EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2033503656
Title
A randomised trial comparing usual versus strict home blood pressure
control in elderly patients with hypertension: protocol and initial
progress.
Source
Blood Pressure. 34(1) (no pagination), 2025. Article Number: 2472192. Date
of Publication: 2025.
Author
Zhang D.-Y.; Zhang Y.-Q.; An D.-W.; Cheng Y.-B.; Tang S.-T.; Liu M.; Li
J.; Staessen J.A.; Wang J.-G.; Li Y.
Institution
(Zhang, Zhang, An, Cheng, Staessen, Wang, Li) Department of Cardiovascular
Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of
Hypertension, National Research Centre for Translational Medicine, State
Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong
University School of Medicine, Shanghai, China
(Tang) Liaobu Community Health Center, Guangdong Province, Dongguan City,
China
(Liu) Henan Province People's Hospital, Henan, Zhengzhou, China
(Li) Department of Epidemiology, Tongji University School of Medicine,
Shanghai, China
(Staessen) Non-Profit Research Association Alliance for the Promotion of
Preventive Medicine, Mechelen, Belgium
(Staessen) Biomedical Research Group, Faculty of Medicine, University of
Leuven, Leuven, Belgium
Publisher
Taylor and Francis Ltd.
Abstract
Objective: The optimal level of home blood pressure (HBP) for the
prevention of cardiovascular complications is unknown. The Home Blood
Pressure Intervention in the Community Trial (HomeBP, [NCT05858944]) is
addressing this issue by randomising elderly hypertensive patients to
standard or tight HBP control. Methods and analysis: HomeBP is an
investigator-initiated randomised clinical trial with open design and
blinded endpoint evaluation. Eligible patients of either sex, aged 60-80
years, having uncontrolled home hypertension (>=135/85 mm Hg) after
medication for at least 2 weeks will be recruited nationwide in China at
up to 200 community healthcare centres. After stratification for centre
and the presence of office hypertension (>=140/90 mm Hg), 10,000 patients
will be randomised in a 1:1 proportion to a target HBP of 125-134/75-84 mm
Hg or <125/75 mm Hg and followed up for 4 years. The primary outcome is a
composite of cardiovascular death, non-fatal myocardial infarction,
coronary revascularisation, unstable angina pectoris or heart failure
requiring hospitalisation, and non-fatal stroke. Follow-up visits are
scheduled monthly for 3 months after randomisation and 3-monthly
thereafter. Patients record HBP for 7 consecutive days before every visit.
A unique feature of the trial is the information technology setup,
allowing the secure and instantaneous flow of HBP and other data to the
study coordinating centre, where a standardised HBP report is generated.
Hypertension specialists at Ruijin Hospital, Shanghai and at local
tertiary hospitals provide treatment recommendations, which are
transmitted to the caregivers at the community centres, who then fine-tune
the treatment recommendations in a shared decision process with the
patients to meet the values and clinical needs of the patients. Currently,
2281 patients have been randomised with no between-group differences in
the baseline characteristics. Trial registration number. URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT05858944.<br/>Copyright &#xa9; 2025 The Author(s). Published by Informa
UK Limited, trading as Taylor & Francis Group.

<2>
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. 33(1) (pp 62-72), 2025. Date of
Publication: 01 Jan 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. <br/>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.
<br/>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.
<br/>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.<br/>Copyright &#xa9; The
Author(s) 2025.

<3>
Accession Number
2032808555
Title
Intensive blood pressure lowering in acute stroke with intracranial
stenosis post-thrombectomy: A secondary analysis of the OPTIMAL-BP trial.
Source
International Journal of Stroke. 20(3) (pp 328-337), 2025. Date of
Publication: 01 Mar 2025.
Author
Kim K.H.; Yun J.; Jung J.W.; Kim Y.D.; Heo J.; Lee H.; Choi J.K.; Lee
I.H.; Lim I.H.; Hong S.-H.; Baik M.; Kim B.M.; Kim D.J.; Shin N.-Y.; Cho
B.-H.; Ahn S.H.; Park H.; Sohn S.-I.; Hong J.-H.; Song T.-J.; Chang Y.;
Kim G.S.; Seo K.-D.; Lee K.; Chang J.Y.; Seo J.H.; Lee S.; Baek J.-H.; Cho
H.-J.; Shin D.H.; Kim J.; Yoo J.; Lee K.-Y.; Jung Y.H.; Hwang Y.-H.; Kim
C.K.; Kim J.G.; Lee C.J.; Park S.; Lee H.S.; Kwon S.U.; Bang O.Y.; Heo
J.H.; Nam H.S.
Institution
(Kim, Yun, Jung, Kim, Heo, Lee, Choi, Lee, Lim, Hong, Baik, Heo, Nam)
Department of Neurology, College of Medicine, Yonsei University, Seoul,
South Korea
(Kim, Kim, Shin) Department of Radiology, College of Medicine, Yonsei
University, Seoul, South Korea
(Cho) Department of Neurology, Korea University Anam Hospital, College of
Medicine, Seoul, South Korea
(Ahn) Department of Neurology, School of Medicine, Chosun University,
Gwangju, South Korea
(Park, Sohn, Hong) Department of Neurology, Brain Research Institute,
School of Medicine, Keimyung University, Daegu, South Korea
(Song) Department of Neurology, Ewha Womans University Seoul Hospital,
College of Medicine, Seoul, South Korea
(Chang) Department of Neurology, Ewha Womans University Mokdong Hospital,
College of Medicine, Seoul, South Korea
(Kim, Seo, Lee) Department of Neurology, National Health Insurance Service
Ilsan Hospital, Goyang, South Korea
(Chang, Kwon) Department of Neurology, Asan Medical Center, College of
Medicine, University of Ulsan, Seoul, South Korea
(Seo) Department of Neurology, Dong-A University Hospital, Busan, South
Korea
(Lee) Department of Neurology, Busan Paik Hospital, College of medicine,
Inje University, Busan, South Korea
(Baek) Department of Neurology, Kangbuk Samsung Hospital, School of
Medicine, Sungkyunkwan University, Seoul, South Korea
(Cho) Department of Neurology, School of Medicine, Pusan National
University, Busan, South Korea
(Shin) Department of Neurology, Gachon University Gil Medical Center,
Incheon, South Korea
(Kim, Yoo) Department of Neurology, Yongin Severance Hospital, College of
Medicine, Yonsei University, Yongin, South Korea
(Lee, Jung) Department of Neurology, Gangnam Severance Hospital, College
of Medicine, Yonsei University, Seoul, South Korea
(Hwang) Department of Neurology, Kyungpook National University Hospital,
School of Medicine, Daegu, South Korea
(Kim) Department of Neurology, Korea University Guro Hospital, College of
Medicine, Seoul, South Korea
(Kim) Department of Neurology, Daejeon Eulji Medical Center, School of
Medicine, Eulji University, Daejeon, South Korea
(Lee, Park) Division of Cardiology, Department of Internal Medicine,
Severance Hospital, College of Medicine, Yonsei University, Seoul, South
Korea
(Park) Integrative Research Center for Cerebrovascular and Cardiovascular
Diseases, College of Medicine, Yonsei University, Seoul, South Korea
(Lee) Biostatistics Collaboration Unit, Department of Research Affairs,
College of Medicine, Yonsei University, Seoul, South Korea
(Bang) Department of Neurology, Samsung Medical Center, School of
Medicine, Sungkyunkwan University, Seoul, South Korea
Publisher
SAGE Publications Inc.
Abstract
Background: Intensive blood pressure (BP) management within 24 h after
successful reperfusion following endovascular thrombectomy (EVT) is
associated with worse functional outcomes than conventional BP management
in Asian randomized controlled trials. Given the high prevalence of
intracranial atherosclerotic stenosis (ICAS) in Asia, ICAS may influence
these outcomes. <br/>Aim(s): We aimed to assess whether ICAS affects the
outcomes of intensive BP management after successful EVT. <br/>Method(s):
We conducted a secondary analysis of the Outcome in Patients Treated With
Intra-Arterial Thrombectomy-Optimal Blood Pressure Control trial, which
enrolled participants from June 2020 to November 2022. Patients with
anterior circulation large vessel occlusion (LVO) were stratified into
ICAS-related and embolic LVO groups. Clinical outcomes for intensive
(target systolic BP < 140 mm Hg) and conventional BP management (target
systolic BP = 140-180 mm Hg) were analyzed in each group. The primary
outcome was a favorable outcome, defined as a modified Rankin Scale score
of 0 to 2 at 3 months. Safety outcomes included symptomatic intracerebral
hemorrhage within 36 h and stroke-related death within 3 months.
<br/>Result(s): Among 192 patients, 59 were in the ICAS-related LVO group,
and 133 were in the embolic LVO group. In the ICAS-related LVO group, the
rate of achieving a favorable outcome at 3 months was 37.5% with intensive
BP management and 55.6% with conventional management (adjusted odds ratio
(OR) = 0.49 (95% confidence interval (CI) = 0.14 to 1.75); P = 0.27). In
the embolic LVO group, these rates were 29.9% and 42.4%, respectively
(adjusted OR = 0.64 (95% CI = 0.28 to 1.45); P = 0.29). No significant
interaction was found (P for interaction = 0.68). In addition, the
ICAS-related LVO group receiving intensive BP management had lower rates
of successful reperfusion at 24 h compared to conventional management
(67.7% vs. 91.7%; P = 0.03), while no significant difference was found in
the embolic LVO group. A significant interaction effect on successful
reperfusion at 24 h was observed between ICAS-related and embolic LVO
groups (P for interaction = 0.04). No significant differences in safety
outcomes were observed between intensive BP management and conventional
management within both ICAS-related LVO and embolic LVO groups.
<br/>Conclusion(s): ICAS did not significantly affect outcomes of
intensive BP management within 24 h after successful EVT. After successful
reperfusion by EVT, intensive BP management should be avoided regardless
of ICAS presence. Data access statement: The data that support the
findings of this study are available from the corresponding author upon
reasonable request.<br/>Copyright &#xa9; 2025 World Stroke Organization.

