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<1>
Accession Number
2037799177
Title
Use of Hydroxycobolamin in the Prevention of Vasoplegic Syndrome in Adult
Patients Undergoing Cardiopulmonary Bypass: A Controlled Prospective
Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Salah D.; Ahmed S.; Ibrahim D.A.
Institution
(Salah, Ahmed, Ibrahim) Anesthesia, Intensive Care Unit, and Pain, Ain
Shams University, Cairo, Egypt
Publisher
W.B. Saunders
Abstract
Objective: We hypothesized that the prophylactic use of hydroxocobalamin
in patients at high-risk patients to develop vasoplegia after
cardiopulmonary bypass (CPB) may decrease its incidence. Design(s):
This randomized placebo-controlled prospective single-center study was
conducted on high-risk patients for vasoplegia who underwent coronary
artery bypass grafting (CABG). Setting(s): This study was conducted
in Ain Shams University Hospitals from August 2019 to October 2023 in
cardiothoracic operative rooms and its intensive care unit.
 Participant(s): Patients included in the study were 18 to 60 years
old and undergoing CABG and/or valve surgery on CPB and had 2 or more
preoperative risk factors for vasoplegia. They were receiving using
preoperative beta-blocker or angiotensin-converting enzyme inhibitor with
a preoperative ejection fraction of less than 35% and a history of thyroid
disease and preoperative diuretics. Intervention(s): At the end of
CPB, the patients were assigned randomly into two groups: group I
consisted of 30 patients who received hydroxocobalamin 5 g intravenously
via the central venous catheter as a bolus over 15 minutes reconstituted
in 200 mL of normal saline, and group II (control) consisted of 30
patients who received 200 mL of normal saline intravenously over 15
minutes. Measurements and Main Results: The primary outcome was the
change in mean arterial pressure between baseline and all time points (30
and 60 minutes after CPB initiation and 30 and 60 minutes after CPB
separation) between the two groups and within the same group. The
comparison regarding the change in systemic venous resistance between
baseline and all time points (30 and 60 minutes before CPB initiation and
30 and 60 minutes after CPB separation) between the two groups and within
the same group is calculated. Cardiac index was calculated 30 min before
CPB initiation and 30 min after CPB separation. Doses of norepinephrine
and its equivalent, incidence of vasoplegic shock syndrome, serum lactate,
number of ventilator days, intensive care unit length of stay, hospital
length of stay, incidence of norepinephrine-resistant refractory
vasoplegia, acute kidney injury, shock liver and mortality in 1 week were
calculated. Results showed that mean arterial pressure and systemic venous
resistance at minutes 30 and 60 after CPB separation was significantly
higher in group I compared to group II. Cardiac index was significantly
lower in group I compared to group II. Norepinephrine requirements
(microg/kg/min) at minutes 30 and 60 after CPB separation as well as
average total dose norepinephrine equivalent were significantly lower in
group I. Serum lactate was also found to be significantly lower in group
I. Incidence of vasoplegic shock syndrome, norepinephrine-resistant
refractory vasoplegia, number of ventilator days, intensive care unit
length of stay, hospital length of stay, acute kidney injury, shock liver,
and mortality was less frequent in group I, but the differences were
statistically significant only for vasoplegia and refractory vasoplegia.
 Conclusion(s): This study showed that prophylactic hydroxocobalamin
can be used effectively to decrease the incidence of vasoplegic syndrome,
and total vasopressor dose, as well as improve tissue perfusion in
high-risk patients in cardiac surgeries. Copyright © 2025
Elsevier Inc.

<2>
Accession Number
2036876140
Title
Bacterial air contamination and the protective effect of coverage for
sterile surgical goods: A randomized controlled trial.
Source
American Journal of Infection Control. 53(4) (pp 467-472), 2025. Date of
Publication: 01 Apr 2025.
Author
Wistrand C.; Soderquist B.; Friberg O.; Sundqvist A.-S.
Institution
(Wistrand, Sundqvist) University Health Care Research Centre, Faculty of
Medicine and Health, Orebro University, Orebro, Sweden
(Wistrand, Friberg) Department of Cardiothoracic and Vascular Surgery,
Orebro University Hospital, Orebro, Sweden
(Soderquist, Friberg) School of Medical Sciences, Faculty of Medicine and
Health, Orebro University, Orebro, Sweden
(Soderquist) Department of Laboratory Medicine, Faculty of Medicine and
Health, Orebro University, Orebro, Sweden
Publisher
Elsevier Inc.
Abstract
Background: There is limited knowledge regarding how long prepared sterile
goods can wait before becoming contaminated. We investigated whether
surgical goods could be prepared the day before surgery and kept sterile
overnight in the operating room, if protected by sterile covers.
 Method(s): Sterile surgical goods for open-heart surgeries (n = 70)
were randomized to preparation on the morning of the operation or on the
previous evening. Exposure time was the total time between preparation and
use. Primary outcome was bacterial growth reported as colony forming units
(cfu), isolated on 840 agar plates. The protocol was registered with
ClinicalTrials.gov (NCT05597072). Result(s): When the agar plates
were protected with sterile covers, exposure time had no impact
(intervention group: 7 cfu, control group: 17 cfu). Without protection,
longer exposure time was associated with more cfu (P =.016). A total of
499 cfu were isolated, displaying 59 different types of bacteria including
13 resistant Staphylococcus epidermidis, 6 (46%) of which were multidrug
resistant. Conclusion(s): Sterile goods could wait in the operating
room for at least 15 hours before use without increased risk of bacterial
air contamination, if protected with sterile covers. However, if the goods
were not covered, bacterial air contamination occurred over
time. Copyright © 2025 The Authors

<3>
Accession Number
2036208939
Title
Reduced direct oral anticoagulant dose vs dual antiplatelet therapy after
left atrial appendage closure in patients with nonvalvular atrial
fibrillation: A systematic review and meta-analysis.
Source
Heart Rhythm. 22(4) (pp 979-986), 2025. Date of Publication: 01 Apr 2025.
Author
Lima N.A.; Filho F.W.P.A.; Mendes B.X.; Neto V.L.M.; d'Avila A.L.B.
Institution
(Lima, Mendes) Department of Medicine, Christus University Center, Ceara,
Fortaleza, Brazil
(Filho, Neto) Department of Medicine, Federal University of Ceara, Ceara,
Sobral, Brazil
(d'Avila) Departments of Medicine, Beth Israel Deaconess Medical Center
and Harvard Medical School, Boston, Massachusetts, United States
Publisher
Elsevier B.V.
Abstract
Background: Left atrial appendage closure (LAAC) is an alternative therapy
for patients with nonvalvular atrial fibrillation who are not eligible for
long-term oral anticoagulation. However, the optimal therapy after this
procedure still is controversial, especially in a subgroup of patients
with severe renal dysfunction. Objective(s): The purpose of this
study was to evaluate the use of low-dose direct oral anticoagulation
(l-DOAC) vs dual antiplatelet therapy (DAPT) after LAAC in patients with
nonvalvular atrial fibrillation. Method(s): We systematically
searched PubMed, Embase and Cochrane. Outcomes were the incidence of
device-related thrombus (DRT), major bleeding, stroke, cardiovascular
mortality, all-cause mortality, thromboembolic events (DRT, ischemic
stroke, transient ischemic attack, peripheral thromboembolism), and the
composite outcome of thromboembolic events and major bleeding. Risk ratios
(RRs) with 95% confidence intervals (CIs) were calculated using a random
effects model. Review Manager 5.4.1 was used for statistical analyses.
Heterogeneity was assessed with I2 statistics. Result(s): A total of
1015 participants from 2 randomized controlled trials and 3 nonrandomized
cohorts were included. The incidence of DRT was significantly reduced with
l-DOAC relative to DAPT (0.81% vs 5.08%, respectively; RR 0.37; 95% CI
0.15-0.94; P = .04; I2 = 0%). We also found the patients who
used l-DOAC had a reduction in the composite outcomes of thromboembolic
events and major bleeding (1.41% vs 11.13%; RR 0.14; 95% CI 0.05-0.36; P
<.0001; I2 = 0%). Conclusion(s): In this systematic review
and meta-analysis, the use of l-DOACs in patients with nonvalvular atrial
fibrillation who underwent LAAC reduces the occurrence of the DRT and
composite outcomes of thromboembolic events and major
bleeding. Copyright © 2024 Heart Rhythm Society

<4>
Accession Number
2037346943
Title
Efficacy of surgical ablation and left atrial appendage occlusion in
patients with AF undergoing coronary artery bypass grafting: A network
meta-analysis.
Source
Journal of Cardiology. 85(3) (pp 177-185), 2025. Date of Publication: 01
Mar 2025.
Author
Awad A.K.; Elbahloul M.A.; Gamal A.; Attia A.N.; Hamed S.M.; Elsekhary
A.I.; Sa M.P.
Institution
(Awad) Faculty of Medicine, Ain-Shams University, Cairo, Egypt
(Awad) Department of Cardiothoracic Surgery, Ain-Shams University
Hospitals, Cairo, Egypt
(Elbahloul) Faculty of Medicine, Kafr El-Shaikh University, Kafr
El-Shaikh, Egypt
(Gamal) Clinical Pharmacy Department, Faculty of Pharmacy, Deraya
University, Minia, Egypt
(Attia, Elsekhary) Kasr Alainy School of Medicine, Cairo University,
Cairo, Egypt
(Hamed) Faculty of Medicine, Mansura University, Dakahlia, Egypt
(Sa) Division of Cardiac Surgery, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, United States
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Atrial fibrillation (AF) is a prevalent cardiac arrhythmia
that greatly elevates the risk of stroke. This risk increases both during
and after cardiac procedures, such as coronary artery bypass grafting
(CABG). There is an increasing interest in non-pharmacological treatments
such as left atrial appendage occlusion (LAAO) and surgical ablation,
intending to enhance both immediate and long-term postoperative results.
 Objective(s): To investigate the efficacy of surgical ablation (SA),
LAAO, or both in patients with AF undergoing CABG. Method(s): We
searched four electronic databases: PubMed, Scopus, Cochrane Library, and
WOS. We analyzed data using R language and "netmeta" and "netrank"
packages of meta-insight software. Pooled outcomes were reported as mean
difference or risk ratio (RR) with 95 % confidence interval (CI) in a
random effect method. Result(s): A total of 16 studies were included
with 594,312 patients included. The 30-day mortality showed a
non-statistically significant difference between CABG-LAAO compared to
CABG alone and CABG-SA with RR of 1.70 (95%CI 0.38-7.61) and 0.62 (95%CI
0.10-3.94). However, compared to CABG alone, CABG-SA + LAAO, CABG-LAAO,
and CABG-SA had significantly lower risk of long-term mortality with RR
0.75 (95%CI 0.57-0.98), 0.78 (95%CI 0.65-0.94), and 0.73 (95%CI
0.61-0.88), respectively. CABG-SA + LAAO, CABG-LAAO, and CABG-SA reduced
the risk of short-term stroke compared to CABG alone with RR of 0.73
(95%CI 0.43-1.24), 0.93 (95%CI 0.78-1.11), and 1.01 (95%CI 0.75-1.36),
respectively. Moreover, only CABG-SA + LAAO and CABG-LAAO showed a
statistically significant reduction in long term stroke and
hospitalization due to heart failure while CABG-SA showed no statistically
significant difference. Furthermore, there was no statistically
significant difference between our interventions in terms of 30-day
rehospitalization, intra-aortic balloon pump support, and risk of
hemorrhage. Conclusion(s): Among patients with AF undergoing CABG,
whether undergoing SA alone or LAAO alone or both showed significant
clinical outcomes such as reduced risk of both short- and long-term
mortality and short-term stroke. Copyright © 2025 Elsevier Ltd

<5>
Accession Number
2032858073
Title
Real-time continuous glucose monitoring improves postoperative glucose
control in people with type 2 diabetes mellitus undergoing coronary artery
bypass grafting: A randomized clinical trial.
Source
Diabetes, Obesity and Metabolism. 27(4) (pp 1836-1844), 2025. Date of
Publication: 01 Apr 2025.
Author
Son H.; Sohn S.H.; Kim H.A.; Choe H.J.; Lee H.; Jung H.S.; Cho Y.M.; Park
K.S.; Hwang H.Y.; Kwak S.H.
Institution
(Son, Jung, Cho, Park, Kwak) Division of Endocrinology and Metabolism,
Department of Internal Medicine, Seoul National University Hospital,
Seoul, South Korea
(Sohn, Hwang) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Kim) Division of Endocrinology, Department of Internal Medicine, Veteran
Health Service Medical Center, Seoul, South Korea
(Choe) Division of Endocrinology and Metabolism, Department of Internal
Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South
Korea
(Lee) Department of Internal Medicine, Seoul National University Hospital,
Seoul, South Korea
(Lee) Department of Translational Medicine, Seoul National University
College of Medicine, Seoul, South Korea
(Lee) Genomic Medicine Institute, Medical Research Center, Seoul National
University College of Medicine, Seoul, South Korea
(Cho, Park, Kwak) Divison of Endocrinology and Metabolism, Department of
Internal Medicine, Seoul National University College of Medicine, Seoul,
South Korea
(Kwak) Innovative Medical Technology Research Institute, Seoul National
University Hospital, Seoul, South Korea
Publisher
John Wiley and Sons Inc
Abstract
Background: Effective glycaemic control following cardiac surgery improves
clinical outcomes, and continuous glucose monitoring (CGM) might be a
valuable tool in achieving this objective. We investigated the effect of
real-time CGM and telemonitoring on postoperative glycaemic control in
people with type 2 diabetes (T2D) after coronary artery bypass grafting
(CABG). Method(s): In this randomized clinical trial (RCT), adults
with T2D undergoing CABG were assigned to either a test group utilizing
real-time CGM (Dexcom G6) and telemetry for glycaemic control, or a
control group with blinded CGM measures, relying on point-of-care
measures. The primary outcome was the percentage of time in range (TIR) of
blood glucose between 70 and 180 mg/dL (3.9-10.0 mmol/L), measured by CGM.
 Result(s): Among 91 subjects, 48 were in the test group and 43 were
in the control group. The least squares (LS) mean +/- standard error of
TIR was 60.3 +/- 2.7%, 50.3 +/- 2.9% in the test and control group,
respectively. The test group had significantly higher TIR when adjusted
with age, sex, body mass index, baseline fasting blood glucose and
baseline glycated haemoglobin (LS mean difference, 10.0%; 95% confidence
interval, 2.1-18.0; p = 0.014). The test group also had lower time above
range and mean glucose levels, with no differences in time below range or
hypoglycaemic events. Conclusion(s): In this RCT, real-time CGM and
telemonitoring improved glycaemic control during postoperative period
without increasing hypoglycaemia risk. Given the benefits of effective
glycaemic control on perioperative outcomes, CGM may be helpful in
managing T2D after CABG. Copyright © 2025 John Wiley & Sons Ltd.

<6>
Accession Number
2033578432
Title
Management of acute coronary syndrome in resource-limited set up: a
summary of 4-year review of two hospitals in Ethiopia.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1520899. Date of Publication: 2025.
Author
Kebede D.A.; Woyimo T.G.; Geleta M.N.; Chiri S.B.; Asefa E.T.; Tukeni K.N.
Institution
(Kebede) Division of Cardiology, Department of Internal Medicine, Haramaya
University, Harar, Ethiopia
(Woyimo, Asefa, Tukeni) Division of Cardiology, Department of Internal
Medicine, Jimma University, Jimma, Ethiopia
(Geleta) Division of Cardiology, Department of Internal Medicine, Ambo
University, Ambo, Ethiopia
(Chiri) Division of Cardiology, Department of Internal Medicine, St. Paul
Millennium Medical College, Addis Ababa, Ethiopia
Publisher
Frontiers Media SA
Abstract
Introduction: Acute coronary syndrome refers to a group of diseases
characterized by sudden, decreased blood supply to the heart muscle that
results in cell death, also known as acute myocardial infarction. This
results in severe chest pain or discomfort, with the subsequent release of
cardiac biomarkers, and alterations in the electrocardiogram. It can cause
diminished heart function and mortality if not treated properly with
suitable measures. Despite the fact that percutaneous coronary
intervention is the standard of care in one subset of acute coronary
syndrome, significant number of patients were treated medically due to the
limited service in the setting. The purpose of this study was to look at
the patterns of acute coronary syndrome (ACS), as well as the management
and outcomes of these patients in two Ethiopian tertiary institutions.
 Method(s): A four-year retrospective study was undertaken on 308
patients with acute coronary syndrome, at two tertiary hospitals located
in Ethiopia's capital-Addis Ababa. Results and Discussion: Of the 308
patients 72.4% were male, with the average age of 56.3 +/- 13.5 years.
Hypertension and diabetes were the two most common risk factors
identified. The average time to present to the emergency room after
symptom onset was 3.7 (SD +/- 3.2) days. The majority of patients (67.9%)
have been diagnosed with ST- Elevated Myocardial Infarction and were
classified as Killip class I. Percutaneous Coronary Intervention was
performed for 12.3% of patients, with the remaining receiving medical
care. The average hospital stay was 8.51 (SD +/- 7.2) days while
In-hospital mortality was 8.8%. Tachycardia of >140 (AOR = 7.50, 95% CI:
1.36, 41.57), any degree of left ventricular dysfunction, Killip class IV
(AOR = 6.03, 95% CI: 1.27, 28.61), and non-initiation of betablockers (AOR
= 0.17,95% CI: 0.05, 0.63) were significantly associated with increased
in-hospital mortality. Copyright 2025 Kebede, Woyimo, Geleta, Chiri,
Asefa and Tukeni.

<7>
Accession Number
2035883495
Title
Health and Economic Advantages Associated With the Use of TachoSil: An
Update of Systematic Review.
Source
Therapeutics and Clinical Risk Management. 21 (pp 257-271), 2025. Date of
Publication: 2025.
Author
Colombo G.L.; Droghetti A.; Di Matteo S.; Ottenjann H.; Bruno G.M.
Institution
(Colombo) Center of Pharmaceuticals Economics and Medical Technologies
Evaluation, Department of Drug Sciences, University of Pavia, Pavia, Italy
(Colombo, Di Matteo, Bruno) S.A.V.E. Studi Analisi Valutazioni Economiche
S.r.l, Health Economics & Outcomes Research, Milan, Italy
(Droghetti) Candiolo Cancer Institute, FPO-IRCCS, (TO), Candiolo, Italy
(Ottenjann) Medizin & Wort, Munich, Germany
(Bruno) Department of Drug Science, University of Pavia, Pavia, Italy
Publisher
Dove Medical Press Ltd
Abstract
Background: The international scientific literature is systematically
analyzed in this review over a period of nearly 10 years with respect to
the use of the active hemostat and surgical sealant patch TachoSil,
considering its economic effects. It`s an update of the first review
published in 2014. Method(s): A PubMed systematic literature review
was done from Nov 2013 up to December 2022. Based on the criteria used to
select, the papers were grouped in terms of study design, surgery type,
reduction in the time to hemostasis, shorter hospital stay, fewer number
of post-operative complications, and the impact of TachoSil to operative
procedures. Result(s): Medical evidence of TachoSil is well
documented, in different clinical studies and for several indications. In
this second review 18 scientific papers were screened. In total data from
3.375 patients were analyzed, of whom 1.748 were treated with TachoSil.
Nine of the 18 papers (50%) were classified as randomized clinical trials
(RCTs). The time required for hemostasis following the administration of
TachoSil was significantly shorter than that observed with other surgical
treatment techniques, with a median time of up to four minutes. The
reduction in post-operative complications was evaluated in 15 studies that
were conducted on patients in a variety of surgical specialties. When
using TachoSil the hospitalization duration was briefer, as observed in
the past review. Conclusion(s): The second analysis of scientific
papers demonstrates that TachoSil plays a supporting role in surgical
procedures, enhancing hemostasis and facilitating tissue sealing when
conventional techniques are inadequate.This approach has been linked to a
reduction in post-operative complications, length of hospital stay, and
consequently, hospital cost. Copyright © 2025 Colombo et al.

<8>
Accession Number
2033089172
Title
Intracardiac or transesophageal echocardiography for left atrial appendage
occlusion: an updated systematic review and meta-analysis.
Source
International Journal of Cardiovascular Imaging. 41(3) (pp 489-505), 2025.
Date of Publication: 01 Mar 2025.
Author
Beneki E.; Dimitriadis K.; Theofilis P.; Pyrpyris N.; Iliakis P.;
Kalompatsou A.; Kostakis P.; Koukos M.; Soulaidopoulos S.; Tzimas G.;
Tsioufis K.; Lancellotti P.; Aggeli C.
Institution
(Beneki, Dimitriadis, Theofilis, Pyrpyris, Iliakis, Kalompatsou, Kostakis,
Koukos, Soulaidopoulos, Tsioufis, Aggeli) First Cardiology Department,
School of Medicine, Hippokration General Hospital, National and
Kapodistrian University of Athens, Athens, Greece
(Beneki, Tzimas) Department of Cardiology, Lausanne University Hospital
and University of Lausanne, Lausanne, Switzerland
(Lancellotti) Department of Cardiology, University Hospital Center, Liege,
Belgium
Publisher
Springer Science and Business Media B.V.
Abstract
Background: Intracardiac echocardiography (ICE) appears to be a potential
alternative for percutaneous left atrial appendage occlusion (LAAO) to
transesophageal echocardiography (TEE). Thus, a meta-analysis was
performed comparing ICE vs. TEE for LAAO guidance. Method(s): A
comprehensive literature search was performed using MEDLINE, Scopus and
Web of Science electronic databases from their inception to November 2023.
 Result(s): 18 studies (124,230 patients) were included. Technical
success was higher in ICE- compared to TEE-guidance (OR: 1.36, 95% CI 1.14
to 1.63, p = 0.006) and fewer devices employed (SMD: -0.22, 95% CI -0.43
to -0.01, p = 0.04, I2 = 62%). ICE guidance related with more pericardial
effusion/tamponade and iatrogenic residual shunts (logRR: 0.62, 95% CI
0.36 to 0.89, p < 0.001 and RR: 1.53, 95% CI 1.12 to 2.09, p = 0.02, I2 =
1%, respectively). More vascular complications were noted in ICE group
(logRR: 0.45, 95% CI 0.11 to 0.78, p = 0.009). Conclusion(s):
ICE-guided imaging is an effective alternative to TEE in LAAO, as it shows
better efficacy than TEE, considering technical success. However, the
higher rates of adverse events should be carefully
considered. Copyright © The Author(s) 2025.

<9>
Accession Number
2035890135
Title
Effects of Glucagon-Like Peptide-1 Receptor Agonists, Sodium-Glucose
Cotransporter-2 Inhibitors, and Their Combination on Neurohumoral and
Mitochondrial Activation in Patients With Diabetes.
Source
Journal of the American Heart Association. 14(5) (no pagination), 2025.
Article Number: e039129. Date of Publication: 04 Mar 2025.
Author
Ikonomidis I.; Pavlidis G.; Pliouta L.; Katogiannis K.; Maratou E.; Thymis
J.; Michalopoulou E.; Prentza V.; Katsanaki E.; Vlachomitros D.; Kountouri
A.; Korakas E.; Andreadou I.; Kouretas D.; Parissis J.; Lambadiari V.
Institution
(Ikonomidis, Pavlidis, Katogiannis, Maratou, Thymis, Prentza, Katsanaki,
Vlachomitros, Parissis) 2nd Department of Cardiology, School of Medicine,
National and Kapodistrian University of Athens, Athens, Greece
(Pliouta, Kountouri, Korakas, Lambadiari) 2nd Propaedeutic Department of
Internal Medicine, Research Unit and Diabetes Center, School of Medicine,
National and Kapodistrian University of Athens, Athens, Greece
(Maratou) Laboratory of Clinical Biochemistry, School of Medicine,
University General Hospital "Attikon", National and Kapodistrian
University of Athens, Athens, Greece
(Andreadou) Laboratory of Pharmacology, Faculty of Pharmacy, National and
Kapodistrian University of Athens, Athens, Greece
(Kouretas) Department of Biochemistry and Biotechnology, University of
Thessaly, Larissa, Greece
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: We investigated the effects of the combined treatment with
glucagon like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose
cotransporter-2 inhibitors (SGLT-2i) on NT-proBNP (N-terminal pro-brain
natriuretic peptide), GDF-15 (growth differentiation factor 15), and
MOTS-c (mitochondrial-derived peptide-c) in patients with type 2 diabetes
(T2D) and high or very high cardiovascular risk. METHOD(S): We
studied 163 consecutive patients with type 2 diabetes who were treated
with insulin (n=40), liraglutide (n=41), empagliflozin (n=42), or their
combination (GLP-1RA+SGLT-2i) (n=40) and were matched using propensity
score analysis. We measured the following at baseline and 4 and 12 months
of treatment: (1) NT-proBNP, GDF-15, and MOTS-c; (2) 2,2'-azino-bi
s(3-ethylbenzothiazoline-6-sulfonic acid), and (3) left ventricular global
longitudinal strain, left atrial strain during atrial reservoir phase, and
global work index using speckle-tracking imaging. RESULT(S): At 12
months, GLP-1RA, SGLT-2i, and their combination showed a greater reduction
of NT-proBNP (-43.1% versus -54.2% versus -56.9% versus -14.7%) and GDF-15
than insulin. Only treatment with SGLT-2i and GLP-1RA+SGLT-2i improved
MOTS-c. GLP-1RA, SGLT-2i, or GLP-1RA+SGLT-2i provided an increase of
global longitudinal strain, left atrial strain, and global work index
compared with insulin. In all patients, the reduction of NT-proBNP was
associated with the improvement of global longitudinal strain, left atrial
strain during atrial reservoir phase, and global work index; the decrease
of GDF-15 with the increase of ABTS and MOTS-c; and the increase of MOTs-c
with improved global longitudinal strain and constructive myocardial work
at 12 months (P<0.05). CONCLUSION(S): Twelve-month treatment with
combination of GLP-1RA+SGLT-2i was associated with a greater reduction of
neurohumoral markers and increase of antioxidant ability than each
treatment alone and insulin. SGLT-2i appear more effective in the
improvement of neurohumoral and mitochondrial activation. REGISTRATION:
URL: https://www.clinicaltrials.gov; Unique identifier:
NCT03878706. Copyright © 2025 The Author(s).

<10>
Accession Number
2037315022
Title
Best evidence topic: Transcatheter aortic valve implantation in
asymptomatic aortic stenosis patients.
Source
Cirugia Cardiovascular. 32(2) (pp 110-116), 2025. Date of Publication: 01
Mar 2025.
Author
Martin Gutierrez E.; Maiorano P.; Castillo Pardo L.; Meana Fernandez B.;
Ramos Barragan B.; Gualis Cardona J.; Castano Ruiz M.; Martinez Comendador
J.M.; Garrido Jimenez J.M.
Institution
(Martin Gutierrez, Maiorano, Castillo Pardo, Meana Fernandez, Ramos
Barragan, Gualis Cardona, Castano Ruiz) Servicio de Cirugia Cardiaca,
Complejo Asistencial Universitario de Leon, Leon, Spain
(Martinez Comendador) Servicio de Cirugia Cardiaca, Complexo Hospitalario
Universitario de A Coruna (CHUAC), A Coruna, Spain
(Garrido Jimenez) Servicio de Cirugia Cardiaca, Hospital Universitario
Virgen de las Nieves, Granada, Spain
Publisher
Sociedad Espanola de Cirugia Cardiovascular y Endovascular (SECCE)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has become the
most frequent option for severe aortic stenosis treatment. Patients with
severe aortic stenosis may present an increased risk of mortality in the
asymptomatic phase. Furthermore, the progression of their heart disease
may have prognostic implications. It is proposed to carry out a
bibliographic review to assess the benefit of TAVI in this context.
 Method(s): A systematic search in Pubmed and Cochrane was conducted,
identifying comparative studies on surgery and/or TAVI versus conservative
management in asymptomatic patients. Thus, an algorithm of better
management of patients with severe aortic stenosis would be developed
according to the available evidence. Result(s): After the selection
of papers and elimination of duplicates, 34 studies were full-text
analyzed, among which we remark: 6 meta-analyses, 4 reviews, 14 original
articles and 4 ongoing clinical trials were identified. Early surgery was
unanimously superior to conservative management in terms of survival. In
the case of TAVI, two studies demonstrated a better prognosis for
asymptomatic patients compared to symptomatic patients when their valve
disease was corrected with TAVI, and a sub-analysis of the Evolut Low Risk
trial demonstrated superior survival results for TAVI compared to surgery
and conservative treatment. Conclusion(s): In the absence of a solid
evidence, TAVI can be considered a valid treatment alternative for
patients with asymptomatic aortic stenosis, although this indication
relies on indirect evidence. More research is needed in this
field. Copyright © 2024 Sociedad Espanola de Cirugia
Cardiovascular y Endovascular

<11>
Accession Number
644588009
Title
Ultra-short-period perioperative pulmonary rehabilitation on short-term
outcomes after surgery in smoking patients with lung cancer: a randomized
clinical trial.
Source
International journal of surgery (London, England). 111(1) (pp 581-588),
2025. Date of Publication: 01 Jan 2025.
Author
Han D.; Wang X.; Sun X.; Cao Y.; Li C.; Guo W.; Hu Y.; Hang J.; Li J.; Xie
Q.; Li H.
Institution
(Han, Wang, Cao, Li, Guo, Hu, Hang, Li) Department of Thoracic Surgery,
Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
(Sun, Xie) Department of Rehabilitation, Ruijin Hospital, Shanghai Jiao
Tong University School of Medicine
(Li) Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong
University School of Medicine, Shanghai, China
Abstract
BACKGROUND: Pulmonary rehabilitation (PR) is essential for airway
management after thoracic surgery. Most current PRs are composed of
2-4-week exercises, which require significant consumption of medical
resources and concerns about disease progression. MATERIALS AND METHODS:
This single-center, prospective, randomized controlled trial enrolled
smoking patients with pulmonary masses or nodules suitable for lobectomy,
aged 18-80, with a smoking history (>=20 pack-years). Eligible patients
were randomized in a 1:1 ratio into two groups. Patients in the
intervention group underwent perioperative breathing exercises based on
positive pressure vibration expectoration and 3-day preoperative lower
limb endurance training. Patients in the control group received routine
perioperative care. The primary outcome was in-hospital incidence of
postoperative pulmonary complications. Secondary outcomes included
postoperative hospital stay, total hospitalization cost, postoperative
drainage time, drainage volume, semiquantitative cough strength score,
pain score, Borg scale-assessed fatigue, and walking distance on
postoperative days 1 and 2. RESULT(S): A total of 194 patients were
included in the study, with 94 in the intervention group and 100 in the
control group. Our ultrashort PR program potentially reduced pulmonary
complications incidence (24.5 vs. 33.0%), but without statistical
significance ( P =0.190). No significant differences were found in other
perioperative outcomes, except for postoperative semiquantitative cough
strength score (3 [interquartile range, 3-3.75] vs. 3 [interquartile
range, 2-3], P <0.001) and change in walking distance from postoperative
days 1 to 2 (60 [interquartile range, 40-82.5] vs. 30 [interquartile
range, 10-60], P =0.003). CONCLUSION(S): There were no significant
differences in postoperative complications and other hospitalizations, but
our ultrashort rehabilitation program improved patients' semiquantitative
cough strength score and walking distance, indicating the potential for
better outcomes. This treatment is a safe and effective means of airway
management for thoracic surgery in the era of enhanced recovery
(ClinicalTrials.gov Identifier: NCT03010033). Copyright © 2024
The Author(s). Published by Wolters Kluwer Health, Inc.

<12>
Accession Number
2037753435
Title
Intrapleural Fibrinolytics Versus Thoracic Surgery for Complicated Pleural
Infections: A Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2025. Date of Publication:
2025.
Author
Rodrigues A.L.S.D.O.; Salomao I.F.A.; Scabello I.F.; Vieira C.M.;
Cavalcante D.V.S.; de Melo Neto G.J.; de Lima D.P.; de Carvalho R.L.C.
Institution
(Rodrigues, Scabello, de Lima, de Carvalho) University Center of Joao
Pessoa (UNIPE), Paraiba, Joao Pessoa, Brazil
(Salomao) Department of Anesthesiology, Hospital Regional Unimed Missoes,
Santo Angelo, Brazil
(Vieira) Federal University of Amazonas (UFAM), Amazonas, Manaus, Brazil
(Cavalcante) Federal University of Maranhao (UFMA), Sao Luis - Maranhao,
Brazil
(de Melo Neto) University Center Facid (UniFacid), Teresina, Brazil
(de Lima, de Carvalho) Department of Thoracic Surgery, Hospital
Metropolitano Dom Jose Maria Pires Joao Pessoa, Paraiba, Brazil
Publisher
Elsevier Ltd
Abstract
Background: Intrapleural fibrinolytic therapy (IPFT) is an option for
complicated pleural effusion (CPE). However, concerns remain about its use
compared with thoracic surgery (TS). Therefore, we conducted a systematic
review and meta-analysis to assess the length of stay associated with IPFT
compared to TS in treating CPE. Method(s): We searched PubMed,
Embase, and Cochrane Library databases for studies that compared TS with
IPFT in patients with complicated pleural infections. We used a
random-effects model with a 95% confidence interval (CI) to pool the data.
R version 4.4.1 was used for statistical analysis and heterogeneity was
examined using I2 statistics. Result(s): A total of 16
studies, including 13 randomised controlled trials, involving a total of
764 were analysed. Of whom, 40% underwent IPFT. The success rate was
higher in the TS group (odds ratio 0.3; 95% CI 0.11-0.78; p=0.014;
I2=47%), and had a significantly shorter length of stay (mean
difference 2.76; 95% CI 1.40-4.13; p<0.001; I2=92%) compared
with the IPFT group. There were no statistical differences between groups
in the mortality endpoint. Considering only the paediatric population,
there were also no statistically significant differences for length of
stay (mean difference 1.32; 95% CI -2.37 to 5.01; p=0.08;
I2=91%) or success rates (odds ratio 0.86; 95% CI 0.27-2.74;
p=0.74; I2=0%). Conclusion(s): Our findings suggest that
TS is an effective treatment for pleural infections. There is no
significant increase in adverse events, and both treatments are equally
effective and safe. Copyright © 2024 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ)

<13>
Accession Number
2037734157
Title
Training and Assessment of Nontechnical Skills in Cardiothoracic Surgery:
Current Literature Review.
Source
Journal of Surgical Education. 82(5) (no pagination), 2025. Article
Number: 103480. Date of Publication: 01 May 2025.
Author
Okoli C.C.; Nwanna-Nzewunwa O.C.; Buchanan S.
Institution
(Okoli) Division of General Surgery, Maine Medical Center, Portland,
Maine, United States
(Nwanna-Nzewunwa) Division of Cardiothoracic Surgery, UT Southwestern
Medical Center, Dallas, Texas, United States
(Buchanan) Division of Cardiac Surgery, Maine Medical Center, Portland,
Maine, United States
Publisher
Elsevier Inc.
Abstract
Background: This review explores the surgical and psychological literature
on cardiothoracic (CT) surgeons' intraoperative nontechnical skills (NTS).
Successful task performance depends on the seamless integration of
technical skills (TS) and NTS. This paper aims to identify the training
and assessment modalities for NTS in cardiothoracic surgery (CTS).
 Method(s): PubMed, Cochrane Library, BioMed Central, Medline, EDINA
BIOSIS, Web-of-Knowledge, PsychINFO, and ScienceDirect were searched
through to December 2023. Additionally, a manual search of the referenced
work of each included article and relevant reviews in PubMed were
performed to avoid missing any important data. Original research articles
were included if they described NTS training modalities and their
assessment in cardiac or thoracic surgeries. Exclusion criteria included
any study without full-text availability, non-peer-reviewed publications,
studies without extractable data, and duplicates. Retrieved articles were
screened, and data extracted in duplicate by 2 independent reviewers.
 Result(s): The literature search found 371 relevant references
related to cardiothoracic surgery, 17 articles were included in this
literature review, and 12 training tools were identified.
 Conclusion(s): This review demonstrates the need for additional work
to create reliable training and assessment methods for NTS in
CTS. Copyright © 2025 Association of Program Directors in Surgery

<14>
Accession Number
2032424843
Title
Safety of Anticoagulation When Undergoing Endoscopic Variceal Ligation: A
Systematic Review and Meta-Analysis.
Source
Liver International. 45(4) (no pagination), 2025. Article Number: e16188.
Date of Publication: 01 Apr 2025.
Author
Loo J.H.; Quek J.W.E.; Low J.T.G.; Tay W.X.; Ang L.S.; Montano-Loza A.J.;
G Abraldes J.; Wong Y.J.
Institution
(Loo, Low, Tay, Ang, Wong) Department of Gastroenterology & Hepatology,
Changi General Hospital, Singapore, Singapore
(Quek, Wong) Yong Loo Lin School of Medicine, National University of
Singapore, Singapore, Singapore
(Montano-Loza, G Abraldes, Wong) Liver Unit, Division of Gastroenterology,
University of Alberta, Edmonton, Canada
Publisher
John Wiley and Sons Inc
Abstract
Introduction: The safety of continuing anticoagulation therapy during
endoscopic variceal ligation (EVL) remains controversial. We performed a
systematic review and meta-analysis to evaluate the safety of
anticoagulation therapy in EVL. Method(s): We systematically searched
four electronic databases from their inception until 1 June 2024, for
studies that evaluated anticoagulation use and risk of rebleeding among
patients undergoing EVL. The primary endpoint was rebleeding after EVL.
The secondary endpoints were post-banding ulcer bleeding (PBUB) and
variceal eradication rate. The PROSPERO registration number is
CRD42024556094. Result(s): A total of 5617 participants from nine
studies (eight cohort studies and one randomised trial) were included. The
most common type of anticoagulation is low-molecular-weight heparin,
followed by warfarin and direct oral anticoagulants (DOAC). The pooled
risk of rebleeding was 10.9% (95%CI: 6.3-16.5; I2 = 65.5%).
Concurrent anticoagulation during EVL did not increase the risk of overall
rebleeding (OR, 1.10; 95%CI: 0.85-1.42, I2 = 0%), PBUB (OR,
1.04; 95%CI, 0.48-2.24; I2 = 24%) or severe bleeding (OR, 0.94;
95%CI, 0.31-2.85; I2 = 0%). Variceal eradication rates were
similar, regardless of the use of anticoagulation therapy during EVL.
 Conclusion(s): Anticoagulation did not increase the risk of
rebleeding in patients who underwent EVL. Since the certainty of evidence
is low, these findings should be confirmed in future randomised
trials. Copyright © 2024 The Author(s). Liver International
published by John Wiley & Sons Ltd.

<15>
Accession Number
2033535872
Title
Unraveling the impact of frailty on postoperative delirium in elderly
surgical patients: a systematic review and meta-analysis.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 114. Date
of Publication: 01 Dec 2025.
Author
Wu H.; Yan S.; Cao H.; Feng C.; Zhang H.
Institution
(Wu, Yan, Cao, Feng, Zhang) School of Clinical Medicine, Department of
Anesthesiology, Tsinghua University, Beijing Tsinghua Changgung Hospital,
No. 168 Litang Road, Changping District, Beijing, China
Publisher
BioMed Central Ltd
Abstract
Background: Frailty has been consistently implicated as a pivotal factor
in the onset of delirium following anesthesia and surgery. Nonetheless, a
comprehensive understanding of the relationship between frailty and
delirium remains to be elucidated. This study addresses that knowledge
gap. Method(s): A comprehensive search of literature databases
identified 43 relevant studies involving 14,441 participants. The studies
were subjected to a rigorous quality assessment using the Newcastle-Ottawa
Scale. Statistical analysis was conducted using Review Manager (v5.4.1),
including subgroup and sensitivity analyses. Result(s): Meta-analysis
revealed a significant association between preoperative physical frailty
and postoperative delirium (pooled odds ratio: 2.47; 95% confidence
interval: 2.04-2.99; I2 = 46.7%). The baseline frailty rate was
34.0% (4,910/14,441), while the overall incidence of postoperative
delirium was 20% (2,783/14,441). Subgroup analyses based on
characteristics such as race, frailty-assessment tools, and surgical types
were conducted to explore potential sources of heterogeneity. This
meta-analysis provided compelling evidence supporting a notable link
between preoperative physical frailty and an increased risk of
postoperative delirium in older surgical patients. Early identification
through frailty screening can enable targeted interventions, potentially
enhancing overall management and individualized treatment. Integrating
frailty assessment into preoperative evaluation may improve predictive
accuracy in surgical planning and anesthesia management.
 Conclusion(s): Future research could focus on optimizing the
integration of frailty assessment into preoperative protocols for timely
intervention and improved patient outcomes. Trial registration: The review
protocol was registered with PROSPERO (CRD42023390486), date of
registration: Aug 11, 2023. Copyright © The Author(s) 2025.

<16>
Accession Number
2033540631
Title
Application of family-centered care in cardiac surgery: a scoping review.
Source
European Journal of Medical Research. 30(1) (no pagination), 2025. Article
Number: 156. Date of Publication: 01 Dec 2025.
Author
Zhang D.; Zheng H.; Gan Y.; Chai X.; Zeng Y.; Yu X.; Cheng W.; Zhao Y.;
Chen Z.; Zhou Y.
Institution
(Zhang, Zeng, Yu, Zhao, Zhou) Department of Nursing, Tongji Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Hubei, Wuhan, China
(Zheng) Department of Neurosurgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Hubei, Wuhan,
China
(Gan) Department of Social Medicine and Health Management, School of
Public Health, Tongji Medical College, Huazhong University of Science and
Technology, Hubei, Wuhan, China
(Chai) Department of Traditional Chinese Medicine, Peking University Third
Hospital, Beijing, China
(Cheng) School of Nursing, Sun Yat-Sen University, Guangdong, Guangzhou,
China
(Chen) Department of Virology, Research Institute for Microbial Diseases,
Osaka University, Osaka, Suita, Japan
Publisher
BioMed Central Ltd
Abstract
Background: Family-centered care (FCC) has been widely implemented in
various medical settings, its application in cardiac surgery remains
underexplored. Given the complexity of cardiac surgery and the significant
impact on both patients and families, understanding FCC's role in this
context is essential to improving patient outcomes and family well-being.
 Objective(s): To identify the current state of the application of FCC
in the families of cardiac surgery. Method(s): This study followed
Arksey and O'Malley's methodology and the PRISMA extension for Scoping
Reviews. A systematic search was conducted across ten databases between
July and August 2024. Two researchers independently retrieved literature,
extracted data, and cross-checked findings following predefined inclusion
and exclusion criteria. The results were organized and synthesized using a
structured spreadsheet. Result(s): A total of 23 studies were
included, 95.65% of which were quantitative, spanning nine countries. FCC
interventions focused on collaboration, communication, negotiation, and
support, primarily delivered by healthcare professionals. The main
intervention formats were training sessions (100.00%), written materials
(71.43%), and visual media (42.86%). FCC was linked to improved
psychological well-being and greater satisfaction, with anxiety (52.38%)
being the most commonly assessed outcome using validated scales.
Qualitative findings highlighted the importance of FCC in patient
recovery, emphasizing the need for systematic support to alleviate
caregiving burden. Conclusion(s): This scoping review highlights the
core characteristics and interventions of FCC for cardiac surgery
patients, emphasizing the need for a multidisciplinary approach. While FCC
has shown benefits in improving emotional well-being and satisfaction,
there is a lack of robust longitudinal studies and objective outcome
measures. Future research should focus on interactive, personalized
interventions, integrate technology, and include a broader range of
outcome indicators to better assess FCC's clinical
effectiveness. Copyright © The Author(s) 2025.

<17>
Accession Number
2032112115
Title
Incidence of Infective Endocarditis Post-TPVR with MELODY Valve in
Pediatric Patients: A Systematic Review and Meta-Analysis.
Source
Current Cardiology Reviews. 21(1) (no pagination), 2025. Article Number:
E1573403X324878. Date of Publication: 2025.
Author
Veldurthy S.; Shrivastava D.; Majeed F.; Ayaz T.; Munir A.; Haider A.;
Mylavarapu M.
Institution
(Veldurthy) Department of Pediatrics, Mediciti Institute of Medical
Sciences, Telangana, India
(Shrivastava) Department of Anesthesia, University of Minnesota,
Minneapolis, United States
(Majeed) Department of Medicine, Pakistan Medical and Dental Council,
Islamabad, Pakistan
(Ayaz) Department of Medicine, Baqai Medical University, Karachi, Pakistan
(Munir) Department of Anesthesia, Mayo Hospital, Lahore, Pakistan
(Haider) Department of Allied Health Sciences, The University of Lahore,
Gujrat, Pakistan
(Mylavarapu) Department of Public Health, Adelphi University, NY, United
States
Publisher
Bentham Science Publishers
Abstract
Introduction: Infective Endocarditis (IE) has emerged to be one of the
most impactful adverse complications post-transcatheter procedures,
especially Transcatheter Pulmonary Valve Replacement (TPVR). We conducted
a systematic review and meta-analysis with the aim of identifying the
incidence of IE post-TPVR with the MELODY valve in the pediatric
population. Method(s): A comprehensive literature search was
performed across several prominent databases, including PubMed/MEDLINE,
SCOPUS, and Science Direct. Studies compared the clinical outcomes of
pediatric patients who received TPVR using the MELODY valve. Data
extraction was done for variables like the total pediatric patient
population that underwent TPVR with MELODY valve, mean age, the sex of the
patients, the incidence rate of IE following the procedure, and the
duration between the procedure and the occurrence of IE. Inverse Variance
was used to estimate the incidence of IE in patients who underwent TPVR
with respective 95% confidence interval (CI). Result(s): In total, 4
studies with 414 pediatric patients who underwent TPVR using the MELODY
valve were included in the study. The mean age of the study population was
12.7 +/- 3.11 years. The pooled incidence of IE following TPVR with MELODY
valve in the pediatric population was 17.70% (95% Cl 3.84-31.55;
p<0.00001). Additionally, the mean length of duration to develop IE
following TPVR with MELODY valve in the pediatric population was 2.18
years (95% Cl 0.35-4.01; p<0.00001). Conclusion(s): Our meta-analysis
reveals that IE post-TPVR with MELODY valve in pediatric patients is a
significant complication, clinically and statistically. Further research
needs to be done to understand the risk factors and develop better
management strategies. Copyright © 2025 Bentham Science
Publishers.

<18>
Accession Number
2037753474
Title
The left atrial appendage exclusion for prophylactic stroke reduction
(LEAAPS) trial: Rationale and design.
Source
American Heart Journal. 284 (pp 94-102), 2025. Date of Publication: 01 Jun
2025.
Author
Whitlock R.P.; McCarthy P.M.; Gerdisch M.W.; Ramlawi B.; Alexander J.H.;
Sultan I.; Rose D.Z.; Healey J.S.; Sharma Y.A.; Belley-Cote E.P.; Connolly
S.J.
Institution
(Whitlock) Department of Surgery, McMaster University, Hamilton, Ontario,
Canada
(Whitlock, Healey, Belley-Cote, Connolly) Population Health Research
Institute, Hamilton, Ontario, Canada
(McCarthy) Division of Cardiac Surgery, Department of Surgery, Bluhm
Cardiovascular Institute, Northwestern University Feinberg School of
Medicine and Northwestern Medicine, Chicago, IL, United States
(Gerdisch) Department of Cardiothoracic Surgery, Franciscan Health,
Indianapolis, IN, United States
(Ramlawi) Department of Cardiothoracic Surgery Research, Lankenau
Institute for Medical Research, Wynnewood, PA, United States
(Alexander) Duke Clinical Research Institute, Division of Cardiology, Duke
University, Durham, NC, United States
(Sultan) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center, 5200 Centre Ave, Ste 715, Pittsburgh, PA, United States
(Rose) Department of Neurology, University of South Florida Morsani
College of Medicine, Tampa, FL, United States
(Sharma) AtriCure, Inc, OH, United States
Publisher
Elsevier Inc.
Abstract
Introduction: Left atrial appendage exclusion (LAAE) has been shown in
randomized trials to reduce ischemic stroke risk in patients undergoing
cardiac surgery with known atrial fibrillation (AF). Many patients
undergoing cardiac surgery without pre-existing AF are at risk of stroke
and may benefit from LAAE. Method(s): Left Atrial Appendage Exclusion
for Prophylactic Stroke Reduction (LeAAPS) is an international,
prospective, randomized, multicenter, blinded trial evaluating the
effectiveness of LAAE in preventing ischemic stroke or systemic embolism
in patients undergoing cardiac surgery at increased risk of AF and
ischemic stroke. The trial will enroll 6500 patients at increased risk of
stroke in whom a cardiac surgery is planned at 250 sites worldwide.
Eligible patients are >=18 years old, have no pre-existing AF but are at
increased risk for AF and stroke (based on age,
CHA<inf>2</inf>DS<inf>2</inf>-VASc score, left atrium size or brain
natriuretic peptide). Patients are randomized 1:1 to receive either LAAE
with AtriClip or no LAAE during cardiac surgery. Healthcare providers
outside of the operating room and the patient will be blinded to
allocation. The primary effectiveness endpoint is the first occurrence of
ischemic stroke, systemic arterial embolism, or surgical or endovascular
LAA closure. The powered secondary effectiveness endpoint is ischemic
stroke or systemic arterial embolism. The primary safety endpoint is the
occurrence of one of the following events (through 30 days): pericardial
effusion requiring percutaneous or surgical treatment, peri-operative
major bleeding, deep sternal wound infection, or myocardial infarction.
Other endpoints include mortality, rehospitalizations, clinically
diagnosed AF, transient ischemic attack, and cognitive and quality of life
assessments. Follow-up is every 6 months for a minimum of 5 years; primary
analysis occurs when 469 patients have had an ischemic stroke or systemic
embolism. Conclusion(s): The results of the LeAAPS trial will
demonstrate whether LAAE with AtriClip at the time of other routine
cardiac surgery reduces stroke or systemic arterial embolism during
long-term follow-up in patients at high risk of stroke without
pre-existing AF. Trial Registration: ClinicalTrials.gov, Identifier:
NCT05478304,
https://clinicaltrials.gov/study/NCT05478304?term=%20NCT05478304&rank=1.Copyright © 2024

<19>
Accession Number
2037441058
Title
Six-month safety and efficacy outcomes from the randomized-controlled arm
of the WRAPSODY Arteriovenous Access Efficacy (WAVE) trial.
Source
Kidney International. 107(4) (pp 740-750), 2025. Date of Publication: 01
Apr 2025.
Author
Razavi M.K.; Balamuthusamy S.; Makris A.N.; Hoggard J.G.; Harduin L.O.;
Roy-Chaudhury P.; Jones R.G.
Institution
(Razavi) St. Joseph Heart and Vascular Center, Orange, CA, United States
(Balamuthusamy) Texas Research Institute, PPG Health, Fort Worth, TX,
United States
(Makris) Chicago Access Care, Westmont, IL, United States
(Hoggard) North Carolina Nephrology, Raleigh, NC, United States
(Harduin) University of Rio de Janeiro State, Rio de Janeiro, Rio de
Janeiro, Brazil
(Roy-Chaudhury) University of North Carolina Kidney Center, Chapel Hill,
NC, United States
(Roy-Chaudhury) W.G. (Bill) Hefner Salisbury Department of Veterans
Affairs Medical Center, Salisbury, NC, United States
(Jones) Department of Interventional Radiology, Queen Elizabeth Hospital
Birmingham, University Hospital, Birmingham, United Kingdom
Publisher
Elsevier B.V.
Abstract
Stenosis within the arteriovenous fistula (AVF) of hemodialysis patients
leads to vascular access dysfunction and inadequate hemodialysis.
Percutaneous transluminal angioplasty (PTA) is the standard therapy for
stenosis. However, rates of restenosis and loss of access patency remain
high. Outcomes of a novel cell-impermeable endoprosthesis (CIE) have not
been investigated in this setting. Therefore, our study was designed to
address this as a prospective, international, multicenter pivotal trial
(NCT04540302) with 245 patients with stenosis in their venous outflow
circuit randomized to treatment: 122 receiving CIE and 123 receiving PTA
across 43 international centers. Primary endpoints included target lesion
primary patency (TLPP) at six months (freedom from clinically driven
target lesion revascularization or target lesion thrombosis) and freedom
from safety events through 30 days post-index procedure that affected the
access circuit and resulted in reintervention, hospitalization, or death.
Access circuit primary patency (ACPP) was evaluated as a secondary
efficacy endpoint. Six-month TLPP and ACPP were significantly higher for
the CIE cohort versus PTA (TLPP: 89.6% vs. 62.3%; ACPP: 72.2% vs. 57.0%).
Thirty days post-index procedure, there was no statistically significant
difference in the freedom from safety events for the CIE versus PTA (96.6
vs. 95.0%). No differences were observed in adverse events between either
cohort. Our study shows that among patients with stenosis in their AVF,
the CIE was superior to PTA with respect to six-month TLPP and ACPP with
no observed difference in 30-day primary safety events. Copyright
© 2025 International Society of Nephrology

<20>
Accession Number
2036940956
Title
Current Status of Tricuspid Valve Interventions in Asia Pacific Region.
Source
JACC: Asia. 5(3P2) (pp 405-423), 2025. Date of Publication: 01 Mar 2025.
Author
So K.C.-Y.; Xu J.; Kam K.K.-H.; Sung S.-H.; Meemook K.; Wang D.D.; Tang
G.H.L.; Lee A.P.-W.; Lam Y.-Y.
Institution
(So, Kam, Lee) Department of Medicine and Therapeutics, Prince of Wales
Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
(Xu) Department of Cardiology, Tianjin First Central Hospital, Tianjin,
China
(Sung) Institute of Emergency and Critical Care Medicine, National Yang
Ming Chiao Tung University, Taipei, Taiwan (Republic of China)
(Meemook) Department of Medicine, Faculty of Medicine at Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand
(Wang) Wayne State University School of Medicine, Detroit, MI, United
States
(Tang) Department of Cardiovascular Surgery, Mount Sinai Health System,
New York, NY, United States
(Lee) Laboratory of Cardiac Imaging and 3D Printing, Li Ka Shing Institute
of Health Sciences, Shatin, New Territtories, Hong Kong SAR, China
(Lam) Central Medical, Hong Kong SAR, China
Publisher
Elsevier Inc.
Abstract
Transcatheter tricuspid interventions are becoming increasingly more
common in Asia Pacific. In the past decade, clinicians in Asia Pacific
have worked with a multitude of new transcatheter tricuspid technologies.
A standardized clinical algorithm to diagnose symptomatic tricuspid
regurgitation to increase patient access to novel right heart therapies
has not yet been identified. Anatomic diversity in the Asia Pacific
patient population; disease prevalence patterns; and socioeconomic,
cultural, and local health structures represent unique challenges in the
treatment of these patients with right heart failure. As advancements are
made in right heart failure and transcatheter tricuspid technologies,
hopefully more patients can be treated not just in Asia Pacific, but
across the entire world. Copyright © 2025 The Authors

<21>
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.

<22>
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.

<23>
Accession Number
2033519875
Title
Impact of single-port versus three-port video-assisted thoracic surgery
lobectomy on postoperative pain and quality of life in early-stage
non-small cell lung cancer patients: a meta-analysis.
Source
BMC Cancer. 25(1) (no pagination), 2025. Article Number: 400. Date of
Publication: 01 Dec 2025.
Author
Zhang L.; Luo J.; Wu X.
Institution
(Zhang, Luo) Department of Cardiothoracic Surgery, Mianyang Central
Hospital, Sichuan Province, Mianyang City, China
(Wu) Department of Obstetrics and Gynecology, Mianyang Central Hospital,
No. 12, Changjia Lane, Jinzhong Street, Fucheng District, Sichuan
Province, Mianyang City, China
Publisher
BioMed Central Ltd
Abstract
Objective: This meta-analysis aims to evaluate the impact of these two
techniques on postoperative pain and quality of life in early-stage NSCLC
patients. Method(s): A comprehensive literature search was conducted
in PubMed, Cochrane Library, Web of Science, and CNKI databases.
Randomized controlled trials and cohort studies comparing single-port and
three-port VATS lobectomy for early-stage NSCLC were included. The primary
outcomes were operating time, postoperative complications, and 24-hour
postoperative visual analog scale (VAS) pain scores. The Newcastle-Ottawa
Scale (NOS) was used to assess study quality. Meta-analysis was performed
using random-effects models, and heterogeneity was assessed using the I2
statistic. Result(s): Fifteen studies involving 3,228 patients (801
in the single-port group and 2427 in the three-port group) were included.
The meta-analysis revealed that single-port VATS lobectomy was associated
with a longer operating time (SMD: 0.61, 95% CI: 0.29 to 0.93, p < 0.001)
compared to the three-port approach. However, single-port VATS
demonstrated a lower incidence of postoperative complications (RR: 0.73,
95% CI: 0.59 to 0.90, p < 0.001). There was no significant difference in
24-hour postoperative VAS pain scores between the two groups (SMD: 0.02,
95% CI: -1.41 to 1.45, p > 0.05), although substantial heterogeneity was
observed (I2 = 98.1%). Conclusion(s): This meta-analysis suggests
that single-port VATS lobectomy may offer advantages in terms of reduced
postoperative complications compared to the three-port approach, despite
longer operating times. However, the impact on immediate postoperative
pain remains inconclusive due to high heterogeneity among
studies. Copyright © The Author(s) 2025.

<24>
Accession Number
2033535308
Title
Incidence of acute kidney injury-associated mortality in hospitalized
children: a systematic review and meta-analysis.
Source
BMC Nephrology. 26(1) (no pagination), 2025. Article Number: 117. Date of
Publication: 01 Dec 2025.
Author
Zarei H.; Azimi A.; Ansarian A.; Raad A.; Tabatabaei H.; Roshdi Dizaji S.;
Saadatipour N.; Dadras A.; Ataei N.; Hosseini M.; Yousefifard M.
Institution
(Zarei, Azimi, Ansarian, Raad, Tabatabaei, Roshdi Dizaji, Saadatipour,
Dadras, Yousefifard) Physiology Research Center, Iran University of
Medical Sciences, P.O Box: 14665-354, Hemmat Highway, Tehran, Iran,
Islamic Republic of
(Ataei) Pediatric Chronic Kidney Disease Research Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Hosseini) Department of Epidemiology and Biostatistics, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Hosseini) Department of Epidemiology and Biostatistics, School of Public
Health, Tehran University of Medical Sciences, Poursina Ave. Enqhelab St.,
Tehran, Iran, Islamic Republic of
Publisher
BioMed Central Ltd
Abstract
Background: Acute kidney injury (AKI) is a significant health concern in
hospitalized children and is associated with increased mortality. However,
the true burden of AKI-associated mortality in pediatric populations
remains unclear. Objective(s): To determine the pooled incidence of
mortality independently associated with AKI in hospitalized children
globally. Data sources: Medline and Embase were searched for studies
published by March 2024. Study eligibility criteria: The inclusion
criteria encompassed observational studies involving hospitalized
pediatric patients (< 18 years old) with AKI. Only studies that identified
AKI as an independent risk factor for increased mortality in multivariate
analysis were considered. Study appraisal and synthesis methods: Studies
with at least 100 AKI patients were included in the meta-analysis. Two
authors extracted data on the study and patients' characteristics and
mortality across AKI stages and assessed the risk of bias. We used a
random-effects meta-analysis to generate pooled estimates of mortality.
 Result(s): Analysis of 60 studies including 133,876 children with AKI
revealed a pooled in-hospital mortality rate of 18.27% (95% CI: 14.89,
21.65). Mortality increased with AKI severity; 8.19% in stage 1, 13.44% in
stage 2, and 27.78% in stage 3. Subgroup analyses showed no significant
differences across geographical regions, income levels, or AKI definition
criteria. The pooled post-discharge mortality rate was 6.84% (95% CI:
5.86, 7.82) in a 1-9-year follow-up period. Conclusion(s): This
meta-analysis demonstrates a substantial global burden of AKI-associated
mortality in hospitalized children, with higher mortality rates in more
severe AKI stages. These findings highlight the critical need for early
detection and intervention strategies in pediatric AKI management.
Clinical trial number: Not applicable. Copyright © The Author(s)
2025.

<25>
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

<26>
Accession Number
2037312291
Title
Intra-Arterial Tenecteplase Following Endovascular Reperfusion for Large
Vessel Occlusion Acute Ischemic Stroke: The POST-TNK Randomized Clinical
Trial.
Source
JAMA. 333(7) (pp 579-588), 2025. Date of Publication: 18 Feb 2025.
Author
Huang J.; Yang J.; Liu C.; Li L.; Yang D.; Guo C.; Zeng G.; Song J.; Ma
J.; Xu X.; Shi X.; Yang S.; Sun W.; Tang Y.; Jiang M.; Wang L.; Cheng X.;
Luo J.; Zhou P.; Fang X.; Cheng G.; Ruan Z.; Li J.; Liu J.; Lei B.; Tian
Y.; Tan X.; Yuan G.; Wang J.; Huang X.; Deng S.; Jin Z.; Zou X.; Zhang J.;
Cheng D.; Luo X.; Liao J.; Miao J.; Li Z.; Sun Y.; Jiang G.; Kong D.;
Jiang S.; Wang Z.; Wang D.; Kaesmacher J.; Nguyen T.N.; Nogueira R.G.;
Saver J.L.; Chen Y.; Zi W.; Li S.; Huang C.; Ni Y.; Duan Z.; Guo J.; Ni
H.; Zheng B.; Li F.; Yu N.Y.; Peng Z.; Kong W.; Liu X.; Fan S.; Yue C.;
Song M.; Gong C.; Huang L.
Institution
(Huang, Liu, Li, Song, Zhang, Jiang, Wang, Chen, Song, Gong, Huang)
Department of Neurology, The Second Affiliated Hospital of Chongqing
Medical University, Chongqing, China
(Huang, Yang, Liu, Li, Yang, Guo, Song, Ma, Xu, Shi, Yang, Sun, Wang, Zi,
Li, Yu, Peng, Liu, Fan, Yue) Department of Neurology, Xinqiao Hospital and
The Second Affiliated Hospital, Army Medical University (Third Military
Medical University), Chongqing, China
(Zeng) Department of Neurology, The Affiliated Ganzhou Hospital of
Nanchang University, Ganzhou, China
(Tang) Department of Neurology, Mianyang Central Hospital, Mianyang, China
(Jiang) Department of Neurology, The People's Hospital of QianNan, Buyi
and Miao Autonomous Prefecture of QianNan, China
(Wang) Department of Neurology, Zigong Third People's Hospital, Zigong,
China
(Cheng) Department of Neurology, The People's Hospital of Gulin County,
Luzhou, China
(Luo) Department of Cerebrovascular Diseases, Sichuan Mianyang 404
Hospital, Mianyang, China
(Zhou) Department of Neurology, Xiangyang No. 1 People's Hospital,
Xiangyang, China
(Fang) Department of Neurology, Beilun People's Hospital, Ningbo, China
(Cheng) Department of Cerebrovascular Diseases, Zhuhai People's Hospital
Medical Group, Zhuhai, China
(Ruan) Department of Neurology, The First Affiliated Hospital of
University of South China, Hengyang, China
(Li) Department of Neurology, The Affiliated Hospital of Southwest Medical
University, Luzhou, China
(Liu) Department of Neurology, Xiangyang Hospital of Traditional Chinese
Medicine, Xiangyang, China
(Lei) Department of Cerebrovascular Diseases, The People's Hospital of
Leshan, Leshan, China
(Tian) Department of Neurology, Qian Xi Nan People's Hospital, Xingyi,
China
(Tan) Department of Neurology, Meishan Second People's Hospital, Meishan,
China
(Yuan) Department of Emergency, Xiangtan Central Hospital, Xiangtan, China
(Wang) Department of Neurology, Yaan People's Hospital, Ya'an, China
(Huang) Department of Neurosurgery, The Affiliated Baiyun Hospital of
Guizhou Medical University, Guiyang, China
(Deng) Department of Neurology, Wusheng People's Hospital, Guangan, China
(Jin) Department of Neurology, Jiangmen Wuyi Hospital of Traditional
Chinese Medicine, Jiangmen, China
(Zou) Department of Neurology, The Third Hospital of Mianyang, Mianyang,
China
(Cheng) Department of Neurology, Xingyi People's Hospital, Xingyi, China
(Luo) Department of Cerebrovascular Diseases, Guangyuan Central Hospital,
Guangyuan, China
(Liao) Department of Neurology, Suining First People's Hospital, Suining,
China
(Miao) Department of Neurology, Xianyang Hospital of Yan'an University,
Xianyang, China
(Li) Department of Neurosurgery, Ningbo Medical Central Lihuili Hospital,
Ningbo, China
(Sun) Department of Neurology, Shanxi Provincial People's Hospital,
Taiyuan, China
(Jiang) Department of Neurology, Affiliated Hospital of North Sichuan
Medical College, Nanchong, China
(Kong) Department of Neurology, The Second Affiliated Hospital of Guangxi
Medical University, Nanning, China
(Wang) Global Health Trials Unit, Liverpool School of Tropical Medicine,
Liverpool, United Kingdom
(Kaesmacher) Department of Diagnostic and Interventional Neuroradiology,
Inselspital University Hospital Bern, University of Bern, Bern,
Switzerland
(Kaesmacher) Diagnostic and Interventional Neuroradiology, CIC-IT 1415,
CHRU de Tours, Tours, France
(Kaesmacher) Le Studium Loire Valley Institute for Advanced Studies,
Orleans, France
(Nguyen) Department of Neurology and Radiology, Boston Medical Center,
Boston University Chobanian and Avedisian School of Medicine, Boston, MA,
United States
(Nogueira) Department of Neurology and Neurosurgery, University of
Pittsburgh, UPMC Stroke Institute, Pittsburgh, PA, United States
(Saver) Department of Neurology, David Geffen School of Medicine, UCLA,
Los Angeles, CA, United States
(Saver) JAMA
(Li) Department of Neurology, Baise People's Hospital, Guangxi, Baise,
China
(Huang) Department of Neurology, Shantou Central Hospital, Guangdong,
Shantou, China
(Ni) Department of Neurology, Xi Chang People's Hospital, Sichuang,
Xichang, China
(Duan) Department of Neurology, Second Affiliated Hospital of Xuzhou
Medical University, Jiangsu, Xuzhou, China
(Guo) Department of Neurology, The Affiliated Ganzhou Hospital of Nanchang
University, Jiangxi, Ganzhou, China
(Ni) Department of Neurology, Beilun People's Hospital, Zhejiang, Ningbo,
China
(Zheng) Department of Neurology, Yaan People's Hospital, Sichuan, Yaan,
China
(Kong) Department of Neurosurgery, General Hospital of Southern Theatre
Command, Guangdong, Guangzhou, China
Publisher
American Medical Association
Abstract
Importance: The impact of adjunctive intra-arterial tenecteplase
administration following near-complete to complete reperfusion by
endovascular thrombectomy (EVT) for acute ischemic stroke is unknown.
 Objective(s): To assess the efficacy and adverse events of adjunctive
intra-arterial tenecteplase in patients with large vessel occlusion stroke
who had achieved near-complete to complete reperfusion (defined as a score
on the expanded Thrombolysis in Cerebral Infarction [eTICI] scale of 2c to
3) after EVT. Design, Setting, and Participant(s):
Investigator-initiated, randomized, open-label, blinded outcome assessment
trial implemented at 34 hospitals in China among 540 patients with stroke
due to proximal intracranial large vessel occlusion within 24 hours of the
time they were last known to be well, with an eTICI score of 2c to 3 after
EVT, and without prior intravenous thrombolysis. Recruitment took place
between October 26, 2022, and March 1, 2024, with final follow-up on June
3, 2024. Intervention(s): Eligible patients were randomly assigned to
receive intra-arterial tenecteplase (n = 269) at 0.0625 mg/kg or no
intra-arterial thrombolysis (control group; n = 271). Main Outcomes
and Measures: The primary efficacy outcome was freedom from disability,
defined as a score of 0 or 1 on the modified Rankin Scale (range, 0 [no
symptoms] to 6 [death]) at 90 days. The primary safety outcomes were death
at 90 days and symptomatic intracranial hemorrhage within 48 hours.
 Result(s): A total of 539 participants (99.8%) completed the trial
(median age, 69 years; 221 female [40.9%]). The proportion with a modified
Rankin Scale score of 0 or 1 at 90 days was 49.1% (132/269) in the
intra-arterial tenecteplase group and 44.1% (119/270) in the control group
(adjusted risk ratio, 1.15 [95% CI, 0.97-1.36]; P =.11). Ninety-day
mortality was 16.0% and 19.3% (adjusted hazard ratio, 0.75 [95% CI,
0.50-1.13]; P =.16), respectively. The proportions of symptomatic
intracranial hemorrhage were 6.3% and 4.4% (adjusted risk ratio, 1.43 [95%
CI, 0.68-2.99]; P =.35), respectively. Conclusions and Relevance: In
patients with acute ischemic stroke due to large vessel occlusion
presenting within 24 hours of time last known to be well and who had
achieved near-complete to complete reperfusion after EVT, adjunctive
intra-arterial tenecteplase did not significantly increase the likelihood
of freedom from disability at 90 days. Copyright © 2025 American
Medical Association. All rights reserved, including those for text and
data mining, AI training, and similar technologies.

<27>
Accession Number
2032147130
Title
Transcatheter versus surgical aortic valve replacement for severe aortic
valve stenosis: Meta-analysis with trial sequential analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 169(4) (pp 1214-1225.e5),
2025. Date of Publication: 01 Apr 2025.
Author
Jacquemyn X.; Sa M.P.; Rega F.; Verbrugghe P.; Meuris B.; Serna-Gallegos
D.; Brown J.A.; Clavel M.-A.; Pibarot P.; Sultan I.
Institution
(Jacquemyn, Rega, Verbrugghe, Meuris) Department of Cardiovascular
Sciences, KU Leuven, Leuven, Belgium
(Sa, Serna-Gallegos, Brown, Sultan) Department of Cardiothoracic Surgery,
University of Pittsburgh, Pittsburgh, PA, United States
(Sa, Serna-Gallegos, Brown, Sultan) UPMC Heart and Vascular Institute,
University of Pittsburgh Medical Center, Pittsburgh, PA, United States
(Rega, Verbrugghe, Meuris) Department of Cardiac Surgery, University
Hospitals Leuven, Leuven, Belgium
(Clavel, Pibarot) Centre de Recherche de l'Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec City, Quebec, Canada
(Clavel, Pibarot) Department of Medicine, Faculty of Medicine, Universite
Laval, Quebec City, Quebec, Canada
Publisher
Elsevier Inc.
Abstract
Objectives: Randomized controlled trials comparing transcatheter aortic
valve implantation with surgical aortic valve replacement demonstrate
conflicting evidence, particularly in low-risk patients. We aim to
reevaluate the evidence using trial sequential analysis, balancing type I
and II errors, and compare with conventional meta-analysis.
 Method(s): Databases were searched for randomized controlled trials,
which were divided into higher-risk and lower-risk randomized controlled
trials according to a pragmatic risk classification. Primary outcomes were
death and a composite end point of death or disabling stroke assessed at 1
year and maximum follow-up. Conventional meta-analysis and trial
sequential analysis were performed, and the required information size was
calculated considering a type I error of 5% and a power of 90%.
 Result(s): Eight randomized controlled trials (n = 5274 higher-risk
and 3661 lower-risk patients) were included. Higher-risk trials showed no
significant reduction in death at 1 year with transcatheter aortic valve
implantation (relative risk, 0.93, 95% CI, 0.81-1.08, P = .345).
Lower-risk trials suggested lower death risk on conventional meta-analysis
(relative risk, 0.67, 95% CI, 0.47-0.96, P = .031), but trial sequential
analysis indicated potential spurious evidence (P = .116), necessitating
more data for conclusive benefit (required information size = 5944
[59.8%]). For death or disabling stroke at 1 year, higher-risk trials
lacked evidence (relative risk, 0.90, 95% CI, 0.79-1.02, P = .108). In
lower-risk trials, transcatheter aortic valve implantation indicated lower
risk in conventional meta-analysis (relative risk, 0.68, 95% CI,
0.50-0.93, P = .014), but trial sequential analysis suggested potential
spurious evidence (P = .053), necessitating more data for conclusive
benefit (required information size = 5122 [69.4%]). Follow-up results
provided inconclusive evidence for both primary outcomes across risk
categories. Conclusion(s): Conventional meta-analysis methods may
have prematurely declared an early reduction of negative outcomes after
transcatheter aortic valve implantation when compared with surgical aortic
valve replacement. Copyright © 2024 The American Association for
Thoracic Surgery

<28>
Accession Number
2033511068
Title
Venous excess ultrasound score association with acute kidney injury in
critically ill patients: a systematic review and meta-analysis of
observational studies.
Source
Ultrasound Journal. 17(1) (no pagination), 2025. Article Number: 16. Date
of Publication: 01 Dec 2025.
Author
Melo R.H.; Gioli-Pereira L.; Melo E.; Rola P.
Institution
(Melo, Gioli-Pereira, Melo) Hospital Municipal Vila Santa Catarina
Dr.Gilson de Cassia Marques de Carvalho; Hospital Israelita Albert
Einstein, Av. Santa Catarina, 2785 - Vila Santa Catarina, SP, Sao Paulo,
Brazil
(Rola) University of Montreal, Montreal, Canada
Publisher
Springer-Verlag Italia s.r.l.
Abstract
Background: Systemic venous congestion assessed by the venous excess
ultrasound score (VExUS), has been associated with acute kidney injury
(AKI) in patients undergoing cardiac surgery. However, there is a lack of
evidence of this association in the general critically ill patients. Study
Design and Methods: PubMed, Embase, and Cochrane databases were searched
for observational prospective studies that included critically ill
patients and analyzed VExUS score on the first day of admission to the
ICU. The main outcome was occurrence of AKI. Secondary outcome was
all-cause mortality. Statistical analysis was performed using Review
Manager 5.4.1. Odds ratios (OR) with 95% confidence interval were pooled
using a random-effects model. The Quality in Prognosis Studies (QUIPS)
tool was used to assess risk of bias. Publication bias was assessed via
funnel plot and heterogeneity was examined with I2 statistics.
 Result(s): Our analysis included 1036 patients from nine studies, of
whom 17.4% presented venous congestion according to VExUS definition. In
critically ill patients presenting with venous congestion (VExUS score >=
2), the incidence of AKI was significantly higher as compared with those
without congestion (OR 2.63, 95% CI 1.06-6.54; p = 0.04; I2 =
74%). The association was notably stronger in cardiac surgery patients (OR
3.86, 95% CI 2.32-6.42; p < 0.00001; i2 = 0%). There was no
significant association between venous congestion and all-cause mortality
(OR 1.25, 95% CI 0.71-2.19; p = 0.44; i2 = 8%).
 Conclusion(s): These findings suggest that VExUS score may correlate
with an elevation in the incidence AKI in critically ill patients, with a
more pronounced effect observed within the subgroup of patients undergoing
cardiac surgery. There was no statistically significant association
between VExUS score and all-cause mortality. Clinical Trial Registration:
PROSPERO under protocol number CRD535513. Copyright © The
Author(s) 2025.

