 31.9%; HR:
0.40; 95% CI: 0.30-0.53; I2 = 4%; P < 0.01) and stroke (pooled
rate 4.5% vs 7.2%; HR: 0.62; 95% CI: 0.40-0.97; I2 = 0%; P =
0.03). No differences in all-cause mortality (pooled rate 9.7% vs 13.7%;
HR: 0.68; 95% CI: 0.40-1.17; I2 = 61%; P = 0.17) and
cardiovascular mortality (pooled rate 5.1% vs 8.3%; HR: 0.67; 95% CI:
0.35-1.29; I2 = 50%; P = 0.23) were observed with early AVR
compared with CS, although there was a high degree of heterogeneity among
studies. Conclusion(s): In this meta-analysis of 4 RCTs, early AVR
was associated with a significant reduction in unplanned cardiovascular or
HF hospitalization and stroke and no differences in all-cause and
cardiovascular mortality compared with CS. Copyright © 2025 The
Authors

<65>
Accession Number
2037585281
Title
Long-Term Outcomes of Transcatheter vs Surgical Aortic Valve Replacement
for Lower-Risk Patients: Are We There Yet?.
Source
Journal of the American College of Cardiology. 85(9) (pp 941-943), 2025.
Date of Publication: 11 Mar 2025.
Author
Wallach J.D.; Cohen D.J.
Institution
(Wallach) Department of Epidemiology, Rollins School of Public Health,
Emory University, Atlanta, GA, United States
(Cohen) Cardiovascular Research Foundation, New York, NY, United States
(Cohen) St. Francis Hospital and Heart Center, Roslyn, NY, United States
Publisher
Elsevier Inc.

<66>
Accession Number
2032815026
Title
Safety and efficacy of a pharmacist-driven protocolized transition from
insulin infusion to subcutaneous insulin in patients undergoing
cardiothoracic surgery.
Source
JACCP Journal of the American College of Clinical Pharmacy. 8(2) (pp
123-128), 2025. Date of Publication: 01 Feb 2025.
Author
Bird S.A.; Thuyns M.R.
Institution
(Bird, Thuyns) Renown Regional Medical Center, Reno, NV, United States
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Few validated approaches exist for the transition from
intravenous (IV) insulin infusion to subcutaneous (SQ) insulin
post-operatively in cardiothoracic surgery patients. Objective(s):
This study aimed to assess whether a pharmacist-driven protocol utilizing
basal, prandial, correctional, or correctional-only SQ insulin is safe and
efficacious for post-operative glycemic control following 24 h of IV
insulin administration. Method(s): A retrospective, single-center,
observational study investigating outcomes associated with a
pharmacist-driven protocol utilizing basal, prandial, correctional, or
correctional-only insulin from May 2023 through July 2023 when compared
with a historical nursing-driven protocol observed from May 2021 through
July 2021. Adult cardiac intensive care unit patients who received an
insulin infusion within 24 h of cardiothoracic surgery and subsequently
transitioned to SQ insulin were observed. The primary outcome was
percentage of blood glucose (BG) readings at goal (140-180 mg/dL).
Secondary outcomes included percentage of BG readings in a clinically
acceptable range (110-180 mg/dL), hypoglycemia (<70 mg/dL), severe
hypoglycemia (<40 mg/dL), administration of rescue dextrose, reinitiation
of insulin infusion following transition, and surgical site infection.
 Result(s): Use of a pharmacist-driven protocol improved the
percentage of BG readings in goal range when compared with a nursing
driven protocol (24.4% vs. 12.4%, p = 0.001). More BG readings were in the
clinically acceptable range in the pharmacist-driven group: 69.6% of
readings versus 58.5% in the nursing-driven group (p = 0.011). There were
fewer hypoglycemic events in the pharmacist-driven group. There were no
reports of severe hypoglycemia, further IV insulin requirements, or
surgical site infections in either group. Pharmacist compliance to the
protocol was high at 92.4%. Conclusion(s): A pharmacist-driven
protocolized approach to the transition to SQ insulin post-operatively in
cardiothoracic patients is both safe and efficacious. The
pharmacist-driven protocol resulted in an improved percentage of BG
readings in goal range and fewer hypoglycemic events when compared with
the historical nursing-driven protocol. Copyright © 2025
Pharmacotherapy Publications, Inc.

<67>
[Use Link to view the full text]
Accession Number
2037430569
Title
Erratum: Effects of Serratus Anterior Plane Block on Early Recovery from
Thoracoscopic Lung Resection: A Randomized, Blinded, Placebo-controlled
Trial (Anesthesiology (2024) 141 (1065-74) DOI:
10.1097/ALN.0000000000005224).
Source
Anesthesiology. 142(3) (pp 588), 2025. Date of Publication: 01 Mar 2025.
Author
Anonymous
Publisher
Lippincott Williams and Wilkins
Abstract
In the Editor's Perspective for the article on page 1065 in the December
2024 issue, the second bullet point under "What We Already Know about This
Topic"contains an error (i.e., "post-site"instead of "port-site"). The
corrected text is below: Patients who undergo minimally invasive thoracic
surgery have multiple port-site incisions that may cause significant chest
wall pain without intraoperative and postoperative pain management. Also,
in the Intercostal Nerve Blocks section on page 1067, an error appears in
the second sentence (i.e., "injected in the fifth"should be "injected in
the third"). The corrected text is below: After the completion of the lung
resection, the surgical team followed their existing practice of
performing internal intercostal nerve blocks under thoracoscopic
visualization. The intercostal nerve blocks were standardized to 3 ml
bupivacaine 0.25% injected in the third through the eighth intercostal
spaces (six intercostal spaces) for a total volume of 18 ml and a total
dose of 45 mg. All study patients received internal intercostal nerve
blocks. The online version and PDF of the article have been
corrected. Copyright © 2025 Lippincott Williams and Wilkins. All
rights reserved.

<68>
Accession Number
2037042953
Title
Transcatheter Aortic Valve Replacement in Heart Failure, Reduced Ejection
Fraction, and Moderate Aortic Stenosis.
Source
Journal of the American College of Cardiology. 85(9) (pp 894-895), 2025.
Date of Publication: 11 Mar 2025.
Author
O'Gara P.T.
Institution
(O'Gara) Division of Cardiovascular Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
Publisher
Elsevier Inc.

<69>
Accession Number
2037454096
Title
Colchicine for secondary prevention in patients with acute coronary
syndrome: A systematic review and meta-analysis.
Source
International Journal of Cardiology. 425 (no pagination), 2025. Article
Number: 133045. Date of Publication: 15 Apr 2025.
Author
Shaikh S.; Hamza M.; Neppala S.; Singh S.; Upreti P.; Umer A.M.; Manish
K.C.; Pandya K.; Bahar Y.; Sattar Y.; Alraies M.C.
Institution
(Shaikh) Washington University in St Louis, St Louis, MO, United States
(Hamza) Guthrie Medical Group, Cortland, NY, United States
(Neppala) UT Health Science Center, Memphis, TX, United States
(Singh) Sinai Hospital, Baltimore, MD, United States
(Upreti) Sands-Constellation Heart Institute, Rochester Regional Health,
Rochester, NY, United States
(Umer) WVU Medicine Camden Clark Medical Center, Parkersburg, WV, United
States
(Manish) North Alabama Medical Center, Florence, AL, United States
(Pandya) Cleveland Clinic, Cleveland, OH, United States
(Bahar) Wayne State University, Detroit, United States
(Sattar) West Virginia University, Morgantown, WV, United States
(Alraies) Cardiovascular Institute, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Despite optimal therapy, coronary artery disease (CAD) remains
a significant public health concern worldwide. Studies have increasingly
recognized the role of inflammation in atherosclerosis. Colchicine, a
potent anti-inflammatory drug commonly used to treat gout, and
pericarditis is being evaluated in this study for its safety and efficacy
in preventing CAD following an acute coronary syndrome (ACS).
 Method(s): We searched PubMed and Embase for studies up to April 2024
comparing colchicine to standard medical treatment in ACS patients.
Primary outcomes included major adverse cardiovascular events (MACE) and
recurrent ACS, while secondary outcomes were cardiovascular death,
congestive heart failure (CHF), stroke, hospitalizations, and
gastrointestinal (GI) side effects. Data were pooled using a
random-effects model. Result(s): We included nine studies with a
pooled sample size of 7260 patients. The mean age was 60.1 (+/-11.8)
years, with 19.3 % females and a mean follow-up duration of 8.5 (+/-6)
months. Patients who received colchicine treatment demonstrated a reduced
risk of re-hospitalizations (OR 0.52 [0.34-0.81]) but had increased GI
effects (OR 2.10 [1.20-3.68]). There was no significant difference in
cardiovascular death (OR 1.17 [0.52-2.63]), MACE (OR 0.68 [0.45-1.01]),
stroke (OR 0.46 [0.18-1.18]), recurrent ACS (OR 0.55 [0.28-1.09]) and the
incidence of CHF (OR 0.90 [0.38-2.12]) between patients treated with
colchicine versus standard medical treatment. Conclusion(s): Adding
colchicine to standard medical therapy in ACS patients significantly
reduced hospitalizations but is associated with increased GI side effects.
Further prospective trials are required to validate these findings and
determine if early intervention with colchicine treatment improves
clinical outcomes in ACS patients. Copyright © 2025 Elsevier B.V.

<70>
Accession Number
646461356
Title
Colchicine for the primary prevention of cardiovascular events.
Source
Cochrane Database of Systematic Reviews. 2025(2) (no pagination), 2025.
Article Number: CD015003. Date of Publication: 10 Feb 2025.
Author
Marti-Carvajal A.J.; Gemmato-Valecillos M.A.; Monge Martin D.; De Sanctis
J.B.; Marti-Amarista C.E.; Hidalgo R.; Alegria-Barrero E.; Riera Lizardo
R.J.; Correa-Perez A.
Institution
(Marti-Carvajal, Hidalgo) Universidad UTE, Facultad de Ciencias de la
Salud Eugenio Espejo, Centro Asociado Cochrane Ecuador, Centro de
Investigacion en Salud Publica y Epidemiologia Clinica (CISPEC), Quito,
Ecuador, Universidad UTE, Quito, Ecuador
(Marti-Carvajal, Monge Martin, Alegria-Barrero, Correa-Perez) Faculty of
Medicine, Universidad Francisco de Vitoria, Madrid, Spain
(Marti-Carvajal, Riera Lizardo) Catedra Rectoral de Medicina Basada en la
Evidencia, Universidad de Carabobo, Valencia, Venezuela
(Gemmato-Valecillos) Department of Medicine, NYC Health + Hospitals /
Elmhurst, Icahn School of Medicine at Mount Sinai, New York, United States
(De Sanctis) The Institute of Molecular and Translational Medicine,
Palacky University Olomouc, Faculty of Medicine and Dentistry, Olomouc,
Czechia
(Marti-Amarista) Jencare Senior Medical Center, Geriatric Medicine
Department, Berwyn, IL, United States
(Riera Lizardo) Medicine Department, Rheumatology Unit, Universidad de
Carabobo, Valencia, Venezuela
(Correa-Perez) Department of Hospital Pharmacy and Medical Devices,
Hospital Central de la Defensa Gomez Ulla, Madrid, Spain
Publisher
John Wiley and Sons Ltd
Abstract
Background: Atherosclerotic cardiovascular diseases (ACVDs), a condition
characterised by lipid accumulation in arterial walls, which is often
exacerbated by chronic inflammation disorders, is the major cause of
mortality and morbidity worldwide. Colchicine, with its first medicinal
use in ancient Egypt, is an inexpensive drug with anti-inflammatory
properties. However, its role in primary prevention of ACVDs in the
general population remains unknown. Objective(s): To assess the
clinical benefits and harms of colchicine as primary prevention of
cardiovascular outcomes in the general population. Search Method(s):
We searched the Cochrane Heart Specialised Register, the Cochrane Central
Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including
In-Process & Other Non-Indexed Citations), Ovid Embase, Web of Science,
and LILACS. We searched ClinicalTrials.gov and WHO ICTRP for ongoing and
unpublished studies. We also scanned the reference lists of relevant
included studies, reviews, meta-analyses, and health technology reports to
identify additional studies. There were no limitations on language, date
of publication, or study setting. The search results were updated on 31
May 2023. Selection Criteria: Randomised controlled trials (RCTs) in
any setting, recruiting adults without pre-existing cardiovascular
disease. We included trials that compared colchicine versus placebo,
non-steroidal anti-inflammatory drugs, corticosteroids, immunomodulating
drugs, or usual care. Our primary outcomes were all-cause mortality,
non-fatal myocardial infarction, stroke, and adverse events. Data
Collection and Analysis: Two or more review authors independently selected
studies, extracted data, and performed risk of bias and GRADE assessments.
 Main Result(s): We identified 15 RCTs (1721 participants randomised;
1412 participants analysed) with follow-up periods ranging from 4 to 728
weeks. The intervention was oral colchicine compared with placebo,
immunomodulating drugs, or usual care or no treatment. Due to biases and
imprecision, the evidence was very uncertain for all outcomes. All trials
but one had a high risk of bias. Five out of seven meta-analyses included
fewer than six trials (71.4%). The objectives of the review were to assess
cardiovascular outcomes in the general population, but many of the
included trials focused on liver disease. Colchicine compared to placebo.
Colchicine may reduce all-cause mortality compared to placebo in primary
prevention, but the evidence is very uncertain (risk ratio (RR) 0.68, 95%
confidence interval (CI) 0.51 to 0.91; 6 studies, 463 participants; very
low-certainty evidence; number needed to treat for an additional
beneficial outcome (NNTB) 11, 95% CI 6 to 67). Colchicine may result in
little to no difference in non-fatal myocardial infarction, but the
evidence is very uncertain (RR 0.87, 95% CI 0.41 to 1.82; 1 study, 100
participants; very low-certainty evidence). Colchicine may not reduce the
incidence of stroke, but the evidence is very uncertain (RR 2.43, 95% CI
0.67 to 8.86; 1 study, 100 participants; very low-certainty evidence).
Regarding adverse events, colchicine may increase the incidence of
diarrhoea (RR 3.99, 95% CI 1.44 to 11.06; 8 studies, 605 participants;
very low-certainty evidence; number needed to treat for an additional
harmful outcome (NNTH) 10, 95% CI 6 to 17), and may have little to no
effect on neurological outcomes such as seizure or mental confusion (RR
0.72, 95% CI 0.31 to 1.66; 2 studies, 155 participants; very low-certainty
evidence), but the evidence is very uncertain. The effect of colchicine on
cardiovascular mortality is also very uncertain (RR 1.27, 95% CI 0.03 to
62.43; 2 studies, 160 participants; very low-certainty evidence).
Colchicine may not reduce post-cardiac procedure atrial fibrillation, but
the evidence is very uncertain (RR 0.74, 95% CI 0.25 to 2.19; 1 study, 100
participants). We found no trials reporting on pericardial effusion,
peripheral artery disease, heart failure, or unstable angina. Colchicine
compared to methotrexate (immunomodulating drug). Colchicine may result in
little to no difference in all-cause mortality compared to methotrexate,
but the evidence is very uncertain (RR 0.42, 95% CI 0.12 to 1.51; 1 study,
85 participants; very low-certainty evidence). We found no trials
reporting other cardiovascular outcomes or adverse events for this
comparison. Colchicine compared to usual care or no treatment. The
evidence is very uncertain about the effect of colchicine compared with
usual care on all-cause mortality in primary prevention (RR 1.07, 95% CI
0.90 to 1.27; 2 studies, 729 participants; very low-certainty evidence).
Regarding adverse events, colchicine may increase the incidence of
diarrhoea compared to usual care, but the evidence is very uncertain (RR
3.32, 95% CI 1.56 to 7.03; 2 studies, 729 participants; very low-certainty
evidence; NNTH 18, 95% CI 12 to 42). No trials reported other
cardiovascular outcomes for this comparison. Authors' conclusions: This
Cochrane review evaluated the clinical benefits and harms of using
colchicine for the primary prevention of cardiovascular events in the
general population. Comparisons were made against placebo,
immunomodulating medications, or usual care or no treatment. However, the
certainty of the evidence for the predefined outcomes was very low,
highlighting the pressing need for high-quality, rigorous studies to
ascertain colchicine's clinical impact definitively. We identified
numerous biases and inaccuracies in the included studies, limiting their
generalisability and precluding a conclusive determination of colchicine's
efficacy in preventing cardiovascular events. The existing evidence
regarding colchicine's potential cardiovascular benefits or harms for
primary prevention is inconclusive owing to the limitations inherent in
the current studies. More robust clinical trials are needed to bridge this
evidence gap effectively. Copyright © 2025 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<71>
Accession Number
2033391418
Title
Urgent Focus on the Surgical Risks of People Living With HIV: A Systematic
Review and Meta-Analysis.
Source
Journal of Medical Virology. 97(2) (no pagination), 2025. Article Number:
e70260. Date of Publication: 01 Feb 2025.
Author
Li K.; Luo L.; Ji Y.; Zhang Q.
Institution
(Li, Ji, Zhang) Department of Orthopedics, Beijing Ditan Hospital,
National Medical Center for Infectious Diseases, Capital Medical
University, Beijing, China
(Luo) Department of Psychiatry, Peking University Sixth Hospital, National
Medical Center for Psychiatry, Peking University, Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
With the widespread promotion and application of antiretroviral therapy in
clinical practice, people living with HIV (PLWH) have the potential to
live as long as non-HIV people and the probability of surgery for PLWH has
been increasing dramatically. However, the overall postoperative outcome
and risk are still unclear. We performed comprehensive and methodical
searches in PubMed, Embase, and Web of Science without date and language
restrictions. Study outcomes included: (1) cure rate, (2) mortality, (3)
reoperation rate, (4) incidence of any postoperative complications, (5)
length of stay, and (6) operation duration. NOS scores were employed to
evaluate bias risk, while publication bias was assessed using funnel plots
and Egger tests. Review Manager version 5.4.1, R version 4.4.1, and Stata
version 14.0 were employed to determine quantitative analysis, considering
a significance level of p < 0.05. A total of 50 studies were included,
involving 54 565 PLWH undergoing surgical treatment. Synthesis analysis
showed that the mortality (OR = 1.70, 95% CI: 1.58-1.83, p < 0.00001),
reoperation rate (OR = 1.78, 95% CI: 1.36-2.34, p < 0.00001), complication
rate (OR = 1.56, 95% CI: 1.26-1.95, p < 0.00001), LOS (OR = 1.63, 95% CI:
1.28-1.99, p < 0.00001), and operation time (OR = 7.37, 95% CI:
1.14-13.59, p = 0.02) were increased in PLWH. However, there was no
significant difference in the cure rate compared to the control group (OR
= 1.27, 95% CI: 0.90-1.79, p = 0.18). Subgroup analysis showed that
complication rates increased again in orthopedic (OR = 1.65, 95% CI:
1.34-2.05, p < 0.00001) and general surgery (OR = 1.72, 95% CI: 1.08-2.74,
p = 0.02). However, the type of procedure, publication quality, study
type, and patient origin were not sources of complication rate
heterogeneity. Meta-regression showed that CD4 count had no effect on
complication rate, but the anti-retroviral therapy rate had 34.89%
explanatory power. There is an increased risk of postoperative death,
reoperation, complications, and prolonged hospital stay and surgical
duration in PLWH. However, conducting extensive prospective studies across
multiple centers is crucial to validate these findings. Copyright
© 2025 Wiley Periodicals LLC.

<72>
[Use Link to view the full text]
Accession Number
2037425426
Title
Management of Kidney Disease in Heart Transplant Patients: A National
Delphi Survey-based Consensus Expert Paper.
Source
Transplantation. (no pagination), 2025. Article Number:
10.1097/TP.0000000000005302. Date of Publication: 2025.
Author
Garcia-Cosio Carmena M.D.; Farrero M.; Blasco Peiro M.T.; Crespo M.;
Delgado Jimenez J.; Diaz Molina B.; Fernandez Rivera C.; Garrido Bravo
I.P.; Lopez Jimenez V.; Melilli E.; Mirabet Perez S.; Perez Tamajon M.L.;
Rangel Sousa D.; Rodrigo E.; Cruzado J.M.; Hernandez Marrero D.; Dalmau
A.G.; Sanchez Fructuoso A.I.; Gavela Martinez E.; Zarraga Larrondo S.;
Rodriguez Benot A.; Mazuecos Blanca A.; Moreso Mateos F.J.; Torregrosa
Prats J.V.; Andres Belmonte A.; Franco Esteve A.; Beneyto Castello M.I.;
Gonzalez Roncero F.M.; Facundo Molas C.; Perez Saez, M.J.; Jimenez Martin
C.; Gregorio Rbago J.-A.; Lopez Granados A.; Almenar Bonet L.; Sobrino
Marquez J.M.; Crespo Leiro M.; Gonzalez Costello J.; Rodriguez Chaverri
A.; De La Fuente Galan L.; Garcia Quintana A.; Gomez Bueno M.; Gonzalez
Vilchez F.; Ortiz Bautista C.; Segovia Cubero J.; Caravaca Perez P.
Institution
(Garcia-Cosio Carmena) Cardiology Department, CIBERCV, Hospital
Universitario 12 de OctubreImas12, Madrid, Spain
(Farrero) Cardiology Department, Hospital Clinic, Barcelona, Spain
(Blasco Peiro) Cardiology Department, Hospital Universitario Miguel
Servet, Zaragoza, Spain
(Crespo) Nephrology Department, Hospital del Mar, Hospital del Mar
Research Institute, National Network for Kidney Research RICORS2040
RD21/0005/0022, Barcelona, Spain
(Delgado Jimenez) Cardiology Department, Universidad Complutense de
Madrid, CIBERCV, Hospital Universitario 12 de Octubre, Imas12, , Madrid,
Spain
(Diaz Molina) Cardiology Department, Hospital Universitario Central de
Asturias, Oviedo, Spain
(Fernandez Rivera) Nephrology Department, Complexo Hospitalario
Universitario A Coruna, A Coruna, Spain
(Garrido Bravo) Cardiology Department, Hospital Clinico Universitario
Virgen de la Arrixaca, El Palmar, Murcia, Spain
(Lopez Jimenez) Nephrology Department, Hospital Regional Universitario de
Malaga, National Network for Kidney Research RICORS2040 RD21/0005/0012,
Instituto Biomedico de Investigacion de Malaga (IBIMA), Universidad de
Malaga, Malaga, Spain
(Melilli) Nephrology Department, Hospital Universitario de Bellvitge,
Barcelona, Spain
(Mirabet Perez) Cardiology Department, Hospital de la Santa Creu i Sant
Pau, CIBERCV, Barcelona, Spain
(Perez Tamajon) Nephrology Department, Complejo Hospitalario Universitario
de Canarias, Santa Cruz de Tenerife, Spain
(Rangel Sousa) Cardiology Department, Hospital Universitario Virgen del
Rocio, Sevilla, Spain
(Rodrigo) Nephrology Department, Hospital Universitario Marques de
Valdecilla, IDIVAL, Santander, Spain
(Cruzado) Nephrology Department, Hospital Universitario de Bellvitge,
Bellvitge Institute for Biomedical Research (IDIBELL), University of
Barcelona, Barcelona, Spain
(Hernandez Marrero) Nephrology Department, Hospital Universitario de
Canarias, National Network for Kidney Research RICORS2040 RD21/0005/0012,
Instituto de Tecnologias Biomedicas, Universidad de La Laguna, Santa Cruz
de Tenerife, Spain
(Dalmau) Hospital Universitario Miguel Servet, Zaragoza, Spain
(Sanchez Fructuoso) Hospital Clinico San Carlos, Madrid, Spain
(Gavela Martinez) Hospital Universitario Dr Peset, Valencia, Spain
(Zarraga Larrondo) Hospital Universitario de Cruces, Vizcaya, Baracaldo,
Spain
(Rodriguez Benot, Lopez Granados) Hospital Universitario Reina Sofia,
Cordoba, Spain
(Mazuecos Blanca) Hospital Puerta del Mar, Cadiz, Spain
(Moreso Mateos) Hospital Universitario Vall d'Hebron, Barcelona, Spain
(Torregrosa Prats, Caravaca Perez) Hospital Clinic, Barcelona, Spain
(Andres Belmonte) Hospital Universitario 12 de Octubre, Madrid, Spain
(Franco Esteve) Hospital General Universitario de Alicante, Alicante,
Spain
(Beneyto Castello, Almenar Bonet) Hospital Universitari i Politecnic La
Fe, Valencia, Spain
(Gonzalez Roncero, Sobrino Marquez) Hospital Universitario Virgen del
Rocio, Seville, Spain
(Facundo Molas) Fundacio Puigvert, Barcelona, Spain
(Perez Saez) Hospital del Mar, Barcelona, Spain
(Jimenez Martin, Rodriguez Chaverri) Hospital Universitario La Paz,
Madrid, Spain
(Gregorio Rbago) Clinica Universitaria de Navarra, Pamplona, Spain
(Crespo Leiro) Hospital Universitario de A Coruna A Coruna, Spain
(Gonzalez Costello) Hospital Universitari de Bellvitge, L'Hospitalet de
Llobregat, Barcelona, Spain
(De La Fuente Galan) Hospital Clinico Universitario de Valladolid,
Valladolid, Spain
(Garcia Quintana) Hospital Universitario de Gran Canaria Doctor Negrin,
Las Palmas de Gran Canaria, Spain
(Gomez Bueno, Segovia Cubero) Hospital Puerta de Hierro-Majadahonda,
Majadahonda, Madrid, Spain
(Gonzalez Vilchez) Hospital Universitario Marques de Valdecilla,
Santander, Spain
(Ortiz Bautista) Hospital Universitario Gregorio Maranon, Madrid, Spain
Publisher
Lippincott Williams and Wilkins
Abstract
Kidney disease is a common complication in heart transplant recipients and
requires a comprehensive and personalized approach. The interplay between
preexisting kidney disease, perioperative factors, immunosuppression, and
cardiovascular complications makes the management of kidney dysfunction
challenging in these patients. The objective of this expert consensus was
to look for agreements for the management of chronic kidney disease in
heart transplant recipients. A panel of Spanish cardiologists and
nephrologists with expertise in heart and kidney transplantation reviewed
the evidence related to the current management of chronic kidney disease
in heart transplant recipients and consensus statements were developed
using a 2-round Delphi methodology. Consensus statements were proposed
covering key topics, including the identification and management of kidney
disease in heart transplant recipients and the indications for kidney
transplantation. These statements provide additional expert guidance for
the management of kidney disease in patients undergoing heart
transplantation where published clinical evidence is scarce. Copyright
© 2025 Wolters Kluwer Health, Inc.

<73>
[Use Link to view the full text]
Accession Number
2037415111
Title
Efficacy comparison of two doses of dezocine on preventing
sufentanil-induced cough in patients undergoing coronary artery bypass
grafting surgery: A prospective, randomized controlled trial.
Source
Medicine (United States). 104(6) (pp e41416), 2025. Date of Publication:
07 Feb 2025.
Author
Xie C.-M.; He L.-X.; Shen M.-Q.; Yao Y.-T.
Institution
(Xie, He, Shen) Department of Anesthesiology, Affiliated Cardiovascular
Hospital of Kunming Medical University, Fuwai Yunnan Hospital, Chinese
Academy of Medical Sciences, Kunming, China
(Yao) Department of Anesthesiology, Peking Union Medical College and
Chinese Academy of Medical Sciences, Fuwai Hospital, National Center for
Cardiovascular Diseases, Beijing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Sufentanil-induced cough (SIC) is a common but irritating
phenomenon during general anesthesia (GA) induction; studies have reported
that high doses of dezocine can effectively prevent it. The aim is to
explore the efficacy and safety of low-dose dezocine in preventing SIC
during GA induction in coronary artery bypass grafting (CABG) surgery.
 Method(s): 81 elective CABG surgery patients were randomly and
equally divided into 2 dezocine groups of different doses and 1 control
group. Before GA induction, the patients received "pre-injection"solution:
0.1 mg/kg dezocine in the high-dose (HD) group, 0.05 mg/kg dezocine in the
low-dose (LD) group or an equal volume of saline in the control (C) group.
The primary outcome was the incidence of SIC within 1 minute after
sufentanil administration. The secondary outcomes included the severity of
SIC, the adverse reactions within 1 minute after injection of the
"pre-injection"solution, and the vital signs at various time points.
 Result(s): One patient had moderate SIC in the HD group (3.7%), 3
patients (11.1%) had SIC (1 mild and 2 severe) in the LD group, and 8
patients (29.6%) had SIC (3 mild, 1 moderate, and 4 severe) in the C
group. The difference between the HD and the C groups was statistically
significant (P = .01). In contrast, in comparing the LD and the C groups,
the LD and the HD groups had no statistically significant difference (P >
.017). Conclusion(s): The current study suggested that pretreatment
of 0.05 mg/kg dezocine neither prevented SIC occurrence nor attenuated SIC
severity during GA induction in CABG surgery, but 0.1 mg/kg dezocine
did. Copyright © 2025 the Author(s).

<74>
Accession Number
2037571983
Title
Effect of geriatric care on health outcomes in older patients with cardiac
disease: A systematic review.
Source
Archives of Gerontology and Geriatrics. 132 (no pagination), 2025. Article
Number: 105786. Date of Publication: 01 May 2025.
Author
Raijmann R.C.M.A.; van Dalen T.N.; Koek H.L.; van der Meer M.G.;
Emmelot-Vonk M.H.; Keijsers C.J.P.W.
Institution
(Raijmann, Koek, Emmelot-Vonk) Department of Geriatrics, University
Medical Center Utrecht, Utrecht, Netherlands
(Raijmann, van Dalen, Keijsers) Department of Geriatrics, Jeroen Bosch
Hospital, 's-Hertogenbosch, Netherlands
(van der Meer) Department of Cardiology, University Medical Center
Utrecht, Utrecht, Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Background: As patients with cardiac disease age and become frail, their
care needs become more complex. Therefore geriatric care might benefit
these patients. This review summarizes current research investigating the
impact of geriatric care on clinical outcomes in older cardiac patients.
 Method(s): The MEDLINE, Embase, and Cochrane databases were searched
on 11 May 2023 for randomized controlled trials (RCTs) and observational
studies comparing additional geriatric care to usual care in older (+70)
cardiac patients. The Cochrane risk of bias tool and Robbins-E tool were
used for quality assessment of RCTs and observational studies
respectively. Data on mortality rates, readmissions, length of stay,
complications, discharge destinations, functional outcomes, and quality of
life (QoL) were extracted. Two authors independently selected studies,
extracted data and assess study quality. Result(s): Twelve articles
involving 3531 patients (average age 73-85 years; 44-59 % male) were
identified, mainly focussing on heart failure or patients requiring
cardiothoracic surgery. The studies had a moderate to high risk of bias.
Two out of three studies (n = 771) showed reduced complication rates (e.g.
delirium incidence) when comparing geriatric assessment to usual care.
Additionally, two out of three studies (n = 449), indicated improved QoL
scores for patients who received a geriatric care. No significant effects
were found for other outcomes. Conclusion(s): Low-quality evidence
suggests that geriatric care may be associated with lower complication
rates and an improved quality of life in older cardiac patients. However,
more research is needed to clarify the effect of a geriatric care in this
patient population. Registration: The study protocol was registered in the
international prospective register of systematic reviews (PROSPERO 2022
CRD42022337353) Copyright © 2025

<75>
Accession Number
2033204427
Title
Prognostic Value of Perioperative Near-Infrared Spectroscopy Monitoring
for Postoperative Acute Kidney Injury in Pediatric Cardiac Surgery: A
Systematic Review.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. (no pagination),
2025. Date of Publication: 2025.
Author
Niezen C.K.; Modestini M.; Massari D.; Bos A.F.; Scheeren T.W.L.; Struys
M.M.R.F.; Vos J.J.
Institution
(Niezen, Modestini, Massari, Scheeren, Struys, Vos) Department of
Anesthesiology, University Medical Center Groningen, University of
Groningen, Groningen, Netherlands
(Niezen) Department of Anesthesiology, Isala Hospital, Zwolle, Netherlands
(Bos) Department of Neonatology, Beatrix Children's Hospital, University
Medical Center Groningen, University of Groningen, Groningen, Netherlands
(Struys) Department of Basic and Applied Medical Sciences, Ghent
University, Gent, Belgium
Publisher
SAGE Publications Inc.
Abstract
Introduction: Postoperative acute kidney injury (AKI) is a common
postoperative complication in cardiac surgery, with varying reported
incidences and prognostic factors. Renal hypoperfusion is believed to be a
key factor contributing to postoperative AKI. Near-infrared spectroscopy
(NIRS) monitoring, which assesses regional tissue saturation
(RSO<inf>2</inf>), has been suggested as a tool to predict postoperative
AKI. The aim of this systematic review was to examine the prognostic value
of perioperative NIRS monitoring in predicting postoperative AKI in
pediatric patients. Methods and Results: After a systematic search in
PubMed, EMBASE, and Cochrane library, twenty studies (1517 patients) were
included. The inter-rater agreement on study quality was strong, yet a
high risk of bias was identified. Conclusion(s): The heterogeneity of
the results-in part attributable to several potential confounding factors
regarding study population, monitoring technique and the definition of
AKI-together with the lack of a clear and consistent association between
RSO<inf>2</inf> values and AKI, currently preclude recommending NIRS
monitoring as a reliable and valid clinical tool to "predict" AKI in the
individual patient. Copyright © The Author(s) 2025.

<76>
Accession Number
2037585176
Title
The Evolving Landscape of TAVR: A JACC Themed Issue.
Source
Journal of the American College of Cardiology. 85(9) (pp 875-877), 2025.
Date of Publication: 11 Mar 2025.
Author
Gupta A.; Krumholz H.M.
Publisher
Elsevier Inc.

<77>
Accession Number
2037662112
Title
TEG 6s-Guided Algorithm for Optimizing Patient Blood Management in
Cardiovascular Surgery: Systematic Literature Review and Expert Opinion.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Maxey-Jones C.; Seelhammer T.G.; Arabia F.A.; Cho B.; Cardonell B.; Smith
D.; Leo V.; Dias J.; Shore-Lesserson L.; Hartmann J.
Institution
(Maxey-Jones) CNY Medical Services, PLLC, Baldwinsville, NY
(Seelhammer) Mayo Clinic, Rochester, MN
(Arabia) Banner Health, Phoenix, AZ
(Cho) Johns Hopkins University, Baltimore, MD
(Cardonell) University of Missouri Columbia, Columbia, MO
(Smith) Spectrum Healthcare Partners, Portland, ME
(Leo, Dias, Hartmann) Haemonetics Corporation, Boston, MA
(Shore-Lesserson) Northwell, New Hyde Park, NY, and Anesthesiology, North
Shore University Hospital, Manhasset, NY
Publisher
W.B. Saunders
Abstract
Objectives: To propose a comprehensive TEG 6s-based intraoperative and/or
immediately postoperative treatment algorithm for bleeding patients
undergoing cardiac surgery. To achieve this, TEG-based treatment
algorithms in cardiac surgery were evaluated through a literature review
and structured expert opinion. Design(s): Systematic literature
review. Setting(s): Cardiac surgery. Participant(s): Adult
patients undergoing cardiac surgery with intraoperative and/or immediately
postoperative bleeding. Intervention(s): TEG-guided transfusion
algorithm. Measurements and Main Results: A literature search was
conducted for original studies reporting TEG-based treatment algorithms in
cardiac surgery settings. Of 304 identified manuscripts, fourteen met all
inclusion criteria, with two further articles identified through authors'
suggestions. There is limited evidence describing the use of TEG 6s assays
in cardiac surgery with only one study reporting a dedicated algorithm
using the TEG 6s device at a non-US center. Two additional studies
assessed TEG 6s assays. The remaining manuscripts reported algorithms
based on the TEG 5000 device. Following the author's review of the
available data, and feedback from expert opinion, a simple transfusion
algorithm was proposed as an initial framework for developing a TEG
6s-based protocol with consideration for the 2021 Society of Thoracic
Surgery/Society of Cardiovascular Anesthesiologists/American Society of
Extracorporeal Technology/Society for the Advancement of Patient Blood
Management Patient Blood Management Guidelines. Conclusion(s): A new
algorithm for cardiac surgery based on TEG 6s assays has been proposed
based on the available evidence and expert opinion for research alignment
and clinical validation. Copyright © 2025 The Author(s)

<78>
Accession Number
2037690496
Title
Comparison of the effects of an opioid-free anesthetic protocol with two
opioid-based protocols on the intraoperative cardiovascular response and
postoperative pain in cats undergoing elective ovariohysterectomy: A
prospective, randomized, blinded, clinical study.
Source
Topics in Companion Animal Medicine. 65 (no pagination), 2025. Article
Number: 100963. Date of Publication: 01 Mar 2025.
Author
Correia B.S.; Monteiro E.R.; Ferronatto J.V.B.; Pinho I.S.D.L.R.; Surita
L.E.; Alievi M.M.
Institution
(Correia, Monteiro, Ferronatto, Pinho, Surita, Alievi) Faculty of
Veterinary Medicine, Federal University of Rio Grande do Sul, Rio Grande
do Sul, Porto Alegre, Brazil
Publisher
W.B. Saunders
Abstract
This study compared the cardiovascular response to surgery and
postoperative pain between an opioid-free protocol and two opioid-based
protocols in cats undergoing elective ovariohysterectomy. Cats were
randomly allocated into three intramuscular premedication treatments: DEX
(dexmedetomidine 7 microg/kg, n = 12), DEXMET (dexmedetomidine 7 microg/kg
+ methadone 0.3 mg/kg, n = 13) and DEXMOR (dexmedetomidine 7 microg/kg +
morphine 0.3 mg/kg, n = 14). Preoperatively, all cats received meloxicam
0.1 mg/kg, subcutaneously. Anesthesia was induced with propofol and
maintained with sevoflurane. Heart rate (HR) and systolic arterial
pressure (SAP) were measured intraoperatively. Pain was assessed before
premedication (Baseline) and postoperatively for 6 h using the Glasgow
Composite Measure Pain Scale - Feline (CMPS-F) and Feline Grimace Scale
(FGS). Rescue analgesia was given for CMPS-F scores >= 5. In all groups,
HR and SAP increased intraoperatively, but tachycardia (HR > 200
beats/min) or hypertension (SAP > 180 mmHg) did not occur. Postoperative
CMPS-F scores were lower in DEXMET than in DEX; FGS scores in DEX and
DEXMOR were higher than in DEXMET. Rescue analgesia was administered to 50
%, 23 % and 29 % cats in groups DEX, DEXMET and DEXMOR, respectively (p >
0.05). The odds ratio (95 % confidence interval) of receiving
postoperative rescue analgesia within 6 h for opioid-free versus
opioid-based techniques was 2.86 (0.76-11.43). All protocols allowed
surgery to be performed without an exacerbated cardiovascular response.
Incorporating methadone or morphine in the protocol decreased the odds of
requiring postoperative rescue analgesia. Copyright © 2025
Elsevier Inc.