<4>
Accession Number
2034025714
Title
Effect of Combined Vitamin C and Thiamine Therapy on Myocardial and
Inflammatory Markers in Cardiac Surgery: A Randomized Controlled Clinical
Trial.
Source
Nutrients. 17(6) (no pagination), 2025. Article Number: 1006. Date of
Publication: 01 Mar 2025.
Author
Saetang M.; Wasinwong W.; Oofuvong M.; Tanasansutthiporn J.;
Rattanapittayaporn L.; Petsakul S.; Duangpakdee P.; Rodneam P.; Boonthum
P.; Khunakanan S.; Churuangsuk C.; Sriwimol W.; Chantarokon A.; Nuanjun
K.; Yongsata D.
Institution
(Saetang, Wasinwong, Oofuvong, Tanasansutthiporn, Rattanapittayaporn,
Petsakul, Chantarokon, Nuanjun, Yongsata) Department of Anesthesiology,
Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
(Duangpakdee, Rodneam, Boonthum, Khunakanan) Department of Surgery,
Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
(Churuangsuk) Department of Internal Medicine, Faculty of Medicine, Prince
of Songkla University, Songkhla, Thailand
(Sriwimol) Department of Pathology, Faculty of Medicine, Prince of Songkla
University, Songkhla, Thailand
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Oxidative stress and systemic inflammation during cardiac
surgery can lead to postoperative complications. Although vitamin C and
thiamine (vitamin B1) have individually demonstrated protective effects,
their combined effects remain underexplored. This study aimed to evaluate
the efficacy of combined vitamin C and B1 therapy versus that of vitamin C
alone in reducing inflammatory and cardiac biomarkers and improving
postoperative outcomes in patients undergoing cardiac surgery.
<br/>Method(s): In this prospective, double-blind, randomized controlled
trial, 64 patients scheduled for elective cardiac surgery at a tertiary
care center were randomized to receive either 1000 mg vitamin C or a
combination of 1000 mg vitamin C and 100 mg vitamin B1 at four
perioperative time points. Primary outcomes included changes in
inflammatory biomarkers [C-reactive protein, interleukin-6 (IL-6), and
white blood cells], and cardiac biomarkers [creatine kinase-MB,
Troponin-I, and lactate dehydrogenase]. Secondary outcomes included
hemodynamic parameters and left ventricular function. <br/>Result(s):
Compared with vitamin C alone, combined vitamin B1 and vitamin C
significantly reduced postoperative cardiac biomarker levels. IL-6 levels
were significantly lower immediately in the combined group; however, this
effect was not sustained at 24 h post-surgery. Up to 24 h after surgery,
no significant differences in hemodynamic stability or left ventricular
ejection were observed between the groups. Notably, the combined therapy
group demonstrated a lower incidence of postoperative arrhythmias and
shorter dobutamine duration within 24 postoperatively. <br/>Conclusion(s):
Combined vitamin C and B1 therapy significantly reduced markers of
myocardial injury and early inflammatory responses (IL-6) in patients
undergoing cardiac surgery, suggesting its potential as a protective
agent.<br/>Copyright &#xa9; 2025 by the authors.

<5>
Accession Number
2033482784
Title
Traumatic chylothorax management post-coronary artery bypass grafting - A
systematic review.
Source
Asian Cardiovascular and Thoracic Annals. 33(1) (pp 73-86), 2025. Date of
Publication: 01 Jan 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.
<br/>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.
<br/>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. <br/>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.<br/>Copyright &#xa9; The
Author(s) 2025.

<6>
Accession Number
2033546606
Title
Impact of lesion preparation and stent optimisation on lesion-oriented
events in PCI with drug-eluting stents: 5-year results from the AIDA
trial.
Source
Netherlands Heart Journal. 33(4) (pp 130-137), 2025. Date of Publication:
01 Apr 2025.
Author
Renkens M.P.L.; Grundeken M.J.D.; Kerkmeijer L.S.M.; Kraak R.P.; Kalkman
D.N.; van der Schaaf R.J.; Hofma S.H.; Arkenbout K.E.K.; Weevers A.P.J.D.;
Koch K.T.; Onuma Y.; Serruys P.W.; Tijssen J.G.P.; de Winter R.J.;
Wykrzykowska J.J.; Tijssen R.Y.G.
Institution
(Renkens, Grundeken, Kalkman, Koch, Tijssen, de Winter) Department of
Clinical and Experimental Cardiology, Heart Centre, Amsterdam UMC,
University of Amsterdam, Amsterdam, Netherlands
(Kerkmeijer) Department of Cardiology, Isala Heart Centre, Zwolle,
Netherlands
(Kraak, van der Schaaf) Department of Cardiology, Onze Lieve Vrouwe
Gasthuis, Amsterdam, Netherlands
(Hofma) Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden,
Netherlands
(Arkenbout) Department of Cardiology, Tergooi Hospital, Blaricum,
Netherlands
(Weevers) Department of Cardiology, Albert Schweitzer Hospital, Dordrecht,
Netherlands
(Onuma) Department of Cardiology, University of Galway, Galway, Ireland
(Onuma, Serruys) CORRIB Research Centre for Advanced Imaging and Core
Laboratory, University of Galway, Galway, Ireland
(Wykrzykowska) Department of Cardiology, Thorax Centre, University Medical
Centre Groningen, Groningen, Netherlands
(Tijssen) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
Publisher
Bohn Stafleu van Loghum
Abstract
Background: Meticulous implantation strategies (i.e. lesion predilatation,
stent sizing and postdilatation) are known to decrease lesion-oriented
adverse events (LOCE) following percutaneous coronary intervention (PCI)
with bioresorbable scaffolds. Their impact on PCI with drug-eluting stents
remains unclear. <br/>Objective(s): To assess the impact of meticulous
implantation strategies on long-term LOCE in PCI with everolimus-eluting
stents (EES). <br/>Method(s): This substudy of the AIDA trial
(NCT01858077) focused on the evaluation of predilatation, stent sizing and
postdilatation through analyses of vessel and device diameters at various
locations around the lesion. Their interrelations were assessed using
quantitative coronary angiography across various lesion locations.
Logistic regression was used to evaluate how predictors influenced the
primary outcome LOCE, which includes target lesion revascularisation
(TLR), target-vessel myocardial infarction (TV-MI) and definite stent
thrombosis (ST). <br/>Result(s): LOCE occurred in 84 (7.7%) of 1098
lesions, mainly driven by TLR (63, 5.7%) and TV-MI (46, 4.2%), with ST
occurring in 9 (0.8%) lesions. Predilatation and postdilatation were
performed in 92 and 49% of lesions, respectively. The difference between
the diameter of the predilatation balloon and the reference vessel
diameter was significantly associated with an increased risk for LOCE
(odds ratio 4.84, 95% confidence interval: 1.91-12.7) with significant
interaction with diabetes (p for interaction= 0.04), thus disfavouring
predilatation with oversized balloons. <br/>Conclusion(s): The low LOCE
rate (7.7%) over 5 years underscores the efficacy of PCI with EES. The use
of 'oversized' balloons for predilatation was associated with an increased
risk of LOCE by up to fivefold, a risk that was interestingly reduced in
patients with diabetes mellitus.<br/>Copyright &#xa9; The Author(s) 2025.