<29>
Accession Number
2037738077
Title
Clinical impact of CCT-FFR as first-strategy in patients with symptomatic
stable coronary artery disease: A systematic review and meta-analysis.
Source
Journal of Cardiovascular Computed Tomography. (no pagination), 2025.
Date of Publication: 2025.
Author
Di Pietro G.; Improta R.; De Filippo O.; Bruno F.; Birtolo L.I.; Bruno E.;
Galea N.; Francone M.; Dewey M.; D'Ascenzo F.; Mancone M.
Institution
(Di Pietro, Improta, Birtolo, Bruno, Mancone) Department of Clinical,
Internal, Anesthesiological and Cardiovascular Sciences, Umberto I
Hospital, La Sapienza University of Rome, Italy
(De Filippo, Bruno, D'Ascenzo) Division of Cardiology, Cardiovascular and
Thoracic Department, AOU Citta della Salute e della Scienza di Torino and
Department of Medical Sciences, University of Turin, Italy
(Galea) Department of Radiological, Oncological and Pathological Sciences,
Sapienza University of Rome, Viale Regina Elena 324, Rome, Italy
(Francone) IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano,
Milan, Italy
(Francone) Department of Biomedical Sciences, Humanitas University, Pieve
Emanuele, Milan, Italy
(Dewey) Department of Radiology, Charite - Universitatsmedizin Berlin,
corporate member of Freie Universitat Berlin and Humboldt-Universitat zu
Berlin, Berlin, Germany
Publisher
Elsevier Inc.
Abstract
Despite the promising results, the clinical implications of the CCT-FFR is
already debated. This metanalysis aimed to determine the potential
benefits of incorporating FFRCT into stable CAD management. After
searching for studies comparing outcomes of patients with suspected stable
CAD who underwent CCT-FFR as a first strategy versus non-urgent
cardiovascular testing after a clinical judgment, we calculated odds
ratios (ORs) and 95 % confidence intervals (CIs) using a random-effects or
fixed-effects meta-analysis model depending on heterogeneity significance.
5 studies (3 RCTs and 2 observational studies) globally encompassing 5282
patients (CCT-FFR = 2604 patients, Control Group = 2678 patients) were
included in the quantitative analysis. The rates of ICA overall (OR 1.57,
95%CI 1.36-1.81, p value < 0.001) and those without obstructive CAD (OR
6.63, 95%CI 4.79-9.16, p value < 0.001) were reduced in the CCTAFFR group,
as compared to the control group. Moreover, CCT-FFR patients underwent
coronary revascularization more frequently than patients in the control
arm (OR 0.48,CI 0.38-0.62, p value < 0.001). There was no significance
difference between the two strategies in terms of 1 year MACE (OR 1.11,CI
0.86-1.44, p value 0.42), nonfatal MI (OR 0.73, CI 0.41-1.33, p value
0.31), all-cause mortality (OR 1.29,CI 0.47-3.54, p value 0.63) and
unplanned revascularization for angina (OR 0.99, 95%CI 0.65-1.49, p value
0.95). In conclusion, in the management of stable CAD, the use of CCT-FFR
was associated with lower overall rates of ICA but higher rates of
coronary revascularization with comparable 1-year clinical
impact. Copyright © 2025 The Authors

<30>
Accession Number
2032639935
Title
Phone-based telemonitoring of arterial hypertension versus usual care: the
HOROSCOPE study.
Source
Hypertension Research. 48(3) (pp 1135-1143), 2025. Article Number: 11.
Date of Publication: 01 Mar 2025.
Author
Saafi M.; Bel Haj Ali K.; Dhaoui R.; Toumia M.; Sassi S.; Bendaya Y.;
Bouchoucha M.; Hafaeidh S.B.; Trabelsi I.; Sekma A.; Bakir A.; Jaballah
R.; Yaakoubi H.; Youssef R.; Zorgati A.; Beltaief K.; Mezgar Z.; Khrouf
M.; Sghaier A.; Jerbi N.; Razgallah R.; Bouida W.; Grissa M.H.; Saad J.;
Boubaker H.; Dridi Z.; Boukef R.; Msolli M.A.; Nouira S.; Ben Hafeidh S.;
Saadallah F.; Harzallah O.; Hassine F.; Said S.B.; Chebil M.; Gtari A.;
Khedher S.; Ghedira L.; Sahtout M.; Zayene S.; Hafsa M.; Belkacem N.
Institution
(Saafi, Bel Haj Ali, Dhaoui, Sassi, Trabelsi, Sekma, Beltaief, Bouida,
Grissa, Boubaker, Boukef, Msolli, Nouira) Research Laboratory LR12SP18,
Monastir University, Monastir, Tunisia
(Bel Haj Ali, Dhaoui, Sassi, Sekma, Beltaief, Bouida, Grissa, Boubaker,
Msolli, Nouira) Emergency Department, Fattouma Bourguiba University
Hospital, Monastir, Tunisia
(Toumia) Emergency Department, Haj Ali Soua Regional Hospital, Ksar
Hellal, Monastir, Tunisia
(Bendaya, Bouchoucha, Hafaeidh, Ben Hafeidh) Medis Laboratories, Tunis,
Tunisia
(Bakir, Jaballah, Yaakoubi, Youssef, Zorgati, Boukef) Emergency
Department, Sahloul University Hospital, Sousse, Tunisia
(Mezgar, Khrouf) Emergency Department, Farhat Hached University Hospital,
Sousse, Tunisia
(Sghaier, Jerbi) Emergency Department, Taher Sfar University Hospital,
Mahdia, Tunisia
(Razgallah) DACIMA Consulting, Tunis, Tunisia
(Saad) Department of imaging and interventional radiology, Fattouma
Bourguiba University Hospital, Monastir, Tunisia
(Dridi) Cardiology Department of Fattouma Bourguiba University Hospital,
Monastir, Tunisia
(Belkacem) Teboulba Regional Hospital, Monastir, Tunisia
(Hafsa) Liberal Physician, Ksar Hlel, Monastir, Tunisia
(Chebil, Zayene) Liberal Physician, Teboulba, Monastir, Tunisia
(Sahtout) C2 Primary Health Center, Monastir Health Group, Lamta,
Monastir, Tunisia
(Saadallah, Hassine, Said, Gtari, Ghedira) Liberal Physician, Monastir,
Tunisia
(Khedher) Primary Health Center, Jemmel, Monastir, Tunisia
(Harzallah) Liberal Physician, Lamta, Monastir, Tunisia
Publisher
Springer Nature
Abstract
The Horoscope trial aimed to assess the efficacy of home blood pressure
(BP) telemonitoring (TLM) in controlling BP reduction in hypertensive
patients compared with usual care. This is a multi-center, prospective
randomized, parallel-group trial comparing TLM with usual care during a
period of 6 months in patients with hypertension. We included 525 patients
randomly assigned in a 1-1 ratio to telemonitoring (TLM group; n = 260) or
usual care (control group; n = 265). After 6 months of follow up, mean
values of 24-h systolic and diastolic blood pressure decreased in both TLM
and control groups. The mean decrease was significantly greater in the TLM
group vs control group (-3.29 mmHg Vs -1.19; p = 0.009) and (-2.9 mmHg Vs,
-0.07; p = 0.002) for systolic and diastolic blood pressure, respectively.
This study shows that TLM results in significant BP reduction compared to
usual care in a Tunisian population of patients with hypertension. Our
findings highlight the importance of integrating telemedicine in the
management of hypertensive patients; it has the potential to improve the
quality of the delivered care and to prevent cardiovascular consequences
of uncontrolled BP. (Figure presented.) Copyright © The
Author(s), under exclusive licence to The Japanese Society of Hypertension
2024.

<31>
Accession Number
2032505171
Title
Thrombin generation after prothrombin complex concentrate or plasma
transfusion during cardiac surgery.
Source
Journal of Thrombosis and Thrombolysis. 58(2) (pp 309-318), 2025. Date of
Publication: 01 Feb 2025.
Author
Welsby I.J.; Schroeder D.R.; Ghadimi K.; Nuttall G.A.; Smith M.M.
Institution
(Welsby, Ghadimi) Department of Anesthesiology & Critical Care, Duke
University Medical Center, Erwin Road, Durham, NC, United States
(Schroeder) Department of Biomedical Statistics and Informatics, Mayo
Clinic College of Medicine and Science, Rochester, MN, United States
(Nuttall, Smith) Department of Anesthesiology and Perioperative Medicine,
Mayo Clinic College of Medicine and Science, Rochester, MN, United States
Publisher
Springer
Abstract
Thrombin generation (TG) is reduced after cardiac surgery using
cardiopulmonary bypass (CPB), contributing to coagulopathy and bleeding.
Plasma transfusion or four-factor prothrombin complex concentrate (PCC)
are commonly used to treat coagulopathic bleeding after CPB without
knowledge of how each may restore TG. To determine the effect of PCC
infusion on restoration of thrombin generation compared with plasma
transfusion, we performed a laboratory-based secondary analysis of a
randomized, controlled trial of adult patients undergoing cardiac surgery
to assess efficacy and safety of 4 F-PCC versus plasma for treatment of
perioperative coagulopathic bleeding after CPB. Participants were
randomized to receive either PCC (15 IU/kg) or plasma (10-15 ml/kg) after
separation from CPB. Participant blood samples were obtained at
pre-specified serial timepoints, with laboratory assays for TG and factor
levels subsequently performed. The primary outcome was change in thrombin
generation (TG) parameters after each randomized treatment through
postoperative day 5. Secondary outcomes included serially derived clotting
factor levels. Of 100 randomized participants, 99 were included in this
laboratory analysis (PCC group, N = 51; plasma group, N = 48). After
treatment, participants in the PCC group compared with those in the plasma
group showed higher endogenous thrombin potential (ETP, Median,
Interquartile range, IQR: 688 [371-1069] vs. 1088 [550-1691] nM minutes, P
= 0.01), a greater increase din ETP (P = 0.002) and peak TG (P = 0.01) in
the timepoints between heparin reversal and after treatment
administration. Both groups demonstrated similar values in all TG assays
by postoperative day 1 (P > 0.05). The PCC group also demonstrated higher
levels of proteins C, S, and Factors II, VII, IX and X, early after
treatment (P < 0.001 for all comparisons). Antithrombin levels were
initially higher in the plasma group after treatment (Median, IQR: 66%
[61-71%] vs. 56% [51-65%], P = 0.002) but differences did not persist
beyond postoperative day 3. In this laboratory analysis from a recent
randomized trial in adult cardiac surgery, PCC administration restored
thrombin generation more rapidly than plasma in the early postoperative
period without laboratory evidence of hypercoagulability.
ClinicalTrials.gov identifier: NCT02557672 [1]. Copyright © The
Author(s), under exclusive licence to Springer Science+Business Media,
LLC, part of Springer Nature 2024.

<32>
Accession Number
2033490625
Title
Non-fasting versus fasting before percutaneous cardiac procedures: a
systematic review and meta-analysis of randomized controlled trials.
Source
Perioperative Medicine. 14(1) (no pagination), 2025. Article Number: 24.
Date of Publication: 01 Dec 2025.
Author
Balbaa E.; Ibrahim A.A.; Bazzazeh M.; Tabassum S.; Ramadan S.; Gadelmawla
A.F.; Elshimy A.; Altobaishat O.; Abuelazm M.
Institution
(Balbaa, Bazzazeh, Elshimy) Faculty of Medicine, Alexandria University,
Alexandria, Egypt
(Ibrahim, Gadelmawla) Faculty of Medicine, Menoufia University, Menoufia,
Egypt
(Tabassum) Department of Medicine, King Edward Medical University, Lahore,
Pakistan
(Ramadan) Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Altobaishat) Faculty of Medicine, Jordan University of Science and
Technology, Irbid, Jordan
(Abuelazm) Faculty of Medicine, Tanta University, Tanta, Egypt
Publisher
BioMed Central Ltd
Abstract
Background and objective: Despite the absence of scientific evidence,
fasting before percutaneous cardiac catheterization is still recommended
to minimize complications. This systematic review and meta-analysis aimed
to compare the outcomes of non-fasting protocols in patients undergoing
percutaneous cardiac procedures. Material(s) and Method(s): A
systematic search of PubMed, Scopus, WOS, Embase, and Cochrane was
conducted until September 2024. Dichotomous outcomes were pooled using
risk ratio (RR), while continuous outcomes were pooled using standardized
mean difference (SMD). PROSPERO ID: CRD42024586147. Result(s): Five
RCTs with 2034 patients were included. There was no significant difference
between both groups regarding patient satisfaction score [SMD - 0.65, 95%
CI (- 1.39, 0.09), P = 0.08], intra/postoperative aspiration (RR 1.00, 95%
CI [0.20, 4.96], P = 1.00), postprocedural pneumonia (RR 0.60, 95% CI
[0.14, 2.51], P = 0.49), emergency endotracheal intubation (RR 0.99, 95%
CI [0.10, 9.51], P = 1.00), nausea/vomiting (RR 0.89, 95% CI [0.46, 1.76],
P = 0.75), anti-emetic use (RR 0.49, 95% CI [0.24, 1.03], P = 0.06),
hypoglycemia (RR 0.74, 95% CI [0.43, 1.28], P = 0.28), and the need for
inotrope/vasopressor therapy (RR 1.03, 95% CI [0.81, 1.30], P = 0.82).
However, the non-fasting approach significantly decreased the sensation of
tiredness/fatigue (SMD - 0.31 with 95% CI [- 0.51, - 0.11], P < 0.001).
 Conclusion(s): The non-fasting protocol demonstrated comparable
efficacy, safety, and overall satisfaction to the conventional fasting
approach. Review registration : PROSPERO CRD42024586147. Copyright
© The Author(s) 2025.

<33>
Accession Number
2033515017
Title
Echocardiographic Parameters of Right Ventricular Size and Function
Associated With Right Heart Failure After Durable Left Ventricular Assist
Device Implantation-A Systematic Review and Meta-Analysis.
Source
Echocardiography. 42(3) (no pagination), 2025. Article Number: e70119.
Date of Publication: 01 Mar 2025.
Author
Chai J.C.K.; Chew J.L.; Amarasekera A.; Soliman Aboumarie H.; Tan T.C.
Institution
(Chai, Chew, Tan) Department of Cardiology, Blacktown Hospital, Western
Sydney Local Health District, Blacktown, NSW, Australia
(Chai, Tan) School of Medicine, Western Sydney University, South Penrith,
Australia
(Amarasekera) Westmead Heart Rhythm Institute, Faculty of Medicine and
Health, University of Sydney, Sydney, Australia
(Amarasekera) Department of Cardiology, Westmead Hospital, Western Sydney
Local Health District, Westmead, NSW, Australia
(Soliman Aboumarie) Department of Anaesthetics, Critical Care and
Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and
Harefield Hospitals, London, United Kingdom
(Soliman Aboumarie) School of Cardiovascular and Metabolic Medicine and
Sciences, King's College London, London, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Background: Late-onset Right Ventricular (RV) failure is an established
complication of Durable Left-Ventricular Assist Device (D-LVAD)
implantation. Transthoracic echocardiography (TTE) remains the primary
imaging modality for serial monitoring in this population, but its
interpretation remains challenging due to device-related changes in RV
size and function and a lack of guidelines addressing this impact. This
study aims to examine the diagnostic and prognostic utility of TTE
parameters of RV size and function in the detection of late-onset RV
failure post-implantation. Methods and Results: A systematic
literature search of medical databases was performed to identify all
relevant studies assessing TTE parameters in adult patients with D-LVADs
(January 2003-August 2023; English only). Of the 350 studies identified,
nine studies with a pooled cohort of 627 patients and three studies with a
pooled cohort of 175 patients (40 Cases and 135 controls) were
meta-analyzed across a range of structural and functional TTE parameters.
Compared to World Alliance Societies of Echocardiography (WASE) reference
values, this population had dilated RV size (as quantified by RVEDD) and
reduced systolic function (as quantified by TAPSE, RVFAC, and RVEF). TAPSE
was positively associated with the non-RVF group, while RVEDD was
negatively associated with the non-RVF group. Conclusion(s): Based on
the available studies, there was baseline RV dilatation and reduced
systolic function in patients with D-LVADs. Additionally, TAPSE and RVEDD
demonstrated a statistically significant association with the development
of RVF post-implantation, indicating a potential role as prognostic
markers. Further studies should also be conducted to establish
post-implantation TTE reference values. Copyright © 2025 The
Author(s). Echocardiography published by Wiley Periodicals LLC.

<34>
Accession Number
2032362214
Title
Heart failure after left atrial appendage occlusion: Insights from the
LAAOS III randomized trial.
Source
European Journal of Heart Failure. 27(2) (pp 285-292), 2025. Date of
Publication: 01 Feb 2025.
Author
Krisai P.; Belley-Cote E.P.; McIntyre W.F.; Wong J.; Tsiplova K.; Brady
K.; Joseph P.; Johansson I.; Johnson L.; Xing L.Y.; Colli A.; McGuinness
S.; Punjabi P.; Reents W.; Rega F.; Budera P.; Royse A.G.; Paparella D.;
Connolly S.; Whitlock R.P.; Healey J.S.
Institution
(Krisai) Department of Cardiology and Cardiovascular Research Institute
Basel, University Hospital Basel, University of Basel, Basel, Switzerland
(Belley-Cote, McIntyre, Wong, Tsiplova, Brady, Joseph, Connolly, Whitlock,
Healey) McMaster University, Hamilton, ON, Canada
(Belley-Cote, McIntyre, Wong, Brady, Joseph, Connolly, Whitlock, Healey)
Hamilton Health Sciences, Hamilton, ON, Canada
(Belley-Cote, McIntyre, Wong, Brady, Joseph, Johansson, Johnson, Connolly,
Whitlock, Healey) Population Health Research Institute, Hamilton, ON,
Canada
(Johansson) Division of Cardiology, Department of Medicine K2, Karolinska
University Hospital Solna, Karolinska Institutet, Stockholm, Sweden
(Johnson) Department of Clinical Sciences Malmo, Lund University, Lund,
Sweden
(Xing) Department of Cardiology, Copenhagen University Hospital -
Rigshospitalet, Copenhagen, Denmark
(Colli) Department of Surgical, Medical and Molecular Pathology and
Critical Care, University of Pisa, Pisa, Italy
(McGuinness) Auckland City Hospital, Auckland, New Zealand
(Punjabi) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Reents) Rhon-Klinikum Campus Bad Neustadt, Bad Neustadt, Germany
(Rega) Department of Cardiac Surgery, University Hospitals Leuven, Leuven,
Belgium
(Budera) Institute for Clinical and Experimental Medicine, Prague, Czechia
(Royse) University of Melbourne and Royal Melbourne Hospital, Melbourne,
VIC, Australia
(Paparella) Department Medicine and Surgical Science, University of
Foggia, and Santa Maria Hospital, GVM Care & Research, Bari, Italy
Publisher
John Wiley and Sons Ltd
Abstract
Aims: The left atrial appendage (LAA) produces natriuretic peptides and
its removal or occlusion might increase the risk of heart failure (HF). We
aimed to investigate the incidence of HF after LAA occlusion or removal
(LAAO) in the Left Atrial Appendage Occlusion Study (LAAOS III).
 Methods and Results: Patients (n = 4811) with atrial fibrillation
(AF) and a CHA<inf>2</inf>DS<inf>2</inf>-VASc score >=2, who were having
cardiac surgery for another indication, were randomized to undergo
surgical LAAO or not. We compared the composite outcome of HF-related
hospitalizations and HF death between the two groups. HF assessment
required clinical and radiographic evidence of HF. Analyses included a
landmark analysis before and after 30 days and subgroups. Mean age was
71.2 years, 67.5% were male and 57.0% had prior HF. Over a mean follow-up
of 3.8 years, 396 (8.3%) patients met the composite HF outcome: 209 (8.8%)
with LAAO (n = 2379) and 187 (7.8%) without LAAO (n = 2391) (hazard ratio
[HR] 1.12, 95% confidence interval [CI] 0.92-1.37, p = 0.25). There was no
difference between the two groups in the first 30 days (1.6% vs. 1.1%; p =
0.12) and thereafter (7.6% vs. 7.1%; p = 0.57). Subgroups based on age,
sex, body mass index, AF type, prior HF, cardiac rhythm or left
ventricular ejection fraction showed consistent results. There was no
difference in HF outcomes with LAAO between the cut-and-sew (HR 0.93, 95%
CI 0.70-1.23, p = 0.62) versus other closure methods (HR 1.05, 95% CI
0.77-1.41, p = 0.77). Conclusion(s): Left atrial appendage occlusion
or removal at the time of cardiac surgery does not appear to alter the
risk of HF-related hospitalization or death. Clinical Trial Registration:
ClinicalTrials.gov NCT01561651. Copyright © 2024 The Author(s).
European Journal of Heart Failure published by John Wiley & Sons Ltd on
behalf of European Society of Cardiology.

<35>
Accession Number
2031832234
Title
What is known about near miss events in the operating room? A systematic
review of studies of mixed methods design.
Source
Irish Journal of Medical Science. 194(1) (pp 297-310), 2025. Date of
Publication: 01 Feb 2025.
Author
Kavanagh R.; Ward M.E.
Institution
(Kavanagh) Beaumont Hospital, Ireland & Royal College of Surgeons Ireland,
Dublin, Ireland
(Ward) Health Systems Research, St James's Hospital and Centre for
Innovative Human Systems, Trinity College, the University of Dublin,
Dublin, Ireland
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: A near miss event (NME) in healthcare is an event that did not
happen but would have caused serious harm if it did. The operating room
(OR) is prone to risk and incidents, with estimates that 50% of all
hospital adverse events occur in the OR, yet reporting of NME is uncommon
in the OR. Objective(s): To carry out a systematic review of studies
with mixed methods to establish what is known about NME reporting in the
OR. Method(s): Inclusion criteria will be those studies of mixed
methods design, which have been conducted in the OR, with teams of
surgeons, anaesthetists or nurses alone or in any combination. Using a
publication timeframe of 2001-2023, the following databases were searched:
Medline (OVID), CINAHL, Pubmed and Google Scholar. Selected papers for the
review were assessed using the Quality Assessment Tool for Studies of
Diverse Designs. Result(s): Fourteen papers were included in the
review. NMEs are common occurrences that are underreported in the OR. When
NMEs occur in multiples for the same patient, the risk of serious harm
increases. Feedback and education about NME helps to improve reporting;
ORs with high rates of NME reporting have less serious patient harm
events. Discussion(s): The implications of the findings for improving
healthcare safety are discussed and in particular the adoption of the
science of Human Factors Ergonomics into healthcare. Copyright ©
The Author(s), under exclusive licence to Royal Academy of Medicine in
Ireland 2024.

<36>
[Use Link to view the full text]
Accession Number
2037273694
Title
Economic Outcomes With Precision Diagnostic Testing Versus Usual Testing
in Stable Chest Pain: Results From the PRECISE Randomized Trial.
Source
Circulation: Cardiovascular Quality and Outcomes. 18(2) (pp e011008),
2025. Date of Publication: 01 Feb 2025.
Author
Chew D.S.; Mark D.B.; Li Y.; Nanna M.G.; Kelsey M.D.; Daniels M.R.;
Davidson-Ray L.; Baloch K.N.; Rogers C.; Patel M.R.; Anstrom K.J.; Curzen
N.; Vemulapalli S.; Douglas P.S.
Institution
(Chew) Libin Cardiovascular Institute and O'Brien Institute for Public
Health, University of Calgary, Calgary, Canada
(Mark, Li, Kelsey, Daniels, Davidson-Ray, Baloch, Patel, Vemulapalli,
Douglas) Duke Clinical Research Institute, Duke University, Durham, NC,
United States
(Mark, Kelsey, Daniels, Patel, Vemulapalli, Douglas) Division of
Cardiology, Duke University Medical Center, Durham, NC, United States
(Nanna) Section of Cardiovascular Medicine, Yale University School of
Medicine, New Haven, CT, United States
(Rogers) HeartFlow, Inc, Mountain View, CA, United States
(Anstrom) Gillings School of Global Public Health, University of North
Carolina, Chapel Hill, United States
(Curzen) Faculty of Medicine, Cardiothoracic Unit, University of
Southampton, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: The PRECISE (Prospective Randomized Trial of the Optimal
Evaluation of Cardiac Symptoms and Revascularization) demonstrated that a
precision diagnostic strategy reduced the primary composite of death,
nonfatal myocardial infarction, or catheterization without obstructive
coronary artery disease by 65% in patients with nonacute chest pain
compared with usual testing. Medical cost was a prespecified secondary end
point. METHOD(S): PRECISE randomized 2103 patients between December
2018 and May 2021 to usual testing or a precision strategy that used
deferred testing for the lowest risk patients (20%) and coronary computed
tomographic angiography with selective computed tomography-derived
fractional flow reserve for the remainder. Resource use consumption data
were collected from all study participants and hospital cost data from US
participants (n=1125) to estimate total medical costs. The primary and
secondary economic outcomes were total costs at 12 months and at 45 days,
respectively, from the US health care system perspective. The mean cost
differences between the 2 strategies were reported by intention-to-treat.
 RESULT(S): At 45 days, total costs were similar between the precision
strategy and usual testing (mean difference, $182 [95% CI, -$555 to
$661]). By 12 months, percutaneous coronary intervention and coronary
artery bypass surgery had been performed in 7.2% and 2.0% of precision
strategy patients and 3.5% and 1.7% of usual testing patients,
respectively. At 1 year, precision strategy costs were $5299 versus $4821
for usual testing (mean difference, $478 [95% CI, -$889 to $1437];
P=0.43). Precision care decreased mean per-patient diagnostic cost by 27%
and increased mean per-patient revascularization costs by 67%.
 CONCLUSION(S): In the PRECISE trial, the precision strategy, a
risk-based approach endorsed by current clinical practice guidelines,
improved the clinical efficiency of testing and had similar costs to usual
testing at 45 days and a nonsignificant $478 cost difference at 1
year. Copyright © 2025 The Authors.

<37>
Accession Number
646355648
Title
Effect of listening to music on anxiety, pain, and cardiorespiratory
parameters in cardiac surgery: A randomized clinical trial.
Source
Intensive & critical care nursing. 87 (pp 103939), 2025. Date of
Publication: 01 Apr 2025.
Author
de Andrade EV.; Haas V.J.; de Faria M.F.; Dos Santos Felix M.M.; Guimaraes
Raponi M.B.; Barichello E.; da Silva Pires P.; Gomez-Cantarino S.; Barbosa
M.H.
Institution
(de Andrade) Stricto sensu Graduate Program in Health Care, Federal
University of Triangulo Mineiro, 38025-440 Uberaba Minas Gerais Brazil.
(Haas, de Faria, Dos Santos Felix) Stricto sensu Graduate Program in
Health Care, Federal University of Triangulo Mineiro, 38025-440 Uberaba
Minas Gerais Brazil
(Guimaraes Raponi) Faculty of Medicine. College of Nursing. Federal
University of Uberlandia Av. Para, 2U, 38400-902 Uberlandia Minas Gerais
Brazil
(Barichello, Barbosa) Didactic-Scientific Department of Nursing in
Hospital Care, Institute of Health Sciences, Federal University of
Triangulo Mineiro, 38025-440 Uberaba Minas Gerais Brazil
(da Silva Pires) Multidisciplinary Health Institute, 45.029-094, Federal
University of Bahia. Rua Hormindo Barros, Quadra, Brazil
(Gomez-Cantarino) Faculty of Physiotherapy and Nursing. Castilla-La Mancha
University, Arms Factory Technological Campus. Avda. Carlos III s/n 45071
Toledo Castilla-La Mancha Spain
Abstract
PURPOSE: To evaluate the effect of listening to music on preoperative
anxiety, postoperative pain (at rest and during coughing), and
cardiorespiratory parameters in patients undergoing cardiac surgery.
DESIGN: Single-centered, randomized, parallel, superiority clinical trial.
 METHOD(S): This study was carried out with 50 adult patients
undergoing elective cardiac surgery randomly allocated at a 1:1 ratio to
one of the groups, experimental (n = 25) or control (n = 25). The
experimental group listened to music during the immediate preoperative
period and on the first postoperative day. The control group received
standard care. State-Trait Anxiety Inventory and Numeric Pain Rating Scale
were used to collect data. FINDINGS: The classical music significantly
reduced preoperative state anxiety scores (p < 0.001; dCohen = 2.1),
postoperative pain intensity at rest (p < 0.001; dCohen = 1.4) and during
coughing (p < 0.001; dCohen = 1.3). There was also a statistically
significant reduction in systolic (p = 0.001; dCohen = 0.9) and diastolic
blood pressure (p = 0.01; dCohen = 0.6), heart rate (p < 0.001; dCohen =
2.5), respiratory rate (p < 0.001; dCohen = 1.4), and a significant
increase in oxygen saturation (p < 0.001; dCohen = 1.2).
 CONCLUSION(S): Listening to music had a significant impact on the
evaluated outcomes, demonstrating its potential as a complementary
intervention to pharmacological treatment for patients undergoing cardiac
surgery. IMPLICATIONS FOR CLINICAL PRACTICE: The findings reinforce the
evidence that listening to music is a promising nursing intervention to be
used in the perioperative period of cardiac surgeries, with the potential
to promote well-being to patients and improve the quality of care
provided. Copyright © 2024 Elsevier Ltd. All rights reserved.

<38>
Accession Number
2037802871
Title
Seroprevalence and risk factors for Toxoplasma gondii infection in solid
organ transplant patients: A global systematic review and meta-analysis.
Source
Parasite Epidemiology and Control. 29 (no pagination), 2025. Article
Number: e00421. Date of Publication: 01 May 2025.
Author
Mamizadeh M.; Maleki F.; Mohammadi M.R.; Shamsi L.; Asghari A.; Pouryousef
A.
Institution
(Mamizadeh) Department of Dermatology, School of Medicine, Ilam University
of Medical Sciences, Ilam, Iran, Islamic Republic of
(Maleki) Zoonotic Diseases Research Center, Ilam University of Medical
Sciences, Ilam, Iran, Islamic Republic of
(Maleki) Clinical Research Development Unit, Shahid Mostafa Khomeini
Hospital, Ilam University of Medical Sciences, Ilam, Iran, Islamic
Republic of
(Mohammadi) Department of Bacteriology, Faculty of Medical Sciences,
Tarbiat Modares University, Tehran, Iran, Islamic Republic of
(Shamsi) Department of Pathobiology, Faculty of Veterinary Medicine, Urmia
University, Urmia, Iran, Islamic Republic of
(Asghari) Medical Microbiology Research Center, Qazvin University of
Medical Sciences, Qazvin, Iran, Islamic Republic of
(Pouryousef) Leishmaniasis Research Center, Sabzevar University of Medical
Sciences, Sabzevar, Iran, Islamic Republic of
Publisher
Elsevier Ltd
Abstract
This study aimed to assess the global seroprevalence of IgG and IgM
antibodies against Toxoplasma gondii (T. gondii) in solid organ transplant
(SOT) recipients (kidney, liver, heart) through a literature review of
studies published until October 24, 2024. Selected studies reported data
on anti-T. gondii IgG and IgM seroprevalence in the post-transplant stage
of SOT recipients. A random-effects model estimated pooled seroprevalence
rates, and heterogeneity was evaluated using the I2 statistic.
Sensitivity analysis examined prevalence changes after excluding studies,
while subgroup analysis of IgG seroprevalence accounted for publication
years, countries, continents, WHO regions, sample sizes, and types of
transplanted organs. Out of 26 articles and 29 datasets analyzed, 21
articles and 24 datasets involving 19,391 transplant recipients and 880
controls were used to assess anti-T. gondii IgG and IgM seroprevalence and
odds ratios (ORs). Additionally, 8 articles reported the anti-T. gondii
IgG serostatus of donors and recipients. The pooled IgG seropositivity for
T. gondii in SOT recipients was 9.8 % (95 % CI, 4.7-19.4 %), showing
significant variation by region and organ type. The anti-T. gondii IgM
seroprevalence in SOT recipients was 6.4 % (95 % CI, 3.3-12 %). Renal
transplant recipients exhibited higher IgG seroprevalence compared to
liver and heart transplant recipients. The pooled OR for T. gondii
infections in SOT recipients vs. controls was 1.39 (95 % CI, 0.95-2.04, P
= 0.08). The highest pooled anti-T. gondii IgG serostatus was 50.7 % in
the undetermined group, followed by 38 % in the D-/R- group, 15.4 % in the
D-/R+ group, 10.6 % in the D+/R- group, and 9.9 % in the D+/R+ group.
Overall, T. gondii active infections and its increased risk trend in SOT
recipients should not be overlooked. Copyright © 2025 The Authors

<39>
Accession Number
2032458521
Title
Effect of Kuanxiong Aerosol on Perioperative Coronary Microcirculation in
Patients with Unstable Angina Undergoing Elective PCI: A Pilot Randomized
Controlled Trial.
Source
Chinese Journal of Integrative Medicine. 31(3) (pp 206-214), 2025. Date of
Publication: 01 Mar 2025.
Author
Liu Z.-H.; Xing W.-L.; Liu H.-X.; Shang J.-J.; Li A.-Y.; Zhou Q.; Zhang
Z.-M.; Li Z.-B.; Chen K.-J.
Institution
(Liu, Xing, Liu, Shang, Li, Zhou, Zhang, Li) Cardiovascular Department,
Beijing Hospital of Traditional Chinese Medicine, Capital Medical
University, Beijing, China
(Chen) Xiyuan Hospital, China Academy of Chinese Medical Sciences,
Beijing, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objective: To evaluate the immediate effect of Kuanxiong Aerosol (KXA) on
perioperative coronary microcirculation in patients with unstable angina
(UA) suffering from elective percutaneous coronary intervention (PCI).
 Method(s): From February 2021 to July 2023, UA inpatients who
underwent PCI alone in the left anterior descending (LAD) branch were
included. Random numbers were generated to divide patients into the trial
group and the control group at a ratio of 1:1. The index of coronary
microcirculation resistance (IMR) was measured before PCI, and the trial
group was given two sprays of KXA, while the control group was not given.
IMR was measured again after PCI, cardiac troponin I (cTnI) and creatine
kinase isoenzyme-MB (CK-MB) were detected before and 24 h after surgery,
and major cardiovascular adverse events (MACEs) were recorded for 30 days.
The data statistics and analysis personnel were blinded. Result(s):
Totally 859 patients were screened, and 62 of them were involved into this
study. Finally, 1 patient in the trial group failed to complete the
post-PCI IMR and was excluded, 30 patients were included for data
analysis, while 31 patients in the control group were enrolled in data
analysis. There was no significant difference in baseline data (age,
gender, risk factors, previous history, biochemical index, and drug
therapy, etc.) between the two groups. In addition, differences in IMR,
cTnI and CK-MB were not statistically significant between the two groups
before surgery. After PCI, the IMR level of the trial group was
significantly lower than that of the control group (19.56 +/- 14.37 vs.
27.15 +/- 15.03, P=0.048). Besides, the incidence of perioperative
myocardial injury (PMI) was lower in the trial group, but the difference
was not statistically significant (6.67% vs. 16.13%, P=0.425). No MACEs
were reported in either group. Conclusion(s): KXA has the potential
of improving coronary microvascular dysfunction. This study provides
reference for the application of KXA in UA patients undergoing elective
PCI. (Registration No. ChiCTR2300069831) Copyright © The Chinese
Journal of Integrated Traditional and Western Medicine Press and
Springer-Verlag GmbH Germany, part of Springer Nature 2024.

<40>
Accession Number
2035192992
Title
Concomitant Carotid and Coronary Artery Disease Management: A Review of
the Literature.
Source
Annals of Vascular Surgery. 113 (pp 319-326), 2025. Date of Publication:
01 Apr 2025.
Author
Abou-Assi S.; Hanak C.R.; Khalifeh A.; Quatromoni J.G.; Caputo F.J.; Lyden
S.P.; Ambani R.N.
Institution
(Abou-Assi, Hanak, Khalifeh, Quatromoni, Caputo, Lyden, Ambani) Department
of Vascular Surgery, Cleveland Clinic Foundation, OH, United States
Publisher
Elsevier Inc.
Abstract
This review examines current evidence regarding management of patients
with both coronary and carotid artery disease. It highlights the elevated
stroke risk after surgery for this cohort and scrutinizes approaches to
minimize this risk. Various revascularization methods are outlined,
including carotid endarterectomy (CEA), carotid artery stenting (CAS), and
staged versus simultaneous surgical approaches. The importance of
judiciously screening coronary artery bypass grafting (CABG) candidates
for carotid stenosis is emphasized, suggesting risk factor-based targeted
screening is noninferior to indiscriminate screening. Efficacy comparisons
are made between revascularization strategies such as staged versus
synchronous CEA/CABG, CAS, and hybrid techniques. Controversies
surrounding necessity and optimal timing of carotid revascularization in
asymptomatic patients are addressed, indicating a need for rigorous
randomized controlled trials to establish definitive treatment
algorithms. Copyright © 2024 Elsevier Inc.

<41>
Accession Number
2035865498
Title
Preoperative liraglutide modulates control of fat and glucose metabolism
during cardiopulmonary bypass surgery.
Source
Endocrine Connections. 14(4) (no pagination), 2025. Article Number:
e240427. Date of Publication: 01 Apr 2025.
Author
van Wilpe R.; Hulst A.H.; Thiessen S.E.; Devries J.H.; Preckel B.;
Hermanides J.
Institution
(van Wilpe, Hulst, Preckel, Hermanides) Department of Anesthesiology,
Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam,
Netherlands
(Preckel, Hermanides) Amsterdam Public Health Research Institute,
Amsterdam UMC, Amsterdam, Netherlands
(Hulst) Amsterdam Cardiovascular Sciences Research Institute, Amsterdam
UMC, Amsterdam, Netherlands
(Thiessen) Critical Care Department, Ziekenhuis Oost-Limburg, Genk,
Belgium
(Devries) Department of Endocrinology, Amsterdam UMC, Location AMC,
University of Amsterdam, Amsterdam, Netherlands
(Hulst, Devries, Hermanides) Amsterdam Gastroenterology Endocrinology
Metabolism, Amsterdam UMC, Amsterdam, Netherlands
Publisher
BioScientifica Ltd.
Abstract
Introduction: Glucagon-like peptide-1 receptor agonists reduce insulin
requirements and improve glucose control when administered before cardiac
surgery. An increase in endogenous insulin release is the most likely
mechanism, but this has never been studied in the setting of cardiac
surgery. We hypothesized that liraglutide increases pancreatic insulin
secretion during cardiac surgery with cardiopulmonary bypass (CPB).
 Method(s): We performed a planned prospective substudy of a
multicenter randomized-controlled trial (GLOBE trial, NTR6323). Patients
undergoing cardiac surgery with CPB were randomized to receive either two
preoperative subcutaneous injections of liraglutide or a matching placebo.
We measured hormone concentrations before and after surgery, including
insulin, glucagon, C-peptide and free fatty acid (FFA), and calculated
HOMA-B, HOMA-IR and insulin/glucagon ratios. We compared between-group and
before and after surgery differences in outcomes. Result(s):
Metabolic hormone concentrations were measured in 37 participants. HOMA-B
revealed that liraglutide increased insulin secretion relative to glycemia
(258 +/- 179 vs 116 +/- 180, difference (95% CI): 142 (24-261), P =
0.004). While insulin, C-peptide and glucagon levels did not differ
significantly between groups, the insulin/glucagon ratios were
significantly higher in the liraglutide group (preoperatively: 1.09 +/-
0.45 vs 0.79 +/- 0.35 difference (95% CI):-0.30 (-0.57 to-0.03), P =
0.039). Overall, postoperative insulin levels decreased >60% from
preoperative insulin levels (55 +/- 31 to 21 +/- 9.8, difference (95%
CI):-29 (-36 to-22), P < 0.001). Conclusion(s): Preoperative
liraglutide administration increased beta-cell function, measured as
HOMA-B, and higher insulin/ glucagon ratios. These results could explain
the lower glucose and FFA concentrations in the liraglutide-treated
patients. Interestingly, in both groups, we observed a remarkable drop in
insulin and other hormone levels over the course of surgery. Copyright
© 2025 the author(s).

<42>
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.

<43>
[Use Link to view the full text]
Accession Number
2034916712
Title
International incidence of melanoma in heart transplant recipients: a
meta-analysis.
Source
Melanoma Research. 35(1) (pp 24-30), 2025. Date of Publication: 01 Feb
2025.
Author
Campillo P.; Kesler A.; Ramirez C.A.; Ramirez C.J.; Daher J.C.; Grimm M.;
Sabina M.; Bizanti A.
Institution
(Campillo, Kesler, Ramirez, Ramirez, Daher, Grimm, Sabina, Bizanti)
Department of Internal Medicine, Lakeland Regional Health Medical Center,
Lakeland, FL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
The incidence of heart transplants in the USA has increased by 85.8% since
2011, resulting in a growing population of recipients requiring long-term
immunosuppressive therapy. While essential for preventing organ rejection,
this therapy significantly increases melanoma risk. This meta-analysis
investigates the incidence and risk factors of melanoma in heart
transplant recipients. A systematic review and meta-analysis were
conducted following Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines, including observational studies reporting
melanoma incidence in heart transplant recipients. Relative risk (RR) was
synthesized from standardized incidence ratios, hazard ratios, incidence
rate ratios, and standardized mortality ratios. The meta-analysis
incorporated 10 studies, including 22 415 heart transplant recipients. The
pooled RR was 2.21 (95% confidence interval: 1.32-3.71; P = 0.003),
indicating a significantly elevated melanoma risk. This study highlights
the critical need for preventive dermatological strategies in heart
transplant recipients and calls for further research into the impact of
different immunosuppressive regimens on melanoma risk. Despite
limitations, these findings offer valuable insights for optimizing
long-term patient care. Copyright © 2024 The Author(s).

<44>
Accession Number
2037727374
Title
Early Postoperative Intravenous Iron Versus Oral Iron for the Treatment of
Anemia Following Cardiac Surgery: A Randomized Controlled Trial.
Source
Anesthesia and Analgesia. (no pagination), 2025. Article Number:
10.1213/ANE.0000000000007414. Date of Publication: 2025.
Author
Kremke M.; Nyboe C.; Jorgensen M.R.; Atladottir H.O.; Modrau I.S.
Institution
(Kremke, Nyboe, Jorgensen, Atladottir, Modrau) Department of
Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus,
Denmark
(Nyboe, Modrau) Department of Clinical Medicine, Aarhus University,
Aarhus, Denmark
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Postoperative anemia is a common complication after cardiac
surgery, often persisting for months and substantially affecting patient
recovery. Despite its prevalence, optimal treatment strategies are
lacking. We aimed to evaluate whether early postoperative intravenous (IV)
iron is more effective than daily oral iron in correcting anemia after
cardiac surgery. METHOD(S): This single-center, pragmatic randomized
controlled trial enrolled 110 cardiac surgery patients with moderate
postoperative anemia (hemoglobin 8-11 g/dL). Participants were randomized
1:1 to receive either a single infusion of 20 mg/kg ferric derisomaltose
on postoperative day 1 (IV iron group, n = 57) or 100 mg oral ferrous
sulfate twice daily for 4 weeks (oral iron group, n = 53). All outcomes
were assessed at 4 weeks postrandomization. The primary composite outcome
aimed to measure treatment success, defined as the proportion of
participants who were (a) no longer anemic (per World Health Organization
criteria) and (b) neither had received allogeneic red blood cell (RBC)
transfusions after randomization. Secondary end points included
differences in hemoglobin levels, RBC transfusion rates, iron metrics,
6-minute walk test distances, hospital length of stay, and
patient-reported outcomes. RESULT(S): Primary outcome data were
available for 53 participants in the IV iron group and 51 in the oral iron
group. The proportion of participants who achieved the primary end point
did not differ significantly between groups (28% vs 16%; risk difference
13%, 95% confidence interval [CI], -3% to 28%; P =.121). No statistically
significant differences were observed in anemia prevalence (66% vs 82%; P
=.058) or RBC transfusion rates (17% vs 33%; P =.054). Mean hemoglobin
levels (+/- standard deviation) were higher in the IV iron group (12.0 +/-
1.1 g/dL vs 11.4 +/- 1.3 g/dL; P =.013). None of the participants in the
IV iron group had ferritin levels <100 mug/L, compared to 26% in the oral
iron group (P <.001, accounting for 95% CI for 0 numerators). No
significant differences were observed in the 6-minute walk test, hospital
length of stay, or patient-reported outcomes. Notably, no serious adverse
events related to ferric derisomaltose were reported. CONCLUSION(S):
Early postoperative IV iron did not demonstrate superiority over oral iron
for the primary outcome. However, secondary end points suggest it may
improve hemoglobin levels and reduce the prevalence of postoperative iron
deficiency. These findings warrant further investigation in larger trials
to confirm the clinical effectiveness of early postoperative IV
iron. Copyright © 2025 International Anesthesia Research Society.

<45>
Accession Number
2033504263
Title
Randomized clinical trial in cancer patients shows immune metabolic
effects exerted by formulated bioactive phenolic diterpenes with potential
clinical benefits.
Source
Frontiers in Immunology. 16 (no pagination), 2025. Article Number:
1519978. Date of Publication: 2025.
Author
Gomez de Cedron M.; Moreno-Rubio J.; de la O Pascual V.; Alvarez B.;
Villarino M.; Sereno M.; Gomez-Raposo C.; Roa S.; Lopez Gomez M.;
Merino-Salvador M.; Jimenez-Gordo A.; Falagan S.; Aguayo C.; Zambrana F.;
Tabares B.; Garrido B.; Cruz-Gil S.; Fernandez Diaz C.M.; Fernandez L.P.;
Molina S.; Crespo M.C.; Ouahid Y.; Montoya J.J.; Ramos Ruiz R.; Reglero
G.; Ramirez de Molina A.; Casado E.
Institution
(Gomez de Cedron, Cruz-Gil, Fernandez Diaz, Fernandez, Molina, Crespo,
Ramos Ruiz, Ramirez de Molina) Molecular Oncology Group, IMDEA Food, CEI
UAM+CSIC, Madrid, Spain
(Moreno-Rubio, Villarino, Sereno, Gomez-Raposo, Roa, Lopez Gomez,
Merino-Salvador, Jimenez-Gordo, Falagan, Aguayo, Zambrana, Tabares,
Garrido, Casado) Medical Oncology Department, Infanta Sofia University
Hospital-Henares University Hospital, Foundation for Biomedical Research
and Innovation (FIIB HUIS HHEN), Madrid, Spain
(Moreno-Rubio, Sereno, Gomez-Raposo, Jimenez-Gordo, Casado) Clinical
Oncology Group, IMDEA Food, CEI UAM+CSIC, Madrid, Spain
(de la O Pascual) Precision Nutrition and Cardiometabolic Health, IMDEA
Food, CEI UAM+CSIC, Madrid, Spain
(de la O Pascual) Faculty of Health Sciences, International University of
La Rioja (UNIR), Logrono, Spain
(Alvarez) Centro Nacional de Investigaciones Cardiovasculares CarlosIII,
CNIC Carlos III), Madrid, Spain
(Ouahid, Montoya) MiRNAX Biosens Research & Development Unit (MBR&DU),
Madrid, Spain
(Montoya) Faculty of Medicine, School of Sport Medicine, Universidad
Complutense de Madrid, Madrid, Spain
(Reglero) Institute of Food Science Research CIAL CSIC-UAM, Madrid, Spain
(Reglero) Production and Development of Foods for Health, IMDEA Food, CEI
UAM+CSIC, Madrid, Spain
Publisher
Frontiers Media SA
Abstract
Background: Nutrients, including bioactive natural compounds, have been
demonstrated to affect key metabolic processes implicated in tumor growth
and progression, both in preclinical and clinical trials. Although the
application of precision nutrition as a complementary approach to improve
cancer treatments is still incipient in clinical practice, the development
of powerful "omics" techniques has opened new possibilities for delivering
nutritional advice to cancer patients. Precision nutrition may contribute
to improving the plasticity and function of antitumor immune responses.
 Objective(s): Herein, we present the results of a randomized,
prospective, longitudinal, double-blind, and parallel clinical trial
(NCT05080920) in cancer patients to explore the immune-metabolic effects
of a bioactive formula based on diterpenic phenols from rosemary,
formulated with bioactive alkylglycerols (Lipchronic©
WO/2017/187000). The trial involved cancer patients, including those with
lung cancer (LC), colorectal cancer (CRC), and breast cancer (BC),
undergoing chemotherapy, targeted biological therapy, and/or
immunotherapy. The main readouts of the study were the analysis of Lip on
systemic inflammation, hemogram profile, anthropometry, lipid and glucose
profiles, and tolerability. Additionally, a deep immune phenotyping of
peripheral blood mononuclear cells (PBMCs) was performed to identify the
functional effects of Lip on key mediators of the immune system.
 Result(s): Lip was well tolerated. The lung cancer subgroup of
patients showed a reduction in biomarkers of systemic inflammation,
including the neutrophil-to-lymphocyte ratio (NLR). Furthermore,
modulation of key players in the immune system associated with the
experimental treatment Lip compared to the control placebo (Pla) treatment
was revealed, with particularities among the distinct subgroups of
patients. Our results encourage further research to apply molecular
nutrition-based strategies as a complementary tool in the clinical
management of cancer patients, particularly in the current era of novel
immunotherapies. Clinical trial registration: ClinicalTrials.gov,
identifier NCT05080920 Copyright © 2025 Gomez de Cedron,
Moreno-Rubio, de la O Pascual, Alvarez, Villarino, Sereno, Gomez-Raposo,
Roa, Lopez Gomez, Merino-Salvador, Jimenez-Gordo, Falagan, Aguayo,
Zambrana, Tabares, Garrido, Cruz-Gil, Fernandez Diaz, Fernandez, Molina,
Crespo, Ouahid, Montoya, Ramos Ruiz, Reglero, Ramirez de Molina and
Casado.

<46>
Accession Number
2033525650
Title
Precision medicine in the management of valvular heart disease.
Source
Herz. (no pagination), 2025. Date of Publication: 2025.
Author
Nettersheim F.S.; Baldus S.
Institution
(Nettersheim, Baldus) Klinik III fur Innere Medizin, Medizinische Fakultat
und Uniklinik Koln, Universitat zu Koln, Kerpener Str. 62, Koln, Germany
Publisher
Springer Medizin
Abstract
The management of valvular heart disease has undergone a remarkable
transformation over the past two decades, which was driven by the advent
of catheter-based treatment methods. Whereas medical therapy was the only
available treatment option for many older patients deemed unsuitable for
conventional surgery until the early 2000s, a wide range of interventional
therapies is now available. Transcatheter aortic valve replacement and
mitral valve transcatheter edge-to-edge repair evidently provide
prognostic advantages over medical therapy for inoperable patients with
severe aortic stenosis and secondary mitral regurgitation, and they have
been demonstrated to be non-inferior to conventional surgery in certain
operable patient groups. Although catheter-based therapies of aortic and
tricuspid regurgitation have not yet been proven to provide prognostic
benefits, these approaches enable substantial and sustainable improvements
in symptoms as well as quality of life while demonstrating a favorable
safety profile. Given the multitude of available options for the treatment
of valvular heart diseases, determining the appropriate indication and
selecting the optimal therapeutic approach often pose significant
challenges. This review article highlights the latest advancements in
valvular heart disease management and explores the patient-centered
application of available therapies within the framework of an approach
toward precision medicine. Copyright © The Author(s), under
exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer
Nature 2025.

<47>
Accession Number
2033511294
Title
RETRACTION: Effects of Quality Nursing on the Surgical Site Wound
Infections in Patients Undergoing Cardiothoracic Surgery: A
Meta-Analysis(International Wound Journal, (2024), 21, 1, (e14553),
10.1111/iwj.14553).
Source
International Wound Journal. 22(3) (no pagination), 2025. Article Number:
e70284. Date of Publication: 01 Mar 2025.
Author
Lv X.; Zhou A.; Chen M.; Qi C.; Zhang Q.
Publisher
John Wiley and Sons Inc
Abstract
RETRACTION: X. Lv, A. Zhou, M. Chen, C. Qi, and Q. Zhang, "Effects of
Quality Nursing on the Surgical Site Wound Infections in Patients
Undergoing Cardiothoracic Surgery: A Meta-Analysis," International Wound
Journal 21, no. 1 (2024): e14553, https://doi.org/10.1111/iwj.14553. The
above article, published online on 15 January 2024, 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.

<48>
Accession Number
646766242
Title
Early Aortic Valve Replacement in Asymptomatic Severe Aortic Stenosis: A
Meta-Analysis of Randomized Controlled Trials.
Source
The American journal of cardiology. (no pagination), 2025. Date of
Publication: 05 Mar 2025.
Author
Brar S.K.; Leong D.W.; Razi R.R.; Moore N.; Zadegan R.; Mansukhani P.;
Brar S.S.
Institution
(Brar, Leong, Moore, Zadegan, Mansukhani) Regional Department of Cardiac
Catheterization, Kaiser Permanente, Los Angeles, Mexico
(Razi) Kaiser Permanente School of Medicine, Pasadena, CA, United States
(Brar) Regional Department of Cardiac Catheterization, Kaiser Permanente,
Los Angeles; Kaiser Permanente School of Medicine, Pasadena, CA
Abstract
Determining the best time for aortic valve replacement (AVR) in
asymptomatic severe aortic stenosis (AS) with preserved left ventricular
function remains controversial, as current guidelines recommend waiting
until symptoms appear. Recent evidence suggests that early AVR may improve
outcomes for select patients. This meta-analysis of randomized controlled
trials evaluated the efficacy of early AVR, including surgical and
transcatheter approaches, versus conservative management in asymptomatic
severe AS. We systematically searched PubMed, Embase, CENTRAL, and
ClinicalTrials.gov to identify eligible trials. The outcomes of interest
included all-cause mortality, unplanned hospitalization, stroke, as well
as the composite endpoint of each trial, which was derived from
combinations of these outcomes. Four trials involving 1,427 patients were
included. Early AVR significantly reduced the risk of unplanned
hospitalizations (HR 0.42, 95% CI 0.33-0.53, p < 0.001, I2 = 0%). Although
there was a trend towards reduced all-cause mortality, it did not reach
statistical significance (HR 0.76, 95% CI 0.48-1.21, I2 = 42%). Stroke
also trended lower with early AVR (HR 0.63, 95% CI 0.40-1.00, p = 0.05, I2
= 0%). In conclusion, these findings indicate that early AVR may provide
clinical benefits by reducing adverse events in asymptomatic severe AS, in
particular unplanned rehospitalization, suggesting that early AVR could be
beneficial and should be considered in future guideline
revisions. Copyright © 2025. Published by Elsevier Inc.

<49>
Accession Number
646764351
Title
Evaluation of efficacy and safety of perioperative albumin administration
in major non-cardiac surgery: a systematic review and meta-analysis of
randomized controlled trials.
Source
Minerva surgery. 80(1) (pp 76-85), 2025. Date of Publication: 01 Feb 2025.
Author
Boukhlik M.A.; Daghmouri M.A.; Chaouch M.A.; Depret F.; Deniau B.
Institution
(Boukhlik, Depret, Deniau) Department of Anesthesiology, Critical Care and
Burn Unit, University Hospital Saint-Louis-Lariboisiere, AP-HP, Paris,
France
(Daghmouri) Department of Anesthesiology, re Gregoire Hospital, Montreuil,
France
(Daghmouri, Depret, Deniau) Cardiovascular Markers in Stress Condition
(MASCOT), Universite de Paris Cite, INSERM UMR-S 942, Paris, France
(Chaouch) Department of Visceral Surgery, University Hospital of Fattouma
Bourguiba, Monastir, Tunisia
(Depret, Deniau) Universite de Paris Cite, Paris, France
Abstract
INTRODUCTION: Studies suggested that restrictive fluid therapy during
major surgery could be associated with better post-operative outcomes. The
albumin uses in the perioperative period has been the subject of numerous
studies with a still controversial efficacy and safety profile. This study
aimed to assess the efficacy and safety of perioperative albumin use
during major non-cardiac surgery. EVIDENCE ACQUISITION: This study was
registered in PROSPERO (ID: CRD42022353278). We performed an electronic
search of the relevant literature from 2000 until 2023. The primary
endpoint was the incidence of moderate postoperative complications
(defined by a Clavien-Dindo classification grade >=2). Secondary endpoints
were intraoperative fluid balance, intraoperative blood loss,
postoperative wound infection and acute kidney injury (AKI). EVIDENCE
SYNTHESIS: We identified four relevant studies involving 426 patients (213
patients in the albumin group versus 213 patients in the control group).
The meta-analysis did not reveal any significant difference between both
group regarding the incidence of postoperative moderate complications even
after subgroup analyses based on intraoperative or postoperative albumin
administration (OR=1.23, 95% CI 0.73, 2.08, P=0.44). No difference was
found for intraoperative fluid balance (MD=-190.83, 95% CI -408.67, 27.02,
P=0.09), intraoperative blood loss (MD=-27.54, 95% CI -225.55, 170.48,
P=0.79) and postoperative wound infection (OR=1.91, 95% CI 0.98, 3.73,
P=0.06). Moreover, albumin administration was not associated with a
significant increase of AKI incidence (OR=2.02, 95% CI 0.90, 4.53,
P=0.09). CONCLUSION(S): Perioperative use of albumin during major
non-cardiac surgery did not result in an increased incidence of moderate
postoperative complications.

<50>
Accession Number
2037868956
Title
Routine anaesthesia ward-based patient visits in surgery: 1-year outcomes
of the TRACE randomized clinical trial.
Source
British Journal of Surgery. 112(3) (no pagination), 2025. Article Number:
znaf019. Date of Publication: 01 Mar 2025.
Author
Smit-Fun V.M.; De Korte-De Boer D.; Damen T.; Stolze A.; Posthuma L.M.;
Hollmann M.W.; Buhre W.F.F.A.; Boer C.; van Kuijk S.; Noordzij P.G.; Rinia
M.; Hering J.P.; In't Veld B.; Scheffer G.J.; Breel J.S.; Bouw T.; van
Dijk F.; Geurts J.; Glas W.; van Gorp R.; Jwair A.; Koca F.; Lange I.;
Preckel B.; van Roy J.P.; Theunissen M.; Wensing A.G.C.L.; Werger A.
Institution
(Smit-Fun, De Korte-De Boer, Damen) Department of Anaesthesia and Pain
Medicine, Maastricht University Medical Centre +, Maastricht, Netherlands
(Stolze, Hollmann) Department of Anaesthesia, Amsterdam University Medical
Centre, Amsterdam, Netherlands
(Posthuma) Department of Anaesthesia and Intensive Care, Albert Schweitzer
Hospital, Dordrecht, Netherlands
(Buhre) Department of Anaesthesia, University Medical Centre Utrecht,
Utrecht, Netherlands
(Boer, In't Veld, Breel, Jwair, Koca, Preckel, Wensing) Amsterdam
University Medical Centre, Amsterdam, Netherlands
(van Kuijk, Bouw, van Gorp, Theunissen) Maastricht University Medical
Centre +, Maastricht, Netherlands
(Noordzij, Lange) St. Antonius Hospital, Nieuwegein, Netherlands
(Rinia, van Dijk, Geurts) Rijnstate Hospital, Arnhem, Netherlands
(Hering, Glas, van Roy) Dijklander Hospital, Hoorn, Netherlands
(Werger) Medical Centre Haaglanden, The Hague, Netherlands
(Scheffer) Radboud University Medical Centre, Nijmegen, Netherlands
(van Kuijk) Maastricht University, Maastricht, Netherlands
Publisher
Oxford University Press
Abstract
Background: The TRACE (Routine posTsuRgical Anaesthesia visit to improve
patient outComE) RCT did not show any perioperative benefit from
ward-based visits by anaesthetists after surgery. The aim of this study
was to evaluate the impact of this intervention on longer-term outcomes.
 Method(s): Patients were followed up in the TRACE RCT to 1 year in
nine hospitals in the Netherlands. Patients undergoing elective
non-cardiac surgery, and at risk for adverse postoperative outcome, were
included. Patients in the intervention group additionally received routine
anaesthesia visits on postoperative days 1 and 3. Clinical outcome
measures included 1-year mortality, hospital readmission, and reoperation.
Functional recovery (FR) was measured using the patient-reported global
surgical recovery (GSR) index, ability to perform activities of daily
living (ADL), and functional recovery index (FRI). Quality of life (QoL)
was measured using EQ-5D-5L. Result(s): Some 5473 adult patients were
followed up. No differences were found between the control and
intervention groups for clinical, FR, and QoL outcome measures. One-year
mortality was 5.4% in the control group and 5.8% in the intervention
group, readmission was 27% and 26% respectively, and reoperation was 20%
and 18% respectively. At 1 year, FR and QoL had recovered to preoperative
levels. However, 30% of patients were not able to fully perform ADL and
40%-51% of patients still reported a problem in the EQ-5D-5L dimensions
mobility, usual activities, and pain/discomfort. Conclusion(s):
Routine postoperative anaesthesia ward visits of patients did not improve
clinical, functional, and QoL outcomes. A substantial proportion of
patients still experienced health-related limitations in daily life 1 year
after surgery. In conclusion, an early postoperative intervention with
postoperative anaesthesia visits in the ward after non-cardiac surgery had
no effect on 30-day or 1-year clinical outcome. Remarkably, TRACE shows
that compared with data sampled 10 years ago, 1-year mortality has not
improved in the Netherlands. At 1 year, functional recovery or QoL showed
little improvement compared with baseline. Importantly, a substantial
number of patients still reported incomplete recovery and problems that
limit QoL, which indicate that there is still room for
improvement. Copyright © 2025 The Author(s). Published by Oxford
University Press on behalf of BJS Foundation Ltd.

<51>
Accession Number
2037914635
Title
Contemporary risk models for transcatheter aortic valve replacement: A
narrative review.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2025. Date of
Publication: 2025.
Author
Chan N.; Agrawal A.; Arockiam A.D.; Majid M.; Haroun E.; Shah A.; Puri R.;
Griffin B.; Wang T.K.M.
Institution
(Chan) Section of Cardiovascular Medicine, Heart and Vascular Center,
Dartmouth-Hitchcock Health System, Lebanon, NH, United States
(Agrawal, Arockiam, Majid, Haroun, Shah, Puri, Griffin, Wang) Department
of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute,
Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Aortic stenosis (AS) is the most common form of valvular heart disease in
older adults requiring intervention. Severe symptomatic AS, if left
untreated, is typically associated with a poor prognosis. Over the past
two decades, there have been significant advances in the field of
transcatheter aortic valve replacement (TAVR), leading to its emergence as
an alternative to the well-established surgical aortic valve replacement
(SAVR) for treating severe AS. Multiple randomized clinical trials have
demonstrated comparable efficacy and safety outcomes of TAVR vs SAVR in
high, intermediate, and low-risk surgical candidates. In the process,
multiple risk scores, both traditional surgical and TAVR-specific, have
been developed to better risk stratify patients as well as guide
periprocedural management and patient counseling. This review aims to
discuss the currently available risk models for risk prediction in TAVR
patients, highlighting their strengths, limitations, and applicability to
different patient populations. Copyright © 2025 The Authors

<52>
Accession Number
646770430
Title
Preoperative prediction models for postoperative delirium in cardiac
surgery patients - a scoping review.
Source
Contemporary nurse. (pp 1-19), 2025. Date of Publication: 10 Mar 2025.
Author
Blako M.; Olsen D.B.; Noergaard M.W.
Institution
(Blako) Department of Cardiology, Rigshospitalet, Heart Center, Copenhagen
University Hospital, Copenhagen, Denmark
(Olsen) Department of Cardiothoracic Surgery, Rigshospitalet, Heart
Center, Copenhagen University Hospital, Copenhagen, Denmark
(Noergaard) Centre for Clinical Guideline, Department of Clinical
Medicine, Aalborg University, Aalborg, Denmark
Abstract
BACKGROUND: Postoperative delirium is believed to be preventable in up to
40% of all cases. Researchers have proposed various preoperative risk
prediction models for postoperative delirium in patients undergoing
cardiac surgery, however, no consensus exists on which model is the most
suitable. AIM: To identify and map existing preoperative risk prediction
models, detecting cardiac surgery patients at elevated risk of developing
postoperative delirium. DESIGN: This scoping review considered cohort and
case-control studies eligible if they developed or validated preoperative
prediction models for postoperative delirium, in adult patients admitted
for cardiac surgery via sternotomy. DATA SOURCES: The primary search was
conducted on May 6th, 2022, and a secondary search was conducted on
September 18th, 2024. We searched MEDLINE, CINAHL, Embase, and PsycINFO
where 2126 references were identified and 15 were included for full-text
analysis. METHOD(S): This scoping review was conducted in line with
the Systematic Reviews and Meta-Analyses extension for Scoping Reviews
(the PRISMA-ScR) guideline. RESULT(S): Twelve unique risk prediction
models and three validation studies were included in this review,
comprising between 77 and 45,744 participants. In total, 157 candidate
prognostic variables were investigated of which 40 had a predictive value
and thus, were included in the prediction models. The included models
revealed an AUC from 0.68-0.93 in the derivation cohorts and 0.61-0.89 in
the validation cohorts. CONCLUSION(S): Twelve unique prediction
models and 3 validation studies were identified and mapped. Collectively,
the models demonstrated an AUC ranging from 0.61-0.93, indicating a fair
to good discrimination performance. PROTOCOL REGISTRATION: A protocol is
registered at Open Science Framework (OSF)
https://osf.io/wr93y/?view_only=d129c3bb6be04357bac35c2c41ba2a40.

<53>
Accession Number
2033147397
Title
Serial Lactate in Clinical Medicine - A Narrative Review.
Source
Journal of Intensive Care Medicine. (no pagination), 2025. Date of
Publication: 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, Universite
Paris Cite, Paris, France
Publisher
SAGE Publications Inc.
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. Finding(s): 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(s): 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. Copyright
© The Author(s) 2025.

<54>
Accession Number
2033594447
Title
Efficacy and safety of gastrodin in preventing postoperative delirium
following cardiac surgery: a randomized placebo controlled clinical trial.
Source
Critical Care. 29(1) (no pagination), 2025. Article Number: 108. Date of
Publication: 01 Dec 2025.
Author
Bai Y.-X.; Wu H.-L.; Xie W.-L.; Li X.; Han J.-J.; Liu J.; Chen S.-Q.; Yin
P.; Dong N.-G.; Wu Q.-P.
Institution
(Bai, Xie, Li, Han, Liu, Chen, Wu) Department of Anesthesiology, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
(Bai, Xie, Li, Han, Liu, Chen, Wu) Institute of Anesthesia and Critical
Care Medicine, Union Hospital, Tongji Medical College, Huazhong University
of Science and Technology, Wuhan, China
(Bai, Xie, Li, Han, Liu, Chen, Wu) Key Laboratory of Anesthesiology and
Resuscitation (Huazhong University of Science and Technology), Ministry of
Education, Wuhan, China
(Wu, Dong) Department of Cardiovascular Surgery, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Wuhan,
China
(Yin) Department of Epidemiology and Biostatistics, School of Public
Health, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
Publisher
BioMed Central Ltd
Abstract
Background: Delirium and postoperative cognitive dysfunction (POCD) are
common complications post-cardiac surgery, yet no specific medical
intervention is currently recommended for prevention. This study aimed to
evaluate the efficacy of gastrodin infusion in preventing delirium and
POCD in critically ill patients following cardiac surgery.
 Material(s) and Method(s): A double-blind, randomized,
placebo-controlled trial was conducted on patients aged 18-75, scheduled
for coronary artery bypass grafting (CABG) surgery, with or without valve
replacement. Participants were randomized in a 1:1 ratio to receive
gastrodin infusion 600 mg twice daily or placebo from the day of surgery
until the postoperative day (POD) 6. The co-primary outcomes were the
incidences of delirium and POCD, assessed from ICU admission until POD 7
and at 1 and 3 months postoperatively. This study was registered with the
Chinese Clinical Trials Registry (ChiCTR1800020414). Result(s): Of
160 randomized participants, 155 were analyzed (77 gastrodin, 78 placebo)
according to a modified intention to treat principle. The incidence of
postoperative delirium was 19.5% in the gastrodin group and 35.9% in the
placebo group, with a significant relative risk of 0.54 (95% CI 0.32-0.93,
p = 0.022). The incidence of in-hospital POCD was 2.9% and 4.0% in the
placebo and gastrodin groups, respectively. The odds of hospital discharge
were significantly greater in the gastrodin group (subhazard ratio, 1.20;
95% CI 1.00-1.84; p = 0.049). Adverse events occurred in 9.1% (7/77) of
patients administered gastrodin and 14.1% (11/78) of patients administered
the placebo, with none being drug-related. Conclusion(s): Gastrodin
infusion significantly reduced postoperative delirium and improved
discharge outcomes in patients undergoing CABG, but larger studies are
needed to confirm its efficacy in preventing delirium. Copyright
© The Author(s) 2025.

<55>
Accession Number
2033594120
Title
A narrative review on miniaturized extracorporeal technology and circuits:
a revolutionary approach to cardiac surgery.
Source
Cardiothoracic Surgeon. 33(1) (no pagination), 2025. Article Number: 11.
Date of Publication: 01 Dec 2025.
Author
Shetty T.; Darbari A.; Sainath P.
Institution
(Shetty, Darbari) CTVS Department, AIIMS Rishikesh, Rishikesh, India
(Sainath) Perfusion Technology Program, MCHP, MAHE, Manipal, India
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: The development of the cardiopulmonary bypass machine for
extracorporeal circulation by Dr. John Gibbon marked a significant
milestone in the advancement of medical technology. Subsequent
enhancements in this equipment and methodologies have refined this
ground-breaking invention for better cardiac surgical results. Main body
of the abstract: The emergence of miniaturized extracorporeal circuits has
demonstrated more promising results in various research studies. This
narrative article explores the impacts of miniaturized extracorporeal
circuits on different organ systems and their potential advantages over
traditional bypass systems, focusing on currently commercially available
devices to enhance our understanding. Short conclusion: Nevertheless,
practical limitations in standard usage and acceptance have hindered its
widespread implementation. Hence, this technique is still in the process
of acceptance as the standard of care. The information presented in this
review has been collected by accessing major databases and recent reviews,
meta-analyses and clinical trials on the internet, adhering to the Revised
Standards for QUality Improvement Reporting Excellence (SQUIRE 2.0)
guidelines. Copyright © The Author(s) 2025.

<56>
Accession Number
2037799449
Title
Prognostic value of myocardial computed tomography-derived extracellular
volume in severe aortic stenosis requiring aortic valve replacement: A
systematic review and meta-analysis.
Source
European Heart Journal Cardiovascular Imaging. 26(3) (pp 518-531), 2025.
Date of Publication: 01 Mar 2025.
Author
Faggiano A.; Gherbesi E.; Carugo S.; Brusamolino M.; Cozac D.A.; Cozza E.;
Savo M.T.; Cannata F.; Guglielmo M.; La Mura L.; Fazzari F.; Carrabba N.;
Conte E.; Mushtaq S.; Baggiano A.; Guaricci A.I.; Pedrinelli R.; Indolfi
C.; Sinagra G.; Perrone Filardi P.; Pergola V.; Pontone G.
Institution
(Faggiano, Gherbesi, Carugo) Department of Cardio-Thoracic-Vascular
Diseases, Foundation Irccs Ca' Granda Ospedale Maggiore Policlinico,
Milan, Italy
(Faggiano, Carugo, Brusamolino) Department of Clinical Sciences and
Community Health, University of Milan, Milan, Italy
(Brusamolino, Cannata, Fazzari, Mushtaq, Baggiano, Pontone) Department of
Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico
Monzino Irccs, Via C. Parea 4, Milan, Italy
(Cozac, Cozza, Savo, Pergola) Department of Cardiac, Cardiology Clinic,
Department of Cardiac, Thoracic, Vascular Sciences and Public Health,
Padova, Italy
(Cozac) Department of Physiology, University of Medicine, Pharmacy,
Science and Technology 'George Emil Palade' of Targu Mures, Targu Mures,
Romania
(Guglielmo) Department of Cardiology, Division of Heart and Lungs, Utrecht
University Medical Center, Utrecht University, Utrecht, Netherlands
(Guglielmo) Department of Cardiology, Haga Teaching Hospital, The Hague,
Netherlands
(La Mura, Perrone Filardi) Department of Advanced Biomedical Sciences,
University Federico Ii of Naples, Naples, Italy
(Carrabba) Department of Cardiothoracovascular Medicine, Azienda
Ospedaliero-Universitaria Careggi, Florence, Italy
(Conte) Department of Clinical Cardiology and Cardiovascular Imaging,
Galeazzi-Sant'Ambrogio Hospital Irccs, Milan, Italy
(Guaricci) Interdisciplinary Department of Medicine, University Cardiology
Unit, University of Bari Aldo Moro, Bari, Italy
(Pedrinelli) Cardiac, Thoracic and Vascular Department, University of
Pisa, Pisa, Italy
(Indolfi) Dipartimento di Scienze Mediche e Chirurgiche, Istituto di
Cardiologia, Universita Degli Studi 'Magna Graecia', Catanzaro, Italy
(Sinagra) Cardiology Specialty School, University of Trieste, Trieste,
Italy
(Sinagra) Cardiovascular Department, Center for Diagnosis and Treatment of
Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina
(ASUGI), Trieste, Italy
(Pontone) Department of Biomedical, Surgical and Dental Sciences,
University of Milan, Milan, Italy
Publisher
Oxford University Press
Abstract
Computed tomography (CT)-derived extracellular volume (ECV) fraction is a
non-invasive method to quantify myocardial fibrosis. Evaluating CT-ECV
during aortic valve replacement (AVR) planning CT in severe aortic
stenosis (AS) may aid prognostic stratification. This meta-analysis
evaluated the prognostic significance of CT-ECV in severe AS necessitating
AVR. Electronic database searches of PubMed, Ovid MEDLINE, and Cochrane
Library were performed. The primary outcome was to compare the occurrence
of a composite of cardiovascular outcomes in patients with severe AS
undergoing AVR with elevated myocardial CT-ECV values vs. patients with
normal values. Secondary outcomes included all-cause mortality and heart
failure (HF)-related hospitalization. A total of 1223 patients undergoing
AVR for severe AS were included in 10 studies: 524 patients with high
values of CT-ECV and 699 with normal values of CT-ECV. The pooled CT-ECV
cut-off to define elevated values and predict prognosis was 30.7% [95%
confidence interval (CI): 28.5-33.7%]. At a mean follow-up of 17.9 +/- 2.3
months after AVR, patients with elevated CT-ECV experienced a
significantly higher number of cardiovascular events [43.4 vs. 14.0%; odds
ratio (OR): 4.3, 95% CI: 3.192-5.764, P < 0.001]. Regarding secondary
outcomes, all-cause mortality occurred in 29.3% of patients with elevated
CT-ECV vs. 11.6% with CT-ECV below the cut-off (OR: 3.5, 95% CI:
2.276-5.311, P < 0.001), whereas HF hospitalization was observed in 25.5%
vs. 5.9% (OR: 4.9, 95% CI: 2.283-10.376, P < 0.001). Patients undergoing
AVR for severe AS with elevated CT-ECV values experience a worse
post-intervention prognosis. The implementation of CT-ECV evaluation in
routine AVR planning protocols should be considered. Copyright ©
The Author(s) 2025.