<79>
Accession Number
2037661777
Title
Computed tomography coronary angiography as an alternative to invasive
coronary angiography in preoperative evaluation for mitral surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2025.
Date of Publication: 2025.
Author
Patil A.R.; Zheng A.; Israel Y.; Shah A.; El-Eshmawi A.; Pandis D.;
Anyanwu A.C.; Adams D.H.; Boateng P.
Institution
(Patil, Zheng, El-Eshmawi, Pandis, Anyanwu, Adams, Boateng) Mount Sinai
Health System, New York, NY
(Israel) Icahn School of Medicine, New York, NY
(Shah) Quality Operations and Clinical Data Registries, Icahn School of
Medicine at Mount Sinai, New York, NY
Publisher
Elsevier Inc.
Abstract
Objective: To assess the effectiveness of noninvasive coronary computed
tomography angiography (CTA) as an alternative to traditional invasive
coronary angiography (ICA) for preoperative evaluation of low-risk
patients with an indication for nonemergent mitral surgery and to assess
any difference in adverse outcomes from this strategy. Method(s):
This was a retrospective cohort study from a single center with data
collected from July 2014 to June 2020 for 1576 patients undergoing mitral
valve surgery of all etiologies, excluding patients requiring coronary
artery bypass surgery. We performed a 1:2 propensity score matching for
patients evaluated with CTA (n = 345) to those evaluated with ICA (n =
602). The primary outcome was a composite of major adverse events in the
immediate postoperative period, including death, stroke, new-onset renal
failure, postoperative cardiac arrest, need for unplanned coronary artery
bypass grafting or percutaneous coronary re-vascularization. The odds
ratio was calculated for occurrence of major adverse events in the CTA
group compared with the catheterization group. Result(s): The mean
age (standard deviation) was 55.62 years (11.54) for the CTA group and
58.22 years (10.11) for the ICA group. In the CTA group 334 (96.8%) and
from the ICA group 582 (96.7%) patients underwent mitral valve repair.
Thirteen (3.8%) patients in the CTA group experienced a major adverse
event compared with 25 (4.2%) patients in the ICA group. Of these, there
were no mortalities in the CTA group but 1 (0.2%) operative mortality in
the ICA group. Four (1.2%) patients in the CTA group had a postoperative
stroke compared with 3 (0.5%) patients in the ICA group. One (0.3%)
patient in the CTA group required renal-replacement therapy
postoperatively compared with 11 (1.8%) in the ICA group. Percutaneous
coronary intervention was required in 1 (0.3%) patient in CTA group and 2
(0.3%) patients in ICA group for a coronary complication of valve surgery
despite nonobstructive coronary anatomy being confirmed in both groups
preoperatively. The odds ratio for having a major adverse event when
worked up by CTA compared with ICA was 0.904 (0.443, 1.761).
 Conclusion(s): There were no increased odds of experiencing a major
adverse event for low-risk patients undergoing elective mitral valve
surgery and preoperative coronary evaluation with CTA compared with ICA.
These data have modified our practice pattern, where we now offer coronary
CTA to all elective patients who are low risk for coronary artery
disease. Copyright © 2025 The American Association for Thoracic
Surgery

<80>
Accession Number
2037693617
Title
Similar Goals, Divergent Paths: Exploring Approaches to Hepatitis C
Treatment Protocols in Heart Transplantation.
Source
Journal of Cardiac Failure. (no pagination), 2025. Date of Publication:
2025.
Author
Rao R.A.; Abraham S.O.N.U.; Vest A.R.; Munnagala M.; Bhardwaj A.N.J.U.;
Contreras J.; Rajapreyer I.; Hall S.
Institution
(Rao) Division of Cardiovascular Medicine, Indiana University School of
Medicine, Indianapolis, IN, United States
(Abraham) Division of Cardiovascular Medicine, Feinberg School of
Medicine, Northwestern University, Chicago, IL, United States
(Vest) Division of Cardiovascular Medicine, Cleveland Clinic Foundation,
Cleveland, OH, United States
(Munnagala) Department of Cardiology, Miller School of Medicine,
University of Miami, Miami, FL, United States
(Bhardwaj) Department of Cardiology, McGovern Medical School, University
of Texas, Texas Medical Center Houston, Houston, TX, United States
(Contreras) Department of Cardiology, Mount Sinai Medical School, New
York, NY, United States
(Rajapreyer) Department of Cardiology, Tufts Medical Center, Boston, MA,
United States
(Hall) Department of Cardiology, Baylor Scott and White Medical Center
Houston, Dallas, TX, United States
Publisher
Elsevier B.V.
Abstract
Background: Heart transplantation from hepatitis C-positive donors is on
the rise, yet there exists divergence in approaches to managing recipients
of these organs. Practices range from prophylactic treatment of recipients
prior to transplantation to delayed treatment following the detection of
viremia, with no established consensus on the optimal approach.
 Method(s): An online survey was conducted among the heart transplant
centers in the United States and Canada from January 2023-February 2024.
The survey gathered comprehensive information from the institutions
regarding direct antiviral (DAA) therapies used, timing and duration of
DAA, frequency of viral load testing, adverse effects, virological
response, and immunosuppressive therapy modifications. The treatment
pathways were categorized based on the timing of treatment initiation into
prophylactic, preemptive or reactive approaches. Analysis was restricted
to adult transplant programs in the U.S. that had an HCV transplant
protocol and performed at least 1 HCV NAT-positive transplant. The
Scientific Registry of Transplant Recipients database was queried for
total heart transplants using hepatitis C virus nucleic acid testing (HCV
NAT)-positive donors. Result(s): Of 122 heart transplant programs, 35
(28.7%) institutions responded; 689 heart transplants (49.1%) using HCV
NAT-positive donors were captured across institutions. Among 30 U.S.
institutions performing adult heart transplantation with HCV NAT-positive
donor hearts, 5 (16.7%) used prophylactic, 9 (30%) preemptive and 16
(53.3%) reactive treatment pathways. Most employed pan-genotype DAA
therapies for a median of 12 weeks. Significant heterogeneity existed in
treatment and monitoring protocols. Conclusion(s): Practice patterns
for management of HCV NAT-positive donor hearts vary significantly.
Establishing registries and randomized control trials for these patients
is crucial for guiding future practices. Copyright © 2025
Elsevier Inc.

<81>
Accession Number
2033165076
Title
Bempedoic Acid: A Review in Cardiovascular Risk Reduction in
Statin-Intolerant Patients.
Source
American Journal of Cardiovascular Drugs. 25(1) (pp 7-16), 2025. Article
Number: e069116. Date of Publication: 01 Jan 2025.
Author
McGuigan A.; Blair H.A.
Institution
(McGuigan, Blair) Springer Nature, Private Bag 65901, Mairangi Bay,
Auckland, New Zealand
Publisher
Adis
Abstract
Oral bempedoic acid (NEXLETOL in the USA; Nilemdo in
the EU) and the fixed dose combination (FDC) of bempedoic acid/ezetimibe
(NEXLIZET in the USA; Nustendi in the EU) are
approved to reduce cardiovascular (CV) risk in statin-intolerant patients
who are at high risk for, or have, CV disease. A first-in-class therapy,
bempedoic acid inhibits the adenosine triphosphate-citrate lyase enzyme in
the cholesterol biosynthesis pathway. In the multinational phase III CLEAR
Outcomes trial in statin-intolerant patients, once-daily bempedoic acid
180 mg significantly reduced the risk of the primary endpoint (a
four-component major adverse CV event composite of CV death, nonfatal
myocardial infarction, nonfatal stroke, or coronary revascularization)
compared with placebo. Bempedoic acid was generally well tolerated and,
unlike statins, was associated with a low incidence of musculoskeletal
adverse events (AEs). In conclusion, bempedoic acid as a monotherapy or
adjunctive to other lipid-lowering therapies expands the treatment options
available for the pharmacological reduction of CV risk in
statin-intolerant patients, supporting achievement of low-density
lipoprotein cholesterol (LDL-C) targets required for CV risk
reduction. Copyright © Springer Nature Switzerland AG 2025.

<82>
Accession Number
646631202
Title
Cardiovascular Outcomes With Icosapent Ethyl by Baseline Low-Density
Lipoprotein Cholesterol: A Secondary Analysis of the REDUCE-IT Randomized
Trial.
Source
Journal of the American Heart Association. (pp e038656), 2025. Date of
Publication: 19 Feb 2025.
Author
Aggarwal R.; Bhatt D.L.; Steg P.G.; Miller M.; Brinton E.A.; Dunbar R.L.;
Ketchum S.B.; Tardif J.-C.; Martens F.M.A.C.; Ballantyne C.M.; Szarek M.;
Mason R.P.
Institution
(Aggarwal, Mason) Brigham and Women's Hospital Heart and Vascular Center
Harvard Medical School Boston MA
(Bhatt) Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at
Mount Sinai New York NY
(Steg) Universite de Paris, FACT (French Alliance for Cardiovascular
Trials), Hopital Bichat, Assistance Publique-Hopitaux de Paris
(Miller) Department of Medicine Crescenz Veterans Affairs Medical Center
and University of Pennsylvania School of Medicine Philadelphia PA
(Brinton) Utah Lipid Center Salt Lake City UT
(Dunbar, Ketchum) Amarin Pharma, Inc. Bridgewater NJ
(Dunbar) Department of Medicine Perelman School of Medicine at the
University of Pennsylvania Philadelphia PA
(Tardif) Montreal Heart Institute, Universite de Montreal Montreal Quebec
Canada, Canada
(Martens) Department of Cardiology Amsterdam UMC Amsterdam The
Netherlands, Netherlands
(Ballantyne) Department of Medicine Baylor College of Medicine
(Szarek) Division of Cardiology University of Colorado School of Medicine
Aurora CO
(Szarek) CPC Clinical Research Aurora CO
(Szarek) State University of New York, Downstate Health Sciences
University Brooklyn NY
(Mason) Elucida Research LLC Beverly MA
Abstract
BACKGROUND: The efficacy of icosapent ethyl among patients with very
well-controlled baseline low-density lipoprotein cholesterol (LDL-C) is
unknown. METHOD(S): In this post hoc analysis of the REDUCE-IT
(Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention
Trial) randomized clinical trial, statin-treated patients with high
cardiovascular risk, elevated triglycerides (135-499 mg/dL), and baseline
LDL-C of 41 to 100 mg/dL were included. Patients were randomized to
icosapent ethyl (2 g twice daily) or placebo and then post hoc stratified
by baseline LDL-C (<55 mg/dL versus >=55 mg/dL). The primary composite end
point included cardiovascular death, nonfatal myocardial infarction,
nonfatal stroke, coronary revascularization, or unstable angina.
 RESULT(S): Among 8175 patients with baseline LDL-C data, 7117 (87.1%)
had LDL-C >=55 mg/dL and 1058 (12.9%) had LDL-C <55 mg/dL. In patients
with LDL-C <55 mg/dL, the rate of the primary composite end point was
lower in the icosapent ethyl group (16.2% versus 22.8%) than in the
placebo group (hazard ratio [HR], 0.66 [95% CI, 0.50-0.87]; absolute risk
reduction, 6.6%; P=0.003). Among patients with LDL-C >=55 mg/dL, a primary
composite end point event occurred in a lower proportion of patients in
the icosapent ethyl group (17.4% versus 21.9%) than in the placebo group
(HR, 0.76 [95% CI, 0.69-0.85]; absolute risk reduction, 4.5%; P<0.0001).
No significant interaction was observed between baseline LDL-C and
treatment group (P for interaction=0.40). Findings were consistent among
secondary cardiovascular end points and in sensitivity analyses.
 CONCLUSION(S): Among statin-treated patients with elevated
triglycerides and high cardiovascular risk, icosapent ethyl reduced the
rate of cardiovascular end points irrespective of baseline LDL-C,
including among eligible patients with optimal LDL-C control.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier:
NCT01492361.

<83>
Accession Number
646634076
Title
Feasibility of coronary access after transcatheter aortic valve
implantation (TAVI): a systematic review and metanalysis of observational
studies.
Source
European heart journal. Quality of care & clinical outcomes. (no
pagination), 2025. Date of Publication: 19 Feb 2025.
Author
Giacobbe F.; Morena A.; Bruno F.; Nebiolo M.; De Filippo O.; Odeh Y.;
Pietro G.D.; Cabau J.R.; Conrotto F.; Kini A.; Giannino G.; Latib A.;
Omede P.; Noble S.; La Torre M.W.; Barbanti M.; Tarantini G.; Kim W.-K.;
Blumenstein J.; Boukantar M.; Htun W.W.; de Ferrari G.M.; Salizzoni S.;
D'Ascenzo F.
Institution
(Giacobbe, Morena, Bruno, Nebiolo, De Filippo, Odeh, Conrotto, Giannino,
Omede, de Ferrari, D'Ascenzo) Division of Cardiology, Cardiovascular and
Thoracic Department, Citta della Salute e della Scienza, Turin, Italy
(Giacobbe, Morena, Nebiolo, Odeh, Giannino, de Ferrari, D'Ascenzo)
Division of Cardiology, Department of Medical Sciences, University of
Turin, Italy
(Pietro) Department of Clinical, Internal, Anesthesiology and
Cardiovascular Sciences, Sapienza University of Rome, Viale del
Policlinico, 155, 00161 Rome, Italy
(Cabau) Quebec Heart & Lung Institute, Laval University, Quebec City, QC,
Canada
(Kini) Division of Cardiology, Mount Sinai Medical Center, Icahn School of
Medicine at Mount Sinai, NY, United States
(Latib) Montefiore-Einstein Center for Heart and Vascular Care, Montefiore
Medical Center, Albert Einstein College of Medicine, Bronx, NY, United
States
(Noble) Cardiology Division of the University Hospital of Geneva,
Switzerland
(La Torre, Salizzoni) Division of Cardiac Surgery, Cardiovascular and
Thoracic Department, Citta della Salute e della Scienza, Turin, Italy
(Barbanti) Universita degli Studi di Enna "Kore", Enna, Italy
(Tarantini) Cardiology Clinic, Department of Cardiac, Thoracic, Vascular
Sciences and Public Health Padova, University of Padua, Italy
(Kim, Blumenstein) Department of Cardiology, Kerckhoff Heart and Thorax
Center, Bad Nauheim, Germany
(Boukantar) Department of Cardiovascular, Henri Mondor University
Hospital, Creteil, France
(Htun) Department of Cardiology, Detroit Medical Center/Wayne State
University, Detroit, MI, United States
(Htun) Department of Cardiothoracic Surgery, Lenox Hill Hospital,
Northwell Health, NY, United States
Abstract
INTRODUCTION: The expanding indications for transcatheter aortic valve
implatation (TAVI) to younger, lower-risk patients, entails assessing not
only the short-term clinical outcomes but also the long-term
considerations for future interventions. The prevalence of coronary artery
disease (CAD) in TAVI patients is relevant, and the optimal timing of
percutaneous coronary intervention (PCI) remains a question.
 METHOD(S): We conducted a systematic literature review and meta
analysis including 20 eligible studies involving 1660 patients who
underwent coronary angiography after TAVI. 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 TAVI was feasible
in the majority of patients, with a higher success rate observed for the
left main (LM) compared to the right coronary artery (RCA). BEVs
demonstrated the highest success rates in coronary ostia cannulation,
achieving nearly 100% success for both LM and RCA. Among SEVs, the Acurate
Neo and Evolut R/PRO showed superior success rates in selective coronary
access (68% and 77% for LM; 57% and 72% for RCA, respectively) compared to
the CoreValve (46% for LM and 49% 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). CONCLUSION(S): Selective coronary engagement
after TAVI is generally achievable, with BEVs demonstrating superior
success rates compared to SEVs. Among SEVs, the Acurate NEO showed better
outcomes than the other types. Copyright © The Author(s) 2025.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<84>
Accession Number
2037634074
Title
Intravenous amino acids for renal protection in patients receiving
temporary mechanical circulatory support: a secondary subgroup analysis of
the PROTECTION study.
Source
European Journal of Cardio-thoracic Surgery. 67(2) (no pagination), 2025.
Article Number: ezaf035. Date of Publication: 01 Feb 2025.
Author
Belletti A.; Pisano A.; Scandroglio A.M.; Garofalo E.; Calabro M.G.;
Ferrod F.; Monaco F.; Brambillasca C.; Baiardo Redaelli M.; Meroi F.;
Fominskiy E.; Vignale R.; Ajello S.; Venditto M.; Scquizzato T.; Porta S.;
Losiggio R.; Suriano P.; Pontillo D.; Orso D.; Tomasi E.; Paternoster G.;
Lomivorotov V.; Longhini F.; Landoni G.; Zangrillo A.; Maisano F.; Bellomo
R.; Pieri M.; D'Amico F.; Manazza M.; Marmiere M.; Marzaroli M.; Monti G.;
Oliva F.M.; Pruna A.; Turi S.; Veneziano M.; Vietri S.; Zaraca L.; Fraja
D.D.; Verniero L.; Bruni A.; Perrelli G.; Prezzi L.; Massaro C.; Ferrante
P.; Arangino C.; Angelini F.; Bacchetti G.; Vitielli M.; Gallicchio F.;
Bradic N.; Ti L.K.
Institution
(Belletti, Scandroglio, Calabro, Monaco, Brambillasca, Baiardo Redaelli,
Fominskiy, Ajello, Scquizzato, Losiggio, Pontillo, Landoni, Zangrillo,
Pieri) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Pisano, Venditto, Porta) Monaldi Hospital, Cardiac Anesthesia and ICU,
AORN "Dei Colli, Naples, Italy
(Garofalo, Longhini) Department of Medical and Surgical Sciences, Magna
Graecia University of Catanzaro, Anesthesia and Intensive Care, Catanzaro,
Italy
(Ferrod) S.C. Anestesia e Rianimazione Cardiovascolare, A.O. Ordine
Mauriziano Umberto I di Torino, Torino, Italy
(Suriano) Dipartimento di Chirurgia Cardiovascolare, IRCCS Centro
Cadiologico Monzino, Unita Operativa di Anestesia E Terapia Intensiva,
Milan, Italy
(Meroi, Orso) Department of Emergency Santa Maria della Misericordia,
University Hospital of Udine, Azienda Sanitaria Universitaria Friuli
Centrale, Udine, Italy
(Vignale) San Carlo Hospital, Cardiovascular Anesthesia and ICU, Potenza,
Italy
(Tomasi) IRCCS San Raffaele Scientific Institute, Hospital Pharmacy,
Milan, Italy
(Paternoster) Department of Health Science Anesthesia and ICU, School of
Medicine,, University of Basilicata, San Carlo Hospital, Potenza, Italy
(Lomivorotov) Department of Anesthesiology and Perioperative Medicine,
Penn State Milton S. Hershey Medical Center, Penn State College of
Medicine, Hershey, PA, United States
(Landoni, Zangrillo, Maisano, Pieri) School of Medicine, Vita-Salute San
Raffaele University, Milan, Italy
(Maisano) Cardiac Surgery Department, San Raffaele University Hospital,
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) Department of Intensive Care, Royal Melbourne Hospital,
Melbourne, Australia
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: In cardiac surgery patients, acute kidney injury (AKI)
frequently occurs in the setting of haemodynamic instability and treatment
with temporary mechanical circulatory support (tMCS). Recent evidence
suggests amino acids (AA) infusion may reduce AKI rate. However, the
effect of AA infusion in patients requiring tMCS may be less effective.
 METHOD(S): We performed a secondary analysis of the PROTECTION
multicentre randomized controlled trial including all patients treated
with tMCS. Patients undergoing elective cardiac surgery with
cardiopulmonary bypass were randomized to receive 2 g/kg ideal body
weight/day of intravenous AA to a maximum of 100 g/day or matching placebo
from operating room admission until up to 3 days, receipt of
renal-replacement therapy, discharge from ICU or death. The primary
outcome of the PROTECTION study was the rate of AKI, as in this secondary
analysis. A total of 3511 patients were randomized in the study.
 RESULT(S): We studied 232 patients who received tMCS, 112 randomized
to AA infusion and 120 to placebo. The median preoperative serum
creatinine value was significantly higher among AA group patients (AA:
1.08, interquartile range 0.90-1.26; placebo: 0.98, interquartile range
0.85-1.15; P = 0.02). The rate of AKI, however, was lower in patients
randomized to AA (44.6% vs 60.8%; relative risk 0.73; 95% confidence
interval (0.57-0.94); P = 0.01; number needed to treat = 6). We found no
significant differences in secondary outcomes. CONCLUSION(S):
Short-term AA infusion appears to reduce rate of AKI among patients
requiring tMCS. Use of AA in this population at high-risk for renal
failure appears justified. Copyright © 2025 The Author(s).

<85>
Accession Number
646630093
Title
No-touch vein grafts in coronary artery bypass surgery: a registry-based
randomized clinical trial.
Source
European heart journal. (no pagination), 2025. Date of Publication: 19
Feb 2025.
Author
Thelin S.; Modrau I.S.; Duvernoy O.; Dalen M.; Dreifaldt M.; Ericsson A.;
Friberg O.; Holmgren A.; Hostrup Nielsen P.; Hultkvist H.; Jensevik
Eriksson K.; Jeppsson A.; Liden M.; Nozohoor S.; Ragnarsson S.; Sartipy
U.; Ternstrom L.; Themudo R.; Vikholm P.; James S.
Institution
(Thelin, Vikholm) Department of Thoracic Surgery, Uppsala University
Hospital, Uppsala, Sweden
(Thelin, Vikholm) Department of Surgical Sciences, Thoracic Surgery,
Uppsala University, Sweden
(Modrau, Hostrup Nielsen) Department of Cardiothoracic and Vascular
Surgery, Aarhus University Hospital, Aarhus, Denmark
(Modrau) Department of Clinical Medicine, Aarhus University, Aarhus,
Denmark
(Duvernoy) Department of Surgical Sciences, Radiology, Uppsala University,
Sweden
(Dalen, Sartipy) Department of Cardiothoracic Surgery, Karolinska
University Hospital, Stockholm, Sweden
(Dalen, Sartipy) Department of Molecular Medicine and Surgery, Karolinska
Institutet, Stockholm, Sweden
(Dreifaldt, Friberg) Department of Cardiovascular and Thoracic Surgery,
Orebro University, Sweden
(Ericsson) Department of Thoracic Surgery, Blekinge Hospital, Karlskrona,
Sweden
(Holmgren) Department of Public Health and Clinical Medicine, Umea
University, Umea, Sweden
(Hultkvist) Department of Cardiothoracic and Vascular Surgery, Linkoping
University Hospital, Linkoping, Sweden
(Hultkvist) Department of Health, Medicine and Caring Sciences, Unit of
Cardiovascular Medicine, Linkoping University, Linkoping, Sweden
(Jensevik Eriksson, James) Uppsala Clinical Research Center, Uppsala
University, Sweden
(Jeppsson, Ternstrom) Department of Cardiothoracic Surgery, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Jeppsson) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
(Liden) Department of Radiology, Faculty of Medicine and Health, Orebro
University, Sweden
(Nozohoor, Ragnarsson) Department of Cardiothoracic and Vascular Surgery,
Skane University Hospital, Lund, Sweden
(Nozohoor, Ragnarsson) Department of Clinical Sciences, Lund University,
Lund, Sweden
(Themudo) Department of Clinical Science, Intervention and Technology,
Karolinska Institutet, Stockholm, Sweden
(James) Department of Medical Sciences, Cardiology, Uppsala University
Hospital, Uppsala, Sweden
Abstract
BACKGROUND AND AIMS: No-touch saphenous vein harvesting may enhance graft
patency and improve clinical outcomes after coronary artery bypass
grafting (CABG). METHOD(S): In this registry-based, randomized trial,
patients undergoing CABG were randomly assigned to no-touch or
conventional harvesting. The primary composite outcome was the proportion
of patients with occluded/stenosed >50% vein graft on coronary computed
tomography angiography, or who underwent percutaneous coronary
intervention to a vein graft, or died. Secondary outcomes included
clinical outcomes and leg wound complications. RESULT(S): A total of
902 patients were enrolled with a mean total number of distal vein
anastomoses of 2.0 (SD 0.87). The primary endpoint occurred in 90/454
(19.8%) of patients randomized to no-touch and in 107/446 (24.0%) of
patients randomized to the conventional technique [difference, -4.3
percentage points; 95% confidence interval (CI) -10.1-1.6; P = .15] at a
mean follow-up time of 3.5 (SD 0.1) years. The composite of death,
myocardial infarction, or repeat revascularization at 4.4 (SD 1.3) years
occurred in 57/454 (12.6%) and 44/446 (9.9%) in the no-touch and
conventional groups, respectively (hazard ratio 1.3; 95% CI, 0.87-1.93).
Leg wound complications were more common in patients assigned to no-touch
harvesting at 3 months [107/433 (24.7%) vs. 59/427 (13.8%); difference,
10.9 percentage points; 95% CI 5.7-16.1]. At 2 years, 189/381 (49.6%) vs.
91/361 (25.2%) had remaining leg symptoms (difference, 24.4 percentage
points; 95% CI 17.7-31.1). CONCLUSION(S): No-touch vein graft
harvesting for CABG was not superior to conventional open harvesting in
reducing vein graft failure or clinical events after CABG but increased
leg wound complications. The primary outcome requires cautious
interpretation due to a lower-than-expected number of primary
events. Copyright © The Author(s) 2025. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<86>
Accession Number
2035751487
Title
ROLE OF TRIMETAZIDINE IN PREVENTING MYOCARDIAL INJURY IN PATIENTS
UNDERGOING OFF PUMP CABG.
Source
International Journal of Medicine and Public Health. 15(1) (pp 581-585),
2025. Date of Publication: 01 Jan 2025.
Author
Iqbal K.; Mir B.A.; Siddique S.; Wani I.A.; Iram N.I.; Manjubhargava P.;
Mehmood S.
Institution
(Iqbal) Department of CTVS at Eras Lucknow Medical College and Hospital,
India
(Mir) Department of Microbiology at Era's Lucknow Medical College and
Hospital, India
(Siddique, Manjubhargava, Mehmood) Department of Cardiology at Era's
Lucknow Medical College and Hospital, India
(Wani) Department of Cardiology at Career Institute of Medical Sciences
and Hospital, India
(Iram) Department of Pathology at Era's Lucknow Medical College and
Hospital, India
Publisher
Pink Petals Publications Pvt Ltd
Abstract
Background: Off-Pump coronary artery bypass graft surgery (OPCABG)
continues to be the main stay of surgical coronary revascularization for
coronary artery disease in India. We evaluated the role of Trimetazidine
(TMZ) in prevention of myocardial injury in patients undergoing OPCABG.
 Material(s) and Method(s): A randomized prospective study was carried
out to evaluate the efficacy of Trimetazidine in the prevention of
myocardial tissue injury by measuring pre-operative and post-operative
levels of cardiac troponin I (cTnI) at 8, 24 and 48 hours in patients
undergoing elective OPCABG surgery. Seventy patients undergoing elective
CABG were included in the study and were randomly (Covariate adaptive
randomization) assigned to two groups, TMZ and Control (no TMZ) group.
Thirty-five patients, received 80 mg of TMZ once daily in the
pre-operative period (started a week before admission), were assigned to
the TMZ group and thirty-five patients who did not receive TMZ, were
assigned to the control group. Result(s): In a study involving 150
enrolled cases, it was observed that 24 individuals experienced
hypoglycemia within the first 72 hours of life. The occurrence of
hypoglycemia observed in our study was 16%. Hypoglycemia occurred more
frequently in neonates born to mothers under the age of 30; however, this
association was not statistically significant. The incidence of
hypoglycemia was observed to be higher in infants born via LSCS. In our
research, we analyzed a total of 150 enrolled cases, of which 112 were
classified as term, 30 as preterm, and 8 as post term. Our research
identified 20 instances classified as small for gestational age (SGA).
Among these, 13 were categorized as Term SGA, while 7 were identified as
Preterm SGA. Conclusion(s): Despite similar pre-operative baseline
characteristics and pre-operative cTnI values, post-operative cTnI values
showed a rising trend in both the groups, with the values peaking at 8
hours and thereafter following a gradual declining trend at 24 and 48
hours. However, the rise in cTnI levels, were significantly higher in the
control group as compared to the TMZ group, in the post-operative
period. Copyright © 2025, Pink Petals Publications Pvt Ltd. All
rights reserved.

<87>
Accession Number
2033334296
Title
Heart disease in pregnancy and adverse outcomes: an umbrella review.
Source
Frontiers in Medicine. 12 (no pagination), 2025. Article Number: 1489991.
Date of Publication: 2025.
Author
Zhang J.; Ren Y.; Li B.; Cao Q.; Wang X.; Yu H.
Institution
(Zhang, Ren, Wang, Yu) Department of Obstetrics and Gynecology, West China
Second University Hospital, Sichuan University, Sichuan, Chengdu, China
(Zhang, Ren, Cao, Wang, Yu) Key Laboratory of Birth Defects and Related
Diseases of Women and Children (Sichuan University), Ministry of
Education, Sichuan, Chengdu, China
(Li) Clinical Trial Center, National Medical, Products Administration Key
Laboratory for Clinical Research and Evaluation of Innovative Drugs, West
China Hospital, Sichuan University, Sichuan, Chengdu, China
(Cao) Department of Reproductive Medical Center, West China Second
University Hospital, Sichuan University, Sichuan, Chengdu, China
Publisher
Frontiers Media SA
Abstract
Background: Heart disease in pregnancy encompasses both congenital heart
disease and maternal-acquired heart disease, both of which are associated
with an increased risk of various adverse outcomes for mothers and their
offspring. Objective(s): The objective of the study was to review and
summarize the evidence regarding the association between heart disease in
pregnancy and adverse outcomes in mothers and their offspring. Data
sources: A comprehensive search was conducted in Embase, PubMed, Web of
Science, and the Cochrane Database of Systematic Reviews from inception to
March 2024. The protocol for this review was registered in PROSPERO
(CRD42024519144). Study eligibility criteria: This review included
systematic reviews and meta-analyses that examined the association between
heart disease in pregnancy and adverse outcomes for mothers and their
offspring. Study appraisal and synthesis methods: Data were independently
extracted by two reviewers. The quality of the systematic reviews and
meta-analyses was assessed using the A Measurement Tool to Assess
Systematic Reviews 2 (AMSTAR2), while Grading of Recommendations,
Assessment, Development, and Evaluation (GRADE) was used to evaluate the
strength of the evidence for each outcome. Result(s): A total of 12
meta-analyses and systematic reviews were included, which documented 156
adverse outcomes for mothers and 65 adverse outcomes for offspring.
Evidence was found for both primary and secondary adverse outcomes.
Adverse outcomes for mothers were death, cardiac events (cardiac arrest,
heart failure, surgery, arrhythmia, anesthesia or sedation, endocarditis,
mitral regurgitation, myocardial infarction, NYHA III-IV, restenosis,
syncope, and others), pulmonary events (respiratory failure, pulmonary
edema, and respiratory support), embolism, cerebrovascular events,
postpartum hemorrhage, arterial events, delivery mode, and hospital stay.
Adverse outcomes for offspring were death, pregnancy loss, growth
restriction, low birth weight, preterm birth, recurrence, and uncertainty.
No publication bias was detected using Egger's test. The overall AMSTAR 2
confidence rating for the included meta-analyses and systematic reviews
was moderate. The majority (55.3%) of the evidence evaluated by GRADE was
of low quality, while the remaining outcomes were categorized as having
"very low"-quality evidence. Conclusion(s): Current evidence links
heart disease during pregnancy to adverse maternal outcomes, including
death and cardiac, pulmonary, and cerebrovascular events, as well as
increased mortality risk for offspring. Many meta-analyses in this field
have limitations that raise concerns about their validity, highlighting
the need for high-quality prospective studies. Copyright © 2025
Zhang, Ren, Li, Cao, Wang and Yu.

<88>
Accession Number
646638406
Title
Transcatheter aortic valve implantation vs. surgery for failed
bioprosthesis: a meta-analysis of over 20 000 patients.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 26(3) (pp 153-166),
2025. Date of Publication: 01 Mar 2025.
Author
Comentale G.; Ahmadi-Hadad A.; Moldon H.J.; Carbone A.; Manzo R.; Franzone
A.; Piccolo R.; Bossone E.; Esposito G.; Pilato E.
Institution
(Comentale, Ahmadi-Hadad, Moldon, Pilato) Division of Cardiac Surgery
(Carbone) Division of Cardiology, University of Campania 'L. Vanvitelli'
(Carbone, Bossone) Department of Public Health, University of Naples
'Federico II', Naples, Italy
(Manzo, Franzone, Piccolo, Esposito) Division of Cardiology, Department of
Advanced Biomedical Sciences, University of Naples 'Federico II'
Abstract
OBJECTIVES: Valve-in-valve transcatheter aortic valve implantation
(ViV-TAVI) has gained popularity as a less invasive alternative to a redo
surgical aortic valve replacement (redo-SAVR); which one is the preferred
technique in these cases, however, remains a topic of debate, as the
available data refer to retrospective studies with few patients or limited
follow-up. The present metanalysis aimed to compare the short-term and
long-term outcomes of the two techniques in the setting of a failed
surgical bioprosthesis. METHOD(S): PubMed, MEDLINE, and Embase were
searched on 10 November 2023 yielding 355 results (PROSPERO ID:
CRD42023490612), of which 27 were suitable for meta-analysis. The primary
outcomes were short-term and long-term all-causes and cardiovascular
mortality. Logarithmic risk ratio (Log RR) and mean difference were used
for categorical and continuous data, respectively. RESULT(S): Both
redo-SAVR and ViV-TAVI exhibited similar procedural and short-term
mortality. However, ViV-TAVI demonstrated lower 1-year mortality [RR:
0.74, 95% confidence interval (CI) (0.57-0.96), P = 0.02], acute kidney
injury (RR: 0.47, P < 0.001), bleeding (RR: 0.44, P < 0.001), stroke (RR:
0.70, P < 0.05), and new pacemaker implantation (RR: 0.69, P < 0.05).
Conversely, redo-SAVR demonstrated more favorable mean postoperative
aortic valve gradients [mean difference 2.59, 95% CI (0.86-4.31), P <
0.01]. CONCLUSION(S): Short-term mortality was similar between the
groups, but ViV-TAVI showed better survival at 1 year as well as reduced
rates of acute kidney injury, bleeding, stroke, and pacemaker
implantation. However, redo-SAVR leads to a better hemodynamic profile.
Even if collected data come from retrospective studies, the present
results could help to guide the choice of the best approach case-by-case
according to the patient's clinical profile. Copyright © 2025 The
Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the
Italian Federation of Cardiology.

<89>
Accession Number
646632708
Title
Early vs Delayed Bypass Surgery in Patients With Acute Coronary Syndrome
Receiving Ticagrelor: The RAPID CABG Randomized Open-Label Noninferiority
Trial.
Source
JAMA surgery. (no pagination), 2025. Date of Publication: 19 Feb 2025.
Author
So D.Y.F.; Wells G.A.; Lordkipanidze M.; Chong A.Y.; Ruel M.; Perrault
L.P.; Le May M.R.; Sun L.; Tran D.; Labinaz M.; Glover C.; Russo J.;
Welman M.; Chan V.; Chen L.; Bernick J.; Rubens F.; Tanguay J.-F.
Institution
(So, Chong, Le May, Labinaz, Glover, Russo) Division of Cardiology,
Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON,
Canada
(Wells, Chen, Bernick) Cardiovascular Research Methods Centre, Department
of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
(Lordkipanidze, Welman) Montreal Heart Institute Research Centre,
Montreal, QC, Canada
(Lordkipanidze) Faculty of Pharmacy, University of Montreal, Montreal, QC,
Canada
(Ruel, Chan, Rubens) Division of Cardiac Surgery, Department of Surgery,
University of Ottawa Heart Institute, Ottawa, ON, Canada
(Perrault) Division of Cardiac Surgery, Department of Surgery, Montreal
Heart Institute, Montreal, QC, Canada
(Sun, Tran) Division of Cardiac Anesthesia, Department of Anesthesiology,
University of Ottawa Heart Institute, Ottawa, ON, Canada
(Tanguay) Department of Medicine, Montreal Heart Institute, University of
Montreal, Montreal, QC, Canada
Abstract
Importance: Perioperative bleeding is a major concern in patients
receiving ticagrelor for acute coronary syndromes (ACS) when coronary
artery bypass graft (CABG) surgery is required. Objective(s): To
evaluate whether early CABG surgery at 2 to 3 days after ticagrelor
cessation is noninferior to waiting 5 to 7 days. Design, Setting, and
Participant(s): RAPID CABG was a noninferiority, open-label randomized
trial with 6 months of follow-up. Participants were patients with ACS who
had received ticagrelor and required CABG. Patients were enrolled in
tertiary centers in Canada between January 2016 and March 2021. Data were
analyzed from March 2021 to December 2023. Intervention(s): Early or
delayed CABG. Main Outcomes and Measures: The primary outcome was
based on noninferiority comparison of class 3 or 4 universal definition of
perioperative bleeding (UDPB). Noninferiority was prespecified as 8%
between groups. Twelve-hour chest tube drainage was reported as a
noninferiority comparison. Other bleeding, ischemic, and length-of-stay
outcomes were assessed for superiority. Result(s): Among 143
randomized patients, the median (IQR) age was 65 (58-72) years; there were
117 male patients (82%) and 26 female (18%). Of these, 123 patients
(86.0%) underwent surgery in the allocated time frame (per protocol). The
median (IQR) time to surgery was 3 (2-3) days in the early group and 6
(5-7) days in the delayed group (P < .001). In a per-protocol analysis,
severe or massive UDPB occurred in 3 of 65 early-group patients (4.6%) and
3 of 58 patients (5.2%) in the delayed group (between-group difference,
-0.6%; 95% CI, -8.3% to 7.1%; P = .03 for noninferiority). Median (IQR)
chest tube drainage was 470 (330-650) mL vs 495 (380-610) mL
(between-group difference -25 mL; 95% CI, -111.25 to 35; P = .01 for
noninferiority). Median (IQR) hospital stay was 9 (7-13) days and 12
(10-15) days for the early and delayed groups (P < .001). Conclusion and
Relevance: This study found that an early surgical strategy, 2 to 3 days
after ticagrelor cessation, was noninferior in incurring perioperative
bleeding. The data support a reduction in the delay between ticagrelor
cessation and CABG surgery and may decrease hospital length of stay. Trial
Registration: ClinicalTrials.gov Identifier: NCT02668562.