<7>
Accession Number
2034049206
Title
Anticoagulation quality through time in therapeutic range in Sub-Saharan
Africa: a systematic review and meta-analysis.
Source
Frontiers in Medicine. 12 (no pagination), 2025. Article Number: 1517162.
Date of Publication: 2025.
Author
Demsie D.G.; Addisu Z.D.; Tafere C.; Feyisa K.; Bahiru B.; Yismaw M.B.;
Mihret G.; Tilahun A.; Gebrie D.; Berhe D.F.
Institution
(Demsie, Addisu, Tafere, Feyisa, Bahiru, Yismaw) Department of Pharmacy,
College of Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
(Mihret) Department of Neurology, St. Peter Hospital, Addis Ababa,
Ethiopia
(Tilahun) Department of Anesthesia, College of Medicine and Health
Sciences, Adigrat University, Adigrat, Ethiopia
(Gebrie) Department of Pharmacy, College of Medicine and Health Sciences,
Woldia University, Woldia, Ethiopia
(Berhe) Department of Pharmacology, Biomedical Division, and Center for
Equity in Global Surgery, University of Global Health Equity, Kigali,
Rwanda
Publisher
Frontiers Media SA
Abstract
Background: The quality of anticoagulation with warfarin is often assessed
through the time in therapeutic range (TTR). However, achieving optimal
TTR and maintaining therapeutic INR levels presents significant challenges
in Sub-Saharan Africa. This review aims to summarize the existing evidence
on the quality of warfarin anticoagulation among patients in Sub-Saharan
Africa. <br/>Method(s): We searched MEDLINE via Ovid, PubMed, Embase via
Ovid, and Scopus, and citation analysis from Google Scholar. The review's
primary focus was therapeutic INR and TTR>=65. Meta-analysis was conducted
using R version 4.3.3. A mixed-effects meta-regression model was used to
examine the influence of moderators, with heterogeneity estimated using
I² and prediction intervals (PI), and publication bias assessed
through funnel plots and Egger's test, with p<0.05 indicating potential
bias. The robustness of pooled proportions was tested using a
leave-one-out sensitivity analysis. The preparation of this review adhered
to the guidelines outlined in the PRISMA. <br/>Result(s): We identified 15
observational studies for inclusion in this systematic review and
meta-analysis. Egger's test confirmed an absence of publication bias
across these studies. Sensitivity analyses showed consistency in
individual therapeutic INR (pooled estimate: 0.37; range: 0.37-0.40) and
TTR (pooled estimate: 0.16; range: 0.15-0.17), closely aligning with
pooled proportions. Meta-analysis of high-quality TTR measurements yielded
a pooled prevalence of 17% (I²=89%), with study-specific values
ranging from 10 to 29% and predicted effect sizes between 0.05 and 0.34.
The therapeutic INR was observed at a pooled prevalence of 40%
(I²=86%; prediction interval: 0.16, 0.67). <br/>Conclusion(s):
Warfarin therapy is associated with very low percentage of TTR suggests
poor quality of anticoagulation management. Sensitivity analyses confirmed
the robustness of these findings.<br/>Copyright &#xa9; 2025 Demsie,
Addisu, Tafere, Feyisa, Bahiru, Yismaw, Mihret, Tilahun, Gebrie and Berhe.

<8>
Accession Number
2038049818
Title
Sex Differences in Acute Coronary Syndromes: A Scoping Review Across the
Care Continuum.
Source
Global Heart. 20(1) (no pagination), 2025. Article Number: 26. Date of
Publication: 2025.
Author
Marza-Florensa A.; Kiss P.; Youssef D.M.; Jalali-Farahani S.; Lanas F.; Di
Cesare M.; Juanatey J.R.G.; Taylor S.; Uijl A.; Grobbee D.E.; Rosiers
S.D.; Perel P.; Peters S.A.E.
Institution
(Marza-Florensa, Kiss, Youssef, Uijl, Grobbee, Peters) Global Public
Health and Bioethics, Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht,
Netherlands
(Jalali-Farahani, Di Cesare) Institute of Public Health & Wellbeing,
University of Essex, United Kingdom
(Lanas) Universidad de La Frontera, Chile
(Juanatey) University Hospital, Santiago de Compostela, Spain
(Taylor, Perel) World Heart Federation, Geneva, Switzerland
(Uijl) Department of Cardiology, Amsterdam University Medical Centers,
Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam,
Netherlands
(Uijl) Division of Cardiology, Department of Medicine, Karolinska
Institutet, Stockholm, Sweden
(Rosiers) The Novartis Foundation, Basel, Switzerland
(Perel) Department of Non Communicable Disease Epidemiology, London School
of Hygiene & Tropical Medicine, United Kingdom
(Peters) The George Institute for Global Health, School of Public Health,
Imperial College London, London, United Kingdom
(Peters) The George Institute for Global Health, University of New South
Wales, Sydney, NSW, Australia
Publisher
Ubiquity Press
Abstract
Introduction: Optimal diagnosis and management of acute coronary syndrome
(ACS) is essential to improve clinical outcomes and prognosis. Sex
disparities in ACS care have been reported in the literature, but evidence
gaps remain. This review aims to map and to summarize the global evidence
on sex differences in the provision of care across the ACS continuum.
<br/>Method(s): A systematic literature search was conducted in Pubmed,
EMBASE, and the World Health Organization Global Index Medicus. The search
was restricted to original research articles published between January 1,
2013, and August 30^th, 2023, and with a full-text available in
English, Spanish, Dutch, or French. The search terms and key words covered
five aspects of the ACS care continuum: pre-hospital care, diagnosis,
treatment, in-hospital events, and discharge. <br/>Result(s): Of the
15,033 identified articles, 446 articles (median percentage of women per
study: 29%), reporting on 1,483 outcomes, were included. Most studies were
conducted in high-income regions (65%). Studies reported on pre-hospital
care (8%), diagnosis (9%), treatment (45%), discharge (14%) and events
(24%). For 45% of outcomes, results favored men, 5% favored women, and 50%
showed mixed results or no sex difference. ACS care aspects with the
largest sex differences were pre-hospital care (58% of the outcomes
favored men vs 7% favored women) and diagnosis (70% favored men vs 2%
favored women). <br/>Conclusion(s): Studies on sex differences in ACS
mainly come from high-income regions. Sex differences in ACS management
are widely reported and mainly unfavorable to women, especially in the
early phases of pre-hospital care and diagnosis.<br/>Copyright &#xa9; 2025
The Author(s).

<9>
Accession Number
2033112338
Title
The role of amino acids and protein administration in preventing cardiac
surgery-associated acute kidney injury.
Source
Future Cardiology. 21(3) (pp 191-202), 2025. Date of Publication: 2025.
Author
Bottussi A.; D'Andria Ursoleo J.; Agosta V.T.; De Luca M.; Monaco F.
Institution
(Bottussi, D'Andria Ursoleo, Agosta, De Luca) Department of Anesthesia and
Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
Publisher
Taylor and Francis Ltd.
Abstract
Acute kidney injury (AKI) persists as one of the most common complications
after cardiac surgery. Beyond being burdened by high morbidity and
mortality rates, effective therapeutic options are still lacking. To date,
the management of cardiac surgery-associated AKI (CSA-AKI) mainly focuses
on preventive strategies, e.g. the implementation of standardized care
bundles. Interestingly, recent experimental studies have suggested a
potential nephroprotective role for both amino acids (AA) and proteins. As
such, these compounds show multiple beneficial renal effects, spanning
enhancement of renal blood flow, improved oxygenation, and recruitment of
renal functional reserve. Moreover, clinical studies have investigated the
therapeutic potential of single AA, AA combinations, and proteins. A
recent large multicenter randomized controlled trial showed reduced AKI
incidence in cardiac surgery patients receiving intravenous AA
supplementation. However, these interventions have not yet demonstrated
beneficial effects on major clinical outcomes, such as survival. Given the
well-established AA safety profile and the underlying biological rationale
supporting their use, this review summarizes the existing literature on
the effects of various formulations and combinations of perioperative AA
and protein on renal outcomes when administered in cardiac surgery
patients.<br/>Copyright &#xa9; 2025 Informa UK Limited, trading as Taylor
& Francis Group.