<57>
Accession Number
646766109
Title
Transcatheter Edge-to-Edge Repair for Severe Mitral Regurgitation in
Patients With Cardiogenic Shock: A Systematic Review and Meta-Analysis.
Source
Journal of the American Heart Association. (pp e034932), 2025. Date of
Publication: 07 Mar 2025.
Author
Dimitriadis K.; Soulaidopoulos S.; Pyrpyris N.; Sagris Mu.; Aznaouridis
K.; Beneki E.; Theofilis P.; Tsioufis P.; Tatakis F.; Fragkoulis C.; Shuvy
M.; Chrysohoou C.; Aggeli K.; Tsioufis K.
Institution
(Dimitriadis, Soulaidopoulos, Pyrpyris, Sagris, Aznaouridis, Beneki,
Theofilis, Tsioufis, Tatakis, Fragkoulis, Chrysohoou, Aggeli, Tsioufis)
First Cardiology Department, Hippokration General Hospital, School of
Medicine National and Kapodistrian University of Athens Athens Greece,
Greece
(Shuvy) Jesselson Integrated Heart Centre, Shaare Zedek Medical Center and
Faculty of Medicine Hebrew University Jerusalem Israel, Israel
Abstract
BACKGROUND: Patients with severe mitral regurgitation and cardiogenic
shock demonstrate a poor prognosis. Mitral transcatheter edge-to-edge
repair could alter patient management. METHODS AND RESULTS: We
systematically reviewed PubMed/Medline, Scopus, and Cochrane Library until
January 2023, including studies assessing transcatheter edge-to-edge
repair in patients with severe mitral regurgitation and cardiogenic shock.
Studies with <5 patients were excluded. The primary outcome was device
success and all-cause death, while secondary outcomes included myocardial
infarction, stroke, and heart failure hospitalization rates at 30-day and
intermediate-term follow-up. A fixed-effects meta-analysis was used to
estimate pooled rates. Risk of bias was assessed with the Newcastle-Ottawa
Scale. A total of 24 studies and 5428 patients were included, with a mean
age of 71.2+/-3.3 years and a high mean Society of Thoracic Surgery score
(15.2+/-8.9). Device success was achieved in 86% (95% CI, 85%-87%) and
mitral regurgitation <=2+ in 89% (95% CI: 88%-90%). The 30-day all-cause
mortality rate was 14% (95% CI, 13%-15%). Stroke, myocardial infarction,
and heart failure hospitalization rates were 2% (95% CI, 1%-2%), 15% (95%
CI, 13%-18%), and 9% (95% CI, 8%-10%), respectively. Patients with acute
myocardial infarction had similar device success (81% [95% CI, 74%-87%]),
a 30-day mortality rate of 20% (95% CI, 16%-25%), and intermediate-term
mortality rate of 14% (95% CI, 9%-19%). In non-myocardial infarction
populations, the 30-day mortality rate was 13% (95% CI, 13%-14%), and the
intermediate-term mortality rate was 35% (95% CI, 34%-36%).
 CONCLUSION(S): In patients with mitral regurgitation and cardiogenic
shock, transcatheter edge-to-edge repair is associated with favorable
30-day and intermediate-term outcomes. Limitations, including the
observational design of included studies and considerable heterogeneity,
necessitate further research in this setting.

<58>
Accession Number
2033391956
Title
Surgical outcomes of cardiac surgery in patients with antiphospholipid
syndrome and systemic lupus erythematosus: A systematic review.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2025. Date of
Publication: 2025.
Author
Agarwal R.; Mudgal S.; Rout S.; Arnav A.
Institution
(Agarwal) Department of Cardiothoracic Surgery, All India Institute of
Medical Sciences (AIIMS) Deoghar, Jharkhand, Deoghar, India
(Mudgal) College of Nursing, All India Institute of Medical Sciences
(AIIMS) Deoghar, Jharkhand, Deoghar, India
(Rout) Department of Cardiology, All India Institute of Medical Sciences
(AIIMS) Deoghar, Jharkhand, Deoghar, India
(Arnav) Department of Surgical Oncology, All India Institute of Medical
Sciences (AIIMS) Deoghar, Jharkhand, Deoghar, India
Publisher
SAGE Publications Inc.
Abstract
Background: Antiphospholipid syndrome and systemic lupus erythematosus are
autoimmune inflammatory conditions involving multiple organs and sharing
various clinical aspects. Owing to the scarcity of data about the surgical
outcomes of these autoimmune disorders, we conducted a systematic review
to assess the outcomes for patients with these diagnoses undergoing heart
surgery and contextualize the findings regarding high-risk cardiac
surgeries. Method(s): A thorough search of PubMed, Embase and Scopus
used Preferred Reporting Items for Systematic Reviews and Meta-Analyses
standards to find articles that involved patients who underwent heart
surgery and had antiphospholipid syndrome and systemic lupus
erythematosus. Inclusion criteria concentrated on a definitive diagnosis,
while case reports and studies lacking data on surgical outcomes were
excluded. Using the Joanna Briggs Institute's methodologies, quality
evaluation categorized studies according to their risk of bias.
 Result(s): Fourteen studies with 277 patients and a prevalence of
middle-aged females met the inclusion criteria out of 6381 papers. The
major preoperative comorbidity in the cohort was a history of
thromboembolic events (43%). Thromboembolic complications (6%) and
catastrophic antiphospholipid syndrome (2%), even with appropriate
anticoagulation, were notable early post-operative outcomes. Six percent
of people died within 30 days. Data from follow-up studies showed a 14%
death rate and a 23% frequency of thromboembolic events.
 Conclusion(s): With the striking exception of a high frequency of
thromboembolic complications and catastrophic antiphospholipid syndrome,
surgical results in patients with antiphospholipid syndrome and systemic
lupus erythematosus are analogous to those in high-risk cardiac
procedures. Improving surgical care for this susceptible population
requires an understanding of these hazards. Copyright © The
Author(s) 2025.

<59>
Accession Number
2037912913
Title
Patient Selection for Surgery vs Surveillance in Moderately Dilated
Ascending Aorta: Insights From Treatment in Thoracic Aortic Aneurysm:
Surgery versus Surveillance (TITAN:SvS), an International Prospective
Trial.
Source
Annals of Thoracic Surgery. (no pagination), 2025. Date of Publication:
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, San Francisco, CA, United States
(Atoui) Division of Cardiac Surgery, Health Sciences North, Sudbury, ON,
Canada
Publisher
Elsevier Inc.
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 vs surveillance, patient and
aneurysm characteristics were compared for patients in the randomized and
registry arms of a large prospective, multicenter, multinational trial.
 Method(s): TITAN:SvS (Treatment in Thoracic Aortic aNeurysm: Surgery
versus Surveillance) is a large prospective multicenter study of patients
with ATAA between 5.0 and 5.4 cm, randomizing patients 1:1 to initial
surgery vs surveillance. Nonrandomized patients are enrolled into a
registry where results of operative or surveillance strategy can be
monitored prospectively. Between 2018 and 2023, 615 patients were enrolled
at 22 sites in the United States and Canada. Demographic and aneurysm
characteristics were compared between randomized and registry arms.
 Result(s): Compared with randomized and operative registry groups,
patients in the surveillance registry were older with more comorbidities.
No significant differences were observed in maximal ascending aortic
diameter (5.1 cm [interquartile range, 5.0-5.2 cm] vs 5.1 cm
[interquartile range, 4.9-5.2 cm] P =.2) or other aneurysm
characteristics. Despite similar numbers of enrolling centers in the
United States (n = 11) and Canada (n = 12), Canadian patients were more
likely to be randomized (58% vs 7%, P <.01) and less likely to be enrolled
in the operative (9% vs 42%, P <.01) or surveillance registry (34% vs
51%). Conclusion(s): Enrollment data for TITAN:SvS suggest 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, because sicker patients may be
excluded. Copyright © 2025 The Authors

<60>
Accession Number
2033594195
Title
Cardiomyopathies and a brief insight into DOX-induced cardiomyopathy.
Source
Egyptian Heart Journal. 77(1) (no pagination), 2025. Article Number: 29.
Date of Publication: 01 Dec 2025.
Author
Tanwar S.S.; Dwivedi S.; Khan S.; Sharma S.
Institution
(Tanwar, Sharma) Shri Vaishnav Vidyapeeth Vishwadvidyalaya, Indore, India
(Dwivedi) Acropolis Institute of Pharmaceutical Education and Research,
Indore, India
(Khan) The University of Texas Rio Grande Valley, Edinburg, United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Cardiomyopathy is a heterogeneous group of myocardial
disorders characterized by structural and functional abnormalities of the
heart muscle. It is classified into primary (genetic, mixed, or acquired)
and secondary categories, resulting in various phenotypes including
dilated, hypertrophic, and restrictive patterns. Hypertrophic
cardiomyopathy, the most common primary form, can cause exertional
dyspnea, presyncope, and sudden cardiac death. Dilated cardiomyopathy
typically presents with heart failure symptoms, while restrictive
cardiomyopathy is rarer and often associated with systemic diseases.
Diagnosis involves a comprehensive evaluation including history, physical
examination, electrocardiography, and echocardiography. Treatment options
range from pharmacotherapy and lifestyle modifications to implantable
cardioverter-defibrillators and heart transplantation in refractory cases.
Main body: Anthracyclines, particularly doxorubicin, have emerged as
crucial components in cancer treatment, demonstrating significant
antitumor activity across various malignancies. These drugs have become
standard in numerous chemotherapy regimens, improving patient outcomes.
However, their use is associated with severe cardiotoxicity, including
cardiomyopathy and heart failure. The mechanisms of anthracycline action
and toxicity are complex, involving DNA damage, iron-mediated free radical
production, and disruption of cardiovascular homeostasis.
Doxorubicin-induced cardiomyopathy (DIC) is a severe complication of
cancer treatment with a poor prognosis and limited effective treatments.
The pathophysiology of DIC involves multiple mechanisms, including
oxidative stress, inflammation, mitochondrial damage, and calcium
homeostasis disorder. Despite extensive research, no effective treatment
for established DIC is currently available. Dexrazoxane is the only
FDA-approved protective agent, but it has limitations. Recent studies have
explored various potential therapeutic approaches, including natural
drugs, endogenous substances, new dosage forms, and herbal medicines.
However, the lack of experimental models incorporating pre-existing cancer
limits the understanding of DIC pathophysiology and treatment efficacy.
 Conclusion(s): Cardiomyopathy, whether primary or secondary, poses a
significant clinical challenge due to its varying etiologies and poor
prognosis in advanced stages. Anthracycline-induced cardiomyopathy is a
severe complication of chemotherapy, with doxorubicin being a notable
contributor. Despite advancements in cancer therapies, the cardiotoxic
effects of anthracyclines necessitate further investigation into effective
preventive strategies and therapeutic interventions to improve patient
outcomes. Copyright © The Author(s) 2025.

<61>
Accession Number
646763499
Title
Meta-analysis on sex differences in mortality and neurodevelopment in
congenital heart defects.
Source
Scientific reports. 15(1) (pp 8152), 2025. Date of Publication: 09 Mar
2025.
Author
Crain A.K.; Lim Z.N.; Sarfatis C.J.; Arias M.; Holder T.; Moreira A.G.;
Corno A.F.; Findley T.O.
Institution
(Crain, Sarfatis, Findley) Division of Neonatal-Perinatal Medicine,
Department of Pediatrics, McGovern Medical School at the University of
Texas Health Science Center in Houston and Children's Memorial Hermann
Hospital, Houston, TX, United States
(Lim) University College London, Great Ormond Street Institute of Child
Health, London, United Kingdom
(Arias) Nova Southeastern College of Osteopathic Medicine, Fort
Lauderdale, FL, United States
(Holder) Research Medical Library, University of Texas MD Anderson Cancer
Center, Houston, TX, United States
(Moreira) Department of Pediatrics, Neonatology Regenerative and Precision
Medicine Laboratory, University of Texas Health Science Center at San
Antonio, San Antonio, TX, United States
(Moreira) Veterans Administration Center for Personalized Medicine, South
Texas Veterans Health Care System, San Antonio, TX, United States
(Corno) School of Engineering, University of Leicester, Leicester, United
Kingdom
(Corno) Faculty of Science and Engineering, Manchester Metropolitan
University, Manchester, United Kingdom
Abstract
Given the increasing survival rates among congenital heart disease (CHD)
patients and the growing emphasis on their quality of life, there is a
need to comprehensively assess the impact of surgical interventions on
neurodevelopmental outcomes. With increasing awareness in sex-related
disparities in CHD, there is a need to explore potential differences in
surgical mortality and neurodevelopmental outcomes between male and female
patients. In this systematic review, we adhered to PRISMA guidelines and
PROSPERO registration (#CRD42021225610). Articles published from 2015 to
2021 were searched using MeSH descriptors in three major databases
(MEDLINE Ovid, Elsevier Embase, and Cochrane Library). Study selection
criteria focused on pediatric (< 18 years of age) CHD patients undergoing
primary cardiac surgery. A total of 163 articles that met inclusion
criteria were reviewed. The definition and assessment of
neurodevelopmental impairment, data extraction, risk of bias assessment,
and statistical analysis methods were adhered by blinded reviewers.
Previous studies have reported higher rates of early childhood mortality
in female patients and higher rates of neurodevelopmental impairment in
male patients with CHD requiring surgery. Our meta-analysis suggests that
these differences may no longer be valid in contemporary surgical cohorts.
However, it is unclear if sex-related risk factors have truly been
mitigated with current surgical and medical approaches Our meta-analysis
does underscore the need for further research considering sex as a
variable and for additional investigative efforts in long term
neurodevelopmental outcomes. Copyright © 2025. The Author(s).

<62>
Accession Number
2033486442
Title
Impact of Chronic Inflammatory Diseases on Clinical Outcomes in Patients
undergoing Aortic Valve Replacement: A Systematic Review and
Meta-analysis.
Source
Angiology. (no pagination), 2025. Date of Publication: 2025.
Author
Theodoropoulou T.; Apostolos A.; Ktenopoulos N.; Koliastasis L.;
Tsalamandris S.; Mourouzis I.; Pantos C.; Tsioufis K.; Toutouzas K.
Institution
(Theodoropoulou, Apostolos, Ktenopoulos, Koliastasis, Tsalamandris,
Tsioufis, Toutouzas) Unit for Structural Heart Diseases and
Valvulopathies, First Department of Cardiology, Athens School of Medicine,
Hippokration Hospital, Athens, Greece
(Mourouzis, Pantos) Department of Pharmacology, National and Kapodistrian
University of Athens, Athens, Greece
Publisher
SAGE Publications Inc.
Abstract
Patients with autoimmune chronic inflammatory disease (CID) are at an
increased risk of valvular heart disease, including aortic valve stenosis,
insufficiency, or both. The impact of CID on the prognosis of surgical or
transcatheter aortic valve replacement (AVR) remains unclear. This
meta-analysis aims to evaluate the impact of CID on major clinical
outcomes in this population. A comprehensive literature search of PubMed,
Cochrane, and Embase databases was conducted to identify relevant studies.
The primary endpoint was 30-day all-cause mortality between patients with
CID and controls. Secondary endpoints included, long-term all-cause
mortality, stroke and in-hospital infection. Statistical analysis included
Risk Ratio (RR) with 95% confidence interval (CI) using the random-effects
model. Five studies involving 572,351 patients were included in the
meta-analysis. Patients with CID had a greater 30-day mortality (RR =
1.17, 95% CI: 1.09, 1.27; P <.001) and a higher rate of in-hospital
infection (RR = 2.13, 95% CI: 1.03, 4.41; P <.001). No differences were
observed in the other secondary endpoints. Patients with CID are at an
increased risk of short-term all-cause mortality and in-hospital
infections after AVR. Further studies are required to validate our results
and define the optimal management of these patients. Copyright ©
The Author(s) 2025.

<63>
Accession Number
2037915051
Title
Vasoplegia in Cardiac Surgery: A Systematic Review and Meta-analysis of
Current Definitions and Their Influence on Clinical Outcomes.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Papazisi O.; van der Schoot M.M.; Berendsen R.R.; Arbous S.M.; le Cessie
S.; Dekkers O.M.; Klautz R.J.M.; Marczin N.; Palmen M.; de Waal E.E.C.
Institution
(Papazisi, Klautz, Palmen, de Waal) Department of Cardiothoracic surgery,
Leiden University Medical Center, Leiden, Netherlands
(van der Schoot, Berendsen) Department of Anesthesiology, Leiden
University Medical Center, Leiden, Netherlands
(Arbous) Department of Intensive Care, Leiden University Medical Center,
Leiden, Netherlands
(le Cessie, Dekkers) Department of Clinical Epidemiology, Leiden
University Medical Center, Leiden, Netherlands
(le Cessie) Department of Biomedical Data Sciences, Leiden University
Medical Center, Leiden, Netherlands
(Klautz) Department of Cardiothoracic surgery, Amsterdam University
Medical Center, Amsterdam, Netherlands
(Marczin) Division of Anaesthesia, Pain Medicine and Intensive Care,
Imperial College London, Royal Brompton & Harefield Hospitals, Guy's & St.
Thomas' NHS, London, United Kingdom
(Marczin) Department of Anesthesia and Intensive Care, Semmelweis
University, Budapest, Hungary
(de Waal) Department of Anesthesiology, University Medical Center Utrecht,
Netherlands
Publisher
W.B. Saunders
Abstract
Objectives: To identify differences in the reported vasoplegia incidence,
intensive care unit (ICU) length of stay (LOS), and 30-day mortality rates
as influenced by different vasoplegia definitions used in cardiac surgery
studies. Design(s): A systematic review was performed covering the
period 1977 to 2023 using PubMed/MEDLINE, Embase, Web of Science, Cochrane
Library, and Emcare and a meta-analysis (PROSPERO: CRD42021258328) was
performed. Setting and Participants: One hundred studies defining
vasoplegia in cardiac surgery patients were systematically reviewed. Sixty
studies with 20 or more patients, irrespective of design, reporting
vasoplegia incidence, ICU LOS, or 30-day mortality were included for
meta-analysis. Intervention(s): Cardiac surgery on cardiopulmonary
bypass. Measurements and Main Results: Studies were categorized
depending on the used mean arterial pressure (MAP) thresholds. Random
intercept logistic regression models were used for meta-analysis of
incidence and mortality. Random effect meta-analysis was used for ICU LOS.
One hundred studies were reviewed systematically. MAP and cardiac index
thresholds varied considerably (<50-80 mmHg and 2.0-3.5
L.min-1m-2, respectively). Vasopressor dosages also
differed between definitions. The reported incidence (60 studies; mean
incidence, 19.9%; 95% confidence interval [CI], 16.1-24.4) varied largely
between studies (2.5%-66.3%; I2 = 97%; p < 0.0001).
Meta-regression models, including the MAP-threshold, did not explain this
heterogeneity. Similarly, the effect of vasoplegia on ICU LOS, and 30-day
mortality was very heterogeneous among studies (I2 = 99% and
I2 = 73%, respectively). Conclusion(s): The large
variability in vasoplegia definitions is associated with significant
heterogeneity regarding incidence and clinical outcomes, which cannot be
explained by factors included in our models. Such variations in
definitions leads to inconsistent patient diagnosis and renders published
vasoplegia research incomparable. Copyright © 2025 The Authors

<64>
Accession Number
2037903521
Title
Effects of naloxegol on transit recovery in patients undergoing cardiac
surgery: A randomized, double-blind, placebo-controlled trial.
Source
Anaesthesia Critical Care and Pain Medicine. 44(2) (no pagination), 2025.
Article Number: 101498. Date of Publication: 01 Apr 2025.
Author
Laghlam D.; Gibert H.; Merzoug M.; Leclerc D.; Coroyer L.; Estagnasie P.;
Squara P.; Nguyen L.S.; Geri G.
Institution
(Laghlam, Coroyer, Estagnasie, Squara, Nguyen, Geri) From the Department
of Cardiology and Critical Care, CMC Ambroise Pare-Hartmann, 48 Ter
boulevard Victor Hugo, Neuilly-sur-Seine, France
(Gibert, Leclerc) From the Department of Cardiovascular Anesthesiology,
CMC Ambroise Pare-Hartmann, 48 Ter boulevard Victor Hugo,
Neuilly-sur-Seine, France
(Merzoug) From the Department of Clinical Research, CMC Ambroise
Pare-Hartmann, 48 Ter boulevard Victor Hugo, Neuilly-sur-Seine, France
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Paralytic ileus is a major surrounding after cardiac surgery
and worsens patients' prognosis. Method(s): We conducted a
single-centre, randomized, double-blind, placebo-controlled phase 3 study.
We enrolled patients over 18 years old who underwent non-urgent cardiac
surgery. Eligible patients were randomly allocated to Naloxegol or
matching placebo in an equal ratio. The participants were randomly
assigned to one of the following groups: (1) Naloxegol 12,5 mg 2 h before
index surgery, and then Naloxegol 25 mg once daily, or (2) matching
placebo. Naloxegol or placebo was administered for up to 5 days and
permanently stopped if the patient had transit recovery. The primary
endpoint was the time of postoperative gastrointestinal transit recovery
after the index cardiac surgery, defined as the time in hours between the
anaesthetic induction and the emission of the first significant stool.
 Result(s): Between October 14, 2020, and January 28, 2022, 299
participants were included in modified intention-to-treat efficacy
analyses (151 in the Naloxegol group and 148 in placebo). The mean age was
62 +/- 10.1 years old, 81.6% were male, 53.8% had hypertension, 20.7% had
diabetes mellitus, and the median body mass index was 25.9 (IQR 23.7-29.4)
kg/m2. Time-to-transit recovery did not differ between
Naloxegol group and placebo (76.0, [IQR 69.3-93.5] vs. 78.3, [IQR
70.0-95.8] h, p value = 0.40). We did not observe any difference in the
prespecified secondary efficacy between both groups. Pain levels and a
number of serious adverse events were not different in both groups.
 Conclusion(s): Naloxegol was not found to be effective in improving
the transit time recovery after elective cardiac surgery. The trial was
registered on ClinicalTrials.gov (NCT04433390) on June 16th,
2020. Copyright © 2025 Societe Francaise d'Anesthesie et de
Reanimation (SFAR)

<65>
Accession Number
2037899666
Title
Outcomes of transcatheter aortic valve implantation in Africa: A
systematic review and meta-analysis.
Source
International Journal of Cardiology. 429 (no pagination), 2025. Article
Number: 133139. Date of Publication: 15 Jun 2025.
Author
Ahmed A.; Safiriyu I.; Kaddoura R.; Mohyeldin M.; Nwokeocha N.; Sandeep
N.; Khalil H.; Alhusain R.; Zarich S.
Institution
(Ahmed, Sandeep) Department of Internal Medicine, Yale University School
of Medicine, Bridgeport Hospital, Bridgeport, CT, United States
(Safiriyu) Division of Cardiology, Yale University School of Medicine,
Yale New Haven Hospital, New Haven, CT, United States
(Kaddoura) Department of Pharmacy, Heart Hospital, Hamad Medical
Corporation, Doha, Qatar
(Mohyeldin) Department of Internal Medicine, Icahn School of Medicine, NY,
United States
(Nwokeocha, Zarich) Division of Cardiology, Yale University School of
Medicine, Bridgeport Hospital, Bridgeport, CT, United States
(Khalil) Division of Cardiology, Tufts University, MA, United States
(Alhusain) Division of Cardiology, Mayo Clinic, FL, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Transcatheter Aortic Valve Implantation (TAVI) has become the
routine standard of care in patients with severe aortic stenosis and
prohibitive surgical risk worldwide. However, data on TAVI outcomes from
Africa remain sparse. This study aimed to evaluate the outcomes of TAVI in
Africa. Method(s): We systematically searched PubMed, Scopus and
Embase from inception to August 15th, 2024, in addition to the gray
literature, and a single proportion meta-analysis was performed to pool
proportions and means of categorical and continuous variables,
respectively, with 95 % confidence interval (95 % CI). continuous variable
reported as median (interquartile range) was converted into a mean
(standard deviation). Inconsistency factor (I2) values greater
than 50 % represent high heterogeneity. The analysis was performed by R
software (RStudio). Result(s): Of 177 articles, we identified seven
observational studies in Africa (n = 704). The mean age was 79.18 years
(95 % CI: 77.26-81.10; I2 = 97 %) and 52 % were male.
Procedural success rate in Africa was 91 % (95 % CI: 86 %-94 %;
I2 = 38 %), however, In-hospital all-cause mortality was 5.0 %
(95 % CI: 3 %-8 %; I2 = 35 %) and all-cause mortality at 1-year
follow-up was 11.0 % (95 % CI: 6 %-20 %; I2 = 61 %). In terms
of adverse events, PPM was in 7.0 % (4.0-11.0, I2 = 14 %),
major bleeding occurred in 8.0 % (4.0-14.0, I2 = 78 %), and
stroke/TIA 2.0 % (1.0-4.0), I2 = 41 %). Conclusion(s): The
procedural success is high in Africa, however, the mortality rate and
adverse events are notable. More national registries are required to
accurately identify these outcomes to improve the healthcare
system. Copyright © 2025 Elsevier B.V.

<66>
Accession Number
646745338
Title
Effects of acoustic stimulation on painful procedures in preterm and
full-term infants: A systematic review and network meta-analysis.
Source
International journal of nursing studies. 165 (pp 105031), 2025. Date of
Publication: 19 Feb 2025.
Author
Ding S.; Wang Q.; Fu X.; Huang X.; Liao L.; Zhang Y.
Institution
(Ding, Wang, Fu, Liao) Birth Room, Chengdu Women's and Children's Central
Hospital, School of Medicine, University of Electronic Science and
technology of, China
(Huang) Surgery Intensive Care Unit, Chengdu Women's and Children's
Central Hospital, School of Medicine, University of Electronic Science and
technology of, China
(Zhang) Birth Room, Chengdu Women's and Children's Central Hospital,
School of Medicine, University of Electronic Science and technology of,
China
Abstract
AIM: This study aims to compare and rank the effects of acoustic
stimulation on painful procedures in both preterm and full-term infants.
 METHOD(S): Six databases including Medline, Web of Science, the
Cochrane Central Register of Controlled Trials, Cumulative Index to
Nursing and Allied Health Literature, Embase, and SinoMed, were searched
from inception to July, 2023. A Bayesian network meta-analysis with random
effects models was performed using R software and Stata 15.0. The quality
of included studies was assessed using the Cochrane Collaboration's tool.
The study protocol was registered at PROSPERO (Registration number:
CRD42023451102). RESULT(S): A total of 28 studies involving 2624
preterm and full-term infants were included and 8 acoustic stimulation
interventions were identified. Regarding pain levels during procedures,
maternal voice, maternal voice plus, music therapy and maternal voice
plus, music therapy plus, other pharmaceutical interventions, vocal music
therapy, white noise, and white noise plus were significantly more
effective than control group [standardized mean differences (SMD) ranged
from -2.6 to -0.87]. White noise plus was the most effective intervention
for reducing pain levels during procedures (90.6 %). Regarding pain levels
after procedures (no specific time mentioned), maternal voice, maternal
voice plus, music therapy and maternal voice plus, music therapy plus,
other pharmaceutical interventions, other non-pharmaceutical
interventions, routine care, vocal music therapy, and white noise plus
were significantly more effective than control group (SMD ranged from -4.7
to -1.6). Music therapy and maternal voice plus was the most effective
intervention for reducing pain levels after procedures, without specific
time mentioned (95.29 %). Regarding pain levels 1 min after procedures,
only music therapy plus and other pharmaceutical interventions were
effective (SMD ranged from -4.5 to -4.9) and music therapy plus was the
most effective intervention (93.41 %). No interventions had significant
effects on pain levels 3, 5, and 10 min after procedures. Regarding heart
rate, only white noise plus could provide a lower increase during
procedures. For oxygen saturation, only vocal music therapy could provide
a lower decrease after painful procedures (no specific time mentioned). No
interventions had significant effects on stabilizing respiratory rate.
 CONCLUSION(S): This review suggests that multiple acoustic
stimulation interventions are effective for pain relief in both preterm
and full-term infants undergoing painful procedures. More high quality
studies with larger sample size are required to generate evidence
regarding the short- and long-term effectiveness and safety of acoustic
stimulation interventions on painful procedures. Copyright © 2025
Elsevier Ltd. All rights reserved.

<67>
Accession Number
646746274
Title
RETRACTION: Effects of Negative Pressure Wound Therapy on Surgical Site
Wound Infections after Cardiac Surgery: A Meta-Analysis.
Source
International wound journal. 22(3) (pp e70320), 2025. Date of Publication:
01 Mar 2025.
Author
Anonymous
Abstract
RETRACTION: Y. Tao, Y. Zhang, Y. Liu, and S. Tang, "Effects of Negative
Pressure Wound Therapy on Surgical Site Wound Infections after Cardiac
Surgery: A Meta-Analysis," International Wound Journal 21, no. 2 (2024):
e14398, https://doi.org/10.1111/iwj.14398. The above article, published
online on 23 September 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.

<68>
Accession Number
2033630268
Title
The Influence of Social Determinants of Health on the Survival of Heart
Transplants in the Pediatric Age: An Analysis of a Mexican Cohort and Its
Comparison with Latin America and the Caribbean.
Source
Journal of Clinical Medicine. 14(5) (no pagination), 2025. Article Number:
1506. Date of Publication: 01 Mar 2025.
Author
Marquez-Gonzalez H.; Bolio-Cerdan A.; Ruiz-Gonzalez S.; Erdmenger-Orellana
J.; Alcantara-Noguez C.; Romero-Cardenas M.P.P.; Avila-Montiel D.;
Koretzky S.G.
Institution
(Marquez-Gonzalez, Avila-Montiel, Koretzky) Department of Clinical
Research, Federico Gomez Children's Hospital, Mexico City, Mexico
(Bolio-Cerdan, Alcantara-Noguez, Romero-Cardenas) Department of
Cardiothoracic Surgery, Federico Gomez Children's Hospital, Mexico City,
Mexico
(Ruiz-Gonzalez) Sub Directorate of Surgical Assistance, Federico Gomez
Children's Hospital, Mexico City, Mexico
(Erdmenger-Orellana) Department of Pediatric Cardiology, Federico Gomez
Children's Hospital, Mexico City, Mexico
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: A heart transplantation (HT) is the definitive
treatment for heart failure. There is a difference in the success between
national HT programs in developed countries and those in Central America,
South America, and the Caribbean (LAC), and social determinants of health
(SDHs) can directly influence this. The objectives of this study were to
describe the survival since the beginning of the HT program of a national
pediatric institute in Mexico City and to compare it with the results of a
systematic review of LAC. Method(s): A cohort study of a pediatric
hospital (which performed 42% of the pediatric HTs in Mexico) was
performed since the beginning of the HTs program in 2001. Clinical
variables related to the transplants were identified, and the SDHs were
divided into three categories: personal, family, and community. A
systematic literature review was performed using keywords and a search in
the medical indexes of LAC countries. The statistical analysis included
descriptive statistics and a bivariate survival analysis. A risk
calculation was estimated using the hazard ratio (HR) of the SDHs.
 Result(s): A total of 38 HTs were performed, the median age was 7
(4-16) years, and 22 (58%) were men. The leading cause was cardiomyopathy
in 20 (53%) cases. The first-year survival rate was 76.3 per 100 HTs. The
SDHs that increased the risk of death were suboptimal immunosuppression,
the persistence of malnutrition, parental education, the distance from the
center, the socioeconomic level, and the absence of transitional care.
 Conclusion(s): This cohort of pediatric patients with HTs resulted in
the identification of risk variables of personal and community SDHs for
mortality in the first and fifth years. Chronic rejection occurred in 50%,
and the absence of transitional care to adulthood was the variable with
the highest risk. The systematic review identified Mexico as the country
with the second-highest frequency of HTs, and our cohort represented 42%
of the total number of transplants in the country. Numerically, LAC has a
lower frequency of transplants and survival in the first year compared to
other developed countries, possibly due to a gap associated with
organizational justice. Copyright © 2025 by the authors.

<69>
Accession Number
2033482784
Title
Traumatic chylothorax management post-coronary artery bypass grafting - A
systematic review.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2025. Date of
Publication: 2025.
Author
Carmichael G.J.; Prinsloo D.; Bentley C.; Prinsloo R.; Kovoor J.G.; Jacob
M.O.; Gupta A.
Institution
(Carmichael, Prinsloo, Bentley, Prinsloo, Kovoor, Jacob) University of
Melbourne, Melbourne, VIC, Australia
(Carmichael, Kovoor, Jacob) Grampians Health, Ballarat, VIC, Australia
(Prinsloo) Western Hospital, Footscray, VIC, Australia
(Bentley) St Vincent's Hospital, Fitzroy, VIC, Australia
(Prinsloo) Cairns and Hinterland Hospital and Health Service, Cairns, QLD,
Australia
(Gupta) Department of Surgery, University of Adelaide, Adelaide, SA,
Australia
Publisher
SAGE Publications Inc.
Abstract
Introduction: Coronary artery bypass graft (CABG) surgery is performed
globally around 400,000 times annually. Despite its benefits, CABG can
lead to complications, including chylothorax, a rare condition where chyle
accumulates in the pleural cavity due to thoracic duct trauma. Currently,
there are no international guidelines for traumatic chylothorax management
post-CABG. This is the first systematic review to provide a comprehensive
overview of the current state of management for chylothorax post-CABG.
 Method(s): This systematic review was conducted by searching EMBASE,
Cochrane, Ovid and PubMed databases on 16 June 2024. The inclusion
criteria focused on studies addressing post-CABG chylothorax management
and reporting clinical outcomes. Data was extracted from 11 studies
focusing on graft type, complications and management strategies.
 Result(s): This review included 11 case report studies with 14 cases
of post-CABG chylothorax. Conservative management was attempted in all
cases, with varying components such as total parenteral nutrition, nil by
mouth, octreotide and low-fat diets. High-output chylothorax (>1000
mL/day) often necessitated surgical intervention after an average of 12.5
days of conservative management. Surgical approaches included thoracic
duct ligation, embolisation and pleurodesis. Surgical ligation was
effective in three cases, while thoracic duct embolisation was successful
in one case. Conclusion(s): Chylothorax post-CABG is managed
initially with conservative strategies, but high-output cases often
necessitate surgical intervention. This review highlights the need for
standardised guidelines, regarding the timing of surgical escalation and
the use of octreotide and somatostatin. Further research should focus on
higher-powered studies to validate these findings and establish clinical
guidelines for managing chylothorax post-CABG. Copyright © The
Author(s) 2025.

<70>
Accession Number
2037873309
Title
Waist circumference and body surface area and the risk of developing
new-onset atrial fibrillation: A systematic review and meta-analysis of
observational studies.
Source
Heart and Lung. 72 (pp 1-12), 2025. Date of Publication: 01 Jul 2025.
Author
Shojaei S.; Radkhah H.; Akhlaghipour I.; Shad A.N.; Azarboo A.; Mousavi A.
Institution
(Shojaei, Azarboo, Mousavi) Tehran Heart Center, Cardiovascular Diseases
Research Institute, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Shojaei, Mousavi) School of Medicine, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Radkhah) Sina Hospital Department of Internal Medicine, Tehran, Iran,
Islamic Republic of
(Akhlaghipour, Shad) Student Research Committee, Faculty of Medicine,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Elsevier Inc.
Abstract
Background: Atrial fibrillation (AF) is a prevalent cardiac arrhythmia
with significant health consequences. Identifying modifiable risk factors,
such as obesity, is crucial. While body mass index (BMI) is linked to
increased AF risk, the association between new-onset AF (NOAF) and other
anthropometric measures like waist circumference (WC) and body surface
area (BSA) warrants further investigation. Objective(s): This
systematic review and meta-analysis aimed to compare mean WC and BSA
between individuals who developed NOAF and those who did not.
 Method(s): We conducted a comprehensive search up to February 2024
for studies comparing mean WC and BSA in groups with and without incident
NOAF. Participants had no prior AF history. We used a random-effects model
to calculate standardized mean differences (SMDs) and 95 % confidence
intervals (CIs). Subgroup analyses explored NOAF occurrence following
coronary artery bypass graft (CABG) surgery, in the absence of any
preceding procedure, and after other cardiac procedures. Result(s):
Our analysis of 34 studies revealed that adults with NOAF had
significantly higher WC (SMD = 0.20, 95 % CI 0.01; 0.39) and BSA (SMD =
0.06, 95 % CI 0.01; 0.11) compared to those without NOAF. Subgroup
analysis showed a more pronounced association in individuals developing
NOAF after CABG (SMD = 0.33, 95 % CI 0.17; 0.48) and in those without any
prior procedure before NOAF diagnosis (SMD = 0.23, 95 % CI 0.08; 0.38)
versus those without NOAF. Conclusion(s): Higher WC and BSA appear to
be significantly associated with an increased risk of NOAF, with the
relations being more pronounced in specific subgroups. Copyright
© 2025

<71>
Accession Number
646743902
Title
COMPARE CABG: A Meta- Analysis of Comparative Outcomes in On- Pump vs.
Off-Pump Coronary Artery Bypass Grafting.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Da Nobrega Borges J.V.; Machado M.; Leila S.
Institution
(Da Nobrega Borges) University of Sao Paulo, Sao Paulo, Brazil
(Machado) Clinica Central de Diagnostico, Vilhena, Rondonia, Brazil
(Leila) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Coronary artery bypass grafting (CABG) can be performed using
onpump or off-pump techniques. The optimal approach remains debated.
 Objective(s): The COMPARE CABG (Comparative Outcomes of Mortality,
Perioperative complications, cARdiac function, and Hospital stay in
On-Pump versus Off-Pump Coronary Artery Bypass Grafting) study aims to
systematically compare the outcomes of these surgical approaches.
 Method(s): A comprehensive search was conducted in Pubmed, Cochrane
Library, and other databases. Studies with a sample size > 4000 were
included. Outcomes analyzed included mortality, complications, cardiac
function, and hospital stay. Result(s): Meta-analysis of 5 studies
with 58,232 patients showed that off-pump CABG was associated with a
slightly lower complication rate: 15% for on-pump CABG and 13.5% for
off-pump CABG with a pooled effect size of 0.90 (95% CI: 0.85-0.95). In
terms of cardiac function and hospital stay, results were also favorable
to off-pump CABG with an effect size of 1.12 (95% CI: 1.05-1.19) and 1.15
(95% CI: 1.10-1.20), respectively. The pooled mortality rate was 2.5% for
on-pump and 2.4% for off-pump CABG, with an effect size of 1.05 (95% CI:
0.98-1.12), indicating no significant difference between the groups.
 Conclusion(s): These findings suggest that off-pump CABG may be a
preferable option for reducing surgical complications, though both
techniques yield comparable mortality outcomes. Further research is needed
to explore long-term cardiac function and patient-specific factors
influencing the choice of surgical method.

<72>
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Accession Number
646742539
Title
Safety and Efficacy of Self-Expanding vs Balloon-Expandable Valves for
Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis: A
Systematic Review and Real- World Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Siddiqui A.H.; Mansoor J.; Habib H.; Devi P.; Waheed M.; Hotwani P.;
Saleem K.; Kumar L.; Kumar M.
Institution
(Siddiqui) Dow University of Health Sciences, Sindh, Karachi, Pakistan
(Mansoor) Aga Khan University, Karachi, Pakistan
(Habib) Rawal Institute of Health Sciences, Islamabad, Pakistan
(Devi) Liaquat University of Medical and Health Sciences, Hyderabad,
Pakistan
(Waheed) Rawal Institute of Health, Islamabad, Pakistan
(Hotwani) Parkview Heath, Fort Wayne, IN, United States
(Saleem) Altamash Institute of Dental Medicine, Karachi, Pakistan
(Kumar, Kumar) Shaheed Mohtarma Benazir Bhutto Medical College, Karachi,
Pakistan
Publisher
Lippincott Williams and Wilkins
Abstract
Background: There are two approved methods for transcatheter aortic valve
replacement (TAVR) namely balloon-expandable valves (BEV) and
self-expanding valves (SEV). While several randomized controlled trials
(RCTs) have compared the efficacy of SEV and BEV, the generalizability of
their findings is questioned. Therefore, to generate concrete evidence
regarding the superiority between the two, we conducted this real-world
meta-analysis to compare the clinical efficacy and safety outcomes of SEV
vs BEV in patients undergoing TAVR for aortic stenosis (AS).
 Method(s): MEDLINE, EMBASE, and Scopus were queried to shortlist
studies including AS patients undergoing TAVR. Primary outcomes included
30-day and 1- year all-cause and cardiac mortality. Secondary outcomes
were permanent pacemaker implantation (PPI), paravalvular leak (PVL),
aortic regurgitation (AR), stroke, major vascular complications (MVC),
major bleeding (MB), acute kidney injury (AKI), myocardial infarction
(MI), length of stay (LOS), patient prosthesis mismatch (PPM), and atrial
fibrillation (AF). A random effects meta-analysis was conducted to derive
risk ratios and mean differences with corresponding 95% confidence
intervals (CI). Result(s): Our meta-analysis included 38 real-world
studies. No significant association was seen in 30-day (RR=1.13, P=0.15)
and 1-year all-cause mortality (RR=1.04, P=0.55), and cardiac mortality
(RR=1.28, P=0.12). SEV was associated with a higher risk of 30-day PPI
(RR=1.61, 95% CI 1.28-2.02, I2 = 88%, P<0.0001), mild PVL (RR=1.52, 95% CI
1.17-1.97, I2=76%, P=0.002), and moderate to severe PVL (RR=1.97, 95% CI
1.43-2.72, I2=51%, P<0.0001). Patients in the SEV group experienced more
statistically significant AR (RR=1.72, 95% CI 1.29-2.30, I2=27%,
P=0.0002), and 30-day MVC (RR=1.1, 95% CI 1.02-1.2, I2=0%, P=0.02) when
compared to the BEV group. No statistically significant association was
established for stroke, MB, AKI, MI, LOS, PPM, and AF. Conclusion(s):
Our real-world analysis showed that SEV increases the risk of PPI, PVL,
AR, and MVC. However, all-cause and cardiovascular mortality were
comparable between both groups. Our results confirm the conclusions drawn
from RCTs, thus reassuring decision-makers that these findings can be
extrapolated to real-world populations.

<73>
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Accession Number
646742987
Title
Partial Cardiac Denervation To Prevent Postoperative Atrial Fibrillation
After Coronary Artery Bypass Grafting: A Randomized Controlled Trial.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Yang Z.; Tiemuerniyazi X.; Xu F.; Sun Y.; Yan P.; Tian L.; Han C.; Zhang
Y.
Institution
(Yang, Tiemuerniyazi, Xu, Sun, Yan, Tian, Han, Zhang) Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy Peking Union
Medical College, Beijing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative atrial fibrillation (POAF) is commonly seen in
patients undergoing coronary artery bypass grafting (CABG), increasing the
risk of both shortterm and long-term clinical adverse events. This study
aimed to evaluate the effectiveness of partial cardiac denervation, which
is achieved by cutting off the ligament of Marshall (LOM) and resecting
the fat pad along the Waterston groove, on the prevention of POAF after
CABG. Method(s): In this single-center randomized controlled study,
patients planned for isolated CABG were recruited during August 2022 and
December 2023, then randomized into the intervention group (CABG + partial
cardiac denervation) and the control group (CABG only) in a 1:1 pattern.
All the participants were continuously monitored for the incidence of POAF
through electrophysiologic device till day 6 after the operation, and
invited to follow-up visits 30 days after discharge. The primary endpoint
was the incidence of POAF, while the secondary endpoints were the safety
and economics outcomes. Result(s): A total of 430 patients were
enrolled (215 in the intervention vs. 215 in the control). The mean age
was 61.9 +/- 7.8 years, and 18.4% of them were female. Baseline
characteristics were well balanced after ramdomizaiton. All participants
underwent successful CABG and each one in the intervention group received
scheduled partial cardiac denervation procedure. Compared with the control
group, the 6-day incidence of POAF was significantly lower in the
intervention group (18.1% vs. 31.6%, p=0.001). The time-to-event analysis
also showed a significant reduction in the occurrence of POAF in the
intervention group (hazard ratio: 0.53, 95% confidence interval: 0.36 to
0.79, p = 0.002). Similar effect was observed in the subgroup analysis.
Safety assessments showed no difference between the two groups, for the
incidence of need for blood transfusion, transferring to on-pump CABG,
re-operation for postoperative bleeding, delayed epicardial effusion,
critical arrhythmias other than atrial fibrillation and major adverse
events in the 30-day follow up. The economic assessments showed that
postoperative medical cost was reduced in the intervention group
(p=0.050). Conclusion(s): Partial cardiac denervation through cutting
off the LOM and resecting the fat pad along the Waterston groove, was an
effective and safe procedure to reduce the occurrence of POAF after
isolated CABG.

<74>
Accession Number
646742427
Title
Machine-learning versus traditional risk scores for predicting clinical
outcomes after coronary artery bypass graft surgery: a systematic review
and metaanalysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Gupta A.; Zaka A.; Mutahar D.; Muston B.; Tyagi D.; Farag M.; Lombardo A.;
Stretton B.; Parvez R.
Institution
(Gupta, Zaka) Gold Coast University Hospital, Southport, QLD, Australia
(Mutahar, Stretton, Parvez) Bond University, QLD, Australia
(Muston) Royal Prince Alfred Hospital, Sydney, NSW, Australia
(Tyagi) University of Newcastle, Newcastle, NSW, Australia
(Farag) Griffith University, Southport, QLD, Australia
(Lombardo) Princess Alexandra Hospital, Brisbane, QLD, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Coronary Artery Bypass Graft Surgery (CABG) is the most
commonly performed operation in cardiac surgery and results from isolated
CABG are used as benchmark to rate cardiac surgery programs in the US by
the Society of Thoracic Surgeons (STS). Accurate and reliable mortality
risk prediction of CABG patients is essential for developing targeted
treatment strategies. Traditional risk scores such as the STS score and
EuroSCORE II offer moderate discriminative value, and have limited utility
in predicting outcomes for high-risk patients. Machine learning (ML)
models have emerged as an alternate method that may offer improved risk
assessment. This study aims to compare machine learning models with
traditional risk scores for predicting all-cause mortality in patients
undergoing CABG. Method(s): PubMed, EMBASE, Web of Science and
Cochrane databases were searched until 18 May 2024 for studies comparing
ML models with traditional statistical methods for event prediction of
CABG patients. The primary outcome was comparative discrimination measured
by C-statistics with 95% confidence intervals between ML models and
traditional methods in estimating the risk of all-cause mortality. A
secondary aim was to compare model calibration between ML models and
traditional risk scores, adhering to guidelines for predictive algorithm
comparisons. Result(s): A total of 27 studies were included (568,190
patients). The summary Cstatistic of all ML models across all endpoints
was 0.82 (95% CI, 0.78-0.85), compared to traditional methods 0.73 (95%
CI, 0.70-0.75). The difference in C-statistic between all ML models and
traditional methods was 0.09 (p<0.0001). One model undertook external
validation, and calibration was inconsistently reported.
 Conclusion(s): ML models demonstrated superior discrimination of
all-cause mortality for CABG patients compared to traditional risk scores.
Whilst there is great potential for ML models to be integrated into
electronic healthcare systems to improve preth operative risk
stratification, and guide clinical decision making, the methodological and
validation limitations pose a hurdle for immediate clinical
implementation.

<75>
Accession Number
2033650696
Title
Management of Acute Ischemic Stroke Following Transcatheter Aortic Valve
Implantation: A Systematic Review and Multidisciplinary Treatment
Recommendations.
Source
Journal of Clinical Medicine. 13(23) (no pagination), 2024. Article
Number: 7437. Date of Publication: 01 Dec 2024.
Author
Hammond-Haley M.; Almohtadi A.; Gonnah A.R.; Raha O.; Khokhar A.; Hartley
A.; Khawaja S.; Hadjiloizou N.; Ruparelia N.; Mikhail G.; Malik I.;
Banerjee S.; Kwan J.
Institution
(Hammond-Haley, Almohtadi, Gonnah, Khokhar, Hartley, Khawaja, Hadjiloizou,
Ruparelia, Mikhail, Malik) National Heart and Lung Institute, Hammersmith
Hospital, Imperial College London, London, United Kingdom
(Raha) Oxford University Hospitals NHS Trust, Oxford, United Kingdom
(Banerjee, Kwan) Department of Brain Sciences, Imperial College London,
London, United Kingdom
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Acute ischemic stroke is an uncommon but
potentially devastating complication of Transcatheter Aortic Valve
Implantation (TAVI). Despite improvements in device technology and
procedural techniques, stroke rates have remained stable, with cerebral
embolic protection devices demonstrating only limited efficacy to date.
Therefore, the management of acute ischemic stroke complicating TAVI
(AISCT) remains a key priority. We conducted a systematic review of the
management of AISCT and provided multidisciplinary consensus
recommendations for optimal management. Method(s): PubMed, Google
Scholar, and Cochrane databases were searched from inception to October
2023. All the original studies focusing on the treatment of AISCT were
included. Non-English language studies, review articles, and studies in
pediatric populations were excluded. Consensus recommendations were made
by a working group comprising experts in stroke medicine and structural
interventional cardiology. Result(s): A total of 18 studies met the
inclusion criteria, including 14 case reports/series and 4 observational
studies. No clinical trials were identified. The included case reports and
series suggest that tissue-type plasminogen activator (tPA) and mechanical
thrombectomy (MT) might be effective strategies for managing AISCT.
However, significant bleeding complications were reported in two out of
the four patients receiving tPA. Four observational studies also suggest
an association between tPA and/or MT and improved functional outcomes and
survival compared to conservative management. Higher bleeding rates were
reported following tPA. Observational data suggest that there is currently
little real-world utilization of either reperfusion strategy.
 Conclusion(s): There is an absence of high-quality randomized data to
guide clinical decision making in this important area. Observational data
suggest reperfusion strategies are associated with improved clinical
outcomes once important confounders such as stroke severity have been
accounted for. While MT can be recommended as the standard of care in
appropriately selected patients, significantly increased rates of bleeding
with tPA following large-bore arterial access raise important safety
concerns. We present simple clinical guidance for AISCT based on the
limited available data. Close multidisciplinary work and patient-specific
consideration of ischemic and bleeding risk is essential. Copyright
© 2024 by the authors.

<76>
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Accession Number
646742312
Title
Semaglutide and cardiovascular outcomes by blood pressure in the SELECT
trial.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Verma S.; Deanfield J.; Arbel Y.; Cariou B.; Jeppesen O.K.; Hovingh G.K.;
Matos A.L.S.A.; Latkovskis G.; Kahn S.
Institution
(Verma) St Michael's Hospital in Toronto, University of Toronto, Toronto,
ON, Canada
(Deanfield) Institute of Cardiovascular Science, University College
London, London, United Kingdom
(Arbel) Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel
Aviv University, Tel Aviv, Israel
(Cariou) Nantes Universite, CHU Nantes,CNRS,INSERM, L'institut du thorax,
Nantes, France
(Jeppesen, Hovingh, Matos) Novo Nordisk A/S, Copenhagen, Denmark
(Latkovskis, Kahn) Department of Medicine, VA Puget Sound Health Care
System and University of Washington, Seattle, WA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Although glucagon-like peptide-1 receptor agonists have been
shown to reduce BP and major cardiovascular adverse events (MACE), little
is known about whether the benefits of these therapies vary in individuals
with hypertension (HT) or across the spectrum of BP categories. Research
Question and Aim: To evaluate the effect of once-weekly semaglutide 2.4 mg
vs placebo on cardiovascular (CV) outcomes by baseline BP categories in
SELECT. Method(s): SELECT was a double-blind, randomized,
placebo-controlled trial that included patients aged >=45 years with
preexisting CV disease and BMI >=27 kg/m2 without diabetes.
Patients received onceweekly semaglutide 2.4 mg or placebo; the primary
endpoint was time to first MACE analyzed with a Cox proportional hazards
model with semaglutide and placebo as fixed factors according to baseline
BP categories. Result(s): Among 17,604 randomized patients, 14,392
(82%) had a history of HT. Patients with history of HT were older and more
likely female, with a higher BMI, lower eGFR, and higher UACR. A higher
proportion presented with atrial fibrillation, obstructive sleep apnea,
and heart failure NYHA class II/III, but fewer underwent coronary
revascularization (Table). Patients with HT who received placebo had a
higher incidence rate of MACE vs semaglutide (2.6 vs 2.1 per 100
patient-years, respectively). Semaglutide generally exhibited consistent
benefits for CV outcomes regardless of history of HT or baseline BP
categories (Figure). Compared with placebo, semaglutide significantly and
consistently reduced systolic BP (SBP) across BP categories (normal, -2.9
[95% CI-4.0; -1.9]; elevated BP, -2.8 [-4.0; -1.6]; stage 1, -3.4: [-4.1;
-2.6]; stage 2, -3.7 [- 4.4; -2.9]). Conclusion(s): HT is highly
prevalent in people with overweight or obesity and atherosclerotic CV
disease without diabetes and is associated with increased MACE.
Semaglutide led to consistent reductions in MACE and lowered SBP
irrespective of baseline BP category.

<77>
Accession Number
646742565
Title
Perioperative Aspirin and Coronary Artery Bypass Graft Surgery: An Updated
Meta-Analysis of Randomised Controlled Trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Gupta A.; Zaka A.; Lombardo A.; Baccoi S.; Kovoor J.; Stretton B.;
Tsimiklis J.; Chcin J.; Ramponi F.
Institution
(Gupta, Zaka) Gold Coast University Hospital, Southport, QLD, Australia
(Lombardo) Princess Alexandra Hospital, Brisbane, QLD, Australia
(Baccoi, Kovoor, Stretton, Tsimiklis) University of Adelaide, Adelaide,
SA, Australia
(Chcin, Ramponi) Yale University, New Haven, CT, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The decision to continue Aspirin before elective coronary
artery bypass graft surgery remains contentious due to competing
thrombotic and bleeding risks. We performed a contemporary systematic
review and meta-analysis to compare outcomes between CABG patients who
stopped and continued aspirin before surgery. Method(s): PubMed,
MEDLINE and CENTRAL databases were searched from inception to 4 May 2024
for randomized controlled trials (RCTs) comparing patients undergoing CABG
who continued preoperative aspirin with those who discontinued before
surgery. Studies with co-intervention arms and multivariable-adjusted or
propensity matched observational studies were excluded. Summary odds
ratios were calculated using a random effects model for dichotomous and
continuous variables. Subgroup and sensitivity analyses were conducted in
order to explore sources of heterogeneity. Result(s): Sixteen
eligible RCTs were included with a total of 6188 patients. Patients who
continued Aspirin demonstrated no significant difference in all-cause
mortality [OR 1.37 (0.81-2.33)], perioperative myocardial infarction [OR
0.81 (0.55-1.18)] and postoperative blood loss [mean difference 66.12mL
(-1.45-133.69)]. No significant difference was observed between low-dose
and higher doses of Aspirin. There was minimal heterogeneity amongst
included studies (i = 0%, p=0.97, i =33%, p=0.13 and i =76, p=0.06
respectively). Studies were of low methodological quality according to
Cochrane Risk of Bias for Randomized Trials. Conclusion(s): This
largest to-date systematic review and meta-analysis found no significant
difference for risk of all-cause mortality, perioperative myocardial
infarction, and postoperative bleeding between patients continuing and
stopping Aspirin before CABG.

<78>
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Accession Number
646742382
Title
Multiple Arterial Graft Use: Sustained Quality Improvement Following a
Targeted Assessment and Programmatic Intervention.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Chinedozi I.; Daskam M.; Briscoe J.; Kumar N.; Darby Z.; Sangalang J.;
Kancj J.K.; Kpuska V.; Behrens K.
Institution
(Chinedozi, Daskam, Briscoe, Kumar, Darby, Sangalang, Kancj, Kpuska,
Behrens) Johns Hopkins University, Baltimore, MD, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction/Background: Multiple arterial grafting (MAG) provides
superior outcomes compared to single arterial grafting in coronary artery
bypass graft (CABG) patients. Studies and meta-analyses demonstrate MAG's
association with improved survival, reduced major adverse cardiac events,
and lower repeat revascularization rates. Despite strong evidence and
guidelines, MAG utilization remains low nationally, ranging from 4-11%.
Surgeons cite concerns such as advanced age, diabetes, and high body mass
index (BMI) for not employing MAG. An educational and quality improvement
initiative raised MAG usage from 11% to over 30% at one academic
institution. This study reassesses MAG adoption trends and barriers three
years later at the same institution. Research Question/Hypothesis: We
investigated whether the increased adoption of MAG after a quality
improvement initiative was sustained three years later. We hypothesized
that MAG utilization would remain elevated due to the lasting impact of
initial educational efforts, though some barriers might persist.
Methods/Approach: We assessed MAG utilization and surgeons' reasons for
not using MAG in isolated CABG procedures with two or more grafts over a
four-month period. This evaluation aimed to determine if the previous
quality improvement initiative's adoption of MAG was sustained
post-implementation. The study analyzed MAG use frequency and surgeons'
justifications for alternative methods, including patient outcomes,
surgeon preferences, and institutional practices. Result(s): A total
of 92 patients were included, with MAG used in 28 cases (30.4%). The MAG
use rate three years earlier following the quality initiative was 30.5%.
Predominant reasons for not using MAG were age > 65 (29.9%), diabetes
(18.8%), BMI >=35 (14.1%), and non-critical disease (9.4%), similar to
concerns from three years prior: age >75 (30.8%), diabetes (23.1%), and
BMI > 35 (22.9%) (Figure 1). Conclusion(s): The sustained adoption
rate of MAG among cardiac surgeons at one institution highlights the
complexities of changing surgical practices, even with targeted
educational efforts. Continuous support and educational initiatives led by
surgeon-champions are crucial for enhancing long-term adoption of
evidence-based practices like MAG, ultimately improving patient care.
Dedicated mentoring and regular training updates significantly influence
the integration of advanced surgical techniques into routine practice,
advancing patient treatment quality .

<79>
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Accession Number
646742498
Title
Impact of Sodium- Glucose Cotransporter 2 Inhibitors on Acute Kidney
Injury Post Coronary Artery Bypass Grafting :A Retrospective Cohort Study
and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Zhou X.; Yang X.; Hua K.
Institution
(Zhou, Yang, Hua) Beijing Anzhen Hospital, Capital Medical University,
Beijing Institute of Heart, Beijing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: sodium-glucose cotransporter 2 inhibitors (SGLT2i), a new type
of oral hypoglycemics agent used to treat type 2 diabetes, have a positive
effect on the progression of heart failure, but there is a concern with
the association between SGLT2i and acute kidney injury (AKI).
 Material(s) and Method(s): We retrospectively evaluated consecutive
patients undergoing CABG surgery from January 2018 to December 2021 in the
hospital. A cohort of patients who had been prescribed SGLT2i was
identified and matched by propensity score with a cohort of patients who
had not been prescribed SGLT2i in a ratio of 1:3. The primary outcome was
AKI following CABG. Furthermore, a metaanalysis was conducted on the
relationship between SGLT2i and acute kidney injury (AKI). Four studies,
comprising a total of 25,116 patients, were included in the analysis.
 Result(s): A total of 403 patients who had received SGLT2i and 1209
without SGLT2i were included in the analysis. AKI was observed in 54
patients (13.4%) in the SGLT2i group and 373 patients (30.9%) in the
non-SGLT2i group following CABG. The SGLT2i exhibited a lower incidence of
AKI compared with the non-SGLT2i (P < 0.001). The findings of the
meta-analysis indicated that SGLT2i was associated with a decreased
incidence of AKI (P < 0.001; OR= 0.525, [95% CI, (0.437-0.631]).
 Conclusion(s): The results of our prospective study indicated a
reduced risk of AKI in patients undergoing CABG and were treated with
SGLT2i.

<80>
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Accession Number
646742317
Title
Association of Vasoactive-Inotropic Score and Poor Outcomes, Including
Mortality, in Patients Who Underwent Coronary Artery Bypass Grafting: A
Systematic Review and Meta- Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Damarlapally N.; Vempati R.; Vasudevan S.S.; Mathur G.; Banda P.; Khan A.;
Desai R.; Polamarasetty MBBS H.; Mourad D.
Institution
(Damarlapally) Houston Community, College - Coleman Campus, Houston, TX,
United States
(Vempati) Gandhi Medical College and Hospital, Telangana, Secunderabad,
India
(Vasudevan) Lousiana State University, Health Sciences Center, Shreveport,
LA, United States
(Mathur, Banda) Mahatma Gandhi Memorial Medical College, Indore, India
(Khan) Central Michigan University, Saginaw, MI, United States
(Desai, Polamarasetty MBBS, Mourad) University of Houston, Houston, TX,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Vasoactive-inotropic score (VIS) has been previously utilized
as one of the predictors in open heart procedures postoperatively, but its
association with poor outcomes in patients who underwent coronary artery
bypass graft (CABG) is still unclear. We aim to find the association in
this population. Method(s): PubMed, Google Scholar, and Scopus were
systematically searched for studies showing an association of poor
cardiovascular (CV) outcomes, including mortality with VIS from inception
to May 2024 following CABG surgery. Pooled effect sizes were estimated
using a fixed-effect model and 95% confidence intervals (CI). I statistics
was used to measure heterogeneity. Leave-one-out sensitivity analysis and
meta-regression analysis were utilized to measure the robustness of our
findings and detect influencing confounding variables, respectively.
Quality assessment of the studies was done through the Joanna Briggs
Institute (JBI) tool. P-value <0.05 was considered significant.
 Result(s): Six studies with a total sample size of 6504 patients
following CABG surgery, with a mean age of 63.6 +/- 3.15 years, containing
predominantly males (71.8%) reported poor outcomes such as CV morbidity,
cardiopulmonary resuscitation, mechanical ventilation, stroke, and
mortality. Most studies had hypertension, diabetes, and chronic kidney
disease as comorbidities. Our meta-analysis found a significant
association between VIS > 5 and poor outcomes, including mortality in six
studies with pooled unadjusted OR-1.08 [95% CI: 1.06-1.10, p < 0.0001] and
in four studies with adjusted OR-1.07 [95% CI: 1.04-1.09, p < 0.0001]
among those who underwent CABG (Figure 1a). Sensitivity analysis showed no
variations among studies and confirmed the robustness of our findings
(Figures 2a&2b). Additionally, meta- regression analysis indicated that
mean age was associated with a minimal progression rate of mortality in
patients succeeding CABG with a VIS > 5 (p = 0.04). (Figure 1b) High
scores in the JBI tool revealed high quality among the studies selected.
 Conclusion(s): Our study suggests that there is a significant
association of VIS > 5 with poor cardiovascular outcomes in patients
following CABG surgery. This association can help in preventing
deleterious cardiovascular outcomes.

<81>
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Accession Number
646742440
Title
Radial Artery Pseudoaneurysm Following Transradial Cardiac
Catheterization: A Systematic Review and Case Report.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Chinedozi I.; Sulague R.M.; Kilic A.; Kang J.K.; Darby Bo Z.; Juboori H.;
Le A.; Kumar N.; Athipathy N.
Institution
(Chinedozi) Johns Hopkins University, Baltimore, MD, United States
(Sulague) Cedars-Sinai Medical Center, Los Aeles, CA, United States
(Kilic, Kang, Darby Bo, Juboori, Le, Kumar, Athipathy) Johns Hopkins
University, Baltimore, MD, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction/Background: Transradial cardiac catheterization (TRC) is
recommended for patients with acute coronary syndrome over femoral artery
catheterization. Randomized controlled trials show TRC has significantly
lower rates of bleeding, vascular complications, and mortality in
high-risk acute coronary syndrome patients. However, vascular
complications like radial artery spasm, occlusion, arteriovenous fistula,
perforation, and pseudoaneurysm (PSA) can still occur. Despite TRC's
widespread adoption, recent data summarizing radial artery pseudoaneurysm
post-TRC is lacking. Research Question/Hypothesis This review aims to
identify at-risk patients, present a case of catheterization-related
radial artery pseudoaneurysm, and provide diagnostic and management
insights. We hypothesize that older patients with hypertension are at
higher risk and that early detection and management are associated with
low complication rates. Methods/Approach: Systematic searches were
conducted in PubMed, Web of Science, EMBASE, and CINAHL databases. Two
researchers independently selected articles, extracted data, and evaluated
study quality on RA PSA post-TRC (2003- 2023). A third reviewer resolved
conflicts. The Joanna Briggs Institute (JBI) tool was used to evaluate
bias risk. Additionally, a case report is presented. Result(s): From
3,262 records, 43 studies were selected, involving 67 patients (58.8%
female, median age 73.5 years). Hypertension (39.5%) and atrial
fibrillation (27.9%) were the most common comorbidities. Percutaneous
interventions like stenting and angioplasty caused 58.1% of cases;
diagnostic catheterizations accounted for 37.2%. Ultrasonography diagnosed
83.7% of cases. Symptoms appeared a few hours to four months post-TRC,
with pulsatile mass (21.4%) and swelling (14.3%) being the most common,
and pain and ecchymosis at 2.4% each. More than half of the patients
(51.2%) required surgical intervention, but 66.7% recovered without
deficits. Severe complications were rare, affecting fewer than 5%.
 Conclusion(s): A literature review of 43 articles with 67 patients
suggests older female patients with hypertension may be more prone to
radial artery pseudoaneurysm post- TRC. It typically presents as a
pulsatile, painful swelling detectable by ultrasound. This complication
precludes the use of the radial artery as a conduit for coronary artery
bypass grafting. The review highlights the importance of vigilant
post-catheterization monitoring to enable early detection and treatment .

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Accession Number
646742761
Title
Direct Oral Anticoagulants vs Vitamin K Antagonists for Cardiovascular
Interventions: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Martinez E.C.; Salazar Ore J.V.; Miret Durazo C.I.; Gonzalez N.A.Z.; Salas
Y.Z.; Navarro E.M.; Betances C.; Rodriguez E.E.G.; Floridia L.
Institution
(Martinez) University of Texas Science Medical Center at Houston, Houston,
TX, United States
(Salazar Ore) Universidad de Buenos Aires, Buenos Aires, Argentina
(Miret Durazo) Centro de Estudios Universitarios Xochicalco, Tijuana,
Mexico
(Gonzalez) Universidad Juarez del Estado de Durango, Durango, Mexico
(Salas) Universidad Juarez Autonoma de Tabasco, Tabasco, Mexico
(Navarro) Universidad Autonoma de Guadalajara, Guadalajara, Mexico
(Betances) Universidad Tecnologica de Santiago, Santiago, Dominican
Republic
(Rodriguez) Brookdale University Hospital and Medical Center, Brooklyn,
NY, United States
(Floridia) Universidad Nacional del Litoral, Santa fe, Argentina
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Anticoagulation therapy is crucial in enhancing
perioperative outcomes, yet uncertainty persists regarding the optimal use
of Direct Oral Anticoagulants (DOACs) and Vitamin K Antagonists (VKAs) in
cardiovascular interventions. Key outcomes such as bleeding,
thromboembolic events, and mortality are critical. Conducting a thorough
review is essential to make well-informed decisions that improve patient
quality of life and mitigate complications. Hypothesis: This meta-analysis
aimed to investigate whether Direct Oral Anticoagulants (DOACs) reduce
perioperative complications such as bleeding, thromboembolic events, and
mortality compared to Vitamin K Antagonists (VKAs) in patients undergoing
cardiovascular procedures. Method(s): The present study was conducted
in accordance with PRISMA guidelines. A systematic search was conducted in
PubMed, MEDLINE, Scopus, Web of Science, Cochrane, and EMBASE databases on
05/14/2024. Data extraction was rigorously performed, and a random-effects
model was used for data synthesis. Result(s): The review included 25
studies involving a total of 25,754 patients. For bleeding risk, the
meta-analysis showed that DOACs are associated with a lower risk compared
to VKAs, with a relative risk (RR) of 0.69 (95% CI: 0.51 to 0.94, p =
0.0457, I = 60%). Thromboembolic events showed no significant difference
between DOACs and VKAs (RR: 1.13, 95% CI: 0.74 to 1.73, p = 0.5313, I =
15%). Mortality outcomes also showed no significant difference (RR: 0.53,
95% CI: 0.20 to 1.43, p = 0.1622, I = 68%). Conclusion(s): The
systematic review and meta-analysis demonstrate that DOACs are associated
with a lower risk of bleeding compared to VKAs, with no significant
difference in thromboembolic events and mortality. This evidence supports
the substantial benefit of DOACs in cardiovascular interventions. Further
research is needed to consolidate these findings and improve patient
outcomes.

<83>
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Accession Number
646742383
Title
Dexmedetomidine for prevention of postoperative delirium in patients
undergoing cardiac surgery: a meta-analysis of randomized controlled
trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Barbosa L.; Tavares A.; Queiroz I.; Mesquita C.
Institution
(Barbosa) Federal University of Minas Gerais, Belo Horizonte, Brazil
(Tavares) University of Pernambuco, Recife, Brazil
(Queiroz) Universidade catolica de Pernambuco, Recife, Brazil
(Mesquita) Federal University of Pernambuco, Recife, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative delirium is a prevalent complication following
cardiac surgery. In recents studies, dexmedetomidine has been proposed as
a potential alternative to mitigate this condition. This meta-analysis
aimed to evaluate the efficacy of dexmedetomidine for prevention of
postoperative delirium after cardiac surgery. Method(s): We
systematically searched PubMed, Embase, and Cochrane databases for
randomized controlled trials (RCTs) analyzing the efficacy of
dexmedetomidine compared to placebo in patients undergoing cardiac
surgeries. We pooled risk ratios (RR) for binary outcomes with 95%
confidence intervals (CI) with a random-effects model. We used R version
4.3.2 for all statistical analyses. Result(s): Our meta-analysis
included 12 RCTs comprising 3016 patients, of whom 1515 (50.2%) were
randomized to dexmedetomidine. The mean age ranged from 43 to 74 years
among studies. Compared with placebo, dexmedetomidine significantly
reduced the incidence of postoperative delirium (RR 0.67; 95% CI: 0.48 to
0.95; p<0.05; Figure A). However, there were no significant differences in
hypotension (RR 1.34; 95% CI: 0.75 to 2.42; p=0.33; Figure B), and death
(RR 0.83; 95% CI: 0.45 to 1.53; p=0.54; Figure C) between groups.
 Conclusion(s): In patients undergoing cardiac surgery dexmedetomidine
significantly reduced the incidence of postoperative delirium. Larger RCTs
are warranted to validate these results.

<84>
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Accession Number
646743210
Title
Safety and Therapeutic Potential of Allogeneic Adipose-Derived Stem Cell
Spray Transplantation in Ischemic Cardiomyopathy: A Phase I Clinical
Trial.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Kawamura T.; Yoshioka D.; Kawamura A.; Misumi Y.; Taguchi T.; Saito S.;
Yamauchi T.; Mlyagawa S.
Institution
(Kawamura) Osaka University, Osaka, Japan
(Yoshioka) OSAKA UNIVERSITY HOSPITAL, Suita Osaka, Japan
(Kawamura) Osaka University, Osaka, Suita-city, Japan
(Misumi) OSAKA UNIVERSITY, Suita, Japan
(Taguchi) Osaka university, Suita, Japan
(Saito, Mlyagawa) Osaka University, Suita, Japan
(Yamauchi) Osaka graduate school of medicine, Suita, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Ischemic cardiomyopathy, characterized by an imbalance in
myocardial blood supply due to coronary artery atherosclerosis, presents a
formidable health challenge. Although coronary artery bypass grafting
(CABG) can enhance long-term survival, a subset of patients does not
exhibit significant improvement in cardiac function post-surgery. This
study investigated the safety and therapeutic potential of allogeneic
adipose-derived stem cell (ADSC) spray transplantation combined with CABG
in ischemic cardiomyopathy. Method(s): This single-center,
double-blind, randomized clinical trial included six eligible patients
with ischemic cardiomyopathy who underwent CABG. The ADSCs, suspended in
fibrin glue, were sprayed directly onto the heart during surgery. Primary
endpoints encompassed adverse events, late gadolinium-enhanced magnetic
resonance imaging (LGE-MRI) volume changes, and feasibility. Secondary
endpoints included alterations in left ventricular function, exercise
tolerance, and heart failure symptoms. Result(s): All patients
underwent surgery successfully without complications. ADSC spray
transplantation, evidenced by a reduced LGE-MRI volume, exhibited
potential therapeutic benefits by improving left ventricular function and
exercise tolerance in the ADSC group compared to the placebo group
(Figures 1 and 2). Adverse events were minimal and primarily associated
with the CABG procedure. Conclusion(s): This study establishes the
safety and feasibility of ADSC spray transplantation combined with CABG
for the treatment of ischemic cardiomyopathy. The observed improvements in
LGE-MRI volume and cardiac function suggest a potential therapeutic
effect, warranting further investigation in larger phase II and III
clinical trials. This novel approach holds promise as a clinically viable
treatment strategy to enhance revascularization outcomes in patients with
ischemic cardiomyopathy .

<85>
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Accession Number
646742367
Title
Infrequent Cognitive Assessments in CABG Trials (from 2005- 2023)
Highlight Need for Improved Strategies for Cognitive Screening
postcoronary bypass grafting (CABG) surgery.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Srivatsa S.; Sujanthan S.; Rivera S.N.; Creber R.M.; Swartz R.
Institution
(Srivatsa) University of North Carolina, School of Medicine, Chapel Hill,
NC, United States
(Sujanthan, Swartz) SUNNYBROOK HSC, Toronto, ON, Canada
(Rivera) Columbia University, Irving Medical Center, New York, NY, United
States
(Creber) Columbia University, New York, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The incidence of cognitive decline following coronary artery
bypass grafting (CABG) is well-documented, significantly impacting patient
morbidity, mortality, and quality of life. We conducted a systematic
review that examines cognitive outcomes in CABG randomized controlled
trials (RCTs) to identify which cognitive assessments were used, their
administration frequency, attrition rates, and their effectiveness in
detecting perioperative cognitive changes in control groups.
 Method(s): We conducted a search of MEDLINE, EMBASE, Cochrane
Library, and PsycINFO for CABG RCTs that included cognitive assessments,
from January 2005 to December 2023. Descriptive statistics were used to
summarize the frequency, domains, and attrition rates of each cognitive
task. For tasks assessed both pre- and post-operatively in at least three
RCTs, control group scores and standard deviations were reported.
 Result(s): Out of 3337 screened studies, 2163 were CABG RCTs, and
only 69 (3.2%) included cognitive evaluations (Figure 1). These trials
involved 15,839 subjects (79% male, mean age 64.4, median follow-up time
90 days) and used 145 unique cognitive tasks. The Trailmaking Test Part B
(40/69; 58.0%) and Part A (38/69; 55.0%) were the most frequently used.
Only 7 tasks had means and standard deviations reported before and after
surgery in more than three RCTs, and none detected significant preto
post-operative changes. Attrition rates averaged 19.3%, with a wide range
from 0% to 62%. Figure 2 demonstrates the decline in cognitive assessments
in CABG trials over the years, with a sharp decline after 2014. Trials
that assessed cogntion after 2014 tended to favor screening tasks
(MMSE/MoCA) alone. Conclusion(s): Cognitive assessments are
infrequent in CABG trials, and existing tests fail to consistently detect
cognitive changes. To effectively evaluate and address cognitive impact
after CABG, new assessment strategies that are resilient to attrition and
practical for use in diverse trial settings are needed.