<90>
Accession Number
2035763894
Title
Ex vivo Coronary Angiography: Safety of Iopromide in Cold Preservation of
Pig Hearts.
Source
Brazilian Journal of Cardiovascular Surgery. 40(2) (no pagination), 2025.
Article Number: e20240080. Date of Publication: 2025.
Author
Zhulkov M.O.; Sirota D.A.; Zykov I.S.; Poveshchenko O.V.; Surovtseva M.A.;
Kim I.A.; Protopopov A.V.; Sabetov A.K.; Agaeva K.A.; Makaev A.G.; Nadeev
A.P.; Kliver V.E.; Kliver E.E.; Volkov A.M.; Karmadonova N.A.; Smirnov
Y.M.; Limanskiy A.D.; Tarkova A.R.; Chernyavskiy A.M.
Institution
(Zhulkov, Sirota, Zykov, Poveshchenko, Surovtseva, Kim, Protopopov,
Sabetov, Agaeva, Makaev, Nadeev, Kliver, Volkov, Karmadonova, Smirnov,
Limanskiy, Tarkova, Chernyavskiy) Adult Cardiac Surgery Department,
Meshalkin National Medical Research Center, Novosibirsk, Russian
Federation
(Sirota, Kliver, Chernyavskiy) Department of Cardiovascular Surgery,
Novosibirsk State Medical University, Novosibirsk, Russian Federation
(Poveshchenko, Surovtseva, Kim) Cell Technology Laboratory, Research
Institute of Clinical and Experimental Lymphology - Branch of the
Institute of Cytology and Genetics, Siberian Branch of the Russian Academy
of Sciences, Novosibirsk, Russian Federation
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Objective: To evaluate the effects of intracoronary iopromide (Ultravist,
Germany) administration on the recovery of cardiac pump function and
cardiomyocytes metabolism during ex vivo cold preservation of pig hearts
in the early posttransplant period. Method(s): Three-month-old mini
pigs weighing 73 +/- 2.8 kg were used as experimental models (n=12).
Physiological parameters were obtained with the IntelliVue MP70 system
(Philips, Netherlands). Blood samples were taken from the coronary sinus
to evaluate myocardial ischemia markers - troponin I, creatine
phosphokinase-MB, lactate dehydrogenase, and lactate - and apex biopsy was
performed before and after the ischemia period according to the protocol.
Myocardial samples were taken from the left ventricle and prepared
according to the protocol either. Result(s): Twelve orthotopic heart
transplantations were performed during the study. Sample size was divided
into two groups with six each. Cardiac output was 5.11 (4.99; 5.41) l/min
and 5.77 (4.97; 6.62) l/min (P-0.0009) after 120 minutes of cardiac
activity in both groups. Change of lactate dehydrogenase, creatine
phosphokinase-MB, and troponin I levels in the coronary sinus blood were
significantly higher in the early reperfusion period. However, there were
no statistically significant differences between the groups (P>0.05).
Myocardial oxygen consumption was considerably reduced during reperfusion
but returned to baseline by 60 minutes of postischemia without significant
differences between groups (P>0.05). Conclusion(s): We observed that
intracoronary iopromide administration was safe during the ex vivo stage
cold preservation phase of the study. Intracoronary iopromide
administration did not affect cardiac pump function and cardiomyocytes
metabolism in the early posttransplant period. Copyright © 2025,
Sociedade Brasileira de Cirurgia Cardiovascular. All rights reserved.

<91>
Accession Number
2035765469
Title
Rheumatic Mitral Valve Surgery: Repair or Replacement?.
Source
Brazilian Journal of Cardiovascular Surgery. 40(2) (no pagination), 2025.
Article Number: e20230294. Date of Publication: 2025.
Author
Pereira L.H.O.; Camara K.; Pinheiro T.S.; Lemos M.M.; Oliveira A.L.A.; de
Oliveira M.E.P.; Trindade G.M.; Kanisky M.F.S.; Raksa M.F.; da Silva G.C.;
Manuel V.
Institution
(Pereira, Camara, Pinheiro, Lemos, Kanisky, Raksa, da Silva) Department of
Medicine, Faculdade de Medicina, Universidade Centro de Ensino de Maringa
(UNICESUMAR), Parana, Maringa, Brazil
(Oliveira) Faculdade Pernambucana de Saude (FPS), Pernambuco, Recife,
Brazil
(de Oliveira) Department of Medicine, Faculdade de Medicina, Universidade
Vila Velha (UVV), Espirito Santo, Vila Velha, Brazil
(Trindade) Department of Medicine, Faculdade de Medicina, Centro
Universitario Max Planck (UniMax), Sao Paulo, Indaiatuba, Brazil
(Manuel) Clinica Girassol, Luanda, Angola
(Manuel) Complexo Hospitalar de Doencas Cardio-Pulmonares Cardeal Dom
Alexandre do Nascimento, Luanda, Angola
(Manuel) Instituto do Coracao (InCor), Hospital das Clinicas, Universidade
de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: Rheumatic heart disease remains a public health problem,
especially in developing countries. The mitral valve (MV) is the main
affected cardiac structure, requiring intervention in many cases. The
discussion of which is the best option - repair or replacement - is still
a controversy. Objective(s): To compare the survival of patients with
rheumatic MV submitted to replacement or repair. Method(s): We
systematically reviewed the English literature through PubMed, Literatura
Latino-Americana e do Caribe em Ciencias da Saude (or LILACS), Scientific
Electronic Library Online (or SciELO), and Google Scholar between January
2021 and February 2022, based on the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (or PRISMA) methodology. Articles
with a sample of at least 30 patients who underwent MV replacement or
repair were included. Result(s): Six studies including 2874 patients
were analyzed. Most of the patients were female (2001; 69.6%) with a ratio
of 2.3:1. The ages ranged from 11 to 66 years. The mean follow-up varied
from six to 106 months. In the MV repair group, mortality was 2.5% (62 of
2473) and reoperation was 3.7% (93 of 2473), while in the MV replacement
group, mortality was 8.2% (106 of 1291), and 3.6% (54 of 1475) of the
patients required reoperation. The patient's survival was similar (85% for
repair and 87% for replacement). The main complications post-MV repair or
replacement were stroke (1.8%; 2.5%) and endocarditis (0.5%; 1.3%).
 Conclusion(s): The MV repair had lower mortality and fewer
complications compared to MV replacement. Reoperation rate and survival
are similar. Copyright © 2025, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<92>
Accession Number
646630845
Title
Impact of 3D Printing on Cardiac Surgery in Congenital Heart Diseases: A
Systematic Review and Meta-Analysis.
Source
Arquivos brasileiros de cardiologia. 121(12) (pp e20240430), 2024. Date of
Publication: 01 Nov 2024.
Author
Yahiro D.S.; Cruz M.P.; Ribeiro B.F.C.; Teixeira L.M.; Oliveira M.F.R.M.;
Souza A.L.A.A.G.; Torbey A.F.M.; Silveira J.S.D.; Mesquita C.T.
Institution
(Yahiro, Cruz, Ribeiro, Teixeira, Oliveira, Souza, Torbey, Mesquita)
Universidade Federal Fluminense, Niteroi
(Silveira, Mesquita) Pro-Cardiaco Hospital, Rio de Janeiro, Brazil

<93>
Accession Number
646613955
Title
Effect of sotagliflozin on major adverse cardiovascular events: a
prespecified secondary analysis of the SCORED randomised trial.
Source
The lancet. Diabetes & endocrinology. (no pagination), 2025. Date of
Publication: 13 Feb 2025.
Author
Aggarwal R.; Bhatt D.L.; Szarek M.; Cannon C.P.; Leiter L.A.; Inzucchi
S.E.; Lopes R.D.; McGuire D.K.; Lewis J.B.; Riddle M.C.; Davies M.J.;
Banks P.; Carroll A.K.; Scirica B.M.; Ray K.K.; Kosiborod M.N.; Cherney
D.Z.I.; Udell J.A.; Verma S.; Mason R.P.; Pitt B.; Steg P.G.
Institution
(Aggarwal, Cannon) Brigham and Women's Hospital Heart and Vascular Center,
Harvard Medical School, Boston, MA, United States
(Bhatt) Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at
Mount Sinai, New York, NY, USA
(Szarek) Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at
Mount Sinai, New York, NY, USA; CPC Clinical Research and University of
Colorado Anschutz Medical Campus, Aurora, CO, USA; State University of New
York Downstate School of Public Health, Brooklyn, NY, USA
(Leiter, Verma) Li Ka Shing Knowledge Institute, St Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Inzucchi) Yale School of Medicine, New Haven, CT, United States
(Lopes) Duke University School of Medicine, Durham, NC, United States
(McGuire) University of Texas Southwestern Medical Center and Parkland
Health, Dallas, TX, United States
(Lewis) Vanderbilt University Medical Center, Nashville, TN, United States
(Riddle) Oregon Health and Science University, Portland, OR, USA
(Davies, Banks, Carroll) Lexicon Pharmaceuticals, The Woodlands, TX,
United States
(Scirica) TIMI Study Group, Division of Cardiovascular Medicine, Brigham
and Women's Hospital, Harvard Medical School, Boston, MA, United States
(Ray) Department of Primary Care and Public Health, Imperial College
London, London, United Kingdom
(Kosiborod) Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City, MO, United States
(Cherney) Toronto General Hospital Research Institute, University of
Toronto, University Health Network, Toronto, ON, Canada
(Udell) Women's College Hospital and Peter Munk Cardiac Centre, Toronto
General Hospital, University of Toronto, ON, Canada
(Mason) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, USA; Elucida Research, Beverly, MA, USA
(Pitt) University of Michigan, Ann Arbor, MI, United States
(Steg) Universite Paris-Cite, INSERM U1148 and AP-HP Hopital Bichat,
Paris, France; French Alliance for Cardiovascular Trials, Paris, France
Abstract
BACKGROUND: Sodium-glucose co-transporter (SGLT)-2 inhibitors have shown
consistent benefit in improving heart failure-related outcomes but not
ischaemic cardiovascular events such as myocardial infarction or stroke.
We assessed if the dual SGLT1/2 inhibitor sotagliflozin improves ischaemic
outcomes. METHOD(S): We did a prespecified secondary analysis of the
SCORED trial, which was a double-blind, placebo-controlled, randomised
clinical trial enrolling patients (aged >=18 years) with type 2 diabetes,
chronic kidney disease (estimated glomerular filtration rate [eGFR] 25-60
mL/min per 1.73 m2), and additional cardiovascular risk factors. Patients
at 750 sites in 44 countries were randomly assigned (1:1) to oral
sotagliflozin or placebo via an interactive response technology system
(block size of four; stratified by heart failure-related criteria and
geographical region), with participants, investigators, and study staff,
including those who assessed outcomes, masked to group assignment.
Sotagliflozin treatment was prescribed at 200 mg once a day, with the dose
increased to 400 mg once a day within the first 6 months if tolerated.
Matching placebo was prescribed at the same treatment frequency as the
intervention regimen. A prespecified secondary outcome was total major
adverse cardiovascular events (MACE), which was defined as a composite of
cardiovascular death, non-fatal myocardial infarction, and non-fatal
stroke, assessed as first and subsequent events. Other outcomes included
total myocardial infarction and total stroke (fatal and non-fatal events)
as individual post-hoc endpoints. Outcomes were assessed by intention to
treat with competing-risk proportional hazard models in the overall
population, and, for total MACE, in prespecified subgroups stratified by
baseline demographic and clinical features (sex, age, geographical region,
heart failure-related criteria, eGFR, urine albumin-creatinine ratio, and
cardiovascular disease history). The SCORED trial was registered at
ClinicalTrials.gov, NCT03315143, and was ended early due to loss of
funding. FINDINGS: 10 584 patients were enrolled and randomly assigned to
sotagliflozin (n=5292 [50.0%]) or placebo (n=5292 [50.0%]) between Dec 8,
2017 and Jan 20, 2020 (median age 69 years [IQR 63-74]; 4754 [44.9%]
female patients and 5830 [55.1%] male patients). 5144 (48.6%) patients had
a history of cardiovascular disease, of whom 2108 (19.9% of the total
population) had a history of myocardial infarction, 946 (8.9%) had a
history of stroke, and 2375 (22.4%) had a history of coronary
revascularisation. Patients in the sotagliflozin group had a significantly
lower rate of total MACE than those in the placebo group (4.8 events per
100 person-years vs 6.3 events per 100 person-years; hazard ratio [HR]
0.77 [95% CI 0.65-0.91]; p=0.0020). Interaction analyses suggested a
consistent effect of sotagliflozin on total MACE among stratified
subgroups without evidence of heterogeneity. Additionally, sotagliflozin
significantly reduced the rate of myocardial infarction (1.8 events per
100 person-years vs 2.7 events per 100 person-years; HR 0.68 [0.52-0.89];
p=0.0041) and stroke (1.2 events per 100 person-years vs 1.8 events per
100 person-years; HR 0.66 [0.48-0.91]; p=0.012) compared with placebo.
INTERPRETATION: Sotagliflozin reduced MACE, with independent reductions in
myocardial infarction and stroke, among patients with type 2 diabetes,
chronic kidney disease, and additional cardiovascular risk. The ischaemic
benefit on both myocardial infarction and stroke has not been previously
observed with other SGLT inhibitors and warrants investigation of combined
SGLT1 and SGLT2 inhibition as a possible underlying mechanism. FUNDING:
Lexicon Pharmaceuticals. Copyright © 2025 Elsevier Ltd. All
rights reserved, including those for text and data mining, AI training,
and similar technologies.

<94>
Accession Number
646614784
Title
Ten-year clinical outcomes after left main coronary artery stenting with
new-generation or early-generation DES.
Source
Revista espanola de cardiologia (English ed.). (no pagination), 2025.
Date of Publication: 15 Feb 2025.
Author
Wiebe J.; Kuna C.; Ibrahim T.; Kufner S.; Hintz I.; Justenhoven P.;
Kessler T.; Schunkert H.; Valgimigli M.; Richardt G.; Bresha J.; Laugwitz
K.-L.; Kastrati A.; Cassese S.
Institution
(Wiebe, Kessler, Schunkert, Kastrati) Department of Cardiology, Deutsches
Herzzentrum Munchen, Technische Universitat, Munich, Germany; DZHK (German
Centre for Cardiovascular Research), Partner Site Munich Heart Alliance,
Munich, Germany
(Kuna, Kufner, Hintz, Justenhoven, Cassese) Department of Cardiology,
Deutsches Herzzentrum Munchen, Technische Universitat, Munich, Germany
(Ibrahim, Bresha) 1. med. Klinik, Klinikum rechts der Isar, Technische
Universitat, Munich, Germany
(Valgimigli) Division of Cardiology, Cardiocentro Ticino Institute, Ente
Ospedaliero Cantonale, Lugano, Switzerland
(Richardt) Department of Cardiology, Germany
(Laugwitz) DZHK (German Centre for Cardiovascular Research), Partner Site
Munich Heart Alliance, Munich, Germany; 1. med. Klinik, Klinikum rechts
der Isar, Technische Universitat, Munich, Germany
Abstract
INTRODUCTION AND OBJECTIVES: Long-term data after stenting of the left
main coronary artery (LMCA) are scarce, especially regarding
new-generation drug-eluting stents (DES). This analysis aimed to describe
the 10-year clinical outcomes of patients who underwent percutaneous
coronary intervention with different DES generations for LMCA disease.
 METHOD(S): Individual patient data from the randomized controlled
ISAR-LEFT MAIN and ISAR-LEFT MAIN 2 trials were pooled and 10-year
clinical follow-up was obtained. The Kaplan-Meier method was used to
calculate event rates. The main endpoints of interest for this analysis
were all-cause mortality, myocardial infarction, target lesion
revascularization and definite stent thrombosis. RESULT(S): A total
of 1257 patients were included in this analysis, of which 650 patients
were treated with new-generation DES and 607 with early-generation DES. At
10 years, the mortality rate was more than 40% in both groups. After
statistical adjustment, 10-year mortality was significantly reduced in
patients treated with new-generation DES compared with those treated with
early-generation DES (HRadj, 0.78; 95%CI, 0.62-0.97). After 10 years, the
risk of myocardial infarction (HRadj, 0.43; 95%CI, 0.23-0.80), target
lesion revascularization (HRadj, 0.66; 95%CI, 0.49-0.89), and definite
stent thrombosis (HRadj, 0.13, 95%CI, 0.04-0.49) was significantly reduced
by new-generation DES compared with early-generation DES.
 CONCLUSION(S): Patients undergoing percutaneous coronary intervention
for LMCA disease have high 10-year mortality regardless of DES generation.
The use of new-generation DES in patients with LMCA disease is associated
with improved long-term clinical outcomes compared with early-generation
DES. Copyright © 2025. Published by Elsevier Espana, S.L.U.

<95>
[Use Link to view the full text]
Accession Number
646614972
Title
How Long Should Patients Be Treated With Postcardiotomy Venoarterial
Extracorporeal Membrane Oxygenation? Individual Patient Data Pooled
Analysis.
Source
Critical care medicine. (no pagination), 2025. Date of Publication: 18
Feb 2025.
Author
Biancari F.; Makikallio T.; L'Acqua C.; Ruggieri V.G.; Cho S.-M.; Dalen
M.; Welp H.; Jonsson K.; Ragnarsson S.; Hernandez Perez F.J.; Gatti G.;
Alkhamees K.; Loforte A.; Lechiancole A.; D'Errigo P.; Rosato S.;
Spadaccio C.; Pettinari M.; Fiore A.; Mariscalco G.; Perrotti A.; Arafat
A.A.; Albabtain M.A.; AlBarak M.M.; Laimoud M.; Djordjevic I.;
Samalavicius R.; Alonso-Fernandez-Gatta M.; Wilhelm M.J.; Kaserer A.;
Bonalumi G.; Juvonen T.; Polvani G.
Institution
(Biancari, Bonalumi, Polvani) Department of Cardiac Surgery, Centro
Cardiologico Monzino IRCCS, Milan, Italy
(Makikallio) Department of Medicine, South-Karelia Central Hospital,
University of Helsinki, Lappeenranta, Finland
(L'Acqua) Anesthesia and Intensive Care Unit, Centro Cardiologico Monzino,
Milan, Italy
(L'Acqua) Anesthesia and Intensive Care Unit, Fondazione IRCCS Istituto
Nazionale dei Tumori, Milan, Italy
(Ruggieri) Division of Cardiothoracic and Vascular Surgery, Robert Debre
University Hospital, Reims, France
(Cho) Divisions of Neurosciences, Critical Care and Cardiac Surgery,
Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns
Hopkins University School of Medicine, Baltimore, MD, Liberia
(Dalen) Department of Molecular Medicine and Surgery, Department of
Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital,
Stockholm, Sweden
(Welp) Department of Cardiothoracic Surgery, Munster University Hospital,
Munster, Germany
(Jonsson) Department of Cardiac Surgery, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Ragnarsson) Department of Cardiothoracic Surgery, University of Lund,
Lund, Sweden
(Hernandez Perez) Department of Cardiology, Puerta de Hierro University
Hospital, Madrid, Spain
(Gatti) Division of Cardiac Surgery, Cardio-Thoracic and Vascular
Department, University Hospital of Trieste, Trieste, Italy
(Alkhamees) Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
(Loforte) Department of Surgical Sciences, University of Turin, Turin,
Italy
(Lechiancole) Cardiothoracic Department, University Hospital of Udine,
Udine, Italy
(D'Errigo, Rosato) Center for Global Health, Italian National Institute,
Rome, Italy
(Spadaccio) Department of Cardiac Surgery, University of Cincinnati
Medical Center, Cincinnati, OH, United States
(Pettinari) Cardiac Surgery Unit, Cardiovascular Department, Cliniques
Universitaire Saint Luc, Belgium
(Fiore) Department of Cardiac Surgery, Hopitaux Universitaires Henri
Mondor, Creteil, France
(Mariscalco) Department of Intensive Care Medicine and Cardiac Surgery,
University Hospitals of Leicester, Glenfield Hospital, Leicester, United
Kingdom
(Perrotti) Department of Thoracic and Cardio-Vascular Surgery, University
Hospital Jean Minjoz, Besancon, France
(Arafat) Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
(Arafat) Cardiothoracic Surgery Department, Tanta University, Egypt
(Albabtain) Cardiology Clinical Pharmacy, Prince Sultan Cardiac Center,
Riyadh, Saudi Arabia
(AlBarak) Intensive Care Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
(Laimoud) Cardiac Surgical Intensive Care Department, King Faisal
Specialist Hospital and Research Center, Riyadh, Saudi Arabia
(Laimoud) Critical Care Medicine Department, Cairo University, Cairo,
Egypt
(Djordjevic) Department of Cardiothoracic Surgery, University Hospital
Cologne, Cologne, Germany
(Samalavicius) 2nd Department of Anesthesia, Vilnius University Hospital
Santaros Klinikos, Vilnius, Lithuania
(Samalavicius) Clinic of Emergency Medicine, Medical Faculty, Vilnius
University, Vilnius, Lithuania
(Alonso-Fernandez-Gatta) Cardiology Department, University Hospital of
Salamanca, Instituto de Investigacion Biomedica de Salamanca, Salamanca,
Spain
(Alonso-Fernandez-Gatta) CIBER-CV Instituto de Salud Carlos III, Madrid,
Spain
(Wilhelm) Clinic for Cardiac Surgery, University Heart Center, University
and University Hospital Zurich, Zurich, Switzerland
(Kaserer) Institute of Anesthesiology, University and University Hospital
Zurich, Zurich, Switzerland
(Juvonen) Research Unit of Surgery, Anesthesiology and Intensive Care,
University of Oulu, Oulu, Finland
(Juvonen) Department of Cardiac Surgery, Heart and Lung Center, Helsinki
University Hospital, Helsinki, Finland
(Polvani) Department of Biomedical, Surgical and Dental Sciences,
University of Milan, Milan, Italy
Abstract
OBJECTIVES: To investigate the optimal duration of venoarterial
extracorporeal membrane oxygenation (ECMO) for cardiogenic shock
refractory to medical therapies after cardiac surgery and whether its
prolonged use is justified. DATA SOURCES: Previously published articles on
postcardiotomy venoarterial ECMO. STUDY SELECTION: Articles reporting on
the early outcome after postcardiotomy venoarterial ECMO in adult patients
were identified through a systematic review of the literature. DATA
EXTRACTION: Data on prespecified patients' characteristics, operative
variables, and outcomes were provided by the authors of previous studies
on this topic. DATA SYNTHESIS: Individual data of 1267 patients treated at
25 hospitals from ten studies were included in this meta-analysis.
In-hospital mortality rates were lowest among patients treated 3-6 days
with venoarterial ECMO. Multilevel mixed-effects logistic regression
considering the cluster effect of the participating hospitals adjusted for
individual patient's risk profile and operative variables showed that the
risk in-hospital mortality did not significantly increase in patients
treated more than 6 days up to 20 days. CONCLUSION(S): The present
study demonstrated that prolonged venoarterial ECMO support after adult
cardiac surgery may be justified. However, the analysis was limited by the
knowledge of only those circumstances known at the start of
ECMO. Copyright © 2025 by the Society of Critical Care Medicine
and Wolters Kluwer Health, Inc. All Rights Reserved.

<96>
Accession Number
646616696
Title
Evaluation of hemodynamic response to laryngoscopy and endotracheal
intubation using conventional laryngoscope versus C-Mac video laryngoscope
in patients undergoing elective coronary artery bypass grafting (CABG)
surgery -A Randomized control trial.
Source
Anesthesia and Analgesi. Conference: 4th National Anaesthesia Research
Symposium: Enhancing the Quality of Anaesthesia Research in the Developing
World. Karachi Pakistan. 137(5 Supplement 1) (pp 25), 2023. Date of
Publication: 01 Nov 2023.
Author
Khan S.; Khan W.R.; Hameed M.; Samad K.
Institution
(Khan, Khan, Hameed, Samad) Department of Anaesthesiology, Aga Khan
University, Karachi, Pakistan
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Cardiac patients have limited cardiac reserves, sympathetic
stimuli such as direct laryngoscopy and tracheal intubation can
precipitate adverse effects causing myocardial supply demand imbalance.
Recently, video laryngoscope has gained popularity for exerting less
mechanical force to align the laryngeal axis, producing less stress
response and better hemodynamics. The study aimed to compare hemodynamic
response upon endotracheal intubation using conventional laryngoscopy with
Macintosh blade versus C-MAC video laryngoscope in patients undergoing
elective coronary artery bypass grafting (CABG). Methodology: After
informed consent a randomized control trial was conducted at the Aga Khan
University Hospital Karachi. 86 patients scheduled for CABG were enrolled
and randomly allocated to Macintosh and C-MAC groups. After standard
induction technique, tracheal intubation was performed. Heart rate,
systolic arterial pressure, diastolic arterial pressure and mean arterial
pressure along with peripheral oxygen saturation, were recorded before
(T1) and after induction (T2), 1 minute after intubation (T3), 5 min (T4)
and 10 min (T5) post intubation. End-tidal carbon dioxide was recorded at
T2, T3, T4 and T5. Result(s): Time taken for successful endotracheal
intubation was higher in the VL group, but the results were statistically
not significant (i.e., 32.7+/-23.1 vs 37.5+/-25.8, P-value =0.0577). CL
(Cormack Lehane) and POGO (Percentage of glottic opening) were comparable
in both groups and statistically insignificant (P = 0.401, P =0.389
respectively). Conclusion(s): In our study the hemodynamic changes
were comparable in both groups (Macintosh and C- MAC) and there is no
advantage in terms of better hemodynamic in patients undergoing CABG.

<97>
Accession Number
646616722
Title
Validation of self-reported smoking cessation through salivary cotinine
levels before general anaesthesia.
Source
Anesthesia and Analgesi. Conference: 4th National Anaesthesia Research
Symposium: Enhancing the Quality of Anaesthesia Research in the Developing
World. Karachi Pakistan. 137(5 Supplement 1) (pp 40), 2023. Date of
Publication: 01 Nov 2023.
Author
Nazir M.; Munir T.; Khan M.S.; Afshan G.
Institution
(Nazir, Munir, Khan, Afshan) Department of Anaesthesiology, Aga Khan
University, Karachi, Pakistan
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Smoking cessation before surgery is generally determined
through self-reported smoking status. This study was aimed to validate
self-reported smoking cessation period among patients scheduled for
elective non-cardiac surgeries. Methodology: This validation study was
nested in our previously published cohort study, conducted at the Aga Khan
University Hospital Karachi, Pakistan. Approximately 30% (80 out of 256)
of patients from the primary cohort were randomly selected for validation
study using a systematic sampling approach, including every third
recruited patient. Subsequently, salivary cotinine measurement was
performed on 80 collected samples using a commercially available Human
Cotinine ELISA kit. Result(s): A statistically insignificant positive
correlation was observed between preoperative smoking cessation and
salivary cotinine levels i.e. (R = 0.14, p=0.25), as well as salivary
cotinine level and intensity level (R = 0.20, p=0.087). The correlation
between salivary cotinine and smoking cessation was also insignificant in
minor to intermediate surgeries (R = 0.22, p=0.160) and major and complex
surgeries (R = -0.10, p=0.610). Furthermore, educational levels showed a
low negative correlation at the professional (R = -0.05, p=0.70), a
non-significant positive correlation at the basic level (R = 0.21,
p=0.860), and a highly significant positive correlation at the
intermediate level (R = 0.84, p<0.001). Conclusion(s): The validation
of self-reported smoking cessation using salivary cotinine levels revealed
that cotinine level was not a robust parameter. However, in major
surgeries and among highly educated patients, a weak but negative
correlation was observed.

<98>
[Use Link to view the full text]
Accession Number
646609492
Title
Iron Supplementation for Patients Undergoing Cardiac Surgery: a systematic
review and metaanalysis of randomized-controlled trials.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2021 Annual
Meetings. Virtual. 132(5 Supplement) (pp 122), 2021. Date of Publication:
01 May 2021.
Author
Yang S.; Al Kharusi L.; Chirico A.; Baradari P.G.; Gosselin A.; Cameron M.
Institution
(Yang, Al Kharusi, Chirico, Baradari, Gosselin, Cameron) McGill
University, Montreal, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Iron supplementation has been evaluated in several
randomized controlled trials (RCTs) for the potential to increase baseline
hemoglobin and decrease the incidence of red blood cell (RBC) transfusion
during cardiac surgery. This study's main objective was to evaluate the
evidence for iron administration in cardiac surgery patients, for its
effect on the incidence of perioperative RBC transfusion. METHOD(S):
This systematic review protocol was registered with PROSPERO
(CRD42020161927) on Dec. 19th, 2019, and was prepared as per the PRISMA
guidelines. MEDLINE, EMBASE, CENTRAL, Web of Science databases, and Google
Scholar were searched for RCTs evaluating perioperative iron
administration in adult patients undergoing cardiac surgery. Each abstract
was independently reviewed by two reviewers using predefined eligibility
criteria. The primary outcome was perioperative RBC transfusion, with
secondary outcomes of the number of RBC units transfused, change in
ferritin level, reticulocyte count, hemoglobin, and adverse events, after
iron administration. The risk of bias was assessed with the Cochrane
Collaboration Risk of Bias Tool, and the primary and secondary outcomes
were analyzed with a random-effects model. RESULT(S): Out of 1556
citations reviewed, five studies (n = 554 patients) met the inclusion
criteria. The use of iron demonstrated no difference in transfusion
incidence (RR 0.86; 95% CI 0.65 to 1.13). There was a low heterogeneity
between studies (I2=0%). The trial sequential analysis suggested an
optimal information size of 1,132 participants, which the accrued
information size did not reach. CONCLUSION(S): The current literature
does not support the routine use of iron supplementation before cardiac
surgery; however, insufficient data is available to draw a definite
conclusion. A critical knowledge gap has been identified, and more robust
RCTs are required on this topic.

<99>
[Use Link to view the full text]
Accession Number
646609702
Title
Randomized Controlled Trial of the Efficacy and Safety of Sugammadex on
Time-to-Extubation Following Cardiac Surgery.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2021 Annual
Meetings. Virtual. 132(5 Supplement) (pp 271-272), 2021. Date of
Publication: 01 May 2021.
Author
Bardia A.; Treggiari M.; Johnson C.; Dai F.; Tickoo M.; Kunze K.; Tantawy
H.; Geirsson A.; Schonberger R.B.
Institution
(Bardia, Treggiari, Johnson, Dai, Tickoo, Kunze, Tantawy, Geirsson) Yale
University, New Haven, CT, United States
(Schonberger) Yale University, School of Medicine, New Haven, CT, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Residual neuromuscular blockade (NMB) represents a key
factor leading to prolonged intubation after cardiac surgery1 and has been
associated with postoperative pulmonary complications2,3. Sugammadex
rapidly reverses NMB without adverse cardiovascular effects commonly seen
with traditional NMB reversal agents4. However, its use in the post
cardiac surgery setting has not been investigated. We designed a
randomized, controlled trial to determine the effectiveness of sugammadex
in reducing time to extubation in mechanically ventilated patients
admitted to the ICU after cardiac surgery. METHOD(S): This was a
single center, randomized, double-blind, placebo-controlled trial. The
study was approved by the institutional IRB, and all patients gave written
informed consent preoperatively. Eligible participants were adult patients
with preoperative left ventricular ejection fraction (LVEF) >=45%
undergoing elective aortic valve replacement (AVR), coronary artery bypass
grafting (CABG) or a combination of the two. Exclusion criteria were:
BMI>40, moderate to severe right ventricular dysfunction, estimated GFR
<30 mL/ min, home oxygen, chronic opioid use, neuromuscular disorders,
cognitive impairment, emergency procedures, known allergy to rocuronium or
sugammadex, anaphylactoid reaction intraoperatively, intraoperative
hypoxia, cardiac arrest, sudden arrhythmia, postoperative ST changes
postoperative bleeding (chest tube output >100cc/hr), temperature<35.5 or
>38.3 degree C at ICU admission, or anticipated need for prolonged
mechanical ventilation as determined by the treating team.
Postoperatively, all patients were transferred to the ICU intubated and on
a propofol and/or dexmedetomidine infusion. 30 minutes after the ICU
admission, propofol was discontinued, and the participants were randomized
to receive either sugammadex or placebo. Ten minutes after drug
administration, if the patient was able to perform a head lift and
remained hemodynamically stable, a spontaneous breathing trial (SBT) was
initiated for 30 minutes. The patient was extubated if he/she was not
hypoxic/ hypercapnic, had RSBI300 ml. The clinical decision to remove the
endotracheal tube was determine by the treating team. If a patient failed
the SBT, every attempt was made to correct the underlying reversible
causes and the SBT was repeated once the cause was corrected or otherwise
the patient was continued on mechanical ventilation. The primary study
endpoint was time from study drug administration to extubation. Secondary
endpoints were pulmonary function tests including negative inspiratory
force (NIF), vital capacity (VC) at the time of extubation, and adverse
events. The analysis was based on intention-to-treat. For the analysis of
the primary endpoint, a two-sample Student's t-test was used to compare
the time to extubation between the two groups. Frequency of adverse events
were compared between the two groups using chi-square test.
 RESULT(S): A total of 90 patients were randomized on an intention to
treat basis of which 83 patients (Sugammadex=40, placebo=43) received
sugammadex or placebo. The two groups were comparable with respect to
demographic characteristics including age [sugammadex: 67 +/- 8.45 vs.
placebo: 64.4 +/- 11.18 years], sex [women- sugammadex: 17.8% vs. placebo:
11.1%] and BMI [sugammadex: 29.39 +/- 4.61 vs. placebo: 29.55 +/-4.83
kg/m2]. Patients in sugammadex group had reduced time to extubation
compared with the placebo group [sugammadex: 178 +/- 130 minutes vs.
placebo: 250.9 +/- 201.9 minutes, difference 72.8 [95% CI:1.63- 144.0]
minutes, p=0.04]. There were no differences in NIF [sugammadex: -31.06 +/-
15.90 vs. placebo: -29.22 +/- 12.98, p=0.59] and VC [sugammadex:425 +/-
466 ml vs. placebo: 470.7 +/- 513.9 ml, p=0.68]. There were no difference
in postoperative blood product requirements [sugammadex: 0.13 +/- 0.76 vs.
placebo: 0.04 +/- 0.21 pRBC units, p=0.45] or dysrhythmias [sugammadex:
6.82% vs. placebo:13.33%, p=0.31] between the two groups. There were no
serious adverse events in either group. CONCLUSION(S): This
randomized trial in patients undergoing cardiac surgery showed that
Sugammadex administration decreased time to extubation by over one hour,
without detectable difference in measures of pulmonary function. Larger
trials may be required to confirm these findings and determine the
clinical implications. (Table Presented).

<100>
[Use Link to view the full text]
Accession Number
646609471
Title
Evaluation of postoperative analgesia of erector spinae plane block in
elective laparoscopic cholecystectomy: a randomized control trial.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2021 Annual
Meetings. Virtual. 132(5 Supplement) (pp 950), 2021. Date of Publication:
01 May 2021.
Author
Garg G.; Sethi D.
Institution
(Garg, Sethi) ESIC-PGIMSR, Basaidarapur, New Delhi, India
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Laparoscopic cholecystectomy is a minimally invasive and
commonly performed surgical procedure. The pain of laparoscopic
cholecystectomy has different components including somatic pain due to
trochar insertion sites, visceral pain from gall bladder resection,
parietal pain from peritoneal distention, and shoulder tip pain (referred
visceral pain) due to diaphragm irritation from carbon dioxide
insufflation. Commonly non-steroidal inflammatory agents, intravenous
opioids, dexamethasone, gabapentin, local anesthetics infiltration at
liver bed or port site, and regional anesthesia techniques such as
epidural, transversus abdominis plane block, and paravertebral block have
been used for postoperative pain management. Ultrasound-guided ESPB
(Erector Spinae Plane block) is a regional anesthetic technique first
described by Forero et al in 2016 for the treatment of thoracic
neuropathic pain. In ESPB, the local anesthetic is administered in the
inter-facial plane between the erector spinae muscle and the transverse
process of the vertebrae. The drug spreads in a craniocaudal direction
over multiple paravertebral spaces blocking both ventral and dorsal rami
of spinal nerve roots. Since the initial description of ESPB, there have
been several case reports and a few clinical trials demonstrating its
analgesic efficacy in surgeries including thoracic, abdominal, breast, and
spinal surgeries. We planned the present study to evaluate the analgesic
benefits of ESPB in laparoscopic cholecystectomy. METHOD(S): Seventy
patients of ASA grade I / II, aged 18-60 years undergoing elective
laparoscopic cholecystectomy were enrolled. They were randomized to group
C or T using a computer-generated random numbers list. Patients in group C
were given general anesthesia alone and patients in group T were given
bilateral ultrasound-guided ESPB followed by general anesthesia. The
primary objective was total 24hr postoperative analgesic consumption of
tramadol and the secondary objective was need for rescue analgesia
(fentanyl) and numeric pain rating scores (NRS) at rest and on movement
(coughing). A linear high frequency (6-13 MHz) ultrasound probe (SonoSite,
Bothell, WA, USA) was placed 3cm lateral to the T7 spinous process in
longitudinal parasagittal orientation. The transverse process of the T7
vertebral and the three muscle layers above it including trapezius
(uppermost), rhomboid major (middle), and erector spinae (lowermost) were
identified using a linear high-frequency ultrasound probe, A 22-gauge 8-cm
SonoTap needle was inserted in-plane in craniocaudal direction to place
needle tip above the T7 transverse process and deep to the erector spinae
muscle and 20 ml of 0.25% levobupivacaine was injected visualizing the
lifting of the erector spinae muscle away from the transverse process
bilaterally. Statistical analysis was done using Statistical Package for
Social Sciences (SPSS) version 21.0. Categorical variables were presented
in number and percentage (%) and continuous variables were presented as
mean +/- SD and median (interquartile range). The normality of data was
tested by the Kolmogorov-Smirnov test. If the normality was rejected then
the non-parametric test was used. Normally distributed continuous
variables (age, weight, times, the dose of tramadol, and fentanyl) were
compared using the independent t-test, whereas non-normally distributed
variables (NRS) were compared using the Mann-Whitney U test. Categorical
variables were compared using the Chi-Square test. A P value of <0.05 was
considered statistically significant. RESULT(S): Sixty-six patients
were included for the final analysis. The total tramadol consumption in
24hr postoperative period for Group C was 178.12 +/- 54.3 mg and for group
T was 178.12 +/- 54.3 mg, the difference was statistically highly
significant (P = 0.0001). The need for rescue analgesia (fentanyl) was
also statistically significantly lower in group T compared to group C
(0.91 +/- 5.22 mcg vs. 13.64 +/- 23.82 mcg, P= 0.002). The postoperative
NRS at 1/2, 2, 4, 6, 8 hr at rest and on movement (coughing) were
statistically lower in group T than group C, although this difference was
not of clinical significance. CONCLUSION(S): In patients undergoing
laparoscopic cholecystectomy, bilateral ultrasound-guided ESPB provided
effective analgesia as it reduced the total tramadol consumption and the
need for rescue analgesia (fentanyl) in 24hr postoperative period.

<101>
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Accession Number
646609759
Title
Endothelial Glycocalyx Degradation and Postoperative Acute Kidney Injury
in Cardiac Surgery Patients.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2021 Annual
Meetings. Virtual. 132(5 Supplement) (pp 282-283), 2021. Date of
Publication: 01 May 2021.
Author
DeBeaux A.C.; Zhou J.; Baker T.; Campbell D.D.; Billings F.; Lopez M.
Institution
(DeBeaux, Zhou, Baker, Campbell, Billings, Lopez) Vanderbilt University
Medical Center, Nashville, TN, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Acute kidney injury (AKI) occurs in an estimated 30% of
cardiac surgery patients and is associated with increased mortality.1,2
Intraoperative hyperoxia may promote the formation of reactive oxygen
species (ROS) which have deleterious effects on renal permeability through
oxidative stress.1,3. The glomerular endothelial glycocalyx is a critical
regulator of renal permeability and is composed of glycosaminoglycans,
proteoglycans, and other glycoproteins including syndecan-1, a heparan
sulfate proteoglycan.4 Surgery, cardiopulmonary bypass, and oxidative
stress induce shedding of soluble syndecan-1, and plasma syndecan-1
concentrations reflect glycocalyx degradation.3,5 We tested the hypotheses
that increased endothelial glycocalyx damage is associated with AKI
following cardiac surgery and that intraoperative normoxia decreases
glycocalyx damage compared to hyperoxia. METHOD(S): We tested these
hypotheses in a cohort of cardiac surgery patients enrolled in a
randomized clinical trial of intraoperative normoxia (lowest fraction of
inspired oxygen [FIO2] to maintain an arterial hemoglobin saturation of
95-97%) vs. hyperoxia (FIO2 =1).6 Plasma concentrations of syndecan-1 were
measured using an enzyme-linked immunosorbent assay (Abcam, Cambridge, MA)
before surgery, immediately following cardiopulmonary bypass, and 6 hours
after surgery. AKI was defined using KDIGO creatinine criteria. We
measured the association between the area under the curve (AUC) of plasma
syndecan-1 concentrations following CPB and 6 hours postoperatively and
AKI using logistic regression adjusted for baseline syndecan-1
concentration, age, baseline estimated glomerular filtration rate
(calculated using the Chronic Kidney Disease Epidemiology Collaboration
formula), and use of cardiopulmonary bypass. We measured the effect of
intraoperative oxygen treatment on syndecan-1 concentration using the
Mann-Whitney U test. RESULT(S): One hundred thirty patients comprised
the cohort. The median (10th, 90th percentile) participant age was 66 (50,
76) years, 33 (25%) were female, median baseline eGFR was 74 (43, 96)
mL/min/1.73m2. Twenty-five participants (19%) developed AKI. Seventeen
participants (13%) developed stage I AKI), 5 (4%) stage 2 AKI, and 3 (2%)
stage 3 AKI. Median syndecan-1 concentrations were 155.6 ng/mL (69.6,
601.6) at baseline, increased to 333.4 (138.1, 798.7) ng/ml after CPB and
decreased to 273.1 ng/mL (109.1, 934.1) 6 hours postoperatively. A 50
ng/ml increase of plasma syndecan-1 concentration AUC was independently
associated with an 10% increase in the odds of AKI (OR 1.10; 95% CI: 1.00
to 1.20; P=0.04). Median (10th, 90th percentile) syndecan-1 AUCs were
330.5 ng/ml (137.8, 701.2) and 314.6 ng/ml (138.5, 1038.2) in patients
receiving normoxia vs. hyperoxia, respectively (P=0.92).
 CONCLUSION(S): Increased perioperative plasma concentrations of
syndecan-1 were independently associated with postoperative AKI in
patients undergoing cardiac surgery. Intraoperative normoxia vs. hyperoxia
did not affect perioperative plasma concentrations of syndecan-1. Future
investigations will test therapeutic interventions to decrease glycocalyx
degradation and reduce postoperative AKI. (Table Presented).