<10>
Accession Number
2038136658
Title
Esketamine mitigates systemic inflammation via modulating phenotypic
transformation of monocytes in patients undergoing thoracic surgery.
Source
Life Sciences. 371 (no pagination), 2025. Article Number: 123594. Date of
Publication: 15 Jun 2025.
Author
Shen W.; Yan Y.; Zhang W.; Xu J.; Li Z.; Yang L.
Institution
(Shen, Yan, Xu, Li, Yang) Department of Anesthesiology, Second Xiangya
Hospital, Central South University, Hunan Province, Changsha, China
(Shen, Yan, Xu, Li, Yang) Hunan Anesthesia Clinical Medical Care
Technology Research Center, Hunan Province, Changsha, China
(Zhang) Department of Laboratory, Second Xiangya Hospital, Central South
University, Hunan Province, Changsha, China
(Yan) Department of Anesthesiology, Xiamen Cardiovascular Hospital, Xiamen
University, China
Publisher
Elsevier Inc.
Abstract
Aim: To assess esketamine's anti-inflammatory effects during thoracic
surgery and its modulation of immune responses. <br/>Material(s) and
Method(s): In a randomized trial, 64 of 73 patients undergoing thoracic
surgery were allocated into the Control (not receiving esketamine) or the
ES-KTM group (intraoperative esketamine infusion). Blood routine tests
were conducted one day before (T0) and one day after the surgery (T3).
Plasma levels of tumor necrosis factor-alpha (TNF-alpha) and
interleukine-10 (IL-10) were analyzed by ELISA, and cell surface markers
including CD14, CD16, CD163, CD40, CX3CR1, CD206 were tested by cytometry
at the entry to the surgical room (T1) and the skin closure (T2). For the
in vitro study, esketamine at 10 muM was employed to treat the
lipopolysaccharide (LPS) stimulated macrophage cell line-Raw264.7, and its
effects were tested by cytometry and RNA sequencing analysis. <br/>Key
Findings: Esketamine application reduces the count of neutrophils and
monocytes, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte
ratio (PLR) and systemic inflammatory index (SII), and enhances the
lymphocyte counting and lymphocyte to monocyte ratio (LMR). Then,
esketamine application decreases the plasma TNF-alpha levels, while
maintaining the IL-10 level in comparison with the Control group.
Additionally, esketamine reduced the proportion of intermediate monocytes,
downregulates the expressions of CD16, CD40 and CX3CR1, while upregulates
the CD206 expression. Finally, in the in-vitro study, esketamine inhibits
the M1 pro-inflammatory markers in LPS-challenged macrophages, and
downregulates multiple immune-related pathways. <br/>Significance:
Esketamine mitigates surgery-triggered inflammation by suppressing
monocyte/macrophage proinflammatory activity and TNF-alpha release,
offering dual anesthetic and immunomodulatory benefits.<br/>Copyright
&#xa9; 2025

<11>
Accession Number
2038063608
Title
Different antithrombotic strategies after left atrial appendage closure
with the LACbes occluder: Protocol of the DAAL trial.
Source
BMJ Open. 15(3) (no pagination), 2025. Article Number: e084351. Date of
Publication: 18 Mar 2025.
Author
Zhang T.; Zhou J.; Zhang K.; Zhang C.; Chen K.; Han Z.; Tang Z.; Zhang Z.;
Zhang Q.; He Q.; Zhang J.
Institution
(Zhang, Zhou, Zhang, Zhang, Chen, Han, Tang, Zhang, Zhang, He, Zhang)
Department of Cardiology, Shanghai Jiao Tong University, School of
Medicine, Affiliated Ninth People's Hospital, Shanghai, China
Publisher
BMJ Publishing Group
Abstract
Introduction The purpose of this study is to evaluate the safety and
efficacy of two different antithrombotic strategies, dual antiplatelet
therapy (DAPT, aspirin and ticagrelor) and direct oral anticoagulant
(DOAC, rivaroxaban), after left atrial appendage closure (LAAC) using the
LACbes occluder. Methods and analysis This study is a prospective,
randomised, controlled and multicentre clinical trial that will compare
the clinical efficacy of antiplatelet and anticoagulation therapy after
LAAC with the LACbes occluder. It is planned to enrol 296 subjects with
non-valvular atrial fibrillation (NVAF) who complete transcatheter closure
of the left atrial appendage successfully. All subjects who pass the
screening process and sign informed consent forms will be randomised in a
1:1 ratio to the DAPT group (aspirin 100 mg/day and ticagrelor 90 mg two
times a day) or the DOAC group (rivaroxaban 15 mg/day). Baseline data
within 24 hours after the operation and follow-up information at 3, 6 and
12 months will be recorded to investigate the difference in the incidence
of device-related thrombosis, clinical thrombotic events, bleeding and
other adverse events. Ethics and dissemination Ethics approval has been
obtained from the Ethics Committee of Shanghai Ninth People's Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
(Approval number SH9H-2022-T426-1). The protocol (Version: V1, 20230105)
has also been submitted and approved by the institutional ethics committee
at each participating centre. Results are expected in 2025 and will be
disseminated through peer-reviewed journals and presentations at national
and international conferences.<br/>Copyright &#xa9; Author(s) (or their
employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ Group.

<12>
Accession Number
2032976910
Title
The correlation between serum angiopoietin-2 levels and acute kidney
injury (AKI): A meta-analysis.
Source
Clinical Chemistry and Laboratory Medicine. 63(2) (pp 239-248), 2025. Date
of Publication: 02 Jan 2025.
Author
Zhang J.; Huang Z.; Lin Q.; Hu W.; Zhong H.; Zhang F.; Huang J.
Institution
(Zhang, Huang, Lin, Hu, Zhong, Zhang, Huang) The School of Clinical
Medicine, Fujian Medical University, Fujian, Fuzhou, China
(Lin, Hu, Zhong, Zhang, Huang) Department of Nephrology, Xiamen Key
Laboratory of Precision Diagnosis and Treatment of Chronic Kidney Disease,
The Fifth Hospital of Xiamen, Fujian, Xiamen, China
(Lin, Hu, Zhong, Zhang, Huang) Department of Nephrology, Fujian Clinical
Research Center for Chronic Glomerular Disease, The First Affiliated
Hospital of Xiamen University, School of Medicine, Xiamen University,
Xiamen, China
Publisher
Walter de Gruyter GmbH
Abstract
Introduction: The correlation between serum angiopoietin-2 levels and
acute kidney injury (AKI) is a topic of significant clinical interest.
This meta-analysis aims to provide a comprehensive evaluation of this
relationship. Content: A systematic search was conducted in PubMed,
Embase, Web of Science, and Cochrane databases up to October 11, 2023. The
included studies were evaluated using the Newcastle-Ottawa Scale (NOS) and
Methodological Index for Non-Randomized Studies (MINORS). Weighted mean
differences (WMD) and odds ratios (OR) were calculated using
random-effects models. Sensitivity analysis, funnel plots, and Egger's
test were used to assess the robustness and publication bias of the
findings. Subgroup analyses were performed to explore potential variations
between adults and children. <br/>Summary: Eighteen studies encompassing a
total of 7,453 participants were included. The analysis revealed a
significant elevation in serum angiopoietin-2 levels in patients with AKI
compared to those without (WMD: 4.85; 95% CI: 0.75 to 0.27;
I²=93.2%, p<0.001). Subgroup analysis indicated significantly
higher angiopoietin-2 levels in adults with AKI (WMD: 5.17; 95% CI: 3.51
to 6.83; I²=82.6%, p<0.001), but not in children. Additionally,
high serum angiopoietin-2 levels were associated with an increased risk of
AKI (OR: 1.58; 95% CI: 1.39 to 1.8; I²=89.1%, p<0.001).
Sensitivity analysis validated the robustness of these results, showing no
substantial change in the overall effect size upon the exclusion of
individual studies. Outlook: This meta-analysis supports a significant
association between elevated serum angiopoietin-2 levels and increased
risk of AKI. The observed differential association between adults and
children highlights the need for further targeted research to understand
these age-specific variations.<br/>Copyright &#xa9; 2024 Walter de Gruyter
GmbH, Berlin/Boston.