<86>
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Accession Number
646742655
Title
Massage therapy for postoperative pain in patients undergoing cardiac
surgery: a meta-analysis of randomized controlled trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Barbosa L.; Araujo B.; Queiroz I.; Barbosa J.M.; Ferreira Y.; Mesquita C.
Institution
(Barbosa) Federal University of Minas Gerais, Belo Horizonte, Brazil
(Araujo) Universidade Nove de Julho, Sao Bernardo do Campo, Brazil
(Queiroz) Universidade catolica de Pernambuco, Recife, Brazil
(Barbosa) Faculty of Medical Science Afya, Palmas, Brazil
(Ferreira) FAMINAS-BH, Belo Horizonte, Brazil
(Mesquita) Federal University of Pernambuco, Recife, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Massage therapy has been increasingly recognized as a
complementary intervention that can help alleviate pain and anxiety in
various clinical settings. However, the efficacy of this intervention in
patients undergoing cardiac surgeries remains unclear. This systematic
review and meta-analysis aims to evaluate the existing evidence of massage
therapy for postoperative pain in cardiac surgery patients.
 Method(s): We systematically searched PubMed, Embase, and Cochrane
databases for randomized controlled trials (RCTs) analyzing the efficacy
of massage therapy in patients undergoing cardiac surgeries. We pooled
standardized mean differences (SMD) for continuous outcomes with 95%
confidence intervals (CI) with a randomeffects model. We utilized mean
change from baseline values and post intervention values in separated
plots to preserve the weighting of this meta-analysis. We performed a
trial sequential analysis (TSA) to assess the random risk of postoperative
pain with mean change from baseline values. We used R version 4.3.2 and
TSA version 0.9.5.10 for statistical analyses. Result(s): Our
meta-analysis included 12 RCTs comprising 1015 patients, of whom 484
(47.7%) were randomized to massage therapy. Compared with control, massage
significant reduced postoperative pain based on mean change from baseline
values (SMD -0.47; 95% CI: -0.73 to -0.21; p<0.01; Figure A), and post
intervention values (SMD -0.47; 95% CI: -0.82 to -0.12; p<0.01; Figure B).
Additionally, massage therapy demonstrated a significant reduction in
postoperative anxiety analyzing mean change from baseline values (SMD
-0.46; 95% CI: -0.73 to -0.20; p<0.01; Figure C), and post intervention
values (SMD -0.60; 95% CI: -0.94 to -0.26; p<0.01; Figure D). For the
primary endpoint, TSA indicated a low risk of type 1 error, therefore this
result may not be conclusive. Conclusion(s): In patients undergoing
cardiac surgery, massage therapy significantly reduced postoperative pain
and anxiety.

<87>
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Accession Number
646742273
Title
Association of Preoperative Neutrophil to Lymphocyte Ratio (NLR) and
Post-operative AKI in Patients Undergoing CABG: A Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Patel B.; Jariwala P.; Lapsiwala B.; Suresh A.; Rejani A.; Patel S.;
Vanani S.; Desai R.
Institution
(Patel) Trinity Health Oakland Hospital, Pontiac, MI, United States
(Jariwala, Lapsiwala) Government Medical College, Surat, India
(Suresh) Sri Ramachandra Institute of Higher Education and Research, Tamil
Nadu, Chennai, India
(Rejani, Patel, Vanani) Medical College Baroda, Gujarat, Baroda, India
(Desai) Independent Researcher, Atlanta, GA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Inflammation is associated with pathologies including post
operative acute kidney injury (AKI). AKI is one of the common post
operative conditions which prolongs hospitalization, intensive care unit
stay and causes higher health costs and mortality. Pre-operative
neutrophil to lymphocyte ratio (NLR) has predictive value for
post-operative AKI after coronary artery bypass grafting (CABG). Hence, we
aimed to evaluate the association of pre-operative NLR and post-operative
AKI in patients undergoing CABG. Method(s): A comprehensive
literature review was conducted using PubMed, Google Scholar and SCOPUS
databases from 2000 until 2024 using related keywords to identify studies
reporting association of pre-operative NLR and post-operative AKI in
patients undergoing CABG. The data was extracted and independently
reviewed by four authors using standard forms. A random-effects model was
used to calculate odds ratios (OR) and heterogeneity was assessed using I2
statistics. The sensitivity analysis was performed using the leave-one-out
method. Result(s): Our final analysis included 6 retrospective
studies which included 1757 patients with CABG. The mean age of the
included patients was 64 years and 63.4% were males. Initial unadjusted
analysis showed higher odds of post-operative AKI in patients having
higher pre-operative NLR values with unadjusted OR 1.67, 95% CI 1.20-2.34,
p <0.001 with high heterogeneity (I2=94.89%). After adjusting for baseline
characteristics and comorbidities, odds for post-operative AKI increased
to aOR 1.69, 95% CI 1.03-2.79, p <0.001 with high heterogeneity
(I2=85.16%), which indicates stronger association after adjusting for
confounders. Leave-one-out sensitivity analysis confirmed the robustness
of these findings. Conclusion(s): Our meta-analysis suggests that
higher pre-operative NLR is associated with 69% higher risk of
post-operative AKI in patients undergoing CABG. This warrants more
prospective studies to validate these findings. Moreover, better
prediction of AKI can help to establish preventive measures to avoid
adverse outcomes including the need for renal replacement therapy or
hemodialysis in highrisk patients.

<88>
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Accession Number
646742313
Title
Efficacy And Safety Of Inhaled Nitric Oxide In Pediatric Cardiac Surgery:
A Systematic Review And Meta- Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Ramadan A.; Elrosasy A.; Ali A.; Abd al-azim H.; Kamel M.; Eid H.; Mahmoud
N.-A.; Ghimire M.; Chamay S.
Institution
(Ramadan, Elrosasy) Faculty of Medicine, Cairo universit, Cairo, Egypt
(Ali) Faculty of Medicine, Merit University, Sohag, Egypt
(Abd al-azim, Kamel, Eid, Mahmoud) Faculty of Medicine Cairo universit,
Cairo, Egypt
(Ghimire, Chamay) SBH Health System, The Bronx, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Congenital heart diseases affect one in every 100 live births.
Surgical intervention is necessary for almost half of these cases, with a
significant proportion requiring surgery within the first year after
birth. This meta-analysis aims to evaluate the efficacy and safety of
inhaled nitric oxide (iNO), selective pulmonary vasodilator, particularly
its impact on perioperative clinical outcomes such as low cardiac output
syndrome (LCOS), duration of mechanical ventilation, blood and fresh
frozen plasma (FFP) transfusion, ICU stay, and hospital stay.
 Method(s): We conducted a comprehensive search of PubMed, Scopus,
WOS, and Cochrane databases for relevant studies from inception to April
1, 2024. We included randomized controlled trials (RCTs) comparing iNO
with placebo or standard care in pediatric patients undergoing
cardiopulmonary bypass. Data extraction and quality assessment were
performed according to PRISMA guidelines and Cochrane's risk of bias tool.
Mean differences (MD) and their 95% confidence intervals (CI) were
calculated using OpenMeta [Analyst]. Result(s): We included six RCTs
in our meta-analysis. Our analysis showed that iNO significantly reduced
the duration of mechanical ventilation (MD = -5.733, 95% CI [-10.494;
-0.972]). However, no significant differences were observed between the
iNO group and the control group for hospital stay, ICU stay, or incidence
of LCOS. Safety outcomes showed no significant differences in blood or
platelet transfusion rates, though iNO was associated with statistically
significant lower FFP transfusion (MD = -5.199, 95% CI [-8.032; -2.366]).
 Conclusion(s): our review and meta-analysis highlights the potential
benefits of iNO in reducing ventilation time and FFP transfusion in
pediatric patients undergoing cardiac surger, while also emphasizing the
need for further research to conclusively determine its impact on other
clinical outcomes and safety parameters.

<89>
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Accession Number
646742698
Title
Music therapy for postprocedural pain in patients undergoing cardiac
surgery: a meta-analysis of randomized controlled trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Barbosa L.; Araujo B.; Almiron G.; Queiroz I.; Parriao V.D.; De Oliveira
Vieira D.
Institution
(Barbosa, Araujo) Nine of July University, Sao Bernardo do Campo, Brazil
(Almiron) Metropolitan University of Santos, Santos, Brazil
(Queiroz) Universidade catolica de Pernambuco, Recife, Brazil
(Parriao) Faculty of Medical Science Afya, Palmas, Brazil
(De Oliveira Vieira) Federal University of Sao Paulo, Sao Paulo, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Patients undergoing cardiac surgeries often experience
significant levels of pain and anxiety, which can impair effective
recovery. Music therapy has been proposed as a non-pharmacological
intervention to alleviate these symptoms. This meta-analysis aimed to
evaluate the effectiveness of music therapy in patients undergoing cardiac
surgeries. Method(s): We systematically searched PubMed, Embase, and
Cochrane databases for randomized controlled trials (RCTs) analyzing music
therapy in patients undergoing cardiac surgeries. We pooled mean
differences (MD), and standardized mean differences (SMD) for continuous
outcomes with 95% confidence intervals (CI) with a random-effects model.
We performed a trial sequential analysis (TSA) to assess the random risk
of pain, and conducted a subgroup analysis to compare heart and
respiratory rate between children and adults. We used R version 4.3.2 and
TSA version 0.9.5.10 for statistical analyses. Result(s): Our
meta-analysis included 20 RCTs comprising 1379 patients, of whom 715
(51.9%) were randomized to music therapy. Compared with control, music
significantly reduced postoperative pain (SMD -0.59; 95% CI: -0.76 to
-0.41; p<0.05; Figure A), and anxiety (SMD -0.59; 95% CI: -0.74 to -0.44;
p<0.05; Figure B). There was a significant difference between groups in
heart rate (MD -5.68 bpm; 95% CI: -9.73 to -1.63; p<0.05), overall there
was an important subgroup interaction between children and adults
(p=0.01). In children, music therapy reduced the respiratory rate (MD
-5.98 ipm; 95% CI: -6.71 to -5.25) compared to control, whereas in adults,
no significant differences were observed among these groups, overall,
there was a significant subgroup interaction (p<0.01). For the primary
endpoint, TSA suggested a low risk of type 1 error, therefore these
results may be conclusive. Conclusion(s): In patients undergoing
cardiac surgery, music therapy reduced postoperative pain, anxiety, heart
rate, and respiratory rate.

<90>
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Accession Number
646743327
Title
Discontinuation vs Continuation of Renin-Angiotensin System Inhibition
Before Non-Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Queiroz I.; Defante M.L.R.; Barbosa L.; Do Livramento Junior Antunes V.;
Mendes B.X.; Mazetto R.; Bulhoes E.; Silva C.; Rompro P.
Institution
(Queiroz) Universidade catolica de Pernambuco, Recife, Brazil
(Defante) Redentor University Center, Itaperuna, Brazil
(Barbosa) Federal University of Minas Gerais, Belo Horizonte, Brazil
(Do Livramento Junior Antunes) UFCSPA, Porto Alegre, Brazil
(Mendes) Unichristus, Ceara, Fortaleza, Brazil
(Mazetto) Amazon State University, Manaus, Brazil
(Bulhoes) College of Higher Education of the United Amazon, BELEM, Para,
Brazil
(Silva, Rompro) University Center CESMAC, Maceio, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The optimal management of angiotensin-converting enzyme (ACE)
inhibitors during elective surgeries remains uncertain. While some studies
suggest that continuing ACE inhibitors increase the risk of perioperative
hypotension, others argue that discontinuation may heighten the risk of
significant clinical events. This meta-analysis aims to clarify the
clinical outcomes associated with continuation compared to discontinuation
of ACE inhibitors in surgical settings. Method(s): We conducted a
systematic search of MEDLINE, Cochrane, and Embase for clinical trials
comparing the effects of continuing versus discontinuing ACE inhibitors
during surgery. Outcomes evaluated included death, stroke, myocardial
injury (MI), intraoperative hypotension, postoperative hypotension, and
acute kidney injury (AKI). Data were synthesized using odds ratios (OR)
with 95% confidence intervals (CI). Heterogeneity was assessed with I2
statistics, and a random-effects model was applied. Statistical analyses
were performed using R software version 4.3.2. Result(s): From 865
identified studies, 15 studies involving 11,519 patients met the inclusion
criteria. Not all studies had outcomes available for comparison between
them. The average age was 65.75 years, with 86.45% having hypertension and
13.13% with heart failure. Continuing ACE inhibitors was associated with a
higher risk of intraoperative hypotension (OR 1.33; 95% CI 1.16-1.53). No
significant differences were found between groups for mortality (OR 1.06;
95% CI 0.68-1.65), stroke (OR 0.99; 95% CI 0.47-2.09), MI (OR 0.98; 95% CI
0.72-1.31), postoperative hypotension (OR 1.27; 95% CI 0.74-2.17), and AKI
(OR 0.88; 95% CI 0.66-1.16). Conclusion(s): Discontinuation of ACE
inhibitors before non-cardiac surgery may lower the risk of intraoperative
hypotension without significantly affecting mortality, stroke, MI,
postoperative hypotension, or AKI. Further research with greater power and
better design is needed to confirm these findings.

<91>
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Accession Number
646743863
Title
Substantial cardiovascular risk reduction with icosapent ethyl in patients
with prior cardiovascular events regardless of coronary artery disease
history: REDUCE-IT CAD.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Aggarwal R.; Bhatt D.; Ballantyne C.; Miller M.; Brinton E.; Jacobson T.;
Aetchum S.; Pineda A.L.; Doyle R.; Tardif J.-C.; Steg P.
Institution
(Aggarwal, Doyle, Tardif, Steg) Brigham and Women's Hospital, Boston, MA,
United States
(Bhatt) Mount Sinai Fuster Heart Hospital, Scarsdale, NY, United States
(Ballantyne) Baylor College Medicine, Houston, TX, United States
(Miller) Philadelphia VA-Univ Penn, Philadelphia, PA, United States
(Brinton) Utah Lipid Center, Salt Lake City, UT, United States
(Jacobson) Emory University, Atlanta, GA, United States
(Aetchum, Pineda) Amarin Pharma Inc., Bridgewater, NJ, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: REDUCE-IT (Reduction of Cardiovascular Events with Icosapent
Ethyl-Intervention Trial) was a multinational, double-blind trial that
randomized 8,179 statin-treated patients with controlled low-density
lipoprotein cholesterol, elevated triglycerides, and cardiovascular (CV)
risk, to icosapent ethyl (IPE) 4 g daily or placebo. Randomization was
stratified by established CV history (70.7%), or diabetes and other risk
factors (29.3%). METHODS/RESULTS: We evaluated IPE in patients with CV
history, further characterized as having a documented history of coronary
artery disease (CAD), or not. Primary (CV death, nonfatal myocardial
infarction [MI], nonfatal stroke, coronary revascularization,
hospitalization for unstable angina) and key secondary (CV death, nonfatal
MI, nonfatal stroke) CV endpoints were evaluated. Of the 5,785 (70.7%)
REDUCE-IT patients with established CV disease, 4,532 patients had a
history of CAD (multi vessel CAD, prior MI, hospitalization for high-risk
non-ST-segment elevation acute coronary syndrome) and 1,253 patients did
not. IPE reduced primary and key secondary first and total (first plus
recurrent) events in patients with and without a history of CAD. In
patients with CAD, IPE demonstrated a 25% relative risk reduction in first
(HR 0.75; 95% CI 0.66, 0.84; P<0.0001; NNT 17) and 32% reduction in total
primary endpoint events (RR 0.68; 95% CI 0.59, 0.78; P<0.0001) compared
with placebo (Figure 1A). In patients without CAD, IPE demonstrated a 34%
relative risk reduction in first (HR 0.66; 95% CI 0.51, 0.85; P=0.0012;
NNT 13) and 47% reduction in total primary endpoint events (RR 0.53; 95%
CI 0.40, 0.70; P<0.0001) (Figure 1B). In patients with and without CAD,
similar robust reductions were observed for key secondary endpoint events.
CV risk reductions were generally consistent across subgroup analyses by
CAD history. Safety findings in patients with or without CAD were
generally consistent with the overall study findings and did not differ
substantially in patients with or without CAD. CONCLUSION(S): IPE
demonstrated robust CV benefit in statin-treated patients with CV disease.
Patients with and without CAD experienced large reductions in absolute and
relative risk of CV events. (Figure Presented).

<92>
[Use Link to view the full text]
Accession Number
646743365
Title
Efficacy of Stem Cell Transplantation in Cardiac Regeneration and Function
in Ischemic Heart Disease: A Systematic Review and Meta-Analysis of
Randomized Controlled Trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Shivani R.; Ahmad O.; Nandipi V.S.; Mathew B.; Michael A.; Vasini V.;
Banerjee S.; Pradeep K.B.; Oaur S.
Institution
(Shivani) Dr. P. S. I. Medical college, Vijayawada, India
(Ahmad) Khyber Medical College, Peshawar, Pakistan
(Nandipi) Navodaya Medical College, Karnataka, Raichur, India
(Mathew) Sri devaraj urs medical College, Karanataka, Tamaka, India
(Michael) PSG Institute of Medical Sciences and Research, Coimbatore,
India
(Vasini) Konaseema Institute of Medical Sciences and Research Foundation,
Andhra Pradesh, India
(Banerjee) Burdwan Medical College, West Bengal, Baburbag, India
(Pradeep, Oaur) Government Medical College, Patiala, India
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Myocardial ischemia remains a significant global health
concern for cardiovascular morbidity and mortality. In addition to the
traditional treatment modalities, stem cell transplantation is emerging as
a promising therapeutic intervention for cardiac regeneration and
functional recovery. Our study evaluated the efficacy and clinical impact
of SCT by reducing infarct scar size and improving cardiac function. The
secondary objectives are to compare stem cell types, identify optimal
transplantation strategies, and address safety and feasibility.
 Method(s): Randomized controlled trials from January 2000 to July
2023 were collected from PubMed, Cochrane, Google Scholar, and Elsevier.
Based on criteria and evidence quality, screening and selection were done.
A RevMan analysis was done. Infarct size, LVEF, LVESV, LVEDV, and
mortality were measured. Comparator variables included placebo, medical
therapy, CABG, and other types of stem cells. Randomization, allocation
concealment, blinding, and therapeutic interventions differed among
trials. Heterogeneity and publication bias were assessed using
random-effects model and funnel plots. Sensitivity analysis and
meta-regression identified outcome variability. Result(s): Seventeen
studies (n = 1022 patients) met the inclusion criteria, encompassing
various cell types, doses, and administration routes. Compared to
controls, SCT greatly enhanced LVEF (MD: 3.39, 95% CI: 1.05 to 5.73, p =
0.005) and reduced infarct size (MD: 14.23, 95% CI: 7.12 to 21.35,
p<0.0001) with an average dose of 2.03 x 107 cells/ml injected
intracoronarily directly into the infarcted myocardium or the target
vessel. LVESV (MD: -2.63, 95% CI: -7.99 to 2.73, p = 0.34) or LVEDV (MD:
-2.00, 95% CI: -4.40 to 0.40, p = 0.10) did not improve. Differences in
mortality rates were insignificant (OR: 0.71, 95% CI: 0.29 to 1.74, p =
0.46). A diverse range of patients was included, leading to moderate
heterogeneity (I^2 = 52%). Conclusion(s): SCT shows potential
benefits for cardiac regeneration and functional improvement. The analysis
is robust, with no publication bias and mild attrition bias issues. Due to
low mortality, safety was comparable to conventional therapy. These
findings highlight the need for SCT strategy optimization and long-term
clinical outcome studies.

<93>
Accession Number
2037833884
Title
Accuracy of Large Language Models for Literature Screening in Thoracic
Surgery: Diagnostic Study.
Source
Journal of Medical Internet Research. 27 (no pagination), 2025. Article
Number: e67488. Date of Publication: 2025.
Author
Dai Z.-Y.; Wang F.-Q.; Shen C.; Ji Y.-L.; Li Z.-Y.; Wang Y.; Pu Q.
Institution
(Dai, Wang, Shen, Ji, Li, Wang, Pu) Department of Thoracic Surgery, West
China Hospital of Sichuan University, Chengdu, China
Publisher
JMIR Publications Inc.
Abstract
Background: Systematic reviews and meta-analyses rely on labor-intensive
literature screening. While machine learning offers potential automation,
its accuracy remains suboptimal. This raises the question of whether
emerging large language models (LLMs) can provide a more accurate and
efficient approach. Objective(s): This paper evaluates the
sensitivity, specificity, and summary receiver operating characteristic
(SROC) curve of LLM-assisted literature screening. Method(s): We
conducted a diagnostic study comparing the accuracy of LLM-assisted
screening versus manual literature screening across 6 thoracic surgery
meta-analyses. Manual screening by 2 investigators served as the reference
standard. LLM-assisted screening was performed using ChatGPT-4o (OpenAI)
and Claude-3.5 (Anthropic) sonnet, with discrepancies resolved by
Gemini-1.5 pro (Google). In addition, 2 open-source, machine
learning-based screening tools, ASReview (Utrecht University) and
Abstrackr (Center for Evidence Synthesis in Health, Brown University
School of Public Health), were also evaluated. We calculated sensitivity,
specificity, and 95% CIs for the title and abstract, as well as full-text
screening, generating pooled estimates and SROC curves. LLM prompts were
revised based on a post hoc error analysis. Result(s): LLM-assisted
full-text screening demonstrated high pooled sensitivity (0.87, 95% CI
0.77-0.99) and specificity (0.96, 95% CI 0.91-0.98), with the area under
the curve (AUC) of 0.96 (95% CI 0.94-0.97). Title and abstract screening
achieved a pooled sensitivity of 0.73 (95% CI 0.57-0.85) and specificity
of 0.99 (95% CI 0.97-0.99), with an AUC of 0.97 (95% CI 0.96-0.99). Post
hoc revisions improved sensitivity to 0.98 (95% CI 0.74-1.00) while
maintaining high specificity (0.98, 95% CI 0.94-0.99). In comparison, the
pooled sensitivity and specificity of ASReview tool-assisted screening
were 0.58 (95% CI 0.53-0.64) and 0.97 (95% CI 0.91-0.99), respectively,
with an AUC of 0.66 (95% CI 0.62-0.70). The pooled sensitivity and
specificity of Abstrackr tool-assisted screening were 0.48 (95% CI
0.35-0.62) and 0.96 (95% CI 0.88-0.99), respectively, with an AUC of 0.78
(95% CI 0.74-0.82). A post hoc meta-analysis revealed comparable effect
sizes between LLM-assisted and conventional screening. Conclusion(s):
LLMs hold significant potential for streamlining literature screening in
systematic reviews, reducing workload without sacrificing quality.
Importantly, LLMs outperformed traditional machine learning-based tools
(ASReview and Abstrackr) in both sensitivity and AUC values, suggesting
that LLMs offer a more accurate and efficient approach to literature
screening. Copyright © 2025 JMIR Publications Inc.. All rights
reserved.

<94>
Accession Number
2037709313
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: 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
Publisher
American Medical Association
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 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 PARTICIPANTS 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 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.
RESULTS 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. Copyright © 2025 American Medical Association All rights
reserved.

<95>
Accession Number
2037797955
Title
Efficacy and Safety of Distal Radial Artery Access versus Proximal Radial
Artery Access for Cardiac Procedures: A Systematic Review and
Meta-Analysis.
Source
Medical Principles and Practice. (no pagination), 2025. Date of
Publication: 2025.
Author
Rehman M.E.U.; Raja H.A.A.; Osama M.; Kakakhail A.; Waseem M.H.; Mukhlis
M.; Abdullah Ali M.; Abideen Z.U.; Shoaib M.; Din Z.U.; Tahir A.; Hassan
M.Z.U.; Mazhar U.; Haider S.T.; Saeed S.; Nashwan A.J.
Institution
(Rehman, Raja, Mazhar, Haider, Saeed) Department of Medicine, Rawalpindi
Medical University, Rawalpindi, Pakistan
(Osama, Abdullah Ali, Shoaib, Din, Hassan) Khyber Medical College,
Peshawar, Pakistan
(Kakakhail) Khyber Girls Medical College, Peshawar, Pakistan
(Waseem) Allama Iqbal Medical College, Lahore, Pakistan
(Mukhlis) Ayub Medical College, Abbottabad, Pakistan
(Abideen) Department of Medicine, King Edward Medical University, Lahore,
Pakistan
(Tahir) Department of Medicine, Liaquat University of Medical and Health
Sciences, Jamshoro, Pakistan
(Nashwan) Hamad Medical Corporation, Doha, Qatar
Publisher
S. Karger AG
Abstract
Objective: Cardiac catheterization using the distal radial artery (DRA)
access, at the level of the anatomical snuff box postradial artery
bifurcation,may be linked to a lower rate of arterial occlusion and better
hemostasis. In this meta-analysis, we compare DRA versus proximal radial
artery (PRA) access in cardiac catheterization or angiography.
 Method(s): A detailed literature search was performed on PubMed,
Cochrane, Embase, and Clinicaltrials.gov from inception till June 2024.
Risk ratios (RRs) and mean differences (MDs) were pooled for categorical
and continuous outcomes, respectively. Random effects meta-analysis was
undertaken on RevMan. Result(s): Our meta-analyses include 21
randomized controlled trials with 9,539 patients (DRA 4,761, PRA 4,778).
DRA significantly reduced 24-h radial artery occlusion rates (RR 0.30, 95%
CI: 0.23 to 0.40, p <= 0.00001) and time to hemostasis (minutes) (MD
-44.46, 95% CI: -50.64 to -38.92, p < 0.00001), whereas PRA was
significantly superior in terms of the puncture success rate (RR 0.96, 95%
CI: 0.93 to 0.99, p < 0.01), the crossover rate (RR 2.89, 95% CI: 2.02 to
4.15, p < 0.00001), and puncture attempts (MD 0.69, 95% CI: 0.37 to 1.00,
p = 0.00001). Conclusion(s): DRA was associated with a lower risk of
occlusion and lower time to hemostasis, but required a greater number of
puncture attempts and had lower success rate. Further research is required
to elucidate the most optimal approach. Copyright © 2025 The
Author(s).

<96>
[Use Link to view the full text]
Accession Number
2037820402
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. Article Number: 6618. Date
of Publication: 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, United States
(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, Brussel, Belgium
(Fiore) Department of Cardiac Surgery, Hopitaux Universitaires Henri
Mondor, Creteil, France
(Mariscalco) Department of Intensive Care Medicine and Cardiac Surgery,
Glenfield Hospital, University Hospitals of Leicester, 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, Tanta, 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
Publisher
Lippincott Williams and Wilkins
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.

<97>
Accession Number
2037753661
Title
Multivitamins after Myocardial Infarction in Patients with Diabetes: A
Randomized Clinical Trial.
Source
JAMA Internal Medicine. (no pagination), 2025. Date of Publication: 2025.
Author
Ujueta F.; Lamas G.A.; Anstrom K.J.; Navas-Acien A.; Boineau R.; Rosenberg
Y.; Stylianou M.; Jones T.L.Z.; Joubert B.R.; Yu Q.; Wen J.; Nemeth H.;
Huang Z.; Fonseca V.; Nathan D.M.; Uwaifo G.; Arenas I.A.; Luo L.; Baker
J.; Visentin D.; Paixao A.; Schmedtje J.F.; Mark D.B.
Institution
(Ujueta) Brigham and Women's Hospital Division of Cardiovascular Medicine,
Boston, MA, United States
(Lamas) Columbia University, Division of Cardiology, Mount Sinai Medical
Center, Miami Beach, FL, United States
(Anstrom) Gillings School of Global Public Health, University of North
Carolina, Chapel Hill, United States
(Navas-Acien) Department of Environmental Health Sciences, Columbia
University Mailman, School of Public Health, New York, NY, United States
(Boineau, Yu) National Center for Complementary and Integrative Health,
National Institutes of Health, Bethesda, MD, United States
(Rosenberg, Stylianou) National Heart, Lung and Blood Institute, National
Institutes of Health, Bethesda, MD, United States
(Jones) National Institute of Diabetes and Digestive and Kidney Diseases,
National Institutes of Health, Bethesda, MD, United States
(Joubert) National Institute of Environmental Health Sciences, National
Institutes of Health, Durham, NC, United States
(Wen, Nemeth, Huang, Mark) Duke Clinical Research Institute, Duke
University, Durham, NC, United States
(Fonseca) Tulane University, School of Medicine, New Orleans, LA, United
States
(Nathan) Massachusetts General Hospital, Diabetes Research Center, Harvard
Medical School, Boston, United States
(Uwaifo) Southern Illinois University, School of Medicine, Springfield,
United States
(Arenas) Salem Health, Salem, OR, United States
(Luo) Central Florida Heart Center, Ocala, United States
(Baker) Clinical Research Prime, Idaho Falls, ID, United States
(Visentin) South Simcoe Cardiac Services, Barrie, ON, Canada
(Paixao) Arkansas Heart Hospital, Little Rock, United States
(Schmedtje) Roanoke Heart Institute, Roanoke, VA, United States
Publisher
American Medical Association
Abstract
Importance: In 2013, the Trial to Assess Chelation Therapy (TACT) reported
that in 1708 patients with stable coronary disease and prior myocardial
infarction (MI), oral multivitamins and multiminerals (OMVMs), in a
factorial design with edetate disodium (EDTA) chelation therapy, did not
reduce cardiovascular events relative to placebo OMVMs, but active EDTA
combined with active OMVMs was superior to placebo OMVM/placebo EDTA.
 Objective(s): To compare OMVM vs placebo in terms of efficacy for
reducing major adverse cardiovascular events in patients with diabetes and
prior MI. Design, Setting, and Participant(s): The TACT2 randomized,
multicenter double-masked 2 x 2 factorial clinical trial took place across
88 sites in the US and Canada. Participants were 50 years or older, had
diabetes, and had an MI 6 weeks ago or more. TACT2 participants were
enrolled between September 2016 and December 2020. Data were collected
between October 2016 and June 2023. Intervention(s): Six caplets
daily of a 28 component OMVM or matching OMVM placebo, and 40 weekly
infusions of an EDTA-based chelation solution or matching placebo, in a
1:1:1:1 allocation ratio. Main Outcomes and Measures: The primary end
point was the composite of all-cause mortality, MI, stroke, coronary
revascularization, or hospitalization for unstable angina. Result(s):
A total of 1000 participants were randomized (500 in the active OMVM group
and 500 in the placebo group). The median (IQR) age was 67 (60-72) years,
and 730 (73%) were male. Median (IQR) follow-up was 48 (34-58) months. The
primary end point occurred in 175 participants (35%) in the active OMVM
group and 175 (35%) in the placebo group (hazard ratio [HR], 0.99 [95% CI,
0.80-1.22]; P =.92). The 5-year event rate for the primary end point in
the EDTA chelation + active OMVM group was 34.0%; in the EDTA chelation +
placebo OMVM group, 35.7%; in the placebo infusion + active OMVM group,
36.0%; and in the placebo infusion + placebo OMVM group, 34.3%. The
comparison of the active infusion + active OMVM with the placebo infusion
+ placebo OMVM was not significant (HR, 0.91 [95% CI, 0.67-1.23]; P =.54).
Although nonsignificant, there was a numerically higher event rate of MI,
stroke, mortality from cardiovascular causes in the active OMVM compared
to placebo OMVM group. Conclusions and Relevance: The results of this
randomized clinical trial demonstrated that, for participants with chronic
coronary disease, diabetes, and a previous MI, high-dose OMVM alone or in
conjunction with EDTA-based chelation did not reduce cardiovascular
events. Trial Registration: ClinicalTrials.gov Identifier:
NCT02733185. Copyright © 2025 Ujueta F et al. JAMA Internal
Medicine.

<98>
Accession Number
2037886198
Title
Handling non-ignorable missing intimal hyperplasia data - Lessons from the
VEST trial.
Source
Contemporary Clinical Trials. 152 (no pagination), 2025. Article Number:
107878. Date of Publication: 01 May 2025.
Author
Overbey J.R.; Raymond S.; Chang H.; Bagiella E.
Institution
(Overbey, Raymond, Chang, Bagiella) Center for Biostatistics, Department
of Population Health Science and Policy, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Overbey) Berry Consultants, Austin, TX, United States
Publisher
Elsevier Inc.
Abstract
Non-ignorable missing data arise often in clinical trials. The VEST trial,
a randomized, within-patient-controlled study, assessed the effect of an
external scaffold for saphenous vein grafts on intimal hyperplasia (IH)
one year after coronary artery bypass graft surgery. It was anticipated
that approximately 13 % of grafts would be occluded and unsuitable for
intravascular ultrasound, resulting in missing IH values at 1-year. Given
graft occlusion is a negative outcome and higher IH is associated with
occlusion, this missing data is non-ignorable. To address this, we
developed a novel two-part method for the MNAR (missing not at random)
scenario in the VEST trial. This method combines penalized multiple
imputation with a modified Wilcoxon signed-rank test. We evaluated the
approach's performance against alternatives in a series of simulation
studies. The new method did not show type I error inflation. Under trial
assumptions, it provided adequate power. However, if missing data exceeds
20 %, power decreases notably with the double penalization method due to
underestimation of the treatment effect. When missing data is balanced
between arms, penalized multiple imputation alone is more powerful and
unbiased. Conversely, for unbalanced MNAR data, as might occur with a
treatment effect on IH, the penalized multiple imputation with a modified
Wilcoxon signed-rank test approach is more powerful. The VEST trial showed
more occlusions than expected, balanced across arms, resulting in
potential underestimation of the true treatment effect. However, given the
potential for unbalanced missingness, this approach was suitable and could
be applied in other settings with similar challenges. Copyright ©
2025 Elsevier Inc.

<99>
Accession Number
2033650687
Title
Pregnancy Outcomes in Women with Biventricular Circulation and a Systemic
Right Ventricle: A Systematic Review.
Source
Journal of Clinical Medicine. 13(23) (no pagination), 2024. Article
Number: 7281. Date of Publication: 01 Dec 2024.
Author
Grantza T.; Arvanitaki A.; Baroutidou A.; Tsakiridis I.; Mamopoulos A.;
Giannopoulos A.; Ziakas A.; Giannakoulas G.
Institution
(Grantza, Arvanitaki, Baroutidou, Ziakas, Giannakoulas) First Department
of Cardiology, AHEPA University General Hospital, School of Medicine,
Aristotle University of Thessaloniki, Thessaloniki, Greece
(Arvanitaki) Adult Congenital Heart Centre and National Centre for
Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and
St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom
(Tsakiridis, Mamopoulos) Third Department of Obstetrics and Gynecology,
School of Medicine, Faculty of Health Sciences, Aristotle University of
Thessaloniki, Thessaloniki, Greece
(Giannopoulos) Pediatric Department, AHEPA University General Hospital,
School of Medicine, Aristotle University of Thessaloniki, Thessaloniki,
Greece
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Pregnancy in women with biventricular circulation and a
systemic right ventricle (sRV) is considered high risk, with limited data
available on pregnancy outcomes. This study aimed to investigate pregnancy
outcomes in this population. Material(s) and Method(s): A systematic
review was conducted using four major electronic databases. Pregnant women
with a complete transposition of great arteries (d-TGA) after an atrial
switch operation or a congenitally corrected transposition of the great
arteries (ccTGA) were included. Result(s): In total, 15 studies
including 632 pregnancies in 415 women with an sRV and biventricular
circulation were identified, of whom 299 (72%) had d-TGA and 116 (28%)
ccTGA. Maternal mortality or cardiac transplantation occurred in 0.8% of
pregnancies. The most frequent maternal complications were the worsening
of systemic atrioventricular valve regurgitation [pooled estimate (PE):
16%, 95% CI: 5;26], the deterioration of sRV function (PE: 15%, 95% CI:
2;27), the worsening of the NYHA class (PE: 13%, 95% CI: 6;20), all-cause
hospitalization (PE): 10%, 95% CI: 7;12), arrhythmias (PE: 8%, 95% CI:
5;11), and symptomatic heart failure (PE: 6%, 95% CI: 3;10). Stillbirth
occurred in 0.7% of pregnancies and neonatal death in 0.4%.
Small-for-gestational-age neonates were encountered in 36% (95% CI: 21;52)
of pregnancies and preterm delivery in 22% (95% CI: 14;30). A subgroup
analysis showed no significant difference in outcomes between women with
d-TGA and those with ccTGA, except for the worsening of the NYHA class,
which occurred more often in d-TGA (18%, 95% CI: 12;27 vs. 6%, 95% CI:
3;15, respectively, p = 0.03). Conclusion(s): Maternal and
fetal/neonatal mortality are low among pregnant women with biventricular
circulation and an sRV. However, significant maternal morbidity and poor
neonatal outcomes are frequently encountered, rendering management in
specialized centers imperative. Copyright © 2024 by the authors.

<100>
Accession Number
646730964
Title
Analysis of stress responses in medical students during simulated
pericardiocentesis training using virtual reality and 3D-printed
mannequin.
Source
Scientific reports. 15(1) (pp 7645), 2025. Date of Publication: 04 Mar
2025.
Author
Rubio-Lopez A.; Garcia-Carmona R.; Zarandieta-Roman L.; Rubio-Navas A.;
Gonzalez-Pinto A.; Cardinal-Fernandez P.
Institution
(Rubio-Lopez) Intensive Care Unit, Hospital Universitario HM
Monteprincipe, HM Hospitales, Madrid, Spain
(Rubio-Lopez) Universidad San Pablo-CEU, CEU Universities, Facultad de
Medicina, Campus Monteprincipe, Madrid, Spain
(Garcia-Carmona, Zarandieta-Roman) Department of Information Technologies,
Institute of Technology, Universidad San Pablo-CEU, CEU Universities,
Campus Monteprincipe, Madrid, Spain
(Rubio-Navas) Universidad Autonoma. Facultad de Biologia., Madrid, Spain
(Gonzalez-Pinto) Head of Cardiac Surgery Unit, Hospital General
Universitario Gregorio Maranon, Madrid, Spain
(Gonzalez-Pinto) Head of Cardiac Surgery Unit, Hospital Universitario HM
Monteprincipe, HM Hospitales, Madrid, Spain
(Cardinal-Fernandez) Intensive Care Unit, Hospital Universitario HM
Torrelodones, HM Hospitales, Madrid, Spain
(Cardinal-Fernandez) Facultad HM de Ciencias de la Salud, Universidad
Camilo Jose Cela, Madrid, Spain
Abstract
We investigated the effectiveness of Virtual Reality (VR) and
three-dimensional (3D)-printed mannequins in replicating stress levels
during pericardiocentesis training and compared their impact on learners'
emotional and physiological responses. A secondary analysis explored how
demographic, lifestyle, and academic factors influence stress responses,
providing deeper insights into the variability of physiological markers
among medical trainees. We conducted a randomized study involving 108
final-year medical students (mean age: 23.6 years, 87% female) to compare
stress responses during pericardiocentesis training using a 3D-printed
mannequin and VR model as simulation modalities, both custom-designed by
the research team. We investigated the influence of demographic,
lifestyle, and academic factors, including medication use and perceived
stress, on heart rate variability (HRV) markers. The two simulations
showed similar HRV parameters, validating their effectiveness in
replicating physiological stress levels associated with clinical
scenarios. Secondary analysis revealed significant associations between
the low frequency/high frequency ratio and family income and a trend-level
effect for anxiolytic use, suggesting an interplay of socioeconomic and
pharmacological factors on stress responses. Age and sex interacted
significantly with HRV metrics, with younger students demonstrating
heightened sympathetic activation. Our results suggest that the
incorporation of VR into medical training programs may enhance learning
outcomes and accessibility. Copyright © 2025. The Author(s).

<101>
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Accession Number
646741407
Title
Catheter Ablation Alone Versus Catheter Ablation With Combined
Percutaneous Left Atrial Appendage Closure For Atrial Fibrillation: A
Systematic Review and Metaanalysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Junarta J.; Siddiqui M.; Cainitz L.; Park D.; Jankelson L.; Barbhaiya C.;
Roshandel A.; Zhang P.; Abaza E.
Institution
(Junarta, Cainitz) NYU Langone Health, Long Island City, NY, United States
(Siddiqui) Thomas Jefferson University Hospitals, Philadelphia, PA, United
States
(Park, Jankelson, Barbhaiya, Roshandel, Zhang, Abaza) NYU Langone Health,
LongIsland City, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Combined catheter ablation (CA) with left atrial appendage
closure (LAAC) may produce comprehensive treatment for atrial fibrillation
(AF) whereby rhythm control is achieved and stroke risk is reduced without
the need for chronic oral anticoagulation. However, the efficacy and
safety of this strategy is still controversial. Aim(s): To
investigate the efficacy and safety of a combined CA with LAAC approach to
treat AF in patients moderate-to-high-risk for bleeding. Method(s):
This meta-analysis was reported according to the Preferred Reporting Items
for Systematic Review and Meta-Analyses guidelines. Medline, Scopus, and
Cochrane Central Register of Controlled Trials were systematically
searched to identify relevant studies. Risk of bias was assessed using the
Modified Newcastle-Ottawa scale and Cochrane risk of bias tool. Eligible
studies reported outcomes in patients with AF who underwent combined CA
and LAAC versus CA alone. Studies performing CA without pulmonary vein
isolation were excluded. Result(s): Eight studies comprising 1878
patients were included (2 RCT, 6 observational). Pooled results showed no
difference in arrhythmia recurrence (risk ratio [RR] 1.05; 95% confidence
interval [CI] 0.84- 1.30), stroke or systemic embolism (RR 0.71; 95% CI
0.26-1.94), total procedure time (mean difference 31.45 minutes; 95% CI
-5.91-68.81), or major periprocedural complications (RR 1.28; 95% CI
0.28-5.89) when comparing combined CA and LAAC versus CA alone.
 Conclusion(s): Combined CA with LAAC for AF is associated with
similar rates of arrhythmia free survival, stroke, major periprocedural
complications, and procedure time when compared to CA alone. A combined
strategy may be as safe and efficacious for patients moderate-to-high-risk
for bleeding events to negate the need for chronic oral anticoagulation.

<102>
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Accession Number
646742975
Title
Clinical Outcomes of Postoperative Atrial Fibrillation Following Non-
Cardiovascular Procedures: A Three-Year Study.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Thangjui S.; Abdelazeem B.; Al Hajji M.; Perkowski G.; Watson H.; Santer
M.; Thyageturu H.; Balla S.; Arorn S.
Institution
(Thangjui, Abdelazeem, Al Hajji, Perkowski, Watson, Santer, Thyageturu,
Balla, Arorn) West Virginia University, Morgantown, WV, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative atrial fibrillation (AF) is common, often brief,
and may recur, with some studies reporting a recurrence rate lower than
30% at one year. The initiation of anticoagulation (AC) in these patients,
particularly those at lower stroke risk, remains debatable due to
insufficient evidence. This study aims to assess outcomes in postoperative
non-cardiovascular procedures with acute AF, focusing on patients at lower
stroke risk, comparing those treated with and without AC. Method(s):
Using the TriNetX database, we identified patients aged 18 to 64 years
with new-onset AF following non-cardiovascular procedures, excluding those
with a history of stroke or other indications for anticoagulation.
Patients were divided into AC and Non-AC groups based on AC initiation
within two weeks of AF onset, then followed for three years. Propensity
score matching (PSM) balanced confounders between groups. Thromboembolic
and bleeding outcomes were assessed. Result(s): Among 10,108
patients, 734 (7%) received anticoagulation within two weeks of postop AF.
After PSM, mean ages were 53.7+/-7.6 years for the AC group and
54.2+/-7.17 years for the Non-AC group. At 3 years, the incidence of
composite thromboembolic events did not significantly differ between AC
and Non-AC groups (5.8% vs. 4.1%, OR 0.70 (95% CI: 0.43-1.14)). Most
thromboembolic events occurred within one month of AF onset. There were no
significant differences in the composite of intracranial bleeding,
gastrointestinal bleeding, retroperitoneal bleeding, or need for blood
transfusion between the AC and Non-AC groups at 3 years (OR 1.04 (95% CI
0.72-1.50)). Conclusion(s): At three years, there is no significant
difference in thromboembolic and bleeding outcomes in patients undergoing
non-cardiovascular procedures who develop new-onset AF. Further randomized
controlled trial is needed to determine the necessity of anticoagulation
in this patient population.

<103>
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Accession Number
646742623
Title
A Meta-Analysis on the Effect of Chronic Total Occlusion of Coronary
Arteries on Cardiovascular Outcomes in Patients Undergoing Transcatheter
Aortic Valve Replacement.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Goyal A.; Tariq M.D.; Zahra R.; Jain H.; Khan R.; Mahalwar G.
Institution
(Goyal) Seth GSMC, KEM Hospital, Mumbai, India
(Tariq) Foundation University Medical College, Islamabad, Pakistan
(Zahra) Allama Iqbal Medical College, Lahore, Pakistan
(Jain) AIIMS Jodhpur, Jodhpur, India
(Khan) Medical University of South Carolina, Florence, SC, United States
(Mahalwar) Cleveland Clinic Foundation, Cleveland, OH, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Aims: Transcatheter aortic valve replacement (TAVR) has
revolutionized the management of severe aortic stenosis, particularly
prevalent in elderly patients. These patients often present with
coexisting coronary artery disease (CAD) due to shared risk factors. There
is evidence suggesting that underlying CAD may result in poorer outcomes
for patients undergoing TAVR. Chronic total occlusion (CTO), representing
a severe manifestation of CAD, could therefore be hypothesized to worsen
prognosis in TAVR patients, although data supporting this hypothesis are
limited. Our meta-analysis aims to consolidate all available data
concerning patients undergoing TAVR with concurrent CTO. Method(s):
We conducted a thorough literature search across major bibliographic
databases, including PubMed, Embase, Cochrane Library, and SCOPUS, from
their inception until May 15, 2024, to identify studies comparing outcomes
of TAVR in patients with and without CTO. Pooled odds ratios (OR) with 95%
confidence intervals (CIs) were calculated using the random-effects model
via Comprehensive Meta- Analysis Software. The primary outcome assessed
was in-hospital mortality, with several secondary endpoints also
evaluated. Statistical significance was determined at p<0.05.
 Result(s): Eight studies, encompassing a total of 540,910 patients
undergoing TAVR (11,679 with CTO; 529,231 without CTO), were included in
this meta-analysis. TAVR in patients with CTO was associated with
significantly increased odds of in-hospital mortality (OR: 1.25; 95% CI:
1.05, 1.49; p=0.011; I2 =0%) and acute myocardial infarction
(periprocedural) (OR: 1.68; 95% CI: 1.48, 1.91; p<0.001; I2
=0%). However, no significant difference was observed in all-cause
mortality (OR: 1.18; 95% CI: 0.71, 1.96; p=0.525; I2 =59.37%),
acute kidney injury (OR: 1.32; 95% CI: 0.94, 1.85; p=0.11; I2
=72.12%), and stroke (OR: 1.06; 95% CI: 0.89, 1.28; p=0.509; I2
=0%) (see Figures 1 and 2). Conclusion(s): CTO emerges as a
substantial risk factor for patients undergoing TAVR, elevating the risk
of in-hospital mortality and acute myocardial infarction. Considering a
heart team's multidisciplinary approach in patients with underlying CTO
may be advisable during TAVR, allowing for a comprehensive assessment of
the benefits versus risks of revascularization prior to TAVR. (Figure
Presented).

<104>
Accession Number
646743086
Title
Online Cognitive Behavioral Therapy Targeting Psychological Distress
Following Open Heart Surgery: An Uncontrolled Pilot Study.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Sarnholm J.; Wahlund T.; Kronish I.; Bergman M.; Stenman M.; Sartipy U.
Institution
(Sarnholm, Wahlund) Karolinska Institutet, Stockholm, Sweden
(Kronish) COLUMBIA UNIVERSITY, New York, NY, United States
(Bergman) Columbia University Irving Medical Center, New York State
Psychiatric Institute, New York City, NY, United States
(Stenman, Sartipy) Karolinska Institutet, Karolinska University Hospital,
Stockholm, Sweden
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Cardiac surgery is a significant procedure that reduces
mortality and alleviates symptom burden in individuals with cardiovascular
diseases. However, many patients develop depression and cardiac-related
anxiety postoperatively, which negatively affects long-term prognosis and
rehabilitation. There is a clinical need to develop scalable psychological
treatments to mitigate these negative health effects. Objective(s):
To investigate the feasibility and potential efficacy of a brief
internet-delivered cognitive behavioral therapy (internet-CBT)
intervention to reduce psychological distress in patients following
cardiac surgery. Method(s): The pilot study included 32 cardiac
surgery patients (i.e., CABG, heart valve repair/replacement, aortic
repair, or combined CABG and valve repair/replacement) with endorsed
postoperative psychological distress and/or interference with daily life
who underwent surgery from eight weeks to nine months prior to enrollment.
Exclusion criteria included prior cardiac surgery with a ventricular
assist device or heart transplant and severe medical or psychiatric
illness. The internet-CBT targeted cardiac anxiety and depressive
inactivity, lasted for five weeks, and was guided by clinical
psychologists via text-based interactive online treatment modules. It
included interoceptive exposure, in-vivo exposure, and behavioral
activation. Self-assessments were completed at pre-treatment,
posttreatment, and at 6-month follow-up. Result(s): Preliminary
analyses post-treatment showed substantial pre-post improvements across
multiple domains. Notable findings included significant reductions in
depressive symptoms (Cohen's d = 0.70; p = 0.04), cardiac anxiety (Cohen's
d = 1.53; p < 0.001), and perceived severity of post-operative symptoms
(Cohen's d = 1.06; p = 0.006). Participants demonstrated high adherence to
the treatment, with the large majority of participants completing all five
treatment modules (83.3%). Satisfaction with the treatment was also high
(25.5 points out of 32), as measured by the Client Satisfaction
Questionnaire, and no adverse events were reported. Conclusion(s):
This novel internet-CBT intervention post-cardiac surgery appears to be
feasible, acceptable, and clinically promising in reducing postoperative
psychological distress. It could be used as a viable adjunct treatment to
enhance recovery post-cardiac surgery. These preliminary findings warrant
further testing in a randomized controlled trial.

<105>
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Accession Number
646741217
Title
High-Dose Folic acid Supplementation in Acute Myocardial Infarction - A
systematic review.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Hashim H.T.; Alhatemi A.Q.M.; Ahmed S.; Khan M.A.; Iqbal U.; Hafeez M.H.;
Al-Obaidi A.D.; Saab O.
Institution
(Hashim) University of Warith Al-Anbiyaa, College of Medicine, Karbala,
Karbala, Iraq
(Alhatemi) Al-Nassiryah teaching hospital, Nassiryah, Thi, Iraq
(Ahmed) Fatima Memorial hospital, College of Medicine and Dentistry,
Lahore, Pakistan
(Khan) Shalamar Institute of Health Sciences, Lahore, Pakistan
(Iqbal) Allama Iqbal Medical College, Lahore, Pakistan
(Hafeez) Shalamar Medical and Dental College, Lahore, Pakistan
(Al-Obaidi) University of Baghdad, College of Medicine, Baghdad, Iraq
(Saab) Cleveland Clinic, Cleveland, OH, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Folic acid, a B vitamin, is essential for DNA synthesis and
repair, and its role in reducing homocysteine levels has been linked to
cardiovascular health. Elevated homocysteine is a risk factor for
cardiovascular diseases, including acute myocardial infarction (MI) and
coronary artery disease (CAD). Despite evidence suggesting that folic acid
supplementation may lower homocysteine levels, its clinical benefits in
reducing cardiovascular events remain unclear. Method(s): A
comprehensive literature search was conducted in PubMed/Medline, Google
Scholar, and Cochrane Library databases for studies published from 2000 to
2024 using MeSH terms related to "folic acid," "B vitamin," "acute
myocardial infarction," "cardiac arrest," "heart attack," and "coronary
heart disease." Only randomized controlled trials (RCTs) and observational
studies in English involving adult patients with acute MI or CAD were
included. Exclusion criteria were applied to poor-quality studies,
irrelevant outcomes, overlapping populations, and non-English texts. Data
on study characteristics and patient demographics were extracted, and
study quality was assessed using the RoB2 tool. Outcomes were pooled using
RevMan 5.3.4 software. Result(s): Fourteen studies on all-cause
mortality showed a risk ratio (RR) of 0.99 [95% CI: 0.94-1.04], indicating
no significant difference between folic acid and control groups. Eight
studies on cardiovascular mortality yielded a RR of 0.90 [95% CI:
0.82-0.99], suggesting a significant reduction in cardiovascular deaths
with folic acid supplementation. Analyses of sudden death, coronary artery
bypass graft (CABG) events, revascularization procedures, stroke, and
recurrent MI found no significant associations with folic acid
supplementation. Conclusion(s): High-dose folic acid supplementation
appears to reduce cardiovascular mortality in post- MI patients but shows
no significant impact on other clinical outcomes. This meta-analysis's
limitations include potential publication bias, heterogeneity among
included studies, and variability in folic acid dosages and treatment
durations. Furthermore, the lack of comprehensive homocysteine level data
constrained the analysis. Future large-scale RCTs are needed to fully
ascertain the therapeutic potential of folic acid supplementation in
secondary prevention of cardiovascular events. (Table Presented).

<106>
Accession Number
646743574
Title
Identification of individuals who benefit from omega-3 fatty acid
supplementation to prevent coronary heart disease: A machine-learning
analysis of the VITAL.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Hamaya R.; Cook N.; Sesso H.; Mora S.; Buring J.; Manson J.A.
Institution
(Hamaya, Cook, Sesso, Mora, Buring, Manson) Brigham and Women's Hospital,
Boston, MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Backgrounds: Randomized controlled trials (RCTs) have demonstrated
benefits of marine omega-3 polyunsaturated fatty acids (omega-3 FA)
supplementation for the prevention of coronary heart disease (CHD).
However, it has not been clear which individuals would benefit the most
from the supplementation. We sought to predict the individual treatment
effect of omega-3 FA supplementation on CHD prevention and to develop an
omega-3 effect score to stratify individuals according to their expected
benefit from the supplementation. Method(s): Among the 25,871
randomized participants without history of CVD in the VITamin D and
OmegA-3 TriaL (VITAL), we applied machine-learning (ML) approaches to
predict individual treatment effect of omega-3 FA supplementation on
5-year CHD risk (a composite of myocardial infarction, coronary
revascularization, and CHD death) using 11 covariates pre-specified in the
VITAL trial protocol. A 10-fold cross-validation was used and held-out
test dataset was used for the evaluation. An omega-3 effect score was
developed such that each covariate contributed linearly, and utility of
the score was further evaluated by transportability analysis using the
National Health and Nutrition Examination Survey (NHANES) data as the
target population. Result(s): Omega-3 FA intervention led to absolute
0.48% [SE: 0.20] reduction in CHD in the total population. ML algorithms
effectively stratified participants by their expected benefit according to
individual factors; decreased CHD risk was observed in those with quintile
1 and 2 of the expected benefit (absolute CHD risk reduction %: 1.30 %
[0.55] and 1.32 % [0.51] in quintile 1 and 2, respectively). Race,
diabetes, and fish intake most contributed to the omega-3 effect score.
CHD incidence rates per 1000 person-year were 5.5 [0.44] if treated and
8.5 [0.55] if not treated (35.3% reduction) in individuals with the score
>=11 (upper 40th percentile), and 3.9% [0.31] if treated and 3.4% [0.55]
if not treated (14.7% increase) in those with the score <11, respectively.
The transportability of the utility of the score to baseline NHANES data
was confirmed. Conclusion(s): In VITAL, ML approaches identified
individuals who experienced greater CHD reduction from the omega-3 FA
intervention, and an omega-3 effect score stratified the expected benefit.
Although it warrants testing in a new RCT, the omega-3 effect score holds
promise for guiding the indication of omega-3 FA supplementation in US
primary prevention population.

<107>
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Accession Number
646742574
Title
Diagnostic Accuracy of Non- Invasive Assessments for Detecting Cardiac
Transplant Rejection: A Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Han D.; Shah K.; Kim I.-C.; Stern L.; Kransdorf E.; Chang D.; Hamilton M.;
Nikolova A.; Kittleson M.; Patel J.; Berman D.; Kobashigawa J.
Institution
(Han, Shah, Stern, Kransdorf, Chang, Hamilton, Nikolova, Kittleson, Patel,
Berman, Kobashigawa) Cedars-Sinai Medical Center, West Hollywood, CA,
United States
(Kim) Keimyung University, Daegu, South Korea
Publisher
Lippincott Williams and Wilkins
Abstract
Background: After heart transplantation, endomyocardial biopsy (EMBx) is
the standard diagnostic modality for acute rejection (AR). However, EMBx
is invasive with some limitations to conventional histological
interpretation. Non-invasive assessments, such as cardiac magnetic
resonance Imaging (MRI) and donor-derived cell-free DNA (dd-cfDNA) assays,
have emerged as viable methods for diagnosing acute rejection. This study
aims to assess the diagnostic performance of cardiac MRI and dd-cfDNA for
evaluating acute cardiac transplant rejection. Method PubMed and Web of
Science were searched for relevant publications reporting on the use of
dd-cfDNA or cardiac MRI for the detection of acute cardiac transplant
rejection defined as acute cellular rejection (ACR) and/or
antibody-mediated rejection (AMR), with EMBx as the reference standard.
Pooled sensitivity, specificity, and hierarchical modeling-based summary
receiver-operating characteristic (sROC) curves were calculated.
 Result(s): Out of 725 screened papers, 23 studies were included (10
studies with cardiac MRI and 13 studies with dd-cfDNA). Five studies
considered only ACR as a rejection criterion, while eighteen studies
included both ACR and AMR. The sensitivity and specificity for detecting
acute transplant rejection were 0.68 (95% CI: 0.58-0.77) and 0.82 (95% CI:
0.74-0.88) for dd-cfDNA, and 0.79 (95% CI: 0.66-0.88) and 0.72 (95% CI:
0.62-0.81) for cardiac MRI. The areas under the hierarchical modelingbased
sROC curves were 0.82 (95% CI: 0.78-0.85) for dd-cfDNA and 0.82 (95% CI:
0.79-0.85) for cardiac MRI. While there was no significant difference in
the sROC between dd-cfDNA and cardiac MRI (p = 0.959), cardiac MRI had
significantly higher sensitivity (p < 0.001) and dd-cfDNA had
significantly higher specificity (p = 0.001) (Figure) Conclusion(s):
dd-cfDNA and cardiac MRI demonstrated comparable high diagnostic accuracy
for acute cardiac transplant rejection. Given the high sensitivity of
cardiac MRI and the high specificity of ddcfDNA, combining these two
non-invasive modalities may provide an effective screening strategy to
detect acute cardiac transplant rejection and reduce the need of EMBx.

<108>
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Accession Number
646742084
Title
Immediate versus staged percutaneous coronary intervention of nonculprit
lesions in patients with st-elevation myocardial infarction and
multivessel disease: a meta-analysis of 4,120 patients.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Paulino D.; Arbaiza E.A.; Martinez D.N.; Xiloj S.; Hernandez B.;
Garcia-Mena L.
Institution
(Paulino) Universidad Autonoma Metropolitana, Mexico City, Mexico
(Arbaiza) Universidad de El Salvador, San Miguel, El Salvador
(Martinez) Indiana University, Indianapolis, IN, United States
(Xiloj) Universidad de San Carlos de Guatemala, Guatemala, Guatemala
(Hernandez, Garcia-Mena) Universidad Nacional Autonoma de Mexico, Mexico
City, Mexico
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Multivessel coronary artery disease is common in patients
with ST-segment elevation myocardial infarction (STEMI). Previous trials
have shown that comprehensive revascularization of nonculprit arteries
with significant stenosis reduces the risks of cardiovascular death,
myocardial infarction, and ischemia-driven revascularization compared to
culprit-only revascularization. However, the optimal timing for
revascularizing non-culprit lesions-immediate versus staged percutaneous
coronary intervention (PCI)-remains unclear. This meta-analysis aims to
determine if staged or immediate PCI is associated with fewer major
adverse cardiovascular events. Method(s): A meta-analysis was
conducted following PRISMA guidelines, with a protocol registered in
PROSPERO (CRD42023485163). We included studies from PubMed, Embase, and
Cochrane databases until October 10, 2023. Inclusion criteria were: 1)
patients over 18 with STEMI and hemodynamically stable multivessel
disease; 2) intervention: immediate PCI; 3) comparator: staged PCI; 4)
study types: randomized clinical trials (RCTs) and cohort studies. Study
quality was assessed using ROBINS-I for observational studies and ROB 2
for RCTs. Result(s): Nine studies met inclusion criteria: 3 RCTs and
6 cohort studies, with a total of 4,120 patients. Staged PCI was
significantly associated with reduced cardiovascular death
(RR2= 1.77; 95% CI = 1.11- 2.81; p = 0.02, I2= 24%)
and all-cause mortality (RR2= 1.83; 95% CI = 1.19-2.79; p =
0.005, I2= 42%). Hazard ratio analysis also favored staged PCI
for cardiovascular death (HR2= 4.11; 95% CI = 1.07-5.87; p =
0.04, I2= 12%) and all-cause mortality (HR2= 8.13;
95% CI = 1.01-8.17; p = 0.05, I2= 37%). No significant
differences were found for major adverse cardiovascular events
(RR2= 0.98; 95% CI = 0.74- 1.28; p = 0.86, I2= 53%)
or in major bleeding, stroke, or target vessel revascularization.
 Conclusion(s): In patients with STEMI and multivessel disease, staged
coronary revascularization is associated with a lower risk of major
adverse cardiovascular events, cardiovascular death, and all-cause
mortality compared to immediate revascularization, without increasing
adverse outcomes. Further research is needed to confirm these findings.

<109>
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Accession Number
646740770
Title
The Safety and Efficacy of Surgical Cardiac Sympathetic Denervation for
Ventricular Arrhythmias: An Updated Systematic Review&Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Hanna D.; Karimianpour R.; Acarmo D.; Navas E.; Verghese D.; Sierra J.;
Fiechter C.; Mamprejew N.
Institution
(Hanna, Acarmo, Navas, Verghese, Sierra, Fiechter, Mamprejew) Rooney Heart
Institute, Naples, FL, United States
(Karimianpour) Piedmont Heart of Buckhead Electrophysiology, Atlanta, FL,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: This meta-analysis sought to explore the long-term arrhythmic
outcomes of cardiac sympathetic denervation (CS) by measuring event rates
of recurrent ventricular arrhythmias (VA) and implantable cardiac
defibrillator shocks (ICD) post CSD. Background(s): The role of
sympathetic nervous system in the beginning and continuation of
ventricular arrhythmias (VAs) is well known. CS has been associated with
improved arrhythmic outcomes in patients with refractory ventricular
arrhythmias. However, whether CSD lowers shock event rates after the
procedure is still uncertain and therefore, we performed a systematic
review and meta-analysis to evaluate this. Methods&Materials: A
comprehensive literature search was performed at Medline and Embase until
March 2023. Our primary outcome was event rate of ICD shocks at 30 days,
90 days, and 1 year following CS. All analysis was conducted using
Comprehensive Meta-Analysis software. Result(s): The initial search
found 1,324 articles. After all articles were examined, a total of 29
studies fit our criteria. ICD shocks 1 year post CSD had a pooled event
rate of 66.5% with a 95% confidence interval (CI) of 57.7% to 74.3% and
the I-squared (I2) statistics. ICD shocks at 6 months had an event rate at
61.7% with a 95% confidence interval of 53.3% to 69.4% with I2 at 46. VA
in one year post CSD had a pooled event rate of 62.5 with a 95% with a CI
of 53.3% to 69.1% and I2 at 22%. At 6 months the event rate was 64.2 with
a 95% CI of 56.3% to 71.4% with I2 at 33% Mortality from cardiac
arrhythmia and classified 0-30 days (short term), 21-364 days (medium
term), and >365 days (long term). The pooled event rate for short term
morality was 6.8% with a 95% CI of 4.2%-11.0% with I2 at 0%, medium term
was 5.2% with a 95% CI of 2.9% to 8.9% with I2 at 0%, and long term was
5.0% with a 95% CI of 2.7% to 9.2% and I2 at 0%. Conclusion(s): CSD
may be an alternative form of therapy that reduces shock event rates and
recurrent VA in patients that are refractory to ablation and medical
therapy. However larger prospective studies are needed to further evaluate
the usefulness and safety of CSD.

<110>
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Accession Number
646741672
Title
Effect of metabolic surgery on cardiovascular outcomes in people with
obesity and pre-existing cardiovascular disease: A systematic review and
meta-analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Qazi S.; Ali H.; Ansari H.; Qazii S.; Dawood M.H.; Batool R.; Shaikh M.A.;
Ahmed S.Z.; Aisha E.
Institution
(Qazi, Ali, Ansari, Qazii, Dawood, Batool, Shaikh, Ahmed, Aisha) Dow
University of Health Sciences, Karachi, Pakistan
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Previous literature shows that metabolic surgery effectively
decreases the risk of cardiovascular disease (CVD) events in patients with
obesity. The use of metabolic surgery has, however, been limited in people
with obesity and pre-existing CVD due to concerns of poor postoperative
cardiovascular outcomes. This study aims to determine the effectiveness
and safety of metabolic surgery in patients with pre-existing CVD.
 Method(s): A search of electronic databases, PubMed, Cochrane Central
and SCOPUS was conducted from their inception till May 2024. The study was
conducted adhering to the PRISMA guidelines. Outcomes of interest were
risk of all-cause mortality, major adverse cardiovascular events (MACE),
risk of myocardial infarction (MI), and cerebrovascular events in patients
with and without prior CVD undergoing bariatric surgery. Data was pooled
as generic inverse variance using a random effects model, and presented as
hazard ratios (HR) with their 95% confidence intervals (CI).
 Result(s): We included four studies in our analysis (n = 5,244). Our
pooled analysis shows that metabolic surgery leads to significant
reduction in risk of all-cause mortality (HR = 0.51, 95% CI: [0.42, 0.61];
p<0.01). We also observed a significant risk reduction of 43% in MACE with
metabolic surgery (HR = 0.57, 95% CI: [0.5, 0.64]; p<0.01). Metabolic
surgery was not associated with a significant reduction in the risk of MI
(HR = 0.53, 95% CI: [0.24, 1.18]; p = 0.12, I = 83%). Similarly, a
non-significant decrease in risk of cerebrovascular events was observed
with metabolic surgery (HR = 0.89, 95% CI: [0.65, 1.22]; p = 0.48)
 Conclusion(s): Metabolic surgery is associated with decreased risk of
all-cause mortality and MACE in patients with obesity and established CVD.
These results are thought to be mediated through reduction in risk factors
such as obesity, but also by reducing inflammatory mediators and having
other beneficial effects on cardiac structure and left ventricular
workload.

<111>
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Accession Number
646742683
Title
Hemodynamic and Clinical Outcomes with Balloon-Expandable Valves Versus
Self-Expanding Valves in Patients with Small Aortic Annulus Undergoing
Transcatheter Aortic Valve Implantation: A Meta-Analysis of Randomized
Controlled Trials and Propensity Score Matched Studies.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Ahmed M.; Ahsan A.; Tariq I.; Raja M.F.; Mahmood A.; Tabassum S.; Ramphul
K.; Ahmad A.; Rahman A.; Shahid F.; Ahmed R.
Institution
(Ahmed, Rahman, Shahid, Ahmed) Rawalpindi Medical University, Rawalpindi,
Pakistan
(Ahsan) Foundation University Medical College, Islamabad, Pakistan
(Tariq) United Medical and Dental College, Karachi, Pakistan
(Raja, Mahmood) Allama Iqbal Medical College, Lahore, Pakistan
(Tabassum) King Edward Medical University, Faisalabad, Pakistan
(Ramphul) Independent Researcher, Triolet, Mauritius
(Ahmad) Chelsea and Westminster Hospital, London, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is thought to
be more effective than surgery for patients with small aortic annulus
(SAA), however, the comparative efficacy of different transcatheter heart
valves (THVs) remains uncertain. The objective of this meta-analysis was
to compare the effects of balloon-expandable valves (BEVs) and
self-expanding valves (SEVs) on hemodynamic parameters and clinical
outcomes in patients with SAA who underwent TAVI. Method(s): A
thorough literature search was performed across PubMed/MEDLINE, Embase,
and the Cochrane Library from their inception until May 2024 to identify
eligible randomized controlled trials (RCTs) and propensity-score matched
(PSM) studies. Clinical outcomes were evaluated using a random-effects
model to pool risk ratios (RRs) with 95% confidence intervals (CIs).
 Result(s): The analysis included 8 studies; 2 RCTs and 6 PSM studies,
with a total of 2,180 patients with SAA. BEVs were associated with a
smaller indexed effective orifice area (MD: -0.18, 95% CI: -0.31 to -0.05)
and a higher transvalvular mean pressure gradient (MD: 5.23, 95% CI 3.44
to 7.02) than SEVs. The risk for prosthesispatient mismatch (PPM) (RR=
1.82, 95% CI: 1.27 to 2.60) and severe PPM (RR= 2.77, 95% CI: 1.93 to
3.98) was significantly higher for patients receiving BEVs than those
receiving SEVs. However, no significant difference was observed between
BEVs and SEVs regarding the risk of paravalvular leak (RR= 0.98, 95% CI:
0.57 to 1.69) and the permanent pacemaker implantation (RR= 0.78, 95% CI:
0.50 to 1.23). Although patients receiving BEVs showed a slightly lower
risk of major bleeding events (RR= 0.69, 95% CI: 0.49 to 0.99), BEVs were
associated with a significantly increased risk of 1-year cardiovascular
mortality (RR= 1.61, 95% CI: 1.05 to 2.47) compared to those receiving
SEVs. However, no significant differences were observed between BEVs and
SEVs regarding 30-day all-cause mortality (RR= 1.19, 95% CI: 0.57 to
2.49), 1-year all-cause mortality (RR= 1.17, 95% CI: 0.89 to 1.53), stroke
rates (RR= 0.83, 95% CI: 0.52 to 1.31) and any vascular complication (RR=
1.13, 95% CI: 0.72 to 1.75). Conclusion(s): In patients with SAA,
SEVs showed reduced risks of PPM and severe PPM compared to BEVs, along
with a larger indexed effective orifice area. Moreover, SEVs were
associated with a lower risk of 1-year cardiovascular mortality. (Figure
Presented).

<112>
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Accession Number
646740341
Title
Ticagrelor Monotherapy in Patients with ACS Undergoing Coronary Stenting:
An Updated Meta-Analysis of 3 Month versus 12 Month DAPT.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Haseeb M.; Shafiq A.; Mungee S.
Institution
(Haseeb, Mungee) UIC Peoria, Peoria, IL, United States
(Shafiq) Al Aleem Medical College, Lahore, Pakistan
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Current guidelines recommend DAPT for 12 months in patients
with ACS undergoing PCI. However, data on ticagrelor monotherapy after
early aspirin discontinuation (<3 months, Short-DAPT) is scarce. We
conducted an updated meta-analysis to assess the safety and efficacy of <3
month of DAPT (aspirin and ticagrelor) in patients with ACS undergoing
PCI. Hypothesis: Short-DAPT will be more favorable than Standard-DAPT.
 Method(s): This meta-analysis reviewed literature obtained
systematically. Inclusion criteria encompassed randomized controlled
trials of ticagrelor comparing <3 month of DAPT with 12 month of DAPT in
ACS patients undergoing coronary stenting with a minimum follow up of one
year. The primary endpoint was major adverse cardiovascular events (MACE).
Secondary outcomes were net adverse clinical events (NACE), all-cause
mortality, and major bleeding. We estimated inverse variance pooled hazard
ratios using a random-effects model and DerSimonian-Laird method to
calculate between-study variance. Result(s): Five trials with 21407
patients of ACS undergoing PCI were included (FIGURE). When comparing
Short-DAPT with Standard- DAPT, the pooled hazard ratios and corresponding
95% confidence intervals for MACE, NACE, all-cause mortality, and major
bleeding were 0.90 (0.77, 1.06), 0.72 (0.57, 0.91), 0.76 (0.59, 0.99), and
0.44 (0.35, 0.56), respectively Conclusion(s): Patients with ACS
undergoing PCI can benefit from superior clinical outcomes, lower bleeding
rate and a similar rate of MACE, with aspirin discontinuation at or less
than 3 months and maintenance on ticagrelor monotherapy afterwards.
(Figure Presented).

<113>
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Accession Number
646742094
Title
Comparative Outcomes of Cardiogenic Shock in Acute Myocardial Infarction
Versus Acute Heart Failure: A Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Saravanabavanandan R.; Venugopal D.; Saha S.; Panchal V.; Venugopal S.;
Al-Tawil M.; Pullatt R.
Institution
(Saravanabavanandan, Venugopal) University of Illinois, College of
Medicine, Peoria, IL, United States
(Saha) John H. Stroger Jr. Hospital of Cook County, Chicago, IL, United
States
(Panchal) Smt. N.H.L. Municipal Medical College and SVPISMR, Gujarat,
Ahmedabad, India
(Venugopal) Medstar Health, Hollywood, MD, United States
(Al-Tawil) Al-Quds University, Jerusalem, Palestine, State of, United
States
(Pullatt) Trinitas Regional Medical Center, Watchung, NJ, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Clinical trends show a rise in non-ischemic causes of
cardiogenic shock (CS), especially acute heart failure CS (AHFCS).
Compared to acute myocardial infarction cardiogenic shock (AMICS), AHFCS
typically occurs in the context of chronic heart failure with compensatory
mechanisms that seem to better withstand hemodynamic disturbances. Given
the clinical heterogeneity, we aim to compare the in-hospital outcomes of
AMICS and AHFCS to enhance clinical decision-making. Method(s): We
conducted a comprehensive literature search until April 2024 and included
8 studies from PubMed, Scopus, Embase, etc. We used Mantel-Haenszel random
effects and inverse variance models to estimate the pooled risk ratio (RR)
and mean differences at a 95% confidence interval. Result(s):
Patients with AMICS were older by an average of 6.3 years compared to
those with AHFCS [p<0.00001]. The AMICS cohort showed an 80% greater risk
of using temporary mechanical circulatory support (tMCS) [RR: 1.80;
p<0.00001] and an 88% greater risk of using > 1 tMCS [RR: 1.88; p<0.00001]
than patients with AHFCS. When categorized by tMCS type, Impella use was
notably higher in the AMICS group [RR: 1.65; p<0.0001]. AMICS patients
showed a 79% lower risk of undergoing LVAD implantation [RR: 0.21; p=0.03]
and 88% lower risk of heart transplantation (HT) [RR: 0.12; p<0.0001]
compared to AHFCS cohort. Our meta-analysis revealed no significant
differences between the two groups in hospital mortality [RR: 1.13; p =
0.50], length of stay (LOS), vasopressor use, or occurrence of bleeding.
 Conclusion(s): This pioneering meta-analysis reveals distinct
differences in treatment approaches between AMICS and AHFCS. AMICS
patients more frequently utilized tMCS but were less likely to receive
LVAD or HT. Despite these variations, in-hospital mortality, LOS,
vasopressor use, and bleeding remain comparable between the two groups.
This emphasizes the critical need for tailored treatment strategies based
on CS etiology.