<102>
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Accession Number
646609579
Title
Enhanced Recovery after Pediatric Congenital Heart Repair with Erector
Spinae Plane Blockade: An Ongoing Prospective, Randomized Controlled
Trial.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2021 Annual
Meetings. Virtual. 132(5 Supplement) (pp 722-724), 2021. Date of
Publication: 01 May 2021.
Author
Lee C.K.; Caruso T.; Lawrence K.; Fonseca A.; Boltz G.; Quinonez Z.; Maeda
K.; Tsui B.
Institution
(Lee, Lawrence) Stanford University, School of Medicine, Stanford, CA,
United States
(Caruso, Fonseca, Boltz, Quinonez, Maeda, Tsui) Lucile Packard Children's
Hospital Stanford, Stanford, CA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Children who undergo congenital heart repair are at high
risk for morbidity. Prolonged postoperative intubation is associated with
high mortality, long ICU stays, and long hospital stays. While intubated,
children are typically sedated with opioids, which are associated with
increased risks of pneumonia. Bilateral ESPB catheters have been described
as effective regional anesthesia during cardiac surgery.1 Unlike
paravertebral blocks, the ESPB is superficial with a lower risk of
pneumothorax. Given the potential opioid-sparing benefits of ESPB
catheters, we report the preliminary findings of an ongoing prospective,
randomized controlled trial examining bilateral ESPB compared to standard
of care (SOC). The primary aim was to determine whether lidocaine ESPB
reduces CVICU length of stay (LOS) compared to SOC. Secondary aims
examined time to extubation and total opioid consumption. METHOD(S):
After IRB approval, patients were randomized to SOC control or treatment
(ESPB). Patients in the treatment group received bilateral T7 ESPB
catheters, with lidocaine 0.25% 1.5 mg/kg (max 20mL) through each catheter
prior to surgery, followed by alternating-side lidocaine boluses every 2
hours postoperatively. Both groups received a standardized postoperative
pain management regimen: acetaminophen 15 mg/kg every 6 hours, ketorolac
0.5 mg/kg every 6 hours for 6 doses, and as needed parenteral morphine,
oral ibuprofen, and oral oxycodone. Inclusion criteria were patients age
0-21 years old undergoing these congenital heart surgeries: atrial septal
defect repair, ventricular septal defect repair, anomalous aortic origin
of a coronary artery repair, and left ventricular or right ventricular
outflow repairs. Exclusion criteria were patients weighing <5kg, patients
who were clinically unstable or requiring emergent surgery, and patients
with pre-existing kidney or liver insufficiency. RESULT(S): At the
time of submission, 28 patients, ages 2 months to 19 years were enrolled.
14 patients were randomized to control and 14 to ESPB . Compared to SOC
patients, ESPB patients had a lower mean total opioid consumption,
measured in morphine equivalents per weight in kg (2.607 +/- 1.440 vs.
6.367 +/- 9.585, p =0.1922, Figure 1) and a shorter mean time to
Extubation (15.86 +/- 7.049hrs vs. 22.24 +/- 32.14hrs, p=0.4750, Figure 2)
but a longer CVICU LOS (55.71 +/- 37.72hrs vs. 34.86 +/- 19.28hrs,
p=0.0769, Figure 3), though all the differences were not yet statistically
significant. No adverse events were recorded in either group. Data
collection is ongoing; final presentation will include aggregate results
from patients collected to date. CONCLUSION(S): Given the increasing
use of regional during cardiac surgery,1 this study may yield important
findings to help guide clinical indications for ESPB during pediatric
heart repair. (Figure Presented).

<103>
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Accession Number
646610085
Title
Monitored Anesthesia Care, When Compared to General Anesthesia, Is
Associated With a Higher Risk of Postoperative Permanent Pacemaker
Placement Following Transcatheter Aortic Valve Replacement.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2021 Annual
Meetings. Virtual. 132(5 Supplement) (pp 194-195), 2021. Date of
Publication: 01 May 2021.
Author
Feehan B.; Padilla L.A.; Davies J.; Zaky A.; Broyles M.G.
Institution
(Feehan, Padilla, Davies, Zaky, Broyles) University of Alabama at
Birmingham, Birmingham, AL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is the
recommended treatment for patients with severe, symptomatic aortic
stenosis who are at high operative risk and is gaining a growing number of
new indications1. Choice of anesthetic for TAVR has been a matter of a
debate between general anesthesia (GA) and monitored anesthesia care
(MAC), which appears to be largely based off institutional and regional
practices2, with a recent trend towards MAC3, and some regions performing
100% of TAVRs under MAC3. MAC for TAVR is largely safe2, and is associated
with several benefits, such as shorter procedure time and hospital stays4,
but a number of studies have identified a possible association with MAC
and a higher incidence of permanent pacemaker (PPM) placement
postoperatively. Initially identified as a trend,2,5,6 a recent
meta-analysis reached statistical significance (28.2% vs 20.8%, p <
0.0001)7. STS data demonstrated no significant difference in new PPM
implantation after falsification end point analysis adjustment8. These
studies face a number of limitations, including small sample size for the
single site studies and varying institutional practices for the multi-site
studies. Causal factors for the association between anesthesia type and
postoperative PPM placement have been unelucidated. Proposed mechanisms
include differences in valve type (despite a positive association in a
cohort of patients who only received one valve type9), impaired or altered
valve positioning during MAC7, surgical technique differences, attributed
to residual confounding10, and anesthetic agents. Dexmedetomidine, in
particular, could play a role given the rapid adoption in its use for the
procedure, and as it has been found to have prolonged hemodynamic effects,
particularly bradycardia11,12,13, including in a study which compared MAC
using propofol to dexmedetomidine in patients undergoing TAVR14. In this
study we take advantage of our large volume of TAVR procedures and
dexmedetomidine-based MAC protocol to compare postoperative PPM and other
outcomes between patients who undergo MAC and GA for TAVR. We hypothesize
that patients who underwent MAC anesthesia for TAVR will have a
significantly increased incidence of postoperative PPM placement.
 METHOD(S): This is a single center retrospective study. A query of
electronic medical records was conducted to identify all patients who
underwent TAVR from 2011-2018. Exclusion criteria were the presence of a
preoperative PPM, other preoperative pacing, and crossover from MAC to GA.
Baseline demographics and perioperative data were extracted from medical
records and dichotomized by anesthesia type. The MAC and GA groups were
compared using x2, Fisher's exact, Wilcoxon rank sum, and Student's t-test
where appropriate. Our primary endpoint was postoperative PPM placement,
with secondary endpoints of temporary pacemaker requirement, and ICU and
hospital length of stays. Logistic regression was used to identify the
association of MAC and PPM. All data analysis was performed using SAS, and
a two-sided <0.05 p-value for all statistical tests were considered
significant. RESULT(S): 698 patients were included; 476 underwent GA
and 222 underwent MAC. There were no statistically significant differences
between the groups at baseline. The rate of postoperative PPM was
significantly higher in the MAC group when compared to the GA group (13.1%
vs 7.3%, p 0.01). There was no difference in rate of temporary pacemaker
between groups (p 0.18). Patients undergoing MAC had shorter ICU and
hospital lengthof- stays (p 0.04, p 0.01). Logistic regression showed a
significant association between PPM and anesthesia type; those who
underwent MAC were 89% more likely to require a PPM compared to those who
underwent GA (OR 1.89, CI 1.12-3.18, p 0.01). CONCLUSION(S): Our
large single center study shows that MAC is independently associated with
PPM placement when compared to GA in patients undergoing TAVR, and
confirms previous findings of shorter lengths of stay. The association of
MAC and PPM requires consideration, as identifying those at-risk or
altering treatment could decrease the need for postoperative PPM
placement. Our study is limited by its design as a retrospective cohort
study, and the lack of an association between a specific factor, such as a
medication, and the outcome of increased rate of PPM. Future studies are
needed to identify factors that may better explain the association between
anesthetic type and postoperative PPM placement for TAVR. (Figure
Presented).

<104>
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Accession Number
646609839
Title
Effects of methylprednisolone on early postoperative pain and recovery in
patients undergoing thoracoscopic lung surgery: a randomized controlled
trial.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2021 Annual
Meetings. Virtual. 132(5 Supplement) (pp 639), 2021. Date of Publication:
01 May 2021.
Author
Yu H.; Shi W.
Institution
(Yu, Shi) West China Hospital, Sichuan University, Chengdu, China
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Postoperative acute pain, one chanllenge in postoperative
managnement of thoracic surgery, induced unsatisfaction of patients and
delayed postoperative recoevery. Emerging evidence has found that
methylprednisolone plays a critical role in postoperative analgesia.
However, the effectiveness of methylprednisolone with regards to
postoperative acute pain and recovery is unclear in thoracoscopic lung
surgery. The aim of this study was to evaluate the effects of
methylprednisolone on acute pain and quality of recovery after
thoracoscopic lung surgery. METHOD(S): In this single-center,
patient-andevaluator- blinded, superiority randomized trial, 180 patients
scheduled for elective thoracoscopic lung surgery were randomly assigned
to receive 40 mg methylprednisolone, 120 mg methylprednisolone or placebo.
The primary outcome was the proportion of moderate-to-severe pain
(numerical rating scale, NRS>= 4) on the first day postoperatively. The
pain scores, postoperative quality of recovery-15 (QoR-15) and other
secondary outcomes were also recorded. All data were checked for normal
distribution with inspection of Kolmogorov-Smirnov. Continuous data were
presented as mean with standard deviation (SD) or confidence interval (CI)
for normally distributed variables and medians with CI for nonnormally
distributed data. Categorical variables were summarized using proportion
with CI. Continuous variables were analyzed using Student's t test or
Mann-Whitney U test. Categorical variables were compared using the
Pearson's X2 test or Fisher's exact test as appropriate.
Specifically, generalized estimating equations (GEE) with robust standard
error estimates were used to account for repeated measures of pain scores
and QoR-15 scores. To investigate for a linear trend between the dosage of
methylprednisolone and the proportion of patients with moderate-to-severe
pain, a CochranArmitage test of trend was used. Secondary analyses for the
primary outcome were adjusted analyses (for sex, age, body mass index
(BMI), duration of surgery, anesthesia regimens and surgical procedures)
by logistic regression. The pairwise comparisons among three groups were
considered as an exploratory analysis. The level of significance and CI
were 0.05 and 95% for primary and secondary outcomes compared the combined
methylprednisolone groups with the placebo group, 0.017 and 98.3% for the
exploratory outcomes (3 pairwise comparisons). RESULT(S): A total of
173 patients were included in the primary analysis. There was no
difference in the proportion of moderate-to-severe pain between patients
in the combined methylprednisolone groups and the placebo group (51.7% vs
64.9%; absolute difference, 13.2%; 95% CI, -2.1 to 29.3; P= 0.10).
Patients in the combined methylprednisolone groups had lower pain scores
at rest and coughing on the first day after surgery compared with the
placebo group, with mean difference of 0.6 and 0.8, respectively (P<
0.01). QoR-15 scores were higher in the combined methylprednisolone groups
on the first (mean difference, 6.9; P< 0.001) and second days after
surgery (mean difference, 7.2; P< 0.001) than the placebo group. Patients
in the 120 mg methylprednisolone group had lower pain scores at rest than
the 40 mg methylprednisolone group (mean difference, 0.8; 95% CI, 0.3 to
1.3; P< 0.001) and the placebo group (mean difference, 1.0; 95% CI, 0.5 to
1.4; P< 0.001), respectively. Patients in both methylprednisolone groups
had higher QoR-15 scores than the placebo group and patients in the 120 mg
methylprednisolone group had higher QoR-15 scores in contrast with the 40
mg methylprednisolone group on the first and second days after surgery. No
side-effects were observed. CONCLUSION(S): A single dose of
methylprednisolone did not reduce the proportion of moderate-to-severe
pain. However, it could decrease postoperative pain scores and improve
quality of recovery without increasing adverse events in thoracoscopic
lung surgery.

<105>
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Accession Number
646610211
Title
Quality Indicators in the Perioperative Period Specific to the Practice of
Anesthesiology: An Umbrella Review.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2021 Annual
Meetings. Virtual. 132(5 Supplement) (pp 920-921), 2021. Date of
Publication: 01 May 2021.
Author
Nguyen F.; Liao G.; McIsaac D.I.; Lalu M.M.; Pysyk C.; Hamilton G.M.
Institution
(Nguyen, Lalu) Ottawa Hospital, Ottawa, Canada
(Liao) University of Ottawa, Ottawa, Canada
(McIsaac) University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada
(Pysyk, Hamilton) University of Ottawa, Ottawa, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Improvement in health care delivery depends on the ability
to measure outcomes that can direct changes in the system. Existing
systematic reviews have examined specific aspects of perioperative quality
indicators in different settings, but no study has clearly synthesized a
concise overview of the important quality indicators specific to
anesthesiology. This umbrella review was undertaken to provide an overview
of evidencebased quality indicators specific to the perioperative period.
 METHOD(S): An umbrella review was conducted according to Joanna
Briggs Institute methodology1 A systematic search was conducted in
accordance with the Peer Review of Electronic Search Strategies (PRESS)
checklist. We included systematic reviews examining perioperative
indicators in patients greater than 18 years of age undergoing non-cardiac
surgery. The primary outcome was any quality indicator specific to
anesthesiology. Classification system (eg. Donabedian2, Institute of
Medicine), strength of evidence (eg. Oxford, GRADE), perioperative phase,
and surgical subspecialty were collected. All indicators were classified
into a Donabedian and Institute of Medicine (IOM) domain of quality and
were then classified into a novel perioperative classification system we
created. Risk of bias of each of the included studies was evaluated using
AMSTAR2 (A MeaSurement Tool to Assess systematic Reviews). RESULT(S):
Our initial systematic literature search returned 1216 studies. After
duplicate removal, title and abstract screening and full text screening,
twenty-three systematic reviews encompassing 3164 primary studies met our
inclusion criteria. In total, 339 perioperative quality indicators were
collected. Two hundred and fifty (250/339) indicators were classified
according to a Donabedian domain in their original systematic review.
After classification of remaining indicators, process indicators were most
common (n=173), followed by outcome indicators (n=119), then structure
indicators (n=47). When classifying quality indicators by our novel
perioperative classification system, indicators for General Complications
or Adverse Events (n=96) and Preoperative Management (n=70) occurred with
highest frequency (Fig 1). Few identified quality indicators were
supported by Oxford Level of Evidence (90/339=27%), with an even smaller
portion supported by high level of evidence (46/339=14%). Indicators with
the highest evidence included antibiotic prophylaxis (Oxford Level of
Evidence: Ia), venous thromboembolism (VTE) prophylaxis (Ia), and post-op
nausea/vomiting prophylaxis (Ib) Intraoperative management indicators
focused on maintenance of normothermia (Ia) and goal-directed fluid
therapy (Ib). CONCLUSION(S): This review highlights the importance of
utilizing high quality evidence to guide quality improvement but also
emphasizes the scarcity of evidence that exists for perioperative quality
indicators. By summarizing the existing quality indicators related to
anesthesiology, we provide an overview of potential targets for future
evidence-based quality improvement programs in anesthesiology. (Figure
Presented).

<106>
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Accession Number
646610259
Title
Effects of Comprehensive Geriatric Care Models on Postoperative Outcomes
in Geriatric Surgical Patients: A Systematic Review and Meta-analysis.
Source
Anesthesia and Analgesia. Conference: International Anesthesia Research
Society and Society of Critical Care Anesthesiologists 2021 Annual
Meetings. Virtual. 132(5 Supplement) (pp 460-461), 2021. Date of
Publication: 01 May 2021.
Author
Saripella A.; Wasef S.; Nagappa M.; Riazi S.; Englesakis M.; Wong J.;
Chung F.F.
Institution
(Saripella, Wasef, Riazi, Wong, Chung) Toronto Western Hospital,
University Health Network, University of Toronto, Toronto, ON, Canada
(Nagappa) London Health Sciences Centre, St. Joseph Health Care, Western
University, London, ON, Canada
(Englesakis) Toronto General Hospital, University Health Network, Toronto,
ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Surgery on the elderly results in greater complications,
prolonged length of hospital stay (LOS), increase in emergency department
visits, readmission rates, post-discharge care requirements, and health
care costs. It is not clear whether comprehensive geriatric care models
are effective in reducing adverse events. The objective of this systematic
review and meta-analysis is to determine whether the comprehensive
geriatric care models improved clinical outcomes, particularly in
decreasing the prevalence of delirium and length of hospital stay (LOS) in
elderly surgical patients. METHOD(S): We searched Medline, PubMed,
Embase, Cochrane Central Register of Controlled Trials, Cochrane Database
of Systematic Reviews, Emcare Nursing, Web of Science, Scopus, CINAHL,
ClinicalTrials. Gov, and ICTRP between 2009 to January 23, 2020. We
included studies on geriatric care models in elderly patients (>=60 years)
undergoing elective, noncardiac high-risk surgery. The included studies
were randomized controlled trials (RCTs) and observational studies
(including cohort and cross-sectional). Two reviewers (AS, SW) screened
literature studies (using Rayyan), assessed the risk of bias, collected
data, and analyzed independently. All conflicts were resolved by consensus
and a third reviewer (FC). The risk of bias was assessed using the
Cochrane Risk of Bias Tool (RCTs) and Newcastle-Ottawa scale
(observational studies). The outcomes were the prevalence of delirium,
LOS, rates of 30-days readmission, and 30-days mortality. Random effect
meta-analysis was conducted using the Cochrane Review Manager Version 5.3.
We assessed the quality of the evidence by the Grading of Recommendations
Assessment, Development, and Evaluation (GRADE). RESULT(S): Eleven
studies were included with 2,672 patients; RCTs: 4;Observational studies
(non-RCTS): 7. Data pooled from three RCTs showed that there was a
significant difference in the prevalence of delirium between the
intervention and control groups: 7.9% vs. 16% (odds ratio: 0.45; 95% CI:
0.29, 0.7; I2: 0%; p=0.0003) with an absolute risk reduction of 8%; and
number needed to treat of 13. For both RCTs and non-RCTs, there were no
significant differences in the LOS (non- RCT: p=0.90), (Figure A, B) rates
of 30-day readmission (RCT: p=0.25; non-RCT: p=0.96), and 30-day mortality
(RCT: p=0.11; non-RCT: p=0.86). All geriatric care models contained CGA,
which is an established multi-domain assessment addressing patients'
physiological, social, psychological, and functional state before surgery.
Using the Cochrane tool, the four RCTs had low bias on most of the
domains. According to the Newcastle Ottawa scale scoring system, the
quality of the six non-RCTs ranked from 7 to 9 indicated a low risk of
bias. The quality of evidence was low to very low. CONCLUSION(S): The
geriatric care models involved pre-operative comprehensive geriatric
assessment, and intervention tools to address cognition, frailty, and
functional status. In non-cardiac high-risk surgeries, these care models
decrease the prevalence of delirium in geriatric patients. We found no
differences in the LOS, rates of 30-days readmission, and mortality.
Further RCTs are warranted to evaluate these models on the postoperative
outcomes. (Table Presented).

<107>
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Accession Number
646621713
Title
The Association of Prothrombin Complex Concentrates with Transfusion
Requirement and Postoperative Outcomes in Cardiac Surgery: A Post-Hoc
Analysis of the FIBRES Randomized Controlled Trial.
Source
Anesthesia and Analgesi. Conference: 2020 Annual Meeting of the
International Anesthesia Research Society, IARS 2020. San Francisco, CA
United States. 130(5 Supplement) (pp 103-107), 2020. Date of Publication:
01 May 2020.
Author
Bartoszko J.; Karkouti K.; Callum J.
Institution
(Bartoszko) University of Toronto, Toronto, ON, Canada
(Karkouti) Toronto General Hospital, Toronto, ON, Canada
(Callum) Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Coagulopathy after cardiopulmonary bypass (CPB) is common
and associated with bleeding and adverse outcomes. The mainstay of therapy
for coagulation factor deficiency is frozen plasma (FP), however
prothrombin complex concentrates (PCCs) may be more effective and
logistically simpler to administer.1, 2 We sought to describe the
association of comparable PCC or FP doses with transfusion requirements
and adverse outcomes after CPB surgery. METHOD(S): This was a
post-hoc analysis of the FIBRES (Effect of Fibrinogen Concentrate vs.
Cryoprecipitate on Blood Component Transfusion after Cardiac Surgery)
randomized controlled trial.3 The predictors of interest were dose of PCC
or FP within 24 hours of CPB. Patients who received only PCC or only FP
were included. The primary outcome was RBC transfusion within 24 hours of
CPB. Secondary outcomes included platelet transfusion within 24 hours of
CPB and adverse postoperative outcomes. Each association was examined by
generalized estimating equation models for either count (Poisson) or
binary (Logistic) data, which were adjusted for pre-operative creatinine
clearance, hemoglobin level, BMI, age, sex, presence of heart failure,
study arm, critical pre-operative status of the patient, and surgical
complexity and urgency. RESULT(S): Of the 735 patients included in
FIBRES, 416 with significant post-CPB bleeding received PCC (n=72, 17%) or
FFP (n=344, 83%) at 11 Canadian institutions from 2017 to 2018 (31%
female; 77% complex surgery; 39% urgent; 22% critical pre-operative
status). Two patients who received PCC but for whom dosing was not
available were excluded. The median number of RBC units transfused was 3
[Interquartile Range (1, 5)] and platelet pools was 2 [Interquartile Range
(1, 3)]. A total of 66 (16%) patients experienced thromboembolic events
within 28 days, 54 (13%) fluid overload or respiratory events within 28
days, 145 (35%) renal events within 7 days, and 78 (19%) required surgical
re-exploration. Each unit of FP was associated with an increased adjusted
odds ratio (aOR) of RBC transfusion [aOR 1.50 (95% CI, 1.29, 1.75),
p<0.01], while each 500 units of PCC was protective [aOR 0.70 (95% CI,
0.60, 0.83), p<0.01]. Similarly, each unit of FP was associated with an
increased adjusted odds of platelet transfusion [aOR 1.41 (95% CI 1.14,
1.73), p<0.01], while each 500 units of PCC was protective [aOR 0.81 (95%
CI, 0.71, 0.93), p<0.01]. Results are presented in Table 2. There was no
increase in adverse events with PCC use compared to FP, with 17% of
patients receiving PCC experienced thromboembolic events compared to 16%
in the FP group. CONCLUSION(S): In cardiac surgical patients with
post- CPB bleeding, PCC use was associated with decreased RBC and platelet
transfusion compared to FP, without a significant increase in adverse
events. In this setting, PCCs appear to confer hemostatic advantages to
FP. (Figure Presented).

<108>
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Accession Number
646621503
Title
Perioperative colloid choice and effects on bleeding in patients
undergoing musculoskeletal surgery.
Source
Anesthesia and Analgesi. Conference: 2020 Annual Meeting of the
International Anesthesia Research Society, IARS 2020. San Francisco, CA
United States. 130(5 Supplement) (pp 762-763), 2020. Date of Publication:
01 May 2020.
Author
Motika C.; Krishnamoorthy V.; Ohnuma T.; McLean D.; Ellis A.; Raghunathan
K.
Institution
(Motika, Krishnamoorthy, Ohnuma, Raghunathan) Duke University, Durham, NC,
United States
(McLean) University of North Carolina, Chapel Hill, NC, United States
(Ellis) North Carolina State University, Raleigh, NC, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: The use of colloids such as hydroxyethyl starch (HES) and
albumin is common for intravenous fluid resuscitation in the perioperative
period. [1, 2] Meta-analyses comparing albumin with HES (human-derived
versus synthetic colloids respectively) in patients with sepsis and in
patients undergoing cardiac surgery (with cardiopulmonary bypass) have
found that red blood cell transfusions are reduced when albumin is
used.[3, 4] However, HES continues to be used worldwide in non-cardiac
surgical settings. Our study compares the association of albumin versus
HES with major perioperative bleeding in musculoskeletal surgery, the most
common surgery performed in the United States. METHOD(S): In this
retrospective cohort study, we extracted data from the Premier Healthcare
Database (Premier Inc., Charlotte, NC, USA) between October 2008 and
September 2014, a period of time prior to a safety warning about HES in
United States (when HES was still widely used). We identified patients who
underwent elective inpatient surgery on the musculoskeletal system and
received either albumin or hydroxyethyl starch (HES). Patients who
received both albumin and HES were excluded from the study. The primary
outcome was major perioperative bleeding; secondary outcomes were acute
renal failure and prolonged postoperative length-of-stay (>75th%ile), as a
surrogate for significant in-hospital complications. We examined
differences in baseline characteristics - demographics, comorbidities, and
co-treatments. We then conducted propensity-score weighted analysis to
ensure comparability of study groups prior to examining outcome
differences. RESULT(S): We identified 579,392 patients who underwent
surgery in the musculoskeletal system. Only 43,454 received colloids on
the day of surgery. After excluding dual colloid recipients (n= 2,243),
41,211 (94.8%) were included in the analysis: 12,803 in the albumin in the
albumin group and 28,408 in the HES group. As shown in table 1, there were
minor differences between the two groups that were resolved upon
propensity-score weighting. This include: Van walraven score, which was
lower in the albumin group; the higher rate of regional anesthesia (spinal
or epidural) that was noted in the albumin vs. starch group; and the use
of anti-fibrinolytic medications was noted to be higher in the HES vs.
albumin, 19.3% and 13.9% respectively. The propensity-score weighted mean
van Walraven score in patients receiving albumin was 0.59, compared to
0.58 in patients that received HES (standardized mean difference= 0.003).
There was no difference in the use of anti-platelet medication or
anti-thrombotic medication in either group before or after propensityscore
weighting. However, the high rate of non-steroidal anti-inflammatory drugs
(NSAIDs) usage noted in the albumin group persisted even after
propensity-score weighting (standardized mean difference = 0.24 and 0.21
before and after propensity-score weighting respectively). The primary
analysis indicated that the rate of major perioperative bleeding was
higher in those exposed to HES compared with those receiving albumin. The
rate of major bleeding was 16.8% in patients exposed to albumin, compared
with 18.5% in those exposed to HES, [Relative Risk 0.89 (95% CI
0.84-0.93)]. We observed no significant difference in secondary outcomes.
 CONCLUSION(S): Compared with albumin, exposure to HES on the day of
musculoskeletal surgery was associated with an increased risk of major
perioperative bleeding. Given that HES continues to be used as a colloid
in multiple patient populations worldwide, further studies examining the
safety of HES solutions are needed. (Figure Presented).

<109>
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Accession Number
646621753
Title
Effects of Low dose Hydroxyethyl Starch 13//0.4 on FVIII and vWF in
Cardiac Surgery.
Source
Anesthesia and Analgesi. Conference: 2020 Annual Meeting of the
International Anesthesia Research Society, IARS 2020. San Francisco, CA
United States. 130(5 Supplement) (pp 112-113), 2020. Date of Publication:
01 May 2020.
Author
Devarajan J.; Timur A.A.; Duncan A.
Institution
(Devarajan) Cleveland Clinic, Westlake, OH, United States
(Timur, Duncan) Cleveland Clinic, Cleveland, OH, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: The FDA warns that use of hydroxyethyl starch (HES) for
plasma volume replacement in patients undergoing open heart surgery
increases risk of bleeding(1), although other investigations suggest that
third-generation hydroxyethyl starch (HES) solutions, such as 6% HES
130/0.4 cause less coagulopathy than earlier solutions(2). We recently
reported that a postoperative measure of coagulation, specifically clot
initiation, was prolonged in cardiac surgical patients who received
intraoperative plasma volume replacement with a third-generation HES
versus those who received human albumin 5%. The purpose of this
investigation was thus to examine the effect of HES on coagulation
factors, specifically Factor VIII and von Willebrand's factor (vWF), which
may contribute to prolonged clot initiation in cardiac surgical patients.
 METHOD(S): This sub study of a larger prospective, double-blind
clinical trial randomized patients having aortic valve replacement with or
without coronary artery bypass grafting to HES versus 5% human albumin at
the Cleveland Clinic. Institutional Review Board approval and written
informed consent was obtained. Exclusion criteria included renal failure,
anticipation of deep hypothermic circulatory arrest, pre-existing
coagulation disorders, patients in whom anticoagulant other than heparin
was used. Coagulation tests including PT, INR, aPTT were performed at
baseline following anesthetic induction before surgical incision, 1 hour
and 24 hours after patient arrived in ICU. Components of
thromboelastography including reaction time (R), kinetics time (K),
maximum amplitude (MA), slope between R and K (alpha angle), amplitude
reduction at 30 minutes after MA (lysis LY 30) and clotting indices were
compared and evaluated at the same intervals. In twenty patients randomly
selected from 141 patients enrolled in original study, we compared Factor
VIII and von Willebrand factor concentrations. The noninferiority between
HES and albumin was assessed for each outcome at the 0.025 level. We could
claim non inferiority of HES to albumin if non-inferiority was shown on
all of the variables in this set. Therefore no adjustment for multiple
testing was done (i.e. intersection-union test). RESULT(S): 149
patients were randomized and 141 were included in the final analysis. (HES
= 69, albumin=72). Demographics, medical comorbidities and surgical types
were comparable between the two groups. Volume of HES used was 611+/-278
and albumin 674+/-275 (P=0.18) and were comparable . HES was found not
comparable to albumin in initiation of coagulation after surgery (R at 1
hour sample (5.7+/-3.9 vs 5.1+/-2.0 in HES vs albumin groups (P=0.030),
but HES performed non-inferior to that of albumin in other measures of
coagulation such as INR, clotting time, APTT, K value, MA and alpha
angles. In the subsequent factor analysis (N=20), HES was found to be
non-inferior to that of albumin in the vWF -170 +/- 46 HES vs174 +/- 53
Albumin, P=0.84) and FVIII (149 +/- 38 vs164 +/- 59 HES vs Albumin, P=
0.34) assays. HES and albumin groups were comparable in terms of 24 hour
chest drain median 590 (SD 460-810) mL HES and median 600 (SD 410-826) mL
albumin) No difference in red blood cell transfusion was seen (19% HES
versus14% albumin; P=0.13) CONCLUSION(S): Although clot initiation
was slightly longer in patients who received HES as assessed by TEG, other
coagulation tests and Factor VIII and von Willebrand factor concentrations
were comparable between groups. We conclude that HES had minimal effect on
coagulation in patients having cardiac surgery. (Table Presented).

<110>
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Accession Number
646620020
Title
Pecto-Intercostal Fascial Block For Post- Operative Analgesia After
Cardiac Surgery: A Pilot Study.
Source
Anesthesia and Analgesi. Conference: 2020 Annual Meeting of the
International Anesthesia Research Society, IARS 2020. San Francisco, CA
United States. 130(5 Supplement) (pp 122-123), 2020. Date of Publication:
01 May 2020.
Author
Khera T.; Wilson K.; Shankar P.; Rangasamy V.; Leibowitz A.; Murugappan
K.R.; Oren-Grinberg A.; Novack V.; Subramaniam B.
Institution
(Khera, Wilson, Shankar, Leibowitz, Murugappan, Novack, Subramaniam) Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Rangasamy) Riley Hospital for Children, Indianapolis, IN, United States
(Oren-Grinberg) BIDMC, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Inadequate analgesia post-cardiac surgery results in
immediate and long-term adverse surgical outcomes including pulmonary
complications increased length of ICU and hospital stay.[1 ] Opioid based
postoperative pain management is associated with respiratory depression,
GI complications, addiction potential raising concerns of the 'opioid
epidemic'.[2] Pecto-intercostal fascial block (PIFB) post-sternotomy, is a
novel, less invasive regional analgesic approach for optimal pain control.
Non-opioid analgesic approaches such as PIFB aims at establishing a
balanced multimodal technique for expedited post-operative recovery. In
this study, we explore the feasibility of PIFB and its impact on
analgesia, opioid requirements, and incidence of delirium in cardiac
surgical patients METHODS: This study is a prospective, randomized (1:1),
quadruple blinded, placebo-controlled trial, in adult cardiac surgical
patients (age > 18 years) requiring median sternotomy. This study was
approved by the institutional review board (IRB) and carried out at a
tertiary care center. Patients were randomized to receive either 0.25%
Bupivacaine (group 1, n=40) or Placebo (group 2, n=40) on postoperative
day 0 and 1. The block was administered bilaterally between the pectoralis
major and intercostal muscles, lateral to the sternotomy under ultrasound
guidance. Dropout criteria were assessed prior to administering the block
to ensure patient safety. The primary outcome was postoperative opioid
consumption during the first 48 hours. Secondary outcomes included patient
self-reported pain scores, postoperative delirium (assessed using 3D-CAM
instrument), length of ICU and hospital stay, and the incidence of
complications. The data was assessed for 80 randomly assigned patients who
received study medications at least once, on a modified intention to treat
basis. RESULT(S): Of the 80 patients randomized (mean age 65.7
+/-9.2; female 23.7%), all were included in the final analysis. Patient's
receiving PIFB block with 0.25% bupivacaine showed a decline in the
cumulative opioid requirement, computed as oral morphine milligram
equivalents (97+/-104 vs 118+/-104 placebo; p=0.36). A similar decreasing
trend was observed with postoperative pain scores (5.43 vs 5.79 placebo;
p=0.076). There was a comparable decline in the incidence of postoperative
delirium in the bupivacaine group (4/40; 10%) vs placebo (6/40; 15%;
p=0.54). No procedure-related adverse events were reported during this
study. CONCLUSION(S): We report a decreasing trend in opioid
requirement, pain scores and incidence of in-hospital delirium post
cardiac surgery in patients receiving PIFB. This procedure is safe and
feasible. The results of this study were not statistically significant,
this may be due to a type-2 error, and a larger multicenter, statistically
powered trial is required to establish the efficacy of PIFB in pain
management and delirium prevention for post cardiac surgery patients
(Figure Presented).

<111>
Accession Number
646609269
Title
Anesthetics to Prevent Lung Injury in Cardiac Surgery.
Source
Anesthesia and Analgesi. Conference: SCA 41st Annual Meeting and Workshops
and 8th Annual Thoracic Anesthesia Symposium (TAS). Chicago, IL United
States. 130(4 Supplement) (pp 16-18), 2020. Date of Publication: 01 Apr
2020.
Author
Gosling A.; Kumaresan A.; Subramanian B.; Mahmood F.; Shaefi S.; aO'Gara
B.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Up to 53% of cardiac surgery patients will have at least one
postoperative pulmonary complication (PPC).1-3 Inflammatory lung injury
may represent an important inciting factor for PPCs.4 Volatile anesthetics
have been shown to limit the release of multiple inflammatory biomarkers
and incidence of PPCs when compared to total intravenous anesthesia (TIVA)
in humans undergoing lung surgery with one lung ventilation.5-9 To date,
it is unknown whether this effect can be observed on patients undergoing
cardiac surgery. We performed a clinical trial with the objective of
investigating the impact of anesthetic selection on perioperative lung
inflammation and PPCs after cardiac surgery. We hypothesized that
anesthetic maintenance with sevoflurane as opposed to TIVA with propofol
would limit pulmonary inflammation and potentially reduce the risk of
PPCs. Method(s): Randomized controlled trial. Patients undergoing
cardiac surgery with cardiopulmonary bypass (CPB) were randomized to
receive intraoperative anesthetic maintenance with either sevoflurane or
propofol (see Figure 1). Patients with severe comorbid lung disease, an
allergy to either anesthetic, or receiving preoperative steroids were
excluded. Mechanical ventilation and oxygenation were standardized in both
groups. Serum and BAL were collected after intubation and 2 hours after
cross clamp removal. The primary outcome was differences in the
bronchoalveolar lavage (BAL) TNFalpha concentrations before and after CPB.
Other secondary inflammatory biomarkers were tested (IL-1beta/6/8, MCP1,
protein, sRAGE, angiopoietin 1 and 2, surfactant protein D, and sICAM1).
Differences between groups in continuous variables were compared using
t-tests. Two-sided p values < 0.05 were considered statistically
significant. Analysis of the incidence of PPCs for both groups is ongoing.
 Result(s): After institutional review board (IRB) approval, 51
patients undergoing cardiac surgery with CPB were enrolled between 09/2017
and 12/2018. The difference between post- and pre-CPB BAL TNFalpha
concentrations was not significantly different between patients receiving
Sevoflurane or Propofol (median (IQR) 15.37(0.0, 51.50) vs. 71.20(0.67,
324.27) pg/ml, p = 0.38, see Table 1). Sevoflurane group patients had
significantly lower concentrations of post-CPB plasma IL8 (53.92(34.50,
55.91) vs. 66.92(55.03, 94.44) pg/ml) and a significantly lower difference
between post- and pre-CPB plasma sRAGE (174.53(73.59, 446.06) vs.
548.22(193.15, 852.39) pg/ml, p=0.03) as compared to Propofol. There were
no other significant differences in biomarker concentrations between
groups. Conclusion(s): In this randomized trial assessing
inflammatory lung injury in patients undergoing cardiac surgery, the use
of Sevoflurane as opposed to Propofol did not result in consistent
reductions in pulmonary inflammatory mediators after CPB. Significant
differences were found in the concentrations of key pulmonary injury
biomarkers IL8 and sRAGE in plasma favoring the Sevoflurane group. Due to
multiple comparisons, however, these findings should be interpreted as
exploratory requiring further confirmation in follow up studies. (Figure
Presented).