<13>
Accession Number
2033952195
Title
Investigating the results of transcatheter aortic valve implantation
(TAVI) in non-diabetic and diabetic patients: a systematic review and
meta-analysis.
Source
BMC Cardiovascular Disorders. 25(1) (no pagination), 2025. Article Number:
205. Date of Publication: 01 Dec 2025.
Author
Soleimani A.; Maghsoodi M.; Bahrani S.; Amerizadeh A.; Teimouri-Jervekani
Z.
Institution
(Soleimani, Amerizadeh, Teimouri-Jervekani) Cardiac Rehabilitation
Research Center, Isfahan Cardiovascular Research Institute, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Maghsoodi, Bahrani) Hypertension Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
Publisher
BioMed Central Ltd
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has emerged as
an effective treatment option for patients with severe aortic stenosis,
particularly in those who are not suitable candidates for open-heart
surgery. While diabetes is known to be associated with a higher risk of
cardiovascular diseases, the impact of diabetes on the outcomes of TAVI
remains controversial. <br/>Method(s): A systematic literature search was
conducted across major databases, including PubMed, Web of Science (WOS),
and Google Scholar, for studies published in English over the past 20
years, up until July 2024. <br/>Result(s): A total of 10 observational
studies were analyzed, revealing that diabetic patients were generally
younger than non-diabetic patients. The 30-day mortality rate was lower in
non-diabetics (0.03 [0.02-0.04]) compared to diabetics (0.04 [0.03-0.05]).
However, the hazard ratio for death beyond 30 days in diabetics was 2.05
(95% CI: 0.91-4.60, p = 0.08), and at one year, it was 1.04 (95% CI:
0.78-1.39, p = 0.77), with neither result reaching statistical
significance. Meta-regression analysis showed that non-insulin-treated
diabetes was significantly associated with an increased risk of acute
kidney injury (AKI) compared to non-diabetics, with a log odds ratio
(LogOR) of 0.3393 (p = 0.035) in one analysis and 0.3166 (p = 0.028) in
another, confirming a statistically significant increase in AKI risk.
<br/>Conclusion(s): This review highlights that while diabetes slightly
increases short-term mortality after TAVI, long-term survival remains
comparable to non-diabetic patients. However, non-insulin-treated diabetes
significantly raises the risk of acute kidney injury (AKI), emphasizing
the need for enhanced renal protection and perioperative management.
Clinical trial number: Not applicable.<br/>Copyright &#xa9; The Author(s)
2025.

<14>
Accession Number
646599905
Title
The effect of mother's voice and music therapy on pain and physiological
parameters during the endotracheal suctioning procedure: A randomized
controlled study.
Source
Journal of pediatric nursing. 81 (pp e47-e56), 2025. Date of Publication:
01 Mar 2025.
Author
Kos F.M.; Bektas M.; Bektas I.; Ayar D.; Metin S.K.
Institution
(Kos) Bilecik Seyh Edebali University Faculty of Health Science Nursing
Department, Bilecik, Turkey
(Bektas) Dokuz Eylul University Faculty of Nursing, Pediatric Nursing
Department, Izmir, Turkey
(Bektas) Izmir Bakircay University Faculty of Health Science Pediatric
Nursing Department, Izmir, Turkey
(Ayar) Alanya Alaaddin Keykubat University Faculty of Health Science,
Pediatric Nursing Department, Alanya, Turkey
(Metin) Departmentof Cardiovascular Surgery, Faculty of Medicine, Dokuz
Eylul University, Izmir, Turkey
Abstract
OBJECTIVE: This study aimed to examine the effects of maternal voice and
music therapy on pain and physiological parameters during the endotracheal
suctioning process in intubated children. DESIGN: The study was a
single-centre, randomized controlled trial. SETTING: The
Thoracic-Cardiovascular Surgery Intensive Care Unit of a University
Hospital in Turkey. <br/>METHOD(S): This study involved three groups of 27
children, aged between 2 and 36 months. All three groups, including the
control group (CG), received the standard suction protocol before, during,
and after each intervention. Additionally, the children in the music
therapy (MT) group listened to music titled 'The Happiest Child', while
the children in the mother's voice (MV) group listened to recordings of
their mothers' voices. The variables assessed are pain and physiological
parameters. <br/>RESULT(S): When the pain results of the children were
evaluated, the pain score of the children in the control group was found
to be significantly higher than children in the mother's voice and music
voice group (p < .05). It was determined that the lowest FLACC Pain Scale
value was in the mother's voice group (p < .05). When the physiological
parameters results were evaluated, it was determined that the
physiological measurement values of the children in the experimental group
were positively affected (p < .05), there was a significant difference
between the control group (p < .05) and the most effective result was in
the mother's voice group (p < .05). <br/>CONCLUSION(S): The application of
mother's voice and music therapy to children before, during and after the
aspiration procedure reduces the pain of children, positively affects
their physiological parameters and improves the quality of nursing care.
IMPLICATIONS FOR CLINICAL PRACTICE: This study provides a scientific basis
for nursing practices in clinical settings and contributes to clinical
practice by shedding light on future evidence-based studies.<br/>Copyright
&#xa9; 2025 Elsevier Inc. All rights reserved.

<15>
Accession Number
2038099793
Title
Protocol and design of the REPOSE study: A double-blinded, randomised,
placebo-controlled trial to evaluate the efficacy of suvorexant to improve
postoperative sleep and reduce delirium severity in older patients
undergoing non-cardiac surgery.
Source
BMJ Open. 15(3) (no pagination), 2025. Article Number: e091099. Date of
Publication: 13 Mar 2025.
Author
Fallon J.M.; Hashemaghaie M.; Peterson C.E.; Tran D.; Wu S.R.; Valdes
J.M.; Pedicini N.M.; Adams M.E.; Soltis M.; Mansour W.; Wright M.C.;
Raghunathan K.; Treggiari M.M.; Sasannejad C.; Devinney M.J.
Institution
(Fallon, Valdes, Pedicini) Duke University, Trinity College of Arts and
Sciences, Durham, NC, United States
(Hashemaghaie, Peterson, Adams, Wright, Raghunathan, Treggiari, Devinney)
Department of Anesthesiology, Duke University School of Medicine, Durham,
NC, United States
(Tran) Louisiana State University School of Medicine, New Orleans, LA,
United States
(Wu) Duke University Pratt School of Engineering, Durham, NC, United
States
(Soltis, Sasannejad) Department of Neurology, Duke University School of
Medicine, Durham, NC, United States
(Mansour) Department of Medicine, Duke University School of Medicine,
Durham, NC, United States
Publisher
BMJ Publishing Group
Abstract
Introduction Postoperative delirium occurs in up to 40% of older surgical
patients and has been associated with prolonged hospital stays, long-Term
cognitive impairment and increased 1-year postoperative mortality.
Postoperative sleep disturbances may increase the risk of delirium, but
studies investigating pharmacotherapies to improve postoperative sleep to
prevent delirium remain limited. Suvorexant is a selective antagonist of
orexin 1 and 2 receptors and is approved for insomnia pharmacotherapy by
the Food and Drug Administration. It has the potential to improve
postoperative sleep and reduce postoperative delirium rates, but
randomised controlled trials (RCTs) are needed to determine the efficacy
of postoperative suvorexant administration. The REPOSE study (reducing
delirium by enhancing postoperative sleep with suvorexant) is a
single-centre, randomised, double-blinded RCT that aims to evaluate the
efficacy of suvorexant in increasing total sleep time (TST) and decreasing
delirium severity in older patients undergoing non-cardiac surgery.
Methods and analysis REPOSE will enroll 130 patients (aged >=65 years)
undergoing non-cardiac surgery with a planned postoperative inpatient
stay. Participants will be randomised to receive 20 mg oral suvorexant or
placebo nightly on postoperative nights 0, 1 and 2. The primary endpoint
is TST on the first postoperative night, as measured using an
electroencephalography headband. The secondary endpoint is peak
postoperative delirium severity as measured by the 3-minute diagnostic
interview for the confusion assessment method severity scores. Primary
endpoint data will be analysed with a two-sample t-Test using an
intent-To-Treat approach to compare TST on the first night that a patient
received a study drug dose. Secondary and exploratory endpoint data will
be analysed using two-sample t-Tests between groups. Ethics and
dissemination Ethical approval was obtained from the Duke Institutional
Review Board (protocol #00111869). Results of the REPOSE study will be
published in a peer-reviewed journal and presented at academic
conferences. Trial data will be deposited in ClinicalTrials.gov. Trial
registration number NCT05733286.<br/>Copyright &#xa9; 2025 BMJ Publishing
Group. All rights reserved.