<114>
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Accession Number
646741626
Title
Have Gender-Specific Outcomes After STEMI Improved? - A Meta- Analysis of
the Past Decade.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Hariyanto J.; Hardi C.J.; Setiawan J.A.; Ng S.
Institution
(Hariyanto, Hardi, Setiawan, Ng) Universitas Pelita Harapan, Jakarta,
Indonesia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Over the past decade, research has focused on gender
disparities in cardiovascular outcomes. Historically, women have had
higher mortality rates and worse outcomes after STEMI compared to men.
This study aims to investigate if advancements in interventional
cardiology and prehospital and in-hospital care have improved outcomes for
women over 10 years. Method(s): PubMed, Scopus and Cochrane were
reviewed for cohort studies and registries from 2014- 2024 comparing male
and female STEMI patients, focusing on mortality, reinfarction, heart
failure, stroke, and stent thrombosis. In-hospital and 1-year outcomes
were assessed. Statistical analysis used Review Manager and I-2 for
heterogeneity with a random-effects model. Result(s): We found 28
studies from 39 countries, with 39% female participants. T2DM was
prevalent for 33.2% of males and 36.9% of females, with 32.2% of males and
21.3% of females being smokers. Both genders had an equal history (50%) of
previous MI, PCI, and CABG. Primary PCI was performed in a majority (73%)
of male patients compared to 62% of female patients; while thrombolysis
was received by 73.1% of males and 61.5% of females. For in-hospital
outcomes, women have a higher all-cause mortality risk (RR = 1.77, 95% CI:
1.65-1.91), consistent in 2014-2018 (RR = 1.75, 95% CI: 1.49-2.05) and
2019-2024 (RR = 1.79, 95% CI: 1.63-1.96; P = 0.81) Women have higher risks
of stroke (RR = 1.64, 95% CI: 1.34-2.02) and heart failure (RR = 1.50, 95%
CI: 1.31-1.70) No significant differences were found in reinfarction (RR =
1.19, 95% CI: 0.82-1.74) or stent thrombosis (RR = 1.05, 95% CI:
0.53-2.07) At 1 year, women have a significantly higher all-cause
mortality risk (RR = 1.94, 95% CI: 1.48-2.53), observed in both 2014-2018
(RR = 1.77, 95% CI: 1.26-2.50) and 2019-2024 (RR = 1.98, 95% CI:
1.45-2.72; P = 0.64) Women also face higher cardiovascular mortality (RR =
2.45, 95% CI: 1.11-5.40) and stroke risk, (RR = 1.85, 95% CI: 1.43-2.39)
with no significant difference in reinfarction risk (RR = 0.96, 95% CI:
0.53- 1.73) Conclusion(s): Women with STEMI still face higher risks
of in-hospital and 1-year all-cause mortality, stroke, and heart failure
compared to men, indicating insufficient improvement in outcomes. There
were no significant differences in reinfarction and stent thrombosis. It
is important for future efforts to focus on understanding these
disparities to improve outcomes for women.

<115>
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Accession Number
646742049
Title
Paclitaxel-Coated Balloon vs Uncoated Balloon for Coronary In-Stent
Restenosis: A Systematic Review and Metaanalysis of Randomized Controlled
Trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Tanashat M.; Abdelgalil M.S.; Abuelazm M.; Manasrah A.; Abouzid M.; Abu El
Haija M.; El Khatib S.; Abu-Laila M.; Ayyad M.
Institution
(Tanashat, Abu-Laila, Ayyad) Yarmouk University, Irbid, Jordan
(Abdelgalil) Ainshams University, Cairo, Egypt
(Abuelazm) Tanta University, Tanta, Egypt
(Manasrah, El Khatib) UHS-WIlson Medical Center, Binghamton, NY, United
States
(Abouzid) Poznan University of Medical Sciences, Poznan, Poland
(Abu El Haija) King Hussein Cancer Center, Amman, Jordan
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Despite the effectiveness of drug-eluting stents (DES) in
preventing restenosis, many patients still experience DES restenosis.
Neointimal hyperplasia and neoatherosclerosis can develop within these
stents, leading to recurrent coronary syndromes. Hypothesis: Repeated
stenting with DES is limited by additional metal layers, the need for
prolonged dual antiplatelet therapy, and heightened risks of stent
thrombosis. Locally acting drugs with sustained efficacy may prevent this
progression. Paclitaxel delivery via contrast medium or drug-coated
balloon catheters could exert antiproliferative effects, reducing
neointimal proliferation. Aim(s): To synthesize existing evidence on
the efficacy and safety of Paclitaxel-Coated Balloons versus Uncoated
Balloons in coronary in-stent restenosis. Method(s): Following the
PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses) guidelines, we searched five electronic databases (PubMed,
EMBASE, Cochrane Library, Scopus, and Web of Science) to identify eligible
studies reported up to March 23, 2024. Using R version 4.4.0, we reported
outcomes as risk ratios (RRs) or mean differences (MD) and confidence
intervals (CIs). This review has been registered and published in PROSPERO
(CRD42024527412). Result(s): The meta-analysis included a total of
six trials with 1,541 patients. PCB significantly reduced the incidence of
myocardial infarction (RR 0.65, 95% CI [0.42, 1.00], p = 0.052), stent
thrombosis (RR 0.26, 95% CI 0.08, to 0.83], p = 0.023), major adverse
cardiac events (RR 0.32, 95% CI 0.25, to 0.42], P < 0.001), target lesion
revascularization (RR 0.34, 95% CI [0.14, 0.84], p < 0.001). No
significant differences were observed between PCB and UCB regarding
cardiac-related mortality, target vessel revascularization, percutaneous
coronary intervention, all-cause death, Q wave and non-Q wave myocardial
infarction, coronary artery bypass grafting, and target vessel failure.
 Conclusion(s): PCB for ISR significantly reduced the incidence of
myocardial infarction, MACE, and stent thrombosis compared to UCB. (Figure
Presented).

<116>
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Accession Number
646742684
Title
Comparative Analysis of Transcatheter Mitral Valve Replacement versus
Redo-Surgical Mitral Valve Replacement: A Systematic Review and Meta
Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Shaukat M.T.; Rehman W.; Ur Rehman A.; Mohsin A.; Ur Rahman S.; Imran H.;
Qureshi M.A.; Abbott J.; Ehsan A.; Sellke F.
Institution
(Shaukat, Rehman, Ehsan, Sellke) King Edward Medical University, Lahore,
Pakistan
(Ur Rehman) University of Alabama, Birmingham, AL, United States
(Mohsin) Brown University, Providence, RI, United States
(Ur Rahman) Carle Health, Urbana, IL, United States
(Imran, Abbott) Rhode Island Hospital, Providence, RI, United States
(Qureshi) Henry Ford Jackson Hospital, Jackson, MI, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter mitral valve replacement (TMVR) has emerged as a
promising alternative to conventional redo-surgical intervention in
patients presenting with mitral valve prosthesis failure. We conducted a
meta-analysis to delineate efficacy and safety of transcatheter mitral
valve replacement (TMVR), encompassing both valve-in-valve (ViV) and
valve-in-ring (ViR) procedures, compared to redosurgical mitral valve
replacement (SMVR). Aim(s): The primary aim of our meta-analysis was
to investigate the early clinical outcomes following either ViV/ViR TMVR
or SMVR. Method(s): PubMed/MEDLINE, Cochrane Library, and
clinicaltrials.gov were systematically searched according to predefined
inclusion and exclusion criteria. Several efficacy and safety outcomes
were pooled and reported as risk ratios (RRs) with 95% confidence
intervals (CIs). Result(s): Fourteen retrospective cohort studies
(patients=18,519) were evaluated in this analysis. Compared with redo-SMVR
for mitral valve prosthesis failure, TMVR exhibited lower in-hospital
mortality (OR=0.69; 95% CI 0.56-0.86; p<0.01). Moreover, stroke (OR=0.46;
95% CI 0.31-0.68; p=0.05), renal dysfunction (OR=0.49; 95% CI 0.38-0.63;
p<0.01), need for pacemaker implantation (OR=0.28; 95% CI 0.23-0.34;
p<0.01), major cardiac complications (OR=0.43; 95% CI 0.32-0.59; p<0.01),
length of ICU stay (OR=-2.11; 95% CI -2.82 - -1.39; p< 0.01), and need for
exploration for bleeding (OR=0.23; 95% CI 0.17-0.30; p<0.01) also revealed
significant improvements in the TMVR cohort. To minimize heterogeneity, we
performed subgroup analysis for in-hospital mortality, which remained
significant (OR=0.42; 95% CI 0.34-0.51; P< 0.01) on propensity matching.
Conversely, paravalvular leak (OR=22.12; 95% CI 2.81-174.16; p=0.003)
generated results favoring SMVR. There was negligible and nonsignificant
difference in mean mitral valve gradient (MD: -0.01; 95% CI: -0.57 to 0.5;
P =0.97), 30-day mortality (OR: 0.86; 95% CI: 0.48-1.53; P = 0.60), and
1-year mortality (OR: 1.05; 95% CI: 0.68-1.61; P = 0.83) between the two
groups. Conclusion(s): In patients experiencing mitral valve
prosthesis failure, TMVR offers an efficacious, safe, and less invasive
alternative to SMVR. However, the risk of paravalvular leak requires
careful monitoring. (Figure Presented).

<117>
Accession Number
646741435
Title
New-onset atrial fibrillation following coronary artery bypass graft
surgery: A systematic review.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Gandhi D.; Prakash A.; Guragain A.; Garcia Risk A.; Vaz C.; Patel G.
Institution
(Gandhi, Guragain, Garcia Risk, Vaz, Patel) NYMC at St. Mary's and St.
Clare's Health, Dover, NJ, United States
(Prakash) St Marys General Hospital,Passaic, Cedar Grove, NJ, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Post coronary artery bypass surgery atrial fibrillation
(Post-CABG AF) was reported to have variable incidence ranging from 10 to
40% and also noted to have a significant risk of stroke and all-cause
mortality. This systematic review evaluated the incidence and adverse
outcomes of post- CABG AF. Method(s): The search period was from 1
January 2010 to September 30, 2023. We conducted a literature search in
PubMed of English language, peer-reviewed manuscripts. We included
observational and experimental studies among patients who underwent CABG
and developed new-onset atrial fibrillation. We analyzed the overall
incidence of new-onset AF, 30-day mortality, and adverse outcomes,
including cerebrovascular accidents. Result(s): Thirty-two
manuscripts, including findings from two randomized controlled trials
conducted among patients with post-CABG new onset atrial fibrillation were
reviewed, comprising of 150,788 patients. Of these, 39,327 (26%) developed
new-onset post-CABG AF. The median age of patients with new onset
post-CABG is 67.5 (IQR 66-69) years, with 52.5% males. The average
incidence of cerebrovascular accidents calculated from four manuscripts
was 6.26% and 3.38% among patients with and without new-onset AF
post-CABG, respectively, with RR 1.92 (95% CI 1.69 - 2.18). Four studies
described 30 days of mortality risk, which averaged at 3.05% and 1.46%
among patients with and without new-onset AF post-CABG, respectively, with
RR 2.08 (95% CI 1.77,2.45). Conclusion(s): This systematic analysis
shows a higher incidence of post-CABG new-onset AF, along with a
significant increase in 30-day mortality risk and incidence of
cerebrovascular accident when compared to patients who did not develop
new-onset AF postoperatively. We propose further studies on determining
solutions for post-CABG AF.

<118>
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Accession Number
646743225
Title
Renal Outcomes of Staged Versus Concomitant Percutaneous Coronary
Intervention and Transcatheter Aortic Valve Replacement: A meta-analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Chanda V.; Bittar V.; Carvalho P.; Garot P.
Institution
(Chanda) Johns Hopkins University, Baltimore, MD, United States
(Bittar) Centro Universitario das Faculdades Associadas de Ensino, Sao
Paulo, Brazil
(Carvalho) Minneapolis Heart Institute Foundation, Minneapolis, MN, United
States
(Garot) Institut Cardiovasculaire Paris Sud, Massey, France
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The impact of staged on renal outcomes percutaneous coronary
intervention (PCI) in patients undergoing transcatheter aortic valve
replacement (TAVR) is uncertain. Method(s): MEDLINE, Embase, and
Cochrane were systematically searched for studies comparing staged versus
concomitant PCI in patients with aortic stenosis and coronary artery
disease undergoing TAVR and PCI. A random-effects model metaanalysis
calculates the odds ratio (OR) with a 95% confidence interval (CI). Our
outcome of interest was the incidence of contrast-induced acute coronary
injury (CIAKI) and its respective stages. Result(s): 11 studies
comprising 6,056 patients undergoing TAVR and PCI were included. Compared
with concomitant PCI, staged PCI did not reduce the incidence of CI-AKI
(OR 0.89; 95% CI 0.48-1.64; p=0.70; Figure 1). In a subgroup analysis,
there was no difference between staged and concomitant PCI in the
incidence of stage 1 CI-AKI (OR 1.99; 95% CI 0.38-10.47; p=0.70), stage 2
CI-AKI (OR 1.01; 95% CI 0.39- 2.64; p=0.70), and stage 3 CI-AKI (OR 0.48;
95% CI 0.23-1.00; p=0.051). Conclusion(s): In patients undergoing
TAVR, there was no difference between staged versus concomitant PCI in the
incidence of contrast-induced nephropathy .

<119>
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Accession Number
646742667
Title
Successful Left Atrial Appendage Occlusion (LAAO) with WATCHMAN FLX via
Transhepatic Approach.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Charbonne G.; Card A.; Fischer K.; Mitiek O.; Valencia D.; Schwartz B.
Institution
(Charbonne, Card, Fischer, Mitiek, Valencia, Schwartz) KetteringHealth
Main Campus, Kettering, OH, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Left atrial appendage occlusion (LAAO) with the WATCHMAN FLX (Boston
Scientific) has been proven to reduce stroke risk in patients with
paroxysmal atrial fibrillation (PAF). Certain circumstances may preclude
LAAO1. In this case, transhepatic vein access was used to successfully
deploy a WATCHMAN FLX in a 72 year old male with PAF not on
anticoagulation due to recent subdural hemorrhage and recurrent bilateral
lower extremity deep venous thrombosis (DVT) post IVC filter placement.
Recent attempt at LAAO was unsuccessful due to total occlusion of
bilateral femoral veins (Figure 1 A-B) and inability to cross the IVC.
Access to the inferior branch of the right hepatic vein was achieved by
micropuncture technique at the right mid-axillary line at the level of the
12th rib, which was confirmed by venogram (Figure 2A). The 4F microsheath
was upsized to 16F. Intraoperative TEE was used for device sizing and
delivery (Figure 3A). The transseptal sheath and dilator were positioned
in the right atrium at the level of the fossa ovalis (Figure 3B) before
successfully crossing into the left atrium (Figure 2B). After confirming
placement (Figure 3C), a pigtail catheter was positioned within the LAA
(Figure 3D) and an angiogram was performed (Figure 2C). A 24 mm WATCHMAN
FLX was partially unsheathed and positioned (Figure 3E). Repeat LAA
angiogram was performed through the WATCHMAN delivery sheath (Figure 2D).
A Tug test was performed. The device was released (Figure 3F). Repeat
venogram was performed to confirm location (Figure 2E) of the access site,
and coil embolization closure of the venotomy access site was performed
(Figure 2F). The patient was discharged the following day on dual
antiplatelet (aspirin, clopidogrel) without complication. Venous access
via right hepatic vein is a viable option for LAAO using the WATCHMAN FLX
device. (Figure Presented).

<120>
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Accession Number
646740078
Title
Clinical Outcomes Following Transcatheter Edge-to-Edge Mitral Valve Repair
in Cancer Survivors: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Costa T.; Felix N.; Clemente M.; Costa B.; Lima N.; Guha A.; Silva G.
Institution
(Costa) University of Colorado, School of Medicine, Fortaleza, Ceara,
Brazil
(Felix) Federal University of Campina Grande, Campina Grande, PB, Brazil
(Clemente) Faculdade de Medicina de Petropolis, Petropolis, Brazil
(Costa) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Lima) Hartford Hospital, Hartford, CT, United States
(Guha) Augusta University, Augusta, GA, United States
(Silva) Texas Heart Institute, Houston, TX, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Little is known about the outcomes of cancer survivors
versus patients without a history of cancer undergoing Transcatheter
Edge-to-Edge Mitral Valve Repair TEER for mitral regurgitation MR.
Moreover, recent publications retrieved conflicting results on the safety
and efficacy of TEER in cancer survivors. Hypothesis: Performing TEER in
cancer survivors produces similar outcomes when compared to patients with
no history of cancer. Aim(s): Conduct a systematic review and
meta-analysis to evaluate clinical outcomes after TEER for MR in patients
with versus without a history of cancer. Method(s): From inception to
December 2023, we systematically searched PubMed, Web of Science, and
Embase for studies comparing the safety and efficacy of TEER for MR in
cancer survivors versus in patients without a history of cancer. Outcomes
of interest were 30-day and 1-year all-cause mortality, incidence of
post-procedural MR grade >= 3, post-procedural stroke, and 30-day
readmissions. Statistical analyses were performed using R software version
4.3.2. We pooled odds ratios OR with 95% confidence intervals CI for
binary endpoints. Result(s): We included six observational studies
comprising 25,334 patients, of whom 6.1% were cancer survivors. Cancer
survivors and controls had comparable rates of 30-day all-cause mortality
OR 1.15; 95% CI 0.55 to 2.39; p=0.71, 1-year all-cause mortality OR 1.61;
95% CI 0.93 to 2.79; p=0.09, postprocedure severe MR OR 1.49; 95% CI 0.67
to 3.30; p=0.33, post-procedural stroke OR 1.25; 95% CI 0.47 to 3.27;
p=0.66, and 30-day readmission OR 1.16; 95% CI 0.92 to 1.46; p=0.19.
 Conclusion(s): This meta-analysis suggests that cancer survivors with
symptomatic MR have similar outcomes after TEER as compared with patients
who do not have a history of cancer. Future multicenter studies are
warranted to confirm and expand these findings in larger populations and
with multivariableadjusted analysis.

<121>
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Accession Number
646740968
Title
Colchicine for prevention of pericarditis after catheter ablation: A
systematic review and meta-analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Mashaly D.; Hassan A.; Mustafa Qafesha R.; Elbadry M.; Dervis M.; Mohamed
A.; Abdelazeem B.; Ramadan S.; Abdelaziz A.
Institution
(Mashaly, Hassan) Faculty of medicine, October 6 University, Giza, Egypt
(Mustafa Qafesha) Faculty of medicine, Al-Quds university, Jerusalem,
Palestine
(Elbadry) Faculty of medicine, October 6 university, Giza, Egypt
(Dervis) Faculty of Medicine, Ankara Yilidirim Beyazit University, Ankara,
Turkey
(Mohamed) Faculty of medicine, Tanta university, Tanta, Egypt
(Abdelazeem, Ramadan, Abdelaziz) Faculty of medicine, Ain shams
university, Cairo, Egypt
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Catheter ablation (CA) therapy is well established therapy
for different types of atrial fibrillation, with some concern including
post ablation pericarditis which increases the morbidity and mortality.
Colchicine, known for its anti-inflammatory effects has shown to be
effective in reducing the incidence of perioperative AF after cardiac
surgery. However, the efficacy of post ablation colchicine is still
debatable. We aimed to establish evidence on the use of colchicine for
preventing pericarditis after catheter ablation. Method(s): We
searched PubMed, Scopus, WOS and Cochrane until May 2024 for relevant
studies that assessed colchicine after CA. The primary outcome of interest
was the incidence of pericarditis following AF. Other secondary outcomes
were the incidence of pericardial effusion, GI adverse events, and
hospitalization rates. Result(s): A total of nine studies were
included with a total of 2795 patients aged 66 to 69.4 years, Colchicine
administration before catheter ablation showed a significant decrease in
the occurrence of clinical pericarditis after AF ablation compared to
placebo (RR=0.38; 95% CI: 0.27, 0.53). Moreover, colchicine was favored to
decrease the incidence of AF recurrence rate at 3, 6, and 12 months with
the following values, respectively (RR=0.58, 95% CI: 0.42 to 0.80, 0.69,
95% CI: 0.5 to 0.97, and 0.76, 95% CI: 0.66 to 0.87). On the other hand,
colchicine was associated with a significant increase in GI adverse events
(RR= 2.62, 95% CI: 1.57, 4.37). Conclusion(s): Colchicine was found
to be a promising intervention for reducing the incidence of pericarditis
following atrial fibrillation ablation. Despite some contradictory data
about gastrointestinal side effects, cautious dosage measures, such as
weight-adjusted doses, may improve tolerability while maintaining efficacy
in reducing post-ablation events.

<122>
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Accession Number
646741926
Title
Combined left atrial appendage occlusion and catheter ablation in patients
with atrial fibrillation: a systematic review and meta-analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Clemente M.R.C.; Navalha D.; Bittar V.; Costa T.; Fernandes G.P.; Silva L.
Institution
(Clemente) Petropolis School of Medicine, Rio de Janeiro, Brazil
(Navalha) University of Nebraska Medical Center, Omaha, NE, United States
(Bittar) Centro Universitario das Faculdades Associadas de Ensino, Sao
Joao da Boa Vista, Brazil
(Costa) University of Colorado, School of Medicine, Aurora, CO, United
States
(Fernandes) Centro Universitario do Estado do Para, Belem, Brazil
(Silva) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Left atrial appendage occlusion (LAAO) and catheter ablation
(CA) for atrial fibrillation (AF) have been increasingly performed in
combination. However, the effects of this combined procedure remain
unknown. Hypothesis: Combined LAAO and CA improves outcomes of patients
with AF relative to isolated LAAO. Aim(s): To compare the outcomes of
combined LAAO and CA with isolated LAAO in patients with AF.
 Method(s): PubMed, Embase, and Cochrane Library were systematically
searched from inception to March 2024 to identify studies comparing
combined LAAO and CA versus isolated LAAO. We pooled odds ratios (OR) with
95% confidence intervals (CI) for binary endpoints. Statistical analyses
were performed using R software version 4.3.1. Result(s): We included
eight retrospective studies comprising 51,802 patients, of whom 1,375
(2.6%) received the combined procedure, and 29,696 (57.3%) were men. Mean
age of patients ranged from 63.6 to 71.4 years. Follow-up ranged from 1 to
37.6 months. Additionally, 626 (1.2%) patients had paroxysmal AF and 757
(1.4%) had persistent AF. There were no significant differences between
the combined procedure and LAAO alone in terms of major bleeding (OR 0.55;
95% CI 0.09 to 3.41; p=0.52; Figure 1A), stroke (OR 1.03; 95% CI 0.35 to
3.00; p=0.96; Figure 1B), or pericardial effusion (OR 1.18; 95% CI 0.60 to
2.33; p=0.63; Figure 1C). Conclusion(s): In this meta-analysis, there
were no significant differences in major bleeding, stroke, or pericardial
effusion when comparing combined LAAO and CA with isolated LAAO.

<123>
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Accession Number
646741300
Title
Timing of Percutaneous Coronary Intervention for Non-infarct-related
Coronary Artery in Patients with Acute Myocardial Infarction and
Multivessel Disease: A Systematic Review and Network Meta-analysis of
Randomized Controlled Trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Toyota T.; Nakamura K.; Sano M.; Azumi Y.; Hideyuki H.; Murai R.; Ooka J.;
Sasaki Y.; Taniguchi T.; Kim K.; Kobori A.; Ehara N.; Kinoshita M.
Institution
(Toyota) Kobe City Medical Center General Hospital, Kobe, Japan
(Nakamura) Kyoto University Hospital, Kyoto, Japan
(Sano, Azumi, Hideyuki, Murai, Ooka, Sasaki, Kim, Kobori, Ehara,
Kinoshita) Kobe City Medical Center General HP, Kobe city, Japan
(Taniguchi) Kobe City Medical Center General HP, Kobe, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Although prior reports suggest that percutaneous coronary
intervention (PCI) of noninfarct- related artery (NIRA) in patients with
acute myocardial infarction (AMI) and multivessel disease improves
clinical outcomes, the optimal timing for NIRA-PCI remains debated.
Research Questions: When is the preferred timing to perform NIRA-PCI after
infarct-related-artery (IRA)- PCI? Aims: We aimed to compare the clinical
outcomes based on PCI strategies classified by the timing of NIRA-PCI in
AMI patients with multivessel disease. Method(s): We performed a
systematic review and network meta-analysis of randomized controlled
trials (RCTs) evaluating clinical outcomes to compare PCI strategies for
multivessel disease in AMI patients until September 2023. The primary
outcome measure was all-cause death, while the secondary outcomes included
myocardial infarction, stroke, coronary revascularization, and bleeding.
 Result(s): We included 22 RCTs (N=13,093) comparing the IRA only-PCI
and NIRA-PCI strategies. Immediate NIRA-PCI strategy was defined as
performing NIRA-PCI after IRA-PCI without delay. Staged NIRA-PCI
strategies were categorized into three groups based on the
protocol-defined or treated timing for NIRA-PCI from the IRA-PCI: within
one week (Staged-Within1W), one week to one month (Staged-1Wto1M), and
after one month (Staged-After1M). Compared with IRA-only PCI,
Staged-Within1W had significantly lower risks for all-cause death,
myocardial infarction, and coronary revascularization. The immediate PCI
strategy relative to IRA-only PCI favored for myocardial infarction and
coronary revascularization; however, there was no significant difference
for all-cause death. Although Staged-1Wto1M or Staged-After1M showed
trends similar to Staged-Within1W, all outcome measures had no significant
difference. The risk for bleeding or stroke was comparable among the four
strategies. Conclusion(s): This meta-analysis demonstrated a
consistent benefit of the NIRA-PCI strategies relative to IRA-only PCI
strategy in patients with AMI and multivessel disease. Among the NIRA-PCI
strategies, NIRA-PCI within one week appeared the most preferred strategy
in patients with AMI and multivessel disease.

<124>
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Accession Number
646743806
Title
A Pilot Study of Post- Discharge Atrial Fibrillation Using a Novel Mobile
Electrocardiography Monitoring Device.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Iribarne A.; Patel N.; D'Alessandro D.; DiMaio J.; Bhavnani S.; Badhwar
V.; Sengupta P.; Gajewska-Dendek E.; Johnson L.
Institution
(Iribarne) Staten Island University Hospital, Northwell Health, Staten
Island, NY, United States
(Patel) Lenox Hill Hospital/Northwell Health, New York, NY, United States
(D'Alessandro) Massacusetts General Hospital, Boston, MA, United States
(DiMaio) Heart Hospital Baylor Plano, Dallas, TX, United States
(Bhavnani) Scripps Clinic, La Jolla, CA, United States
(Badhwar) West Virginia University, Morgantown, WV, United States
(Sengupta) Rutgers RWJ Medical School, New Brunswick, NJ, United States
(Gajewska-Dendek, Johnson) Lund University, Malmo, Sweden
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Post-operative atrial fibrillation (AF) is the most common
arrhythmic complication after CABG. Following inpatient treatment, data on
the frequency and duration of recurrent AF after hospital discharge remain
sparse. Research Question: Do patients who experience in-hospital
post-operative AF have recurrent arrhythmias in the 30 days post
discharge? Goals: To characterize the burden of AF after hospital
discharge using a wearable telemetry device. Method(s): Patients
enrolled in the CTSN PACeS trial were eligible for this sub-study. PACeS
is a randomized trial of anticoagulation versus no-anticoagulation in
patients with new-onset post-operative AF. Eligibility criteria include
patients with new onset AF defined as AF > lasting 60 minutes or recurrent
AF episodes within 7 days after CABG and before hospital discharge. All
patients in this sub-study wore a 3-lead mobile telemetry device upon
hospital discharge that provided continuous beat-to-beat data for 30 days.
For this analysis, an AF event was counted if it was at least 30 seconds
in duration. Result(s): Forty-six patients participated in this
sub-study. The mean age was 68.8 years, 21.7% were women, 78.3% White and
11% Hispanic. The mean and median device wear times were 23 and 29 days,
respectively. The average total available analytic time (i.e., total time
of interpretable electrocardiographic signal) was 20.3+/-3.3 hours/day. At
least one episode of AF post-discharge was detected in 38 (82.6%) of
patients. Among these, the median number of days in which patients had an
episode of AF was 6. The mean duration of time in AF was 1.6+/-1.7
hours/day and the overall percent time in AF was 7.5%. Most patients
(78.3%, n=36) had AF for <10% of the recording time. Nearly all AF events
occurred within the first two weeks post discharge (Figure).
 Conclusion(s): In this telemetry study, patients who developed
postoperative AF within 7 days of CABG were found to have a modest burden
of post discharge AF episodes, most frequently within the first 2 weeks.
These preliminary data should be verified in larger prospective studies,
and may help inform anti-thrombotic and other management decisions for
patients who develop AF following CABG surgery.

<125>
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Accession Number
646740181
Title
Impella in Myocardial Infarction Complicated by Cardiogenic Shock: A
Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Haider M.; Berry R.; Hamza M.; Upreti P.; Mir J.; Naveed H.; Naseer U.;
Pandya K.; Harmouch K.M.; Ahmed M.; Karamat M.K.; Sattar Y.; Alraies M.C.
Institution
(Haider, Ahmed, Karamat, Sattar, Alraies) Carle Foundation Hospital,
Champaign, IL, United States
(Berry) Authority Healt, Detroit, MI, United States
(Hamza) Albany Medical Center, Aldan, PA, United States
(Upreti) Sands-Constellation Heart Institute, Rochester Regional Health,
Rochester, NY, United States
(Mir) University of Missouri, Columbia, MO, United States
(Naveed) HCA, Houston, TX, United States
(Naseer) USD Sanford School of Medicine, Sioux Falls, SD, United States
(Pandya, Harmouch) Cleveland Clinic, Cleveland, OH, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Despite recent technological advancements, myocardial
infarction complicated with cardiogenic shock is associated with high
mortality. Impella has been advocated as an adjunct to the standard of
care, but conflicting data has hindered greater utilization. We performed
an updated metaanalysis with the recent data. Method(s): We searched
PubMed and Embase, screened 787 articles, and identified twelve studies
that met eligibility criteria; these randomized controlled trials and
cohort studies compared Impella to other mechanical circulatory support
systems in patients with myocardial infarction complicated by cardiogenic
shock. We evaluated groups with twenty-three metrics related to adverse
events and clinical outcomes. A random effects model assessed
heterogeneity between studies. Result(s): We did not find a
statistically significant difference between groups across all
twenty-three included metrics: in-house mortality, 30-day mortality,
6-month mortality, brain death, cardiovascular death, non-cardiac
mortality, myocardial infarction, need for repeat percutaneous coronary
intervention, need for left ventricular assist device, coronary bypass
artery graft, stroke, limb ischemia, hemolysis, major bleeding,
thrombosis, and sepsis. Table 1 Our subgroup analyses for intra-aortic
balloon pump, extracorporeal membrane oxygenation, and medical management
revealed similar results for mortality. In terms of bleeding, IABP was
associated with better outcomes whereas ECMO was associated with worse
outcomes than Impella. Impella was also associated with an increased risk
of thrombosis as compared to IABP. Table 2,3,4 Conclusion(s): Our
updated meta-analysis did not relate Impella use to better outcomes.
Heterogeneity in the timing of device implantation calls for stricter
reporting in subsequent larger, randomized controlled trials.

<126>
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Accession Number
646742448
Title
Comparison of 30-Day Outcomes of TAVR vs. SAVR in Patients with Prior
CABG: A Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Qureshi M.A.; Haseeb S.; Bakht D.; Amir M.; Hussain M.; Ahmed O.; Ur
Rehman A.; Ahmed H.; Ansari U.; Munir S.; Zulqarnain M.; Qureshi A.A.
Institution
(Qureshi, Ahmed, Ansari, Munir, Zulqarnain, Qureshi) Henry Ford Jackson
Hospital, Jackson, MI, United States
(Haseeb) Northwell Health, Port Jefferson, NY, United States
(Bakht, Amir, Hussain, Ur Rehman) King Edward Medical University, Lahore,
Pakistan
(Ahmed) Sheikh Zayed Medical College, Rahim Yar Khan, Pakistan
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Managing severe aortic stenosis in patients with a history
of coronary artery bypass grafting (CABG) is challenging. Traditionally,
surgical aortic valve replacement (SAVR) was the standard treatment, but
transcatheter aortic valve replacement (TAVR) offers a less invasive
alternative. This meta-analysis compares the 30-day outcomes of TAVR
versus SAVR in patients with prior CABG. Method(s): A systematic
review and meta-analysis were conducted according to PRISMA guidelines.
Studies comparing TAVR and SAVR in patients with prior CABG were included.
The primary outcomes were 30-day (cardiovascular) CV mortality, allcause
mortality, stroke, and myocardial infarction. Heterogeneity was assessed
using the Chi-squared test and I-squared statistic. P value <0.05 was
considered statistically significant. Result(s): Nine studies with a
total of 8,487 patients were included for the 30-day outcomes. The pooled
odds ratio (OR) for 30-day CV mortality was 1.00 (95% CI: 0.48-2.06), with
no significant difference between TAVR and SAVR (p=0.99). For 30- day
all-cause mortality, the pooled OR was 0.75 (95% CI: 0.51-1.10), also
showing no significant difference between TAVR and SAVR (p=0.14). The
pooled OR for 30-day myocardial infarction was 0.34 (95% CI: 0.09-1.27),
indicating no significant difference between TAVR and SAVR (p=0.11).
However, the pooled OR for 30-day stroke was 0.67 (95% CI: 0.50-0.90),
showing a significantly lower incidence with TAVR compared to SAVR
(p=0.007). Detailed results in Figure 1. Conclusion(s): In patients
with a history of CABG, TAVR appears to have comparable 30-day outcomes to
SAVR in terms of CV mortality, all-cause mortality, and myocardial
infarction. However, TAVR is associated with a significantly lower
incidence of 30-day stroke. These findings suggest that TAVR may be a
safer option in the short term for this high-risk patient population.
Further research is needed to confirm these results in larger, randomized
controlled trials. (Figure Presented).

<127>
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Accession Number
646742107
Title
Efficacy of selfexpandable versus balloon-expandable Transcatheter aortic
valve replacement in severe aortic stenosis patients: A systematic review
and meta-analysis of randomized control trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Scardini P.G.; Prata A.; Katsuyama E.; Coan A.C.; Fukunaga C.; Neto W.F.;
Fernandes J.; Pinheim R.P.; Andrade N.; Gioli-Pereira L.
Institution
(Scardini, Andrade, Gioli-Pereira) Escola Superior de Ciencias da Santa
Casa de Misericordia de Victoria, EMESCAM, Victoria, Brazil
(Prata) UFES, Victoria, Brazil
(Katsuyama, Fukunaga) Faculdade de Medicina do ABC, Sao Paulo, Brazil
(Coan) Federal University of Espirito Santo, Victoria, Brazil
(Neto) Faculdade de Medicina de Catanduva, Olimpia, Brazil
(Fernandes) Faculdade Israelista de Ciencias da Saude Albert Einstein, Sao
Paulo, Brazil
(Pinheim) Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has become the
primary treatment for severe aortic stenosis, surpassing surgery in
multiple trials. However, there is limited evidence between
self-expandable valves (SEV) and balloonexpandable valves (BEV).
Therefore, we performed a systematic review and metaanalysis comparing the
efficacy of SEV and BEV undergoing TAVR in severe aortic stenosis
patients. Method(s): We systematically searched Pubmed, Cochrane, and
Embase for randomized controlled trials (RCTs) comparing SEV and BEV in
patients with severe aortic stenosis. Our primary endpoint was (1)
All-cause mortality. Additionally, we reported the following secondary
outcomes:(2) stroke, (3)all-cause mortality within 30 days, and (4) stroke
within 30 days. Risk ratios (RRs) with 95% confidence intervals (CIs) were
pooled across studies using a random-effects model. Result(s): Our
meta-analysis included six RCTs comprising 3488 patients, of whom 1617
subjects (46.3%) underwent SEV. The mean age was 81 years, and the mean
follow-up was 2 years. In the pooled analysis, our results show no
significant difference in all-cause mortality (RR: 0.95; CI 95%:
0.81,1.12; p= 0.56; Fig. 1A) and stroke (RR:0.97; CI 95%: 0.72,1.32; p=
0.86; Fig. 2A) between SEV and BEV in patients with severe aortic stenosis
undergoing TAVR. Our 30 days follow-up analysis also showed no significant
change in all-cause mortality (RR: 1.74; CI 95%: 0.88,3.45; p= 0.11; Fig.
1B) and stroke (RR: 0.59; CI 95%: 0.17,1.98; p= 0.39; Fig. 2B).
 Conclusion(s): In this meta-analysis comparing SEV versus BEV in
patients undergoing TAVR in patients with severe aortic stenosis, there
was no significant difference between all-cause mortality and stroke.
These findings were consistent in our 30-day follow-up subanalysis.
(Figure Presented).

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Accession Number
646743608
Title
Safety and Efficacy of Left Atrial Appendage Occlusion Procedure for
Patients with Nonvalvular Atrial Fibrillation and Prior Intracerebral
Hemorrhage: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Chanda V.; Bittar V.; Carvalho P.; Garot P.
Institution
(Chanda) Johns Hopkins University, Baltimore, MD, United States
(Bittar) Centro Universitario das Faculdades Associadas de Ensino, Sao
Joao da Boa Vista, Sao Paulo, Brazil
(Carvalho) Minneapolis Heart Institute Foundation, Minneapolis, MN, United
States
(Garot) Institut Cardiovasculaire Paris Sud, Massey, France
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Patients with nonvalvular atrial fibrillation AF and a history
of intracranial bleeding while on anticoagulant therapy commonly undergo
left atrial appendage occlusion LAAO to prevent thromboembolic events.
Despite being suitable candidates for LAAO, treatment for this patient
population is underrepresented in clinical trials. Method(s): PubMed,
Cochrane, and Embase databases were systematically searched for studies
reporting clinical outcomes after LAAO in patients with prior intracranial
bleeding. Pooled incidence data were presented as mean percentages with
95% confidence intervals CI using a random-effects model. Result(s):
A total of 20 observational studies were included comprising 1,945
patients with nonvalvular AF and prior intracranial bleeding receiving
LAAO. The mean age was 73.2 years, 35.2% were women, 49.8% received
Watchman device. The mean CHA DS VASc was 4.48 and the mean HASBLED was
3.74. In patients with prior intracranial bleeding, the LAAO procedure was
associated with an all-cause mortality pooled incidence rate of 4.42% 95%
CI 2.408.02; I2= 81%, Figure 1A, major bleeding rate of 3.93%
95% CI 2.436.30; I2= 54%, Figure 1B, device-related thrombosis
rate of 1.46% 95% CI 0.83 2.66; I2= 0%, peri device leak rate
of 4.70% 95% CI 1.6112.97; I2= 86%, and stroke rate of 3.48%
95% CI 2.145.63; I2 47%. Conclusion(s): This meta-analysis
of 20 studies found that, in patients with history of intracranial
bleeding receiving LAAO, the incidence of clinical outcomes is comparable
to the overall population undergoing LAAO.

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Accession Number
646742595
Title
30-day and one-year outcomes of patients with severe aortic stenosis after
TAVI using Myval : A Metaanalysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Hasabo E.; Abo Ali A.; Hemmeda L.; Salah A.; Alrawa S.S.; Elgadi A.;
Abdalmotalib M.M.; Eissa A.Y.H.; Allah M.M.F.; Sultan S.; Soliman O.
Institution
(Hasabo, Allah, Sultan, Soliman) University of Galway, Galway, Ireland
(Abo Ali) Alexandria University, Alexandria, Egypt
(Hemmeda, Salah, Alrawa, Elgadi, Abdalmotalib, Eissa) University of
Khartoum, Khartoum, Sudan
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) has been
growing rapidly. The Myval balloon-expandable (BE) valve is a novel valve
used for treating patients with severe aortic stenosis. No previous
meta-analysis has assessed the different outcomes of TAVR using the Myval.
We aim to evaluate the performance and outcomes of the Myval BE valve in
patients with aortic stenosis. Methodology: A systematic search was done
in PubMed, Scopus, Web of Science, Embase, and Cochrane from inception to
June 2024. We used the relevant keywords to include studies that reported
the outcomes of people who underwent a Myval balloon-expandable procedure
for Aortic stenosis. 30-day and one-year outcomes were extracted across
the studies. Device success of Myval was identified using Valve Academic
Research Consortium (VARC)-2 and VARC-3 criteria. Result(s): Thirteen
studies comprising 1256 patients of aortic valve stenosis were included.
Of those, 679/1198 (56.7%) were males. The device success of Myval reached
97% CI [0.95, 0.98] across in included studies (Figure 1). Following TAVI,
the procedural death and life-threatening bleeding with Myval were 1.3%,
CI [0.6, 2.8], and 0.6%, CI [0.2, 2.5], respectively. Stroke cases
following Myval were noticed in 3.6%, CI [2.2, 5.6] of total participants.
After following for 30-days, all-cause mortality and moderate or severe
aortic regurgitation cases were 1.8%, CI [1.0, 3.2], and 2.3%, CI [1.0,
5.0], respectively. Also, the transvalvular mean pressure gradient was
found to be 7.7 mmHg, CI [7.5, 8.0]. One year follow-up showed that
all-cause mortality slightly increased, reaching 8.4% CI [6.1, 11.4] and
stroke cases were noticed in 5.2%, CI [3.4, 7.9] Conclusion(s): Myval
showed good safety and efficacy outcomes after 30 days and one-year
following the TAVI. (Figure Presented).

<130>
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Accession Number
646742615
Title
Mid-term Outcomes of Transcatheter Versus Surgical Aortic Valve
Replacement in Low to Moderate Risk Patients with Severe Aortic Stenosis:
A Meta-analysis of Randomised Clinical Trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Pascoal C.; Faria H.S.; Peres C.; Francisco A.; Tavares L.F.; Doma M.;
Masiero B.B.; Manuel V.
Institution
(Pascoal, Francisco) Universidade Agostinho Neto, Luanda, Angola
(Faria) Federal University of Santa Maria, Santa Maria, Brazil
(Peres) Federal University of Pernambuco, Recife, Brazil
(Tavares) Faculdades de Medicina, Universidade Federal de Alfenas,
Alfenas, Brazil
(Doma) Alexandria Faculty of Medicine, Alexandria, Egypt
(Masiero) Pontifical Catholic University of Rio Grande do Sul, Rio Grande
do Sul, Brazil
(Manuel) Complexo Hospitalar de Doengas Cardio-Pulmonares Cardeal Dom
Alexandre do Nascimento, Luanda, Angola
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Several clinical trials have demonstrated non-inferiority of
transcatheter aortic valve replacement (TAVR) compared with surgical
aortic valve replacement (SAVR) in patients with severe aortic stenosis
(AS) and low to intermediate surgical risk. However, mid-term results are
still contentious. Question: Is TAVR superior to SAVR in the mid-term in
terms of mortality outcomes or adverse cardiovascular events? Methods: We
searched Embase, Pubmed and Cochrane databases for RCTs that compared TAVR
with SAVR in patients with symptomatic severe AS with a follow-up of at
least 4 years. Outcomes of interest were all-cause mortality and disabling
stroke. Result(s): We included six RCTs involving 6,444 patients with
severe AS, of whom 3,282 (50.9%) underwent TAVR. There was no difference
in mortality from all causes (RR 1.08; 95%CI 0.94-1.25; p=0.30;
I2 =45%) and disabling stroke (RR 0.95; 95%CI 0.75-1.21;
p=0.67; I2 =9%) between groups. In the subgroup analysis,
5-year mortality (RR 1.28; 95%CI 1.10-1.49; I2 =0%) was higher
in the TAVI group. The new pacemaker implantation rate was higher in the
TAVI group (RR 2.22; 95%CI 1.42- 3.45; p=0.0004 ; I2 =91%).
However, new atrial fibrillation rate was higher in the SAVR group (RR
0.42; 95%CI 0.37-0.49; p=0.00001; I2 =62%). Conclusion(s):
Mid-term mortality and disabling stroke of patients with severe AS treated
with TAVR or SAVR were similar. (Figure Presented).

<131>
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Accession Number
646743104
Title
TAVR versus SAVR for Severe Aortic Stenosis in the Low and Intermediate
Surgical Risk Population: A Meta-Analysis of Randomized Controlled Trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Krishna M.M.; Joseph M.; Ezenna C.; Pereira V.; Goldsweig A.
Institution
(Krishna) Medical College Thiruvananthapuram, Mavelikara, India
(Joseph) Medical College Thiruvananthapuram, Thodupuzha, India
(Ezenna) UMass-Baystate Medical Center, Springfield, MA, United States
(Pereira) Universidad Austral, Joinville, Brazil
(Goldsweig) Baystate Medical Center, West Hartford, CT, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Randomized control trials (RCTs) have compared transcatheter
aortic valve replacement (TAVR) with surgical aortic valve replacement
(SAVR) for patients with severe aortic stenosis (AS) at low-intermediate
surgical risk. Objective(s): To compare TAVR vs. SAVR for AS in
low-intermediate surgical risk patients. Method(s): We systematically
searched PubMed, Scopus, and Cochrane Central databases for studies
comparing TAVR with SAVR for AS in low-intermediate surgical risk.
Outcomes included composite death or stroke, death, stroke, myocardial
infarction (MI), cardiac death, new atrial fibrillation (AF), new
pacemaker implantation, acute kidney injury (AKI), bleeding, major
vascular complications, endocarditis, aortic valve reintervention, and
rehospitalization at 1 year. Random effects models were used to generate
risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity was
assessed using I2 statistics. Result(s): The systematic
review identified 8 RCTs including 9,239 patients (TAVR n=4,695, 50.8%).
Death or stroke (RR 0.78; 95%CI 0.62-0.98; p=0.033; I2=52%),
cardiac death (RR 0.79; 95%CI 0.63-0.98; p=0.029; I2=1%),
bleeding (RR 0.39; 95%CI 0.25-0.60; p<0.001; I2=94%), new AF
(RR 0.28; 95%CI 0.20-0.40; p<0.001; I2=83%), and AKI (RR 0.50;
95%CI 0.35-0.70; p<0.001; I2=0%) were lower with TAVR. New
pacemaker implantation (RR 2.25; 95%CI 1.50-3.39; p<0.001;
I2=86%) and aortic valve reintervention (RR 1.95; 95%CI
1.19-3.20; p=0.008; I2=0%) were higher with TAVR. Death,
stroke, MI, major vascular complications, endocarditis, and
rehospitalization were comparable. Conclusion(s): In low-intermediate
surgical risk patients, TAVR carries a lower risk of major adverse
outcomes than SAVR. (Figure Presented).

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Accession Number
646743970
Title
Effect of Disclosing a Polygenic Risk Score for Coronary Heart Disease on
Adverse Cardiovascular Events: 10-year Follow-up of the MI-GENES
Randomized Clinical Trial.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Naderian M.; Hamed M.; Vaseem A.; Norland K.; Dikilitas O.; Teymourzadeh
A.; Bailey K.; Kullo I.
Institution
(Naderian, Vaseem, Norland, Teymourzadeh) Mayo Clinic in Rochester,
Rochester, MN, United States
(Hamed, Dikilitas, Bailey, Kullo) Mayo Clinic, Rochester, MN, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The MI-GENES randomized clinical trial (NCT01936675)
assessed the effect of disclosing a polygenic risk score (PRS) for
coronary heart disease (CHD), in addition to a clinical risk based on
Framingham risk score (FRS), on LDL-C levels. The trial enrolled
participants from Olmsted County, Minnesota, without cardiovascular
disease, at intermediate CHD risk (10-y risk: 5-20%), and not on statins.
There was a significant LDL-C reduction in the integrated risk score group
(IRS ; received PRS information in addition to the FRS) compared to the
FRS group (FRS<inf>g</inf>; received their risk based on FRS), due to more
frequent statin initiation. Research Question: Does disclosure of an IRS
for CHD lead to a lower rate of major adverse cardiovascular events
(MACE)? Methods: Participants were followed from randomization beginning
in October 2013 until September 2023 to ascertain cardiovascular events,
testing for CHD, and risk factor changes, by blinded review of electronic
health records. The primary outcome was time from randomization to the
first MACE- defined as cardiovascular death, nonfatal MI, coronary
revascularization, and nonfatal stroke. Analyses were done using Cox and
linear mixed-effects models. Result(s): We followed all 203
participants, who completed the MI-GENES trial, 100 in FRS<inf>g</inf> and
103 in IRS (mean age at the end of follow-up 68.2+/-5.2 years, 48% male).
During a median follow-up of 9.5 years, 9 MACE occurred in FRS<inf>g</inf>
and 2 in IRS (HR, 0.20; 95% CI, 0.04 to 0.94; P=0.042, Figure 1A). In
FRS<inf>g</inf> , 47 (47%) underwent at least one test for CHD, compared
to 30 (29%) in IRS (HR, 0.51; 95% CI, 0.32 to 0.81; P=0.004, Figure 1B).
IRS participants had a longer duration of statin therapy during the first
four years post-randomization (Figure 1C) and a greater reduction in LDL-C
for up to 3 years postrandomization (Figure 1D). No significant
differences between the two groups were observed for hemoglobin A1C, blood
pressure, weight, and smoking cessation rate during follow-up.
 Conclusion(s): The disclosure of 10-year CHD risk that included a PRS
to those at intermediate risk was associated with lower incidence of MACE
after a decade, likely due to more frequent and prolonged statin use,
leading to lower LDL-C levels. (Figure Presented).

<133>
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Accession Number
646743112
Title
Left Versus Right Ventricular Pacing during TAVR and Balloon Aortic
Valvuloplasty: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Khalefa B.; Ayyad M.; Albandak M.; Ayyad A.; Yassin M.N.A.; Gardezi S.K.;
Awad A.K.
Institution
(Khalefa) Ain Shams University, Cairo, Egypt
(Ayyad) Rutgers New Jersey Medical School, Ramallah, NJ, United States
(Albandak, Ayyad) Al-Quds University, Ramallah, Palestine
(Yassin) Faculty of Medicine, Cairo University, Giza, Egypt
(Gardezi) Tj Samson Community Hospital, Oak Park, IL, United States
(Awad) Faculty of Medicine, Ain Shams University, Cairo, Egypt
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: While right ventricular pacing (RVP) is the conventional
temporary pacing modality used for transcatheter aortic valve replacement
(TAVR), this approach possesses inherent risks and procedural challenges.
We aim to assess and compare safety and efficacy of left ventricular
pacing (LVP) and RVP during TAVR and balloon aortic valvuloplasty (BAV).
 Method(s): Following the Preferred Reporting Items for Systematic
Reviews and Meta- Analyses (PRISMA) guidelines, a comprehensive literature
search was conducted in four databases from inception to December 15th,
2023. We included observational studies and clinical trials comparing LVP
with RVP during TAVR and BAV procedures. The risk ratio (RR) with a 95%
confidence interval (CI) was used to compare dichotomous outcomes, while
continuous outcomes were reported in form of mean difference (MD).
 Result(s): Five studies involving 830 patients with RVP and 1577 with
LVP were included. Short-term mortality was significantly higher in the
RVP group (RR 2.32, 95% CI: [1.37-3.93], P = 0.002), as was the incidence
of cardiac tamponade (RR 2.19, 95% CI: [1.11-4.32], P = 0.02). Subgroup
analysis of the TAVR studies only revealed similar trends with higher
short-term mortality in the RVP group (RR 1.99, 95% CI: [1.13-3.51],
P-value = 0.02). LVP demonstrated shorter hospital stays (MD = 1.34 d, 95%
CI: [0.90, 1.78], P<0.001) and reduced procedure duration (MD = 7.75 min,
95% CI: [5.08, 10.41], P<0.00001) compared to RVP. New pacemaker
implantation was higher in the RVP group (RR 2.23, 95% CI: [1.14, 4.39], P
= 0.02). Major vascular complications (RR 1.78, 95% CI: [0.86-3.70],
P-value = 0.12), Cerebrovascular accidents (RR 1.67, 95% CI: [0.78-3.57],
p-value = 0.18) and all bleeding (RR 0.95, 95% CI: [0.51-1.76], p-value =
0.86) were all comparable between both groups. Conclusion(s): Left
ventricular pacing is a plausible alternative to RV pacing in patients
undergoing TAVR or valvuloplasty, particularly in the absence of
high-grade conduction disturbances. LV pacing has demonstrated superior
outcomes with lower short-term mortality rates, lower incidence of cardiac
tamponade, and pacemaker implantation. On the other hand, RV pacing could
be the preferred modality of treatment if baseline conduction
abnormalities are present. (Figure Presented).

<134>
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Accession Number
646740361
Title
Dexmedetomidine for junctional ectopic tachycardia in patients undergoing
tetralogy of Fallot repair: a metaanalysis of randomized controlled
trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Barbosa L.; Queiroz I.; Defante M.; Romeiro P.; Antunes V.; Bulhoes E.;
Mendes B.X.; Silva C.; Guida C.; Barbosa E.; Lages T.I.
Institution
(Barbosa) Federal University of Minas Gerais, Belo Horizonte, Brazil
(Queiroz) Universidade Catolica de Pernambuco, Recife, Brazil
(Defante) Redentor University Center, Rio de Janeiro, Brazil
(Romeiro) University Center of Maceio, Maceio, Brazil
(Antunes) Federal University of Health Science of Porto Alegre, Porto
Alegre, Brazil
(Bulhoes) College of Higher Education of the United Amazon, Redencao,
Brazil
(Mendes) Unichristus, Fortaleza, Brazil
(Silva) University Center CESMAC, Maceio, Brazil
(Guida) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Barbosa) EMESCAM, Paraiso do Tocantins, Brazil
(Lages) University of Sao Paulo, Ribeirao Preto, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Junctional ectopic tachycardia JET occurs in 2 to 22% of
patients after cardiac surgery for congenital heart diseases, including
tetralogy of Fallot TOF repair. Dexmedetomidine emerged as a potential
drug to prevent JET in these patients. This systematic review and
meta-analysis aimed to evaluate the efficacy of dexmedetomidine in JET in
patients undergoing TOF repair. Method(s): We systematically searched
PubMed, Embase, and Cochrane databases for randomized controlled trials
RCTs) analyzing the use of dexmedetomidine in patients undergoing TOF
repair. We pooled risk ratios RR for binary outcomes, and mean differences
MD for continuous outcomes with 95% confidence intervals CI with a
random-effects model. We performed a trial sequential analysis TSA to
assess the random risk of incidence of JET. We used R version 4.3.2 and
TSA version 0.5.9.10 for statistical analyses. Result(s): Our
meta-analysis included 5 RCTs comprising 546 patients, of whom 268 49%
were randomized to dexmedetomidine. Compared with control, dexmedetomidine
significantly reduced the incidence of JET RR 0.46; 95% CI 0.30 to 0.71;
p<0.05; Figure A. However, there were no significant differences in
mortality RR 0.45; 95% CI 0.12 to 1.71; p=0.24; Figure B between groups.
In addition, dexmedetomidine also reduced the length of intensive care
unit ICU stay MD -7.75 hours; 95% CI -15.08 to 0.41; p<0.05; Figure C.
There were no significant differences in ionotropic score MD 0.97
ug.min/Kg; 95 % CI -1.98 to 0.18; p=0.10; Figure D, and ventilation time
MD -2.29 hours; 95% CI -8.39 to 2.41; p=0.27; Figure E. For the primary
endpoint, TSA suggested a low risk of type 1 error; therefore, this result
may be conclusive. Conclusion(s): In patients undergoing TOF repair
surgery, dexmedetomidine significantly reduced the incidence of JET and
the length of ICU stay.

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Accession Number
646740019
Title
Cardioprotective Role of Metformin: A Systemic Review and Meta-Analysis on
Reducing Reperfusion Injury and Improving Endothelial Function.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Notta S.; Magacha H.; Al Akeel M.; Notta N.; Jagadish A.; Jbara M.; Ramu
V.
Institution
(Notta, Magacha, Al Akeel, Notta, Jagadish) East Tennessee State
University, Knoxville, TN, United States
(Jbara, Ramu) East Tennessee State University, Johnson City, TN, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Reperfusion injury, defined as the injury to tissue upon
restoring blood flow after a period of ischemia, remains a concern in many
clinical scenarios such as myocardial infarction and coronary artery
bypass surgery. Among several mechanisms of action, metformin, a commonly
used antidiabetic medication, has received attention recently for its
potential protective effects against reperfusion injury. Hypothesis:
Metformin ameliorates reperfusion injury due to a reduction in myocardial
injury markers and improvement in endothelial function across diverse
clinical settings. Method(s): A systematic literature search of
PubMed, Embase, and Cochrane Library databases up to January 2022 was
performed. Metformin's effects on reperfusion injury were identified by
searching myocardial injury and endothelial dysfunction. The study
included eight articles on metformin and reperfusion injury. Animal
studies, expert opinions, and reviews were excluded. Result(s):
Treatment with metformin significantly lowered myocardial injury markers,
with reduced troponin levels: pooled SMD -0.61, 95% CI -0.87 to -0.36, and
infarct size by a pooled mean difference of -5.25%, 95% CI -8.96 to -1.53.
Additionally, metformin had beneficial effects on the endpoints of
endothelial function, including flow-mediated dilation (pooled SMD 0.68,
95% CI 0.38 to 0.97) and markers of oxidative stress and inflammation.
Subgroup analysis showed a consistent effect of metformin across different
patient populations and different clinical settings. The sensitivity
analysis did not indicate the presence of a single study that affected the
stability of the result. Conclusion(s): This meta-analysis supports
the protective effect of metformin against reperfusion injury in various
clinical settings. Metformin appears to reduce myocardial injury and
promote improvement in endothelial function, which may translate into
reducing the risk of adverse cardiovascular events among patient
populations at high risk for them. Further research is warranted to
investigate the mechanisms for its cardioprotective effect. (Figure
Presented).

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Accession Number
646740645
Title
Thyroid Hormone Supplementation for Heart Donors: a Systematic Review and
Meta-analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Fernandes J.; Pinheiro R.P.S.; Katsuyama E.; Fukunaga C.; Andrade N.;
Prata A.; Neto W.F.; Scardini P.G.; Coan A.C.
Institution
(Fernandes, Neto, Scardini) Faculdade de Ciencias da Saude Albert Einsten,
Santos, Brazil
(Pinheiro) Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
(Katsuyama) Faculdade de Medicina do ABC, Sao Paulo, Brazil
(Fukunaga) Faculdade de Medicina do ABC, Sao Paulo, Brazil
(Andrade) Escola Bahiana de Medicina e Saude, Salvador, Brazil
(Prata) UFES, Vitoria, Brazil
(Coan) Federal University of Espirito Santo, Vitoria, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Thyroid hormone (TH) supplementation is a well-known guideline
recommendation for eligible donors of heart transplantation. However, few
research data demonstrated a benefit of this therapy, and some suggest
higher rates of graft failure. Therefore, we aim to expand on previous
literature through a systematic review and meta-analysis comparing TH
therapy to placebo in potential heart transplant donors. Method(s):
We systematically searched Embase, Pubmed and Cochrane for randomized
controlled trials (RCT) and observational studies comparing TH therapy to
placebo in heart donors. We focused on the following outcomes: (1)
receptor graft complications; (2) all-cause mortality; and (3)
retransplantation. A subgroup analysis was performed according to graft
complications: (1) dysfunction; (2) failure; (3) loss; and (4) survival.
 Result(s): We included six studies, of which 2 were RCTs. A total of
16,452 were analyzed, of whom 10,573 (64.3%) underwent TH supplementation.
The follow-up period ranged from 30 days to 10 years. The included
subjects were mostly male (69.1%), with a mean age of 30.6 years. In the
pooled analysis, we found no significant difference between groups in
graft complications (Figure 1;RR 0.94; 95% CI 0.52-1.69; p=0.83),
all-cause mortality (RR 1.13; 95% CI 0.64-2.00; p=0.67), and
retransplantation rates (RR 1.21; 95%CI 0.64-2.26; p=0.55). Subgroup
analysis of graft complications demonstrated similar results between
groups (p=0.29). Conclusion(s): In our meta-analysis of heart
transplant donors, TH therapy was associated with similar rates of
all-cause mortality, graft complications and retransplantation rates
compared to the placebo group. It is important that further studies be
conducted to reassess the guidelines regarding the use of TH in eligible
heart transplant donors.

<137>
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Accession Number
646742578
Title
Racial/Ethnic Disparities in Outcomes of Post-Transcatheter Aortic Valve
Replacement: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Pawar S.; Ganduboina R.; Dutta P.; Gulati S.; Ranka S.
Institution
(Pawar) Shree Vighanaharta Superspeciality Hospital, Maharashtra, Dhule,
India
(Ganduboina) NRI Institute of medical Sciences, Visakhapatnam, India
(Dutta) Kyiv Medical University, Kyiv, Ukraine
(Gulati) Sir Ganga Ram Hospital, New Delhi, India
(Ranka) University of Florida Leesburg Hospital, Leesburg, FL, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: There has been growing awareness and recognition of discrepant
health outcomes based on ethnic and racial background in patients
undergoing cardiovascular procedures. Transcatheter aortic valve
procedures has become the primary treatment for aortic stenosis and is
currently the standard of care. Despite widespread adoption of TAVR,
African Americans (AA) have continued to remain underrepresented and
typically suffer poorer outcomes. Thus, we conducted a systematic review
and meta-analysis to compare TAVR outcomes between AA and non-AA
populations. Methodology: We systematically searched all electronic
databases (PubMed, EMBASE, Scopus, Web of science) from inception until
May 25th, 2024. A pooled analysis of data from observational studies and
randomized controlled trials reporting post-TAVR outcomes based on racial
background were included. The key endpoints evaluated were in-hospital
mortality, post-procedure myocardial infarction (MI), pacemaker placement,
in-hospital stroke, vascular complications, major bleeding, acute kidney
injury (AKI). We used the I2 statistic to assess heterogeneity among
studies using the Random-Effects model, with significance set at I2 > 50%.
All analysis was carried out using R version 4.3.2. Result(s): The
meta-analysis of eleven observational studies, involving 953,892 TAVR
patients [912,301 (95.64%) Caucasians and 41,591 (4.36%) AAs], showed a
statistically significant higher risk of post-procedure pacemaker
placement (OR 1.08, 95% CI: 0.77-1.51, p=<0.001, I2=99%) for Caucasians
compared to AAs. In secondary outcomes, AAs had significant higher risk of
in-hospital stroke (OR 0.83, 95% CI: 0.67-1.02, p <0.01, I2=90%), major
bleeding (OR:0.89, 95% CI: 0.77-1.02, p <0.01, I2=74%), AKI (OR: 0.77,
95%CI:0.67-0.88, P=0.04, I2=59%) compared to Caucasians. However, no
significant differences were found for in-hospital mortality, MI, vascular
complications as mentioned in Figure 1-3. Conclusion(s): The current
study suggests a worse clinical outcome for AA undergoing TAVR. Further
studies are needed to evaluate the factors responsible for the discrepancy
and implementing mitigation strategies. (Figure Presented).

<138>
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Accession Number
646742217
Title
Effectiveness of Additive Cardiac Computed Tomography Angiography for
Pre-procedural Planning of Left Atrial Appendage Occlusion: A Systematic
Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Pereira V.; Fernandes J.; Pinheiro R.P.S.; Andrade N.; Katsuyama E.;
Ezenna C.; Krishna M.M.; Joseph M.; Gomes W.
Institution
(Pereira, Joseph, Gomes) Universidad Austral, Joinville, Santa Catarina,
Brazil
(Fernandes) Faculdade Israelita de Ciencias da Saude Albert Einstein, Sao
Paulo, Brazil
(Pinheiro) Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
(Andrade) Escola Bahiana de Medicina e Saude Publica, Salvador, Bahia,
Brazil
(Katsuyama) Faculdade de Medicina do ABC, Sao Paulo, Brazil
(Ezenna) University of Massachusetts, Baystate Medical Center,
Springfield, MA, United States
(Krishna) Medical College Thiruvananthapuram, Mavelikara, India
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The latest expert consensus on catheter-based Left Atrial
Appendage Occlusion (LAAO) suggests considering either transesophageal
echocardiography (TEE) alone or the addition of Cardiac Computed
Tomography Angiography (CCTA) for pre-procedural planning. However,
evidence comparing the effectiveness of adding CCTA to regular TEE
planning on procedural success is limited. Method(s): We aimed to
perform a systematic review and meta-analysis to determine the impact of
adding CCTA to regular TEE for pre-procedural planning in patients
undergoing LAAO. We systematically searched Cochrane, Embase, and Medline
for observational studies and randomized controlled trials (RCTs)
comparing TEE alone to TEE with the addition of CCTA. The primary endpoint
was procedural success. Risk ratios (RRs) with 95% confidence intervals
(CIs) were pooled across studies using a random-effects model.
 Result(s): Four studies were included in our meta-analysis, three of
which were RCTs and one observational study, comprising a total of 824
patients, of whom 496 (60.2%) underwent additional CCTA. In the pooled
analysis, procedural success was higher in the group with added CCTA (RR
1.10; 95% CI 1.01 - 1.19; p=0.022; I2=52%). A subgroup analysis of RCTs
alone confirmed these findings, with a slightly higher magnitude of effect
in benefit of the addition of CCTA, and with lower heterogeneity (RR 1.15;
95% CI: 1.06 - 1.25; I2 = 0%). Conclusion(s): In this meta-analysis
comparing TEE alone vs TEE with the addition of CCTA for preprocedural
planning of LAAO, the addition of CCTA was associated with a higher
procedural success rate, and this finding was confirmed in a subgroup
analysis of randomized data. (Figure Presented).

<139>
[Use Link to view the full text]
Accession Number
646742504
Title
Cusp-overlap view versus three cusp coplanar view during transcatheter
aortic valve replacement using self-expandable valves: A meta-analysis of
5947 patients.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Awad A.K.; Khalefa B.; Gonnah A.R.; Yassin M.N.A.; Hamam N.G.; Ramadan M.;
Dway A.; Alsalhi K.; Osman M.T.; Sicouri S.; Basel R.
Institution
(Awad, Osman, Sicouri, Basel) Faculty of Medicine, Ain shams University,
Cairo, Egypt
(Khalefa) Ain Shams University, Cairo, Egypt
(Gonnah) Imperial College Healthcare NHS Trust, Lo, United Kingdom
(Yassin, Hamam, Ramadan) Faculty of medicine, Cairo University, Cairo,
Egypt
(Dway) Faculty of Medicine, Al-Andalus University for Medical Sciences,
Tartus, Syrian Arab Republic
(Alsalhi) Faculty of Medicine, Batterjee Medical College, Jeddah, Saudi
Arabia
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: Transcatheter aortic valve replacement (TAVR) is
currently the treatment of choice for most patients with symptomatic
severe aortic stenosis. We conducted this systematic review, and
meta-analysis to compare the efficacy and procedural outcomes of using the
cusp overlap technique (COT) versus the standard three-cusp technique
during self-expandable valves implantation for the management of aortic
stenosis. Methodology: We systematically searched PubMed, Scopus, Embase,
Cochrane, and Web of Science (WOS) from inception to March 5, 2024,
following the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) statement. To estimate the effect size, dichotomous
outcomes were pooled as risk ratio (RR), and continuous outcomes were
pooled as mean difference (MD) with their respective 95% confidence
interval (CI). Result(s): We included seventeen studies in our
systematic review and meta-analysis with a total of 3129 patients in
cusp-overlap technique (COT) arm and 2818 patients in standard technique
(ST) arm. The rate of 30-day mortality was significantly decreased in COT
compared with ST (RR = 0.61; 95% CI: [0.37-1.00], P = 0.05). Regarding
conduction abnormalities, COT was related to lower risk of complete
atrioventricular (AV) block (RR = 0.51; 95% CI: [0.37-0.69], P < 0.01),
reduced likelihood of left bundle branch block (RR = 0.77; 95% CI:
[0.61-0.97], P = 0.03) and permanent pacemaker implantation (PPI) (RR =
0.56; 95% CI: [0.46-0.70], P < 0.01). There was also lower likelihood of
major and life-threatening bleeding with the COT compared to ST (RR =
0.60; 95% CI: [0.46-0.79], P < 0.01). Our analysis also showed that COT
was associated with significantly lower implantation depth compared with
ST (MD = -1.00; 95% Cl: [-1.83 to -0.17], P = 0.02). Procedural success
was similar between COT and ST (RR = 1.01; 95% CI: [0.98-1.04], P = 0.42).
Major vascular complications (RR = 0.90; 95% CI: [0.61-1.33], P = 0.61),
and mild to severe paravalvular leak (RR = 1.00; 95% CI: [0.66-1.51], P =
1.00) were also comparable between COT and ST. Conclusion(s): Our
study findings suggest that COT offers several advantages over ST,
including reduced 30-day mortality and decreased bleeding complications,
without compromising long-term outcomes or increasing procedural
complications. The COT most importantly lower risk of conduction
abnormalities, and hence permanent pacemaker implantation. (Figure
Presented).

<140>
Accession Number
646742597
Title
Transcatheter mitral valve repair demonstrates lower early mortality rates
and lower rates of adverse events compared to surgical mitral valve repair
among patients with mitral regurgitation: an updated systematic review and
metaanalysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Elfaituri A.; Alzubi A.S.; Faraj H.A.; Khaled A.; Elfaituri M.
Institution
(Elfaituri, Faraj, Khaled, Elfaituri) University of Tripoli, Tripoli,
Libyan Arab Jamahiriya
(Alzubi) Marshall University, Joan C. Edwards School of Medicine, New
York, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Transcatheter mitral valve repair (TMVR) has recently
emerged as a therapy option for patients with severe mitral regurgitation
(MR) deemed unsuitable for traditional cardiac surgery. In contrast to
surgical mitral valve replacement (SMVr), its effectiveness is uncertain.
Therefore, there is a need to assess safety, mortality, and morbidity.
Hypothesis: To compare the mortality and morbidity of TMVR intervention
versus SMVr in patients with MR. Method(s): Pubmed/Medline, EMBASE,
Cochrane, Web of Science, Scopus, and grey literature were searched in May
2022. We only included studies that reported the outcomes of patients
undergoing TMVR intervention compared to SMVr for MR, either secondary or
primary. The primary outcome was early mortality and major adverse cardiac
events (MACE). The secondary outcomes were reoperation rate, long-term
survival, and complications. Statistical analysis was performed using R
4.0.3 Results: Eleven studies comprising 10,627 patients (5307 TMVR and
5320 SMVr) were included in the analysis. In early mortality, the results
showed TMVR has a significantly lower mortality rate than SMVr (RR: 0.84;
95% CI, 0.43-1.63; P < 0.01; I2 = 47.8%). MACE was significantly lower in
TMVR than SMVr (RR: 0.52; 95% CI, 0.22- 1.22; P < 0.01; I2 = 45.1%). Acute
kidney injury (AKI) was significantly lower in TMVR compared to SMVr (RR:
0.76; 95% CI, 0. 34-1.67; P < 0.01; I2 = 75.1%). Although not significant,
TMVR associatedwith higher rates of reoperation (RR: 2.46; 95% CI, 1.31-
4.61; P = 0.53; I2 = 0%). TMVR was associated with non-significant lower
rates of bleeding complications and the needs for transfusion (RR: 0.23;
95% CI, 0.20-0.28; P = 0.56; I2 = 0%). However, in long survival outcome,
TMVR showed significant higher non-survival rate to SMVr (HR: 1.37; 95%
CI, 0.85-2.23; P < 0.01; I2 = 26.1%). Conclusion(s): TMVR showed
significantly lower early mortality, MACE, andAKI than SMVr. Long survival
outcomes showed a negative trend for TMVR compared to SMVr in a few
included studies. Therefore, TMVR can be a safe and effective approach for
mitral valve regurgitation with lower early mortality and morbidity when
compared to surgical management. However, there is a need for longitudinal
studies on long-term outcomes.

<141>
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Accession Number
646742067
Title
Efficacy of TRISCORE in predicting the long-term survival in patients
undergoing transcatheter tricuspid valve replacement or surgical tricuspid
valve replacement: a systematic review and metaanalysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Katsuyama E.; Fernandes J.; Fukunaga C.; Andrade N.; Prata A.; Scardini
P.G.; Neto W.F.; Coan A.C.; Pinheiro R.P.S.; Gioli-Pereira L.
Institution
(Katsuyama, Pinheiro, Gioli-Pereira) Faculdade de Medicina do ABC, Sao
Paulo, Brazil
(Fernandes) Faculdade Israelita de Ciencias da Saude Albert Einstein,
Santos, Brazil
(Fukunaga) Faculty of Medicine of ABC, Sao Paulo, Brazil
(Andrade) Escola Bahiana de Medicina e Saude Publica, Salvador, Brazil
(Prata) UFES, Victoria, Brazil
(Scardini) EMESCAM, Victoria, Brazil
(Neto) Faculdade de Medicina de Catanduva, Catanduva, Brazil
(Coan) Federal University of Espirito Santo, Victoria, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Tricuspid regurgitation (TR) is a prevalent disease in the
population and is usually progressive. Most patients are treated with
conservative management due to the risk involving transcatheter tricuspid
valve replacement (TTVR) and surgical tricuspid valve replacement (STVR).
The TRI-SCORE was developed to evaluate the severity of patients with TR
and their risk of undergoing a correction procedure. However, there is
still controversy regarding the cutoff value of the score. Therefore, we
aim to perform a systematic review and meta-analysis comparing the cutoffs
>=6 with <6 of the TRI-SCORE in patients with TR undergoing TTVR or STVR.
 Method(s): We systematically searched Embase, Pubmed, and Cochrane
for randomized controlled trials (RCT) and observational studies comparing
cutoffs of >=6 with <6 of the TRI-SCORE in patients with TR undergoing
STVR or TTVR. We focused on the primary outcomes of (1) all-cause
mortality. A prespecified subgroup analysis was performed comparing STVR
with TTVR. Odds Rartion(ORs) with 95% confidence interval (CI) were pooled
across studies using a random effect model. Result(s): We included
three studies encompassing 2063 patients, of whom 441 had a cutoff >=6
(42.12%) at the TRISCORE. The mean follow-up was 2.5 years). In the pooled
analysis, our results show all-cause mortality significant decrease at the
cutoff of <6 in TRISCORE, with lower mortality events (OR 1.15; 95%CI
1.06-2.26; p<0.01; Fig.1). The subgroup analysis revealed a significant
subgroup difference between STVR and TTVR for the outcome of all-cause
mortality (p<0.01) favoring the STVR group (OR 2.13; 95%CI 1.51 -
3.01;p<0.01; Fig.1). Conclusion(s): In our meta-analysis of patients
with TR undergoing TTVR or STVR, a cutoff >= 6 at the TRISCORE was
associated with a worse prognosis, with significantly higher rates of
all-cause mortality and 30-day mortality. The subgroup analysis
demonstrated a higher benefit in =TTVR subgroup (Figure Presented).