<112>
Accession Number
646609263
Title
Reduction of microparticles from allogeneic blood using on demand point of
care washing.
Source
Anesthesia and Analgesi. Conference: SCA 41st Annual Meeting and Workshops
and 8th Annual Thoracic Anesthesia Symposium (TAS). Chicago, IL United
States. 130(4 Supplement) (pp 9-10), 2020. Date of Publication: 01 Apr
2020.
Author
Friedland M.; Welsby I.; Mauermann W.; Conn C.; Meade L.; Silliman C.;
Norris P.; Schulte P.; Kor D.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Infused microparticles (MPs) in the donor supernatant of
transfused RBC may generate thrombin or activate the recipient's immune
system, resulting in TRALI. We tested the hypothesis that on demand, point
of care (POC) washing using a continuous automated transfusion system
(CATS, Fresenius Kabi USA LLC, Lake Zurich, IL) can efficiently and
effectively reduce a statistically significant amount of MPs from
allogeneic blood. Method(s): A single blind randomized clinical trial
from two institutions evaluated the feasibility, safety, and efficacy of
POC washing for allogeneic RBC transfusions on the day of cardiac surgery.
Patients at high risk of large volume blood transfusion (4 or more units)
were approached for consent and randomized to the intervention arm (POC
washing) or standard allogeneic RBC transfusion. From the group randomized
to receive washed allogeneic RBCs, samples were taken from each unit of
blood before and after the washing procedures and the supernatant frozen
for batch analysis. Flow cytometry was then used to measure and
characterize the cellular origin of cell derived MPs in pre and post
washed units using the following markers: CD 235a (Glycophorin A), RBC
derived; CD108 (Semaphorin-7A), activated lymphocytes or RBCs derived;
CD41a (Glycoprotein IIb), megakaryocyte/platelet derived. Result(s):
Complete data was available from 74 of the 75 RBC units in the
intervention arm of the study. It was found however that there was nearly
a 100-fold inter-donor variation in MP counts in pre-washed samples. After
washing there was a statistically significant reduction in all cell lines
of MPs; total MP count 6,932,753 (IQR 4,137,335 - 20,382,171) prewash to
830,758 (IQR 332,639 - 2,854,863) (p<0.0001) post wash. However, only 1%
of the median counts of MPs were identified by the cell markers used in
flow cytometry; it is unclear if this is due to the lost of antigens
during washing, too limited of antigen specific testing, or if the
majority of MPs are simply cell debris and not actively formed,
encapsulated vesicles. Conclusion(s): The results indicate that the
POC washing significantly reduces the vast numbers of MPs in RBC units.
Despite lack of cell origin markers, RBC microparticles have previously
been found to support thrombin generation in vitro. Whether sufficient MPs
were removed to avoid deleterious effects of transfusion remains to be
seen. (Figure Presented).

<113>
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Accession Number
646621139
Title
Proteomic Changes Associated with Cardiopulmonary Bypass for Coronary
Artery Bypass Surgery.
Source
Anesthesia and Analgesi. Conference: 2020 Annual Meeting of the
International Anesthesia Research Society, IARS 2020. San Francisco, CA
United States. 130(5 Supplement) (pp 164-165), 2020. Date of Publication:
01 May 2020.
Author
De Biasio J.C.; Shaefi S.; Marcantonio E.; Subramaniam B.; Shankar P.;
Libermann T.A.; Dillon S.
Institution
(De Biasio, Shaefi, Marcantonio, Subramaniam, Shankar, Libermann, Dillon)
Beth Israel Deaconess Medical Center, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: The physiologic consequences of cardiopulmonary bypass for
coronary artery bypass and other cardiac surgical procedures are
substantial. In particular, the Inflammatory and hemostatic changes of
cardiopulmonary bypass are well recognized, and procedures utilizing
cardiopulmonary bypass require the effective management of such
anticipated effects. While it is understood that cardiopulmonary bypass
causes substantial changes in general, a more thorough appreciation of
these effects may be possible with a systematic analysis of the plasma
proteome in this setting. Identifying proteomic changes associated with
cardiopulmonary bypass for coronary artery bypass surgery may help to
determine the pathophysiology of particular adverse outcomes associated
with this procedure. METHOD(S): In a secondary study of a randomized
controlled trial comparing higher and lower concentrations of inspired
oxygen in patients undergoing coronary artery bypass surgery with
cardiopulmonary bypass, we analyzed previously collected and stored plasma
samples from a subset of the study population. A total of 48 sets of
samples were analyzed; the subset was comprised of pairs of subjects with
and without postoperative delirium matched by age, sex, and preoperative
Telephone- Montreal Cognitive Assessment (t-MoCA) score. Each plasma
sample was analyzed with the aptamer-based proteomics assay SOMAscan
(SomaLogic Inc, Boulder, CO) to determine the plasma concentration of
>1300 proteins before and immediately after cardiopulmonary bypass. To
determine the impact of cardiopulmonary bypass, relative fold-change
comparing post-bypass to pre-bypass plasma protein concentration was
determined. Using the Wilcoxon rank-sum test with Benjamini-Hochberg
correction for multiple hypothesis testing, statistical significance was
evaluated. A p-value less than 0.01 was considered significant. Systems
biology analysis was performed using Ingenuity Pathway Analysis (Ingenuity
Systems, Redwood City, CA) to evaluate the pathways most significantly
altered by cardiopulmonary bypass. RESULT(S): Among those proteins
with statistically significant change in concentration from pre-bypass to
post-bypass, there were 48 proteins that exhibited a greater than 2-fold
increase and 14 proteins that exhibited a greater than 2-fold decrease.
Systems biology analysis of these proteins identified disproportionate
involvement of a large number of inflammation- and hemostasis-related
pathways. CONCLUSION(S): Major changes in plasma protein
concentrations occur during cardiopulmonary bypass in the context of
coronary artery bypass surgery. These changes particularly reflect
alterations in inflammatory and hemostatic pathways. The substantial
number and degree of large changes in protein concentration observed in
this context offer several candidate proteins for further evaluation that
may ultimately offer improved prognostication and management of patients
who undergo procedures that utilize cardiopulmonary bypass. (Figure
Presented).

<114>
[Use Link to view the full text]
Accession Number
646621839
Title
The influence of daily habits on perioperative neurocognitive disorders in
patients scheduled for non-cardiac surgery. An observational study.
Source
Anesthesia and Analgesi. Conference: 2020 Annual Meeting of the
International Anesthesia Research Society, IARS 2020. San Francisco, CA
United States. 130(5 Supplement) (pp 815-817), 2020. Date of Publication:
01 May 2020.
Author
Saxena S.; Rodts C.; Nuyens V.; Maze M.; Boogaerts J.; Kruys V.; Vamecq J.
Institution
(Saxena, Rodts, Nuyens, Boogaerts) CHU de Charleroi, Charleroi, Belgium
(Maze) University of California San Francisco, San Francisco, CA, United
States
(Kruys) ULB Immunology Research Center, Gosselies, Belgium
(Vamecq) CHU Lille, Lille, France
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Perioperative neurocognitive disorders (PND) remain an
important complication, caused by the non-resolution of an inflammatory
cascade. (1) (2) (3) (4) Methods of identifying patients who are likely to
develop PND would improve overall perioperative support of these patients.
We aimed to investigate whether the sedentary behavior of the elderly
surgical patient was associated with PND and increased peripheral
inflammatory markers. METHOD(S): 38 patients scheduled for
non-cardiac surgery were included in this prospective observational study
from January until July 2019 at the CHU de Charleroi, Charleroi, Belgium.
Prior to surgery, patients were asked questions regarding their daily
habits. Sedentary behavior was assessed via IPAQ (international physical
activity questionnaire). Baseline MMSE (mini mental state examination)
testing was conducted and a baseline blood sample was taken. Six and 24
hours after surgery, blood samples were again taken. Patients' MMSE were
re-evaluated 6 weeks and 3 months after surgery. Circulating IL-6 and
HMGB1 levels were analyzed through ELISA. RESULT(S): Six weeks
postoperatively MMSE decreased from baseline. (Figure 1) Sedentary
behavior was not associated with a decrease in MMSE. Patients who spoke
more than one language (p=0.028) and who were self-sufficient (p=0.0083)
scored better on the MMSE six weeks postoperatively. (Table 1) Surgery was
associated with an increase in peripheral IL-6 (p<0.0001). (Figure 2)
Interestingly, IL-6 increased from baseline to 24 hours in patients who
underwent general and genitourinary surgeries while in those who underwent
orthopedic surgery, it achieved its maximum at 6 hours and then decreased.
An increase in IL-6 levels was not associated with sedentary behavior.
(Table 2) The postoperative rise in IL-6 was increased in elderly patients
(p=0.0044). It was lower when patients took less psychoactive drugs
(p=0.041) and when work-related IPAQ was high (p=0.024). Surgery was
associated with an increase in peripheral HMGB1(p<0.0001). (Figure 3) No
statistically significant association was found between HMGB1 and
pre-existing/baseline patient characteristics. CONCLUSION(S): Surgery
is associated with an increase in peripheral IL-6 and HMGB1 and with
cognitive impairment 6 weeks postoperatively. Preoperative sedentary
behavior is neither a risk factor for PND nor associated with an increase
in peripheral inflammation, findings that correspond with pre-clinical
data. (5) The putative effect of preoperative lifestyle in surgical
patients should be further tested in randomised controlled trials, ideally
with a battery of memory tests, instead of a single test. (Figure
Presented).

<115>
[Use Link to view the full text]
Accession Number
646619943
Title
Population-level cognitive trajectory before and after coronary
revascularization in older adults.
Source
Anesthesia and Analgesi. Conference: 2020 Annual Meeting of the
International Anesthesia Research Society, IARS 2020. San Francisco, CA
United States. 130(5 Supplement) (pp 330), 2020. Date of Publication: 01
May 2020.
Author
Whitlock E.L.; Diaz-Ramirez L.G.; Smith A.K.; Boscardin W.J.; Avidan M.;
Glymour M.M.
Institution
(Whitlock) University of California, San Francisco School of Medicine, San
Francisco, CA, United States
(Diaz-Ramirez, Smith, Boscardin, Glymour) University of California, San
Francisco, CA, United States
(Avidan) Washington University, School of Medicine in St. Louis, St.
Louis, MO, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Cognitive decline after coronary artery bypass grafting
(CABG) is commonly reported and a major concern for patients, but it is
unknown whether this represents an acute worsening of the rate of
preoperative cognitive change, and whether the postoperative rate of
cognitive change is similar to those undergoing nonsurgical coronary
revascularization (i.e., percutaneous coronary intervention [PCI]).
 METHOD(S): We selected Health and Retirement Study (HRS) participants
who underwent CABG (n=665) or PCI, (n=1,015) between 1998 and 2015 and
were 65 or older. Date of CABG or PCI was ascertained from Medicare
billing data. We modeled up to 15 years of memory score,(1) a
biennially-assessed summary measure of memory-focused cognitive tests from
the HRS battery including proxy cognition reports, using linear
mixedeffects models with random slopes and intercepts. We incorporated
discontinuities at the time of procedure and 6 months after, and a spline
knot at 5 years. Trajectories were adjusted for demographic, health
(including frailty), and other covariates at the time of the last
pre-procedure interview. RESULT(S): Prior to the procedure, the CABG
group was declining 0.012 memory units per year more slowly than the PCI
group (95% CI [0.0004-0.023], p=0.043). When compared to the rate of
cognitive decline in the PCI group, the CABG group was declining 25% more
slowly than the PCI group prior to the procedure (95% CI [7.9% to 48% more
slowly]). After the procedure, the CABG group rate of memory change
accelerated by 68% compared with the pre-procedure trajectory (additional
0.024 memory units per year decline; 95% CI [0.011- 0.038], p=0.001). CABG
and PCI cognitive trajectories were statistically indistinguishable after
the procedure. CONCLUSION(S): Compared with nonsurgical coronary
revascularization, CABG is associated with an acceleration in rate of
cognitive decline compared with pre-procedure cognitive trajectory;
however, the postprocedure rate of cognitive change is indistinguishable
from PCI recipients. The long-term post-procedure rate of cognitive change
may reflect the cognitive impact of cardiovascular disease, which would be
expected to be similar between the CABG and PCI groups. (Figure
Presented).

<116>
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Accession Number
646621853
Title
Comparison of Positional Stability: The EZBlocker Versus a Left-Sided
Double Lumen Endotracheal Tube in Adult Patients Undergoing Non-cardiac
Thoracic Surgery.
Source
Anesthesia and Analgesi. Conference: 2020 Annual Meeting of the
International Anesthesia Research Society, IARS 2020. San Francisco, CA
United States. 130(5 Supplement) (pp 818-820), 2020. Date of Publication:
01 May 2020.
Author
Morris B.N.; Fowler J.G.; VanEenenaam D.P.; Johnson K.; Fernando R.;
Garner C.; Johnson S.D.; Marchant B.E.; Gardner J.; Templeton T.W.
Institution
(Morris, Fowler, VanEenenaam, Johnson, Garner, Johnson, Marchant, Gardner)
Wake Forest Baptist Hospital, Winston Salem, NC, United States
(Fernando) Wake Forest School of Medicine, Winston-Salem, NC, United
States
(Templeton) Wake Forest University, Dept of Anestheisology, Winston-Salem,
NC, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: One-lung ventilation (OLV) with a bronchial blocker or
double lumen tube (DLT) remains a mainstay of thoracic anesthesia (1).
Studies have shown, however, that bronchial blockers are inferior to
double lumen endotracheal tubes in so far as intraprocedural positional
stability is concerned (2). The EZ-Blocker (Teleflex) bronchial blocker
diverges from the design of typical bronchial blockers with its unique
'Y'- shaped design that may provide increased positional stability during
intraprocedural manipulation and OLV (3). Therefore, we performed a
randomized control trial to compare the rate of device repositioning per
hour of one lung ventilation in right and left sided thoracic cases with a
left sided double lumen tube and an EZ-Blocker. METHOD(S): After IRB
approval 163 patients were recruited and randomized to undergo OLV and
surgery using either a EZ-Blocker or left sided DLT. Patients in both
groups were further subdivided into those undergoing right and left sided
procedures. A minimum number of 40 patients were recruited for each side
with each device. Patients with a history of a difficult airway, BMI > 39,
pregnant or required a right-sided DLT were excluded. Demographics and
type of surgery were recorded. Additionally, we recorded the duration of
OLV, time to device placement, incidences of repositioning during OLV,
time required to reposition, and evaluation of the quality of isolation by
the surgeon (1-poor, 2-acceptable, or 3-good isolation). The repositioning
rate per hour of OLV, time required to reposition, time to device
placement, and VAS scores were compared between groups using an unpaired,
bidirectional t-test. Isolation scores were compared using the Mann-
Whitney test. Prevalence of at least one repositioning event per procedure
were compared using the t-test for proportions. P-values < 0.05 were
considered statistically significant. RESULT(S): 163 patients were
randomized: 40 rightsided EZ-Blocker, 41 left-sided EZ-Blocker, 42
rightsided LDLT and 40 left-sided LDLT. See Table 1 for demographics. The
rate of repositioning during OLV per hour was higher in right sided cases
in which an EZ-Blocker was used compared to a left sided DLT: 0.23 and
0.10, respectively (p=0.04) (table 2). The rate of repositioning per hour
of OLV in left sided cases however was similar between the two devices:
0.08 and 0.11 (p=0.57) (table 3). The overall prevalence of repositioning
per case for EZ-Blocker and LDLT were 33.3% and 22.0%. Finally, the
quality of isolation as reflected in our subjective scoring system was
significantly lower in patient in which an EZ-Blocker was used for OLV
compared to a left sided DLT: 2.62 vs 2.84 (p=.001). CONCLUSION(S):
The primary finding of this study is that the EZ-Blocker resulted in an
increased rate of repositioning in right sided cases. In left sided cases
the EZ-Blocker appears to have a similar rate of repositioning when
compared to that of a left sided DLT. This is an important finding as this
may represent a significant rebalancing of the risk benefit analysis of
using a DLT vs an EZ-Blocker in left sided procedures requiring OLV. Other
studies have found no significant differences in efficacy between the EZ
Blocker and LDLT, however these studies did not distinguish between left
and right-sided OLV cases (3-4). Limitations of this study include the
relatively small number of patients and lack of blinding of the surgeon to
which device was being used during a given procedure. More prospective
study in other centers is necessary to further confirm these findings.
(Table Presented).

<117>
Accession Number
646609614
Title
Comparison of Preventive Cardiovascular Pharmacotherapy in Surgical versus
Percutaneous Coronary Revascularization.
Source
Canadian Journal of Hospital Pharmacy. Conference: CSHP Professional
Practice Conference 2019. Toronto, ON Canada. 72(1) (pp 76), 2019. Date of
Publication: 2019.
Author
Barry A.R.; Wang E.; Chua D.; Pearson G.J.
Institution
(Barry) Faculty of Pharmaceutical Sciences, University of British
Columbia, Vancouver, BC, Canada
(Barry) Chilliwack General Hospital, Lower Mainland Pharmacy Services,
Chilliwack, BC, Canada
(Wang, Chua) St. Paul's Hospital, Lower Mainland Pharmacy Services,
Vancouver, BC, Canada
(Pearson) Faculty of Medicine and Dentistry (Division of Cardiology),
University of Alberta, Edmonton, AB, Canada
Publisher
Canadian Society of Hospital Pharmacists
Abstract
Background:Data suggest patients who undergo coronary artery bypass graft
surgery (CABG) have a lower rate of preventive cardiovascular
pharmacotherapy use compared to percutaneous coronary intervention (PCI).
However, these studies do not account for justified non-use (e.g.,
allergy/intolerance/contraindication). Objective(s): To assess rate
of utilization of preventive cardiovascular pharmacotherapy at discharge
in CABG versus PCI patients post-acute coronary syndrome (ACS).
 Method(s): Prospective cohort study was conducted at St. Paul's
Hospital in Vancouver, British Columbia. Consecutive patients aged >18
years discharged post-ACS after CABG or PCI between January-June 2018 were
included. Data collected included demographics, revascularization
strategy, and preventive cardiovascular medication use specifically
acetylsalicylic acid (ASA), P2Y12 inhibitors, beta-blockers,
angiotensinconverting enzyme inhibitors/angiotensin receptor blockers
(ACEI/ ARBs) and statins including adjustment for justified non-use.
Statistical analyses included t-test and chi-square test for continuous
and categorical variables, respectively, with a significance level of
<0.05. Result(s): One hundred and sixty patients were included. Mean
age was 65 years and 83% were male. Comorbidities were similar between
groups. Sixty-six percent presented with a non-ST-elevation ACS and 54%
underwent CABG. More non-ST-elevation ACS patients underwent CABG versus
PCI (70% versus 30%, p<0.01). All patients received ASA, but more CABG
patients received 325 versus 80-81 milligrams (20% versus 1%, p<0.01). All
PCI patients received a P2Y12 inhibitor (primarily ticagrelor) versus 24%
of CABG patients (primarily clopidogrel). All CABG patients received a
beta-blocker versus 97% of PCI patients. Use of ACEI/ARBs was higher in
PCI versus CABG patients (99% versus 69%, p<0.01). Statin use was similar
between groups (97% versus 99%, p=0.45), but more PCI patients received
high-dose (91% versus 57%, p<0.01). Conclusion(s): Use of ASA and
beta-blockers post-ACS was high in both groups. P2Y12 inhibitors and
ACEI/ARBs were underutilized in CABG patients even after adjusting for
justified non-use, and CABG patients were less likely to receive high-dose
statin therapy.

<118>
Accession Number
646616864
Title
25th European Conference on General Thoracic Surgery.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. Conference: 25th
European Conference on General Thoracic Surgery. Innsbruck Austria.
25(Supplement 1) (no pagination), 2017. Date of Publication: 01 Oct 2017.
Author
Anonymous
Publisher
Oxford University Press
Abstract
The proceedings contain 265 papers. The topics discussed include:
pulmonary hypertension may improve in selected patients after lung volume
reduction surgery; conversion due to vascular injury during video-assisted
thoracoscopic surgery lobectomy; video-assisted thoracoscopic surgery
versus open surgery for stage I thymic epithelial tumors: a
propensity-score matched analysis of the Chinese alliance for research in
thymomas retrospective database; prophylactic continuous positive airway
pressure after pulmonary lobectomy for lung cancer: a randomized
controlled trial; vagus nerve stimulation attenuates the acute
postsurgical inflammatory response after lung lobectomy; risk and benefit
of neoadjuvant therapy among patients undergoing resection for non-small
cell lung cancer; and anatomical resections are superior to wedge for the
overall survival in stage I typical carcinoid patients.

<119>
Accession Number
646616843
Title
RISK-ADJUSTED COMPARISON OF PERFORMANCE BETWEEN THREE ACADEMIC THORACIC
SURGERY UNITS USING THE EUROLUNG RISK MODELS.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. Conference: 25th
European Conference on General Thoracic Surgery. Innsbruck Austria.
25(Supplement 1) (pp i18), 2017. Date of Publication: 01 Oct 2017.
Author
Pompili C.; Shargall Y.; Decaluwe H.; Moons J.; Chari M.; Brunelli A.
Institution
(Pompili) Leeds Institute of Cancer and Pathology, University of Leeds,
Leeds, United Kingdom
(Shargall, Chari) Thoracic Surgery, McMaster University, Hamilton, Canada
(Decaluwe, Moons) Thoracic Surgery, University Hospitals Leuven, Leuven,
Belgium
(Brunelli) Department of Thoracic Surgery and Thoracic Endoscopy, St.
James's University Hospital, Leeds, United Kingdom
Publisher
Oxford University Press
Abstract
Objectives: To compare the performance of 3 thoracic surgery centres using
the Eurolung risk models for morbidity and mortality. Method(s):
Retrospective analysis on prospective databases from 3 academic centres
(2014-2016). Two thousand eleven patients (721 patients from centre 1 857
from centre 2 and 433 from centre 3) undergoing anatomic lung resections
(1640 lobectomies, 227 segmentectomies and 144 pneumonectomies, 63% by
minimally invasive techniques) were analysed. The Eurolung1 and Eurolung2
models were used to risk-adjust cardiopulmonary morbidity and 30-day
mortality rates. ANOVA and Student's t-test were used to compare average
outcomes between and within centres. Result(s): Overall
cardiopulmonary complication and 30-day mortality rates were 25% and
2.08%. Analysis of morbidity: The observed morbidity rate of centre 3
(41%) was significantly higher than the ones of centre 1 (21.2%, P <
0.0001) and 2 (20.2%, P < 0.0001). The observed morbidity of centre 1 was
in line with the predicted one (22.7% vs 21.1%, P=0.3). Centre 2 performed
better than expected (observed morbidity 20.2% vs predicted 26.7%, P <
0.0001), whereas the observed morbidity of centre 3 was higher than the
predicted one (41.1% vs 24.3%, P < 0.0001). Analysis of mortality: The
observed mortality of centre 1 (3.6%) was higher than those of centres 2
(1.2%, P=0.001) and 3 (1.4%, P=0.03). The mortality rate observed in
centre 1 was in line with the predicted one (3.6% vs 4.3, P=0.3), whereas
centres 2 (1.2% vs 5.2%, P < 0.0001) and 3 (1.4% vs 5%, P < 0.0001) had
observed mortality rates significantly lower than the predicted ones. The
mortality rates observed in those patients with major cardiopulmonary
complications (according to the TMM score >2) were 32% in centre 1 (vs
predicted mortality 8%, P=0.0001), 8.2% in centre 2 (vs predicted
mortality 8.1%, P=0.9) and 9% in centre 3 vs predicted mortality 7.1%,
P=0.7). Conclusion(s): The use of Eurolung models allow for an
objective comparison of performance between different centres by reliably
identifying outcome differences. Our analysis should be interpreted as a
methodological template for future quality improvement initiatives.

<120>
Accession Number
646616903
Title
VIDEOTHORACOSCOPIC APPROACH IS ASSOCIATED WITH FAVOURABLE OUTCOME IN THE
TREATMENT OF EARLY-STAGE NON-SMALL CELL LUNG CANCER: A PROPENSITY
SCORE-MATCHED ANALYSIS.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. Conference: 25th
European Conference on General Thoracic Surgery. Innsbruck Austria.
25(Supplement 1) (pp i6), 2017. Date of Publication: 01 Oct 2017.
Author
Dziedzic R.; Marjanski T.; Rzyman W.
Institution
(Dziedzic, Marjanski, Rzyman) Department of Thoracic Surgery, Medical
University of Gdansk, Gdansk, Poland
Publisher
Oxford University Press
Abstract
Objectives: Videothoracoscopic approach has become a standard for early
stage non-small cell lung cancer (NSCLC). Recently published meta-analyses
proved the benefit of videothoracoscopic approach regarding overall
survival and postoperative complications comparing with open thoracotomy.
The aim of the study was to compare early, long-term survival and rate of
postoperative complications of videothoracoscopic approach comparing with
open thoracotomy. Method(s): In this retrospective cohort study we
performed an analysis of 982 individuals who underwent surgical resection
for stage I-IIA of NSCLC between 2007 and 2015 in the Department of
Thoracic Surgery. Thirty-day, 90-day mortality, length of hospital stay,
rate of respiratory and cardiovascular complications, and overall survival
were assessed. Subsequently propensity scorematched analysis (PSMA) was
performed to compare 2 groups of patients. Five hundred and five
individuals from open thoracotomy and 203 patients from videothoracoscopic
group were exactly matched with pTNM, sex, Charlson Comorbidity Index,
type of surgical resection and type of NSCLC. Result(s): In the
unmatched and matched groups of patients the videothoracoscopic approach
was associated with a significant benefit regarding overall survival
(log-rank P=0.04). Correspondingly, the Cox proportional hazard ratio of
matched patients was 0.64 (95% CI 0.41-0.98) indicating significant
improvement in survival. We observed reduced rate of postoperative
atelectasis (3.4% vs 9.5%, P=0.006) and need for blood transfusion (4.4%
vs 10.3%, P=0.01) without significant impact on postoperative length of
stay (mean 7.5 vs 8.5 days, P=0.07), 30-day mortality (1.0% vs 1.6%,
P=0.8) and 90-day mortality (1.0% vs 2.6%, P=0.2). Conclusion(s):
Patients operated forearly stage NSCLC through videothoracoscopic approach
have better overall survival compared to those operated through
thoracotomy.

<121>
Accession Number
646618243
Title
THE EFFECT OF CRICOID PRESSURE ON APNEIC OXYGEN RESERVE IN ADULT PATIENTS
UNDERGOING ENDOTRACHEAL INTUBATION FOR SCHEDULED SURGERY.
Source
Anesthesia and Analgesia. Conference: Annual Meeting of the Society for
Technology in Anesthesia, STA 2015. Phoenix, AZ United States. 122(5
Supplement) (pp S11), 2016. Date of Publication: 01 May 2016.
Author
Lenart J.; Cho E.; Clark B.; Andrews G.D.; Applegate R.
Institution
(Lenart, Cho, Clark, Andrews) Loma Linda University, School of Medicine,
Loma Linda, CA, United States
(Applegate) Anesthesiology Loma Linda, University School of Medicine,
Loma, CA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Cricoid pressure is commonly used during anesthesia
induction with planned endotracheal intubation. It is believed that
applying cricoid pressure decreases a patient's risk to aspirate gastric
contents between the time of anesthesia induction and endotracheal
intubation. However there is evidence that application of cricoid pressure
increases heart rate and blood pressure which may result in faster oxygen
consumption1. This pilot study was designed to investigate the effect size
such an increase in oxygen consumption could have on the time to
desaturation. METHOD(S): Adult patients 18-65 years scheduled for
surgery including anesthesia with planned endotracheal intubation gave
written consent to participate in this LLU IRB approved study. Exclusion
criteria were suspected or known difficult mask ventilation/intubation;
elevated ICP; ASA PS 4; ASA PS 3 with cardiopulmonary disease; planned
cardiothoracic surgery; or risk for aspiration of gastric contents.
Patients were randomly assigned to cricoid pressure or sham with
concealment until after consent. The surgical and anesthetic team and
research staff collecting data were blinded to group allocation. Standard
monitors were applied with processed EEG monitoring (PSI). Vital signs
were continuously collected to computer and noted every 60 seconds from
anesthesia induction after intubation. Patients were preoxygenated to
FeO2/ FiO2 > 0.9 prior to induction; or withdrawn for failure to attain
this ratio. After administration of anesthetic and relaxant drugs and
before endotracheal intubation research staff placed their hands on the
patients neck concealed by a drape. The staff that applied cricoid
pressure were trained and demonstrated ability to reliably reproduce 30N
of force2,3 prior to study participation. Timing started at the onset of
apnea (lack of respiratory effort; no EtCO2; time 0). No mask ventilation
or supplemental oxygen was applied after time zero. Cricoid pressure
patients had 30N of cricoid pressure applied at time 0; held until SpO2 <
95% or 6 minutes had elapsed. Cricoid presssure was released prior to
endotracheal intubation. Time to lowest SpO2 and intubation were
calculated. The primary outcome measure was the difference in time to
lowest SpO2. Secondary measures included difference in the lowest SpO2 and
the number of patients with SpO2<95%. RESULT(S): 40 patients
consented with 2 from each group withdrawn for preoxygenation failure.
There were no significant differences in patient characteristics (Fig 1).
We did not find a significant difference in time to reach lowest SpO2 or
lowest SpO2 (Fig 2 3). CONCLUSION(S): Application of 30N cricoid
pressure was not associated with a difference in time to lowest SpO2 or
lowest SpO2 in preoxygenated patients. Prior reports showing
cardiovascular activation used 40N cricoid pressure. It is possible that
excess pressure may cause more sympathetic response than the recommended
30N cricoid pressure.

<122>
Accession Number
646610336
Title
DIGITAL DEVICES IN THORACIC SURGERY: ARE THEY REALLY USEFUL IN CLINICAL
PRACTICE TO PREDICTAIR LEAK? RESULTS FROM A PROSPECTIVE RANDOMIZED
CLINICALTRIAL.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. Conference: 24th
European Conference on General Thoracic Surgery. Naples Italy.
23(Supplement 1) (no pagination), 2016. Date of Publication: 01 Sep 2016.
Author
Chiappetta M.; Nachira D.; Lococo F.; Petracca Ciavarella L.; Romano R.;
Pastina M.; Congedo M.T.; Porziella V.; Margaritora S.
Institution
(Chiappetta) Department of Surgical Oncology, Thoracic Surgery Unit,
Regina Elena National Cancer Institute - IFO, Rome, Italy
(Nachira, Petracca Ciavarella, Romano, Pastina, Congedo, Porziella,
Margaritora) Department of Thoracic Surgery, Catholic University of the
Sacred Heart, Rome, Italy
(Lococo) Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria Nuova,
Reggio Emilia, Italy
Publisher
Oxford University Press
Abstract
Objectives: Digital devices could help clinical practice measuring the air
leak, but their role is still debated. The aim of this study is to test
advantages using these devices. Method(s): From June 2012 to May 2015
we enrolled 95 patients who underwent lobectomy or wedge resection in a
prospective randomized trial at our division of thoracic surgery. The
patients were divided in group D (50 patients) and group E (45 patients):
air-leak was evaluated by digital device in group D and by water seal in
group E. In group D the chest drain was removed when the air leak was
absent or <0.5 l/h for 12 consecutive hours. In group E the chest drain
was removed when clinical signs of air leak were absent. Result(s):
Male/female ratio was 50/45, mean age was 63.63 +/- 12.95 years.
Cumulative mean postoperative hospitalization was 6.00 +/- 3.33 days
(range 2-31), mean chest tube stay was 5.17 +/- 3.54 days, persistent
air-leak (>5 days) occurred in 9 (9.9%). Postoperative hospital stay in
group D was 5.81 +/- 2.56 days and in group E it was 6.20 +/- 4.12 days (P
= 0.8), mean chest tube stay was 5.08 +/- 3.01 days in group D and 5.27
+/- 4.07 days in group E (P = 0.8); clamping test was needed in 1 patient
in group D and in 7 in group E (P = 0.02). Interestingly, air-leak in the
first postoperative day was a predictive factor of persistent air-leak
(AUC on the ROC curve of 69.7%, sensibility: 77.8%). In detail, in D group
an air-leak value >0.2 l/h with spikes over 0.5 l/h in III p.o was
predictive of a persistent air-leak; chest tube duration was 7.73+/-5.20
days in patients with spikes and 4.32+/-1.33 days in patients without
spikes, P = 0.001; AUC: 83%, sensitivity: 80%. Conclusion(s): Digital
devices reduced clamping tests and mistakes in chest drain removal timing.
They are also useful to assess and predict persistent air-leak, helping
clinical practice and chest tube management.

<123>
Accession Number
646619911
Title
UNIPORT AND MULTIPORT EPIDURAL CATHETERS IN POST-SURGICAL PATIENTS.
Source
Anesthesia and Analgesia. Conference: Annual Meeting of the Society for
Technology in Anesthesia, STA 2015. Phoenix, AZ United States. 122(5
Supplement) (pp S320), 2016. Date of Publication: 01 May 2016.
Author
Foley M.R.; Connolly M.; VanderWielen B.; Shnider M.; Hess P.
Institution
(Foley) Northwestern University, Chicago, IL, United States
(Connolly, VanderWielen, Shnider, Hess) Beth Israel Deaconess Medical
Center, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: A properly functioning epidural is the gold standard
analgesic modality for many thoracic and abdominal procedures
post-operatively. However, epidural analgesia has been studied almost
exclusively in the lumbar spaces of parturient1-4 and not the thoracic
spaces of post-surgical patients. Integral to the spread of local
anesthetic within the epidural space, and ultimately providing pain
relief, is whether the catheter design has one endhole, or multiple side
holes. These two catheter designs provide equivalent analgesia in laboring
patients1. However, this may not be true in post-surgical patients wherein
lower volumes are typically used for longer duration and the thecal sac is
thinner and narrower. We hypothesize that flexible multi-port thoracic
epidural catheters will provide superior analgesia when compared to
flexible uniport catheters for post-surgical patients as measured by
epidural failure rate (primary outcome defined as the need to use
adjunctive opioids, replacing or removing the epidural) and pain scores
(secondary outcomes). METHOD(S): This is an IRB approved randomized,
doubleblind, prospective trial registered with clinicaltrials.gov.
Patients undergoing thoracic or abdominal surgery, requesting a thoracic
epidural expected to be in place >24 hours, and ages 18 to 75 were
approached by an investigator. Exclusion criteria included any chronic
pain/opioids, BMI >40, delirium and dementia. Using alpha=0.05, beta=0.80
and an analgesic failure difference of 20%, power analysis predicted 91
patients would be needed per group. The placement team was unblinded to
catheter type but the acute pain service that followed the patient post-op
and recorded outcomes was blinded (the catheters appear identical).
Ultimately, a blinded interim analysis was performed after the first 100
patients due to significant pushback to end the study from our acute pain
service citing time constraints. A t-test was used to compare continuous
pain score data and Kaplan-Meier curves displaying epidural 'survival'
were calculated for each catheter. RESULT(S): 100 patients were
enrolled and underwent randomization. A significant number of patients
were excluded from data analysis because the epidural was never used
(post-op intubation, hemodynamic instability). 31 patients received the
'green' and 35 patients received the 'blue' catheter. CONCLUSION(S):
One of the catheter designs appears to provide superior analgesia
(although both have a higher incidence of failure than typically seen in
obstetrics). VNAS scores at PACU admit and discharge and on POD 1 and 2
are all lower, but only PACU discharge and POD 1 are statistically
significant. The Kaplan Meier curves demonstrate that more epidurals are
functioning appropriately in the blue group at all time points. This
interim analysis provided us the necessary data to convince our acute pain
service to continue enrollment until criteria was reached.

<124>
Accession Number
646619186
Title
A SYSTEMATIC REVIEW AND META-ANALYSIS OF INHALATION AGENTS FOR THE
TREATMENT OF PULMONARY HYPERTENSION IN CARDIAC SURGICAL PATIENTS.
Source
Anesthesia and Analgesia. Conference: Annual Meeting of the Society for
Technology in Anesthesia, STA 2015. Phoenix, AZ United States. 122(5
Supplement) (pp S83), 2016. Date of Publication: 01 May 2016.
Author
Elmi-Sarabi M.; Deschamps A.; Delisle S.; Denault A.
Institution
(Elmi-Sarabi, Deschamps, Denault) Montreal Heart Institute, Montreal,
Quebec, Canada
(Delisle) Intensive Care Unit, Hopital Sacre- Coeur de Montreal, Montreal,
Quebec, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: In cardiac surgery, pulmonary hypertension (PH) is an
important prognostic factor for which several treatments have been
suggested over time. In this systematic review, we compared the efficacy
of inhaled pulmonary vasodilators to placebo in the treatment of PH during
cardiac surgery. METHOD(S): We searched MEDLINE, CENTRAL, EMBASE, The
Web of Science and clinicaltrials.gov databases up to October 2015 for
randomized controlled trials comparing the efficacy of inhaled agents to
placebo in cardiac surgical patients. Hemodynamic profile was assessed as
the primary outcome. Secondary outcomes included mortality, length of stay
in hospital and in intensive care unit, and mean dosage of inotropic and
vasopressor agents. RESULT(S): Of the 2897 citations identified, 5
studies were included comprising a total of 211 patients.1-5 No
significant hemodynamically meaningful differences were observed between
inhaled agents and placebo defined as heart rate, mean pulmonary artery
pressure, mean arterial pressure, pulmonary vascular resistance, pulmonary
capillary wedge pressure and central venous pressure (Table 1).
Sensitivity analyses were consistent with these findings. Secondary
outcomes could not be evaluated due to insufficient data.
 CONCLUSION(S): A systematic review of the literature revealed that to
date very few trials have reported on the efficacy of inhaled vasodilator
agents compared to placebo. Furthermore, these are small trials with few
participants. A meta-analysis of these studies reported no significant
meaningful differences in hemodynamic variables between inhaled agents and
placebo. Moreover, due to the limited number of studies reporting on the
use of inhaled agents in cardiac surgical patients, the effect on
clinically relevant end-points could not be assessed. Further research is
therefore warranted in this area of research and should focus on
clinically significant outcomes.