<16>
Accession Number
2037784441
Title
Robotic approach for surgical correction of scimitar syndrome via direct
anastomosis.
Source
JTCVS Techniques. 30 (pp 130-131), 2025. Date of Publication: 01 Apr 2025.
Author
Blitzer D.; Patel K.; Nguyen S.N.; Lalonde M.; Bacha E.; Geirsson A.
Institution
(Blitzer, Patel, Nguyen, Lalonde, Bacha, Geirsson) Section of Pediatric
and Congenital Cardiac Surgery, Department of Surgery, NewYork
Presbyterian-Morgan Stanley Children's Hospital, Columbia University
Irving Medical Center, New York, NY
Publisher
Elsevier Inc.

<17>
Accession Number
2029814887
Title
Extracorporeal life support after surgical repair for acute type a aortic
dissection: A systematic review and meta-analysis.
Source
Perfusion (United Kingdom). 40(3) (pp 631-639), 2025. Date of Publication:
01 Apr 2025.
Author
Sa M.P.; Jacquemyn X.; Hess N.; Brown J.A.; Caldonazo T.; Kirov H.; Doenst
T.; Serna-Gallegos D.; Kaczorowski D.; Sultan I.
Institution
(Sa, Hess, Brown, Serna-Gallegos, Kaczorowski, Sultan) Department of
Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United
States
(Sa, Hess, Brown, Serna-Gallegos, Kaczorowski, Sultan) UPMC Heart and
Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh,
PA, United States
(Jacquemyn) Department of Cardiovascular Sciences, KU Leuven, Leuven,
Belgium
(Caldonazo, Kirov, Doenst) Department of Cardiothoracic Surgery, Jena
University Hospital, Jena, Germany
Publisher
SAGE Publications Ltd
Abstract
Background: The use of extracorporeal life support (ECLS) in patients
after surgical repair for acute type A aortic dissection (ATAAD) has not
been well documented. <br/>Method(s): We performed a systematic review and
meta-analysis to assess the outcomes of ECLS after surgery for ATAAD with
data published by October 2023 in compliance with the Preferred Reporting
Items for Systematic Reviews and Meta-analyses (PRISMA) and the
Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting
guidelines. The protocol was registered in PROSPERO (CRD42023479955).
<br/>Result(s): Twelve observational studies met our eligibility criteria,
including 280 patients. Mean age was 55.0 years and women represented
25.3% of the overall population. Although the mean preoperative left
ventricle ejection fraction was 59.8%, 60.8% of patients developed left
ventricle failure and 34.0% developed biventricular failure. Coronary
involvement and malperfusion were found in 37.1% and 25.6%, respectively.
Concomitant coronary bypass surgery was performed in 38.5% of patients.
Regarding ECLS, retrograde flow (femoral) was present in 39.9% and central
cannulation was present in 35.4%. In-hospital mortality was 62.8% and
pooled estimate of successful weaning was 50.8%. Neurological
complications, bleeding and renal failure were found in 25.9%, 38.7%, and
65.5%, respectively. <br/>Conclusion(s): ECLS after surgical repair for
ATAAD remains associated with high rates of in-hospital death and
complications, but it still represents a chance of survival in critical
situations. ECLS remains a salvage attempt and surgeons should not try to
avoid ECLS at all costs after repairing an ATAAD case.<br/>Copyright
&#xa9; The Author(s) 2024.

<18>
Accession Number
2029544283
Title
A systematic review of cardiac surgery clinical prediction models that
include intra-operative variables.
Source
Perfusion (United Kingdom). 40(2) (pp 328-342), 2025. Date of Publication:
01 Mar 2025.
Author
Jones C.; Taylor M.; Sperrin M.; Grant S.W.
Institution
(Jones, Sperrin) Division of Informatics, Imaging and Data Science,
Faculty of Biology, Medicine and Health, Manchester Academic Health
Science Centre, University of Manchester, Manchester, United Kingdom
(Jones) Department of Clinical Perfusion, University Hospital Southampton
NHS Foundation Trust, Southampton General Hospital, Southampton, United
Kingdom
(Taylor) Department of Cardiothoracic Surgery, Manchester University
Hospital Foundation Trust, Wythenshawe Hospital, Manchester, United
Kingdom
(Grant) Division of Cardiovascular Sciences, ERC, Manchester University
Hospitals Foundation Trust, University of Manchester, Manchester, United
Kingdom
(Grant) South Tees Academic Cardiovascular Unit, South Tees Hospitals NHS
Foundation Trust, Middlesbrough, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Background: Most cardiac surgery clinical prediction models (CPMs) are
developed using pre-operative variables to predict post-operative
outcomes. Some CPMs are developed with intra-operative variables, but none
are widely used. The objective of this systematic review was to identify
CPMs with intra-operative variables that predict short-term outcomes
following adult cardiac surgery. <br/>Method(s): Ovid MEDLINE and EMBASE
databases were searched from inception to December 2022, for studies
developing a CPM with at least one intra-operative variable. Data were
extracted using a critical appraisal framework and bias assessment tool.
Model performance was analysed using discrimination and calibration
measures. <br/>Result(s): A total of 24 models were identified. Frequent
predicted outcomes were acute kidney injury (9/24 studies) and
peri-operative mortality (6/24 studies). Frequent pre-operative variables
were age (18/24 studies) and creatinine/eGFR (18/24 studies). Common
intra-operative variables were cardiopulmonary bypass time (16/24 studies)
and transfusion (13/24 studies). Model discrimination was acceptable for
all internally validated models (AUC 0.69-0.91). Calibration was poor
(15/24 studies) or unreported (8/24 studies). Most CPMs were at a high or
indeterminate risk of bias (23/24 models). The added value of
intra-operative variables was assessed in six studies with statistically
significantly improved discrimination demonstrated in two.
<br/>Conclusion(s): Weak reporting and methodological limitations may
restrict wider applicability and adoption of existing CPMs that include
intra-operative variables. There is some evidence that CPM discrimination
is improved with the addition of intra-operative variables. Further work
is required to understand the role of intra-operative CPMs in the
management of cardiac surgery patients.<br/>Copyright &#xa9; The Author(s)
2024.

<19>
Accession Number
2029025221
Title
Effect of oxygen delivery during cardiopulmonary bypass on postoperative
neurological outcomes in patients undergoing cardiac surgery: A scoping
review of the literature.
Source
Perfusion (United Kingdom). 40(2) (pp 283-294), 2025. Date of Publication:
01 Mar 2025.
Author
Elsebaie A.; Shakeel A.; Zhang S.; Alarie M.; El Tahan M.; El-Diasty M.
Institution
(Elsebaie) Faculty of Health Sciences, Queen's University, ON, Kingston,
Bangladesh
(Shakeel) School of Medicine, Queen's University, ON, Kingston, Bangladesh
(Zhang) Department of Biomedical and Molecular Sciences, Queen's
University, ON, Kingston, Bangladesh
(Alarie) Kingston Health Sciences Centre, Kingston, ON, Canada
(El Tahan) Anesthesiology Department, College of Medicine, Imam
Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
(El-Diasty) University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
Publisher
SAGE Publications Ltd
Abstract
Background: Reduced oxygen delivery (DO<inf>2</inf>) during
cardiopulmonary bypass (CPB) was proposed as a risk factor for the
development of postoperative neurological complications (PONCs), including
cerebrovascular accidents (CVA), delirium, and postoperative cognitive
dysfunction (POCD). We aimed to review the current evidence on the
association between intraoperative DO<inf>2</inf> and the incidence of
PONCs. <br/>Method(s): MEDLINE, Embase, the Cochrane Library, and Web of
Science were electronically searched to identify comparative studies from
inception until July 2023 that reported the association between
intraoperative DO<inf>2</inf> levels and the incidence of PONCs (as
defined by the scales and diagnostic tools utilized by the studies'
authors) in adults patients undergoing cardiac surgery using CPB.
<br/>Result(s): Of the 2513 papers identified, 10 studies, including
21,875 participants, were included. Of these, three studies reported on
delirium, two on POCD, and five on CVA. Eight studies reported reduced
intraoperative DO<inf>2</inf> in patients who developed delirium and CVA.
There was a lack of consensus on the cut-off of DO<inf>2</inf> levels or
the correlation between the period below these threshold values and the
development of PONC. <br/>Conclusion(s): Limited data suggest that
maintaining intraoperative DO<inf>2</inf> above the critical threshold
levels and ensuring adequate intraoperative cerebral perfusion may play a
role in minimizing the incidence of neurological events in adult patients
undergoing cardiac surgery on cardiopulmonary bypass.<br/>Copyright &#xa9;
The Author(s) 2024.