<142>
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Accession Number
646742350
Title
A Meta-Analysis Comparing Same-Day Discharge to Later- Day Discharge in
Transcatheter Aortic Valve Replacement.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Jain H.; Jain J.; Goyal A.; Wasir A.; Ahmed M.; Patel N.; Yadav A.; Shah
J.; Mehta A.; Passey S.
Institution
(Jain, Jain, Patel, Mehta, Passey) All India Institute of Medical Sciences
(AIIMS), Jodhpur, India
(Goyal) Seth GS Medical College, KEM Hospital, Mumbai, India
(Wasir) Bharati Vidyapeeth (Deemed to be), University Medical College,
Pune, India
(Ahmed) Rawalpindi Medical University, Rawalpindi, Pakistan
(Yadav) Sardar Patel Medical College, Bikaner, India
(Shah) St Luke's Hospital, Chesterfield, MO, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: One of the benefits of transcatheter aortic valve replacement
(TAVR) over surgical aortic valve replacement (SAVR) is the possibility of
same-day discharge, allowing for early mobilization and reduced total
hospital stay. However, there is limited evidence comparing same-day
discharge to later-day post-TAVR discharge. This meta-analysis aimed to
compare the outcomes of same-day and laterday discharge post-TAVR in
patients with aortic stenosis. Method(s): A systematic bibliographic
search was conducted using electronic databases, including PubMed, Embase,
and the Cochrane Library, from inception to May 23, 2024. We pooled the
risk ratios (RR) with 95% confidence intervals (CI) using the
inverse-variance random-effects model. Statistical significance was set at
p <0.05. Result(s): Six studies were included with 71,550 patients
undergoing TAVR (2215: same-day discharge; 69335: later-day discharge).
The mean age for the same-day and later-day discharge groups was 77.3 +/-
8.3 and 78.3 +/- 8.5, respectively. Same-day discharge for patients
post-TAVR was associated with a higher risk of 30-day stroke [RR: 1.93;
95% CI: 1.14, 3.27] and 30-day major vascular complications [RR: 1.82; 95%
CI: 1.02, 3.24] as compared to later-day discharge post-TAVR. However, no
significant differences in the risks of 30-day mortality [RR: 0.30; 95%
CI: 0.06, 1.57], 30-day readmission [RR: 0.93; 95% CI: 0.66, 1.32], 30-day
major bleeding [RR: 0.86; 95% CI: 0.52, 1.42], 30-day new permanent
pacemaker [RR: 1.00; 95% CI: 0.81, 1.22], 30-day acute kidney injury [RR:
1.04; 95% CI: 0.73, 1.49], and 30-day valve reintervention [RR: 5.77; 95%
CI: 0.60, 55.39] were noted between the two groups. Conclusion(s):
This meta-analysis concluded that same-day discharge post-TAVR is
associated with a higher risk of 30-day stroke and 30-day major vascular
complications than later-day discharge after TAVR. Same-day discharge was
comparable to later-day discharge post-TAVR in terms of 30-day mortality,
30-day readmission, 30-day major bleeding, 30-day new permanent pacemaker,
30-day acute kidney injury, and 30-day valve reintervention. This study
underscores the possibility of same-day discharge after uncomplicated TAVR
in select patients. Further randomized studies are required to evaluate
the safety and feasibility of the same-day discharge protocols. (Figure
Presented).

<143>
Accession Number
646741985
Title
Efficacy and Safety of Left Atrial Appendage Closure Devices in Patients
Aged Above 80 Years: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Bar rem N.I.; Jimenez Y.; Koyner F.G.; Jou K.; Cerrud-Rodriguez R.;
Ammirati G.; Dibiase L.
Institution
(Bar rem, Ammirati, Dibiase) Montefiore Medical Center, New York City, NY,
United States
(Jimenez) University of Florida, Gainesville, FL, United States
(Koyner, Jou) St Barnabas Hospital, Bronx, NY, United States
(Cerrud-Rodriguez) Yale-New Haven Hospital, East Haven, CT, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Limited single-center and observational studies suggest that
left atrial appendage occlusion (LAAO) may be a safe alternative in
selected elderly patients with AFib. Hypothesis: We hypothesize that
patients aged over 80 will have similar rates of complications and the
same level of efficacy in stroke prevention as young patients.
 Aim(s): This review aims to establish the safety and efficacy of LAAO
in octogenarians and nonagenarian patients with AFib. Method(s): A
systematic search of PubMed, Science Direct, and CENTRAL was performed for
studies that reported outcomes comparing octogenarian and nonagenarian
patients who underwent LAAo with their younger counterparts. The Review
Manager 5.4 software was utilized to conduct a meta-analysis of the
outcomes. Result(s): Seven observational studies consisting of 6,126
patients were included, of whom 1,879 (31%) were >=80 years old and 4247
(69%) <80 years old. The mean age of the octogenarian and older cohort
ranged from 82.3 to 84.5 years, while that of the younger cohort ranged
from 68.2 to 75.9 years. The mean follow-up across the studies ranged from
one month to five years post-LAAO. Our pooled analysis showed no
significant difference in the odds of mortality (OR 1.30; 95% CI [0.49,
3.47]; p = 0.60), all causes of stroke (OR 1.22; 95% CI [0.61, 2.43]; p=
0.57), vascular complications (OR 1.70; 95% CI [0.61,4.73]; p=0.31), and
pericardial complications (OR 1.45; 95% CI [0.69, 3.05]; p = 0.33) but a
significant difference in the odds of major bleeding events (OR 1.88; 95%
CI [1.51, 2.34]; p<0.00001)occurred in patients aged >80 compared to their
younger counterparts. Conclusion(s): This meta-analysis suggests that
LAAO in patients aged 80 years and above demonstrates comparable mortality
rates, post-procedural complications, and efficacy to those seen in
younger patients. The findings support the safety and effectiveness of
LAAO as a viable alternative for stroke prevention in very elderly
patients, with additional consideration needed for those with increased
susceptibility to bleeding events .

<144>
[Use Link to view the full text]
Accession Number
646742772
Title
Balloon-Expandable versus Self-Expandable Valve for the Management of
Bicuspid Aortic Disease: An Updated Meta-Analysis of Clinical Outcomes.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Oliveira I.; De Sousa A.; Paiva A.; Ferreira V.; De Sa C.E.N.; Alencar
J.V.A.; Alencar P.L.A.; Lima A.P.D.; Oliveira V.; Moreira H.G.
Institution
(Oliveira, De Sousa, Ferreira, De Sa, Alencar, Alencar, Lima, Oliveira,
Moreira) Federal University of Goias, Goiania, Goias, Brazil
(Paiva) University of Campinas, Campinas, Sao Paulo, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has been
employed in the management of aortic stenosis (AS) in patients with
bicuspid aortic valve (BAV) disease. Nevertheless, the comparative
clinical outcomes of different types of valves used in this procedure
remain inconclusive. Therefore, we conducted an updated meta-analysis to
evaluate the performance of balloon-expandable (BEV) vs selfexpandable
valves (SEV) in patients with BAV going through TAVI. Method(s): We
systematically searched PubMed, Embase and Cochrane for studies comparing
BEV and SEV in the treatment of AS in patients with BAV undergoing TAVI.
Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated
using a random-effects model. Heterogeneity was assessed with the Cochran
Q test and I statistics. Statistical analysis was performed utilizing
Review Manager 5.4.1. Result(s): We included 9 observational studies
with a total of 1,666 patients, of whom 974 (58,46%) received a BEV. The
follow-up duration ranged from 30 days to 2 years. The pooled analysis
revealed no significant differences between the BEV and SEV groups in
terms of procedural death (OR 1.05; 95% CI 0.29 - 3.74; P=0.94), 30-day
all-cause mortality (OR 0.98; 95% CI 0.55 - 1.72; P=0.93; Figure 1A),
30-day cardiovascular mortality (OR 1.02; 95% CI 0.47 - 2.23; P=0.96), 1
year all-cause mortality (OR 1.06; 95% CI 0.58 - 1.93; P=0.86), annulus
rupture (OR 2.67; 95% CI 0.53 - 13.59; P=0.24), coronary obstruction (OR
1.29; 95% CI 0.31 - 5.43; P=0.72), new pacemaker implant (OR 0.76; 95% CI
0.48 - 1.20; P=0.23), moderate or severe aortic regurgitation (OR 0.34;
95% CI 0.11 - 1.00; P=0.05) and stroke (OR 1.18; 95% CI 0.58 - 2.40;
P=0.64). However, the requirement of a second valve was significantly less
common in patients with BEV compared to those with SEV (OR 0.36; 95% CI
0.17 - 0.76; P<0.01; Figure 1B). Conclusion(s): This meta-analysis
suggests that both types of valves exhibit similar clinical outcomes in
patients with BAV undergoing TAVI. Nonetheless, BEV was associated with
lower odds of requiring a second valve compared to SEV. Further randomized
controlled trials are necessary to confirm these findings. (Figure
Presented).

<145>
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Accession Number
646742694
Title
Single Perclose Plus Angioseal Versus Double Perclose for Percutaneous
Femoral Access: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Bertolino E.; Fontoura M.M.M.; Pimentel D.; Fernandez M.; Mesquita C.;
Queiroz I.; Diaz B.; Barbosa L.; Mulatti G.
Institution
(Bertolino, Mulatti) State University of Maringa, Maringa, Parana, Brazil
(Fontoura) Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
(Pimentel) Fluminense Federal University, School of Medicine, Niteroi, Rio
de Janeiro, Brazil
(Fernandez) Bahiana School of Medicine and Public Health, Salvador, Bahia,
Brazil
(Mesquita) Federal University of Pernambuco, Recife, Brazil
(Queiroz) Universidade Catolica de Pernambuco, Recife, Brazil
(Diaz) Universidad Autonoma del Estado de Hidalgo and Instituto Nacional
de Cardiologfa Ignacio Chavez, Mexico City, Federal District, Mexico
(Barbosa) Federal University of Minas Gerais, Belo Horizonte, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Vascular Closure utilizing Suture Based Devices (SBD) is an
established approach for large-bore arterial access in percutaneous
procedure patients. Standard of care uses two devices when accessing the
artery with 8 Fr sheaths and above. The bailout use of Plug-based devices
(PBD) is well established, but little is known about the intentional
combination of SBD with PBD and how this technique compares to the
standard approach. We aimed to compare these different approaches in this
meta-analysis. Method(s): PubMed, Scopus, and Cochrane databases were
searched for observational studies comparing the hybrid approach to the
standard one utilizing exclusively SBDs for arterial closure in large bore
vascular access and reported the outcomes of (1) Access-related
complications (ARC); (2) Major bleeding; (3) All bleeding events; (4) Need
for surgical intervention; (5) Need for endovascular intervention ; (6)
Device failure; (7) Pseudoaneurysm. Heterogeneity was examined with I2
statistics. A random-effects model was used for all outcomes.
 Result(s): We included five observational studies with 1,586
patients, of whom 1,489 (93.8%) underwent TAVI and 97 (6.1%) EVAR. Sheath
size had an average of 20.56 Fr in the EVAR patients. ARC (RR 0.48; 95% CI
0.28-0.81; p<0.01), major bleeding (RR 0.29; 95% CI 0.19-0.44; p<0.01),
all bleeding events (RR 0.36; 95% CI 0.23-0.56; p<0.01), surgical
intervention (RR 0.28; 95% CI 0.10-0.78; p=0.01), or endovascular
intervention (RR 0.53; 95 % CI 0.28-0.98; p=0.04), and device failure (RR
0.28; 95% CI 0.11-0.72; p<0.01) were significantly less common in patients
treated with the hybrid technique compared to standard care.
Pseudoaneurysm (RR 1.13; 95% CI 0.57-2.25; p=0.71) was not significantly
different between groups. Conclusion(s): These findings suggest the
hybrid technique, was associated with fewer access complications compared
to the standard double SBD as a closure strategy in patients with large
bore arterial access. (Figure Presented).

<146>
Accession Number
646742633
Title
The Risk of Bundle Branch Block Following Transcatheter Aortic Valve
Implantation Across Different Valve Types: A Systematic Review with
Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Abdulelah Z.; Abdulelah A.; Al-Dqour M.; Rommaneh M.; Salah Q.; Al
Daradkah J.; Athanahjea A.; Al Balbissi K.
Institution
(Abdulelah) Royal Papworth Hospital, Cambridge, United Kingdom
(Abdulelah, Rommaneh, Al Daradkah) Abdali Hospital, Amman, Jordan
(Al-Dqour) East Tennessee State University, Johnson City, TN, United
States
(Salah) University of Arkansas for Medical Sciences, Little Rock, AR,
United States
(Athanahjea, Al Balbissi) University of Jordan, Amman, Jordan
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) is widely
regarded as the treatment modality of choice for the effective and safe
treatment of native aortic stenosis among patients with high surgical
risk. However, bundle branch block (BBB) following TAVI is well-documented
and widely regarded to be the leading complication associated with TAVI,
along with other conduction abnormalities such as atrioventricular node
block (AVB). Research Question: is the risk of BBB higher with a
particular type of TAVI valve compared to the rest? Aim: To evaluate the
risk of developing BBB following TAVI across the different valve types in
a systematic and meta-analytic approach. Method(s): The following
databases were searched; PubMed, Scopus, Cochrane Library, and
ClinicalTrials.gov. We used the following keywords in the search;
((Transcatheter aortic valve implantation OR Transcatheter aortic valve
replacement OR TAVI) AND (Bundle branch block OR Right bundle branch block
OR Left bundle branch block OR BBB)). The studies were included if they
reported the prevalence of BBB in patients undergoing TAVI with a
specified type of valve such as balloonexpandable valve (BEV),
self-expandable valve (SEV), and mechanical-expandable valve (MEV).
 Result(s): A total of 827 articles were initially identified and
eventually only 176 studies were thoroughly reviewed. Finally, 105
articles (55 BEV, 44 SEV and 6 MEV) were included in this systematic
review and meta-analysis with a total number of included patients being
65,491. The prevalence of patients who underwent BEV and developed a
bundle branch block were 30% (95%CI 0.29-0.31). Moreover, the prevalence
of bundle branch block in patients who had a SEV implant were 16% (95% CI
0.16-0.16), whereas patients who underwent a MEV implant had an
exceptionally high prevalence of bundle branch block of 54% (95%CI
0.52-0.56). The overall prevalence of BBB in patients undergoing a TAVI
was 31% (95% CI 0.17-0.50) using random effects model. Utilization of this
model also demonstrated significant heterogeneity (P-value<0.001, I2=100%)
 Conclusion(s): The prevalence of bundle branch block following TAVI
is alarmingly high at an overall rate of 31%. More importantly, MEV
implants demonstrated a worrisome 54% overall prevalence of bundle branch
block, and thus hindering their potential utilization, especially among
patients with pre-existing bundle branch block.

<147>
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Accession Number
646742008
Title
Electrophysiologic Characteristics, Outcomes and Potential Predictors of
Acute Success After Ventricular Tachycardia Ablation in Patients with
Cardiac Sarcoidosis: Systematic Literature Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Rodriguez-Riascos J.; Srikanth Vemulapalli H.; Muthu P.; Iyengar S.;
Chaudhary R.; Srivathsan K.
Institution
(Rodriguez-Riascos, Srikanth Vemulapalli, Muthu, Iyengar) Mayo Clinic
Hospital, Phoenix, AZ, United States
(Chaudhary) B.J Medical College, Ahmedabad, India
(Srivathsan) Mayo Clinic, Phoenix, AZ, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Cardiac sarcoidosis (CS) is a rare condition marked by
conduction disturbances, and ventricular tachycardia (VT) resulting from
reentrant pathways. VT ablation is typically considered for patients with
refractory VT. This systematic review aims to synthesize reported outcomes
and identify potential predictors for the success of VT ablation in CS
patients. Method(s): A systematic literature review was conducted
following the PRISMA guidelines, searching PubMed, Cochrane, Embase, and
Scopus databases up to May 2024. A random-effects model was used to
evaluate electrophysiologic and procedural variables and compare outcomes
to identify potential predictors of success. Result(s): After
excluding duplicates, 473 titles and abstracts were screened. Twenty-five
studies were fully reviewed, and 9 studies comprising data from 311 CS
patients who underwent VT ablation were included. The mean age of patients
was 50.5 years, with 30% being female. Epicardial mapping was performed in
29% (CI 22-36%; 72/251) of cases, and 96% (CI 77-100%; 65/72) of those
underwent epicardial ablation. The prevalence of VT storm before the
procedure was 28% (CI 16-42%; 89/259), with a suppression success rate of
84% (CI 73-93%; 64/76). The acute complete success rate defined as lack of
inducibility was 58% (CI 49-66%; 174/307). During follow-up, which ranged
from 19 to 58 months, 34% (CI 21-48%; 113/271) of patients survived free
from the composite outcome of death, transplantation, or VT recurrence.
Patients with acute success had fewer inducible VTs (MD -1.1; CI: -1.8 to
-0.5; p < 0.001). No other variables were significantly associated with
acute success. However, patients with acute success tended to be older
than those with partial or unsuccessful outcomes (MD 7.5; CI: -0.2 to
15.1; p = 0.055). Conclusion(s): VT ablation in patients with CS
shows acceptable acute success rates. Patients presenting with VT storm
have a high rate of arrhythmia acute suppression. A lower number of
inducible VTs is associated with higher acute success rates. Despite these
results, the prognosis remains poor, with a significant proportion of
patients experiencing disease recurrence, death, or requiring heart
transplantation .

<148>
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Accession Number
646743196
Title
Self-Expanding versus Balloon-Expandable Transcatheter Aortic Valve
Implantation in Patients With Small Aortic Annulus: An Updated Systematic
Review And Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Passos B.M.F.; Curi D.; Galvao L.K.C.S.; Salles J.P.C.E.A.; Zamora F.;
Filippini F.; Pimenta N.; De Farias Santos A.C.F.
Institution
(Passos, Curi) UFRJ, Rio de Janeiro, Brazil
(Galvao, Zamora) UFMG, Brunswick West, VIC, Australia
(Salles, Pimenta) Universidade Federal do Estado do Rio de Janeiro, Rio de
Janeiro, Brazil
(Filippini) InCor, Sao Paulo, SP, Brazil
(De Farias Santos) City University of Sao Paulo (UNICID), Sao Paulo,
Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Both self-expanding (SEV) and balloon-expandable (BEV)
valves are used in transcatheter aortic valve implantation (TAVI) for
patients with severe aortic stenosis (AS) and small aortic annulus (SAA).
This updated meta-analysis compares the efficacy and safety of SEV versus
BEV in TAVI for these patients. Hypothesis: This study investigates
whether SEV valves are hemodynamically and clinically superior to BEV
valves in patients with small aortic annulus. Method(s): PubMed,
SCOPUS, and Cochrane Central databases were systematically searched for
randomized and observational studies comparing SEV and BEV in TAVI for SAA
patients. Odds ratios (ORs) and 95% confidence intervals (CIs) were
calculated using a random-effects model for clinical outcomes (all-cause
mortality, stroke, permanent pacemaker implantation [PPI]) and hemodynamic
parameters (mean gradient [MG], indexed effective orifice area [iEOA],
moderate to severe prosthesis-patient mismatch [PPM], and paravalvular
leak [PVL]). Result(s): A total of 21 studies involving 6,515
patients (58.4% treated with SEV) were included. SEV valves were
associated with lower all-cause mortality (OR 0.75; 95% CI 0.60-0.95;
p=0.014), lower MG (OR -4.44; 95% CI -5.48-3.39; p<0.01), higher iEOA (OR
0.23; 95% CI 0.13-0.23; p<0.01), and less moderate to severe PPM (OR 0.31;
95% CI 0.22-0.45; p<0.001). However, SEV valves had higher rates of PPI
(OR 1.35; 95% CI 1.01-1.80; p=0.042) and PVL (OR 2.69; 95% CI 1.58-4.57;
p<0.001). Stroke rates were not significantly different between the
groups. Conclusion(s): In patients with severe AS and SAA, TAVI with
SEV valves showed better outcomes in all-cause mortality, MG, iEOA, and
moderate to severe PPM. However, BEV valves had advantages in lower PPI
and PVL rates. These findings should be interpreted cautiously due to the
predominance of observational studies and varying valve types and
generations used. (Figure Presented).

<149>
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Accession Number
646742083
Title
Balloon-expandable versus Self-expandable transcatheter aortic valve
replacement for failed surgical prostheses: A systematic review and
metaanalysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Awad A.K.; Khalefa B.; Yassin M.N.A.; Arnaout M.; Mostafa N.; Naeem M.S.;
Eljadid G.; Gardezi S.K.
Institution
(Awad, Mostafa, Naeem) Faculty of Medicine, Ain Shams University, Cairo,
Egypt
(Khalefa) Ain Shams University, Cairo, Egypt
(Yassin) Faculty of Medicine, Cairo University, Giza, Egypt
(Arnaout) Faculty of Medicine, Aleppo University, Aleppo, Syrian Arab
Republic
(Eljadid) Ain Shams University, Nasr City, Egypt
(Gardezi) Tj Samson Community Hospital, Oak Park, IL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter aortic valve-in-valve (VIV) replacement has
emerged as a valid alternative to conventional re-operation for the
treatment of failed bioprosthetic surgical aortic valves. Self-expandable
valves (SEV) and balloon-expandable valves (BEV) are the two major devices
used. The aim of this study is to compare outcomes between SEV and BEV
when used for transcatheter aortic valve replacement (TAVR) procedures in
failed surgical prostheses. <div> Methods: A comprehensive search was
conducted on PubMed, Scopus, Web of Science, Cochrane Library, and Embase
databases to identify studies comparing aortic valve in valve (ViV) with
SEV and BEV for failed surgical aortic prostheses from inception to May
22, 2024. To estimate the effect size, dichotomous outcomes were pooled as
risk ratio (RR), and continuous outcomes were pooled as mean difference
(MD) with their respective 95% confidence interval (CI).</div> <div>
Results: We included nine studies with a total of 1258 patients in the SEV
group and 1079 in the BEV group. Compared to patients in the BEV group,
patients in the SEV group had significantly lower one-year mortality (RR =
0.69; 95% CI: [0.49-0.98], p = 0.04). SEV group also had less incidence of
severe patient protheses mismatch (RR = 0.49; 95% CI: [0.32-0.75], p
<0.01). On the other hand, patients with SEV had a significantly higher
risk of moderate to severe aortic regurgitation (AR) (RR = 2.71; 95% CI:
[1.69-4.36], p = <0.01) as well as permanent pacemaker implantation (PPI)
(RR = 1.63; 95% CI: [1.18 - 2.26], p <0.01). There was no difference in
the rate of coronary obstruction (RR = 0.87; 95% CI: [ 0.49-1.55], p =
0.64), stroke (RR = 0.82; 95% CI: [0.42-1.58], p = 0.55), and short-term
mortality (RR = 0.76; 95% CI: [0.49- 1.18], p = 0.23) between both groups.
One-year change in mean aortic valve gradient was comparable between both
groups (MD = -13.94; 95% CI:[-31.16-3.28], p = 0.11). </div> <div>
 Conclusion(s): The present systematic review and meta-analysis found
that for patients with failed surgical protheses who underwent
transcatheter aortic VIV, SEV was associated with significantly less rate
of one-year mortality and severe patients Prosthesis mismatch, but higher
rates of PPI implantation and AR of moderate or higher degree. These
findings provide valuable information in guiding proper selection of
devices for patients with degenerated aortic surgical bioprostheses.
</div> <div> </div> (Figure Presented).

<150>
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Accession Number
646742609
Title
A Meta-Analysis of Prospective Studies Comparing Short and Longterm
Outcomes of Trans-Catheter Aortic Valve Replacement in Patient with and
without Cancer.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Khan M.A.; Shafique N.; Rahman H.; Aafreen A.; Muhammad A.; Bhatia H.;
Khan A.N.; Akbar U.; Khan A.; Haider A.; Haider T.; Bhattarai S.; Khan B.;
Lamichhane B.
Institution
(Khan, Rahman, Aafreen, Bhatia, Lamichhane) Guthrie Robert Packer
Hospital, Sayre, PA, United States
(Shafique) Nishtar Medical University, Multan, Pakistan
(Muhammad) King Edward Medical University, Lahore, Pakistan
(Khan) Clovis Community College, Fresno, CA, United States
(Akbar) WVU Camden Clark, Vienna, WV, United States
(Khan) CMH, Quetta, Balochistan, Pakistan
(Haider) FAU Hospital, Tampa, FL, United States
(Haider) SSM St Mary Hospital, St Loius, MO, United States
(Bhattarai, Khan) Advent Health, Tampa, FL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: Trans-catheter Aortic Valve Replacement (TAVR) is the
preferred treatment of choice for improving clinical outcomes in patients
with Severe Aortic Stenosis. Studies published in the past in patients
undergoing TAVR with cancer have shown a lower risk of short-term
mortality but an increased risk of long-term mortality. This study aims to
compare short-term (within 30 days) and long-term (3 years) outcomes in
patients with and without a diagnosis of cancer. Method(s):
Electronic databases like MEDLINE, PUBMED, and COCHRANE library were
thoroughly searched from the date of inception till May2024. 4
observational prospective studies were included in this meta-analysis.
Outcomes of interest included short-term mortality (<30-day), stroke,
pacemaker insertion, vascular complications, major bleeding events and
long-term mortality (>3 year). The results were reported as Risk Ratio
(RR) with 95% confidence intervals (CI), using a random effects model.
 Result(s): This meta-analysis included 6603 patients from 4 studies.
Among those undergoing TAVR, individuals with cancer showed clinically
significant reduction in short-term mortality (RR 0.63, 95% CI: 0.43-0.94,
p = 0.02) but had higher rate of long-term mortality (RR 1.27, 95% CI:
1.15-1.42, p = 0.00001) compared to those without cancer. Additionally,
more major bleeding episodes (RR of 1.17, 95% CI: 1.06- 1.29, p: 0.001)
were observed in the cancer group compared to the non-cancer population.
No significant difference was noted between the two groups regarding risk
of Stroke (RR of 0.98, 95% CI: 0.67- 1.43, p: 0.91), pacemaker (PPM)
insertion (RR 1.09, 95% CI: 0.96-1.24, p: 0.20), and Vascular site
complications (RR 1.09, 95% CI: 0.95- 1.25, p: 0.20). Conclusion(s):
Our study shows that cancer patients undergoing TAVR have good short-term
mortality rates and comparable perioperative outcomes, but higher longterm
mortality as compared to those without cancer. More randomized controlled
trials are needed to further assess the long-term outcomes in this
population. (Figure Presented).

<151>
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Accession Number
646742099
Title
The Effect of Periprocedural Statin Therapy on Mortality and
Cardiovascular Outcomes in Patients Undergoing Transcatheter Aortic Valve
Replacement: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Goyal A.; Mashkoor Y.; Abbasi H.Q.; Khan R.; Jain H.; Rathore S.S.;
Puttaswamy D.; Moeed A.; Sulaiman S.; Belur A.
Institution
(Goyal, Puttaswamy, Sulaiman, Belur) Seth GS Medical College, KEM
Hospital, Panchkula, India
(Mashkoor) Dow University of Health Sciences, Karachi, Pakistan
(Abbasi) Ayub Medical College, Abbottabad, Pakistan
(Khan) Medical University of South Carolina, Florence, SC, United States
(Jain) All India Institute of Medical Sciences-Jodhpur, Jodhpur, India
(Rathore) Dr. Sampurnanand Medical College, Jodhpur, India
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter aortic valve replacement (TAVR) stands as a
notable alternative to surgery for severe aortic stenosis (AS). Despite
the established benefits of statins in cardiovascular pathologies, their
specific impact in patients with severe AS undergoing TAVR remains
uncertain. Our study aims to assess whether perioperative statin use
improves survival and outcomes post-TAVR. Method(s): A search was
conducted across various databases to retrieve studies comparing
perioperative statin use versus no statin use in patients undergoing TAVR.
The primary outcome of interest was all-cause mortality (ACM). Secondary
outcomes included stroke, acute kidney injury (AKI), 30-day mortality,
myocardial infarction (MI), cardiovascular complications, and in-hospital
mortality. Comprehensive Meta-Analysis Software (v. 3) was used to pool
odds ratio (OR) under a random-effects model, with statistical
significance set at p < 0.05. Result(s): Our analysis encompassing
20663 patients from 15 observational studies found that perioperative
statin use was associated with a significant reduction in ACM (OR= 0.71,
95% CI: 0.61-0.83, I2 = 50.3%, p<0.001). Although not
statistically significant, perioperative statin use demonstrated a trend
towards a decreased risk of stroke (OR= 0.90, 95% CI: 0.68-1.19,
I2 = 0%, p= 0.455), AKI (OR= 0.99, 95% CI: 0.75-1.31,
I2 = 49%, p= 0.968), and 30-day mortality (OR= 0.71, 95% CI:
0.46-1.10, I2 = 0%, p= 0.126), and no difference was seen in
the risk of MI (OR= 1.72, 95% CI: 0.73- 4.04, I2 = 0%, p=
0.214), cardiovascular complications (OR= 1.12, 95% CI: 0.91- 1.37,
I2 = 0%, p= 0.297), and in-hospital mortality (OR= 0.42, 95%
CI: 0.13-1.38, I2 = 65.8%, p= 0.151) (Figure 1 and 2).
 Conclusion(s): Perioperative statin therapy reduces all-cause
mortality in TAVR patients but shows limited impact on other outcomes.
Further large-scale prospective studies and trials are necessary to
corroborate our findings. (Figure Presented).

<152>
[Use Link to view the full text]
Accession Number
646742805
Title
Statin Intolerance due to Muscle Symptoms Affects Management of Patients:
Insights from the CLEAR Outcomes Trial.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Laufs U.; Lincoff A.; Nicholls S.; Robinaon P.; Bloedon L.; Sasiela W.; Li
N.; Thompson P.; Nissen S.
Institution
(Laufs) Universitatsklinikum Leipzig, Leipzig, Germany
(Lincoff, Thompson, Nissen) CLEVELAND CLINIC, Cleveland, OH, United States
(Nicholls) Victorian Heart Hospital, Clayton, VIC, Australia
(Robinaon, Bloedon, Sasiela, Li) Esperion Therapeutics, Ann Arbor, MI,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In CLEAR Outcomes the non-statin bempedoic acid (BA) 180 mg
daily reduced MACE-4 (nonfatal MI, nonfatal stroke, coronary
revascularization, or CV death) by 13% in 13970 patients at high CV risk
with statin intolerance (SI) over a median of 40.6 months. This is the
largest prospective database of patients with SI. Aim(s): To assess
whether there were differences in SI symptom history and whether this
influenced the clinical course during CLEAR Outcomes. Method(s): SI
symptoms and impact on activities of daily living (ADL) were recorded
prior to randomization. Patients were grouped post hoc as reporting only
statin associated muscle symptoms (SAMS), only non-muscle adverse effects
(NonSAMS), or BOTH. Result(s): At baseline 6887 (49.3%) patients
reported SAMS, 2485 (18%) NonSAMS, and 4587 (33%) BOTH. SI symptoms had a
moderate/severe impact on ADL in 62% SAMS, 48% NonSAMS, and 69% BOTH. Use
of any lipid modifying treatment at baseline was 43% SAMS, 36% NonSAMS,
and 42% BOTH. Compared to placebo, BA reduced LDL-C at 6 months by 21% in
SAMS, 22% in NonSAMS, and 21% in BOTH. There was no difference in the
effect on MACE-4 by SI group. New use of moderate/high intensity statin
during the study was relatively infrequent (3.2-8.0%) but higher in PBO
than BA in all SI groups and was not generally maintained at study end
(Table 1). Muscle adverse events (AE) were more frequent and resulted in
higher rates of treatment DC in SAMS/BOTH vs NonSAMS (Table 2). There was
no difference between BA and PBO in the rate of muscle related AE.
 Conclusion(s): SAMS are the predominant cause of SI in patients in
CLEAR Outcomes. Patients with a history of SAMS had higher rates of muscle
AE and study drug DC due to muscle AE versus NonSAMS. Muscle AE rates and
study drug DC were balanced between BA and PBO within each SI symptom
subgroup. CLEAR Outcomes exhibits the challenges of treating patients with
SI. These data also demonstrate that BA can be useful in reducing CV risk
in this patient population.

<153>
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Accession Number
646742729
Title
Time Trends in Outcomes of Trans-Catheter Aortic Valve Replacement with
Balloon-expanding Versus Selfexpanding Valves: A Meta-analysis of
Randomized Controlled Trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Tavakoli K.; Mohammadi N.S.H.; Bahiraie P.; Saeidi S.; Shaker F.; Moghadam
A.S.; Namin S.M.; Rahban H.; Pawar S.; Tajdini M.; Soleimani H.; Jenab Y.;
Makkar R.; Hosseini K.
Institution
(Tavakoli, Mohammadi, Saeidi, Shaker, Namin, Soleimani, Makkar, Hosseini)
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Bahiraie) Shahid Beheshti University of Medic, Tehran, Iran, Islamic
Republic of
(Moghadam, Jenab) Tehran Heart Center, Tehran, Iran, Islamic Republic of
(Rahban) Medstar Union Memorial Hospital, Baltimore, MD, United States
(Pawar) Cedars Sinai Medical Center, Los Angeles, CA, United States
(Tajdini) Johns Hopkins University, Baltimore, MD, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The research on the outcomes of transcatheter aortic valve
replacement with balloon-expandable valves (BEV) and self-expanding valves
(SEV) are limited. Hypothesis: This study aims to compare the clinical and
hemodynamic outcomes of BEV and SEV at short-term (30 days), mid-term (1
year), and long-term (>1 year) endpoints. Method(s): PubMed, Embase,
Scopus, and Cochrane Library databases were searched up to April 25, 2024,
for randomized controlled trials (RCTs). Random-effect model
(DerSimonian-Laird method) was used to pool the risk ratios (RR), mean
differences (MD) and 95% confidence interval (CI) for binary and
continuous outcomes, respectively. Result(s): A total of 11 RCTs
comprising 4,325 patients (2,295 BEV, 2,030 SEV) were included. At
short-term, the risk of cardiovascular (RR: 0.56, 95% CI: 0.36-0.87) and
all-cause mortality (RR: 0.54, 95% CI: 0.35-0.81) were lower in the BEV
group. However, no differences were noted between the two treatment
modalities in longer follow-ups despite the lower risk of moderate to
severe paravalvular leak (PVL) among BEV patients. The risk of stroke was
comparable between two groups across all three follow-up endpoints, albeit
a limited number of studies suggesting the BEV group showed a greater risk
of clinical valve thrombosis in mid-term and long-term assessments. The
need for permanent pacemaker implantation was lower in BEV arm in
short-term (RR: 0.56, 95% CI: 0.37-0.87) and mid-term (RR: 0.78, 95% CI:
0.64- 0.94). Yet, this difference was not observed in long-term
follow-ups. Conversely, the SEV group had a larger effective orifice area
with lower mean transvalvular pressure gradient from short-term (MD: 0.17,
95% CI: 0.07-0.26 and MD: 3.71, 95% CI: 2.64- 4.78, respectively) to
long-term (MD: 0.25, 95% CI: 0.17-0.32 and MD: 3.73, 95% CI: 3.19-4.27,
respectively) periods. Conclusion(s): BEV is associated with reduced
risk of clinical outcomes at short-term; however, most differences
diminish in longer evaluations, except for moderate to severe PVL.
Conversely, SEV is linked to better hemodynamic outcomes and a lower risk
of clinical valve thrombosis across all follow-up durations. (Figure
Presented).

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Accession Number
646742637
Title
Elevated Pre-Procedural Serum Natriuretic Peptide Levels Are Associated
with All-Cause Mortality in Patients Undergoing Transcatheter Edge-to-
Edge Mitral Valve Repair: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Cui E.; Hung A.; Ko G.; Cheung H.; Day A.; Norman P.; Abuzeid W.
Institution
(Cui, Hung, Ko, Cheung, Abuzeid) Queen's University, Kingston, ON, Canada
(Day, Norman) Kingston General Hospital Research Institute, Kingston, ON,
Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter edge-to-edge mitral valve repair (TEER) is an
established procedure in patients with severe mitral regurgitation (MR)
and elevated surgical risk on optimal medical therapy. However, there
remains considerable mortality in this patient population. Some studies
have shown that serum brain natriuretic peptide (BNP) and N-terminal pro
b-type natriuretic peptide (NT-proBNP) predict all-cause mortality after
TEER, whereas other studies have shown mortality to be independent of
these markers. To address this gap in knowledge, we sought to examine the
existing literature to determine whether there is an association between
pre-procedural serum natriuretic peptides and mortality after TEER.
Hypothesis: Among patients undergoing TEER, elevated pre-procedural BNP
and NT-proBNP are associated with increased all-cause mortality.
 Method(s): Databases including MEDLINE, Embase, and Cochrane Library
were searched from inception through September 2023 for studies assessing
preprocedural serum natriuretic peptide levels and mortality among
patients undergoing TEER. Pooled hazard ratios (HR) and standardized mean
differences (SMD) were calculated using a random-effects model estimated
by restricted maximum likelihood with the Hartung-Knapp modification.
 Result(s): A total of 30 studies comprising 10259 patients undergoing
TEER met inclusion criteria. 25 studies measured NT-proBNP and 5 studies
measured BNP. Elevated pre-procedural NT-proBNP (>5000 or >10000 pg/mL)
was associated with increased all-cause mortality in both adjusted (HR =
2.94; 95% CI2= 1.75 - 4.95; I2 = 46.8%) and unadjusted (HR =
5.16; 95% CI2= 1.85 - 14.40; I2 = 0.0%) analyses (Figures 1 and
2). Pre-procedural BNP and NT-proBNP were also significantly lower among
survivors at 12 months compared to non-survivors (SMD = 0.82; 95%
CI2= 0.37 - 1.27; I2 = 78.3%) (Figure 3). This association was
demonstrated in patients with primary or secondary MR. Conclusion(s):
Pre-procedural BNP and NT-proBNP levels are significant predictors of
all-cause mortality in patients undergoing TEER for primary or secondary
MR. This supports the inclusion of BNP or NT-proBNP in pre-procedural
assessments to help inform patient discussions and guide post-procedural
follow-up and monitoring. (Figure Presented).

<155>
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Accession Number
646741352
Title
Comparison of Percutaneous Coronary Intervention vs Coronary Artery Bypass
Graft for Left Main Coronary Artery Disease in Patients with Prior
Cerebrovascular Disease: A Systematic Review and Meta-analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Majid M.; Hassaan Ali S.; Ansari H.; Qazi S.; Asghar M.S.; Bhalla J.S.;
Amsterdam E.; Klein A.
Institution
(Qazi, Hassaan Ali, Ansari, Qazi, Asghar, Klein) Dow University of Health
Sciences, Karachi, Pakistan
(Majid) AdventHealth, FL, United States
(Bhalla) Cleveland Clinic, Cleveland, OH, United States
(Amsterdam) University California Davis, Davis, CA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The previous literature reports similar cardiovascular (CV)
benefits for either percutaneous coronary intervention (PCI) or coronary
artery bypass graft (CABG) in patients with left main coronary artery
disease (LMCAD). However, limited data exist on the influence of prior
cerebrovascular disease (CEVD) in such patients. Thus, our aim is to
compare the CV outcomes in patients with LMCAD and prior CEVD, undergoing
either PCI or CABG. Method(s): A comprehensive search of electronic
databases, PubMed, SCOPUS, and Cochrane Central was conducted from their
inception till May 2024. Outcomes of interest included all-cause
mortality, major adverse cardiac and cerebrovascular events (MACCE),
Myocardial Infarction (MI), and risk of stroke in patients undergoing
either PCI or CABG for LMCAD. Data were pooled and analyzed using a random
effects model and presented as hazard ratios (HR) along with their 95%
confidence intervals (CI). Heterogeneity was quantified using the I(2)
index. Result(s): We included three studies in our analysis (n =
5,732). Our analysis demonstrated that in patients with prior CEVD, PCI
lead to significantly increased risk of MACCE (HR = 2.56, 95% CI:[1.23,
5.37], p = 0.01] and MI (HR = 2.97, 95% CI: [1.72, 5.13], p< 0.01). While
an elevated risk of all-cause mortality (HR: 1.35, 95% CI: [0.92, 1.98]; p
= 0.12) and repeat stroke (HR: 1.67, 95% CI: [0.81, 3.42], p = 0.16) was
observed, these were comparable across procedures. Similarly, an elevated
but comparable risk of repeat revascularization was observed between the
two procedures (HR: 3.44, 95% CI: [0.50, 23.60]; p = 0.21).
 Conclusion(s): Our results show that PCI significantly elevates the
risk of MACCE and MI in patients with prior CEVD compared to CABG.
However, risks of all-cause mortality, repeat stroke, and
revascularization were comparable. The increased risk of adverse CV events
in CEVD patients may be due to co-morbidities like hypertension, smoking,
diabetes, peripheral vascular disease, renal insufficiency, inflammation,
and hypercoagulability. We recommend including prior CEVD in preoperative
assessments for revascularization and developing novel strategies for
patients with LMCAD and prior CEVD. (Figure Presented).

<156>
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Accession Number
646742719
Title
Short Term Outcomes Of Transcatheter Tricuspid Valve Interventions On
Post-Procedural Length Of Hospital Stay, Readmissions For Heart Failure
And Procedure Success If An Intracardiac Device Is Present: A Systematic
Review And Meta- Analysis In A New Era Of Tricuspid Interventions.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Kumanayaka D.; Perez L.H.; Aiman W.; Abu Ruman Y.; Chandra A.; Patel P.;
Patel A.; Suleiman A.
Institution
(Kumanayaka, Perez, Aiman, Abu Ruman, Chandra, Patel, Patel, Suleiman)
NYMC, Saint Michaels Medical Center, Newark, NJ, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Tricuspid regurgitation (TR) is no longer considered
forgotten. Transcatheter tricuspid valve repair/replacement (TVRR) has
become widely accepted as gauged by clinical outcomes. FDA approved two
tricuspid valve devices for the purpose of improving quality of life and
not necessarily to improve TR severity. We aim to support evidence-based
use of TVRR, by summarizing the latest evidence on the clinical
effectiveness in terms of post-procedural length of hospital stay,
readmissions for heart failure and procedure success if an Intracardiac
device is present. Method(s): We searched Pubmed, Embase and Cochrane
databases and performed a meta-analysis of the included cohort studies
using a fixed-effects model. Studies were excluded if they did not present
an outcome in each intervention group or did not have enough information
required for continuous data comparison. We performed a metaanalysis of
hazard ratio (HR) for two outcomes and odds ratio (OR) for one outcome
using the random effects model to remove inconsistency and compared the
results with fixed effects model. The compared findings of both methods
were similar. The variables used for analysis were number of events in
exposure group and total amount of events. All data analyses were
performed using MedCalc Statistical Software version 22.023.
 Result(s): Of 161 potentially relevant studies, 8 retrospective
studies with a total of 1,717 patients were included in the meta-analysis.
Procedure (TVRR) success was associated with fewer readmissions for heart
failure in all three studies included in the analysis of pooled HR (HR =
0.46, 95% confidence interval [CI]: 0.33 - 0.63, p<0.001). Procedure
success was also associated with shorter length of hospitalization
postprocedure in all three studies included in the analysis of pooled HR
(HR = 0.48, 95% CI: 0.33 - 0.72, p<0.001). There was no significant
association between procedure success and having an intra-cardiac device
in all three studies included in the analysis of pooled OR (OR = 0.79, 95%
CI: 0.56 - 1.12, p=0.18). Conclusion(s): Our meta-analysis showed
that successful TVRR for high risk patients with severe TR is associated
with significant positive outcomes on post-procedural length of hospital
stay and readmissions for heart failure, regardless of presence of an
intracardiac device. With emerging improvements in device technology and
procedural performance, TVRR should be considered in severe and functional
TR, to improve clinical prognosis. (Figure Presented).

<157>
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Accession Number
646742131
Title
Ischemic Stroke and TIA Incidence in Transcatheter Aortic Valve
Replacement Versus Surgical Aortic Valve Replacement: A Comparative
Systematic Review and Meta-analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Patel P.; Karmani V.K.; Oza J.
Institution
(Patel) New York Medical College, Saint Michael's Medical Center, Newark,
NJ, United States
(Karmani) Jinnah Sindh Medical University, Karachi, Pakistan
(Oza) Loyola MacNeal Hospital, Berwyn, IL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: This systematic review and meta-analysis aimed to compare the
incidence of ischemic stroke and Transient ischemic attack (TIA)
post-transcatheter aortic valve replacement (TAVR) and surgical aortic
valve replacement (SAVR) in intermediate or high surgical risk patients
with aortic stenosis, as this assessment may influence the choice of
intervention. Method(s): In accordance with PRISMA guidelines, we
conducted a comprehensive search of PubMed, Google Scholar, and Cochrane
CENTRAL databases from inception to December 2023 to identify trials and
observational studies comparing the incidence of stroke and TIA after 30
days and 1-year post-TAVR vs SAVR from their inception through December
2023. Odds ratios (ORs) with 95% confidence intervals (CIs) for each
study, employing a random-effects model for data synthesis irrespective of
heterogeneity, were utilized as measures of outcomes. Heterogeneity was
assessed using I2 statistics. All statistical analyses were conducted
using Review Manager (Rev Man, Version 5.4; The Cochrane Collaboration,
Copenhagen, Denmark). Result(s): After screening of 4549 articles,
eight randomized controlled trial studies consisting of 5 randomized
controlled trials and three observational studies with a total of 6879
patients were included in this meta-analysis; six studies comparing 30-day
stroke incidence, no significant difference was found between TAVR and
SAVR (OR 0.83, 95% CI 0.59 to 1.17, p=0.30, I2 3%). Seven studies showed
that TAVR patients had a similar 1-year stroke risk to SAVR patients (OR
0.92, 95% CI 0.64 to 1.33, p=0.67, I2 52%). In the TIA case, there was no
evidence of a significant difference between TAVR and SAVR in the risk of
having a transient ischemic attack within 30 days following surgery (OR
0.93, 95% CI 0.24 to 3.63, p=0.92, I2 52%), although There was a greater
1-year risk of having a transient ischemic attack in the TAVR group
compared to the SAVR group, OR 1.15 (95% CI 0.72 to 1.82, p=0.56, I2 0%),
however, this was not a statistically significant difference.
 Conclusion(s): Our meta-analysis showed no significant differences in
either ischemic stroke or TIA occurrences within 30 days and 1-year post
TAVR and post SAVR in intermediate or high surgical risk patients. (Figure
Presented).

<158>
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Accession Number
646742096
Title
Hybrid Coronary Revascularization versus Traditional Coronary Artery
Bypass Grafting for Left Main Disease.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Hebbo E.; Barker M.; Gold D.; Hassan M.E.; Sawan M.; Halkos M.; Jaber W.;
Sandesara P.
Institution
(Hebbo, Barker, Gold, Hassan, Sawan, Halkos, Jaber, Sandesara) Emory
University Hospital, Atlanta, GA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The current guideline-recommended intervention for left main
(LM) disease is coronary artery bypass grafting (CABG). Hybrid coronary
revascularization (HCR) combines robotic coronary artery bypass and
percutaneous coronary intervention (PCI) and offers a less invasive
approach for patients with LM and multivessel coronary artery disease. We
aim to compare clinical outcomes at 30 days, 6 months and 1 year between
HCR and CABG in patients with LM disease. Method(s): We
retrospectively screened 761 patients who underwent bypass for LM disease
between 2019 and 2023 at a single institution. A total of 118 patients who
underwent either HCR (n=59) or CABG (n=59) were included after propensity
matching for baseline characteristics. The primary endpoint was major
adverse cardiovascular events (MACE), defined as death, myocardial
infarction, repeat revascularization and stroke, at 30 days, 6 months and
1 year, which was assessed using chi-squared tests. Secondary outcomes are
individual components of MACE at 30 days, 6 months and 1 year.
Kaplan-Meier curves were used to visualize the difference in 1-year
cumulative MACE-free survival across groups coupled with a logrank test.
 Result(s): The mean age was 68.93+/-11 years for HCR patients and
68.41+/-10.11 years for CABG patients (p=0.394). SYNTAX score was high (>
33) for 49.1% of HCR patients and 67.3% of CABG patients (p=0.15).
Hospital length of stay was shorter for HCR compared to CABG (4.07 +/-
1.21 days vs. 7.58 +/- 7.71 days, p<0.001). MACE events 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). The cumulative MACE-free
survival at 1 year was significantly higher in the HCR group (p=0.007).
There were no significant differences in secondary outcomes at any time
point with the exception of lower 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 viable alternative to CABG
for LM disease. While randomized clinical trial data is still needed, this
less invasive approach is a promising treatment strategy for patients with
high surgical risk. (Figure Presented).

<159>
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Accession Number
646740685
Title
Mavacamten in adolescent patients with symptomatic obstructive
hypertrophic cardiomyopathy: design of the Phase 3 SCOUTHCM trial.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Rossano J.; Canter C.; Wolf C.; Favatella N.; Lockman J.; Puli S.;
Javidialsaadi A.; Dyme J.; Crevar C.; Mital S.
Institution
(Rossano) Childrens Hospital of Philadelphia, Philadelphia, PA, United
States
(Canter) Washington University, School of Medicine, St Louis, MO, United
States
(Wolf) German Heart Center Munich, Munich, Germany
(Favatella, Lockman, Puli, Javidialsaadi, Dyme, Crevar) Bristol Myers
Squibb, Princeton, NJ, United States
(Mital) Hospital for Sick Children, Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Background: While most current treatments can improve symptoms in patients
with obstructive hypertrophic cardiomyopathy HCM, they may be poorly
tolerated and do not target the underlying pathophysiology. Mavacamten is
the first and only cardiac myosin inhibitor approved for the treatment of
adults with symptomatic New York Heart Association NYHA class IIIII
obstructive HCM but has not been evaluated in a pediatric age group.
SCOUTHCM Study of MavaCamten in AdOlescents with Symptomatic ObstrUcTive
HCM; NCT06253221 will evaluate the efficacy, safety, and pharmacokinetics
of mavacamten in adolescents with symptomatic obstructive HCM.
 Method(s): SCOUTHCM is a randomized, double-blind,
placebo-controlled, international phase 3 clinical trial that will enroll
40 adolescents (age 12 to <18 years) with obstructive HCM Figure).
Patients will receive mavacamten or placebo during the first 28 weeks,
followed by a 28-week double-blind active treatment period. Inclusion
criteria include a diagnosis of HCM with presence of symptoms and left
ventricular outflow tract LVOT obstruction. Patients with HCM phenocopies,
LVEF <50% at rest in the past 6 months, planned escalation in HCM therapy
or upcoming intervention (eg, major cardiac surgery) will be excluded. The
primary endpoint is change in Valsalva LVOT gradient from baseline to week
28. Key secondary endpoints include other echocardiographic parameters,
safety, pharmacokinetics, and exercise capacity. Conclusion(s):
SCOUTHCM is the first randomized controlled trial evaluating a targeted
myosin inhibitor in adolescents with symptomatic obstructive HCM. The
results will inform the utility of mavacamten in adolescent patients with
symptomatic obstructive HCM.

<160>
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Accession Number
646739996
Title
Interleukin-1 Blockade in Patients With ST-Segment Elevation Myocardial
Infarction Across the Spectrum of Coronary Artery Disease Complexity.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Denicolai M.; Morello M.; Golino M.; Corna G.; Del Buono M.; Agatiello C.;
Van Russell B.; Abbate A.
Institution
(Denicolai, Morello, Corna, Abbate) University of Virginia,
Charlottesville, VA, United States
(Golino, Van Russell) Virginia Commonwealth University, Richmond, VA,
United States
(Del Buono) Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome,
Italy
(Agatiello) Hopital Italiano de Buenos Aires, Buenos Aires, Argentina
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Patients with ST-segment elevation myocardial infarction
(STEMI) and complex coronary artery disease (CAD) face a poor prognosis,
including increased heart failure (HF) risk. Interleukin-1 (IL- 1)
blockade with Anakinra inhibits the acute inflammatory response and
prevent HF after STEMI, but data on its effects based on CAD complexity
are lacking. Aim(s): To assess the effects of Anakinra in patients
with STEMI, across the spectrum of CAD complexity. Method(s): We
performed a pooled secondary analysis of 139 patients with STEMI from
three randomized clinical trials (VCUART studies) comparing Anakinra
(N=84) versus placebo (N=55). Multivessel CAD was defined as the presence
of at least one >=70% stenosis in a non-culprit vessel of >2.5 mm
diameter, not stented during index coronary intervention. The SYNTAX
(Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac
Surgery), SYNTAX II and Gensini scores were calculated, and patients were
divided by the median. We evaluated a composite endpoint of newonset HF,
HF hospitalization, or all-cause death at 1-year follow-up using
Kaplan-Meier survival curves, Cox regression analysis for Hazard Ratios,
and calculated interactions between groups. Result(s): We included
139 patients with STEMI, 85 (61%) with single vessel CAD and 54 (39%) with
multivessel CAD. According to the spectrum of CAD complexity, 60 (43%)
presented a SYNTAX score >9, 59 (42%) a SYNTAX II score >24 and 65 (47%) a
Gensini score >32. New-onset HF, HF hospitalization, or all-cause death
occurred in a total of 23 patients: 7 among the 84 subjects in the
Anakinra group and 16 within the 55 patients in the placebo group. We
found no statistically significant interactions between CAD complexity and
allocation to Anakinra or placebo for the composite endpoint (Figure).
 Conclusion(s): Among patients with STEMI, IL-1 blockade with Anakinra
significantly reduced the risk of new-onset HF, HF hospitalization, or
all-cause death compared to placebo, regardless of the number of vessels
affected and the spectrum of CAD complexity. (Table Presented).

<161>
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Accession Number
646742997
Title
Differential Cardiovascular Impact of omega-3 Fatty Acid in Patients at
High Cardiovascular Risk in Asians versus non-Asians: Sub-analysis of the
STRENGTH Randomized Clinical Trial.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Wang T.K.M.; Nicholls S.; Nissen S.; Wolski K.; St John J.
Institution
(Wang, Nissen, Wolski, St John) Cleveland Clinic, Cleveland, OH, United
States
(Nicholls) Victorian Heart Hospital, Clayton, VIC, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Racial differences in lipid and cardiovascular risk profiles
are wellestablished including for Asians. The STRENGTH trial found that
omega-3 carboxylic acid (CA) formulation of eicosapentaenoic acid and
docosahexaenoic acid did not result in significant changes in
cardiovascular event rates compared with corn oil in statintreated
patients at high cardiovascular risk, however drug efficacy may vary by
race. We evaluated and compared the cardiovascular treatment effect of
omega-3 CA between Asians and non-Asians in this sub-analysis of the
STRENGTH trial. Method(s): The STRENGTH trial was a double-blinded
1:1 randomized controlled trial of 13,078 high cardiovascular risk
patients enrolled during 10/30/2014-6/14/2017 at 675 centers. Efficacy of
omega-3 CA for Asians (n=1,355) and non-Asians (n=11,723) and interactions
between race and treatment effect were assessed. The primary endpoint is a
composite of cardiovascular death, non-fatal myocardial infarction,
stroke, coronary revascularization and unstable angina hospitalizations.
 Result(s): Key differences in baseline characteristics include Asians
having significantly higher prevalence of men, secondary prevention, and
lower total cholesterol, LDL, apoB100, and hsCRP. In Asians, omega-3 CA
was associated with significantly lower primary endpoint during follow-up,
with 81/698 events [Kaplan-Meier (KM) Estimate: 14.8%] in the omega-3 CA
group, 103/657 events (KM Estimate: 20.4%) in the corn oil group, and
hazard ratio (HR) 0.72, 95% CI 0.54-0.96, P=0.026 (Figure A). In non-
Asians, there was not a significant difference in primary endpoint rates
between the two groups, with 704/5841 events (KM Estimate: 15.6%) in the
omega-3 CA group, 692/5882 events (KM Estimate: 15.9%) in the corn oil
group, and HR 1.03 95% CI 0.93-1.14, P=0.60 (Figure B). There were
significant interactions between race (Asian versus non-Asian) and
treatment group for the primary endpoint (P=0.021) and nonfatal stroke
(P=0.016) and remained significant after adjusting for other covariates.
 Conclusion(s): omega-3 CA was associated with significant reduction
in major adverse cardiovascular events compared with corn oil in Asians
but not in non-Asian patients with high cardiovascular risk. Further
research is necessary to elucidate the mechanisms for potentially
beneficial effects of omega-3 CA unique to Asian race.

<162>
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Accession Number
646742468
Title
The Impact of Fasting vs Non-fasting on Patient Safety and Comfort During
Cardiac Transcatheter Procedures: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Lucena L.; Cavalcante D.; Gomes W.; Freitas M.; Borges R.C.; De Oliveira
A.L.A.; Paiva I.; Carvalho N.S.; Oeite V.; Leite V.; Sousa J.
Institution
(Lucena, Borges, De Oliveira, Paiva, Carvalho, Oeite, Leite, Sousa)
Universidade Federal do Rio Grande do Norte, Jardim do Serido, Brazil
(Cavalcante) Universidade Federal do Maranhao, Sao Luis, MA, Brazil
(Gomes) Universidade Federal do Parana, Curitiba, Brazil
(Freitas) UEMASUL, Imperatriz, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Current guidelines recommend preprocedural fasting for at
least 6 hours for solid food and 2 hours for clear liquids before cardiac
transcatheter procedures. However, the supporting data are limited.
Research Question: Does non-fasting impact (NF) patient safety and comfort
compared to fasting (F) in transcatheter cardiac procedures? Aims: To
compare the effects of fasting vs. non-fasting on patient outcomes in
cardiac transcatheter procedures. Method(s): We searched the
Cochrane, Embase, and Medline databases for RCTs comparing fasting versus
non-fasting states for cardiac transcatheter procedures. Risk ratios (RRs)
and standardized mean difference (SMD) with 95% confidence intervals (CIs)
were pooled for binary and continuous outcomes, respectively, using a
randomeffects model. Endpoints were hunger, thirst, incidence of
aspiration, nausea/vomiting, acute kidney injury (AKI), length of stay,
and patient satisfaction. Result(s): Our meta-analysis included 8
studies with 2,930 patients. Hunger sensation was significantly lower in
the NF group (SMD -0.91; 95% CI: -1.71 to -0.11; P = 0.026; I2 = 96%;
Figure 1A), with no difference in thirst. The incidence of aspiration (RR
2.20; 95% CI 0.29-17.02; P = 0.449; I2 = 0%; Figure 1B), nausea/vomiting
(RR 1.09; 95% CI 0.67-1.78; P = 0.723; I2 = 0%), and AKI (RR 1.90; 95% CI
0.84-4.31; P = 0.126; I2 = 0%) were not significantly different between
groups. Similarly, length of stay (MD -0.01 days; 95% CI -0.39 to 0.36; P
= 0.940; I2 = 3%; Figure 2A), and patient satisfaction (SMD -0.74; 95% CI:
-1.54 to -0.07; P = 0.073; I2 = 98%; Figure 2B) were also similar in both
groups. Conclusion(s): Our study suggests a non-fasting strategy is a
safe option before transcatheter cardiac procedures. (Figure Presented).

<163>
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Accession Number
646741093
Title
Outcomes of Left Atrial Appendage Occlusion With and Without Concurrent
Catheter Ablation for Patients at High Bleeding Risk: A Systematic Review
and Metaanalysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Majumdar A.; Ayyalu T.; Charles F.; Huang E.S.; Turch H.; Martignoni F.;
Sherif A.
Institution
(Majumdar) GMERS Medical College and Hospital, Ahmedabad, Sola, India
(Ayyalu) Lenox Hill Hospital, New York, NY, United States
(Charles) MaineHealth, Portland, ME, United States
(Huang) National Taiwan University, Taipei, Taiwan (Republic of China)
(Turch) Abbott Northwestern Hospital, Minneapolis, MN, United States
(Martignoni) Minneapolis Heart Institute Foundation, Minneapolis, MN,
United States
(Sherif) Saint Vincent Hospital, Worcester, MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The prevalence of non-valvular atrial fibrillation (NVAF)
and stroke-related morbidity is rising. First-line therapy remains rate or
rhythm control with anticoagulation, with catheter ablation (CA) also
considered in suitable candidates. Left atrial appendage closure (LAAC) is
increasingly used due to mounting evidence of non-inferiority compared to
anticoagulation. Despite improved pre-procedural planning and patient
selection reducing complications, adverse outcomes such as pericardial
effusion and device-related thrombus occur in about 5% of patients. This
study evaluates the outcomes of LAAC with CA versus standalone LAAC in
NVAF patients with contraindications to anticoagulation. Method(s):
We searched PubMed, EMBASE, and Cochrane databases for all cohort studies
comparing LAAC with CA to LAAC alone in patients with NVAF. Case series,
reviews, and non-English language studies were excluded. The assessed
outcomes included device compression rate at implant, devicerelated
thrombosis, pericardial effusion, need for pericardiocentesis, and
peri-device leak at 6 weeks. Statistical analysis was performed using
Review Manager 5.1.7. Heterogeneity was assessed with I statistics.
 Result(s): We included 6 studies with 51,545 patients, of whom 1,221
(2.3%) underwent both procedures. LAAC with CA and standalone LAAC cohorts
had similar baseline demographics including age (68, 69 years), percentage
of women (48%, 46%), CHA2DS2-VASc score (3.6, 3.7), and HAS-BLED score
(3.1, 3.2). LAAC with CA was associated with a reduced incidence of
device-related thrombosis (OR=0.18; 95% CI= 0.04-0.89; p=0.04) without an
increase in pericardial effusion rates (OR=0.85; 95% CI= 0.48- 1.51;
p=0.59). There were no significant differences in device compression rates
at implant (MD=0.34; 95% CI= -0.77-1.45; p=0.55), the need for
pericardiocentesis (OR=1.01; 95% CI= 0.30-3.48; p=0.98), or rates of
peri-device leak at 6 weeks (OR=0.61; 95% CI= 0.21-1.78; p=0.37).
 Conclusion(s): Concomitant LAAC with CA may reduce rates of
device-related thrombosis compared to standalone LAAC without increasing
the risk of pericardial effusion or peri-device leak at 6 weeks. These
findings support the consideration of combining these procedures in the
management of highrisk NVAF patients unable to tolerate anticoagulation.

<164>
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Accession Number
646742114
Title
Efficacy of Transcatheter Aortic Valve Replacement for Severe Pure Native
Aortic Valve Regurgitation: A Meta- Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Jha M.; Harikrishna A.; Mal M.; Jain H.; Daga P.; Hanif M.; Aamir M.;
Rajeswaran Y.; Zacks J.
Institution
(Jha, Zacks) Government Medical College and New Civil Hospital, Gujarat,
Surat, India
(Harikrishna) European University Cyprus, Nicosia, Cyprus
(Mal) Liaquat University of Medical and Health Sciences, Jamshoro,
Pakistan
(Jain) AIIMS Jodhpur, Jodhpur, India
(Daga) University of Louisville, Louisville, KY, United States
(Hanif) Upstate Medical University, New York, NY, United States
(Aamir, Rajeswaran) Leigh Valley Hospital Network- Cedar Crest, Allentown,
PA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Surgical aortic valve replacement (SAVR) is the preferred
treatment option for patients with severe aortic regurgitation (AR).
Recently, several patients with mixed aortic valve disease, comprising
severe aortic stenosis (AS) and at least moderate AR, have been
successfully treated with TAVR. However, the treatment of severe native
aortic valve regurgitation (NAVR) without AS remains a matter of
contention, and the efficacy of TAVR remains uncertain. Aim(s): The
primary outcomes were 30-day mortality and the incidence of device
success. The secondary outcomes included incidence of myocardial
infarction (MI), stroke, major bleeding, acute kidney injury (AKI) >=
stage 2, moderate-to-severe paravalvular leak (PVL), permanent pacemaker
implantation (PPM), and postprocedural moderate-to-severe AR.
 Method(s): We systematically searched PubMed, Cochrane Library,
Scopus and ClinicalTrials.gov for published articles from inception until
2nd April 2024 to evaluate clinical outcomes of TAVR in patients with
NAVR. The statistical analysis was conducted using R-Studio 5.3.3. The
rates of events with 95% confidence intervals (CI) and the heterogeneity
was assessed using p-value and I statistics. Result(s): A total of 23
published articles with 4,397 patients were included. All-cause mortality
at 30 days was 12% (95% CI: 6% to 23%), while device success was 86% (95%
CI: 81% to 92%). The incidence of complications such as MI (3%, 95% CI: 2%
to 4%), stroke (3%, 95% CI: 2% to 3%), major bleeding (8%, 95% CI: 5% to
11%), AKI >= stage 2 (8%, 95% CI: 5% to 12%), and major vascular
complications were relatively low (6%, 95% CI: 4% to 7%). PPM was required
for 15% of patients (95% CI: 11% to 18%). PVL was observed in 10% of
patients (95% CI: 2% to 41%) and post-procedural moderate-to-severe AR
occurred in 9% of patients (95% CI: 4% to 20%). Conclusion(s): TAVR
is a viable and reasonable option for a specific population with NAVR.
Nevertheless, it is imperative to conduct larger studies with a longer
duration of follow-up to obtain more robust evidence of the feasibility of
TAVR in patients with NAVR. (Figure Presented).

<165>
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Accession Number
646742701
Title
4-5 Years Outcomes of Left Atrial Appendage Closure vs. Oral
Anticoagulants in Atrial Fibrillation: A Systematic Review and
Meta-Analysis:.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Khan M.A.; Muhammad A.; Shafique N.; Bhatia H.; Aafreen A.; Adil A.N.K.;
Akbar U.; Khan A.; Haider M.A.; Haider T.; Bhattarai S.; Afzal H.; Khan B.
Institution
(Khan, Bhatia, Aafreen) Guthrie Robert Packer Hospital, Sayre, PA, United
States
(Muhammad) King Edward Medical University, Lahore, Pakistan
(Shafique) Nishtar Medical University, Multan, Pakistan
(Adil) Clovis Community Hospital, Fresno, CA, United States
(Akbar) WVU Camden Clark, Vienna, WV, United States
(Khan) CMH, Quetta, Balochistan, Pakistan
(Haider) FAU, Tampa, FL, United States
(Haider) SSM St Mary, St Loius, MO, United States
(Bhattarai, Afzal) JHL, Punjab, Lahore, Pakistan
(Khan) Advent Health, Tampa, FL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Oral anticoagulants (OAC) including Vitamin K antagonists such
as warfarin and direct oral anticoagulants like Apixaban, Rivaroxaban, and
Edoxaban, have long been the standard treatment for stroke prevention in
patients with atrial fibrillation (AF). However, they increase the risk of
bleeding, making them unsuitable for certain patient populations,
particularly those with a personal history of bleeding, elderly
individuals prone to falls or those with high-risk occupation with safety
hazards. In cases of non-valvular AF, where thrombi typically form in the
left atrial appendage, mechanical left atrial appendage closure (LAAC) has
come out as an alternative for selected patients. Numerous studies have
shown that LAAC is comparable to OAC in preventing strokes while
significantly reducing major bleeding events. This metaanalysis aims to
compare the 4-5-year outcomes of these two treatment strategies in
non-valvular AF. Method(s): 4 studies (3 randomized controlled trials
and 1 observational study) comparing the 4-5-year outcomes of LAAC versus
OAC in patients with AF were included in this meta-analysis. These studies
were identified after a thorough search of PUBMED, COCHRANE, and MEDLINE
databases from inception till May 2024. The outcomes of interest were MACE
(composite of stroke, embolism, and death), ischemic stroke, major
bleeding episodes, cardiovascular (CV) deaths, and all-cause death. The
results were reported as Risk Ratio (RR) with 95% confidence intervals
(CI), using a random effects model. Result(s): 6,012 patients were
identified from the 4 studies. After a median follow-up of 4-5 years, LAAC
was associated with a clinically significant reduction in MACE (RR: 0.76,
95% CI: 0.61-0.94, p=0.01), all-cause mortality (RR: 0.77, 95% CI:
0.62-0.96, p=0.02), and CV mortality (RR: 0.64, 95% CI: 0.45-0.90,
p=0.01). Additionally, a significant reduction in major bleeding episodes
(RR: 0.63, 95% CI: 0.44-0.91, p=0.01) was also noted between the two
treatment strategies favoring LAAC treatment group. There was no
significant difference in the incidence of ischemic stroke (RR: 1.07, 95%
CI: 0.62-1.85, p=0.80) between the two groups. Conclusion(s): Over a
median follow-up of 4-5 years, LAAC was found to be as effective as OAC in
preventing ischemic strokes, while also showing lower incidence of MACE,
all-cause, CV mortality and major bleeding episodes. More RCTs are needed
to further assess the long-term outcomes between the two strategies.
(Figure Presented).

<166>
Accession Number
646740285
Title
Efficacy of Adding Sodium- Glucose Co-Transporter 2 Inhibitor versus
Standard Therapy Alone in Post-Percutaneous Coronary Intervention
Patients: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Rovari G.; Rimolo L.; Pereira L.C.; Gomes W.F.
Institution
(Rovari, Rimolo) Federal Fluminense University, Niteroi, Brazil
(Pereira) Jefferson Einstein Hospital, Philadelphia, PA, United States
(Gomes) INC Hospital, Curitiba, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Recent evidence suggests that sodium-glucose cotransporter-2
inhibitors (SGLT2-i) may improve outcomes in patients with coronary artery
disease (CAD) through various physiological pathways. However, their
impact on patients who have undergone percutaneous coronary intervention
(PCI) is not well established. This meta-analysis aims to evaluate the
effectiveness of additive SGLT2 inhibitors versus standard therapy alone
in patients with CAD after PCI. Method(s): A systematic search was
conducted across the Medline, Embase, and Cochrane Library databases for
randomized controlled trials (RCTs) and observational studies that
compared the addition of SGLT2 inhibitors to standard therapy versus
standard therapy alone in patients post-PCI. The outcomes analyzed were
Major Adverse Cardiovascular Events (MACE), all-cause death,
cardiovascular death, recurrent acute myocardial infarction (AMI),
nonfatal stroke, revascularization, and hospitalization for heart failure
(HF). Result(s): A total of 7 studies met the inclusion criteria,
encompassing a total of 11,800 individuals (5,004 on SGLT2-i and 6,796
non-SGLT2-i; mean age of 62.7 years; 28% women; 95% diabetic patients).
SGLT2 inhibitors significantly reduced the risk of all-cause mortality (RR
0.6, 95% CI: 0.5-0.72, p<0.01), cardiovascular death (RR 0.39, 95% CI:
0.16-0.94, p=0.03) and hospitalization for HF (RR 0.55, 95% CI: 0.4-0.76,
p<0.01) compared to standard therapy alone. The occurrence of the
composite endpoint (MACE) (RR 0.67, 95% CI: 0.44-1.01, p=0.056), any
revascularization (RR 0.93, 95% CI: 0.57-1.53, p=0.784), recurrent AMI (RR
0.70, 95% CI: 0.41-1.18, p=0.176) and stroke (RR 0.94, 95% CI: 0.68-1.30,
p=0.717) did not differ significantly between groups. Conclusion(s):
Adding SGLT2 inhibitors to standard therapy significantly improved
cardiovascular outcomes in patients with CAD who have undergone PCI,
including reduced mortality and hospitalization for HF rates, with similar
rates of recurrent AMI, coronary revascularization and stroke. These
findings support the consideration of adding SGLT2 inhibitors as part of
the therapeutic regimen for postangioplasty patients, especially those
with diabetes.

<167>
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Accession Number
646742466
Title
PASCAL versus MitraClip in mitral valve transcatheter edge-to-edge repair:
A systematic review and metaanalysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Mohamed A.; Abdelaziz A.; Afify R.; Elshahat A.; Elesawy M.; Shams M.M.E.;
Desouki M.; Elkhayat I.; Abdelazeem B.; Banour S.
Institution
(Mohamed, Afify, Elesawy, Shams, Elkhayat, Abdelazeem, Banour) Faculty of
Medicine, Tanta University, Tanta, Egypt
(Abdelaziz, Elshahat) Faculty of Medicine, Al-Azhar University, Cairo,
Egypt
(Desouki) Faculty of Medicine, Alexandria University, Alexandria, Egypt
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Mitral regurgitation is the second most common valvular
heart disease, it has a high prevelance in older patients, transcatheter
mitral valve edge-to-edge repair has been introduced as an alternative
treatment to mitral valve surgery especially in the elderly, MitraClip is
used as a standard treatment for transcatheter mitral valve edge-to-edge
repair (M-TEER). PASCAL has recently been used with minimal evidence
comparing both of them. Aim(s): We aimed to compare the outcomes of
both device systems on mitral regurgitation residuals and clinical
outcomes. Method(s): PubMed, Scopus, WOS, and Cochrane were retrieved
from inception until May 2024 for relevant clinical studies that compared
PASCAL to MitraClip approaches in M-TEER procedure and reported the
primary outcome of interest, which was the grade of MR at follow-up. Other
reported outcomes were technical success, Death from any cause, and
reintervention, Dichotomous data were analyzed using OR and 95% CI with a
fixed-effect model. Result(s): Seven studies were included with a
total of 1834 patients. MR <= 2 at discharge was less with MitraClip (RR,
0.67, 95%CI [0.45 to 1]), and MR <= 2 at followup was less with MitraClip
(RR, 0.84, 95% CI [0.64 to 1.1]), MR <= 1 at follow up was significantly
less with MitraClip (RR 0.69, [0.56 to 0.85]). However, there were no
significant differences in technical success, Death from any cause, or
reintervention between the two systems used. Conclusion(s): MitraClip
and PASCAL are similar in procedural success, with better outcomes for
PASCAL regarding Mitral regurgitation grades after the procedure. The
guide to proceed with MitraClip or PASCAL should be guided by mitral valve
anatomy, the etiology of MR, and device-specific features. Also,
Large-volume RCTs are warranted to validate the current findings. (Figure
Presented).

<168>
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Accession Number
646740484
Title
Fractional flow reserve guided complete revascularization versus
Culprit-only percutaneous coronary intervention in patients with
ST-segment elevation myocardial infarction and multivessel coronary artery
disease. A metaanalysis of randomized controlled trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Obi O.
Institution
(Obi) New York Institute of Technology, College of Osteopathic Medicine,
Old Westbury, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Data comparing the efficacy and safety of fractional flow
reserve (FFR)-guided complete revascularization (CR) to culprit-only
percutaneous coronary artery intervention (PCI) in patients with
ST-segment elevation myocardial infarction (STEMI) and multivessel
coronary artery disease are limited. Method(s): Pubmed, Embase and
Cochrane were searched for randomized controlled trails (RCTs) comparing
FFR-guided CR to Culprit-only PCI in patients with STEMI and multivessel
CAD. A metaanalysis was performed on primary outcomes of major adverse
cardiac events (MACE) and all-cause mortality. Heterogeneity was examined
with I statistics. A random-effects model was used for outcomes with high
heterogeneity. Result(s): We included 4 RCTs with 3173 patients
comparing FFR-guided CR with culprit-only PCI in patients with STEMI and
multivessel coronary artery diseases. The pooled results of the 4 RCTs
showed that MACE (RR=0.66; 95% CI [0.45, 0.99]; p=0.01; 16.8% vs 24.1%),
PCI revascularization (RR=0.50; 95% CI [0.37, 0.67]; p<0.00001; 13.1% vs
24.9%) and unplanned revascularization (RR=0.66; 95% CI [0.44, 0.99];
p=0.04; 8.7% vs 12.9%) were significantly reduced in the FFR-guided
complete revascularization group compared to culprit-only PCI group.
However, all-cause mortality (RR=1.09; 95% CI [0.84, 1.42]; p=0.53; 7.2%
vs 6.0%), stroke (RR=1.02; 95% CI [0.38, 2.75]; p =0.97; 2.0% vs 1.8%),
major bleeding (RR=0.95; 95% CI [0.54, 1.67]; p=0.87; 1.7% vs 1.7%), death
from cardiovascular causes (RR=0.82; 95% CI [0.55, 1.21]; p=0.31; 3.1% vs
3.4%), MI (RR=1.09; 95% CI [0.60, 1.95]; p=0.78; 6.7% vs 6.4%),
rehospitalization for HF (RR=0.72; 95% CI [0.44, 1.15]; p=0.17; 3.4% vs
5.3%), death from any cause or MI (RR=1.02; 95% CI [0.61, 1.71]; p=0.95;
14.9% vs 13.6%), any stent thrombosis (RR=1.42; 95% CI [0.35, 5.72];
p=0.62; 2.2% vs 1.4%), contrast induced nephropathy (RR=0.25; 95% CI
[0.02, 2.79]; p=0.26), and CABG revascularization (RR=1.25; 95% CI [0.30,
5.15]; p=0.76) were not statistically different between groups.
 Conclusion(s): Our meta-analysis suggests that FFR-guided CR is safe
and has superior efficacy to Culprit-only PCI in patients with ST-segment
elevation myocardial infarction and multivessel coronary artery disease
with significantly lowered incidence of MACE, PCI revascularization as
well as unplanned or urgent revascularization. However, FFR-guided CR
showed no beneficial effect on all-cause mortality, stroke, major bleeding
and myocardial infarction. (Table Presented).