<125>
Accession Number
646618576
Title
IMPACT OF SURGICAL SPECIAL CARE UNITS: A SYSTEMATIC REVIEW.
Source
Anesthesia and Analgesia. Conference: Annual Meeting of the Society for
Technology in Anesthesia, STA 2015. Phoenix, AZ United States. 122(5
Supplement) (pp S234), 2016. Date of Publication: 01 May 2016.
Author
Mendis N.; Hamilton G.M.; McIsaac D.I.; Fergusson D.; Wunsch H.; Turgeon
A.; Lalu M.M.
Institution
(Mendis) University of Ottawa, Ottawa, ON, Canada
(Hamilton) Research Institute, Ottawa, ON, Canada
(McIsaac) Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
(Fergusson) Medicine,Surgery, and Epidemiology and Community Medicine,
Ottawa Hospital, Canada
(Wunsch) Anesthesia and Critical Care, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, ON, Canada
(Turgeon) Anesthesia and Critical Care, Universite Laval, Quebec, QC,
Canada
(Lalu) Ottawa Hospital, University of Ottawa, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Perioperative intermediate care units (termed surgical
special care unit, or SSCU) may improve surveillance and identification of
at-risk surgical patients. Institution of an SSCU may lead to global
improvements across patient outcomes, as well as reduce the workload and
financial burden at a systems level. We conducted a systematic review in
order to investigate the effects of a 3-level model of care delivery (i.e.
ward, SSCU, ICU) compared to a 2-level model of care (i.e. ward, ICU) on
post-operative mortality, morbidity, and healthcare resource utilization.
 METHOD(S): Our protocol was registered with PROSPERO (CRD
20154025155). Randomized controlled trials (RCTs) and nonrandomized
comparator studies (NRCTs) that compared a three vs two level model of
care of perioperative non-cardiac surgery patients were included. A
systematic search of Medline, CINAHL, Embase, and the Cochrane library was
performed (inception-01/2015). Retrieved citations were screened and data
extracted independently in duplicate. Data were extracted for mortality
(primary outcome) as well as serious adverse events (SAEs), length of
stay, and hospital costs (secondary outcomes). We planned pooling data
(relative risk) using random effect models with the DerSimonian and Laird
method, if applicable. RESULT(S): 1868 citations were retrieved by
our search and 21 studies met eligibility criteria (2 RCTs, 19 NRCTs,
44134 patients). SSCUs were characterized by continuous monitoring (11
studies), absence of mechanical ventilation (7 studies), nursing:patient
ratios (range 1:2-1:4), and number of beds (5, 3-33; median, range).
Thirteen studies reported on mortality, three of which reported overall
in-hospital mortality in a 2 vs. 3-level model of care. Significant
methodological heterogeneity precluded pooled analysis, however two of the
three studies demonstrated no difference in overall hospital mortality,
and one demonstrated an increased mortality in a 3-level model of care vs
2-level model. Four studies reported ICUspecific mortality, two of which
demonstrated an increased ICU mortality in a 3-level model of care. Four
studies compared total inhospital costs, two of which demonstrated
reductions with a 3-level model of care. Nine studies reported on hospital
length of stay and demonstrated no significant difference. Four studies
reported SAE data, however heterogeneity in reporting precluded analysis.
 CONCLUSION(S): In this first systematic review of SSCUs, we observed
significant heterogeneity in SSCU design and reporting of outcomes.
Available data may suggest a 3-level model of care may increase in-ICU
mortality with no difference in overall in-hospital mortality. This may
reflect a 'decanting' of lower acuity patients from the ICU to the SSCU in
a 3-level model of care. The potential effects of a 3-level model of care
on hospitalization costs warrants further investigation.

<126>
Accession Number
646610163
Title
USEFULNESS OF FLEXIBLE SILICONE DRAINAGE VERSUS CONVENTIONAL PLASTIC
DRAINAGE IN THORACIC SURGERY.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. Conference: 24th
European Conference on General Thoracic Surgery. Naples Italy.
23(Supplement 1) (no pagination), 2016. Date of Publication: 01 Sep 2016.
Author
Pinos N.; Moreno-Merino S.; Lopez-Porras M.; Giron J.C.; Zuniga G.;
Jimenez-Merchan R.; Congregado M.
Institution
(Pinos, Moreno-Merino, Lopez-Porras, Giron, Zuniga, Jimenez-Merchan,
Congregado) General Thoracic Surgery, Virgen Macarena University Hospital,
Seville, Spain
Publisher
Oxford University Press
Abstract
Objectives: Pleural drainages are used in general thoracic surgery to
evacuate air and liquids after surgery. It also works as a witness to
detect early postoperative complications. Nowadays rigid drainages are
more commonly used but they have some disadvantages like postoperative
pain that causes respiratory complications due to less physiotherapy
exercises after surgery. Flexible silicone drainages seem to be better
tolerated by patients. The aim of this study is to compare flexible versus
rigid drainage after lung resection surgery. Method(s): A randomized
clinical trial was performed to compare flexible versus rigid drains after
lung resection surgery. Two homogeneous groups of 50 patients were
enrolled: Group A (rigid plastic drainage 24 Fr Medovations), Group B
(round silicone fluted drain 24 Fr BiovacTM). Variables studied: age,
gender, pre- and postoperative diagnosis, type of resection and approach,
intraoperative incidents, air leaks, subcutaneous emphysema, pleural
liquid evacuated, postoperative complications, days with drainage, length
of stay (LOS). Statistical analysis: Chi square for qualitative data and
Student's t-test for quantitative variables (SSPS 22.0). Result(s):
Both groups were comparable and no significant differences were found in
age (P = 0.55), gender (P = 0.79), malignant diagnosis (P = 0.61), type of
resection (P = 0.21), videothoracoscopic or conventional approach (P =
0.82) and intraoperative complications (P = 0.61). Although LOS seems to
be shorter in group B and there were more subcutaneous emphysema in group
B, no statistically significant differences were found in any variable.
 Conclusion(s): According to the data of our study, there are no
differences in the efficacy of rigid drainages against flexible silicone
drains after lung resection surgery. Considering that the patients better
tolerate this kind of drainage, flexible silicon drains can be a good
choice after lung surgery.

<127>
Accession Number
646610294
Title
Cardiac Output Monitoring Technologies During Major Surgery: A Nationwide
Economic Evaluation.
Source
Anesthesia and Analgesi. Conference: Annual Meeting of the Society for
Technology in Anesthesia, STA 2016. Palm Beach, CA United States. 122(5
Supplement) (pp 70), 2016. Date of Publication: 01 May 2016.
Author
Michard F.; Mountford W.K.; Krukas M.R.; Ernst F.R.; Fogel S.L.
Institution
(Michard) Critical Care,Edwards Lifesciences, Irvine, CA, United States
(Mountford, Krukas, Ernst) Premier Inc, Charlotte, NC, United States
(Fogel) Virginia Tech Carilion School of Medicine, Roanoke, VA, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The cost of cardiac output (CO) monitoring technologies is
often perceived as a significant barrier to their adoption. A fair
economic evaluation should take into account savings related to the
decrease in postoperative morbidity usually associated with CO-guided
therapy. A recent meta-analysis (1) showed a 17-29% decrease in
postoperative morbidity with CO-guided therapy. Our objective was to
predict the economic impact of CO-guided therapy by comparing potential
savings and costs. Method(s): We studied 204,680 adult patients from
541 US hospitals who had a major non-cardiac surgical procedure between
January 2011 and June 2013. Hospital costs (including 30-day readmission
costs) in patients with and without complications were extracted from the
Premier Inc. research database. Potential cost-savings associated with a
17-29% decrease in postoperative morbidity were estimated. Average cost of
CO monitoring technologies was estimated at $300 per patient ($250 per
disposable sensor + $48 for the amortization of a $15,000 monitor used two
times a week over 3 years). Result(s): A total of 76,807 patients
developed one or more post-surgical complications (morbidity rate 37.5%).
In patients with and without complications, hospital costs were $27,607
+/- 32,788 and $15,783 +/- 12,282 (p<0.0001), respectively. According to
Pearse et al. (1) morbidity rate was anticipated to decrease to 26.6-31.1%
with CO-guided therapy, yielding potential gross costs savings of
$153-263M for the study period, $61-105M per year, or $754-1,286 per
patient. Potential savings per patient were highly variable from one
surgical procedure to the other, ranging from $354-604 for femur and hip
fracture repair to $3,515-5,996 for esophagectomies (Table 1). Therefore,
our findings suggest that for each $ spent to implement CO-guided therapy,
hospitals could save in return between $1-2 for femur and hip fracture and
up to $12-20 for esophagectomies. Conclusion(s): Postsurgical
complications occurred in more than one third of our study population and
had a dramatic impact on hospital costs (+75%). With CO-guided therapy,
potential cost savings per patient were $754-1,286, i.e. 2.5 to 4 times
higher than the average cost of CO monitoring techniques. These
projections must be confirmed by large prospective studies. But in the
meantime, they should help hospitals estimate the potential return on
investment when considering the purchase of CO monitoring.

<128>
Accession Number
646610106
Title
A RANDOMIZED TRIAL OF ANALGESIA IN VIDEO-ASSISTED THORACIC SURGERY: LOCAL
ANAESTHETIC DELIVERY BY WOUND INFILTRATION CATHETER COMPARED WITH
TOPICALTRANSDERMAL PATCH DELIVERY.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. Conference: 24th
European Conference on General Thoracic Surgery. Naples Italy.
23(Supplement 1) (no pagination), 2016. Date of Publication: 01 Sep 2016.
Author
Abbas N.; Healy D.
Institution
(Abbas) Cardiothoracic Surgery, Mater Misericordiae Hospital, Dublin,
Ireland
(Healy) Thoracic Surgery, St Vincent's University Hospital, Dublin,
Ireland
Publisher
Oxford University Press
Abstract
Objectives: The optimal postoperative analgesia regime in minimally
invasive thoracic surgery is a continuing quest. Local anaesthetic
delivery to the wounds aids pain relief, has a favourable side effect
profile and is a part of an opioid sparing strategy. However
intraoperative delivery is limited by the drug half life. Therefore for
extended postoperative pain relief with local anaesthetic agents,
additional delivery mechanisms need to be explored. Here we compare a
continuous wound infusion catheter delivery with transdermal patch
application in the first 48 hours after surgery Methods: Patients
undergoing minimally invasive VATS surgery were recruited. Randomization
was with a blind envelope method. The camera port site is recycled as a
drain site in all cases. Group Awas allocated to the placement of a wound
infiltration catheter (bupivacaine) to a subpleural level under direct
camera vision, in the intercostal level of the camera/drain entry site.
Group B instead had a lidocaine 5% patch placed proximally to the drain
site. Patients were managed with a standardized postoperative pain
strategy otherwise, and opioids delivered by an intravenous PCA method.
Pain scores and opioid usage were collected. Additional opioid usage was
also noted and morphine equivalence added to the total. Result(s):
Fifty-five patients were available for analysis. There were no adverse
effects with either agent. Demography across the groups was homogenous.
The lidocaine patch was assessed as more expensive on cost analysis. There
was no significant difference between the groups in regard to opioid usage
or subjected pain scores. Conclusion(s): The two methods under test
provided similar pain relief. The transdermal patch provides less of an
obstacle to patient mobility postoperatively but is a more costly method
then a wound catheter. Our recommendation is to use the wound infiltration
catheter based on cost effectiveness.

<129>
Accession Number
646619042
Title
OPTIMIZING CEREBRAL SATURATION IN CARDIAC SURGICAL PATIENTS.
Source
Anesthesia and Analgesia. Conference: Annual Meeting of the Society for
Technology in Anesthesia, STA 2015. Phoenix, AZ United States. 122(5
Supplement) (pp S79), 2016. Date of Publication: 01 May 2016.
Author
Trinh M.; Uysal S.; Fischer G.; Lin H.; Reich D.
Institution
(Trinh, Fischer, Reich) Mount Sinai, New York, NY, United States
(Uysal) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Lin) Biostatistics,Icahn School of Medicine, New York City, NY, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Cerebral oximetry based on near infrared spectroscopy (NIRS)
measures regional cerebral tissue oxygen saturation (SctO2). It is used
intraoperatively as a continuous monitor for detection of cerebral
ischemia and potential brain injury in cardiac surgical patients. Past
research has shown that optimizing SctO2 during cardiac surgery is
associated with reduced incidence of major organ morbidity or mortality.1
Several studies have shown an association between prolonged desaturations
and postoperative cognitive decline.2,3 We conducted a randomized
controlled trial to determine if optimizing SctO2 during cardiac surgery
will lead to improved cerebral oxygen saturation and better neurocognitive
outcomes. METHOD(S): 125 adult (>18 yo) patients who underwent
elective cardiac surgery requiring CPB were studied. Patients with severe
preoperative cognitive impairment or end-stage organ failure were
excluded. Patients were randomly assigned to either a treatment or a
blinded control group. Data extracted from the medical record included:
basic demographics, variables for computing Euroscores and Charlson
Comorbidity Index scores, and NYHA classification. Cerebral oxygen
saturation was monitored intraoperatively using the Fore-Sight cerebral
oximeter (CAS Medical Systems). In the treatment group, an intervention
algorithm (Fig 1) was used to improve SctO2 if desaturation occurred <60
for >1min at either probe. In the control group, the SctO2 data were
hidden from the perioperative team, unless a critical low value, SctO2 <40
for >1 min triggered an alarm. The SctO2 data were then revealed, and the
intervention protocol was followed until SctO2 was restored to >60.
Cognitive function was assessed using the Cognitive Stability Index (CSI)
HeadMinder computerized test battery, which assesses response speed,
cognitive processing speed, attention, and memory. The test battery was
administered preoperatively (n=125) and postoperatively at 3 (n=92) and 6
months (n=78). Data analysis was performed using chi2/Fischer's exact
tests on categorical data and t-test/Wilcoxon rank sum on continuous
variables. The level of statistical significance was set to 0.05.
 RESULT(S): The treatment and control groups were similar with respect
to demographics, preoperative risk scores, baseline cognitive test scores,
surgery duration, and CPB duration. The groups did not differ in incidence
of desaturation episodes, mean time under threshold (TUT), or area under
threshold (total time x depth under threshold). Of patients with
desaturations, intervention was associated with less TUT and AUT (Table
1). Over all subjects, intervention was associated with better memory
function postoperatively (Table 2). CONCLUSION(S): NIRS-guided
optimization of cerebral oxygenation during cardiac surgery is effective
in reducing time and depth of intraoperative desaturation episodes in
cardiac patients. In patients with desaturations, intervention is
associated with better postoperative memory function.

<130>
Accession Number
646610086
Title
PROSPECTIVE COMPARISON OF PARAVERTEBRAL AND EPIDURAL ANALGESIA CONTROL IN
PATIENTS UNDERGOING VIDEO-ASSISTED THORACOSCOPIC LOBECTOMY.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. Conference: 24th
European Conference on General Thoracic Surgery. Naples Italy.
23(Supplement 1) (no pagination), 2016. Date of Publication: 01 Sep 2016.
Author
Roman M.; Griffith O.; Dowdeswell L.; Mwita A.; Majewski A.; Addae-Boateng
E.; Thorpe J.; Kapila R.; Duffy J.
Institution
(Roman, Mwita, Majewski, Addae-Boateng, Thorpe, Duffy) Department of
Thoracic Surgery, Nottingham City Hospital, Nottingham, United Kingdom
(Griffith, Kapila) Department of Anaesthetics, Nottingham City Hospital,
Nottingham, United Kingdom
(Dowdeswell) Department of Pharmacy, Nottingham City Hospital, Nottingham,
United Kingdom
Publisher
Oxford University Press
Abstract
Objectives: Video-assisted thoracic surgery (VATS) has evolved as one of
the mainstay surgical treatments in patients undergoing lobectomy. While
randomized trials have been undertaken in thoracotomy cohorts, there is
currently limited evidence comparing paravertebral and epidural analgesia
control in these patients. Paravertebral blocks (PVB) are an alternative
to epidural analgesia, which may offer similar analgesic efficacy and
lower incidence of side-effects. Method(s): Twenty patients were
prospectively allocated based on receiving epidural or paravertebral
analgesia postoperatively. Pain was evaluated using the comparative pain
scale. The primary outcomes were the average pain score, opioid boluses
during the first 96 hours post-procedure and length of stay. The outcomes
were compared using two-way ANOVA analysis and Pearson correlation.
 Result(s): Average and cumulative pain scores were not significantly
different between groups. Higher opioid boluses were used in the
paravertebral group for the first 24 hours (32.8 +/- 39.2 vs 0 mg of
morphine, P = 0.04), but this was not significant at 48, 72 and 96 hours.
The length of stay for patients with epidural was longer (5.6 vs 4.5 days,
P = 0.18), and correlated with a longer epidural catheter in-situ time
(72.6 vs 43.75 hours, P = 0.03, r = 0.6, P = 0.01). This reflected longer
in-situ urinary catheter times (78.3 vs 43.2 hours, P = 0.07, r = 0.46, P
= 0.04). Both groups had similar haemodynamic parameters and there was no
difference in the fluid boluses received or other secondary outcomes. More
interventions in dose rate changes were noted in the epidural group (7 vs
0). Conclusion(s): Consistent with similar findings in cohorts of
thoracotomy patients, we demonstrated an increase in early (24 h) opioid
use in the patients receiving paravertebral analgesia. More careful
analgesia management planning is indicated in this group. Despite this,
there were no differences in the comparative pain scales reported. The
longer use of epidural and urinary catheters in situ may contribute to
longer hospital stays in this group.

<131>
Accession Number
646609968
Title
THE EFFECTOF COLCHICINE ADMINISTRATION ON POSTOPERATIVE PLEURAL EFFUSION
FOLLOWING THORACIC SURGERY: A RANDOMIZED, DOUBLE BLIND,
PLACEBO-CONTROLLED, FEASIBILITY PILOT STUDY.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. Conference: 24th
European Conference on General Thoracic Surgery. Naples Italy.
23(Supplement 1) (no pagination), 2016. Date of Publication: 01 Sep 2016.
Author
Bessissow A.; Agzarian J.; Srinathan S.; Schneider L.; Devereaux P.; Neary
J.; Dechert W.; Gandy L.; Finley C.; Hanna W.C.; Schieman C.; Shargall Y.
Institution
(Bessissow, Devereaux) Medicine, McMaster University, Hamilton, Canada
(Agzarian, Schneider) Surgery, McMaster University, Hamilton, Canada
(Srinathan) Surgery, University of Manitoba, Winnipeg, Canada
(Neary) Medicine, McMaster University, St. Joseph's Healthcare Hamilton,
Hamilton, Canada
(Dechert) Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Canada
(Gandy) Nursing, St. Joseph's Healthcare Hamilton, Hamilton, Canada
(Finley, Hanna, Schieman, Shargall) Surgery, McMaster University, St.
Joseph's Healthcare Hamilton, Hamilton, Canada
Publisher
Oxford University Press
Abstract
Objectives: Colchicine was previously found to be effective in preventing
postoperative pericardial effusion following cardiac surgery with potent
antiinflammatory effects. This study seeks to assess its effect on the
volume of postoperative pleural drainage, duration of chest tube in-situ
and length of stay following lung resection. Method(s): Between April
2014 and April 2015, 100 patients undergoing lung resection at two
tertiary care centres were randomized to either colchicine (n = 49) or
placebo (n = 51) treatment arms), as part of a feasibility, pilot
double-blind study assessing colchicine for prevention of perioperative
atrial fibrillation. Patients received either colchicine 0.6 mg or placebo
orally twice daily for 10 days, with the first dose given 4 hours prior to
surgery. Pleural drainage volumes were recorded in 8-hour intervals until
chest tube removal as per a standardized, pre-defined protocol.
 Result(s): The two groups were comparable on baseline characteristics
with regard to cancer stage, comorbidities, surgical approach and extent
of resection (51% open procedures; 86% anatomic resections), but not for
gender, coronary artery disease and hypertension. Analysis of total
drainage volumes demonstrated a statistically significant difference in
favour of the colchicine group (583.8 vs 763.3 ml, P = 0.039), with
findings that remained consistent across the time intervals collected. The
volume of pleural drainage at 1-hour postop was significantly less in the
colchicine group (92.9 vs 156.6 ml, P = 0.008), and remained lower at the
40-hour interval (550.9 vs 741.3 ml, P = 0.039). There were no differences
in time to chest tube removal (6.8 vs 5.9 days, P = 0.585), hospital
length of stay (7.4 vs 6.9 days, P = 0.641), or with regards to major
bleeding, infection or adverse events. Conclusion(s): Perioperative
administration of oral colchicine is potentially effective in diminishing
the amount of pleural drainage post-lung resection. A full-scale,
prospective placebo-control randomized trial is needed to assess the
clinical significance of perioperative colchicine administration.

<132>
Accession Number
646609306
Title
Tolerability and Efficacy of Basiliximab as Induction Therapy to Prevent
Cardiac Transplant Rejection: A Systematic Review.
Source
Canadian Journal of Hospital Pharmacy. Conference: CSHP Summer Educational
Sessions, SES 2015. Ottawa, ON Canada. 68(4) (pp 356-357), 2015. Date of
Publication: 2015.
Author
San C.; Chua D.; Su V.
Institution
(San) Faculty of Pharmacy, University of Alberta, Edmonton, AB, Canada
(Chua, Su) St Paul's Hospital, Vancouver, BC, Canada
Publisher
Canadian Society of Hospital Pharmacists
Abstract
Background: In North America, induction therapy with antithymocyte
globulin (ATG) and rabbit antithymocyte globulin (RATG) are traditionally
used in cardiac transplantation to prevent rejection. However, they are
poorly tolerated and increase the risks of lymphoma and infection.
Basiliximab, a newer class of anti-interleukin-2 inhibitors, is approved
in Canada for use as induction therapy in cardiac transplantation to
prevent rejection. Current Canadian and international cardiac transplant
guidelines do not provide recommendations on the agent of choice for
induction therapy. Objective(s): To systematically review the
literature and determine 1) the safety and tolerability and 2) efficacy of
basiliximab as compared to other induction agents in cardiac transplant
Methods: MEDLINE, PubMed, Cochrane databases were searched using the terms
"heart transplant", "cardiac transplant", "basiliximab", "interleukin-2
inhibitor", "IL-2Ra" and "anti-CD25". All studies that compared
basiliximab to another induction agent in adult cardiac transplant with
clinical outcomes were included. Pediatric cardiac transplant,
meta-analyses, case reports and studies using induction agents that are
not commercially available were excluded. Result(s): See page 357.
 Conclusion(s): Based on the available evidence, basiliximab 20mg IV
on day 0 and 4 of cardiac transplant is better tolerated compared to ATG
or RATG. The evidence for efficacy of basiliximab compared to ATG or RATG
in terms of rejection and survival is conflicting. Limitations of the
available studies are its retrospective nature, differing
immunosuppressive regimens in each treatment group, varied definitions of
clinical endpoints and small sample size. Further prospective trials are
warranted to determine the efficacy of basiliximab compared to ATG or
RATG. (Table Presented).

<133>
Accession Number
2037555922
Title
Neurodevelopmental Outcomes after Nitric Oxide during Cardiopulmonary
Bypass for Open Heart Surgery: A Randomized Clinical Trial.
Source
JAMA Network Open. 8(2) (no pagination), 2025. Article Number: e202458040.
Date of Publication: 05 Feb 2025.
Author
Long D.A.; Gibbons K.S.; Horton S.B.; Johnson K.; Buckley D.H.F.; Erickson
S.; Festa M.; D'Udekem Y.; Alphonso N.; Le Marsney R.; Winlaw D.S.;
Masterson K.; Van Loon K.; Young P.J.; Schibler A.; Schlapbach L.J.; Butt
W.
Institution
(Long) School of Nursing, Centre for Healthcare Transformation, Queensland
University of Technology, Brisbane, Australia
(Long, Schlapbach) Paediatric Intensive Care Unit, Queensland Children's
Hospital, Children's Health Queensland, Brisbane, Australia
(Long, Gibbons, Johnson, Le Marsney, Schlapbach) Children's Intensive Care
Research Program, Child Health Research Centre, The University of
Queensland, Brisbane, Australia
(Horton) Cardiac Surgical Unit, Royal Children's Hospital, Melbourne, VIC,
Australia
(Horton, D'Udekem, Butt) Faculty of Medicine, Department of Paediatrics,
University of Melbourne, Melbourne, VIC, Australia
(Horton, Masterson, Butt) Clinical Sciences Theme, Murdoch Children's
Research Institute, Melbourne, VIC, Australia
(Buckley) Paediatric Intensive Care Unit, Starship Children's Hospital,
Auckland, New Zealand
(Erickson) Paediatric Critical Care, Perth Children's Hospital, The
University of Western Australia, Crawley, WA, Australia
(Festa) Kids Critical Care Research, Paediatric Intensive Care Unit,
Children's Hospital at Westmead, Westmead, NSW, Australia
(Festa) Sydney Children's Hospital Network, Sydney, NSW, Australia
(D'Udekem) Children's National Hospital, The George Washington University,
School of Medicine and Health Sciences, Washington, DC, United States
(Alphonso) Cardiac Surgery, Queensland Children's Hospital, Brisbane,
Australia
(Alphonso) School of Medicine, Children's Health Clinical Unit, The
University of Queensland, Brisbane, Australia
(Winlaw) Heart Centre for Children, The Children's Hospital at Westmead,
Westmead, NSW, Australia
(Winlaw) Sydney Children's Hospital Network, Faculty of Medicine and
Health, University of Sydney, Sydney, NSW, Australia
(Masterson) Paediatric Intensive Care Unit, Royal Children's Hospital
Melbourne, Melbourne, VIC, Australia
(Van Loon, Butt) Department of Anaesthesiology, University Medical Center
Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands
(Young) Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
(Young) Medical Research Institute of New Zealand, Wellington, New Zealand
(Young) Australian and New Zealand Intensive Care Research Centre, Monash
University, Melbourne, VIC, Australia
(Young, Butt) Department of Critical Care, University of Melbourne,
Melbourne, VIC, Australia
(Schibler) James Cook University, Townsville, QLD, Australia
(Schibler) Critical Care Research Group, Wesley Medical Research, St
Andrew's War Memorial Hospital, Brisbane, QLD, Australia
(Schlapbach) Department of Intensive Care and Neonatology, University
Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
(Schlapbach) Children's Research Center, University Children's Hospital
Zurich, University of Zurich, Zurich, Switzerland
(Butt) Central Clinical School, Faculty of Medicine, Monash University,
Melbourne, VIC, Australia
Publisher
American Medical Association
Abstract
Importance: Children with congenital heart defects who undergo
cardiopulmonary bypass (CPB) surgery are at risk for delayed or impaired
neurodevelopmental outcomes. Nitric oxide (NO) added to the CPB oxygenator
may reduce systemic inflammation due to CPB and improve recovery from
surgery, including improved neurodevelopmental outcomes.
 Objective(s): To investigate neurodevelopment, health-related quality
of life (HRQOL), and factors associated with impaired neurodevelopment at
12 months post surgery in infants who received CPB with NO or standard
CPB. Design, Setting, and Participant(s): This double-masked
randomized clinical trial was conducted in 6 centers in Australia, New
Zealand, and the Netherlands between July 19, 2017, and April 28, 2021,
with a preplanned prospective follow-up 12 months postrandomization
completed on August 5, 2022. The cohort included 1364 infants younger than
2 years who underwent open heart surgery with CPB for congenital heart
disease. Intervention(s): The intervention group received NO 20 ppm
into the CPB oxygenator. The control group received standard CPB.
 Main Outcomes and Measures: The primary outcome was neurodevelopment,
defined as the Ages and Stages Questionnaire, Third Edition (ASQ-3) total
score. Secondary outcomes were HRQOL and functional status as measured by
Pediatric Quality of Life Inventory and modified Pediatric Overall
Performance Category scores, respectively. Sensitivity analyses modeled
the outcome for patients lost to follow-up. Result(s): Of 1318
infants alive 12 months after randomization, follow-up was performed in
927, with 462 patients in the NO group and 465 in the standard care group
(median [IQR] age at follow-up, 16.6 [13.7-19.8] months; median [IQR] time
since randomization, 12.7 [12.1-13.9] months; 516 male [55.7%]). There
were no differences between the NO and standard care groups in ASQ-3 total
score (mean [SD], 196.6 [75.4] vs 198.7 [73.8], respectively; adjusted
mean difference, -2.24; 95% CI, -11.84 to 7.36). There were no differences
in secondary outcomes. Prematurity (gestational age <37 weeks),
univentricular lesions, congenital syndromes, and longer intensive care
unit length of stay were associated with lower ASQ-3 total scores in
adjusted multivariable analyses. Conclusions and Relevance: In this
randomized clinical trial of infants with congenital heart disease, NO
administered via the CPB oxygenator did not improve neurodevelopmental
outcomes or HRQOL 12 months after open heart surgery. Further research
should explore homogenous cohorts with higher surgical risk and
higher-dose or alternative therapies. Trial Registration: ANZCTR
Identifier: ACTRN12617000821392. Copyright © 2025 Long DA et al.
JAMA Network Open.

<134>
Accession Number
2033439689
Title
Aortopexy for Tracheomalacia in Children: A Systematic Review and
Meta-Analysis.
Source
Journal of Clinical Medicine. 14(4) (no pagination), 2025. Article Number:
1367. Date of Publication: 01 Feb 2025.
Author
Zanini A.; Mazzoleni S.; Arcieri L.; Giordano R.; Marianeschi S.; Macchini
F.
Institution
(Zanini, Mazzoleni, Macchini) Pediatric Surgery, ASST Grande Ospedale
Metropolitano Niguarda, Milan, Italy
(Arcieri, Marianeschi) Pediatric Cardiac Surgery, ASST Grande Ospedale
Metropolitano Niguarda, Milan, Italy
(Giordano) Advanced Biomedical Sciences, Adult and Pediatric Cardiac
Surgery, University of Naples Federico II, Via Pansini 5, Naples, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Introduction: Aortopexy is the most common surgical option for the
treatment of severe tracheomalacia (TM) in children. Despite being
described over 75 years ago, several aspects of the procedure remain
controversial. Material(s) and Method(s): A systematic review of
aortopexy was conducted following the PRISMA guidelines. All original
articles describing at least one case of aortopexy performed in children
for the treatment of TM were included. Patients' characteristics, surgical
indications, approaches and details were collected. Outcomes were
reviewed, and potential factors associated with procedural success were
investigated. Result(s): Of 243 papers, 17 were included in this
review, encompassing a total of 473 patients who underwent aortopexy. Of
these, 65.3% were male, with a mean age at surgery of 12.2 months (5
days-18 years). Primary TM accounted for 7.9% of cases, while 92.1% were
secondary to other anomalies, including esophageal atresia (54.1%),
aberrant innominate artery (16.1%) and vascular rings (8.3%). There is a
general consensus on the surgical indication for TM with severe symptoms,
although the definition of severity is not well established. Overall
success was 84%, but 40.8% of patients experienced some persistent
symptoms. Sternotomy and thoracotomy were the most successful approaches
(92.6% and 84.2%, respectively). Thoracoscopy had a similar success rate
to sternotomy when pericardiotomy, thymectomy and pledgeted suture were
performed (86.4% vs. 92.6% p = 0.41). Conclusion(s): Aortopexy is
associated with good outcomes, but no evidence-based guidelines are
currently available. Success appears to be associated with specific
surgical steps rather than the surgical approach. Prospective studies are
desirable for establishing precise guidelines. Copyright © 2025
by the authors.

<135>
Accession Number
2035731647
Title
Risk Factors of Prolonged Mechanical Ventilation in Post Coronary Artery
Bypass Graft Patients: A Scoping Review.
Source
Journal of Multidisciplinary Healthcare. 18 (pp 903-915), 2025. Date of
Publication: 2025.
Author
Kumalasari R.I.; Kosasih C.E.; Priambodo A.P.
Institution
(Kumalasari) Faculty of Nursing, Universitas Padjadjaran, West Java,
Sumedang, Indonesia
(Kosasih, Priambodo) Department of Critical Care and Emergency Nursing,
Faculty of Nursing, Universitas Padjadjaran, West Java, Sumedang,
Indonesia
Publisher
Dove Medical Press Ltd
Abstract
Prolonged mechanical ventilation (PMV) following CABG surgery is
associated with increased patient morbidity and mortality. A consensus has
yet to be reached regarding the time limit for PMV. Various studies have
identified factors that influence PMV in patients following CABG surgery,
but a review has yet to synthesize the results systematically. This review
aimed to identify the definition and factors associated with PMV in
patients following isolated CABG surgery. This scoping review used the
framework developed by Arksey and O'Malley (2005). Primary sources of
information were searched through 5 databases: PubMed, Scopus, Oxford
Academy, Sage, and CINAHL and two search engines: Science Direct and
Google Scholar, accessed on October 25, 2023. Eight articles with a total
of 12,178 participants were included in this review. The PMV time limits
used in the studies varied from >12 hours to >48 hours. The factors
affecting PMV were grouped into preoperative, intraoperative and
postoperative, with factors that have a high influence, including NYHA
class, acute kidney injury and mediastinitis. Differences in the number of
factors examined, criteria, characteristics, and time limits of the PMV
used to make the study's results vary. Establishing guidelines regarding
PMV time limits is essential according to current
conditions. Copyright © 2025 Kumalasari et al.

<136>
Accession Number
2033448017
Title
Pericardial Fluid Biomarkers as Early Predictors for Postoperative Atrial
Fibrillation-A Systematic Review.
Source
Diagnostics. 15(4) (no pagination), 2025. Article Number: 408. Date of
Publication: 01 Feb 2025.
Author
Mitu F.; Adam C.A.; Richter P.; Costache A.-D.; Gavril R.S.; Cojocaru C.;
Tarus A.; Enache M.; Cumpat C.M.; Leon M.M.; Tinica G.
Institution
(Mitu, Adam, Richter, Costache, Gavril, Cojocaru, Tarus, Enache, Cumpat,
Leon, Tinica) Department of Medical and Surgical Specialties I, II and
III, "Grigore T. Popa" University of Medicine and Pharmacy, University
Street No. 16, Iasi, Romania
(Mitu, Adam, Costache, Gavril, Cojocaru, Cumpat, Leon) Cardiovascular
Rehabilitation Clinic, Clinical Rehabilitation Hospital, Pantelimon Halipa
Street No. 14, Iasi, Romania
(Mitu, Tinica) Academy of Medical Sciences, Bucharest, Romania
(Mitu, Tinica) Academy of Romanian Scientists, Iasi, Romania
(Richter) Rheumatology Clinic, Clinical Rehabilitation Hospital,
Pantelimon Halipa Street No. 14, Iasi, Romania
(Tarus, Enache, Tinica) Cardiovascular Surgery Clinic, Prof. Dr. George I.
M. Georgescu" Cardiovascular Diseases Institute, Iasi, Romania
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
(1) Background: Postoperative atrial fibrillation (POAF) is one of the
most common complications of cardiac surgery, frequently occurring in the
first 2-4 days after surgery. With a variable incidence depending on the
type of surgery, research in recent years has focused on identifying
predisposing factors with the aim of correcting them and thus decreasing
the risk of cardiovascular and total morbidity and mortality. The analysis
of pericardial fluid allowed the identification of biomarkers
(interleukin-6, mitochondrial DNA, myeloperoxidase or natriuretic
peptides) whose presence postoperatively was associated with increased
risk of POAF. (2) Material(s) and Method(s): We conducted a search on
EMBASE and PubMed and identified 75 articles, of which 10 entered the
final analysis. (3) Results: Patients who develop POAF accumulate large
amounts of interleukin 6, mitochondrial DNA, myeloperoxidase, or secondary
atrial natriuretic peptide as a consequence of the associated inflammatory
status, atrial remodeling, or disturbance of homeostasis of various ions.
There are also observations that their levels in the pericardium correlate
with blood levels, but further studies on larger cohorts of patients are
needed to provide new evidence in this regard. (4) Conclusion(s):
Early recognition of patients at risk of developing POAF based on
easy-to-dose and easy-to-use biochemical biomarkers, whose association
with POAF has been demonstrated so far in small cohorts of patients, has
both therapeutic and prognostic implications, which justifies further
research on large cohorts of patients. Copyright © 2025 by the
authors.

<137>
Accession Number
2037646302
Title
Assessment of quitting versus using aspirin therapy in patients with
stabilized coronary artery disease after stenting who require long-term
oral anticoagulation: Rationale for and design of the AQUATIC double-blind
randomized trial.
Source
Archives of Cardiovascular Diseases. (no pagination), 2025. Date of
Publication: 2025.
Author
Didier R.; Lemesle G.; Montalescot G.; Steg P.H.G.; Vicaut E.; Mottier D.;
Bauters C.; Mabo P.; Simon T.; Bouleti C.; Andrieu S.; Angoulvant D.;
Vanzetto G.; Kerneis M.; Cayla G.; Gilard M.
Institution
(Didier, Gilard) Department of Cardiology, Inserm UMR 1304 (GETBO), Brest
University Hospital, Western Brittany Study Group, Brest, France
(Lemesle) Heart and Lung Institute, Inserm U1011, Institut Pasteur de
Lille, University Hospital of Lille, Lille, France
(Montalescot, Kerneis) Allies in Cardiovascular Trials Initiatives and
Organized Networks (ACTION) Study Group, Inserm UMRS 1166, hopital
Pitie-Salpetriere, AP-HP, Sorbonne universite, Paris, France
(Steg) Inserm U1148/LVTS, French Alliance for Cardiovascular Trials
(FACT), AP-HP, universite Paris-Cite, Bobigny, France
(Vicaut) Clinical Research Unit, Fernand-Widal Hospital, Paris, France
(Mottier) Department of Internal Medicine and Pneumology, Inserm UMR 1304
(GETBO), CIC Inserm 1412, F-CRIN INNOVTE, universite de Bretagne
Occidentale, Brest University Hospital, Brest, France
(Bauters) Inserm 1167, Institut Pasteur de Lille, University Hospital of
Lille, universite de Lille, Lille, France
(Mabo) Department of Cardiology, CHU de Rennes, Rennes, France
(Simon) Department of Clinical Pharmacology and Clinical Research Platform
of East of Paris, AP-HP, Sorbonne universite, Paris, France
(Simon) Inserm U 1148/LVTS, French Alliance for Cardiovascular Trials
(FACT), AP-HP, Paris, France
(Bouleti) CIC Inserm 1402, Department of Cardiology, University of
Poitiers, Poitiers, France
(Andrieu) Department of Cardiology, hopital Henri-Duffaut, Avignon, France
(Angoulvant) Department of Cardiology, CHRU de Tours, Tours, France
(Angoulvant) Inserm UMR 1327 - ISCHEMIA, universite de Tours, Tours,
France
(Vanzetto) Department of Cardiology, Grenoble University Hospital, La
Tronche, France
(Cayla) Department of Cardiology, Nimes University Hospital, Montpellier
University, ACTION Study Group, Nimes, France
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Antithrombotic management in patients with chronic coronary
syndrome and previous stent implantation who require long-term oral
anticoagulation is highly challenging in daily practice, especially in
those at high residual risk of coronary and vascular events. Dual therapy
with oral anticoagulation and aspirin may lead to a higher risk of
bleeding, whereas stopping aspirin in high-risk patients with coronary
artery disease after percutaneous coronary intervention may lead to
recurrent ischaemic events. Aim(s): To assess the optimal
antithrombotic regimen that should be pursued long term (often lifelong)
in these patients. Method(s): The AQUATIC study is a prospective,
randomized, double-blind, placebo-controlled, parallel-group, multicentre
study conducted in patients with chronic coronary syndrome at high risk of
ischaemic events (i.e., stent implantation [> 6 months before inclusion]
in a context of previous acute coronary syndrome and/or with high-risk
features of ischaemic event recurrences) and requiring long-term oral
anticoagulation. For superiority, we ensure 80% power at level alpha =
0.05 to detect a 25% reduction in hazard in the experimental group
relative to the control group. Overall, 2000 patients will be randomized
in a 1:1 ratio to receive either oral anticoagulation and aspirin or oral
anticoagulation and placebo. The primary efficacy endpoint is a composite
of cardiovascular death, myocardial infarction, stroke, systemic embolism,
coronary revascularization and acute limb ischaemia. Major bleeding
according to the International Society on Thrombosis and Haemostasis
definition is a secondary safety endpoint that will be assessed as a
priority. Conclusion(s): The AQUATIC trial will test the efficacy and
safety of adding aspirin to long-term oral anticoagulation in patients
with chronic coronary syndrome and previous coronary stenting who are at
high residual risk of recurrent ischaemic events and require oral
anticoagulation. Copyright © 2025

<138>
Accession Number
2037661692
Title
Intraoperative assessment of myocardial perfusion using near-infrared
fluorescence and indocyanine green: A literature review.
Source
JTCVS Techniques. (no pagination), 2025. Date of Publication: 2025.
Author
Peul R.C.; Kharbanda R.K.; Koning S.; Kruiswijk M.W.; Tange F.P.; van den
Hoven P.; Vahrmeijer A.L.; Klautz R.J.M.; Hamming J.F.; Hjortnaes J.; van
der Vorst J.R.
Institution
(Peul, Koning, Kruiswijk, Tange, van den Hoven, Vahrmeijer, Hamming, van
der Vorst) Department of Surgery, Leiden University Medical Center,
Leiden, Netherlands
(Kharbanda, Klautz, Hjortnaes) Department of Cardiothoracic Surgery,
Leiden University Medical Center, Leiden, Netherlands
(Klautz) Department of Cardiothoracic Surgery, Amsterdam University
Medical Center, Amsterdam-Zuidoost, Netherlands
Publisher
Elsevier Inc.
Abstract
Background: Coronary artery bypass grafting (CABG) is among the most
commonly performed major surgical procedures worldwide. While flow
measurements help assess graft patency during surgery, there are limited
tools available for surgeons to objectively evaluate myocardial perfusion
after graft placement. Near-infrared fluorescence (NIRF) imaging shows
promise in this area, offering real-time visualization of flow and
perfusion without the need for radiation or nephrotoxic contrast agents.
This review summarizes current knowledge of and developments in myocardial
perfusion assessment via NIRF imaging, emphasizing the potential benefits
of adding quantification to enhance this technique. Method(s): PubMed
was searched for articles describing the use of NIRF imaging for
myocardial perfusion assessment. Articles were subsequently analyzed based
on study objectives, subjects, and quantification capabilities.
Limitations, future directions, and comparisons with other techniques were
examined to recognize patterns and describe the chronological developments
in NIRF imaging for myocardial perfusion assessment. Result(s):
Twenty-eight articles were included, 11 of which explored quantification.
Only 5 of these articles included patients. Aims and techniques varied
significantly among studies. Compared to the abundance of qualitative
assessments, quantified NIRF imaging in patients remains limited.
 Conclusion(s): This literature review highlights that NIRF imaging
has been broadly researched qualitatively, showing promise for guiding
CABG surgery through visualization of graft flow. However, the critical
step of incorporating quantification to accurately assess myocardial
perfusion remains insufficiently explored. To optimize decision making
during CABG surgery, future studies must focus on intraoperative
application of quantified NIRF imaging in cardiovascular
patients. Copyright © 2025 The Author(s)

<139>
Accession Number
2033466886
Title
Intraoperative hypotension and postoperative risks in non-cardiac surgery:
a meta-analysis.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 103. Date
of Publication: 01 Dec 2025.
Author
Qin G.; Du M.-C.; Yi K.-X.; Gong Y.
Institution
(Qin, Du, Yi, Gong) Institute of Anesthesiology and Critical Care
Medicine, Three Gorges University & Yichang Central People's Hospital,
Hubei, Yichang, China
Publisher
BioMed Central Ltd
Abstract
Background: Postoperative complications are often associated with the
severity and duration of intraoperative hypotension. However, the optimal
approach for managing intraoperative hypotension remains controversial.
The aim of this meta-analysis of randomized controlled trials was to
compare the incidence of common postoperative complications with different
treatment threshold of hypotension. Method(s): We searched PubMed,
the Cochrane Database, and Embase from August 2014 to August 2024 for
studies comparing different treatment threshold of hypotension (low [mean
arterial pressure < 60 mmHg], moderate [60-75 mmHg], and high [> 75
mmHg]). Only randomized controlled trials conducted during 2014-2024 were
included in this meta-analysis without language restrictions. Studies with
the following characteristics were included: randomized controlled study;
involved non-cardiac, non-obstetric surgery; included different blood
pressure management strategies; evaluated major postoperative
complications; and included acute kidney injury, myocardial injury,
altered consciousness, or infection. Data included patient age, type of
surgery, group criteria, and adverse events. Mantel-Haenszel method was
used for analysis. The primary outcomes were postoperative complications,
including acute kidney injury. The secondary outcomes included length of
hospital stay and all-cause mortality. Result(s): Of the 2160 studies
identified, eight randomized controlled trials with 9108 participants were
included. No significant differences in postoperative complications were
observed between the moderate and high mean arterial pressure treatment
threshold groups (risk ratio = 1.0, 95% confidence interval = 0.86-1.18, P
= 0.96). Sensitivity analysis confirmed these findings. Length of
hospitalization was not significantly different between the groups
(standardized mean difference = -0.39; 95% confidence interval = -0.69 to
1.31; P = 0.03). Limited data prevented meta-analysis of mean arterial
pressure management at lower treatment thresholds. Conclusion(s): The
results of this meta-analysis suggest no significant differences in
postoperative complications between moderate and high mean arterial
pressure management. Copyright © The Author(s) 2025.