<20>
Accession Number
2033975200
Title
Surgical pulmonary valve redo versus transcatheter pulmonary valve
replacement for Tetralogy of Fallot patients.
Source
Expert Review of Cardiovascular Therapy. 23(3) (pp 87-95), 2025. Date of
Publication: 2025.
Author
Penteris M.; Lampropoulos K.
Institution
(Penteris) Department of Medicine, Democritus University of Thrace,
Alexandroupolis, Greece
(Lampropoulos) School of Medicine, European University of Cyprus, Nicosia,
Cyprus
Publisher
Taylor and Francis Ltd.
Abstract
Objectives: To perform a systematic review to compare the efficacy and
safety of transcatheter pulmonary valve replacement (TPVR) and surgical
pulmonary valve replacement (SPVR) in managing pulmonary valve dysfunction
in Tetralogy of Fallot (TOF) patients. <br/>Method(s): This review
investigates through three different databases for randomized control
trials or observational studies evaluating TOF patients who underwent TPVR
or SPVR until November 2024. The outcomes of interest were hemodynamic
improvement, reduction in pulmonary regurgitation or stenosis,
complications, quality of life, and long-term outcomes. <br/>Result(s):
Four retrospective studies (1919 procedures) were analyzed. TPVR was
non-inferior to SPVR, with a comparable safety profile. The durability of
bioprosthetic valves was similar between TPVR and SPVR (HR: 0.97, 95% CI:
0.55-1.73; p = 0.93) and was influenced by patients' age at PVR (HR: 0.78
per 10 years from <1 year; 95% CI: 0.63-0.96; p = 0.02) and true inner
valve diameter. <br/>Conclusion(s): TPVR is a safe and less-invasive
alternative to SPVR with comparable efficacy in reducing pulmonary
regurgitation. Complication rates are similar and valve durability is
primarily age- and valve size-dependent. Although further research on long
term outcomes is needed, TPVR may be integrated into routine practices,
offering a viable alternative for high-risk TOF patients. Registration:
This systematic review was registered on the international prospective
register of systematic reviews (PROSPERO; #CRD42024615871).<br/>Copyright
&#xa9; 2025 Informa UK Limited, trading as Taylor & Francis Group.

<21>
Accession Number
2034785389
Title
Safety implications of mask use: A systematic review and evidence map.
Source
BMJ Evidence-Based Medicine. 30(2) (pp 91-103), 2025. Date of Publication:
01 Apr 2025.
Author
Farah W.; Abusalih M.F.; Hasan B.; Lees E.H.; Fleti F.; Elkhatib W.Y.;
Johnson B.D.; Toups G.; Wolf M.; Murad M.H.
Institution
(Farah, Abusalih, Hasan, Fleti, Murad) Evidence-Based Practice Center,
Mayo Clinic, Rochester, MN, United States
(Farah) Division of Pulmonary and Critical Care Medicine, Mayo Clinic,
Rochester, MN, United States
(Abusalih, Hasan, Lees, Fleti, Elkhatib, Toups, Wolf, Murad) Division of
Public Health Infectious Diseases and Occupational Medicine, Mayo Clinic,
Rochester, MN, United States
(Johnson) Division of Preventive Cardiology, Mayo Clinic, Rochester, MN,
United States
Publisher
BMJ Publishing Group
Abstract
Background Widespread use of respiratory protection masks has become a
critical component of public health response. Objectives This systematic
review synthesises the evidence on the acute physiological, cognitive and
psychological impacts associated with different types of masks and
provides an evidence map of research gaps. Methods A comprehensive search
from 2000 to 2023 was conducted across multiple databases (MEDLINE,
EMBASE, Cochrane databases, Scopus and PubMed). An umbrella systematic
overview was conducted for physiological outcomes using existing
systematic reviews. We conducted de novo systematic reviews for cognitive
and psychological outcomes. Pairs of independent reviewers determined
eligibility, extracted data and assessed risk of bias. Certainty at an
outcome level was appraised using the Grading of Recommendations
Assessment, Development and Evaluation approach. Results The search
resulted in 13 370 potential citations, leading to the inclusion of nine
systematic reviews for physiological outcomes (87 primary studies) and 10
primary studies for cognitive and psychological outcomes (3815
participants), with the majority of participants being healthy adults.
Studies evaluating physiological outcomes demonstrated that various types
of masks have little to no significant difference in heart rate (surgical
mask (mean difference (MD): 0.96 (-1.01 to 2.93)), N95 mask (MD: 1.63
(-2.79 to 6.05)) and cloth mask (MD: -0.94 (-6.39 to 4.52))) or
respiratory rate during rest or exercise (surgical mask (MD: -1.35 (-3.00
to 0.29)), N95 mask (MD: 0.10 (-3.10 to 3.29)) and cloth mask (MD: -2.57
(-6.44 to 1.29)) (low certainty for most outcomes)). Mask use may be
associated with very small changes in minute ventilation (surgical mask
(MD: -13.9 (-20.30 to -7.53)) and N95 mask (MD: -16.3 (-28.7 to -3.9))),
tidal volume (surgical mask (MD: -0.14 (-0.23 to -0.05)) and N95 mask (MD:
-0.10 (-0.33 to 0.13))), oxygen saturation (surgical mask (MD: -0.59%
(-0.87 to -0.30)), N95 mask (MD: -0.35% (-0.75 to 0.05)) and cloth mask
(MD: -0.50% (-1.23; 0.24))), carbon dioxide partial pressure (surgical
mask (standardised MD (SMD): 1.17 (0.70 to 1.64)) and N95 mask (SMD: 0.43
(0.08 to 0.79))) and exercise performance (surgical mask (SMD: -0.12
(-0.39 to 0.15)), N95 mask (SMD: -0.42 (-0.76 to -0.08)) and cloth mask
(SMD: -0.26 (-0.54 to 0.02)) (low certainty for most outcomes)). Studies
evaluating cognitive outcomes showed mixed results. Some studies reported
reduced mental workload, and others showed no significant effect or
decreased performance. The impact on attention, errors and reaction time
was variable. These studies were small and at moderate to high risk of
bias. Evidence was insufficient to estimate the effect of mask use on
psychological outcomes (claustrophobia, depression and anxiety) as these
studies were small, non-longitudinal and at high risk of bias. Conclusion
This evidence map provides a comprehensive insight into the multifaceted
impact of respiratory protection mask use, and highlights the limited
certainty in the available body of evidence. This evidence map supports
the development of future research agenda.<br/>Copyright &#xa9; Author(s)
(or their employer(s)) 2025.