<169>
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Accession Number
646743268
Title
Routine stress testing in diabetic patients after coronary intervention: a
systematic review and single arm meta-analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
De Oliveira J.P.; Huntermann R.; De Oliveira Fischer Bacca C.; Da Rocha
F.; De Oliveira R.
Institution
(De Oliveira, Huntermann, De Oliveira Fischer Bacca, Da Rocha, De
Oliveira) UNIDAVI, Rio do Sul, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Stress testing is a well-established non-invasive method
commonly used in clinical practice for patients with angina. However, its
benefit in diabetic patients after coronary intervention remains unclear.
This systematic review aims to address this knowledge gap by evaluating
the impact of routine stress testing in this specific patient population.
Research Question: Does routine stress testing improve outcomes in
diabetic patients with prior revascularization? Goals: We aimed to perform
a systematic review and meta-analysis of studies that evaluated death,
MACE and repeated revascularization episodes in diabetic patients who have
prior coronary intervention. Method(s): We searched PubMed, Embase
and Cochrane databases for randomized controlled trials (RCT) and cohort
studies evaluating diabetic patients who underwent cardiac
revascularization and reporting the following outcomes: (1) Myocardial
Infarction (MI) and Cardiovascular Death; (2) Ischemia; and (3) Repeat
Revascularization. Statistical analysis was performed using Open Meta and
heterogeneity was assessed with I statistical. Result(s): We included
16924 patients from 16 studies, of which 15 were observational cohort
studies and 1 was a RCT. All patients were diabetics and had a history of
revascularization. Follow-up ranged from 1 to 5.2 years. The mean patient
age was 60.8+/-9.5 years and 75% were male. MI and cardiovascular death
was found in 9.8% (95% CI; range 6.8-12.8%; p<0.01; (figure 1A), ischemia
was found in 36.5% (95% CI; range 28.7-44.3%; p<0.01; (figure 1B) and
revascularization was repeated in 16.3% (95% CI; range 4.9- 27.7%; p<0.01;
(figure 1C). Conclusion(s): Routine stress testing in diabetic
patients with prior coronary intervention may not significantly alter the
outcomes. These findings suggest that, while routine stress testing is a
common practice for monitoring heart diseases in diabetic patients, its
impact on improving clinical outcomes requires further investigation
through controlled studies.

<170>
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Accession Number
646742501
Title
Efficacy of Sentinel Cerebral Embolic Protection Device in Transcatheter
Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials
and Propensity Score Matched Studies.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Jain H.; Odat R.; Pervez N.; Dey D.; Goyal A.; Jain J.; Ahmed M.; Patel
N.; Franco A.J.; Shah J.; Jha J.; Passey S.
Institution
(Jain, Jain, Patel, Franco, Shah, Jha, Passey) All India Institute of
Medical Sciences, Jodhpur, India
(Odat) Faculty of Medicine, Jordan University of Science and Technology,
Irbid, Jordan
(Pervez) Dow University of Health Sciences, Karachi, Pakistan
(Dey) Medical College, Kolkata, India
(Goyal) Seth GS Medical College, KEM Hospital, Mumbai, India
(Ahmed) Rawalpindi Medical University, Rawalpindi, Pakistan
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is frequently
associated with stroke due to debris embolization. Although the risk of
stroke with the newergeneration devices is lower, stroke still represents
a significant cause of mortality and morbidity after TAVR. The Sentinel
cerebral embolic protection (CEP) device (Boston Scientific) is a dual
embolic filter device designed to capture debris dislodged during TAVR.
The current literature concerning the efficacy of Sentinel CEP in the
reduction of stroke in patients undergoing TAVR is limited and
inconsistent. Aim(s): This meta-analysis aimed to compare clinical
outcomes with Sentinel CEP device in patients undergoing TAVR.
 Method(s): A comprehensive systematic literature search was performed
on PubMed, Embase, Cochrane Library and Clinicaltrial.gov from inception
until 1st May 2024 to retrieve randomized controlled trials (RCTs) and
propensity-matched studies comparing TAVR with and without the Sentinel
CEP device. Pooled odds ratios (OR) with 95% confidence intervals (CI)
were calculated using the DerSimonian-Laird random-effects model, with a
p-value of <0.05 considered statistically significant. Result(s): 6
studies with a total of 25,130 patients undergoing TAVR (12608: Sentinel
CEP device; 12522: Without Sentinel CEP device) were included in this
metaanalysis. The use of the Sentinel CEP device in TAVR was associated
with a statistically significant lower risk of acute kidney injury [OR:
0.89; 95% CI: 0.81, 0.97; p=0.01]. The use of Sentinel CEP device in TAVR
was associated with a statistically insignificant trend towards reduction
in stroke [OR: 0.80; 95% CI: 0.58, 1.10; p=0.18], all-cause mortality [OR:
0.74; 95% CI: 0.51, 1.07; p=0.11], and major vascular complications [OR:
0.74; 95% CI: 0.46, 1.19; p=0.21]. Conclusion(s): The use of the
Sentinel CEP device in patients undergoing TAVR does not lead to a
statistically significant reduction in stroke, all-cause mortality, and
major vascular complications; however, the risk of acute kidney injury is
lower. Large, multicentric RCTs are warranted to corroborate the findings
of this meta-analysis. (Figure Presented).

<171>
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Accession Number
646742135
Title
Machine Learning Predicts Successful Transcatheter Mitral Valve Edge to
Edge Repair: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Sacoransky E.; Yu Jia Ke D.; Abuzeid W.
Institution
(Sacoransky, Yu Jia Ke) Queen's University, Kingston, ON, Canada
(Abuzeid) Kingston Health Sciences Centre, Kingston, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Transcatheter Mitral Valve Edge to Edge Repair (TEER) is an
established percutaneous treatment for patients with severe symptomatic
Mitral Regurgitation (MR). The current AHA/ACC guidelines recommend TEER
for inoperable patients with severe primary MR or patients with
symptomatic severe secondary MR despite medical therapy. Machine learning
(ML) has emerged as a tool for TEER risk stratification due to the paucity
of established risk scores. To address the lack of consensus on its
efficacy, we conducted a systematic review and metaanalysis of studies
that utilized ML to predict the success of TEER. Method(s):
Electronic databases, including Embase, MEDLINE, and the Cochrane Library,
were searched from inception through April 2024. We included studies that
used TEER and employed at least one ML model to predict the success of
TEER. The Area Under the Receiver Operating Characteristic Curve (AUC) was
used to measure the accuracy of ML risk stratification algorithms.
 Result(s): 102 publications were screened, with seven eventually
included in this analysis. Two studies employed clustering techniques, two
utilized extreme gradient boosting, and three used multiple ML algorithms
to predict outcomes. Of the four studies that compared the accuracy of ML
with traditional Cox regression, all four demonstrated higher accuracy
with ML, and this difference was statistically significant in three of the
four studies. The mean AUC of the aggregated ML data was 0.737 [95% CI:
0.717, 0.758], compared to 0.627 [95% CI: 0.600, 0.653] for the pooled
traditional methods. Conclusion(s): To our knowledge, we conducted
the first systematic review and metaanalysis of ML methods for prediction
of TEER success. ML outperformed established risk scores, demonstrating
promising potential. Future ML models, trained on larger patient datasets,
may further improve predictive accuracy in this patient population.
(Figure Presented).

<172>
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Accession Number
646742038
Title
Comparative Efficacy of Intracardiac and Transesophageal Echocardiography
in Left Atrial Appendage Occlusion: A Meta-Analysis of Clinical Outcomes.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Nugooru S.; Ginnaram S.; Sevella P.; Janga C.; Haddad E.; Shah S.; Watson
R.
Institution
(Nugooru, Ginnaram, Sevella, Janga, Haddad, Shah, Watson) Jefferson
Abington Hospital, Willow Grove, PA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Left atrial appendage occlusion (LAAO) is essential for stroke
prevention in patients with non-valvular atrial fibrillation where
anticoagulation is contraindicated. Intracardiac Echocardiography (ICE)
has been proven effective and safe for LAAO since 2011, yet adoption rates
remain low, with only 2.2% of LAAOs guided by ICE between 2015 and 2019.
Transesophageal Echocardiography (TEE), the current gold standard, and ICE
differ significantly in operational dynamics and patient impacts,
influencing procedural outcomes. Objective(s): This study aims to
compare the efficacy and safety of ICE and TEE in facilitating LAAO,
offering insights into their comparative clinical use. Method(s): A
systematic review and meta-analysis were conducted according to PRISMA
guidelines. Searches were performed in MEDLINE/PubMed, OVID, and Scopus
through December 2023, comparing ICE and TEE in LAAO. Inclusion criteria
centered on studies reporting technical success, with secondary outcomes
including length of stay (LOS), mortality, and adverse outcomes such as
stroke, transient ischemic attacks (TIA), pericardial effusion, cardiac
tamponade, device thrombosis, device embolization, and peri-device leaks.
Data synthesis employed statistical methods utilizing R Studio.
 Result(s): Fourteen studies involving 4184 patients were included.
The meta-analysis revealed no significant differences in technical success
(OR 1.34, 95% CI: [0.76, 2.36]), LOS (OR 1.66, 95% CI: [0.80, 3.42]), or
mortality (OR = 1.00, 95% CI: [0.50, 2.00]) between ICE and TEE.
Similarly, non-significant differences were noted in stroke, TIA,
pericardial effusion, and device leaks, with minimal heterogeneity (I =
0%). Conclusion(s): ICE and TEE provide comparable clinical outcomes
in LAAO, with no significant efficacy or safety differences. These results
suggest that the choice between ICE and TEE should be based on procedural
convenience, patient anatomy, and resource availability, rather than
clinical outcomes alone. The equivalence in performance between these
modalities allows for flexibility in clinical practice, ensuring that
patient care can be customized to individual needs without compromising
safety or effectiveness.

<173>
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Accession Number
646743640
Title
New internet-based warfarin anticoagulation management approach after
mechanical heart valve replacement: prospective, multicenter, randomized
controlled trial.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Zhu Z.; He M.; Zhang H.; Lai Y.
Institution
(Zhu, He, Zhang, Lai) Beijing Anzhen Hospital, Beiji, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Mechanical heart valve replacement (MHVR) is an effective
method for the treatment of severe heart valve disease. However, it
subjects patients to lifelong warfarin therapy after MHVR, with the
attendant risk of bleeding and thrombosis. Whether internet-based warfarin
management reduces complications and improves patient quality of life
remains unknown. Objective(s): This study aimed to compare the
effects of internet-based warfarin management and the conventional
approach in patients who received MHVR in order to provide evidence
regarding alternative strategies for long-term anticoagulation.
 Method(s): This was a prospective, multicenter, randomized,
open-label, controlled clinical trial with a 1-year follow-up. Patients
who needed long-term warfarin anticoagulation after MHVR were enrolled and
then randomly divided into conventional and internet-based management
groups. The percentage of time in the therapeutic range (TTR) was used as
the primary outcome while bleeding, thrombosis, and other events were the
secondary outcomes. Result(s): A total of 721 patients were enrolled.
The baseline characteristics did not reach statistical differences between
the two groups, suggesting the random assignment was successful. As a
result, the internet-based group showed a significantly higher TTR (mean
0.53, SD 0.24 vs. mean 0.46, SD 0.21; P < .001) and fraction of time in
the therapeutic range (mean 0.48, SD 0.22 vs. mean 0.42, SD 0.19; P <
.001) than did those in the conventional group. Furthermore, as expected,
the anticoagulation complications, including bleeding and embolic events,
had a lower frequency in the internet-based group than in the conventional
group (6.94% vs. 12.74%; P = .01). Logistic regression showed that
internet-based management increased the TTR by 7% (odds ratio [OR] 1.07,
95% CI 1.05-1.09; P < .001) and reduced the bleeding and embolic risk by
6% (OR 0.94, 95% CI 0.92-0.96; P = .01). Moreover, low TTR was found to be
a risk factor for bleeding and embolic events (OR 0.87, 95% CI 0.83-0.91;
P = .005). Conclusion(s): Internet-based warfarin management is
superior to the conventional method, as it can reduce anticoagulation
complications in patients who receive longterm warfarin anticoagulation
after MHVR.

<174>
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Accession Number
646742968
Title
Pre-procedural Red Cell Distribution Width As A Prognostic Biomarker In
Patients Undergoing Transcatheter Aortic Valve Implantation: A Systematic
Review and Meta Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Subramanian L.; Srikanth S.; Devaprasad N.; Liu J.; Shan Z.; Podduturi
P.V.R.; Jindal U.; Petel D.; Desai R.
Institution
(Subramanian, Srikanth, Desai) East Carolina University Health,
Greenville, NC, United States
(Devaprasad) SRM Medical College, Hospital and Research Centre, Tamil
Nadu, Chennai, India
(Liu) ECU Health Medical Center, Elizabeth City, NC, United States
(Shan) Sri Guru Ram Das Institute of Medical Sciences and Research,
Punjab, Amritsar, India
(Podduturi) KIMS, Narketpalli, India
(Jindal) K.J. Somaiya Medical College and Research Center, Maharashtra,
Mumbai, India
(Petel) LSUHS Shreveport, Shreveport, LA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Red cell distribution width (RDW) is a measurement of
variability in erythrocyte size and volume, routinely reported as part of
a complete blood count. Recently, it has gained popularity as a novel
prognostic biomarker for cardiovascular disease outcomes. Our study
investigates the predictive value of pre-procedural RDW for all-cause
mortality (ACM) within one year for patients undergoing transcatheter
aortic valve implantation (TAVI). Method(s): We comprehensively
reviewed databases like PubMed, Google Scholar, Embase, and Scopus until
May 2024, looking for studies reporting an association between
pre-procedural RDW and outcomes in TAVI. A binary random effects model was
used to calculate the pooled adjusted odds ratio (aOR), and subgroup
analysis was performed. I2 statistics were used to determine the
heterogeneity of studies, further enhancing the robustness of our
research. Result(s): Our systematic review and meta-analysis included
five studies (three retrospective, two prospective) encompassing 2,565
patients with a mean age of 81.32 years. Our study showed a slight female
predominance (52%). The mean follow-up period was one year. Comorbidities
like coronary artery disease, diabetes melitus, atrial fibrillation, prior
myocardial infarction were commonly reported among the study population.
Higher pre-procedural RDW was associated with increased odds of ACM at the
end of one year with an unadjusted pooled OR 1.86 (95% CI: 1.30-2.67,
p<0.01) and adjusted pooled aOR 2.21 (95% CI: 1.81-2.69, p< 0.01) (Figure
1). Leave one out sensitivity analysis confirmed the robustness of the
meta-analysis, as no single study disproportionately affected the overall
results. Conclusion(s): Our study demonstrates the potential of
pre-procedural RDW as a prognostic biomarker for predicting 1-year ACM in
post-TAVI patients. However, further research is warranted to fully
elucidate the role and mechanism of RDW in this context. (Figure
Presented).

<175>
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Accession Number
646742734
Title
Clinical and Procedural Outcomes after Transcatheter Aortic Valve
Replacement vs Surgical Aortic Valve Replacement in Severe Aortic
Stenosis: A Systematic Review and Meta-Analysis of Randomized Controlled
Trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Shoaib A.; Khan A.A.; Khan M.; Khan I.; Arif M.H.; Afzal A.; Mohiuddin N.;
Siddiqi T.J.
Institution
(Shoaib) Karachi Medical and Dental College, Karachi, Pakistan
(Khan) Nishtar Medical University, Multan, Pakistan
(Khan, Afzal, Mohiuddin) Dow International Medical College, Karachi,
Pakistan
(Khan) King Edward Medical University, Lahore, Pakistan
(Arif) D.G Khan Medical College, Dera Ghazi Khan, Pakistan
(Siddiqi) University of Mississippi Medical Center, Ridgeland, MS, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: A growing body of evidence from randomized controlled trials
(RCTs) has demonstrated the superiority of transcatheter aortic valve
replacement (TAVR) over surgical aortic valve replacement (SAVR)
irrespective of surgical risk in patients with severe aortic stenosis
(SAS). Given the rise in TAVR procedures, analyzing trends in outcomes
over time is critical to aid clinical decision-making. Hence, we pooled
RCT data for a robust assessment of clinical and procedural outcomes in
SAS patients undergoing TAVR and SAVR. Method(s): PUBMED and SCOPUS
were queried until April 2024. Trials were classified into high and
low-risk groups based on surgical risk. The outcomes were analyzed at 30
days (short-term), 1 year (mid-term), and 5 years (long-term). Estimates
were calculated as random effects risk ratios (RRs) with 95% confidence
intervals (CI). Result(s): 10 RCTs with a total of 10,252 patients
were included. There was no significant association between TAVR and SAVR
in reducing all-cause mortality at 30 days (RR: 0.84 [0.64, 1.10]; Figure
1a). While TAVR was associated with a significantly lower all-cause
mortality at 1 year (RR: 0.82 [0.68-0.97]; Figure 1b), it was linked with
a significantly higher all-cause mortality at 5 years (RR: 1.14
[1.07-1.21]; Figure 1c). Myocardial infarction and stroke were similar in
both groups up to 5 years. TAVR was associated with a lower risk of acute
kidney injury for up to 1 year and atrial fibrillation for up to 5 years
but a higher risk of new permanent pacemaker implantation and aortic valve
re-intervention for up to 5 years. In low-risk patients, TAVR showed no
significant differences from SAVR for all-cause mortality at 30 days and 5
years, but it was significant at 1 year. In high-surgical-risk patients,
all-cause mortality was comparable between TAVR AND SAVR at 30 days and 1
year, with a higher rate observed with TAVR at 5 years.
 Conclusion(s): Compared with SAVR, TAVR was superior in reducing
all-cause mortality at 1 year in low-risk patients and inferior in
reducing all-cause mortality at 5 years in high-risk patients. A thorough
evaluation of anatomical, clinical, and procedural factors is crucial to
tailor the optimal intervention for each patient. (Figure Presented).

<176>
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Accession Number
646742880
Title
LDL-C variability was affected by lipid-lowering strategies and associated
with adverse cardiovascular outcomes.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Kim D.-E.; Hong S.-J.; Bangalore S.; Yun K.H.; Him J.-S.; Ahn C.-M.; Lee
S.-J.; Lee Y.-J.; Lee S.-H.
Institution
(Kim, Hong, Him, Ahn, Lee, Lee, Lee) Severance Cardiovascular Hospital,
Seoul, South Korea
(Bangalore) New York University, Grossman School of Medicine, New York,
NY, United States
(Yun) Wonkwang University Hospital, Iksan, South Korea
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Prior studies have shown an independent association between
visit-tovisit variability in low-density lipoprotein cholesterol (LDL-C)
and adverse cardiovascular (CV) events and that this variability can be
reduced by high-intensity statins (HIS). However, it is not known whether
LDL-C variability can be reduced by moderate-intensity statin (MIS) plus
ezetimibe combination or by a treat-to-target strategy (TTS). Hypothesis:
We aimed to evaluate whether visit-to-visit variability in LDL-C is
affected by lipid-lowering strategies and its association with CV outcomes
in patients treated with HIS or MIS plus ezetimibe or statins with a
target LDL-C levels of 50 to 70 mg/dL (TTS). Method(s): Data from the
RACING and LODESTAR trial in patients with atherosclerotic disease, LDL-C
variability was evaluated from 3 months after randomization. In the RACING
trial, MIS plus ezetimibe combination therapy was compared with HIS
monotherapy. In the LODESTAR trial, TTS with a target LDL-C level of 50 to
70 mg/dL by titration of the statin intensity was compared with HIS
strategy. LDL-C variability was compared according to these lipid-lowering
strategies. The primary endpoint was a composite of death, myocardial
infarction, stroke, or coronary revascularization. Result(s): Among
the 6800 patients included, when compared with patients randomized to HIS,
LDL-C variability was similar in the group randomized to MIS plus
ezetimibe combination (SD 8.92+/-7.15 vs 9.17+/-7.34, P=0.325) but higher
in those randomized to TTS (SD 8.9+/-7.2 vs 10.6+/-7.7, P=0.001). There
was a linear association between LDL-C variability and primary endpoint
(Figure 1). The variability in LDL-C (by SD) was a predictor of primary
endpoint (HR 1.024; 95% CI 1.014 to 1.035; P<0.001) even after adjustment
for lipid-lowering strategy and mean LDL-C. Conclusion(s): Compared
with HIS therapy, visit-to-visit variability in LDL-C was not increased in
the MIS plus ezetimibe combination therapy, but was increased in the TTS.
Even in those treated with MIS plus ezetimibe or HIS or statins with a
target LDL-C levels of 50 to 70 mg/dL, increased LDL-C variability was
significantly associated with higher risk of adverse CV outcome.

<177>
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Accession Number
646740479
Title
Effect of Methylprednisolone on Inflammation and Clinical Outcomes in
Neonates Undergoing Cardiac Surgery: A Randomized Controlled Trial.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Jin Y.
Institution
(Jin) Fuwai Hospital, Beijing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Corticosteroids are widely used in neonatal cardiac surgery
for anti-inflammatory purposes. Previous research has demonstrated that
perioperative use of methylprednisolone MP leads to a reduced inflammatory
response. Nevertheless, the benefit of MP for postoperative clinical
outcomes is controversial, especially in neonates. This study aimed to
evaluate the effect of MP on postoperative inflammation and outcomes in
neonatal cardiac surgery with cardiopulmonary bypass CPB. Method(s):
From September 2020 to August 2023, 86 neonates who underwent cardiac
surgery with CPB were enrolled in this double-blind randomized controlled
trial. After anesthesia induction, the MP group received a single dose of
30 mg/kg MP, and the placebo group received an equal volume of saline
solution. The primary endpoints were plasma concentrations of interleukins
(IL6, IL8, and IL10) and Ddimer. Composite outcomes included death,
respiratory infection, cardiac arrest, the need for extracorporeal
membrane oxygenation, acute kidney injury, low cardiac output syndrome,
and prolonged mechanical ventilation. Result(s): MP did not reduce
the odds of a composite outcome OR, 1.208; 95% CI, 0.5152.832; p=0.664,
which occurred in 25 patients 58.1% in the MP group and 23 patients 53.5%
in the control group. Consistent with the observed anti-inflammatory
effects, MP resulted in significantly lower concentrations of
proinflammatory cytokines (IL6 and IL8) and higher concentrations of an
antiinflammatory cytokine IL10. The postoperative vasoactive inotropic
score VIS was significantly lower, while postoperative procalcitonin and
nadir mixed venous oxygen saturation SvO<inf>2</inf>) during the first 24
h were distinctly greater in the MP group. No differences in postoperative
D-dimer, blood glucose or insulin administration were detected between the
two groups. Conclusion(s): Compared with placebo, the prophylactic
administration of 30 mg/kg MP to neonates who underwent cardiac surgery
with CPB did not improve clinical outcomes. However, a decreased
inflammatory response was detected.

<178>
Accession Number
646742585
Title
Comparative Safety and Efficacy of Transfemoral versus Subclavian
Approaches in Transcatheter Aortic Valve Implantation: A Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Elfaituri A.; Faraj H.A.; Alzubi A.S.; Khaled A.; Elfaituri M.
Institution
(Elfaituri, Faraj, Khaled, Elfaituri) University of Tripoli, Tripoli,
Libyan Arab Jamahiriya
(Alzubi) Marshall University, Joan C. Edwards School of Medicine, New
York, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter Aortic Valve Implantation (TAVI) is a minimally
invasive procedure for high-risk aortic stenosis patients. While the
transfemoral approach is traditionally preferred, the subclavian route is
gaining recognition as a feasible alternative when transfemoral access is
not viable. However, a detailed comparison of the safety and efficacy
between these two approaches is not well-established. Objective(s):
This meta-analysis aims to rigorously compare the safety and efficacy of
the transfemoral and subclavian approaches in TAVI procedures.
 Method(s): A comprehensive literature search was performed across
PubMed, EMBASE, Cochrane Library, and Scopus databases up to December
2022. Studies that compared the transfemoral and subclavian TAVI
approaches to various clinical outcomes were included. Statistical
analyses were conducted using R software (version 4.0.3) with metafor and
meta packages, and results were synthesized using Odds Ratios (OR) within
a random-effects model framework. Result(s): The search identified 11
relevant studies involving 11,787 patients (10,740 transfemoral TAVI and
1,047 subclavian TAVI). Comparative analysis revealed no significant
differences between the two approaches in procedure success (OR 1.36; 95%
CI 0.86-2.15; P=0.19; I2=0%), in-hospital mortality (OR 0.77; 95% CI
0.45-1.31; P=0.33; I2=0%), 30-day mortality (OR 1.07; 95% CI 0.75-1.52;
P=0.71; I2=0%), stroke incidence (OR 0.89; 95% CI 0.55-1.47; P=0.67;
I2=0%), vascular complications (OR 1.26; 95% CI 0.67-2.39; P=0.47;
I2=68%), significant bleeding events (OR 0.79; 95% CI 0.49-1.26; P=0.32;
I2=0%), and myocardial infarction rates (OR 0.49; 95% CI 0.19- 1.32;
P=0.16; I2=0%). Conclusion(s): This meta-analysis demonstrates that
both transfemoral and subclavian TAVI approaches offer comparable safety
and efficacy profiles. The choice of approach should be individualized
based on patient characteristics, operator expertise, and resource
availability. The absence of significant differences and the broad
confidence intervals highlight the need for larger, randomized trials to
validate these findings further and explore potential clinical nuances.

<179>
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Accession Number
646743082
Title
Comparison of Early Clinical Outcomes with Balloon-Expanding Valves Versus
Self-Expanding Valves in Transcatheter Aortic Valve Replacement: A
Meta-Analysis of Randomized Controlled Trials.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Jain H.; Odat R.; Goyal A.; Jain J.; Rathore S.S.; Jha M.; Patel N.;
Pessey S.; Saleem M.; Suleiman H.
Institution
(Jain, Jain, Patel, Suleiman) All India Institute of Medical Sciences
(AIIMS), Jodhpur, India
(Odat) Faculty of Medicine, Jordan University of Science and Technology,
Irbid, Jordan
(Goyal) Seth GS Medical College, KEM Hospital, Mumbai, India
(Rathore) Dr Sampurnanand Medical College, Jodhpur, India
(Jha) Government Medical College, Surat, India
(Pessey, Saleem) University of Connecticut Health Center, Hartford, CT,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an effective
percutaneous intervention in patients with severe aortic stenosis,
particularly in those with contraindications for surgical repair.
Currently, two types of aortic valves are used in clinical practice:
balloon-expanding valves (BEV) and self-expanding valves (SEV). The
current data comparing early (30-day) clinical outcomes of BEV to SEV in
patients with severe aortic stenosis undergoing TAVR are inconsistent.
 Method(s): A systematic literature search spanning PubMed, Embase,
Cochrane, and Scopus databases was conducted to retrieve randomized
controlled trials (RCTs) comparing balloon-expanding valves to
self-expanding valves in patients undergoing TAVR. The DerSimonian and
Laird random-effects model was used to pool the odds ratios (OR) with 95%
confidence intervals. Statistical significance was set at p<0.05.
 Result(s): This meta-analysis included five RCTs with 2190 severe
aortic stenosis patients (1097 in the BEV group and 3621 in the SEV
group). BEV-TAVR was associated with a significantly lower risk of 30-day
new permanent pacemaker (PPM) implantation [OR: 0.67; 95% CI: 0.48, 0.93;
p=0.02] and 30-day re-hospitalization for heart failure [OR: 0.20; 95% CI:
0.04, 0.96; p=0.04] compared to SEV-TAVR. The risks of 30-day mortality,
30-day cardiac mortality, 30-day all-cause stroke, 30-day myocardial
infarction, 30-day life-threatening bleeding, 30-day vascular
complications, 30-day acute kidney injury, and 30-day repeat procedures
for valve-related dysfunction were comparable between the two groups.
 Conclusion(s): TAVR in patients with severe aortic stenosis using BEV
is advantageous over SEV in terms of 30-day new PPM implantation and
30-day rehospitalization for heart failure, with comparable risks for
other outcomes. These findings underscore the safety and efficacy of newer
generation valves, including Sapien 3 and EvolutPro, in TAVR. The choice
of prosthetic aortic valve is dependent on individual anatomy and operator
preference. Further RCTs are warranted to evaluate other newer-generation
valves with varying severities of aortic stenosis. (Figure Presented).

<180>
Accession Number
646742150
Title
Protamine Administration and Bleeding Risk Following Transcatheter Aortic
Valve Implantation: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2024 Scientific
Sessions and the American Heart Association's 2024 Resuscitation Science
Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination),
2024. Date of Publication: 01 Nov 2024.
Author
Kara A.O.; Beshr M.S.; Alzubi A.S.; Alansari A.H.A.; Arhaym E.; Aburawi
D.M.; El Awami M.; Shahin H.; Abdelwahed A.F.; Abdulsalam A.A.; Almezghwi
H.; Elhadi M.
Institution
(Kara, Arhaym, El Awami, Abdulsalam, Almezghwi, Elhadi) University of
Benghazi, Benghazi, Libyan Arab Jamahiriya
(Beshr) Sana'a University, Sana'a, Yemen
(Alzubi) Marshall University, Joan C. Edwards School of Medicine, New
York, NY, United States
(Alansari) Gharyan University, Ghadames, Libyan Arab Jamahiriya
(Aburawi) University of Tripoli, Tripoli, Libyan Arab Jamahiriya
(Shahin) South Valley University, Qina, Egypt
(Abdelwahed) East Carolina University, Greenville, NC, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Bleeding risk is a major concern for patients receiving
transcatheter aortic valve implantation (TAVI) due to heparin use. In
recent studies, Heparin antagonists, such as protamine, have shown
potential in mitigating this complication. We aim to evaluate its
potential role in reducing the risk of bleeding in patients post- TAVI.
Methods On March 18, 2024, related articles were searched in the following
databases: PubMed, Embase, Scopus, Web of Science, Cochrane Library, Wiley
Library, VHL, Google Scholar, and clinicaltrials.gov. The inclusion
criteria consisted of studies that reported the use of protamine in
patients who underwent TAVI, with the aim of reducing bleeding risk
compared to administering a placebo or no treatment. Our primary outcomes
included major bleeding, life-threatening bleeding, the need for blood
transfusion, the 30-day mortality rate, and any events of stroke or
transient ischemic attack (TIA). The effect size was calculated using the
odds ratio with a 95% confidence interval. Meta-analysis was conducted
based on random-effect model using Revman. Results Out of the 14,705
articles we obtained, only 5 papers were included. One was a randomized
controlled trial; the remaining 4 were observational cohorts with control
groups. These studies comprised a total of 3,502 patients. Protamine
significantly reduced major bleeding (OR 0.44, 95% CI 0.29-0.69, p =
0.0003, I2 = 37%), especially with full-dose administration (1
mg/100 U UFH) compared to partial-dose administration (0.5 mg/100 U UFH)
(OR 0.38, 95% CI 0.25-0.58, p < 0.00001, I2 = 0%). Similarly,
protamine significantly reduced life-threatening bleeding (OR 0.37, 95% CI
0.20-0.67, p = 0.001, I2 = 4%), particularly with full-dose
usage compared to partialdose (OR 0.37, 95% CI 0.18-0.73, p = 0.004,
I2 = 0%). However, no significant difference was observed in
the need for blood transfusion (OR 0.75, 95% CI 0.46- 1.24, p = 0.27,
I2 = 33%), stroke/TIA risk (OR 0.82, 95% CI 0.41-1.61, p =
0.56, I2 = 49%), or 30-day mortality (OR 0.93, 95% CI
0.62-1.39, p = 0.73, I2 = 0%). Conclusions The use of protamine
appears to significantly reduce major and life-threatening bleeding. The
need for blood transfusion, risk of stroke or TIA, and 30-day mortality
did not show significant differences. These findings suggest that
protamine may be an effective intervention for reducing bleeding
complications post-TAVI. However, large randomized controlled trials are
needed to validate these findings.

<181>
Accession Number
2037784119
Title
Aortic Annular Enlargement: Y-Incision Rationale, Technique, and Outcomes.
Source
Annals of Thoracic Surgery. (no pagination), 2025. Date of Publication:
2025.
Author
Chen S.A.; Do-Nguyen C.C.; Titsworth M.; Yang B.
Institution
(Chen) Division of Cardiac Surgery, University of California, Davis,
Sacramento, California, United States
(Do-Nguyen, Titsworth, Yang) Department of Cardiac Surgery, University of
Michigan, Ann Arbor, MI, United States
Publisher
Elsevier Inc.
Abstract
Background: Trials comparing transcatheter aortic valve replacement and
surgical aortic valve replacement (SAVR) have shown that in patients with
annuli <26 mm, SAVR had negative hemodynamic and clinical outcomes.
Recently, studies revealed that the effective orifice diameter of surgical
prosthetic valves is 5-7 mm smaller than the labeled valve size. To
improve outcomes of SAVR, the Y-incision aortic annular enlargement (AAE)
enlarges the surgical aortic annulus to accommodate a prosthetic valve 3-4
sizes larger with an effective orifice area that matches the patient's
native annulus. This review discusses when and how the Y-incision AAE
should be performed. Method(s): OVID MEDLINE, OVID Embase, and
Cochrane Library were searched with terms that included "Y-incision aortic
annular enlargement," "valve sizes," and "long-term survival." The search
included publications after 2020. The reference lists of included studies
were reviewed to retrieve additional studies. Result(s): In patients
with matched native annular sizes, AAE significantly improved midterm
survival without increasing perioperative complications. Patients treated
with a larger valve had notably better long-term survival and small valve
sizes were significant risk factors for operative and long-term mortality.
Compared with patients treated with a Nicks or Manougian procedure, the
hemodynamics in patients treated with Y-incision AAE were significantly
better. Conclusion(s): Y-incision AAE could be routinely considered
for patients with a normal annulus (17-25 mm) undergoing
SAVR. Copyright © 2025 The Society of Thoracic Surgeons

<182>
Accession Number
2037797920
Title
PERFORMANCE OF CONTEMPORARY RISK SCORES FOR TRANSCATHETER AORTIC VALVE
REPLACEMENT: A META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 889), 2025. Date of Publication: 01 Apr 2025.
Author
Agrawal A.; Majid M.; Arockiam A.D.; Rosenzveig A.; Haroun E.; Safdar A.;
Griffin B.P.; Kapadia S.R.; Wang T.K.M.
Institution
(Agrawal, Majid, Arockiam, Rosenzveig, Haroun, Safdar, Griffin, Kapadia,
Wang) Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Background Transcatheter aortic valve replacement (TAVR) is an established
alternative to surgery for severe aortic stenosis. Risk scores play an
important role in the decision-making for cardiac surgery but have been
underutilized in TAVR patients. This meta-analysis compared the
performance of surgical and TAVR-specific risk scores for predicting TAVR
outcomes. Methods Ovid Medline, Embase, and Cochrane databases were
searched from 1946-2023. Studies were systematically reviewed for
inclusion, and data was extracted for pooled analysis using
OpenMeta-Analyst software. Results Among 4419 articles, 168 full-text
articles were screened, and 114 studies were included for analysis. Pooled
areas under the curve (AUCs) and 95% confidence intervals for operative
mortality and 1-year mortality by score are presented in the Table. The
highest AUCs were 0.775 (0.549-1.000) for STT score for operative
mortality and 0.793 (0.733-0.854) for gradient boosting machine learning
model (GBM) for 1-year mortality. Calibration assessed by Peto's odds
ratios (95% confidence intervals) were 0.35 (0.20-0.61), p<0.001 for
EuroSCORE I and 1.04 (0.72-1.50), p=0.83 for EuroSCORE II. Conclusion STT
score and GBM model had the highest AUCs for operative and 1-year
mortality, respectively, whilst most other risk scores had modest
discrimination for mortality after TAVR, suggesting significant room for
improvement required prior to widespread clinical practice. [Formula
presented] Copyright © 2025 American College of Cardiology
Foundation

<183>
Accession Number
2033629610
Title
Mechanical Protective Ventilation: New Paradigms in Thoracic Surgery.
Source
Journal of Clinical Medicine. 14(5) (no pagination), 2025. Article Number:
1674. Date of Publication: 01 Mar 2025.
Author
Canbaz M.; Senturk E.; Senturk M.
Institution
(Canbaz) Department of Anesthesiology and Reanimation, Istanbul Faculty of
Medicine, University of Istanbul, Istanbul, Turkey
(Senturk) Department of Anesthesiology, Acibadem Atasehir Hospital,
Istanbul, Turkey
(Senturk) Department of Anesthesiology and Reanimation, School of
Medicine, Acibadem University, Istanbul, Turkey
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
One-lung ventilation (OLV) in thoracic anesthesia poses dual challenges:
preventing hypoxemia and minimizing ventilator-associated lung injury
(VALI). Advances such as fiberoptic bronchoscopy and improved anesthetic
techniques have reduced hypoxemia, yet optimal management strategies
remain uncertain. Protective ventilation, involving low tidal volumes (4-6
mL/kg), individualized PEEP, and selective alveolar recruitment maneuvers
(ARM), seek to balance oxygenation and lung protection. However, questions
persist regarding the ideal application of PEEP and ARM, as well as their
integration into clinical practice. As for PEEP and ARM, further research
is needed to address key questions and establish new
guidelines. Copyright © 2025 by the authors.

<184>
Accession Number
2037797999
Title
VALIDATING THE USE OF MEDICARE CLAIMS DATA TO EVALUATE COVARIATES &
OUTCOMES AMONG MEDICARE ADVANTAGE PATIENTS ENROLLED IN THE EVOLUT LOW-RISK
TRIAL.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 934), 2025. Date of Publication: 01 Apr 2025.
Author
Lalani C.; Medina F.A.; Liang L.; Song Y.; Butala N.; Strom J.B.; Yeh R.W.
Institution
(Lalani, Medina, Liang, Song, Butala, Strom, Yeh) Beth Israel Deaconess
Medical Center, Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
Background Medicare Fee-for-Service (FFS) claims that are validated
against adjudicated trial endpoints are often used to assess longterm
outcomes in medical device post-approval studies. As Medicare delivery
becomes increasingly privatized, it is important to evaluate if existing
FFS claims algorithms perform similarly in Medicare Advantage (MA) to
support clinical outcomes assessment. Methods We compared concordance of
claims-based covariates and outcomes among FFS vs MA patients with
covariates and adjudicated outcomes in the Evolut Low-Risk Trial. We used
validated claims algorithms for 1 year outcomes and calculated
sensitivity, specificity, positive predictive value, negative predictive
value and kappa. Results Among 1,324 patients 65+ years old in the Evolut
Low-Risk trial, 782 patients (59.1%, 22.4% MA, 77.6% FFS) were
probabilistically linked to claims data. Linked vs unlinked patients were
similar except there was less surgical valve replacement in linked
patients (44.6% vs. 53.4%). Claims algorithms performed similarly for MA
vs FFS patients, except for prior myocardial infarction (MI) and acute MI,
both of which had few events in the MA group (Table 1). Pacemaker
implantation had the best performance in MA patients (Kappa: 0.83).
Conclusion Medicare claims data perform similarly in MA vs FFS in most
covariates and outcomes. As patients shift from FFS to MA, ascertainment
of outcomes using Medicare claims in post-approval studies remains
promising for similar select outcomes. [Formula presented] Copyright
© 2025 American College of Cardiology Foundation

<185>
[Use Link to view the full text]
Accession Number
2037724688
Title
Evaluating the Appropriate Use Criteria for Coronary Revascularization in
Stable Ischemic Heart Disease Using Randomized Data From the ISCHEMIA
Trial.
Source
Circulation: Cardiovascular Quality and Outcomes. (no pagination), 2025.
Article Number: e010849. Date of Publication: 2025.
Author
Slater J.; Maron D.J.; Jones P.G.; Bangalore S.; Reynolds H.R.; Fu Z.;
Stone G.W.; Kirby R.; Hochman J.S.; Spertus J.A.
Institution
(Slater, Bangalore, Reynolds, Hochman) NYU Grossman School of Medicine,
New York, NY, United States
(Maron) Department of Medicine, Stanford University School of Medicine,
CA, United States
(Jones, Fu, Spertus) University of Missouri - Kansas City (UMKC)'s,
Healthcare Institute for Innovations in Quality, Saint Luke's Mid America
Heart Institute, United States
(Stone) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Kirby) National Heart Lung and Blood Institute, National Institutes of
Health, Bethesda, MD, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: The appropriate use criteria for revascularization of stable
ischemic heart disease have not been evaluated using randomized data.
Using data from the randomized ISCHEMIA trial (International Study of
Comparative Health Effectiveness with Medical and Invasive Approaches;
July 2012 to January 2018, 37 countries), the health status benefits of an
invasive strategy over a conservative one were examined within appropriate
use criteria scenarios. METHOD(S): Among 1833 participants mapped to
36 appropriate use criteria scenarios, symptom status was assessed using
the Seattle Angina Questionnaire-7 at 1 year for each scenario and for
each of the 6 patient characteristics used to define the scenarios.
Coronary anatomy and SYNTAX(Synergy between percutaneous coronary
intervention with Taxus and cardiac surgery) scores were measured using
coronary computed tomography angiography. Treatment effects are expressed
as an odds ratio for a better health status outcome with an invasive
versus conservative treatment strategy using Bayesian hierarchical
proportional odds models. Differences in the primary clinical outcome were
similarly examined. RESULT(S): The mean age was 63 years, 81% were
male, and 71% were White. Diabetes was present in 28% and multivessel
disease in 51%. Most clinical scenarios favored invasive for better 1-year
health status. The benefit of an invasive strategy on Seattle Angina
Questionnaire angina frequency scores was reduced for asymptomatic
patients (odds ratio [95% credible interval], 1.16 [0.66-1.71] versus 2.26
[1.75-2.80]), as well as for those on no antianginal medications.
Diabetes, number of diseased vessels, proximal left anterior descending
coronary artery location, and SYNTAX score did not effectively identify
patients with better health status after invasive treatment, and minimal
differences in clinical events were observed. CONCLUSION(S): Applying
the randomization scheme from the ISCHEMIA trial to appropriate clinical
scenarios revealed baseline symptoms and antianginal therapy to be the
primary drivers of health status benefits from invasive management.
Consideration should be given to reducing the patient characteristics
collected to generate appropriateness ratings to improve the feasibility
of future data collection. Copyright © 2025 American Heart
Association, Inc.

<186>
Accession Number
2037796246
Title
PERCUTANEOUS CORONARY INTERVENTION VERSUS CONSERVATIVE THERAPY IN TAVI
PATIENTS WITH OBSTRUCTIVE CORONARY DISEASE: AN UPDATED SYSTEMATIC REVIEW
AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 999), 2025. Date of Publication: 01 Apr 2025.
Author
Ahmed H.; Ismayl M.; Mangat M.; Petraskova T.; El-Shaer A.; Palicherla A.;
Aboeata A.S.A.; Anavekar N.S.; Goldsweig A.M.
Institution
(Ahmed, Ismayl, Mangat, Petraskova, El-Shaer, Palicherla, Aboeata,
Anavekar, Goldsweig) Creighton University School of Medicine, Omaha, NE,
United States
(Ahmed, Ismayl, Mangat, Petraskova, El-Shaer, Palicherla, Aboeata,
Anavekar, Goldsweig) Baystate Medical Center, Springfield, MA, United
States
Publisher
Elsevier Inc.
Abstract
Background Aortic stenosis and coronary artery disease frequently coexist.
As current guidelines provide no definitive recommendations for performing
percutaneous coronary intervention (PCI) in conjunction with transcatheter
aortic valve implantation (TAVI), the optimal approach in this patient
population remains unclear. Methods We searched multiple databases for
studies comparing PCI versus conservative management in patients
undergoing TAVI. Outcomes, including stroke, myocardial infarction (MI),
mortality (30 days and 1 year), acute kidney injury, and major bleeding,
were pooled and reported as relative risk (RR) with 95% confidence
intervals (CI). Heterogeneity was assessed using the I2 statistic, with a
randomeffects model applied for I2 < 60% and P < 0.1; otherwise a
fixed-effects model was used. Results A total of 9 studies were
identified. There was no significant difference between PCI and
conservative therapy for 30-day mortality (RR 0.81; 95% CI 0.58-1.12) or
1-year mortality (RR 0.97; 95% CI 0.81-1.16). PCI was associated with an
increased risk of major bleeding (RR1.39; 95% CI 1.18-1.64), but no
significant differences were found for acute kidney injury (RR 1.17, 95%
CI 0.64-2.12), myocardial infarction (RR 0.67; 95% CI 0.42-1.09), and
stroke (RR 0.98; 95% CI 0.72-1.33). Conclusion Our findings highlight the
need for individualized decision-making in managing coronary artery
disease in this high-risk patient population. Further studies are needed
to confirm our findings. [Formula presented] Copyright © 2025
American College of Cardiology Foundation

<187>
Accession Number
2037794601
Title
COMPARISON OF FASTING AND NON-FASTING PROTOCOLS ON PATIENT SAFETY AND
COMFORT DURING CARDIAC TRANSCATHETER PROCEDURES: A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 997), 2025. Date of Publication: 01 Apr 2025.
Author
Lucena L.; Cavalcante D.V.S.; Freitas M.; Borges R.C.; De Oliveira A.L.A.;
Leite V.; Carvalho N.S.; Medeiros A.; Duarte I.; Costa T.; Gomes W.F.;
Sousa J.C.
Institution
(Lucena, Cavalcante, Freitas, Borges, De Oliveira, Leite, Carvalho,
Medeiros, Duarte, Costa, Gomes, Sousa) Federal University of Rio Grande do
Norte, Natal, Brazil
Publisher
Elsevier Inc.
Abstract
Background Current guidelines recommend preprocedural fasting for at least
6 hours for solid food and 2 hours for clear liquids before cardiac
transcatheter procedures. However, the supporting data are limited.
Methods We searched the Cochrane, Embase, and Medline databases for
randomized controlled trials (RCTs) comparing fasting versus non-fasting
states for cardiac transcatheter procedures. Endpoints were (1) hunger,
(2) incidence of aspiration, (3) nausea/vomiting, (4) acute kidney injury
(AKI), (5) length of stay, and (6) patient satisfaction. Risk ratios and
standardized mean differences were pooled for binary and continuous
outcomes, respectively. Results Our meta-analysis included 9 RCTs with
3,646 patients, of whom 1,815 followed traditional fasting. Hunger
sensation was significantly lower in the NF group (SMD -0.91; 95% CI:
-1.71 to -0.11; P = 0.026; I2 = 96%, Figure 1A). The incidence of
aspiration (RR 2.20; 95% CI 0.29-17.02; P = 0.449; I2 = 0%, Figure 1B),
nausea/vomiting (RR 1.09; 95% CI 0.67-1.78; P = 0.723; I2 = 0%), and AKI
(RR 1.82; 95% CI 0.90-3.70; P = 0.096; I2 = 0%; Figure 1C) were not
significantly different between groups. Similarly, length of stay (MD
-0.01 days; 95% CI -0.39 to 0.36; P = 0.940; I2 = 3%; Figure 1D) and
patient satisfaction (SMD 0.95; 95% CI: -0.16 to 2.06; P = 0.094; I2 =
98%) were also similar in both groups. Conclusion Our study suggests a
non-fasting strategy is a safe option before transcatheter cardiac
procedures. [Formula presented] Copyright © 2025 American College
of Cardiology Foundation

<188>
Accession Number
2037794735
Title
30-DAY, 1-YEAR AND 2-YEAR CLINICAL OUTCOMES OF TRANSCATHETER AORTIC VALVE
IMPLANTATION VERSUS SURGICAL AORTIC VALVE IMPLANTATION IN PATIENTS WITH
SEVERE AORTIC VALVE STENOSIS AT LOW TO INTERMEDIATE SURGICAL RISKS: A
META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 2383), 2025. Date of Publication: 01 Apr 2025.
Author
Obi O.; Nweze U.; Lee T.; Ononuju I.; sonye P.; Ariahu N.; Adibe E.O.
Institution
(Obi, Nweze, Lee, Ononuju, sonye, Ariahu, Adibe) New York Institute of
Technology College of Osteopathic Medicine, Glen Head, NY, United States
Publisher
Elsevier Inc.
Abstract
Background Data regarding the efficacy and safety of transcatheter aortic
valve implantation (TAVI) versus surgical aortic valve implantation (SAVI)
in patients with low to intermediate surgical risk are limited. Methods
PubMed, Embase and Scopus were searched for randomized controlled trials
(RCTs) comparing TAVI to SAVI in low to intermediate surgical risk
patients with severe aortic stenosis and primary outcome of mortality.
Results We included 9 RCTs comparing TAVI to SAVI in 8404 patients with
low-intermediate surgical risks. The pooled results showed that the
incidence of 30-day (p = 0.360), 1-year (p = 0.090) and 2-year mortality
(p = 0.246) did not differ between TAVI and SAVI. TAVI reduced the
incidence of 30-day stroke (p = 0.035) but not 1-year (p = 0.074) and
2-year stroke (p = 0.217). TAVI reduced the rate of 1-year death from
cardiovascular (CV) causes (p = 0.021) but not 30-day (p = 0.604) and
2-year death from CV causes (p = 0.244). TAVI reduced the incidence of
acute kidney injury (p < 0.001). TAVI reduced the incidence of 30-day
myocardial infarction (MI) (p = 0.040) but not 1-year (p = 0.672) and
2-year MI (p = 0.953). TAVI also reduced the incidence of 30-day (p <
0.001), 1-year (p < 0.001) and 2-year new onset atrial fibrillation (p <
0.001). TAVI increased the rate of 30-day (p < 0.001) and 2-year (p <
0.001) permanent pacemaker implantation (PPI) but not 1-year PPI (p =
0.068). Conclusion TAVI did not reduce mortality in patients with severe
aortic stenosis with low to intermediate surgical risk. [Formula
presented] Copyright © 2025 American College of Cardiology
Foundation

<189>
Accession Number
2033597301
Title
A Comprehensive Overview of Respiratory Compliance in Dogs Under General
Anesthesia: Clinical Factors and Future Perspectives.
Source
Animals. 15(5) (no pagination), 2025. Article Number: 746. Date of
Publication: 01 Mar 2025.
Author
Xu T.; Mandour A.S.; Shimada K.; Hamabe L.; Tanaka R.
Institution
(Xu, Tanaka) Veterinary Teaching Hospital, Tokyo University of Agriculture
and Technology, Tokyo, Japan
(Mandour) Department of Animal Medicine, Suez Canal University, Ismaila,
Egypt
(Shimada) Laboratory of Veterinary Surgery, Department of Veterinary
Medicine, Tokyo University of Agriculture and Technology, Fuchu, Japan
(Hamabe) Veterinary Clinical Oncology, Tokyo University of Agriculture and
Technology, Tokyo, Japan
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Respiratory compliance reflects the ability of the lungs and chest wall to
expand in response to increases in pressure. In this review, relevant
studies were selected through a comprehensive literature search with the
aim of summarizing and generalizing them to describe the relevant factors
that may be present in veterinary clinical practice and affect respiratory
compliance in dogs. Individual factors, including breeds, disease
background, drugs administered, and especially surgical procedures, can
result in alterations to respiratory compliance due to their impact on the
respiratory system in dogs. Despite its potential clinical utility, such
as in anesthesia monitoring, respiratory compliance remains underutilized
in veterinary medicine, and further research is necessary to support its
future clinical applications. Copyright © 2025 by the authors.

<190>
[Use Link to view the full text]
Accession Number
2037724967
Title
Protamine Dosing for Heparin Reversal after Cardiopulmonary Bypass: A
Double-blinded Prospective Randomized Control Trial Comparing Two
Strategies.
Source
Anesthesiology. 142(1) (pp 98-106), 2025. Date of Publication: 01 Jan
2025.
Author
Jain P.; Silva-De Las Salas A.; Bedi K.; Lamelas J.; Epstein R.H.; Fabbro
M.
Institution
(Jain, Silva-De Las Salas, Epstein, Fabbro) Department of Anesthesiology,
Perioperative Medicine, and Pain Management, University of Miami Miller
School of Medicine, Miami, FL, United States
(Bedi) University of Miami, Miller School of Medicine, Miami, FL, United
States
(Lamelas) Department of Surgery, University of Miami Miller School of
Medicine, Miami, FL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Drug shortages are a frequent challenge in current clinical
practice. Certain drugs (e.g., protamine) lack alternatives, and
inadequate supplies can limit access to services. Conventional protamine
dosing uses heparin ratio-based calculations for heparin reversal after
cardiopulmonary bypass and may result in excess protamine utilization and
potential harm due to its intrinsic anticoagulation. This study
hypothesized that a fixed 250-mg protamine dose would be comparable, as
measured by the activated clotting time, to a 1:1 (1 mg for every 100 U)
protamine-to-heparin ratio-based strategy for heparin reversal and that
protamine would be conserved. Method(s): In a single-center,
double-blinded trial, consenting elective adult cardiac surgical patients
without preexisting coagulopathy or ongoing anticoagulation and a
calculated initial heparin dose greater than or equal to 27,500 U were
randomized to receive, after cardiopulmonary bypass, protamine as a fixed
dose (250 mg) or a ratio-based dose (1 mg:100 U heparin). The primary
outcome was the activated clotting time after initial protamine
administration, assessed by Student's t test. Secondary outcomes included
total protamine, the need for additional protamine, and the cumulative
24-h chest tube output. Result(s): There were 62 and 63 patients in
the fixed- and ratio-based dose groups, respectively. The mean
postprotamine activated clotting time was not different between groups
(-2.0 s; 95% CI, -7.2 to 3.3 s; P = 0.47). Less total protamine per case
was administered in the fixed-dose group (-2.1 50-mg vials; 95% CI, -2.4
to -1.8; P < 0.0001). There was no difference in the cumulative 24-h chest
tube output (difference, -77 ml; 95% CI, 220 to 65 ml; P = 0.28).
 Conclusion(s): A 1:1 heparin ratio-based protamine dosing strategy
compared to a fixed 250-mg dose resulted in the administration of a larger
total dose of protamine but no difference in either the initial activated
clotting time or the amount postoperative chest-tube
bleeding. Copyright © 2024 American Society of Anesthesiologists.
All Rights Reserved.

<191>
Accession Number
2037798219
Title
RACIAL AND ETHNIC DISPARITIES IN MAVACAMTEN TRIALS FOR HYPERTROPHIC
CARDIOMYOPATHY - A SYSTEMATIC REVIEW.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 1647), 2025. Date of Publication: 01 Apr 2025.
Author
Raju A.K.V.; Pathiyil M.M.; Abraham G.M.; Hadley M.L.
Institution
(Raju, Pathiyil, Abraham, Hadley) Saint Vincent Hospital, Worcester, MA,
United States
Publisher
Elsevier Inc.
Abstract
Background Hypertrophic cardiomyopathy (HCM) is the most common genetic
heart disease, inherited in an autosomal dominant pattern. It can lead to
sudden cardiac death and heart failure, with a prevalence of 1 in 250 to
500 people, though many remain undiagnosed. Prevalence is similar between
sexes, but women are less frequently diagnosed than men. Racial and ethnic
variations exist: 61.6% to 91.7% of reported cases are in white
populations, and 8.3% to 38.6% are in Black populations. Black patients
are more likely to present with heart failure but are less frequently
referred for interventions like symptom management, surgical septal
myectomy, and implantable cardioverter-defibrillators, even after
adjusting for socioeconomic status. Mavacamten, a cardiac myosin
inhibitor, has been shown to improve symptoms in obstructive HCM, yet
guidelines fail to adequately address racial and ethnic disparities in HCM
care. This review aims to explore racial and ethnic representation in
clinical trials of mavacamten. Methods A literature search of trials
examining mavacamten in HCM was conducted using PubMed, EMBASE, and
CENTRAL. Data extracted included age, sex/gender, race, ethnicity,
socioeconomic status, and study location, if available. Results Four
trials were identified, including 444 participants. Of these, 401 (90.3%)
were White, 12 (2.7%) were Black, 9 (2%) were Asian, and 19 (4.9%) were
multiracial or unknown race. A majority, 416 (93.7%), reported being
non-Hispanic. Three of the four trials were conducted in the USA, with the
remaining trial conducted across high-income countries Conclusion This
review highlights a lack of diversity in clinical trials of mavacamten in
HCM, raising concerns about the generalizability of results to
underrepresented racial and ethnic groups. There needs to be a more
vigorous approach and investment to recruit participants from diverse
backgrounds. Copyright © 2025 American College of Cardiology
Foundation

<192>
Accession Number
646718704
Title
RETRACTION: Effects of Parasternal Intercostal Block on Surgical Site
Wound Infection and Pain in Patients Undergoing Cardiac Surgery: A
Meta-Analysis.
Source
International wound journal. 22(3) (pp e70297), 2025. Date of Publication:
01 Mar 2025.
Author
Anonymous
Abstract
RETRACTION: J.-Q. Li, Z.-H. Li, P. Dong, P. Liu, Y.-Z. Xu, Z.-J. Fan,
"Effects of Parasternal Intercostal Block on Surgical Site Wound Infection
and Pain in Patients Undergoing Cardiac Surgery: A Meta-Analysis,"
International Wound Journal 21, no. 2 (2024): e14433,
https://doi.org/10.1111/iwj.14433. The above article, published online on
17 October 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.

<193>
Accession Number
2033637079
Title
Central Venous Pressure as a Predictor of Acute Kidney Injury in Cardiac
Surgery: A Systematic Review of Observational Studies.
Source
Diagnostics. 15(5) (no pagination), 2025. Article Number: 530. Date of
Publication: 01 Mar 2025.
Author
Griva P.; Griva V.; Samara D.; Talliou C.; Panagouli K.; Roungeris L.
Institution
(Griva, Panagouli) Department of Anesthesiology, University General
Hospital Attikon, Athens, Greece
(Griva) Department of Internal Medicine, General Hospital of Athens
"Sismanoglio", Athens, Greece
(Samara, Talliou) School of Medicine, National and Kapodistrian University
of Athens, Athens, Greece
(Roungeris) Department of Anaesthesiology, Rea Maternity Hospital, Athens,
Greece
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Acute kidney injury (AKI) is a syndrome
characterized by impaired kidney function, which is associated with
reduced survival and increased morbidity. Central venous pressure (CVP) is
a widely used hemodynamic parameter for assessing the volume status of
patients and evaluating their response to fluid resuscitation. This
systematic review aims to analyze various prospective and retrospective
observational and controlled trials to determine the association between
CVP and the risk of developing AKI in patients undergoing cardiac surgery.
Additionally, it examines whether elevated CVP serves as an accurate
predictor of AKI in this patient population. Method(s): A systematic
review was conducted following the PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) guidelines, using PubMed as the
primary database. The search focused on studies published after 2014 that
included adult patients undergoing cardiac surgery with reported
measurements of CVP and kidney function assessment. Studies conducted on
animals, pediatric populations, those published before 2014, or in
languages other than English were excluded from the review.
 Result(s): Through the analysis of 21 studies, a clear association
between higher CVP and increased AKI risk emerged. The most critical CVP
thresholds identified were 10 mmHg, 12 mmHg, 14 mmHg, and 20 mmHg, with
risk increasing progressively beyond these values. CVP >= 10 mmHg was the
most commonly reported cutoff for elevated AKI risk, showing 1.42 to 4.53
times increased odds. CVP >= 12 mmHg further amplified the risk, while CVP
>= 14 mmHg was consistently associated with severe AKI and the need for
RRT. The highest threshold (CVP >= 20 mmHg) showed the greatest risk
escalation, linked to fluid overload, right heart failure, and mortality.
Studies also suggest an optimal CVP range of 6-8 mmHg to minimize AKI
incidence. Conclusion(s): Elevated CVP is an independent risk factor
for the development of AKI in patients undergoing cardiac surgery. These
findings suggest that CVP monitoring can play a significant role in
predicting AKI and guiding perioperative management
strategies. Copyright © 2025 by the authors.

<194>
Accession Number
2033629952
Title
Multiparametric Outcome Assessment After Transcatheter Aortic Valve
Implantation-A Systematic Review.
Source
Journal of Clinical Medicine. 14(5) (no pagination), 2025. Article Number:
1426. Date of Publication: 01 Mar 2025.
Author
Swiatoniowska-Lonc N.; Klausa F.; Sciborski K.; Wysokinska-Kordybach A.;
Banasiak W.; Doroszko A.
Institution
(Swiatoniowska-Lonc, Sciborski, Wysokinska-Kordybach, Banasiak, Doroszko)
Department of Cardiology, Centre for Heart Diseases, 4th Military
Hospital, Wroclaw, Poland
(Klausa) Department of Cardiac Surgery, Centre for Heart Diseases, 4th
Military Hospital, Wroclaw, Poland
(Banasiak, Doroszko) Clinical Department of Cardiology, Faculty of
Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Backround/Objectives: Aortic stenosis (AS) is the most commonly acquired
valvular disorder. Patient risk stratification and the development of an
accurate and reliable tool are crucial in identifying suitable candidates
for TAVI. The present review summarized the current state of knowledge on
the influence of selected factors on the outcomes and course of patients
with AS undergoing transcatheter aortic valve implantation (TAVI).
 Method(s): The inclusion criteria for the present systematic review
were as follows: (1) studies indexed in the medical databases PubMed,
MEDLINE, EMBASE, CINAHL, Web of Science, and Scopus; (2) full-text
articles available in English; (3) papers published between 2013 and 2023;
and (4) addressing the topic of assessing the impact of factors on the
outcomes of patients with aortic stenosis undergoing TAVI. This review
used PRISMA 2020 reporting guidelines for systematic reviews and
meta-analyses. Result(s): One hundred and thirty-two studies were
eligible for this review. The available studies showed an association of
psychosocial and socioeconomic factors, valve parameters, comorbidities,
clinical factors, treatment-related factors, biomarkers, and treatment
methods with the outcomes of patients with AS undergoing TAVI.
 Conclusion(s): Given the conflicting results obtained regarding the
impact of right ventricular dysfunction, paravalvular leaks, and treatment
method on the mortality of patients undergoing aortic valve implantation,
further research in these areas is needed. In view of the researchers'
differing views on some of the factors affecting patient outcomes after
TAVI, further analysis is needed to develop a new tool for assessing
predictive outcomes in AS patients. This study is registered at PROSPERO
(CRD42024612752). Copyright © 2025 by the authors.

<195>
Accession Number
2037785538
Title
Effect of sotagliflozin on major adverse cardiovascular events: a
prespecified secondary analysis of the SCORED randomised trial.
Source
The Lancet Diabetes and Endocrinology. (no pagination), 2025. Date of
Publication: 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, Mason) Brigham and Women's Hospital Heart and Vascular
Center, Harvard Medical School, Boston, MA, United States
(Bhatt, Szarek) Mount Sinai Fuster Heart Hospital, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Szarek) CPC Clinical Research and University of Colorado Anschutz Medical
Campus, Aurora, CO, United States
(Szarek) State University of New York Downstate School of Public Health,
Brooklyn, NY, United States
(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, Tennessee, United
States
(Riddle) Oregon Health and Science University, Portland, OR, United States
(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) University Health Network, Toronto General Hospital Research
Institute, University of Toronto, Toronto, ON, Canada
(Udell) Women's College Hospital and Peter Munk Cardiac Centre, Toronto
General Hospital, University of Toronto, ON, Canada
(Mason) Elucida Research, Beverly, MA, United States
(Pitt) University of Michigan, Ann Arbor, MI, United States
(Steg) Universite Paris-Cite, INSERM U1148 and AP-HP Hopital Bichat,
Paris, France
(Steg) French Alliance for Cardiovascular Trials, Paris, France
Publisher
Elsevier Ltd
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. Finding(s): 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(s): 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(s): Lexicon
Pharmaceuticals. Copyright © 2025 Elsevier Ltd

<196>
Accession Number
646698775
Title
2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients
With Acute Coronary Syndromes: A Report of the American College of
Cardiology/American Heart Association Joint Committee on Clinical Practice
Guidelines.
Source
Circulation. (no pagination), 2025. Date of Publication: 27 Feb 2025.
Author
Rao S.V.; O'Donoghue M.L.; Ruel M.; Rab T.; Tamis-Holland J.E.; Alexander
J.H.; Baber U.; Baker H.; Cohen M.G.; Cruz-Ruiz M.; Davis L.L.; de Lemos
J.A.; DeWald T.A.; Elgendy I.Y.; Feldman D.N.; Goyal A.; Isiadinso I.;
Menon V.; Morrow D.A.; Mukherjee D.; Platz E.; Promes S.B.; Sandner S.;
Sandoval Y.; Schunder R.; Shah B.; Stopyra J.P.; Talbot A.W.; Taub P.R.;
Williams M.S.
Institution
(Rab, Tamis-Holland) ACC/AHA Joint Committee on Clinical Practice
Guidelines liaison
(Baker, Cruz-Ruiz) Lay stakeholder/patient representative
(Feldman) Society for Cardiovascular Angiography and Interventions
representative
(Promes) American College of Emergency Physicians representative, United
States
(Schunder, Talbot) ACC/AHA joint staff representative
(Stopyra) National Association of EMS Physicians representative
(Williams) ACC/AHA Joint Committee on Performance Measures representative
Abstract
AIM: The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of
Patients With Acute Coronary Syndromes" incorporates new evidence since
the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial
Infarction" and the corresponding "2014 AHA/ACC Guideline for the
Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and
the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary
Intervention for Patients With ST-Elevation Myocardial Infarction." The
"2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients
With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for
Coronary Artery Revascularization" retire and replace, respectively, the
"2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet
Therapy in Patients With Coronary Artery Disease." METHODS: A
comprehensive literature search was conducted from July 2023 to April
2024. Clinical studies, systematic reviews and meta-analyses, and other
evidence conducted on human participants were identified that were
published in English from MEDLINE (through PubMed), EMBASE, the Cochrane
Library, Agency for Healthcare Research and Quality, and other selected
databases relevant to this guideline. STRUCTURE: Many recommendations from
previously published guidelines have been updated with new evidence, and
new recommendations have been created when supported by published data.

<197>
Accession Number
2037795312
Title
THE EFFECT OF SUPPLEMENTAL MELATONIN AS A CARDIOPROTECTIVE MEASURE IN
PATIENTS UNDERGOING ELECTIVE CORONARY ARTERY BYPASS GRAFT SURGERY: A
META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 1047), 2025. Date of Publication: 01 Apr 2025.
Author
Alqadi M.; Abdelhafez M.; Bansal N.; Qafisheh Q.; Qwaider M.; Baniowda M.;
Alhroob T.; Dawoud A.
Institution
(Alqadi, Abdelhafez, Bansal, Qafisheh, Qwaider, Baniowda, Alhroob, Dawoud)
The University of Toledo, Toledo, OH, United States
(Alqadi, Abdelhafez, Bansal, Qafisheh, Qwaider, Baniowda, Alhroob, Dawoud)
The University of Missouri-Kansas City, kansas, MO, United States
Publisher
Elsevier Inc.
Abstract
Background Myocardial ischemia/reperfusion injury is a critical
complication associated with coronary artery bypass graft (CABG) surgery.
In this study, we examined the role of melatonin supplements in
alleviating cardiac injury and inflammatory biomarkers in patients who
underwent elective CABG. Methods We searched Medline/PubMed, Embase, Web
of Science, Google Scholar, and the Cochrane Library for randomized
controlled trials that assessed changes in troponin I (cTnI), creatine
kinase myocardial band (CK-MB), and C-reactive protein (CRP) biomarkers in
CABG patients receiving melatonin supplements. We utilized a
random-effects model to calculate the standardized mean difference (SMD).
Results Five trials involving 418 patients (210 in the melatonin arm and
208 in the control arm) were included. All biomarkers were measured at
baseline and 24 hours after surgery. Melatonin supplements showed a
favorable effect on 24-hour cTnI and CK-MB levels, with an SMD of -1.98
(95% CI, -3.22 to -0.75) and -3.03 (95% CI, -4.78 to -1.28), respectively.
The SMD of CRP levels between the melatonin group and the control group at
24 hours was -1.88 (95% CI, -5.14 to 1.38). Conclusion Melatonin therapy
may ameliorate myocardial ischemia/reperfusion injury in patients
undergoing CABG surgery. However, larger randomized controlled trials are
necessary to better define melatonin's cardioprotective role. [Formula
presented] Copyright © 2025 American College of Cardiology
Foundation

<198>
Accession Number
2037796936
Title
INVASIVE VERSUS CONSERVATIVE MANAGEMENT IN ELDERLY PATIENTS WITH
NON-ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: A META-ANALYSIS OF
RANDOMIZED CONTROLLED TRIALS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 1013), 2025. Date of Publication: 01 Apr 2025.
Author
Alqadi M.; Bansal N.; Abdelhafez M.; Qwaider M.; Baniowda M.; Dawoud A.;
Qafisheh Q.; Alhroob T.
Institution
(Alqadi, Bansal, Abdelhafez, Qwaider, Baniowda, Dawoud, Qafisheh, Alhroob)
The University of Toledo, Toledo, OH, United States
(Alqadi, Bansal, Abdelhafez, Qwaider, Baniowda, Dawoud, Qafisheh, Alhroob)
The University of Missouri-Kansas City, kansas, MO, United States
Publisher
Elsevier Inc.
Abstract
Background Non-ST-segment elevation myocardial infarction (NSTEMI) is the
most common acute coronary syndrome subtype in individuals over 75 years
of age. However, this cohort of patients is underrepresented in clinical
trials. Methods We searched Medline/PubMed, Embase, Web of Science, the
Cochrane Library, and Google Scholar for randomized controlled trials that
compared NSTEMI outcomes between invasive therapy (coronary
angiography/revascularization or coronary artery bypass graft surgery) and
conservative medical treatment in patients >=75 years old. Results Eight
RCTs with 3,275 patients were included (1,628 received invasive
management, and 1,647 were treated with conservative medical management
alone). There was no significant difference in all-cause mortality at one
year (RR: 0.89, 95% CI: 0.78-1.02) or cardiovascular mortality at two
years (RR: 1.05, 95% CI: 0.85-1.30) between invasive and conservative
treatment strategies. However, the invasive treatment group showed a
significantly lower risk of nonfatal myocardial infarction (RR: 0.69, 95%
CI: 0.52-0.90) and coronary artery revascularization (RR: 0.29, 95% CI:
0.21-0.40) at two years. Conclusion Invasive therapy for patients >= 75
years old with NSTEMI, compared to conservative management alone, reduces
the risk of nonfatal myocardial infarction and coronary artery
revascularization at two years but not cardiovascular deaths. [Formula
presented] Copyright © 2025 American College of Cardiology
Foundation

<199>
[Use Link to view the full text]
Accession Number
646707508
Title
Association Between Use of WATCHMAN Device and 1-Year Mortality Using
High-Dimensional Propensity Scores to Reduce Confounding.
Source
Circulation. Cardiovascular quality and outcomes. (pp e011188), 2025.
Date of Publication: 03 Mar 2025.
Author
Zhao J.Z.; Ruzieh M.; Du F.; Lian Y.; Foy A.J.; Platt R.W.; Segal M.S.;
Coulombe J.; Winterstein A.G.; Jiao T.
Institution
(Zhao, Du, Winterstein, Jiao) Department of Pharmaceutical Outcomes and
Policy, College of Pharmacy, University of Florida
(Ruzieh, Segal) Department of Medicine, College of Medicine, University of
Florida
(Lian) Department of Biostatistics and Epidemiology, Perelman School of
Medicine, University of Pennsylvania
(Foy) Division of Cardiology, Penn State Heart and Vascular Institute,
Milton S. Hershey Medical Center, Penn State College of Medicine, PA
(A.J.F.), Hershey, United States
(Platt) Departments of Epidemiology, Biostatistics, Occupational Health,
McGill College, Montreal, QC, Canada
(Coulombe) Department of Mathematics and Statistics, Universite de
Montreal, QC, Canada
Abstract
BACKGROUND: Previous observational studies showed left atrial appendage
occlusions with the WATCHMAN device reduced 1-year mortality, which
conflicted with evidence generated from randomized controlled trials. We
proposed to use the high-dimensional propensity score (hdPS) to assist in
nonactive comparator selection (prevalent user of medication) and compared
1-year mortality between patients with atrial fibrillation who received
the WATCHMAN device (percutaneous left atrial appendage occlusion device
[pLAAO]) and direct oral anticoagulants in 2 matched cohorts based on (1)
traditional propensity score (PS) and (2) integrating traditional PS with
information learned from hdPS. METHOD(S): Patients entered the cohort
once diagnosed with atrial fibrillation in the 15% of Medicare
fee-for-service claims database from 2011 to 2018. Patients could enter
the study cohort upon receiving WATCHMAN or at an outpatient visit with an
atrial fibrillation diagnosis, respectively. We used PS matching with a
1:3 ratio for patients in pLAAO and direct oral anticoagulant groups. In
cohort 2, we implemented a multistep approach with information learned
from hdPS. The Cox proportional hazards model was used to estimate hazard
ratios of outcomes with 95% CIs. RESULT(S): In cohort 1, we
identified 1159 and 3477 patients in the pLAAO and direct oral
anticoagulant groups with a mean age of 78.1 versus 77.5 years, 44.9%
versus 40.8% of women, and a 1-year mortality rate of 8.02 versus 8.97/100
person-years (hazard ratio, 0.87 [95% CI, 0.69-1.09]). With the support of
hdPS, in cohort 2, we excluded patients with malignant cancer and added
frailty score in the PS model. We identified 953 and 2859 patients in the
pLAAO and direct oral anticoagulant groups with a mean age of 78.1 versus
77.9 years, 47.2% versus 46.1% of women, and a 1-year mortality rate of
7.45 and 7.69/100 person-years (hazard ratio, 0.95 [95% CI, 0.73-1.24]).
 CONCLUSION(S): No association was found between pLAAO and 1-year
mortality, which is consistent with existing evidence from randomized
controlled trials. The hdPS approach provides an opportunity to improve
nonactive comparator selection in traditional PS analysis.