<140>
Accession Number
2033481171
Title
An increase in micro-vessels beneath the pleural surface on computed
tomography as a preoperative predictor of pleural adhesions: a prospective
study.
Source
Surgery Today. (no pagination), 2025. Article Number: e0154694. Date of
Publication: 2025.
Author
Kawamura T.; Kobayashi N.; Yanagihara T.; Goto Y.; Ichimura H.; Sato Y.
Institution
(Kawamura, Kobayashi, Yanagihara, Goto, Ichimura, Sato) Department of
Thoracic Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Ibaraki,
Tsukuba, Japan
Publisher
Springer
Abstract
Purpose: Pleural adhesions, which may be present in varying degrees and
involve blood vessels, often complicate thoracic surgery. The blood flow
within pleural adhesions can be identified on computed tomography (CT) as
micro-vessels beneath the pleural surface (MVBP). We conducted a
prospective study to assess if MVBP can be detected on preoperative CT to
predict intraoperative pleural adhesions. Method(s): This prospective
study investigated the preoperative CT images of patients scheduled to
undergo surgery for lung tumors. MVBP was defined as positive when lung
vessels were identified below the pleura on CT. MVBP was evaluated for
each lung segment, and intraoperative findings of pleural adhesions on the
segments were then recorded. Result(s): This study included 173
patients, with 1532 segments evaluated. Pleural adhesions were found in 51
patients and confirmed in 92 segments. The number of segments evaluated
preoperatively as MVBP-positive was 134 (9%), of which 36 (26.9%) had
pleural adhesions. Multivariable analysis identified that MVBP was an
independent significant predictor (odds ratio = 2.29, 95% confidence
interval 1.09-4.80, P = 0.028) of pleural adhesions on a per-patient
basis. Conclusion(s): MVBP is a valuable predictor of pleural
adhesions. The method is useful in clinical practice because it does not
require additional examinations and is easy to assess. Copyright
© The Author(s) 2025.

<141>
Accession Number
646605603
Title
Disposcope endoscope guidance versus fiberoptic bronchoscopy guidance for
double-lumen tube intubation in patients undergoing thoracic surgery: a
randomized controlled non-inferiority trial.
Source
Scientific reports. 15(1) (pp 5476), 2025. Date of Publication: 14 Feb
2025.
Author
Jiang W.; Zhou X.; Zeng X.; Pang H.; Zheng H.; Peng S.; Zhang Y.; Zhang X.
Institution
(Jiang, Peng, Zhang) Department of Anesthesiology, Deyang People's
Hospital, China
(Zhou, Pang, Zheng) Chengdu Medical College, Chengdu, China
(Zeng) Renshou County Maternal and Child Health Hospital, China
(Zhang) Sixth People's Hospital of Deyang City, China
Abstract
Double-lumen tube (DLT) intubation is frequently performed for thoracic
surgery, and a fiberoptic bronchoscopy (FOB) can improve the success rate
of correct placement. Disposcope endoscope-guided DLT intubation was
recently introduced and has a high first-attempt success rate. We tested
whether compared with FOB-guided DLT intubation, disposcope
endoscope-guided DLT intubation results in a non-inferior first-attempt
success rate. A total of 181 patients who underwent thoracic surgery and
required DLT intubation were randomly assigned to two groups: FOB guidance
(FOB group) and disposcope endoscope guidance (DE group). The primary
outcome was the first-attempt success rate. The secondary outcomes
included the number of attempts, first intubation time, intraoperative
dislodgement, and changes in the mean arterial pressure (MAP) and heart
rate (HR) after intubation. The difference in the first DLT attempt
success rate between the groups did not exceed the non-inferiority margin
of 8% (DE group: 91.3% vs. FOB group: 89.9%; difference: 1.4%, 95% exact
CI: -7.1-9.9%). The difference in the number of multiple DLT attempts also
did not differ between the DE group and the FOB group (two attempts: 6.5%
vs. 6.7%, P = 0.953; three attempts: 2.2% vs. 3.4%, P = 0.120). The first
DLT intubation time [66 (55-86) vs. 77 (64-98) s, P = 0.010] was
significantly shorter in the DE group. No significant differences were
observed in the intraoperative dislodgement or changes in the MAP or HR
after intubation (P > 0.05). Compared with FOB guidance, disposcope
endoscope guidance provided a non-inferior first-attempt success rate and
a shorter first intubation time for DLT intubation. Copyright ©
2025. The Author(s).

<142>
Accession Number
646600627
Title
Non-Bacterial Thrombotic Endocarditis in Lung Cancer: A Systematic Review.
Source
Current cardiology reviews. (no pagination), 2025. Date of Publication:
11 Feb 2025.
Author
Kamel M.; Hussain F.; Leung C.; Paracha A.; Sathe P.; Jassal A.; Huba M.;
Durrani U.; Ammari N.; Copeland-Halperin R.S.; Seetharamu N.
Institution
(Kamel, Hussain, Leung, Paracha, Sathe, Jassal, Ammari, Copeland-Halperin,
Seetharamu) Department of Medicine, North Shore University Hospital,
Manhasset, NY, United States
(Huba) Department of Medicine, Medical University of South Carolina,
Charleston, SC, United States
(Durrani) Department of Medicine, Saint Louis University School of
Medicine, Saint Louis, MO, United States
Abstract
INTRODUCTION: Nonbacterial Thrombotic Endocarditis (NBTE) is a rare
condition characterized by aseptic vegetations of the heart valves,
predisposing to valvular dysfunction and end-organ infarction. Lung Cancer
(LC) is amongst the most common malignancies associated with NBTE.
 METHOD(S): PubMed/MEDLINE was searched from database inception until
January 2024, pairing "Non-Bacterial Thrombotic Endocarditis (NBTE) and
related terms with "Lung Cancer"( LC). Reports were included if patients
had both NBTE and lung cancer. The risk of bias was assessed using Mixed
Methods Analysis Testing (MMAT). RESULT(S): 32 patients with an
average age of 59y +/- 11.6 were included from 31 peer-reviewed
publications, with significant findings as below: * The majority (47%) of
patients were admitted with stroke. * The most commonly affected valve was
aortic (51%), followed by mitral (43%), and tricuspid (5%). * At diagnosis
of NBTE, 86% of patients had stage IV cancer. * Multi-organ infarct was
common (61%), with the brain most often affected (40%). * Treatment of
NBTE included antibiotics (86%), anticoagulation (50%), and cardiac
surgery (6%). * Treatment of LC included traditional chemotherapy (30.7%),
radiation (16%), tyrosine kinase inhibitors (11.5%), lobectomy (6%), and
immunotherapy (3.8%). * Overall mortality rate was 77%. * Mortality rate
was 38% in patients treated with chemotherapy and 91% in patients who did
not receive chemotherapy. * Mortality rate stratified by anticoagulant:
unfractionated heparin (85.7%), DOAC (75%), and LMWH (20%).
 CONCLUSION(S): High clinical suspicion for NBTE in patients
presenting with LC and thromboembolic phenomena can lead to changes in
treatment and improved clinical outcomes. Copyright© Bentham
Science Publishers; For any queries, please email at
epub@benthamscience.net.

<143>
Accession Number
646585397
Title
Comparative analysis of fully automated vs. conventional ventilation in
postoperative cardiac surgery patients: Impact on alarms, interventions,
and nurse acceptance.
Source
Intensive & critical care nursing. 89 (pp 103963), 2025. Date of
Publication: 11 Feb 2025.
Author
van Haren L.M.A.A.; Nabben D.L.J.; Kloeze C.; Dekker M.A.C.; De Vries
T.J.C.; Buiteman-Kruizinga L.A.; Neto A.S.; van Leijsen T.; Paulus F.; van
Meenen D.M.P.; Montenij L.; Korsten E.H.M.; Bindels A.J.G.H.; Bouwman
A.R.; Schultz M.J.; De Bie Dekker A.J.R.
Institution
(van Haren) Department of Medical Physics, Catharina Hospital, Eindhoven,
Netherlands
(Nabben, Montenij, Korsten) Intensive Care Department, Catharina Hospital,
Eindhoven, Netherlands; Anaesthesiology Department, Catharina Hospital,
Eindhoven, Netherlands; Electrical Engineering, Signal Processing,
Eindhoven University of Technology, Eindhoven, Netherlands
(Kloeze) Department of Medical Physics, Catharina Hospital, Eindhoven,
Netherlands
(Dekker, Bindels) Intensive Care Department, Catharina Hospital,
Eindhoven, Netherlands
(De Vries) Department of Medical Physics, Catharina Hospital, Eindhoven,
Netherlands; Electrical Engineering, Signal Processing, Eindhoven
University of Technology, Eindhoven, Netherlands
(Buiteman-Kruizinga) Department of Intensive Care, Reinier de Graaf
Hospital, Delft, Netherlands; Department of Intensive Care and Laboratory
of Experimental Intensive Care and Anesthesiology, Amsterdam University
Medical Centers, Amsterdam, Netherlands
(Neto) Australian and New Zealand Intensive Care Research Centre
(ANZIC-RC), School of Public Health and Preventive Medicine, Monash
University, Melbourne, Australia; Department of Intensive Care, Austin
Hospital, Melbourne, Australia; Department of Critical Care, Melbourne
Medical School, University of Melbourne, Austin Hospital, Melbourne,
Australia; Department of Critical Care Medicine, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
(van Leijsen, Paulus, van Meenen) Department of Intensive Care and
Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam
University Medical Centers, Amsterdam, Netherlands
(Bouwman) Anaesthesiology Department, Catharina Hospital, Eindhoven,
Netherlands; Electrical Engineering, Signal Processing, Eindhoven
University of Technology, Eindhoven, Netherlands
(Schultz) Department of Intensive Care and Laboratory of Experimental
Intensive Care and Anesthesiology, Amsterdam University Medical Centers,
Amsterdam, Netherlands; Mahidol-Oxford Tropical Medicine Research Unit
(MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of
Medicine, University of Oxford, Oxford, United Kingdom; Division of
Cardiac, Thoracic and Vascular Anesthesia and Intensive Care Medicine,
Department of Anaesthesiology, General Intensive Care and Pain Medicine,
Medical University Vienna, Vienna, Austria
(De Bie Dekker) Intensive Care Department, Catharina Hospital, Eindhoven,
Netherlands; Electrical Engineering, Signal Processing, Eindhoven
University of Technology, Eindhoven, Netherlands
Abstract
OBJECTIVES: To compare the number of alarms, interventions and nurses'
acceptance of automated ventilation with INTELLiVENT-ASV versus
conventional ventilation strategy in patients receiving postoperative
ventilation after cardiac surgery. METHOD(S): This preplanned
secondary analysis of the 'POSITiVE' randomized clinical trial compared
INTELLiVENT-ASV (automated ventilation) with conventional ventilation in
postoperative cardiac surgery patients. The number of critical alarms and
manual ventilator interventions were compared during the first three hours
of ventilation or until extubation. Nurses' acceptance was assessed using
a Technology Acceptance Model 2-based questionnaire and a user acceptance
score from 1 to 10. RESULT(S): POSITiVE randomized 220 patients (109
to automated and 111 to conventional ventilation). The average number of
critical alarms per monitoring hour was similar between the automated and
conventional group (5.6 vs 5.7; p = 0.823). The automated group required
fewer manual interventions per monitoring hour for both ventilation
control (0.7 vs 1.9; p < 0.001) and alarm management (2.0 vs 2.8; p <
0.001). The automated ventilation mode scored higher for perceived
usefulness (2.6 vs 2.1; p < 0.001) and user acceptance (8.0 vs 7.0; p <
0.001), but similar for perceived ease of use. CONCLUSION(S):
Automated ventilation for postoperative cardiac surgery patients had
similar alarm frequencies as conventional ventilation, but reduced the
number of interventions and showed higher nurses' acceptance, indicating
its potential to optimize patient care and reduce nurses' workload.
IMPLICATIONS FOR CLINICAL PRACTICE: Our findings suggest that automated
ventilation modes like INTELLiVENT-ASV can reduce the frequency of manual
interventions and improve nurses' acceptance, which may help alleviate
nurses' workload for postoperative cardiac surgery patients. Copyright
© 2025 Elsevier Ltd. All rights reserved.

<144>
Accession Number
646547800
Title
Non-vitamin K antagonist oral anticoagulants (NOACs) after transcatheter
aortic valve replacement (TAVR): a network meta-analysis.
Source
Cochrane Database of Systematic Reviews. 2025(2) (no pagination), 2025.
Article Number: CD013745. Date of Publication: 24 Feb 2025.
Author
Al Said S.; Kaier K.; Nury E.; Alsaid D.; Gibson C.M.; Bax J.; Westermann
D.; Meerpohl J.J.
Institution
(Al Said, Westermann) Department of Cardiology and Angiology, University
Heart Center Freiburg Bad Krozingen, Medical Center - University of
Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
(Kaier) Institute for Medical Biometry and Statistics, Faculty of Medicine
and Medical Center, University of Freiburg, Freiburg, Germany
(Nury, Alsaid, Meerpohl) Institute for Evidence in Medicine, Medical
Center - University of Freiburg, Faculty of Medicine, University of
Freiburg, Freiburg, Germany
(Nury) Department of General Practice and Primary Care, University Medical
Center Hamburg-Eppendorf, Hamburg, Germany
(Gibson) Cardiology Division, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
(Bax) Department of Cardiology, Leiden University Medical Center, Leiden,
Netherlands
(Meerpohl) Cochrane Germany, Cochrane Germany Foundation, Freiburg,
Germany
Publisher
John Wiley and Sons Ltd
Abstract
Background: Balancing the risk of thromboembolism and bleeding after
transcatheter aortic valve replacement (TAVR) remains clinically
challenging. Questions regarding the efficacy and safety of non-vitamin K
oral anticoagulants (NOACs) after TAVR still need to be definitively
answered. Objective(s): To evaluate the efficacy and safety of NOACs
after TAVR in individuals with and without indication for anticoagulation.
 Search Method(s): We searched CENTRAL, MEDLINE, Embase, Web of
Science, ClinicalTrials.gov, and WHO ICTRP on 7 October 2023 together with
reference checking and citation searching to identify additional studies.
 Selection Criteria: We searched for randomised controlled trials
(RCTs) that compared NOACs versus antiplatelet therapy or vitamin K
antagonists (VKAs) after TAVR in adults with or without an indication for
anticoagulation. Data Collection and Analysis: We used standard
Cochrane methods and conducted random-effects pair-wise analyses and
network meta-analyses (NMAs). Our primary outcomes were all-cause
mortality, cardiovascular mortality, stroke, and major bleeding. We used
GRADE to assess the certainty of evidence. Main Result(s): We
included four RCTs with 4808 participants in the NMA. Of these, one
compared rivaroxaban versus antiplatelet therapy in people without an
indication for anticoagulation after TAVR; one compared apixaban versus
antiplatelet therapy in people without an indication for anticoagulation
or versus VKA in people with an indication for anticoagulation after TAVR;
one compared edoxaban versus VKA in people with an indication for
anticoagulation after TAVR; and one compared edoxaban with antiplatelet
therapy in people without an indication for anticoagulation after TAVR.
The mean age of trial participants was 81 years. Follow-up duration ranged
from 6 to 18 months. Overall, we judged the risk of bias in the included
trials to be low in all domains except for blinding, which was assessed as
high in all four studies. No studies evaluated dabigatran. In people
without an indication for anticoagulation, rivaroxaban and apixaban may
increase all-cause mortality after TAVR as compared to antiplatelet
therapy (rivaroxaban: risk ratio (RR) 1.67, 95% confidence interval (CI)
1.13 to 2.46; studies = 1, participants = 1644; moderate-certainty
evidence; apixaban: RR 1.71, 95% CI 0.97 to 3.02; studies = 1,
participants = 1049; low-certainty evidence), while edoxaban may result in
little or no difference (RR 1.59, 95% CI 0.27 to 9.36; studies = 1,
participants = 229; low-certainty evidence). Low-certainty evidence
suggests little or no difference between rivaroxaban, apixaban, or
edoxaban and antiplatelet therapy in cardiovascular mortality
(rivaroxaban: RR 1.28, 95% CI 0.78 to 2.10; studies = 1, participants =
1644; apixaban: RR 1.30, 95% CI 0.64 to 2.65; studies = 1, participants =
1049; edoxaban: RR 7.44, 95% CI 0.39 to 142.38; studies = 1, participants
= 229) and between rivaroxaban or edoxaban and antiplatelets in stroke
(rivaroxaban: RR 1.19, 95% CI 0.71 to 2.00; studies = 1, participants =
1644; edoxaban: RR 1.06, 95% CI 0.15 to 7.42; studies = 1, participants =
229). While rivaroxaban versus antiplatelets probably increases major
bleeding after TAVR (RR 1.98, 95% CI 1.07 to 3.65; studies = 1,
participants = 1644; moderate-certainty evidence), there may be little or
no difference between apixaban and antiplatelet therapy (RR 1.07, 95% CI
0.70 to 1.64; studies = 1, participants = 1049; low-certainty evidence).
It is unclear if edoxaban has an effect on major bleeding, although the
point estimate suggests increased bleeding (versus antiplatelets: RR 2.13,
95% CI 0.54 to 8.30; studies = 1, participants = 229; low-certainty
evidence). In people with an indication for anticoagulation, low-certainty
evidence suggests apixaban or edoxaban may result in little to no
difference in our predefined primary efficacy outcomes after TAVR when
compared to VKA (all-cause mortality: apixaban: RR 1.02, 95% CI 0.59 to
1.77; studies = 1, participants = 451; edoxaban: RR 0.91, 95% CI 0.69 to
1.20; studies = 1, participants = 1426; cardiovascular mortality:
apixaban: RR 1.43, 95% CI 0.76 to 2.70; studies = 1, participants = 451;
edoxaban: RR 1.07, 95% CI 0.72 to 1.57; studies = 1, participants = 1426;
stroke: apixaban: RR 1.28, 95% CI 0.35 to 4.70; studies = 1, participants
= 451; edoxaban: RR 0.83, 95% CI 0.51 to 1.34; studies = 1, participants =
1426). While apixaban may result in a similar rate of bleeding as VKA in
this population, edoxaban probably increases major bleeding after TAVR in
people with an indication for anticoagulation (apixaban: RR 0.90, 95% CI
0.53 to 1.54; studies = 1, participants = 451; low-certainty evidence;
edoxaban: RR 1.44, 95% CI 1.08 to 1.93; studies = 1, participants = 1426;
moderate-certainty evidence). Authors' conclusions: In people without an
indication for oral anticoagulation, rivaroxaban and apixaban may increase
all-cause mortality when compared to antiplatelet therapy, while edoxaban
may result in little or no difference. There might be little or no
difference between rivaroxaban, apixaban, or edoxaban and antiplatelet
therapy in cardiovascular mortality, and between rivaroxaban or edoxaban
and antiplatelets in stroke. While rivaroxaban probably increases major
bleeding following TAVR, there might be little or no difference between
apixaban and antiplatelet therapy, and the effect of edoxaban on major
bleeding remains unclear. In people with an indication for
anticoagulation, apixaban and edoxaban may be as effective as VKA in
preventing all-cause mortality, cardiovascular death, and stroke. Apixaban
may lead to a similar rate of major bleeding as VKA in this population.
However, edoxaban probably increases major bleeding following TAVR when
compared to VKA. Our NMA did not show superiority of one NOAC over another
for any of the primary outcomes. Head-to-head trials directly comparing
NOACs against each other are required to increase the certainty of the
evidence. Copyright © 2025 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<145>
Accession Number
646599905
Title
The effect of mother's voice and music therapy on pain and physiological
parameters during the endotracheal suctioning procedure: A randomized
controlled study.
Source
Journal of pediatric nursing. (no pagination), 2025. Date of Publication:
12 Feb 2025.
Author
Kos F.M.; Bektas M.; Bektas I.; Ayar D.; Metin S.K.
Institution
(Kos) Bilecik Seyh Edebali University Faculty of Health Science Nursing
Department, Bilecik, Turkey
(Bektas) Dokuz Eylul University Faculty of Nursing, Pediatric Nursing
Department, Izmir, Turkey
(Bektas) Izmir Bakircay University Faculty of Health Science Pediatric
Nursing Department, Izmir, Turkey
(Ayar) Alanya Alaaddin Keykubat University Faculty of Health Science,
Pediatric Nursing Department, Alanya, Turkey
(Metin) Departmentof Cardiovascular Surgery, Faculty of Medicine, Dokuz
Eylul University, Izmir, Turkey
Abstract
OBJECTIVE: This study aimed to examine the effects of maternal voice and
music therapy on pain and physiological parameters during the endotracheal
suctioning process in intubated children. DESIGN: The study was a
single-centre, randomized controlled trial. SETTING: The
Thoracic-Cardiovascular Surgery Intensive Care Unit of a University
Hospital in Turkey. METHOD(S): This study involved three groups of 27
children, aged between 2 and 36 months. All three groups, including the
control group (CG), received the standard suction protocol before, during,
and after each intervention. Additionally, the children in the music
therapy (MT) group listened to music titled 'The Happiest Child', while
the children in the mother's voice (MV) group listened to recordings of
their mothers' voices. The variables assessed are pain and physiological
parameters. RESULT(S): When the pain results of the children were
evaluated, the pain score of the children in the control group was found
to be significantly higher than children in the mother's voice and music
voice group (p < .05). It was determined that the lowest FLACC Pain Scale
value was in the mother's voice group (p < .05). When the physiological
parameters results were evaluated, it was determined that the
physiological measurement values of the children in the experimental group
were positively affected (p < .05), there was a significant difference
between the control group (p < .05) and the most effective result was in
the mother's voice group (p < .05). CONCLUSION(S): The application of
mother's voice and music therapy to children before, during and after the
aspiration procedure reduces the pain of children, positively affects
their physiological parameters and improves the quality of nursing care.
IMPLICATIONS FOR CLINICAL PRACTICE: This study provides a scientific basis
for nursing practices in clinical settings and contributes to clinical
practice by shedding light on future evidence-based studies. Copyright
© 2025 Elsevier Inc. All rights reserved.

<146>
Accession Number
646600158
Title
Mitral Valve Surgery After Failed Transcatheter Edge-to-Edge Repair - A
Meta-Analysis.
Source
The Canadian journal of cardiology. (no pagination), 2025. Date of
Publication: 11 Feb 2025.
Author
Cabrucci F.; Baudo M.; Magouliotis D.E.; Yamashita Y.; Kjelstrom S.;
Bacchi B.; Bonacchi M.; Dokollari A.; Sicouri S.; Ramlawi B.
Institution
(Cabrucci, Baudo, Magouliotis, Kjelstrom, Sicouri) Department of Cardiac
Surgery Research, Lankenau Institute for Medical Research, Main Line
Health, Wynnewood, PA, United States
(Yamashita, Ramlawi) Department of Cardiac Surgery Research, Lankenau
Institute for Medical Research, Main Line Health, Wynnewood, 19096, PA,
USA; Department of Cardiac Surgery, Lankenau Heart Institute, Main Line
Health, Wynnewood, 19096, PA, USA
(Bacchi, Bonacchi) Department of Cardiac Surgery, AOU Careggi University
Hospital, Firenze, Italy
(Dokollari) Department of Cardiac Surgery Research, Lankenau Institute for
Medical Research, Main Line Health, Wynnewood, 19096, PA, USA; Department
of Cardiac Surgery, St. Boniface Hospital, University of Manitoba,
Winnipeg, Canada
Abstract
BACKGROUND: Transcatheter edge-to-edge repair (TEER) is increasingly
utilized for mitral regurgitation (MR), particularly in high-risk
patients. However, when TEER fails, patients often require mitral valve
surgery, which remains challenging due to patients' compromised condition.
This study aims to evaluate short and long term surgical outcomes
following failed TEER. METHOD(S): This meta-analysis included
observational studies with reported outcomes of mitral valve surgery after
failed TEER published until September 2024. Multivariable Meta-regressions
were performed to predict short and long-term mortality. Kaplan-Meier
function was reconstructed from individual studies. RESULT(S):
Sixteen studies were included with a total sample of 892 patients. The
mean age was 74.8 years (55% males), with most patients (87.8%) in NYHA
III/IV before surgery. Pooled mean STS-PROM score before indexed TEER was
6.3%. Surgical indications were recurrent MR >=3+ (93%), mitral stenosis
(17%), and endocarditis (2.7%). The average time between TEER and surgery
was 6.4 months. Mitral valve replacement (MVR) was performed in 83.8% of
cases. Thirty-day all-cause mortality was 12.2% but significantly lower
for elective cases (2.5%). At a mean follow-up of 14.7 months, mortality
was 28.3%. Preoperative incidence of CAD, lower LVEF, rate of concomitant
procedures, and functional mitral regurgitation were predictors of short
and long-term outcomes. CONCLUSION(S): Mitral valve surgery after
failed TEER presents significant challenges, yet acceptable outcomes are
achievable, particularly in elective cases. Complete treatment of
concomitant lesions may improve outcomes in patients with preserved LVEF.
Future research should stratify outcomes based on emergent versus elective
surgery and MR etiology to guide tailored surgical
strategies. Copyright © 2025. Published by Elsevier Inc.

<147>
Accession Number
646578190
Title
RETRACTION: A Meta-Analysis Examined the Effect of Topical Vancomycin
Application in Decreasing Sternal Wound Infections Post Cardiac Surgery.
Source
International wound journal. 22(2) (pp e70228), 2025. Date of Publication:
01 Feb 2025.
Author
Anonymous
Abstract
RETRACTION: Y. Zhang, P. Zhang, H. Li, H. Chi, N. Zheng, X. Pan, and C.
Tang, "A Meta-Analysis Examined the Effect of Topical Vancomycin
Application in Decreasing Sternal Wound Infections Post Cardiac Surgery,"
International Wound Journal 20, no. 6 (2023): 2068-2074,
https://doi.org/10.1111/iwj.14074. The above article, published online on
18 January 2023, in Wiley Online Library
(http://onlinelibrary.wiley.com/), has been retracted by agreement between
the journal Editor in Chief, Professor Keith Harding; and John Wiley &
Sons Ltd. Following an investigation by the publisher, all parties have
concluded that this article was accepted solely on the basis of a
compromised peer review process. The editors have therefore decided to
retract the article. The authors did not respond to our notice regarding
the retraction. Copyright © 2025 The Author(s). International
Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons
Ltd.

<148>
Accession Number
2037645517
Title
Flow-controlled versus pressure-controlled ventilation in thoracic surgery
with one-lung ventilation - A randomized controlled trial.
Source
Journal of Clinical Anesthesia. 103 (no pagination), 2025. Article Number:
111785. Date of Publication: 01 Apr 2025.
Author
Abram J.; Spraider P.; Martini J.; Velik-Salchner C.; Dejaco H.; Augustin
F.; Putzer G.; Hell T.; Barnes T.; Enk D.
Institution
(Abram, Spraider, Martini, Velik-Salchner, Dejaco, Putzer) Department of
Anesthesia and Intensive Care Medicine, Medical University of Innsbruck,
Anichstrasse 35, Innsbruck, Austria
(Augustin) Department of Visceral, Transplant and Thoracic Surgery,
Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
(Hell) Department of Mathematics, Faculty of Mathematics, Computer Science
and Physics, University of Innsbruck, Technikerstrasse 15, Innsbruck,
Austria
(Barnes) University of Greenwich, Old Royal Naval College, Park Row,
London, United Kingdom
(Enk) Faculty of Medicine, University of Munster, Albert-Schweitzer-Campus
1, Munster, Germany
Publisher
Elsevier Inc.
Abstract
Study objective: Comparison of flow-controlled ventilation (FCV) to
standard of pressure-controlled ventilation (PCV) in thoracic surgery
procedures requiring one-lung ventilation. Design(s): Prospective,
non-blinded, randomized, controlled trial. Setting(s): Operating
theater at a university hospital, Austria. Patient(s): Patients
scheduled for elective, thoracic surgery. Intervention(s):
Participants received ventilation randomly either with FCV or PCV
per-protocol for the duration of anesthesia. Measurements: The primary
endpoint was oxygenation assessed by paO<inf>2</inf> / FiO<inf>2</inf>
ratio 30 min after the start of OLV. Secondary endpoints included the
required minute volume for CO<inf>2</inf> removal, applied mechanical
power and incidence of postoperative pulmonary complications. Main
Result(s): A total of 46 patients were enrolled and 43 included in the
primary analysis. The primary endpoint paO<inf>2</inf> / FiO<inf>2</inf>
ratio was significantly higher in the FCV group (n = 21) compared to the
control group (PCV n = 22) (187 vs 136 mmHg, MD 39 (95 % CI 1 to 75); p =
0.047). The required respiratory minute volume to obtain comparable mild
hypercapnia during OLV was significantly lower in FCV (3.0 vs 4.5 l/min,
MD -1.3 (95 % CI -1.9 to -0.8); p < 0.001). The applied mechanical power
was also significantly lower (3.5 versus 7.6 J/min, MD -3.8 (95 % CI -5.3
to -2.7); p < 0.001). Conclusion(s): In this single-center randomized
controlled trial, flow-controlled ventilation improved gas exchange
parameters in terms of oxygenation and carbon dioxide removal during
one-lung ventilation in patients undergoing thoracic surgery and reduced
the mechanical impact of artificial ventilation. Copyright © 2025
The Authors

<149>
Accession Number
2033384849
Title
Comparative Efficacy and Safety of Low-Dose Direct Oral Anticoagulants
Versus Dual Antiplatelet Therapy Following Left Atrial Appendage Occlusion
in Patients With Nonvalvular Atrial Fibrillation: A Systematic Review and
Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2025.
Date of Publication: 2025.
Author
Ibrahim A.; Shalabi L.; Zreigh S.; Ramadan S.; Mourad S.; Eljadid G.;
Beshr M.; Abdelaziz A.; Elhadi M.; Sabouret P.; Mamas M.
Institution
(Ibrahim, Mourad, Abdelaziz) Faculty of Medicine, Alexandria University,
Alexandria, Egypt
(Shalabi) Faculty of Medicine, Gharyan University, Gharyan, Libyan Arab
Jamahiriya
(Zreigh) Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara,
Turkey
(Ramadan, Eljadid) Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Beshr) Faculty of Medicine and Health Sciences, Sana'a University,
Sana'a, Yemen
(Elhadi) Korea University College of Medicine, Seoul, Seongbuk-gu, South
Korea
(Sabouret) National College of French Cardiologists, Paris, France
(Sabouret) ACTION Study Group, Pitie-Salpetriere Hospital, Sorbonne
University, Paris, France
(Mamas) Keele Cardiovascular Research Group, Keele University,
Stoke-on-Trent, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Background: Left atrial appendage occlusion (LAAO) is an alternative to
chronic oral anticoagulation (OAT) for stroke prevention in nonvalvular
atrial fibrillation (NVAF) patients with contraindications to OAT.
Postprocedure antithrombotic therapy (ATT) is essential to reduce the risk
of device-related thrombosis (DRT), but the optimal regimen remains
uncertain. Aim(s): This study aims to compare the safety and efficacy
of low-dose direct oral anticoagulants (DOACs) versus dual antiplatelet
therapy (DAPT) following LAAO. Method(s): A comprehensive search of
PubMed, Scopus, Cochrane, and Web of Science was conducted in August 2024.
Studies comparing low-dose DOACs and DAPT post-LAAO were included. The
primary outcomes were a composite efficacy endpoint (DRT, strokes, and
systemic embolism [SE]) and major bleeding events as the safety endpoint.
Secondary outcomes included all bleeding events, all-cause mortality, and
a composite of efficacy and safety endpoints. Result(s): Four studies
with 727 patients were included. Low-dose DOACs were associated with lower
rates of the primary composite efficacy endpoint compared to DAPT (OR =
0.36; 95% CI [0.16, 0.85], p = 0.01). No significant difference in major
bleeding events was observed (OR = 0.36; 95% CI [0.11, 1.18]; p = 0.091;
I2 = 0%). Compared to DAPT, low-dose DOACs were also associated with lower
rates of DRT events (OR = 0.36; 95% CI [0.16, 0.79], p = 0.011).
 Conclusion(s): Low-dose DOACs effectively reduce thromboembolic
events post-LAAO without increasing bleeding risk. These findings support
their use as a viable ATT option, but larger trials are needed to confirm
optimal regimens. Copyright © 2025 Wiley Periodicals LLC.

<150>
Accession Number
2037646331
Title
Hybrid coronary revascularization versus traditional coronary artery
bypass grafting for left main coronary artery disease.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2025. Date of
Publication: 2025.
Author
Hebbo E.; Barker M.; Gold D.A.; Hassan M.E.; Sawan M.; Rab T.; Nicholson
W.J.; Halkos M.E.; Jaber W.A.; Sandesara P.B.
Institution
(Hebbo, Barker, Gold, Hassan, Sawan, Rab, Nicholson, Jaber, Sandesara)
Emory Clinical Cardiovascular Research Institute, Division of Cardiology,
Department of Medicine, Emory University School of Medicine, Atlanta, GA,
United States
(Halkos) Division of Cardiothoracic Surgery, Emory University, Atlanta,
GA, United States
Publisher
Elsevier Inc.
Abstract
Background: The current recommended intervention for significant left main
(LM) stenosis, especially in patients with complex and high SYNTAX score
disease, is coronary artery bypass grafting (CABG). Hybrid coronary
revascularization (HCR) combines robotic coronary artery bypass and
percutaneous coronary intervention, offering a less invasive approach for
patients with LM disease. Objective(s): We compare clinical outcomes
between HCR and CABG in patients with LM disease. Method(s): We
retrospectively screened all patients treated for LM disease between 2019
and 2023 at a single institution. Propensity matching was used for
baseline characteristics. The primary outcome was major adverse
cardiovascular events (MACE) at 30 days, 6 months and 1 year. Secondary
outcomes included death, myocardial infarction, repeat revascularization
and stroke. Result(s): Out of a total of 761 patients treated for LM
disease, 59 HCR patients were propensity matched to 59 CABG patients and
were included in the final analysis. SYNTAX score was >33 for 49.1 % of
HCR patients and 67.3 % of CABG patients (p = 0.15). Hospital length of
stay was significantly shorter for HCR patients compared to CABG (4.07
days vs. 7.58 days, p < 0.001). MACE were significantly lower in the HCR
group at 30 days (0 % vs 10.2 %; p = 0.01), 6 months (0 % vs 17 %; p =
0.002) and 1 year (2.4 % vs 20.5 %; p = 0.01) compared to CABG group.
Additionally, there was a lower rate of repeat revascularization at 6
months in the HCR group (0 % vs 10.9 %; p = 0.02). Conclusion(s):
This retrospective study demonstrates that HCR is a safe and viable
alternative to CABG in patients with LM disease. Randomized clinical
trials comparing the two treatment modalities are needed to confirm these
findings. Copyright © 2025 Elsevier Inc.

<151>
Accession Number
2037651613
Title
Fasting vs No Fasting Prior to Percutaneous Cardiovascular Procedures: A
Meta-Analysis of Randomized Controlled Trials.
Source
JACC: Cardiovascular Interventions. 18(5) (pp 682-684), 2025. Date of
Publication: 10 Mar 2025.
Author
Maqsood M.H.; Tamis-Holland J.E.; Mamas M.A.; Capodanno D.; Bhatt D.L.;
Bangalore S.
Publisher
Elsevier Inc.