<200>
Accession Number
2037798566
Title
MITRAL VALVE REPAIR VERSUS REPLACEMENT IN PATIENTS WITH RHEUMATIC MITRAL
DISEASE: A SYSTEMATIC REVIEW, META-ANALYSIS AND META-REGRESSION.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 2265), 2025. Date of Publication: 01 Apr 2025.
Author
Barbosa L.M.; Queiroz I.; De Oliveira H.M.; Araujo B.; Tavares A.;
Pimentel T.; Defante M.L.R.; Rivera A.; Ruelas M.G.; Pantaleao A.N.;
Wegner G.R.M.; Fonseca I.M.; Nunes M.C.P.
Institution
(Barbosa, Queiroz, De Oliveira, Araujo, Tavares, Pimentel, Defante,
Rivera, Ruelas, Pantaleao, Wegner, Fonseca, Nunes) Federal University of
Minas Gerais, Belo Horizonte, Brazil
Publisher
Elsevier Inc.
Abstract
Background Mitral valve repair (MVR) has demonstrated better outcomes
compared to mitral replacement in degenerative etiology. This
meta-analysis aims to evaluate whether these advantages extend to patients
with rheumatic mitral disease (RMD) Methods We systematically searched
CENTRAL, MEDLINE and EMBASE for studies comparing MVR to replacement in
patients with RMD. We pooled odds ratios (OR) for endpoints with 95%
confidence intervals (CI) with a random-effects model. Subgroup analyses
were conducted on mean age and type of valve for replacement, while
meta-regression analyzed correlations with mitral stenosis (MS), atrial
fibrillation (AF), and age. Analyses were performed using R 4.4.1 Results
Our meta-analysis included 20 studies with 42,004 patients, of whom 12,938
underwent MVR. The analysis revealed that repair had lower early mortality
compared to replacement (OR 0.67; 95% CI: 0.50 to 0.91; p=0.01). However,
subgroup analysis for patients over 50 years had no significance. For late
mortality, MVR also showed improvement (OR 0.53; 95% CI: 0.40 to 0.72;
p<0.01). Repair had higher reoperation rates (OR 2.91; 95% CI: 1.99 to
4.25; p<0.01). Subgroups for bioprosthetic valves had no difference, while
mechanical aligned with general findings. Meta-regression showed
correlation between late mortality with the percentage of patients with
MS, AF, and age Conclusion In patients with RMD, MVR is associated with
lower early and late mortality but higher reoperation rates compared to
replacement [Formula presented] Copyright © 2025 American College
of Cardiology Foundation

<201>
Accession Number
2037796490
Title
30-DAY CLINICAL OUTCOMES OF TRANSCATHETER AORTIC VALVE IMPLANTATION WITH
BALLOON-EXPANDABLE VERSUS SELF-EXPANDING VALVES: A META-ANALYSIS OF
RANDOMIZED CONTROLLED TRIALS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 2249), 2025. Date of Publication: 01 Apr 2025.
Author
Obi O.; Nweze U.; Lee T.; Ononuju I.; sonye P.; Ariahu N.; Adibe E.O.
Institution
(Obi, Nweze, Lee, Ononuju, sonye, Ariahu, Adibe) New York Institute of
Technology College of Osteopathic Medicine, Glen Head, NY, United States
Publisher
Elsevier Inc.
Abstract
Background Data comparing balloon expandable valves (BEV) to
self-expanding valves (SEV) in patients with small aortic annulus (SAA)
that underwent transcatheter aortic valve implantation (TAVI) remain
unclear. Methods PubMed, Embase and Scopus were search for randomized
controlled trials (RCTs) comparing BEV to SEV in patients that underwent
TAVI with a 30-day follow-up. Results We included 8 RCTs comparing BEV to
SEV in 3134 patients with SAA that underwent TAVI. The pooled results
showed that BEV reduced the rate of all-cause mortality compared to SEV
(RR = 0.60; 95% CI [0.39; 0.95]; I2 = 0%; p = 0,029; Figure
1A). However, the incidence of death from cardiovascular causes (RR =
0.60; 95% CI [0.30; 1.19]; I2 = 0%; p = 0.144; Figure 1B),
stroke (RR = 1.16; 95% CI [0.63; 2.12]; I2 = 41%; p = 0.640;
Figure 1C) and myocardial infarction (RR = 0.58; 95% CI [0.10; 3.56];
I2 = 0%; p = 0.561; Figure 1D) did not differ between groups.
BEV reduced the rate of life-threatening bleeding (RR = 0.67; 95% CI
[0.47; 0.96]; I2 = 0%; p = 0.028; Figure 1E) but not major
bleeding (RR = 0.99; 95% CI [0.64; 1.53]; I2 = 0%; p = 0.955;
Figure 1F). BEV also reduced the incidence of permanent pacemaker
implantation (RR = 0.71; 95% CI [0.55; 0.92]; I2 = 8%; p =
0.010; Figure 1G) but not major vascular complications (RR = 0.73; 95% CI
[0.49; 1.09]; I2 = 0%; p = 0.126; Figure 1H). Conclusion Our
meta-analysis showed lower incidence of early mortality, life-threatening
bleeding and PPI in BEV than SEV. However, the rate of major bleeding did
not differ between groups. [Formula presented] Copyright © 2025
American College of Cardiology Foundation

<202>
Accession Number
2037798522
Title
THE PROGNOSTIC VALUE OF NEUTROPHIL TO LEUKOCYTE RATIO IN RISK
STRATIFICATION AND OUTCOMES OF TRANSCATHETER AORTIC VALVE REPLACEMENT: A
SYSTEMATIC REVIEW.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 891), 2025. Date of Publication: 01 Apr 2025.
Author
Sharma V.; Kumar H.; Wulandari P.; Agarwal A.; Rao A.; Sharma A.; Sharma
S.
Institution
(Sharma, Kumar, Wulandari, Agarwal, Rao, Sharma, Sharma) Guthrie Robert
Packer Hospital, Sayre, PA, United States
Publisher
Elsevier Inc.
Abstract
Background The neutrophil-to-leukocyte ratio (NR) is a key biomarker for
systemic inflammation, and has also been associated with outcomes in a
variety of cardiovascular therapies. This review aims to explore the
predictive utility of NLR in risk classification and outcomes after
transcatheter aortic valve replacement (TAVR). Methods A review of
electronic databases was conducted to uncover studies that investigated
the relationship between NLR and TAVR outcomes. A total of 64 studies were
included, including data from 15,683 patients. Results The review found
that a higher NLR is associated with higher all-cause and cardiovascular
mortality after TAVR. Each unit increase in NLR resulted in a 16% increase
in all-cause mortality and a 25% increase in cardiovascular mortality.
Furthermore, a reduction in NLR between baseline and one year was
associated with a lower risk of death or rehospitalization between one
year and three years. Conclusion For people with TAVR, NLR is a valuable
biomarker for predicting risk and clinical outcomes. Higher NLR readings
are associated with a higher mortality risk and may be a valuable tool for
patient risk assessment. Additional study is needed to develop uniform NLR
values for clinical application. [Formula presented] Copyright ©
2025 American College of Cardiology Foundation

<203>
Accession Number
2037797344
Title
OUTCOMES OF WATCHMAN VS AMULET IN PATIENTS WITH ATRIAL FIBRILLATION - AN
UMBRELLA META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 297), 2025. Date of Publication: 01 Apr 2025.
Author
Parvataneni T.; Patel R.; Shah P.; Sripathi K.; Rajgopal S.; Chenna
V.S.H.; Aboukhreis M.; Dirisanala S.; Patel U.; Gandhi A.; Yarlagadda
B.R.G.
Institution
(Parvataneni, Patel, Shah, Sripathi, Rajgopal, Chenna, Aboukhreis,
Dirisanala, Patel, Gandhi, Yarlagadda) Icahn School Medicine At Mount
Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background Atrial fibrillation (AF) raises the risk of stroke, and devices
like the Watchman and Amulet are designed to occlude the left atrial
appendage (LAA).The main goal of this umbrella meta-analysis is to compare
the safety and effectiveness of these two devices in AF patients. Methods
A PRISMA-based umbrella meta-analysis of published meta-analyses of LAA
occlusion by Watchman vs. Amulet in AF patients using PubMed MeSH terms
was conducted. RevMan 5.4 was used to generate pooled odds ratios (ORs),
95% CI, forest plots, and heterogeneity (I2) using an inverse variance
approach and a random-effects model with alpha criteria 0.05. Results Of
29 studies, 3 had data on outcomes. Watchman device had borderline
increased risk of bleeding [(a) Overall bleeding: 1.13, 1.0-1.28, p=0.05,
I2=0% (b) Major: 1.12, 0.99-1.28, p=0.07, I2=0%] and procedure-related
complications [1.76, 1.19-2.61, p=0.005, I2=0%] than Amulet. There was no
statistically significant difference between major/minor stroke [1.15,
0.91-1.44, p=0.34, I2=0%], thromboembolism [1.12, 0.59-2.10, p=0.73,
I2=0%], and device-related complications [1.23, 0.75-2.01, p=0.99, I2=0%].
Conclusion Our analysis shows that the Watchman device may have a slightly
higher risk of bleeding and procedure-related complications than the
Amulet, but both devices have equivalent stroke and thrombosis outcomes.
More research is needed to confirm these findings and improve AF
treatment.. [Formula presented] Copyright © 2025 American College
of Cardiology Foundation

<204>
Accession Number
2037796576
Title
COMPARATIVE BETWEEN OUTCOMES OF SELF-EXPANDING AND BALLOON-EXPANDABLE
TRANSCATHETER AORTIC VALVES IN PATIENTS WITH LEFT VENTRICULAR SYSTOLIC
DYSFUNCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 931), 2025. Date of Publication: 01 Apr 2025.
Author
Zreigh S.M.M.; Othman A.A.; Elmezayen R.; Shawesh Q.E.; Saleh S.; Farrara
H.; Ali A.; Ali B.M.; Zubaidi M.S.; Hamza O.; Elnaggar A.; Elhadi M.
Institution
(Zreigh, Othman, Elmezayen, Shawesh, Saleh, Farrara, Ali, Ali, Zubaidi,
Hamza, Elnaggar, Elhadi) Ankara Yildirim Beyazit University Faculty of
Medicine, Ankara, Turkey
(Zreigh, Othman, Elmezayen, Shawesh, Saleh, Farrara, Ali, Ali, Zubaidi,
Hamza, Elnaggar, Elhadi) Near East University, Faculty of Medicine,
Nicosia, Cyprus
Publisher
Elsevier Inc.
Abstract
Background Aortic stenosis (AS) is a valvular heart disease characterized
by narrowing the aortic valve. Patients with AS and concurrent left
ventricular systolic dysfunction (LVSD) face higher perioperative risks
and an increased likelihood of complications. While surgical valve
replacement used to be the treatment for severe AS, transcatheter aortic
valve replacement (TAVR) is now considered a better alternative,
especially for patients with high or moderate surgical risk. TAVR uses two
main types of valves: balloon-expandable (BEVs) and self-expanding (SEVs).
We compared the clinical results between SEVs and BEVs in individuals
suffering from severe aortic stenosis and reduced left ventricular
ejection fraction (LVEF). Methods We conducted a systematic search of
PubMed, Scopus, Embase, Cochrane and Web of Science up to September 2024.
Studies were included comparing the outcomes of SEV and BEV in patients
with AS and reduced LVEF. Random effects meta-analysis was conducted to
estimate risk ratio (RR) with 95% CI for outcomes. Statistical analysis
was performed using R Studio version 4.3.2. Results Three studies
comprising 633 patients (261 SEV and 372 BEV) were included. SEV was
associated with an increased risk of 30day all-cause mortality (RR 2.24,
95% CI 1.14-4.41; P = .02; I2 =0%) and 1-year all-cause mortality (RR
1.84, 95% CI 1.23-2.77; P < .01; I2 =0%). No significant differences were
observed for stroke (RR 1.60, 95% CI 0.61-4.22; P = .34; I2 =0%), acute
kidney injury (RR 0.94, 95% CI 0.49-1.78; P = .84; I2 =0%), new pacemaker
implantation (RR 1.36, 95% CI 0.97-1.91; P = .08; I2 =14%), length of
hospital stay (MD 0.50, 95% CI -0.90-1.9; P = .48; I2 =64%), or post-TAVR
LVEF (MD -0.24, 95% CI -2.37-1.89; P = .82; I2 = 8%). The incidence of
major and minor vascular complications also showed no significant
difference between SEV and BEV (RR 1.24, 95% CI 0.60-2.54; P = .56; I2
=0%, and RR 1.20, 95% CI 0.53-2.70; P = .66; I2 =0%, respectively).
Conclusion The analysis indicates that SEV has a higher risk for mortality
compared to BEV in patients with severe aortic stenosis and reduced LVEF.
However, future research must confirm these findings due to the limited
number of included studies and the small sample size. Copyright ©
2025 American College of Cardiology Foundation

<205>
Accession Number
2037798548
Title
ANTITHROMBOTIC THERAPY AND OUTCOMES AFTER TRANSCATHETER AORTIC VALVE
REPLACEMENT: AN UPDATED SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 888), 2025. Date of Publication: 01 Apr 2025.
Author
Siami S.; Maleki S.; Kazemian S.; ebrahimi E.; Ebrahimzade M.; Jodeiri F.;
Hajiqasemi M.; Ebrahimi S.; Mehdizadeh M.; Aghaei M.; Bastan M.-M.; Sabet
M.F.; Nazari R.; Ebrahimi P.; Rana J.S.; Nanna M.; Giri J.S.; Kolte D.;
Alkhouli M.A.; Hosseini K.
Institution
(Siami, Maleki, Kazemian, ebrahimi, Ebrahimzade, Jodeiri, Hajiqasemi,
Ebrahimi, Mehdizadeh, Aghaei, Bastan, Sabet, Nazari, Ebrahimi, Rana,
Nanna, Giri, Kolte, Alkhouli, Hosseini) Tehran Heart Center,
Cardiovascular Research Institute, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Publisher
Elsevier Inc.
Abstract
Background The optimal antithrombotic treatment after TAVR remains
unclear. We aimed to study the safety and efficacy of various
antithrombotic regimens post-TAVR. Methods We systematically searched
PubMed, Embase, Scopus, and ClinicalTrials.gov from inception until August
2024 for studies evaluating antithrombotic regimens post-TAVR in patients
without an indication for chronic oral anticoagulation. The antithrombotic
strategies were assessed in four arms including single antiplatelet
therapy (SAPT), dual antiplatelet therapy (DAPT), oral anticoagulant
(OAC), and a combination of OAC+SAPT. A pairwise frequentist network
meta-analysis approach was utilized. Results We included 11 studies (8
RCTs, 3 propensity-score matched cohorts). SAPT was associated with
significantly lower risk of total bleeding and major/life-threatening
bleeding compared with DAPT (OR 0.53, 95% CI 0.40-0.70; OR 0.53, 95% CI
0.35-0.80), OAC (OR 0.57, 95% CI 0.40-0.82; OR 0.52, 95% CI 0.28-0.99),
and OAC+SAPT (OR 0.35, 95% CI 0.21-0.60; OR 0.32, 95% CI 0.13-0.76),
respectively. Furthermore, OAC+SAPT was associated with a significantly
higher risk of all-cause mortality compared with other regimens.
Cardiovascular mortality, myocardial infarction, and stroke risks were
similar across all post-TAVR antithrombotic regimens. Conclusion In
patients without an indication for OAC, SAPT after TAVR offers the best
balance of safety and reducing bleeding risk without raising the risk of
cardiovascular events. [Formula presented] Copyright © 2025
American College of Cardiology Foundation

<206>
Accession Number
2037796675
Title
THE IMPACT OF INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIGRAPHY VS
INTRACARDIAC ECHOCARDIOGRAPHY ON PERIDEVICE LEAK AFTER WATCHMAN FLX LEFT
ATRIAL APPENDAGE CLOSURE.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 874), 2025. Date of Publication: 01 Apr 2025.
Author
Poliner M.; Bhuta S.; Carlen A.; Pracha N.S.; Rustagi S.; Jacob C.;
Yavornitzky N.; Latif O.; Afzal M.R.
Institution
(Poliner, Bhuta, Carlen, Pracha, Rustagi, Jacob, Yavornitzky, Latif,
Afzal) The Ohio State University Wexner Medical Center, Columbus, OH,
United States
Publisher
Elsevier Inc.
Abstract
Background Left atrial appendage closure (LAAC) is an alternative to oral
anticoagulation for thromboembolism prevention in patients with
non-valvular atrial fibrillation. Peridevice leak (PDL) is a potential
complication of LAAC. The purpose of this study was to assess the impact
of intraoperative transesophageal echocardiography (TEE) vs intracardiac
echocardiography (ICE) on PDL incidence and size after Watchman FLX LAAC.
Methods This single center retrospective study included all patients who
underwent Watchman FLX LAAC from August 2020 to January 2023 with either
intraoperative TEE or ICE. The primary endpoints were incidence and size
of PDL on 45-day follow up imaging. The secondary endpoints were
preoperative imaging modality, implanted device size, device compression,
fluoroscopy time, same day discharge, complications, and device-related
thrombus (DRT). Results A total of 183 patients underwent LAAC, 78 (43%)
with TEE and 105 (57%) with ICE. Of those who underwent follow up imaging,
there was no difference with TEE (40%) vs ICE (40%) in PDL incidence
(p=0.970) or PDL size (p=0.648). As compared to TEE, ICE was associated
with an increased use of cardiac CTA or cardiac MRI for preoperative
planning, less use of general anesthesia, larger implanted device size,
and increased fluoroscopy time. There was no difference in the rate of
same day discharge, complications, or DRT (Table 1). Conclusion
Intraoperative TEE vs ICE guidance did not impact PDL incidence or size
after Watchman FLX LAAC. [Formula presented] Copyright © 2025
American College of Cardiology Foundation

<207>
Accession Number
2037797895
Title
SAFETY OF CONCOMITANT TRANSCATHETER AORTIC VALVE REPLACEMENT AND LEFT
ATRIAL APPENDAGE OCCLUSION IN PATIENTS WITH ATRIAL FIBRILLATION: A
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 928), 2025. Date of Publication: 01 Apr 2025.
Author
Jain H.; Patel N.; Arshad M.M.; Passey S.; Jain J.; Amanullah K.; Ahmed
F.; Kazmi M.H.; Jha M.; Ahmed R.; Khan R.; Alexander T.
Institution
(Jain, Patel, Arshad, Passey, Jain, Amanullah, Ahmed, Kazmi, Jha, Ahmed,
Khan, Alexander) All India Institute of Medical Sciences (AIIMS), Jodhpur,
India
(Jain, Patel, Arshad, Passey, Jain, Amanullah, Ahmed, Kazmi, Jha, Ahmed,
Khan, Alexander) University Hospitals Birmingham NHS Foundation Trust,
Birmingham, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background Patients with severe aortic stenosis and atrial fibrillation
(AF) undergoing TAVR face elevated stroke and bleeding risks. Concomitant
left atrial appendage occlusion (LAAO) with TAVR may mitigate
thromboembolic risk and reduce oral anticoagulation dependence. Methods A
systematic search of the major databases was performed to identify
relevant randomized controlled trials (RCT). Effect estimates were
calculated using risk ratios (RR) and 95% CIs by pooling data employing
the inverse variance random effects model. Statistical significance was
set at p<0.05. Results 3 RCTs were included with 482 patients undergoing
either isolated TAVR (n = 243) or concomitant TAVR + LAAO (n = 239).
Concomitant TAVR + LAAO was non-inferior to isolated TAVR in the risk of
all-cause mortality [RR: 0.98; 95% CI: 0.69, 1.39], cardiovascular
mortality [RR: 1.02; 95% CI: 0.61, 1.69], in-hospital mortality [RR: 0.66;
95% CI: 0.11, 4.00], post-procedural bleeding [RR: 1.12; 95% CI: 0.74,
1.68], and stroke [RR: 0.73; 95% CI: 0.34, 1.57]. However, the concomitant
procedure was associated with a significantly higher risk of vascular
complications [RR: 5.78; 95% CI: 2.03, 16.51; p = 0.001]. Conclusion
Concomitant TAVR + LAAO demonstrates mostly non-inferior outcomes except a
higher risk of vascular complications, compared to isolated TAVR in AF
patients. Large, multicentric RCTs are warranted to validate the results
of this meta-analysis. [Formula presented] Copyright © 2025
American College of Cardiology Foundation

<208>
Accession Number
2037797436
Title
MITRAL ANNULAR CALCIFICATION IN HYPERTROPHIC CARDIOMYOPATHY PATIENTS
UNDERGOING SEPTAL MYECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 1597), 2025. Date of Publication: 01 Apr 2025.
Author
Mohyeldin M.A.M.; Mohamed F.; Anto A.; Alazm M.A.; Bella J.N.
Institution
(Mohyeldin, Mohamed, Anto, Alazm, Bella) BronxCare Health System, Bronx,
NY, United States
Publisher
Elsevier Inc.
Abstract
Background Mitral annular calcification (MAC) is prevalent in hypertrophic
cardiomyopathy (HCM), particularly in the obstructive phenotype. This
systematic review and meta-analysis aimed to synthesize evidence on MAC
prevalence and its association with long-term mortality in HCM patients
undergoing septal myectomy. Methods Following PRISMA guidelines, we
conducted a comprehensive literature search from database inception
through May 2024. Studies reporting MAC prevalence and its impact on
survival in HCM patients undergoing septal myectomy were identified. Two
independent reviewers performed study selection, data extraction, and
quality assessment. Results Six studies encompassing 5,064 HCM patients
undergoing septal myectomy met inclusion criteria. MAC prevalence ranged
from 10.8% to 46% (pooled prevalence: 27.4%, 95% CI: 18.2-38.1%), with
higher rates observed in older patients and females. Meta-analysis
revealed MAC was significantly associated with higher all-cause mortality
(pooled HR 1.90, 95% CI 1.50-2.30, p<0.001). Heterogeneity across studies
was moderate to substantial (I2=68.25%), and funnel plot asymmetry test
suggested no evidence of publication bias (p=0.233). Conclusion In HCM
patients undergoing septal myectomy, MAC is prevalent and independently
associated with increased all-cause mortality. These findings underscore
the importance of MAC evaluation in risk stratification and
prognostication of HCM patients considered for surgical myectomy. [Formula
presented] Copyright © 2025 American College of Cardiology
Foundation

<209>
Accession Number
2037794006
Title
TEMPORAL TREND ANALYSIS OF CLINICAL OUTCOMES WITH TRANSCATHETER AORTIC
VALVE IMPLANTATION VERSUS SURGICAL AORTIC VALVE REPLACEMENT IN PATIENTS
WITH LOW TO INTERMEDIATE SURGICAL RISK: A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 809), 2025. Date of Publication: 01 Apr 2025.
Author
Ahmed M.; Nadeem Z.A.; Arif F.; Ahsan A.; Shafiq A.; Zulfiqar E.; Paray
N.B.; Carver C.; Ullah I.; Gardezi S.K.M.; Rehman N.U.; Mehmood Q.; Naqvi
S.T.H.; Ahmed F.; Ahmad H.; Ahmed R.; Farhan M.; Hassan A.; Shahid F.;
Khan S.Q.
Institution
(Ahmed, Nadeem, Arif, Ahsan, Shafiq, Zulfiqar, Paray, Carver, Ullah,
Gardezi, Rehman, Mehmood, Naqvi, Ahmed, Ahmad, Ahmed, Farhan, Hassan,
Shahid, Khan) Rawalpindi Medical University, Rawalpindi, Pakistan
(Ahmed, Nadeem, Arif, Ahsan, Shafiq, Zulfiqar, Paray, Carver, Ullah,
Gardezi, Rehman, Mehmood, Naqvi, Ahmed, Ahmad, Ahmed, Farhan, Hassan,
Shahid, Khan) National Heart & Lung Institute, Imperial College London,
London, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background Surgical aortic valve replacement (SAVR) is commonly used for
aortic valve replacement (AVR) in patients with aortic stenosis at low or
intermediate surgical risk. Transcatheter aortic valve replacement (TAVR)
has emerged as an alternative. This metaanalysis compares the efficacy and
safety of TAVR versus SAVR in these patients, analyzing outcomes at
various follow-up intervals. Methods A literature search of PubMed,
Embase, and Cochrane Library up to May 2024 identified eligible randomized
controlled trials (RCTs). Risk ratios (RRs) with 95% confidence intervals
(CIs) were pooled using a random-effects model. Results Seventeen reports
(n=9,092) were included in pooled analysis. No significant difference in
all-cause mortality was observed between TAVR and SAVR at 30 days, 1 year,
or 2 years, but TAVR showed a higher risk at >=5 years (RR=1.13, 95% CI:
1.03-1.23). TAVR had a lower risk of cardiac death at 1 year (RR=0.79, 95%
CI: 0.64-0.96) and significantly reduced risks of major bleeding, acute
kidney injury (AKI), and new or worsening atrial fibrillation (AF)
compared to SAVR. However, TAVR was associated with a higher risk of
permanent pacemaker implantation (PPI) and prosthetic valve thrombosis
beyond 2 years. Conclusion TAVR and SAVR have similar all-cause mortality
rates up to 2 years, but TAVR carries a higher risk beyond 5 years. TAVR
also shows advantages in reducing major bleeding, AKI, and AF but has
higher risks of PPI and prosthetic valve thrombosis. [Formula
presented] Copyright © 2025 American College of Cardiology
Foundation

<210>
Accession Number
2037795716
Title
THE PREDICTIVE VALUE OF RIGHT VENTRICLE SPECKLE TRACKING ECHOCARDIOGRAPHY
IN PATIENTS UNDERGOING CARDIAC SURGERY, A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 2060), 2025. Date of Publication: 01 Apr 2025.
Author
Al-Shammari A.S.; Sakini A.A.; Hasan M.T.; Shahzad M.; Islam M.R.;
Lingamsetty S.S.P.; Masih R.; Ibrahim A.; Chitturi S.S.; Elgebaly M.; Jain
H.; Alsawadi R.; Khan U.; Qaraghuli A.A.; Taii H.A.
Institution
(Al-Shammari, Sakini, Hasan, Shahzad, Islam, Lingamsetty, Masih, Ibrahim,
Chitturi, Elgebaly, Jain, Alsawadi, Khan, Qaraghuli, Taii) MedStar
Washington Hospital, Washington, WA, United States
(Al-Shammari, Sakini, Hasan, Shahzad, Islam, Lingamsetty, Masih, Ibrahim,
Chitturi, Elgebaly, Jain, Alsawadi, Khan, Qaraghuli, Taii) Dhari Alfayadh
General Hospital, Diyala, Iraq
Publisher
Elsevier Inc.
Abstract
Background Right ventricular (RV) dysfunction is a critical predictor of
adverse outcomes in cardiac surgery patients. The assessment of right
ventricular global longitudinal strain(GLS) echo has emerged as a
promising tool for detecting early RV dysfunction. This metaanalysis
evaluates the predictive value of RV GLS in these patients Methods Our
search covered all databases from their inception date until 1 September
2024. The primary outcomes included pooled diagnostic performance,
including sensitivity, specificity, and the diagnostic odds ratio (DOR). A
multiple-cutoff model was employed to determine the optimal RV GLS
threshold Results 11 observational studies involving 631 patients were
included. The pooled analysis demonstrated that RV GLS had an Area Under
the Curve of 0.88 (95% CI: 0.746 to 1.073). The pooled DOR was 8.53 (95%
CI: 4.28 to 17.01), showing that abnormal RV GLS values significantly
increased the likelihood of RV dysfunction. The heterogeneity among
studies was moderate (I2 = 46%, tau2 = 0.6860, p = 0.12), and publication
bias was low (LFK index = 1.2). Sensitivity and specificity were 0.83 (95%
CI: 0.74 to 0.89) and 0.78 (95% CI: 0.71 to 0.83), respectively. An
optimal RV GLS cutoff of -11.661 was identified, yielding balanced
sensitivity and specificity values of 0.7423. The summary receiver
operating characteristic curve confirmed the benefit of RV GLS as a
predictive marker Conclusion RV GLS demonstrates excellent predictive
value for RV dysfunction in cardiac surgery patients [Formula
presented] Copyright © 2025 American College of Cardiology
Foundation

<211>
Accession Number
2037796751
Title
DIRECT ORAL ANTICOAGULANTS VERSUS DUAL ANTIPLATELETS THERAPY FOR PATIENTS
UNDERGOING LEFT ATRIAL APPENDAGE CLOSURE: A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 871), 2025. Date of Publication: 01 Apr 2025.
Author
Qadeer A.; Haider M.Z.; Khawar M.; Maryam S.; Shafique N.; Khalid Y.; Jha
M.; Zain S.; Shehzeen D.; Aamir M.; Do V.; Kirchoff R.; Bennett C.
Institution
(Qadeer, Haider, Khawar, Maryam, Shafique, Khalid, Jha, Zain, Shehzeen,
Aamir, Do, Kirchoff, Bennett) Mayo Clinic, pheonix, AZ, United States
(Qadeer, Haider, Khawar, Maryam, Shafique, Khalid, Jha, Zain, Shehzeen,
Aamir, Do, Kirchoff, Bennett) West Virginia University, WV, United States
Publisher
Elsevier Inc.
Abstract
Background Direct oral anticoagulants (DOACs) are commonly used for
anticoagulation in patients undergoing left atrial appendage closure
(LAAC). However, their safety and efficacy remain uncertain compared to
dual antiplatelet therapy (DAPT). Methods A comprehensive literature
search was conducted across multiple databases (EMBASE, OVID, Scopus,
PubMed, ClinicalTrials. gov, and Web of Science). We extracted baseline
characteristics and evaluated outcomes. Odds ratios (OR) with 95%
confidence intervals (CI) were calculated. Statistical significance was
assigned at p<0.05. Results Twelve studies with 4,398 patients were
analyzed. DOACs were associated with a reduced risk of overall mortality
(OR: 0.42, 95% CI: 0.23-0.75, p = 0.003) as compared to DAPT. There was no
difference in the incidence of overall and major bleeding. DOACs were not
associated with a reduction in device-related thrombosis (OR: 0.70, 95%
CI: 0.30-1.63, p = 0.41) or ischemic stroke (OR: 1.17, 95% CI: 0.61-2.25,
p = 0.64) as compared to DAPT. Figure 1 Conclusion DOACs are associated
with a reduction in overall mortality in patients undergoing left atrial
appendage closure compared to DAPT. Larger randomized control trials are
needed to evaluate these outcomes further. [Formula
presented] Copyright © 2025 American College of Cardiology
Foundation

<212>
Accession Number
2037796985
Title
ANTITHROMBOTIC STRATEGY FOR PATIENTS WITH CONCOMITANT CHRONIC CORONARY
SYNDROME AND ATRIAL FIBRILLATION: A POOLED ANALYSIS OF 3
RANDOMIZED-CONTROLLED TRIALS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 1904), 2025. Date of Publication: 01 Apr 2025.
Author
Chi K.-Y.; Lee P.L.; Pazooki P.; Kumar S.S.; Borkowski P.; Hussain A.;
Nanna M.
Institution
(Chi, Lee, Pazooki, Kumar, Borkowski, Hussain, Nanna) Jacobi Medical
Center, Albert Einstein College of Medicine, Bronx, NY, United States
(Chi, Lee, Pazooki, Kumar, Borkowski, Hussain, Nanna) Yale University
School of Medicine, New Haven, CT, United States
Publisher
Elsevier Inc.
Abstract
Background The optimal antithrombotic strategy for patients with
concomitant chronic coronary syndrome and atrial fibrillation (CCS-AF) is
uncertain. Methods We conducted a random-effects meta-analysis of the OAC
ALONE, AFIRE, and EPIC-CAD trials, comparing combined oral anticoagulant
(OAC) and antiplatelet versus OAC alone in AF with CCS, defined as those
medically treated or with coronary revascularization?>1 year prior.
Effectiveness outcomes included death, myocardial infarction (MI) or
in-stent thrombosis, ischemic stroke, and systemic embolism. The safety
outcome was major bleeding. Results The analysis included 3,945 patients
from 3 trials. Combined therapy did not decrease effectiveness endpoints
but significantly increased major bleeding (RR, 1.75; 95% CI, 1.15 to
2.65; I2 = 50%), compared with OAC alone (Figure A). In
patients with elective percutaneous coronary intervention (PCI)?>1 year
prior (Figure B), combined therapy was associated with a significant 55%
reduction in MI or in-stent thrombosis (RR, 0.45; 95% CI, 0.21 to 0.99;
I2 = 0%) at the cost of excess bleeding. Combined therapy
increased major bleeding across all subgroups, except in female patients
(HR, 0.99; 95% CI, 0.39 to 2.51; I2 = 54%) (Figure C).
Conclusion Combined OAC and antiplatelet therapy in CCS-AF is associated
with excess bleeding without clear clinical benefits, aside from those
with a history of remote PCI. Future trials should focus on identifying
subsets of patients who may benefit from combined therapy. [Formula
presented] Copyright © 2025 American College of Cardiology
Foundation

<213>
Accession Number
2037797504
Title
EFFICACY AND SAFETY OF PROTAMINE IN REDUCING BLEEDING AND VASCULAR
COMPLICATIONS AFTER TAVR: A META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 1071), 2025. Date of Publication: 01 Apr 2025.
Author
Qureshi M.A.; Bakht D.; Rehman A.U.; Amjad Z.; Rehman O.U.; Bokhari
S.F.H.; Tareen H.; Haseeb S.; Ahmed O.; Khan L.A.; Munir S.
Institution
(Qureshi, Bakht, Rehman, Amjad, Rehman, Bokhari, Tareen, Haseeb, Ahmed,
Khan, Munir) Hussein Othman, Henry Ford Jackson Hospital, Jackson, MI,
United States
Publisher
Elsevier Inc.
Abstract
Background Transcatheter aortic valve replacement (TAVR) often causes
postoperative bleeding and vascular complications due to intraoperative
heparin. Protamine sulfate reverses heparin but its routine clinical use
in TAVR remains debated. This meta-analysis aims to evaluate protamine's
efficacy and safety in reducing bleeding and vascular complications
compared to standard practices Methods PubMed, Embase, Cochrane and
clinicaltrials.gov were searched. Primary outcomes were 30-day mortality,
major bleeding, lifethreatening bleeding, and vascular complications.
Secondary outcomes were minor bleeding, myocardial infarction, stroke,
acute kidney injury, and hospital stay. Odds ratios (OR) and mean
differences (MD) were calculated through a random-effects model using
RevMan 5.4 Results 6 studies with a total of 4,123 patients were included
in the quantitative synthesis. Protamine reduced minor (OR=0.63, p=0.01),
major (OR=0.46, p<0.001), and life-threatening bleeding (OR=0.35,
p<0.001), minor (OR=0.82, p=0.03) and major vascular complications
(OR=0.45, p<0.001), and shortened hospital stay (MD=-1.95 days, p=0.02).
Protamine did not significantly affect 30-day mortality, risk of pacemaker
implantation, myocardial infarction, stroke, acute kidney injury, or
postoperative transfusion requirement Conclusion Protamine reduces
bleeding and vascular complications in TAVR without raising mortality or
thromboembolic risks. More trials are needed to support routine use
[Formula presented] Copyright © 2025 American College of
Cardiology Foundation

<214>
Accession Number
2037798815
Title
SAFETY AND EFFICACY OF PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS
UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 892), 2025. Date of Publication: 01 Apr 2025.
Author
Singh S.; Bhutta T.; Shabbir M.A.; Tiwari N.; Bliden K.; Tantry U.; Gurbel
P.A.; Kanjwal M.; Lundgren S.
Institution
(Singh, Bhutta, Shabbir, Tiwari, Bliden, Tantry, Gurbel, Kanjwal,
Lundgren) Sinai Hospital, Baltimore, MD, United States
Publisher
Elsevier Inc.
Abstract
Background Studies evaluating percutaneous coronary intervention (PCI) in
patients with coronary artery disease and severe aortic stenosis
undergoing transcatheter aortic valve implantation (TAVI) have shown
conflicting results. We performed a meta-analysis to reconcile the data.
Methods Online databases were searched for studies comparing PCI to
conservative management (no PCI) in patients undergoing TAVI. The outcomes
of interest were major adverse cardiovascular events (MACE), all deaths,
cardiovascular (CV) deaths, major bleeding, myocardial infarction (MI),
cerebrovascular accidents (CVA), revascularization and acute kidney injury
(AKI). Pooled odds ratios (OR) and 95% confidence intervals (CI) were
estimated. Results Fifteen studies (2 randomized and 13 observational)
with a total of 8,675 patients (PCI n=3,950, no PCI n=4,725) were
included. The mean age was 82 years, 56% patients were men and mean follow
up duration was 22 months. No significant differences were found with
respect to MACE (OR 0.92, 95% CI 0.58 to 1.46), all deaths (OR 1.06, 95%
CI 0.92 to 1.22) (Figure), CV deaths (OR 1.09, 95% CI 0.80 to 1.49), MI,
CVA, revascularization and AKI. Major bleeding was higher in the PCI group
(OR 1.34, 95% CI 1.14 to 1.58, p = 0.0004), however the difference was not
significant in the subanalysis of only randomized trials. Conclusion
Patients undergoing PCI with TAVI have comparable outcomes to those only
having TAVI, except for major bleeding which may be higher in the former
group. [Formula presented] Copyright © 2025 American College of
Cardiology Foundation

<215>
Accession Number
2037794642
Title
LEVOSIMENDAN VS. MILRINONE FOR PREVENTION OF LOW CARDIAC OUTPUT SYNDROME
IN PEDIATRIC PATIENTS POST CARDIAC SURGERY: A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 558), 2025. Date of Publication: 01 Apr 2025.
Author
Kumar A.A.; Wasir A.S.; Pillai A.A.; Srivastava D.; Khan F.I.; Henna F.
Institution
(Kumar, Wasir, Pillai, Srivastava, Khan, Henna) GMERS Medical College,
Vadnagar Mahesana, India
(Kumar, Wasir, Pillai, Srivastava, Khan, Henna) Bharati Vidyapeeth
University Medical College, Pune, India
Publisher
Elsevier Inc.
Abstract
Background Low cardiac output syndrome (LCOS) is a common and serious
postoperative complication in pediatric patients undergoing cardiac
surgery. LCOS significantly contributes to perioperative morbidity and
mortality. We analyzed the efficacy and outcomes of Levosimendan vs.
Milrinone in preventing LCOS in pediatric patients. Methods A systematic
literature search was performed on the major bibliographic databases to
identify studies that compared the efficacy and patient outcomes of
Levosimendan and Milrinone in the treatment of LCOS following pediatric
cardiac surgery. Data from eligible studies were pooled, and a
random-effects model was applied to generate summary of relative risk (RR)
and outcome measures with 95% confidence intervals (CI). P value <=0.05
was significant. Results The meta-analysis included 8 studies with 1,200
pediatric patients undergoing cardiac surgery- 600 patients receiving
levosimendon and 600 patients receiving milrinone. The incidence of LCOS
was significantly lower in the Levosimendan group (20%) as compared to the
Milrinone group (30%) (RR= 0.67, 95% CI: 0.54-0.83, p= 0.001). Key
hemodynamic parameters such as cardiac index, ejection fraction, and
stroke volume index showed no significant difference between the two
groups (p>0.05). Levosimendan was associated with a 10.4-hour reduction in
mechanical ventilation duration (p=0.003), 1.5-day reduction in intensive
care unit (ICU) stay (p=0.02), and 3-day shorter overall hospital stay
(p=0.01) when compared to the milrinone group. There was no statistically
significant difference of inotrope scores or new-onset renal complications
between the Levosimendan and Milrinone groups (p>0.05). Conclusion
Levosimendan demonstrated a statistically significant reduction in LCOS
incidence as compared to Milrinone in pediatric patients following cardiac
surgery. Levosimendan was also associated with shorter durations of
mechanical ventilation, ICU stay, and overall hospitalization. Further
randomized studies are warranted to confirm these findings. Copyright
© 2025 American College of Cardiology Foundation

<216>
Accession Number
2037797209
Title
SAFETY AND EFFECTIVENESS OF PROTAMINE SULFATE IN TAVR PROCEDURES - A
SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 887), 2025. Date of Publication: 01 Apr 2025.
Author
Mandava S.; Baral N.; Donatelle M.; Abraham B.; Vedantam K.; Beohar N.
Institution
(Mandava, Baral, Donatelle, Abraham, Vedantam, Beohar) Mount Sinai Medical
Center, Miami Beach, FL, United States
Publisher
Elsevier Inc.
Abstract
Background Protamine sulfate can be used after transcatheter aortic valve
replacement (TAVR) to reverse the anti-coagulation effects of heparin,
minimizing post-procedure bleeding risks. However, concerns about risks
such as valve thrombosis and stroke persist. Methods We searched
PubMed/MEDLINE and Embase for studies from 2000 to 2024, comparing
protamine sulfate for heparin reversal with usual care in patients after
TAVR. Meta-analyses were performed with Review Manager statistical
software. We used a random effects model to assess the pooled odds ratio
and 95% CI for major bleeding, 30-day mortality, stroke, and ischemic
events between the protamine sulfate and usual care groups. Results There
were 2,491 patients in the protamine sulfate group and 1,421 patients in
the standard care group. Our study showed that the use of protamine
sulfate for heparin reversal was not associated with an increased risk of
ischemic events (OR 0.81; 95% CI 0.40-1.65; P=0.56), 30-day mortality (OR
1.13; 95% CI 0.69-1.86; P=0.88) nor increased risk of stroke (OR 0.82; 95%
CI 0.50-1.35; P=0.43). Our meta-analysis showed a significant decrease in
major bleeding events (OR 0.46; 95% CI 0.30-0.71; P=0.0005). Conclusion
The use of protamine sulfate for heparin reversal in TAVR is associated
with a lower occurrence of bleeding events, while not increasing the risk
of ischemic events, 30-day mortality, or stroke. [Formula
presented] Copyright © 2025 American College of Cardiology
Foundation

<217>
Accession Number
2037796274
Title
NON-FASTING VERSUS FASTING STRATEGIES PRIOR TO ELECTIVE PERCUTANEOUS
CARDIAC PROCEDURES: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 1769), 2025. Date of Publication: 01 Apr 2025.
Author
Ibrahim S.; Mohammed Z.; Ozaeta J.C.; Berchie P.O.; Allihien S.-M.;
Arhinful B.; Kommuri A.; Kumi A.; Kanjo W.; Pimentel J.; Ottun A.-R.A.;
Dodoo S.
Institution
(Ibrahim, Mohammed, Ozaeta, Berchie, Allihien, Arhinful, Kommuri, Kumi,
Kanjo, Pimentel, Ottun, Dodoo) AU/UGA Piedmont Athens Regional Medical
Center, Athens, GA, United States
Publisher
Elsevier Inc.
Abstract
Background Pre-operative fasting is considered the standard of care for
patients undergoing cardiac procedures. The relative benefits and harms of
routine fasting prior to elective percutaneous cardiac procedures (EPCPs)
are unclear. We assess patient-centered and safety outcomes by comparing
non-fasting and fasting strategies in patients undergoing EPCPs. Methods
We conducted a systematic review and meta-analysis of randomized
controlled trials (RCTs) comparing non-fasting vs. fasting strategies
before elective percutaneous cardiac procedures. Databases searched
included Cochrane Central, PubMed, Embase, Web of Science, and
clinicalTrials.gov up to September 2024. Patient-centered outcomes were
satisfaction and well-being, while safety endpoints included aspiration
pneumonia, contrast-induced nephropathy (CIN), hypoglycemia,
nausea/vomiting, and a composite of these outcomes. A fixed-effects model
was used if heterogeneity (I2 >= 50%) was not significant; otherwise, a
random-effects model was applied. We calculated standardized mean
difference (SMD) and odds ratio (OR) with 95% confidence intervals (CI).
The protocol was registered on PROSPERO (CRD42024564523). Results Seven
RCTs with 2,752 patients (non-fasting: 1,358; fasting: 1,394; mean age
67+/-9 years, 72% male) were included. The nonfasting strategy
significantly improved patient satisfaction (SMD: 0.64 [95% CI, 0.04,
1.23]; p = 0.04; I2 = 97%) but showed no difference in well-being (SMD:
0.87 [95% CI, -0.30, 2.03]; p = 0.15; I2 = 97%). There were no significant
differences in aspiration pneumonia/pneumonitis (OR: 1.41; p = 0.65), CIN
(OR: 1.86; p = 0.09), hypoglycemia (OR: 0.75; p = 0.31), nausea/vomiting
(OR: 1.09; p = 0.73), or the composite safety outcome (OR: 1.09; p =
0.60), all with low heterogeneity (I2 = 0%). Conclusion In patients
undergoing elective percutaneous cardiac procedures, non-fasting was
associated with significantly higher patient satisfaction compared with a
fasting strategy without a corresponding increased risk of adverse events.
This highlights the potential advantages of reconsidering the current
fasting guidelines prior to elective percutaneous cardiac
procedures. Copyright © 2025 American College of Cardiology
Foundation

<218>
Accession Number
2037798755
Title
PROGNOSTIC VALUE OF PERIOPERATIVE NEUTROPHIL/LYMPHOCYTE RATIO IN
PREDICTING POST-OPERATIVE ATRIAL FIBRILLATION FOLLOWING CARDIAC SURGERY: A
COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS WITH DIAGNOSTIC TEST
ACCURACY.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 223), 2025. Date of Publication: 01 Apr 2025.
Author
Awad M.K.; Ali A.E.; Mazroua M.; Ali K.
Institution
(Awad, Ali, Mazroua, Ali) Faculty of Medicine, Ain Shams University,
Cairo, Egypt
(Awad, Ali, Mazroua, Ali) Internal Medicine Residency, Crestwood Medical
Center, HUNTSVILLE, AL, United States
Publisher
Elsevier Inc.
Abstract
Background Post-operative atrial fibrillation (POAF) is a common and
serious complication following cardiac surgery, resulting in increased
morbidity. Neutrophil/lymphocyte ratio (NLR), a simple and cost-effective
biomarker of systemic inflammation, has been investigated as a potential
predictor of POAF. Methods A comprehensive literature search identified
relevant studies on perioperative NLR and POAF. NLR values between POAF
and non-POAF patients were compared. The overall effect estimates were
presented as mean differences using random effect model. Results Among
1016 identified studies, 18 studies involving 8802 patients (2368 in POAF
and 6434 in non-POAF group) were included. POAF patients had significantly
higher pre-operative NLR (mean difference = 0.64, 95% CI [0.38 - 0.90], p
< 0.001) with significant heterogeneity (I2 = 94.52%).
Similarly, The POAF patients had a significantly elevated post-operative
NLR (mean difference = 1.2, 95% CI [0.07 - 2.33], p = 0.04). Pooled data
from five studies reporting the sensitivity and specificity, showed a
pre-operative NLR diagnostic odds ratio of 4.03 (95% CI, 2.54 - 6.39).
Conclusion Both pre-operative and post-operative NLR show prognostic value
and hence, could serve as useful biomarkers for identifying patients at
higher risk of POAF, thereby aiding in the stratification and management
of patients undergoing cardiac surgery. Larger multicenter studies are
warranted to explore the underlying mechanisms and validate these
findings. [Formula presented] Copyright © 2025 American College
of Cardiology Foundation

<219>
Accession Number
2037794031
Title
TOPICAL VERSUS INTRAVENOUS TRANEXAMIC ACID IN CARDIAC SURGERY: A
SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 554), 2025. Date of Publication: 01 Apr 2025.
Author
Awad A.K.; Rezq H.; Abdelgalil M.; Gowaily I.; Mohamed A.A.; Eltaly H.;
Elbenawi H.; Mohamed O.; Khan U.; Abuelazm M.
Institution
(Awad, Rezq, Abdelgalil, Gowaily, Mohamed, Eltaly, Elbenawi, Mohamed,
Khan, Abuelazm) University of Maryland School of Medicine, Baltimore, MD,
United States
Publisher
Elsevier Inc.
Abstract
Background Tranexamic Acid (TxA) is commonly used in cardiac surgeries to
reduce bleeding and minimize blood transfusion. We aim to assess the
efficacy of both topical versus intravenous (IV) TxA in cardiac surgery.
Methods A systematic review and meta-analysis synthesizing evidence from
randomized controlled trials (RCTs) obtained from PubMed, CENTRAL, Scopus,
and WOS until March 2024. We reported dichotomous outcomes using risk
ratio (RR) and continuous outcomes using standardized mean difference
(SMD) with a 95% confidence interval (CI). PROSPERO ID: CRD42024550916.
Results Six RCTs with 3,581 patients were included. Topical TxA
significantly reduced the postoperative seizures in the adult group (P =
0.02). In contrast there were no significant differences in postoperative
bleeding (P = 0.31), postoperative fresh frozen plasma (FFP) transfusion
(P = 0.26), postoperative intensive care unit (ICU) length of stay (P =
0.12), all-cause mortality (P = 0.7), postoperative cardiac tamponade (P =
0.64), postoperative reoperation and sternotomy (P= 0.49), post-operative
stroke or transient ischemic attack (TIA) (P = 0.06), any post-operative
thromboembolic event (P = 0.27), intraoperative cardiopulmonary bypass
time (CPBT) (P = 0.99), and intraoperative cross-clamp time (P = 0.95).
Conclusion Topical and IV TxA had similar findings in postoperative
outcomes after cardiac surgery, except for a decreased risk of seizures in
adult patients. [Formula presented] Copyright © 2025 American
College of Cardiology Foundation

<220>
Accession Number
2037795317
Title
REDO SURGICAL AORTIC VALVE REPLACEMENT (SAVR) VS. VALVE-IN-VALVE
TRANSCATHETER AORTIC VALVE IMPLANTATION (VIV-TAVI) FOR PATIENTS AS A
TREATMENT FOR DEGENERATIVE VALVES, A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 916), 2025. Date of Publication: 01 Apr 2025.
Author
Moradi A.; Ebrahimi P.; Taheri M.; Soleimani H.; Taheri H.; Sattartabar
B.; Taebi M.; Bhia I.; Mahalleh M.; Anafje M.; Tajdini M.; Elgendy I.;
Hosseini K.; Siegel R.J.
Institution
(Moradi, Ebrahimi, Taheri, Soleimani, Taheri, Sattartabar, Taebi, Bhia,
Mahalleh, Anafje, Tajdini, Elgendy, Hosseini, Siegel) Tehran Heart Center,
Tehran, Iran, Islamic Republic of
Publisher
Elsevier Inc.
Abstract
Background Bioprosthetic valve degeneration is relatively common after
almost 15 years of implantation. Although the surgical method is still the
first choice in managing this condition, the transcatheter approach,
namely the Valve-in-Vale (ViV-TAVR) procedure, has shown promising
outcomes. The present study aims to compare these two therapeutic methods
through a systematic review and meta-analysis of the propensity-matched
cohort studies. Methods The main electronic databases, Cochrane Central,
Scopus, and Medline (PubMed interface), Web of Science, were
systematically searched for literature from inception to July 2024. We
used relative risks (RR) for dichotomous outcomes and mean differences
(MD) for continuous outcomes. Results Thirteen propensity-scored match
studies (16,175 patients) were pooled with a mean follow-up of 16.6
months. The analysis revealed that the ViV-TAVR group showed a significant
reduction in 30-day mortality (RR: 0.44, 95% CI: 0.28-0.71, P < 0.001),
new-onset atrial fibrillation (RR: 0.25, 95% CI: 0.14-0.47, P < 0.01). The
hospital admission days were also considerably lower in ViV patients (RR:
-4.61, 95% CI: -5.54- -3.68). On the other hand, the evaluation of
paravalvular leak (PVL) showed the superiority of the Redo method (RR:
3.65, 95%CI: 1.10, 12.09). There were no significant differences between
either group according to the 1- and 2-year mortality, short-term stroke,
myocardial infarction (MI), and effective orifice area. Conclusion The
analysis of the ViV-TAVR cohort showed a significantly reduced risk of
short-term mortality, morbidity, and reduced length of hospital admission.
However, the long-term and echocardiographic outcomes raise questions
regarding ViV's superiority. Although a reliable comparison without
performing randomized controlled trials can be accompanied by significant
bias, the PSM studies showed that new-generation ViV methods can be
considered a considerable alternative for surgical
implantation. Copyright © 2025 American College of Cardiology
Foundation

<221>
Accession Number
2037797558
Title
SAFETY AND EFFICACY OF OUTPATIENT PARENTERAL ANTIBIOTIC THERAPY IN
PATIENTS WITH INFECTIVE ENDOCARDITIS: A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 2268), 2025. Date of Publication: 01 Apr 2025.
Author
Ashraf H.; Jain H.; Nadeem Z.A.; Amanullah K.; Rehman K.A.; Khan S.; Butt
M.; Khan M.S.; Ashfaq H.; Fatima E.; Ahmed R.
Institution
(Ashraf, Jain, Nadeem, Amanullah, Rehman, Khan, Butt, Khan, Ashfaq,
Fatima, Ahmed) Allama Iqbal Medical College, Lahore, Pakistan
(Ashraf, Jain, Nadeem, Amanullah, Rehman, Khan, Butt, Khan, Ashfaq,
Fatima, Ahmed) Franciscan Health Olympia Fields, Olympia Fields, IL,
United States
Publisher
Elsevier Inc.
Abstract
Background Outpatient Parenteral Antibiotic Therapy (OPAT) for infective
endocarditis (IE) can help reduce the hospital burden while enhancing the
patient experience. This study aims to evaluate the efficacy and safety of
OPAT in the treatment of IE. Methods An electronic search was conducted on
PubMed, Cochrane CENTRAL, Scopus and Google Scholar to find relevant
literature. Primary outcomes included mortality, relapse, readmission, and
cardiac surgery during the treatment and follow-up periods. The pooled
proportions with 95% confidence intervals (CIs) were calculated using a
random-effects model. A leave-one-out sensitivity analysis was performed
to assess individual study effects. Results A total of 25 studies
involving 2,654 patients were included in the analysis. Patients treated
with OPAT had a mortality rate of 0% during the treatment period and 5%
during follow-up. The readmission rate was 16% during the treatment
period, 4% of the patients had relapse, while 16% of patients underwent
cardiac surgery. During follow-up, the readmission rate was 19%, with a
relapse rate of 2%, and 14% of patients underwent cardiac surgery.
Sensitivity analyses did not significantly affect the results,
highlighting the robustness of the findings. Conclusion In conclusion,
adverse events and mortality rates in IE patients treated with OPAT are
low during both the treatment and follow-up periods, with manageable
readmission and relapse rates, indicating that OPAT is a safe and
effective treatment option. [Formula presented] Copyright © 2025
American College of Cardiology Foundation

<222>
Accession Number
2037798080
Title
IMPACT OF CAROTID ARTERY STENOSIS ON OUTCOMES AFTER TRANSCATHETER AORTIC
VALVE IMPLANTATION: AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 890), 2025. Date of Publication: 01 Apr 2025.
Author
Theodoropoulou T.; Vythoulkas-Biotis N.; Apostolos A.; Koliastasis L.;
Ktenopoulos N.; Tsalamandris S.; Latsios G.; Synetos A.G.; Drakopoulou
M.I.; Tsioufis K.; Toutouzas K.P.
Institution
(Theodoropoulou, Vythoulkas-Biotis, Apostolos, Koliastasis, Ktenopoulos,
Tsalamandris, Latsios, Synetos, Drakopoulou, Tsioufis, Toutouzas) First
Department of Cardiology, Athens School of Medicine, Hippokration
Hospital, Athens, Greece
Publisher
Elsevier Inc.
Abstract
Background There is an ongoing debate on whether carotid artery stenosis
(CAS) serves as a predictor of worse outcomes following transcatheter
aortic valve implantation (TAVI). This meta-analysis aims to assess the
impact of CAS on major clinical outcomes in this high-risk population.
Methods A comprehensive literature search of PubMed, Embase, and Cochrane
databases was conducted to identify relevant studies The primary endpoint
was the 30day incidence of Stroke or Transient Ischemic Attack (TIA) in
patients with CAS>= 50% and CAS>= 70%. Secondary endpoints included
in-hospital Stroke/TIA, 30day mortality, in-hospital mortality, bleeding,
myocardial infarction (MI), acute kidney injury (AKI), periprocedural
vascular complications, and permanent pacemaker implantation. Results A
total of 13 studies, involving 126,660 patients, were included in the
metanalysis. CAS was associated with higher rates of 30day Stroke/TIA: 1)
CAS>= 50% (RR: 1.42, 95% CI: 1.01, 2.01), 2) CAS>= 70% (RR: 1.61, 95% CI:
1.10, 2.36). CAS comorbidity was also linked to increased risk for
in-hospital stroke/TIA (RR: 1.81, 95% CI: 1.25, 2.60), 30day mortality
(RR: 1.29, 95% CI: 1.13, 1.47), and 30day bleeding events (RR: 1.15, 95%
CI: 1.08, 1.23). No differences were observed in the other secondary
endpoints. Conclusion CAS was associated with a higher 30-day all-cause
mortality, possibly driven by the higher incidence of Stroke/TIA and
bleeding events following TAVI. Further studies are required to validate
our results. [Formula presented] Copyright © 2025 American
College of Cardiology Foundation

<223>
Accession Number
2037798409
Title
RISK SCORE FOR FUTURE MYOCARDIAL INFARCTION AFTER AN ACUTE CORONARY
SYNDROME AND PHARMACOGENETIC RESPONSE TO DALCETRAPIB.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 1778), 2025. Date of Publication: 01 Apr 2025.
Author
Tardif J.C.; Pfeffer M.A.; Kouz S.; Koenig W.; Maggioni A.P.; McMurray
J.J.V.; Waters D.D.; Gregoire J.C.; L'Allier P.L.; Jukema J.W.; White
H.D.; Heinonen T.; Kallend D.; Laghrissi-Thode F.; Fortier A.; Guertin
M.-C.; Dube M.-P.
Institution
(Tardif, Pfeffer, Kouz, Koenig, Maggioni, McMurray, Waters, Gregoire,
L'Allier, Jukema, White, Heinonen, Kallend, Laghrissi-Thode, Fortier,
Guertin, Dube) Montreal Heart Institute, Montreal, Canada
(Tardif, Pfeffer, Kouz, Koenig, Maggioni, McMurray, Waters, Gregoire,
L'Allier, Jukema, White, Heinonen, Kallend, Laghrissi-Thode, Fortier,
Guertin, Dube) Universite de Montreal, Montreal, Canada
Publisher
Elsevier Inc.
Abstract
Background Acute coronary syndrome (ACS) survivors have heightened risk
for subsequent cardiovascular (CV) events, particularly myocardial
infarction (MI). Methods All baseline characteristics collected in both
the Dal-Outcomes and Dal-GenE trials, such as demographics, prior CV
history, medications, vital signs, and blood markers including lipids and
hs-CRP, were considered as potential risk markers. A risk score for
subsequent fatal and non-fatal MI following ACS was developed using Cox
proportional hazards modeling with backward variable selection on data
from Dal-Outcomes placebo patients (n=7086). Variables not reaching the
significance level of 0.15 were removed. This risk score was then applied
in Dal-GenE participants (n=5989) to determine whether the reduction in MI
observed with dalcetrapib (versus placebo) in patients with the AA
genotype at rs1967309 in the ADCY9 gene remained significant, independent
of the other markers integrated in the risk score. Results Of the 36
baseline variables considered as potential risk markers, 18 contributed to
the risk score with a C-statistic of 0.72 (95% CI, 0.69-0.75) in
Dal-Outcomes placebo patients. In these ACS survivors, prior history of
coronary events (CABG, PCI, ACS and MI) as well as higher LDL-C, blood
pressure, hemoglobin A1C and hs-CRP, current smoking and older age were
contributors. The risk score was strongly predictive when applied to the
5989 AA genotype patients from Dal-GenE, with an increased risk of MI of
1.92 (95%CI: 1.78-2.08) for one standard deviation increase of the score.
When assessing the effect of random assignment to treatment while
adjusting for the risk score, dalcetrapib (versus placebo) reduced the
risk of MI by 23% (HR:0.77, 95% CI, 0.63-0.94) in Dal-GenE. Conclusion
Despite the standard of care for ACS survivors, history of prior coronary
events as well as on-treatment values for blood pressure, LDL-C, A1C and
hs-CRP remain determinants of future MI. In the Dal-GenE AA genotype
patients, dalcetrapib significantly reduced the rate of future fatal and
non-fatal MI, independently of a risk score including those variables. The
ongoing Dal-GenE-2 trial is designed to confirm this pharmacogenetic
hypothesis. Copyright © 2025 American College of Cardiology
Foundation

<224>
Accession Number
2037796129
Title
THE PRE-PROCEDURE MONOCYTE TO HIGH-DENSITY LIPOPROTEIN RATIO AS A
PREDICTIVE BIOMARKER FOR POST-OPERATIVE ATRIAL FIBRILLATION: A
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 114), 2025. Date of Publication: 01 Apr 2025.
Author
Senapati S.G.; Kothawala A.; kotha P.; Tesoro N.A.; Jella H.K.; Kamma
R.B.; Prattipati P.S.S.; Rahman A.; Desai R.
Institution
(Senapati, Kothawala, kotha, Tesoro, Jella, Kamma, Prattipati, Rahman,
Desai) Texas Tech University Health Sciences Center, El Paso, TX, United
States
Publisher
Elsevier Inc.
Abstract
Background Post-operative atrial fibrillation (POAF) is a common
complication after cardiac surgery, linked to higher morbidity and
mortality. Identifying predictors of POAF is vital for risk stratification
and prevention. This meta-analysis evaluates the predictive value of the
pre-procedure monocyte to high-density lipoprotein (MHR) ratio for POAF
across various studies. Methods A systematic search identified studies
examining the association between MHR and POAF. Studies reporting odds
ratios (ORs) or hazard ratios (HRs) were included. We calculated pooled
ORs and 95% confidence intervals (CIs) using a random-effects model.
Heterogeneity was assessed with the I2 statistic, and publication bias was
evaluated through a funnel plot and LFK index. Results Seven studies with
2,330 participants were included. Of these, 68.51% (1,613) were male, with
an average age of 50-70 years. POAF occurred in 480 patients (20.60%). The
combined analysis showed a significant association between higher MHR and
increased POAF risk, with an OR of 4.62 (95% CI: 1.45-14.73, p < 0.001).
Subgroup analyses by study design, demographics, and methodology further
supported this positive relationship. Conclusion This meta-analysis
suggests that the pre-procedure MHR is a strong predictor of POAF in
cardiac surgery patients. Further studies are needed to confirm these
findings and assess the clinical utility of MHR in practice.4o [Formula
presented] Copyright © 2025 American College of Cardiology
Foundation

<225>
Accession Number
2037797447
Title
EFFICACY AND SAFETY OF PROTAMINE FOR HEPARIN REVERSAL IN PATIENTS
UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT: AN UPDATED
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: American
College of Cardiology, (ACC) Meeting 2025. Chicago United States. 85(12
Supplement) (pp 932), 2025. Date of Publication: 01 Apr 2025.
Author
Pervez N.; Rao A.G.; Shahid S.; Pervez R.
Institution
(Pervez, Rao, Shahid, Pervez) Dow University of Health Sciences, Karachi,
Pakistan
Publisher
Elsevier Inc.
Abstract
Background Transcatheter aortic valve replacement (TAVR) has advanced
significantly, yet bleeding complications remain a key concern. Due to
limited literature, we investigated protamine use for heparin reversal and
its outcome trends following TAVR. Methods A systematic review of major
databases assessed protamine use for heparin reversal in TAVR patients.
High-dose protamine and full antagonization were interventions, while
low-dose protamine, partial antagonization, and placebo served as
controls. Outcomes measures were summary random effects odds ratios (OR)
with 95% confidence intervals, and statistical significance was set at a
p-value of <0.05. Results Six studies with 3,912 patients (2,491 protamine
and 1,421 control) were analyzed. Post-intervention protamine
significantly reduced the incidence of life threatening-bleeding events
(OR: 0.37 [0.20, 0.67]; p=0.001) (A), major bleeding events (OR: 0.47
[0.30, 0.74]; p=0.001) (B), major vascular complications (OR: 0.45 [0.31,
0.65]; p<0.0001) (C), and the need for blood transfusions (OR: 0.67 [0.51,
0.88], p=0.04) (D). Moreover, no significant differences were observed in
the incidence of stroke, myocardial infarction, or 30-day mortality.
Conclusion The protamine cohort showed a notable reduction in
life-threatening bleeding, major bleeding, major vascular complications,
and blood transfusions relative to placebo, while other outcomes were
comparable. Larger studies are needed to confirm these results. [Formula
presented] Copyright © 2025 American College of Cardiology
Foundation

<226>
Accession Number
2033501313
Title
Oral vs. Outpatient Parenteral Antimicrobial Treatment for Infective
Endocarditis: Study Protocol for the Spanish OraPAT-IE GAMES Trial.
Source
Infectious Diseases and Therapy. (no pagination), 2025. Article Number:
100213. Date of Publication: 2025.
Author
Alonso-Socas M.M.; Lopez-Lirola A.; Goikoetxea-Agirre A.J.; Ribas M.A.;
Navarro D.; Sala C.; Ambrosioni J.; Olivares P.; Lopez-Cortes L.E.;
Morales I.; Mendez I.; de Cueto M.; Calvo-Jambrina R.; Barquero J.M.;
Araji O.; Almendro-Delia M.; Brase A.; Calvo-Fernandez A.; Tauron M.;
Recasens L.; Sorli L.; Suarez M.; Silverio A.; Sanchez F.; Ribas N.;
Serrat R.; Molina L.; Mestres A.; Mas A.; Ginel A.J.; Horcajada-Gallego
J.P.; Ble M.; Lopez-Montesinos I.; Salavert-Lleti M.; Garcia-Bustos V.;
Fernandez-Navarro J.A.; Calabuig-Munoz E.; Montero-Alonso M.;
Tasias-Pitarch M.; Domingo-Valero D.; Arnau-Vives M.A.; Blanes-Hernandez
R.; Vives-Borras M.; Vidal-Bonet L.; Ruiz de Gopegui-Bordes E.;
Ribas-Blanco M.A.; Zarauza J.; Teira R.; Ruiz-Alonso N.; Parra J.A.;
Pajaron M.; Gutierrez-Diez J.; Gutierrez-Cuadra M.; Gutierrez-Fernandez
L.; Gonzalez-Rico C.; Garrido R.; Garcia I.; Fernandez-Sampedro M.;
Farinas-Alvarez C.; Farinas M.C.; Cobo-Belaustegui M.; Arnaiz de las
Revillas F.; Arminanzas-Castillo C.; Amado-Fernandez C.; Aguero-Balbin J.;
Martin-Blanco N.; Oteo J.A.; Garcia-Alvarez L.; Corral-Armas E.; Blanco
J.R.; Azcona-Gutierrez J.M.; Azcarate P.; Alonso L.J.; Saura D.;
Roura-Piloto A.; Perez-Andreu J.; Ortin A.; Oliva M.J.; Moral-Escudero E.;
Martinez-Toldos M.C.; de Gea J.H.; de la Morena Valenzuela G.; Blazquez
A.; Hernandez-Torres A.; Vazquez E.G.; Canovas S.; Albert L.;
Rivera-Martinez M.A.; Lopez-Contreras J.; Leta-Petracca R.; Grillo S.;
Ginel-Iglesias A.; Barros-Membrilla A.; Camprecios M.; Gasch O.; Monsalvez
V.; Gomila A.; Calzado S.; Diaz E.; Lozano L.; Capilla S.; Guillamon L.;
Guillaumet E.; Castaldo F.; Araujo G.; Dietl B.; Ibars S.; Xercavins M.;
Boix-Palop L.; Badia C.; Rosillo S.; Romero M.; Rial-Baston V.; Ramirez
U.; Moreno M.; Loeches B.; Antorrena I.; Ruiz S.; Rodriguez-Roda-Stuart
J.; del Rio A.; Oliva E.; Navas E.; Martin-Davila P.; Moya J.L.; Hermida
J.M.; Centella T.; Sanchez-Rodriguez I.; Gracia-Sanchez L.; Blasco A.;
Sbraga F.; Ruiz-Majoral A.; Alegre O.; Sanchez-Salado J.C.; Berbel D.;
Ardanuy C.; Grau I.; Carratala J.; Escrihuela-Vidal F.;
Gonzalez-de-la-Aleja P.; Pinargote-Celorio H.; Reus S.; Plazas J.; Merino
E.; Llamas P.; Climent V.; Carrasco R.; Goyeneche M.; Bidegain M.; Sanchez
S.; Zabalo-Arrieta M.; Villanueva-Benito I.; Vicente-Anza D.;
Unamuno-Ugartemendia I.; Solla-Ruiz I.; Sebastian-Alda R.; Sanchez-Haza
E.; Saez-Berbejillo A.; Reviejo K.; Rengel-Jimenez A.;
Perez-Moreiras-Lopez J.I.; Kortajarena-Urkola X.; Iribarren J.A.;
Granda-Bauza A.; Goyeneche del Rio M.; Goenaga M.A.; Fuentes A.;
Eizaguirre-Yarza A.; Echeverria T.; del Bosque-Martin C.;
Bustinduy-Odriozola M.J.; Berritu-Boronat E.; Azkune-Galparsoro H.; Camino
X.; Alvarez-Rodriguez I.; Voces R.; Vitoria Y.; Rodriguez R.; Rodrigo D.;
Nieto J.; Montejo M.; Lopez-Soria L.; Irurzun-Zuazabal J.; Iruretagoyena
J.R.; Ibarrola-Hierro M.; Goikoetxea A.J.; Euba-Ugarte G.; Del Alamo
Martinez de Lagos M.; Guio-Carrion L.; Crespo A.; Campana-Lazaro M.; Boado
M.V.; Blanco R.; Blanco-Vidal M.J.; Bereciartua E.; de la Villa S.;
Verde-Moreno E.; Vazquez P.; Valerio M.; Segado A.; Sanchez-Perez E.;
Rodriguez-Abella H.; Rincon C.; Pinto A.; Pinilla B.; Pedraz A.; Olmedo
M.; Monzon D.; Munoz P.; Melero R.; Martinez-Selles M.; Marin M.; Machado
M.; Hualde A.M.; Kestler-Hernandez M.; Gonzalez-Ramallo V.;
Gonzalez-Moraga F.J.; Mansilla A.G.; Garcia-Leoni M.E.; Gargallo E.;
Fortuny-Ribas R.; Estevez A.; Delgado-Montero A.; Cuerpo-Caballero G.;
Calatayud J.; Bouza E.; Bermejo J.; Alvarez-Uria A.; Alonso J.C.; Adan I.;
Rodriguez-Moreno F.; Prada-Arrondo P.; Perez-Ramirez A.; Lorenzo de la
Pena L.; Lacalzada J.; Gonzalez Gonzalez J.; Garcia-Rosado D.;
Fernandez-Sarabia J.; Delgado-Melian T.; Castro B.; Alonso M.D.M.;
Poyato-Borrego M.; Sanchez-Dominguez E.; Ortiz-Carrellan A.; Marin G.;
Luque-Marquez R.; Lopez-Haldon J.; Lepe J.A.; Gutierrez-Carretero E.;
Navarro-Amuedo D.; de Alarcon A.; Vila J.; Tuset M.; Vidal B.; Urra X.;
Tolosana J.M.; Tellez A.; Soy D.; Sitges M.; Sanchis L.; Sandoval E.;
Rovira I.; Roque M.; Roca C.; Regueiro A.; Ramirez J.; Quintana E.; Pomar
J.L.; Perissinotti A.; Pericas J.M.; Pereda D.; Pare C.; Ortiz J.; Ninot
S.; Nicolas D.; Moreno A.; Miro J.M.; Marco F.; Lopez T.; Llopis-Perez J.;
Hernandez-Meneses M.; Garcia-Pares D.; Garcia de la Maria C.; Fuster D.;
Fita G.; Fernandez-Pittol M.; Espasa M.; Falces C.; de Diego O.; Cuervo
G.; Canas M.A.; Castella M.; Cartana R.; Brunet M.; Azqueta M.; Ascaso M.;
Alcocer J.; Almela M.; Andrea R.
Institution
(Cuervo, Hernandez-Meneses, Moreno, Sala, Ambrosioni, Miro) Infectious
Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona,
Villarroel 170, Barcelona, Spain
(Nicolas) Internal Medicine-Home Hospitalization Unit, Hospital
Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
(Vidal) Cardiology Department, Hospital Clinic-IDIBAPS, University of
Barcelona, Barcelona, Spain
(Fernandez-Pittol) Microbiology Department, Hospital Clinic-IDIBAPS,
University of Barcelona, Barcelona, Spain
(Cuervo, de Alarcon, Martin-Davila, Lopez-Montesinos, Lopez-Cortes,
Ambrosioni, Miro) CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
(de Alarcon, Luque-Marquez, Navarro) Clinical Unit of Infectious Diseases,
Microbiology and Parasitology (UCEIMP), Institute of Biomedicine of
Seville (IBiS), Virgen del Rocio University Hospital/CSIC/University of
Seville, Seville, Spain
(Alonso-Socas, Lopez-Lirola) Hospital Universitario de Canarias, Tenerife,
Spain
(Gonzalez-Ramallo) Hospital General Universitario Gregorio Maranon,
Madrid, Spain
(Goikoetxea-Agirre) Hospital Universitario de Cruces, Bilbao, Spain
(Goenaga) Hospital Universitario Donosti, Instituto Investigacion
Biogipuzkoa, San Sebastian, Spain
(Merino) Unit of Infectious Diseases, Alicante General University Hospital
- Alicante Institute of Health and Biomedical Research (ISABIAL),
Alicante, Spain
(Merino) Clinical Medicine Department, Miguel Hernandez University, Elche,
Spain
(Escrihuela-Vidal) Hospital Universitario de Bellvitge, Barcelona, Spain
(Martin-Davila) Hospital Universitario Ramon y Cajal, Instituto Ramon y
Cajal de Investigacion Sanitaria (IRYCIS), Madrid, Spain
(Loeches) Hospital Universitario La Paz, Madrid, Spain
(Boix-Palop) Hospital Mutua de Terrassa, Terrassa, Spain
(Gasch) Servei de Malalties Infeccioses, Hospital Universitari Parc Tauli,
Institut d'Investigacio i Innovacio Parc Tauli (I3PT-CERCA), Universitat
Autonoma de Barcelona, Sabadell, Spain
(Camprecios) Hospital de la Santa Creu y Sant Pau, Barcelona, Spain
(Hernandez-Torres) Hospital Virgen de la Arrixaca, Murcia, Spain
(Garcia-Alvarez) Hospital San Pedro-CIBIR, Logrono, Spain
(Pajaron) Hospital Marques de Valdecilla, Santander, Spain
(Ribas) Hospital Son Espases, Palma, Spain
(Blanes-Hernandez) Hospital de La Fe, Valencia, Spain
(Lopez-Montesinos) Hospital del Mar, Barcelona, Spain
(Lopez-Cortes) Unidad Clinica de Enfermedades Infecciosas y Microbiologia,
Hospital Universitario Virgen Macarena, Seville, Spain
(Lopez-Cortes) Departamentos de Medicina y Microbiologia, Facultad de
Medicina, Universidad de Sevilla, Seville, Spain
(Lopez-Cortes) Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Seville,
Spain
Publisher
Adis
Abstract
Introduction: The POET trial demonstrated that moving from intravenous to
oral antibiotics in stable patients with left-sided infective endocarditis
(IE) was noninferior to fully parenteral treatment. However, it did not
compare outpatient strategies. Method(s): The OraPAT-IE GAMES trial
is a noninferiority, multicenter, randomized, open-label study aimed to
compare partial oral versus outpatient parenteral antibiotic therapy
(OPAT) for consolidation of antibiotic treatment in left-sided IE. A total
of 342 stable patients with IE caused by selected micro-organisms will
eventually be included. After a minimum of 10 days of parenteral
treatment, stable patients are randomized to oral therapy or OPAT. The
primary end-point is a composite of all-cause mortality, unplanned cardiac
surgery, relapse of positive blood cultures and/or unplanned hospital
admission. Patients are followed-up for 6 months after completing
antibiotic therapy. Planned Outcome: This trial seeks to demonstrate the
equivalent efficacy of the two outpatient strategies currently available
for stable patients with IE in the consolidation phase of antibiotic
treatment. Conclusion(s): In a global context of limited healthcare
resources and a sustained increase in elderly and frail patients, it is of
great importance to demonstrate the effectiveness and safety of outpatient
management strategies that could reduce the duration of conventional
hospitalizations with their potential complications and inherent costs.
Trial Registration: EudraCT: 2020-001024-34. ClinicalTrials.gov
identifier: NCT05398679. Copyright © The Author(s) 2025.

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