<152>
Accession Number
646578179
Title
Dexamethasone as an adjuvant with ropivacaine in thoracoscopy guided
thoracic paravertebral block for postoperative analgesia in thoracic
surgery.
Source
Scientific reports. 15(1) (pp 5038), 2025. Date of Publication: 11 Feb
2025.
Author
Wu K.-W.; Deng S.-Y.; Zhang X.-F.; Zheng D.-W.; Hu L.-H.
Institution
(Wu, Deng, Zhang) Department of Anesthesiology, Affiliated LiHuiLi
Hospital of Ningbo University, No. 57 Xingning Road, Ningbo, Zhejiang,
China
(Zheng) Department of Thoracic Surgery, Affiliated LiHuiLi Hospital of
Ningbo University in Zhejiang Province, Ningbo, China
(Hu) Department of Anesthesiology, Affiliated LiHuiLi Hospital of Ningbo
University, No. 57 Xingning Road, Ningbo, Zhejiang, China
Abstract
Ropivacaine for thoracoscopy-guided thoracic paravertebral block (TTPB)
offers only a short duration of postoperative pain relief, which is
inadequate for managing pain following thoracic surgery. Research has
shown that combining dexamethasone with ropivacaine significantly prolongs
the duration of analgesia from the nerve block. We hypothesised that TTPB
with ropivacaine combined with dexamethasone would enhance postoperative
analgesia and prolong the duration of analgesia in patients undergoing
radical thoracoscopic lung cancer surgery. The study randomly assigned
patients to either a control group (Group C, n = 40) or a dexamethasone
group (Group D, n = 40). TTPB injection of ropivacaine or ropivacaine
combined with dexamethasone prior to surgical sutures. The study compared
postoperative pain satisfaction scores48 h postoperative rescue analgesia
frequencyvisual analogue scale (VAS) scores, the 24-h patient-controlled
analgesia (PCIA) sufentanil consumption, blood glucose levels, adverse
events and recovery status. Group D demonstrated higher postoperative pain
satisfaction scores and lower 48 h postoperative rescue analgesia
frequency compared to Group C. Additionally, Group D had significantly
lower VAS scores at 6, 12, 24, and 48 h post-operation, as well as a
reduced 24-h PCIA sufentanil consumption, shorter time to first
mobilization, and shorter hospital stay compared to Group C (all P <
0.05). The VAS scores at 2 h postoperatively were significantly lower in
Group D compared to scores at 24 and 48 h postoperatively. Conversely,
Group C showed significantly lower VAS scores at 2 h postoperatively
compared to scores at 6, 12, 24, and 48 h postoperatively. The addition of
dexamethasone as an adjuvant to ropivacaine enhanced the analgesic
efficacy of TTPB, prolonged the duration of pain relief, and reduced the
time to first ambulation and hospital stay duration.Trial Registry: ChiCTR
(2400086347); Registered 28/06/2024. Copyright © 2025. The
Author(s).

<153>
Accession Number
646575551
Title
EFFECT OF TRANEXAMIC ACID ON SURGICAL BLEEDING IN PULMONARY RESECTION: A
RANDOMIZED CONTROLLED TRIAL.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. Conference: 23rd
European Conference on General Thoracic Surgery. Lisbon . 21(Supplement 1)
(no pagination), 2015. Date of Publication: 01 Aug 2015.
Author
Boubia S.; Idelhaj N.; Cherkab R.; Ridai M.
Institution
(Boubia, Idelhaj, Ridai) Department of Thoracic Surgery, University
Hospital Ibn Rochd, Casablanca, Morocco
(Cherkab) Department of Anaesthesia and Intensive Care, University
Hospital Ibn Rochd, Casablanca, Morocco
Publisher
Oxford University Press
Abstract
Objectives: The effectiveness of tranexamic acid (TA) in reducing blood
loss and transfusion requirements has been amply demonstrated in many
types of surgeries, including traumatology and cardiovascular surgery.
However, to date, there are no studies evaluating the effect of TA in
pulmonary resection surgery. The aim of our study is to evaluate the
effect of TA on perioperative bleeding and transfusion requirements for
patients undergoing pulmonary resection surgery. Method(s): We
performed a rospective randomized, double blinded, placebo-controlled,
parallel-group trial including patients aged over 18 years, scheduled for
surgical pulmonary resection. Biological, demographic, clinical,
transfusion requirements, blood loss and perioperative complications data
were recorded. There were 2 groups of patients: TA group; Placebo group
(p). Statistical analysis used the Student t-test with significance level
P < 0.05. Result(s): Thirty-three patients comprised the study
cohort. The mean age was 46 +/- 15.46 years. The main comorbidities found
were: COPD (8%) and pulmonary tuberculosis (4%). 54.5% of patients
belonged to the TA group (n =18). There was no significant difference
between the two groups in terms of per-operative blood loss assessed by
surgical aspiration (P = 0.48), gauze and surgical sites (P = 0.32).
Postoperative blood loss quantified by chest tubes were significantly
lower in the TA group (P = 0.009). Perioperative transfusion requirements
were similar in both groups (P = 0.58 vs 0.49). Also, no significant
difference was found in the levels of hemoglobin, hematocrit, and
prothrombin. The most important per-operative and postoperative
complications were bleeding (8%) and sepsis (8%). No side-effects related
to the TA (convulsion, thromboembolism) were noted perioperatively.
 Conclusion(s): In pulmonary resection surgery, TA seems to reduce
postoperative bleeding without having an impact on transfusion
requirements. Other largescale studies are needed to confirm these results
and will thus establish a clear protocol for the use of TA in this type of
surgery.

<154>
Accession Number
646575418
Title
HAS THE QUALITY OF REPORTING OF RANDOMIZED CONTROLLED TRIALS IN THORACIC
SURGERY IMPROVED?.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. Conference: 23rd
European Conference on General Thoracic Surgery. Lisbon . 21(Supplement 1)
(no pagination), 2015. Date of Publication: 01 Aug 2015.
Author
Edwards J.; Dharampal N.; Chung W.; Brar M.; Servatyari R.; Ball C.G.;
Seto J.; Grondin S.
Institution
(Edwards, Dharampal, Chung, Brar, Servatyari, Ball, Seto, Grondin)
University of Calgary, Calgary, Canada
Publisher
Oxford University Press
Abstract
Objectives: To evaluate the quality of reporting of randomized controlled
trials (RCTs) in the thoracic surgery literature according to Consolidated
Standards for Reporting of Trials (CONSORT) and to determine predictors of
quality. Method(s): All RCTs published in four principle journals
between 1998 and 2013 were identified in PubMed. Two independent reviewers
assessed each trial using the CONSORT checklist (1996 Edition) with
discrepancies resolved by a third reviewer. Mean checklist score was
compared between trials published from 1998- 2005 and 2006-2013. The kappa
statistic for inter-rater agreement was calculated. Mean scores from the
two periods were compared using the Students' test with 95% confidence
intervals. Univariable linear regression was then performed to identify
predictors of quality (time period, number of authors, journal, geographic
region, multi versus single centre, anatomic area of thoracic surgery, and
industry sponsorship). Result(s): After two rounds of review, 203 of
the 2838 identified articles met the inclusion criteria. The overall kappa
coefficient was 0.95 indicating very good agreement between reviewers. The
mean CONSORT score was significantly higher in 2006-2013 (mean 10.8; 95%
CI: 10.3-11.2) than 1998-2005 (mean 9.3; 95% CI: 8.7-9.6). There was
strong evidence that mean CONSORTscore increased with increased number of
authors and industry sponsorship, and varied significantly according to
journal and geographic region. Mean score was not influenced by area of
thoracic surgery, although there was a trend toward higher scores in the
transplant literature. The mean score was 2.01 points lower in single
centred trials compared to multicentred trials (95% CI: -2.88 to -1.15).
 Conclusion(s): Our study suggests that the quality of reporting in
the thoracic surgery literature is improving with time and is predicted by
factors including composition and geographic origin of the research group,
industry sponsorship and journal of publication. Efforts should be made to
improve quality of reporting in thoracic surgery.

<155>
Accession Number
646575867
Title
PRELIMINARY PROSPECTIVE STUDY ON DOUBLE-LUMEN TUBE INTUBATION AND ONE-LUNG
VENTILATION CONDITIONS IN THORACIC SURGERY: DO THEY IMPACT POSTOPERATIVE
MORBIDITY?.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. Conference: 23rd
European Conference on General Thoracic Surgery. Lisbon . 21(Supplement 1)
(no pagination), 2015. Date of Publication: 01 Aug 2015.
Author
Le Pimpec-Barthes F.; Pricopi C.; Chevalier B.; Boucherie J.C.; Grand B.;
Bagan P.; Das Neves Pereira J.; Badia A.; Arame A.; Rivera C.
Institution
(Le Pimpec-Barthes, Pricopi, Chevalier, Grand, Bagan, Das Neves Pereira,
Badia, Arame, Rivera) Thoracic Surgery, Georges Pompidou European
Hospital, Paris, France
(Boucherie) Georges Pompidou European Hospital, Paris, France
Publisher
Oxford University Press
Abstract
Objectives: In thoracic surgery, one-lung ventilation by double lumen tube
represented a major improvement making possible complex procedures in
optimal conditions and allowing the development of minimally invasive
surgery. Our objective was to evaluate whether difficulties in
double-lumen tube positioning could induce early postoperative morbidity.
 Method(s): Between April and December 2014, the patients who
underwent thoracic surgery requiring selective intubation could be
included in this prospective study. Incomplete medical files on studied
criteria data, in particular tobacco weaning, were not included. We
defined 2 groups of patients according to whether the process of
double-lumen tube intubation and the fair quality of one-lung ventilation
during surgery was difficult (Group 1) or not (Group 2). Result(s):
One hundred and twenty-seven patients with a mean age 61.4 years (18.7 to
84.5) were thus included in the study. No significant difference was
observed between the 2 groups regarding their comorbidities, functional
characteristics and surgical procedures. A significant difference
regarding the occurrence of early postoperative respiratory complications
was observed between the 2 groups (33.3% in Group 1 vs 14.3% in Group 2, P
= 0.011) without significant impact on mortality (7% in Group 1 and 1.5%
in Group 2, P = 0.111). More pneumonias were observed in Group 1 but it
was not significant (24.6% vs 11.4%, P = 0.052). The limitations of this
study are the heterogeneity of surgical procedures, similar in the 2
groups, and the impossibility to include all the operated patients in the
same period. Conclusion(s): Double-lumen tube intubation is a routine
procedure in thoracic surgery anaesthesiology. However, difficulties in
positioning this type of tube may occur and potentially increase
postoperative respiratory morbidity.

<156>
Accession Number
646575536
Title
3D PRINTING A BONY CHEST WALL FROM COMPUTED TOMOGRAPHY-SCAN DATA AS AN
ADJUNCT TO PROSTHETIC RECONSTRUCTION AFTER CHEST WALL RESECTION.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. Conference: 23rd
European Conference on General Thoracic Surgery. Lisbon . 21(Supplement 1)
(no pagination), 2015. Date of Publication: 01 Aug 2015.
Author
Loganathan K.; West D.; Rahman I.; McElnay P.
Institution
(Loganathan) School of Medicine, University of Bristol, Bristol, United
Kingdom
(West) Thoracic Surgery, University Hospital Bristol NHS Foundation Trust,
Bristol, United Kingdom
(Rahman) University of Bristol, Bristol, United Kingdom
(McElnay) Cardiothoracic Surgery, Newcastle upon Tyne Hospitals NHS
Foundation Trust, Newcastle, United Kingdom
Publisher
Oxford University Press
Abstract
Objectives: Resection of the bony chest wall is usually reconstructed with
a rigid prosthesis, often a nylon mesh and methylmethacrylate (MMA)
sandwich. Currently prostheses are fashioned intraoperatively by visual
estimation. 3D printing of a prosthetic mould may save operative time and
produce a more accurate reconstruction. We aimed to explore the
feasibility of 3D printing a human bony hemithorax to aid prosthesis
manufacture. Based on a recent systematic review, this would be the first
recorded use of 3D printing in thoracic surgery. Method(s): The
computed tomography (CT) scan of a 67 year old male patient was used to
test the feasibility of creating a 3D model. CTscan bony reconstruction
images were converted to a 3D-print compatible format using the SPIERSTM
software package. The specific steps undertaken were recorded together
with the learning points, challenges, and advantages of this novel
technique. Result(s): A completed 3D rendering of the patient's left
thoracic cagewas generated in .stl format, compatible with most 3D
printers, and a graspable model was printed. Specific techniques to deal
with technical difficulties at the thoracic inlet and costal cartilages
were developed. A scaled down graspable model was printed using facilities
available at the university. Conclusion(s): This proof of concept
exercise shows that 3D printing of a human bony chest wall from CT scan
images is possible with existing software. Technical challenges
encountered with rendering costal cartilages and the thoracic inlet could
be overcome. The potential advantages include printing a hemithorax by
mirroring the contralateral side in cases of existing deformity or
destruction, reduced theatre time, improved aesthetics, better planning
and patient education.

<157>
Accession Number
646575599
Title
PREOPERATIVE ASSOCIATION OF GABAPENTIN AND LIDOCAINE PATCH 5% FOR THE
PREVENTION OF ACUTE POST-THORACOTOMY PAIN: A PROSPECTIVE AND RANDOMIZED
STUDY.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. Conference: 23rd
European Conference on General Thoracic Surgery. Lisbon . 21(Supplement 1)
(no pagination), 2015. Date of Publication: 01 Aug 2015.
Author
Fibla J.J.; Hernandez J.; Guirao A.; Sierra A.; Molins L.
Institution
(Fibla, Hernandez, Guirao, Molins) Thoracic Surgery, Sagrat Cor University
Hospital and Hospital Clinic, Barcelona, Spain
(Sierra) Anaesthesiology, Sagrat Cor University Hospital, Barcelona, Spain
Publisher
Oxford University Press
Abstract
Objectives: To evaluate the impact of preoperative gabapentin associated
to lidocaine patch on acute post-thoracotomy pain. Method(s):
Prospective randomized study of 70 patients submitted to thoracotomy for
lung cancer. Patients were divided in two independent groups (anterior
thoracotomy [AT] and posterolateral thoracotomy [PT]). In each group
patients were randomized to receive preoperatively 1200 mg of gabapentin
plus a lidocaine patch 5% placed in the area where the thoracotomy would
be performed (Group A, n = 35) vs no preoperative treatment (Group B, n =
35). All patients received postoperatively bolus of 15 ml of local
anaesthetic -levobupivacaine- through a paravertebral catheter every 6 h
combined with methamizol (every 6 h). Subcutaneous meperidine was employed
as rescue drug. Group A patients received gabapentin 600 mg/12 h during
the first 72 postoperative hours. The level of pain was measured with the
visual analogue scale (VAS) at 1, 6, 24, 48 and 72 h after surgery. The
need of meperidine as rescue drug and secondary effects were also
recorded. Result(s): We did not register significant secondary
effects in relation to gabapentin and lidocaine patch. After gabapentine
administration 7 patients (20%) referred somnolence and 2 (5.6%)
dizziness. Ten patients (14%) needed meperidine as rescue drug (group A:
3/group B:7). Mean VAS values were: all of the cases (n = 70): 5.1 +/-
2.1, AT (n = 38): 4.5 +/- 2.1, PT (n = 32): 5.8 +/- 1.7, Group A (n = 35):
4.5 +/- 2.1, Group B (n = 35): 5.7 +/- 1.9, Group A + AT (n = 19): 4.0 +/-
2.2, Group B + AT (n = 19): 5.0 +/- 2.0, Group A + PT (n = 16): 5.1 +/-
1.6 and Group B + PT (n = 16): 6.5 +/- 1.7. Conclusion(s): The
synergistic preoperative administration of gabapentin and a lidocaine
patch placed in the anatomical area where the thoracotomy was going to be
performed produced a significant decrease on the acute postthoracotomy
pain levels (4.5 vs 5.7, P < 0.05). Both gapapentin and lidocaine patch
were safe and well tolerated. Further studies are warranted to define the
role of preventive synergistic analgesia in thoracic surgical practice.

<158>
Accession Number
646566556
Title
Coronary Artery Bypass Grafting with Mitral Annuloplasty or Replacement
for Ischemic Mitral Regurgitation in Medicare Beneficiaries.
Source
The Annals of thoracic surgery. (no pagination), 2025. Date of
Publication: 08 Feb 2025.
Author
George T.J.; Squiers J.J.; DiMaio J.M.; Banwait J.K.; Grayburn P.A.; Mack
M.J.; Schaffer J.M.
Institution
(George, Squiers, Schaffer) Department Cardiothoracic Surgery, Baylor
Scott & White The Heart Hospital, Plano, TX, United States
(DiMaio, Mack) Department Cardiothoracic Surgery, Baylor Scott & White The
Heart Hospital, Plano,TX; Baylor Scott & White Research Institute,
Plano,TX
(Banwait, Grayburn) Baylor Scott & White Research Institute, Plano, TX,
United States
Abstract
BACKGROUND: Retrospective studies of patients with ischemic mitral
regurgitation(iMR) undergoing coronary artery bypass grafting(CABG) with
concomitant mitral valve surgery frequently report improved survival with
mitral valve annuloplasty(MVr) over replacement(MVR). However, the only
randomized controlled trial found no survival difference. METHOD(S):
Medicare claims data were queried to identify beneficiaries with iMR
undergoing CABG+MVr or CABG+MVR. Kaplan-Meier estimates of survival after
CABG+MVr and CABG+MVR were generated, and 20-year restricted mean survival
times(RMST) were compared. Then, surgeons were stratified by their rate of
CABG/MVr into groups with a demonstrated preference for MVr(PA) or
MVR(PR). Outcomes were re-analyzed by surgeon preference. Overlap
propensity score weighting was used for risk-adjustment in all analyses.
 RESULT(S): Among 10,471 beneficiaries with iMR, 6,457(61.7%)
underwent CABG+MVr and 4,014(38.3%) underwent CABG+MVR. Risk-adjusted
RMSTs were 6.02[5.77,6.26] versus 5.57[5.33,5.81] years after CABG+MVr and
CABG+MVR, respectively(difference 5.4[1.2,9.4] months, p=0.01). Among
1,118 surgeons, 223 PA(performed 2,191 surgeries; 89.5% MVr rate) and 235
PR(performed 1,930 surgeries; 23.0% MVr rate). Risk-adjusted RMSTs were
5.76[5.36,6.15] versus 5.77[5.40,6.14] years among beneficiaries
undergoing surgery by PA surgeons and PR surgeons, respectively(difference
0.1[-6.6,6.6] months, p=0.964). CONCLUSION(S): In Medicare
beneficiaries with iMR undergoing CABG+MVS, CABG+MVr was associated with
improved survival, even after risk-adjustment for measured confounders.
This may be due to unmeasured confounding variables affecting the decision
to perform MVr or MVR, such as valvular pathology and/or severity of
regurgitation. After endeavoring to account for unmeasured confounders
using surgeon preference as an instrumental variable, surgeons who
preferred CABG+MVr or CABG+MVR achieved similar long-term survival for
their patients. Copyright © 2025. Published by Elsevier Inc.

<159>
Accession Number
2037619302
Title
Long-term clinical efficacy of transfemoral transcatheter aortic valve
implantation with three different platforms.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2025. Date of
Publication: 2025.
Author
Dipietro E.; Costa G.; Cali M.; Strazzieri O.; Motta S.C.; Frittitta V.;
Comis A.; Sammartino S.; La Rosa L.; Sgroi C.; Deste W.; Veroux P.;
Lentini S.; Inserra M.C.; Cannizzaro M.T.; Garretto V.; Tamburino C.;
Barbanti M.
Institution
(Dipietro, Costa, Cali, Frittitta, Comis, Sammartino, La Rosa, Sgroi,
Deste, Tamburino) Division of Cardiology, A.O.U. Policlinico "G.
Rodolico-San Marco", Catania, Italy
(Strazzieri, Barbanti) Cardiology Unit, Umberto I Hospital, ASP 4 di Enna,
Enna, Italy
(Motta) Cardiology Unit, Umberto I Hospital, ASP 8 di Siracusa, Siracusa,
Italy
(Veroux) Vascular Surgery and Organ Transplant Unit, University Hospital
of Catania, Catania, Italy
(Lentini) Division of Cardiac Surgery, G. Rodolico - San Marco Policlinic
University Hospital, Catania, Italy
(Inserra, Cannizzaro, Garretto) Division of Radiology, G. Rodolico - San
Marco Policlinic University Hospital, Catania, Italy
(Barbanti) Universita degli Studi di Enna "Kore", Enna, Italy
Publisher
Elsevier Inc.
Abstract
Background: Long-term durability and outcomes of transcatheter aortic
valve implantation (TAVI) have been reported only with first generation
devices. Objective(s): To compare clinical efficacy of TAVI with
Sapien 3 (Edwards Lifesciences), Evolut R/PRO (Medtronic) or Acurate Neo
(Boston Scientific) transcatheter heart valves (THVs) at long-term.
 Method(s): Consecutive TAVI patients treated with Sapien 3, Evolut
R/PRO and Acurate Neo THVs at Policlinico G. Rodolico of Catania with at
least 5 years follow-up were included in this analysis. Patients were
divided into three different groups according to the TAVI device used.
Outcomes were compared after inverse probability of treatment weighting
adjustment. The primary endpoint was the composite of all-cause death,
disabling stroke and heart failure (HF) re-hospitalization at 7 years. The
co-primary endpoint was valve-related clinical efficacy according to Valve
Academic Research Consortium 3 (VARC-3) definition, at 7 years.
 Result(s): From September 2014 to December 2018, 383 tranfemoral TAVI
patients receiving Sapien 3 (n = 131, 34.2 %), Evolut R/PRO (n = 134, 34.9
%), or Acurate Neo (n = 118, 30.8 %) devices were compared. At 7 years,
the composite primary endpoint did not differ among study groups (60.2 %
vs. 51.6 % vs. 62.1 % for Sapien 3, Evolut R/PRO and Acurate Neo,
respectively, p<inf>log-rank</inf> = 0.50). The co-primary endpoint was
also similar (2.2 % vs. 1.2 % vs. 4.2 %, for Sapien 3, Evolut R/PRO and
Acurate Neo, respectively, p<inf>log-rank</inf> = 0.86).
 Conclusion(s): Clinical efficacy of TAVI with Sapien 3, Evolut R/PRO
and Acurate Neo devices was sustained and comparable up to 7 years. Low
and similar rates of valve degeneration were reported among the three
devices. Randomized clinical trials are necessary to corroborate these
findings and to assess the impact of specific hemodynamic differences
among the three THV platforms in the context of long-term clinical
efficacy. Copyright © 2025 Elsevier Inc.

<160>
Accession Number
646565655
Title
Patient Selection for Surgery vs. Surveillance in Moderately Dilated
Ascending Aorta: Insights from Titan:SvS, an International Prospective
Trial.
Source
The Annals of thoracic surgery. (no pagination), 2025. Date of
Publication: 07 Feb 2025.
Author
Makarem A.; Appoo J.J.; Boodhwani M.; Guo M.H.; Brownlee S.; Demers P.;
Patel H.J.; Hughes G.C.; Dagenais F.; Chu M.W.A.; Ouzounian M.; Grau J.B.;
Bozinovski J.; Pozeg Z.; Tseng E.; Atoui R.; Jassar A.S.
Institution
(Makarem, Brownlee, Jassar) Division of Cardiac Surgery, Massachusetts
General Hospital and Harvard Medical School, Boston, MA, United States
(Appoo) Division of Cardiac Surgery, Libin Cardiovascular Institute,
Calgary, AB, Canada
(Boodhwani, Guo) Division of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, ON, Canada
(Demers) Division of Cardiac Surgery, University of Montreal, Montreal,
QC, Canada
(Patel) Division of Cardiac Surgery, University of Michigan Health, Ann
Arbor, MI, United States
(Hughes) Division of Cardiac Surgery, Duke University, Durham, NC, United
States
(Dagenais) Division of Cardiac Surgery, Laval University, Quebec City, QC,
Canada
(Chu) Division of Cardiac Surgery, London Health Centre, London, ON,
Canada
(Ouzounian) Division of Cardiac Surgery, Toronto General Hospital,
Toronto, ON, Canada
(Grau) Division of Cardiac Surgery, Valley Health System, Ridgewood, NJ,
United States
(Bozinovski) Division of Cardiac Surgery, Ohio State University Wexner
Medical Center, Columbus, OH, United States
(Pozeg) Division of Cardiac Surgery, New Brunswick Heart Centre, Saint
John, NB, Canada
(Tseng) Division of Cardiac Surgery, University of California at San
Francisco Medical Center, CA, United States
(Atoui) Division of Cardiac Surgery, Health Sciences North, ON, Canada
Abstract
BACKGROUND: Guidelines for treating ascending thoracic aortic aneurysms
(ATAA) are largely based on single-center studies. To understand factors
influencing patient selection for surgery versus surveillance, patient and
aneurysm characteristics were compared for subjects in the randomized and
registry arms of a large prospective, multi-center, multi-national trial.
 METHOD(S): TITAN: SvS (Treatment in Thoracic Aortic aNeurysm: Surgery
versus Surveillance) is the largest prospective multi-center study of
patients with ATAA between 5.0-5.4 cm, randomizing patients 1:1 to initial
surgery versus surveillance. Non-randomized patients are enrolled into a
Registry where results of operative or surveillance strategy can be
followed prospectively. Between 2018 and 2023, 615 patients were enrolled
at 22 sites in USA and Canada. Demographic and aneurysm characteristics
were compared between randomized and registry arms. RESULT(S):
Compared to randomized and operative registry groups, patients in the
surveillance registry were older with more co-morbidities. No significant
differences were observed in maximal ascending aortic diameter [(5.1 (5.0,
5.2) vs 5.1 (4.9, 5.2) cm, p=0.2] or other aneurysm characteristics.
Despite similar numbers of enrolling centers in the USA (n=11) and Canada
(n=12), Canadian patients were more likely to be randomized (58% vs. 7%,
p<0.01), and less likely to be enrolled in the operative (9% vs. 42%, p
<0.01) or surveillance registry (34% vs. 51%). CONCLUSION(S):
Enrollment data TITAN:SvS suggests that patient and geographic
characteristics, rather than aortic size, influence decision-making
regarding the initial treatment strategy for ATAAs. These findings
highlight the need for caution when generalizing outcomes from operative
registries, as sicker patients may be excluded. Copyright © 2025.
Published by Elsevier Inc.

<161>
Accession Number
2037605881
Title
Left Ventricular Entry to Reduce Brain Lesions during Catheter Ablation: A
Randomized Trial.
Source
Circulation. (no pagination), 2025. Date of Publication: 2025.
Author
Marcus G.M.; Tung R.; Gerstenfeld E.P.; Hue T.F.; Lin F.; Cheng J.; Weiss
J.P.; Tzou W.S.; Hsia H.; Ehdaie A.; Cooper D.H.; Bunch T.J.; Arkles J.;
Nazer B.; Lee A.; Hadjis A.; Nguyen D.T.; Chelu M.G.; Moss J.; Hsu J.C.;
Valderrabano M.; Bhave P.D.; Beaser A.D.; Kanagasundram A.; Wazni O.;
Bradfield J.; Wall G.; Chang K.; Yang M.; Montenegro G.; Jarrott S.;
Kramer J.H.; Kim A.S.; Morris Y.M.; Dillon W.P.
Institution
(Marcus, Gerstenfeld, Hsia, Lee, Moss, Wall, Chang, Yang, Montenegro)
Division of Cardiology, University of California, San Francisco, United
States
(Hue, Lin) Department of Epidemiology and Biostatistics, University of
California, San Francisco, United States
(Cheng) Oral Epidemiology & Dental Public Health, University of
California, San Francisco, United States
(Jarrott, Kramer, Kim) Department of Neurology, University of California,
San Francisco, United States
(Morris) University of California, San Francisco, United States
(Dillon) Department of Radiology and Biomedical Imaging, University of
California, San Francisco, United States
(Tung, Weiss) Division of Cardiology, University of Arizona, College of
Medicine-Phoenix, Banner University Medical Center, United States
(Tzou) Division of Cardiology, University of Colorado, Anschutz Medical
Center, Aurora, United States
(Ehdaie) Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles,
United States
(Cooper) Cardiovascular Division, Washington University, School of
Medicine, St. Louis, United States
(Bunch) Division of Cardiovascular Medicine, University of Utah, Salt Lake
City, United States
(Arkles) Cardiovascular Division, University of Pennsylvania,
Philadelphia, United States
(Nazer) Division of Cardiology, University of Washington, Seattle, United
States
(Hadjis) Division of Cardiology, Hopital du Sacre-Coeur de Montreal,
University of Montreal, Canada
(Nguyen) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
MN, United States
(Chelu) Department of Medicine-Cardiology, Cardiovascular Research
Institute, Baylor College of Medicine, Texas Heart Institute, Baylor St.
Luke's Medical Center, Houston, United States
(Hsu) Division of Cardiology, University of California, San Diego, United
States
(Valderrabano) Department of Cardiology, Houston Methodist Hospital, TX,
United States
(Bhave) Department of Cardiovascular Medicine, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Beaser) Section of Cardiology, University of Chicago, IL, United States
(Kanagasundram) Division of Cardiovascular Medicine, Vanderbilt University
Medical Center, Nashville, TN, United States
(Wazni) Department of Cardiovascular Medicine, Cleveland Clinic, OH,
United States
(Bradfield) Cardiac Arrhythmia Center, University of California, Los
Angeles, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Catheter ablation of ventricular arrhythmias, one of the most
rapidly growing procedures in cardiac electrophysiology, is associated
with magnetic resonance imaging-detected brain lesions in more than half
of cases. Although a retrograde aortic approach is conventional, modern
tools enable entry through a transseptal approach that may avoid
embolization of debris from the arterial system. We sought to test the
hypothesis that a transseptal puncture would mitigate brain injury
compared with a retrograde aortic approach. METHOD(S): The TRAVERSE
trial (Transseptal Versus Retrograde Aortic Ventricular Entry to Reduce
Systemic Emboli) was a multicenter randomized controlled comparative
effectiveness trial. Patients with left ventricular arrhythmias undergoing
catheter ablation procedures were randomly assigned to a transseptal
puncture approach compared (1:1) with a retrograde aortic approach. The
primary outcome was the presence of an acute brain lesion detected by
magnetic resonance imaging. Secondary outcomes included clinically
manifest complications, procedural efficacy, and 6-month neurocognitive
assessments. RESULT(S): Among the 62 patients randomly assigned to a
retrograde aortic approach with postoperative brain magnetic resonance
imaging, 28 (45%) exhibited an acute brain lesion compared with 19 of the
69 (28%) of those randomized to a transseptal puncture (P=0.036). No
differences in clinically manifest complications or procedural efficacy
were observed. More patients in the retrograde aortic arm were categorized
as having a high likelihood of cognitive impairment at 6 months (33%
compared with 19% of those in the transseptal arm), but substantial loss
to follow-up was present. CONCLUSION(S): Among patients undergoing
left ventricular catheter ablation procedures, a transseptal approach
reduced the risk of acute brain lesions by nearly half compared with a
retrograde aortic approach without sacrificing safety or efficacy. Given a
likely embolic pathogenesis, the brain magnetic resonance imaging findings
may reflect a propensity to other organ damage; these findings may extend
to other procedures requiring left ventricular entry. Copyright ©
2025 American Heart Association, Inc.

<162>
Accession Number
2033391792
Title
Predicting Surgical and Non-surgical Curvature Correction by Radiographic
Spinal Flexibility Assessments for Patients With Adolescent Idiopathic
Scoliosis: A Systematic Review and Meta-Analysis.
Source
Global Spine Journal. (no pagination), 2025. Date of Publication: 2025.
Author
Luo Y.-Y.; Hung T.-M.; Zheng Q.; Wu H.-D.; Wong M.-S.; Bai Z.-Q.; Ma
C.Z.-H.
Institution
(Luo, Hung, Wong, Ma) Department of Biomedical Engineering, The Hong Kong
Polytechnic University, Hong Kong
(Zheng) Department of Rehabilitation Medicine, Tongji Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Wuhan,
China
(Wu) Department of Prosthetic and Orthotic Engineering, School of
Rehabilitation, Kunming Medical University, Kunming, China
(Bai) School of Systems Design and Intelligent Manufacturing, Southern
University of Science and Technology, Shenzhen, China
(Ma) Research Institute for Smart Ageing, The Hong Kong Polytechnic
University, Hong Kong
Publisher
SAGE Publications Ltd
Abstract
Study Design: Systematic Review and Meta-analysis. Objective(s): This
systematic review and meta-analysis aimed to: (1) synthesize the prevalent
application ratios of 2 radiographic spinal flexibility assessment methods
in AIS patients treated with PSF or bracing; and (2) quantitatively
evaluate the accuracy of these methods in predicting post-intervention
correction outcomes. Method(s): A systematic search was conducted
across 5 electronic databases: CINAHL, Embase, Ovid, PubMed, and Web of
Science. Meta-analyses were performed to investigate the accuracy of the
spinal flexibility rate in predicting the post-intervention correction
rate in AIS patients treated with PSF surgery or bracing, using RevMan
5.4.1 software. Result(s): The results of 31 studies, involving 1868
AIS patients, showed that the side-bending method was utilized more
frequently than the fulcrum-bending method in both treatments. Meanwhile,
the spinal flexibility evaluated by the fulcrum-bending method may provide
a more accurate prediction of post-surgical correction compared to the
side-bending approach, particularly for main curves. For the bracing
treatment, only a few studies have preliminarily reported good capability
of the side-bending method in predicting the initial in-brace correction.
 Conclusion(s): This review quantitatively assessed the clinical
application ratio and effectiveness of side-bending and fulcrum-bending
radiographs in predicting post-intervention curve corrections in AIS
patients undergoing surgical or bracing treatments. The results of the
current review supported to adopt the fulcrum-bending approach for AIS
patients undergoing PSF surgery with main thoracic curves, and the
side-bending approach for those with thoracolumbar/lumbar curves. For
patients receiving bracing treatment, further research is still needed to
confirm the clinical value of the side-bending method. Copyright
© The Author(s) 2025.

<163>
Accession Number
646561963
Title
Serial Lactate in Clinical Medicine - A Narrative Review.
Source
Journal of intensive care medicine. (pp 8850666241303460), 2025. Date of
Publication: 10 Feb 2025.
Author
Falter F.; Tisherman S.A.; Perrino A.C.; Kumar A.B.; Bush S.; Nordstrom
L.; Pathan N.; Liu R.; Mebazaa A.
Institution
(Falter) Department of Anaesthesia and Intensive Care, Royal Papworth
Hospital, Cambridge, United Kingdom
(Tisherman) Center for Critical Care and Trauma, University of Maryland
School of Medicine, Baltimore, United States
(Perrino) Department of Anesthesiology, Yale School of Medicine, New
Haven, United States
(Kumar) Department of Anesthesiology and Critical Care, Vanderbilt
University Medical Center, Nashville, United States
(Bush) Department of Emergency Medicine, Leeds Teaching Hospitals, Leeds,
United Kingdom
(Nordstrom) Department of Women's and Children's Health, Karolinska
University, Stockholm, Sweden
(Pathan) Department of Paediatrics, Cambridge University Hospitals,
Cambridge, United Kingdom
(Liu) Sutter Health, San Francisco, United States
(Mebazaa) Department of Anaesthesiology and Critical Care, Paris, France
Abstract
BACKGROUND: Blood lactate is commonly used in clinical medicine as a
diagnostic, therapeutic and prognostic guide. Lactate's growing importance
in many disciplines of clinical medicine and academic enquiry is
underscored by the tenfold increase in publications over the past 10
years. Lactate monitoring is presently shifting from single to serial
measurements, offering a means of assessing response to therapy and to
guide treatment decisions. With the promise of wearable lactate sensors
and their potential integration in electronic patient records and early
warning scores, the utility of serial lactate measurement deserves closer
scrutiny. METHOD(S): Articles included in this review were identified
by searching MEDLINE, PubMed and EMBASE using the term "lactate" alone and
in combination with "serial", "point of care", "clearance", "prognosis"
and "clinical". Authors were assigned vetting of publications according to
their specialty (anesthesiology, intensive care, trauma, emergency
medicine, obstetrics, pediatrics and general hospital medicine). The
manuscript was assembled in multidisciplinary groups guided by underlying
pathology rather than hospital area. FINDINGS: Lactate's clinical utility
as a dynamic parameter is increasingly recognized. Several publications in
the last year highlight the value of serial measurements in guiding
therapy. Outside acute clinical areas like the emergency room, operating
room or intensive care, obtaining lactate levels is often fraught with
difficulty and delays. INTERPRETATION: Measuring serial lactate and
lactate clearance offers regular feedback on response to therapy and
patient status. Particularly on the ward, wearable devices integrated in
early warning scores via the hospital IT system are likely to identify
deteriorating patients earlier than having to rely on observations by an
often-overstretched nursing workforce.

<164>
Accession Number
2037589781
Title
Radiomics of baseline epicardial adipose tissue predicts left ventricular
mass regression after transcatheter aortic valve replacement.
Source
Journal of Geriatric Cardiology. 21(12) (pp 1109-1118), 2024. Date of
Publication: 01 Dec 2024.
Author
Zhang Y.; Yang H.-R.; Ji X.-Y.; Xiong T.-Y.; Chen M.
Institution
(Zhang, Yang, Ji, Xiong, Chen) Department of Cardiology, West China
Hospital, Sichuan University, Chengdu, China
(Zhang, Xiong, Chen) Cardiac Structure and Function Research Key
Laboratory of Sichuan Province, West China Hospital, Sichuan University,
Chengdu, China
Publisher
Science Press
Abstract
Background Epicardial adipose tissue (EAT) radiomics derived from cardiac
computed tomography (CT) images may provide insights into EAT
characteristics, which can further predict regression of left ventricular
mass index (LVMI) after transcatheter aortic valve replacement (TAVR).
This study aimed to develop and validate a radiomics nomogram based on
pre-procedural EAT CT to predict inadequate LVMI regression following
TAVR. Methods Inadequate LVMI regression was defined as DELTALVMI% < 15%
at one-year post TAVR. Radiomics features from pre-procedural CT images
were selected mainly by least absolute shrinkage and selection operator
algorithm. The patients were randomly divided into the training and
validation cohorts to establish and evaluate three feature classifier
models based on the selected features, using which the Radiomics scores
(Radscores) were then calculated. A radiomics nomogram was constructed
using independent risk factors and further assessed using area under the
curve, calibration curve, and decision curve analysis. Results A total of
144 consecutive TAVR patients (42 patients with inadequate and 102
patients with adequate LVMI regression) were randomly assigned to the
training and validation cohorts (116 patients and 28 patients,
respectively). A total of 1130 radiomics features from each patient
yielded 6 features for the Radscore construction after selection, with
logistic regression and support vector machine models favored.
Subsequently, a nomogram based solely on the Radscore was constructed,
with an area under the curve of 0.743 in the validation cohort, along with
favorable decision curve analysis and calibration curves. Conclusions The
developed radiomics nomogram, serving as a non-invasive tool, achieved
satisfactory preoperative prediction of inadequate LVMI regression in TAVR
patients, thereby facilitating clinical management. Copyright ©
2024 JGC All rights reserved;

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