<22>
Accession Number
646852111
Title
Mitral repair with annuloplasty for moderate ischemic mitral regurgitation
in people undergoing coronary artery bypass surgery.
Source
Cochrane Database of Systematic Reviews. 2025(3) (no pagination), 2025.
Article Number: CD015777. Date of Publication: 21 Mar 2025.
Author
Paez R.P.; Rocco I.S.; Guizilini S.; Flumignan R.L.G.; Carmo A.C.F.D.;
Gomes W.J.
Institution
(Paez, Rocco, Guizilini, Gomes) Postgraduation Program in Cardiology,
Universidade Federal de Sao Paulo, Sao Paulo, Brazil
(Rocco, Guizilini, Gomes) Division of Cardiovascular Surgery, Universidade
Federal de Sao Paulo, Sao Paulo, Brazil
(Flumignan) Department of Surgery, Division of Vascular and Endovascular
Surgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
(Carmo) Regional Medicine Library (BIREME), Universidade Federal de Sao
Paulo, Sao Paulo, Brazil
Publisher
John Wiley and Sons Ltd
Abstract
Objectives: This is a protocol for a Cochrane Review (intervention). The
objectives are as follows:. To assess the effects of mitral repair with
annuloplasty for moderate ischemic mitral regurgitation in people
undergoing coronary artery bypass grafting.<br/>Copyright &#xa9; 2025 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<23>
Accession Number
2038149474
Title
Evaluating the mechanism of action behind controlled hypothermic
preservation of donor hearts: A randomized pilot study.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2025. Date of
Publication: 2025.
Author
Razavi A.A.; Kobashigawa J.; Stotland A.; Chen Q.; Patel J.; Emerson D.;
Mirocha J.; Bowdish M.E.; Catarino P.; Megna D.; Gunn T.; Rafiei M.; Rai
D.; Song Y.; Babalola O.; Daniels A.; Kittleson M.; Kransdorf E.; Nikolova
A.; Czer L.; Chikwe J.; Gottlieb R.A.; Esmailian F.
Institution
(Razavi, Chen, Emerson, Bowdish, Catarino, Megna, Gunn, Chikwe, Esmailian)
Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical
Center, Los Angeles, California, United States
(Kobashigawa, Patel, Rafiei, Babalola, Daniels, Kittleson, Kransdorf,
Nikolova, Czer, Gottlieb) Department of Cardiology, Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, California, United States
(Stotland, Mirocha, Rai, Song) Advanced Clinical Biosystems Research
Institute, Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, California, United States
Publisher
Elsevier Inc.
Abstract
Background: Controlled hypothermic preservation of donor hearts is
associated with decreased post-transplant primary graft dysfunction
compared to conventional cold storage. However, mechanisms underlying this
benefit in human subjects are unclear. <br/>Method(s): We randomized 20
heart transplant recipients at a single institution to receive donor
hearts preserved with either controlled hypothermic preservation or
standard cold storage. Right ventricular biopsies were obtained at donor
heart recovery, immediately before implantation, and 7 days after
transplantation. Protein expression profiles at each time point were
evaluated using mass spectrometry, Protein Interaction Network Extractor
analysis, and Ingenuity Pathway Analysis. <br/>Result(s): Immediately
before implantation, controlled hypothermic preservation was associated
with increased protein expression related to fatty acid metabolism,
mitochondrial intermembrane space, and contractile fiber machinery.
Pathway analysis indicated increased cell viability, autophagy, and
upregulation of AMP-activated protein kinase pathway with controlled
hypothermic preservation. By post-transplant day 7, the protein expression
profiles of the 2 groups were similar. However, controlled hypothermic
preservation was associated with increased expression in the peroxisome
proliferator-activated receptor signaling pathway and fatty acid
oxidation. <br/>Conclusion(s): Controlled hypothermic preservation of
donor hearts shows beneficial time-dependent variability in protein
expression that may confer improved organ quality at the time of
transplantation.<br/>Copyright &#xa9; 2025

<24>
Accession Number
2034059351
Title
Whole stomach versus narrow gastric tube reconstruction after
esophagectomy for esophageal cancer (ATHLETE trial): study protocol for a
randomized controlled trial.
Source
Trials. 26(1) (no pagination), 2025. Article Number: 111. Date of
Publication: 01 Dec 2025.
Author
Kitadani J.; Hayata K.; Goda T.; Tominaga S.; Fukuda N.; Nakai T.; Nagano
S.; Ojima T.; Shimokawa T.; Kawai M.
Institution
(Kitadani, Hayata, Goda, Tominaga, Fukuda, Nakai, Nagano, Ojima, Kawai)
Second Department of Surgery, School of Medicine, Wakayama Medical
University, 811-1, 811-1 Kimiidera, Wakayama, Japan
(Shimokawa) Clinical Study Support Center, Wakayama Medical University,
Wakayama, Japan
Publisher
BioMed Central Ltd
Abstract
Background: There are two types of methods of creating a gastric conduit
after esophagectomy for patients with esophageal cancer: narrow gastric
tube reconstruction or whole stomach reconstruction. Whole stomach
reconstruction with good blood perfusion was reported in a prospective
cohort study to be safe and that it has the possibility to prevent
anastomotic leakage (AL). We therefore planned a randomized controlled
phase III study to investigate the superiority of whole stomach
reconstruction over narrow gastric tube reconstruction after esophagectomy
for esophageal cancer. <br/>Method(s): This is a single center, two-arm,
open-label, randomized phase III trial. We calculated that 65 patients in
each arm of this study and total study population of 130 patients are
required according to our historical data on narrow gastric tube
reconstruction and prospective data on whole stomach reconstruction. In
the narrow gastric tube group, a 3.5-cm-wide gastric tube is made along
the greater curvature of the stomach using linear staplers. Otherwise, in
the whole stomach group, after the lymphadenectomy of the lesser curvature
and No.2, the stomach is cut just below the esophagogastric junction using
a linear stapler. The primary endpoint of this study is the incidence of
AL. Secondary endpoints are the occurrence rate of anastomotic stenosis,
the occurrence rate of pneumonia, the occurrence rate of all postoperative
complications, the occurrence rate of reflux esophagitis, quality of life
evaluation by EORTC QLQ-C30 and EORTC OES-18, nutritional evaluation, the
amount of blood loss, postoperative hospital stays, and blood flow
evaluation. Complications are evaluated using the Clavien-Dindo
classification (version 2.0), and those of grade II or higher are
considered to be postoperative complications. <br/>Discussion(s): If the
optimal method for creating a gastric conduit after esophagectomy is
clarified, it may be possible to contribute to improving short-term and
long-term surgical outcomes for patients undergoing surgery for esophageal
cancer. Trial registration: The protocol of ATHLETE trial was registered
in the UMIN Clinical Trials Registry as UMIN000050677
(http://www.umin.ac.jp/ctr/index.htm). Date of registration: March 26,
2023. Date of first participant enrollment: March 27, 2023.<br/>Copyright
&#xa9; The Author(s) 2025.

<25>
Accession Number
2027792011
Title
Systematic review and meta-analysis comparing Manta device and Perclose
device for closure of large bore arterial access.
Source
Journal of Vascular Access. 26(1) (pp 15-21), 2025. Date of Publication:
01 Jan 2025.
Author
Cheema T.; Venero C.; Champaneria S.; Younas S.; Hadeed Khan M.A.; Anjum
I.; Ijaz U.; Haider S.; Akbar M.S.; Abdul-Waheed M.; Saleem S.
Institution
(Cheema) West Suburban Medical Center, Oak Park, IL, United States
(Venero, Champaneria, Haider, Akbar, Abdul-Waheed, Saleem) University of
Kentucky College of Medicine, Lexington, KY, United States
(Younas, Ijaz) Khyber Medical College, Khyber Pakhtunkhwa, Peshawar,
Pakistan
(Hadeed Khan) Peshawar Medical College, Khyber Pakhtunkhwa, Peshawar,
Pakistan
(Anjum) Vassar Brothers Medical Center, Poughkeepsie, NY, United States
Publisher
SAGE Publications Ltd
Abstract
Data comparing MANTA device with Perclose device for large bore arterial
access closure is limited. We performed meta-analysis to compare safety
and efficacy of the two devices in large (14 Fr sheath) arteriotomy
closure post-TAVR. Relevant studies were identified via PubMed, Cochrane,
and EMBASE databases until June, 2022. Data was analyzed using random
effect model to calculate relative odds of VARC-2 defined access-site
complications and short-term (in-hospital or 30-day) mortality. A total of
12 studies (2 RCT and 10 observational studies) comprising 2339 patients
were included. The odds of major vascular complications (OR 0.99, 95% CI
0.51-1.92; p = 0.98); life threatening and major bleeding (OR 0.77, 95% CI
0.45-1.33; p = 0.35); minor vascular complications (OR 1.37, 95% CI
0.63-2.99; p = 0.43); minor bleeding (OR 0.94, 95% CI 0.57-1.56; p =
0.82); device failure (OR 0.74, 95% CI 0.49-1.11; p = 0.14); hematoma
formation (OR 0.76, 95% CI 0.33-1.75; p = 0.52); dissection, stenosis,
occlusion, or pseudoaneurysm (OR 1.08, 95% CI 0.71-1.62; p = 0.73) and
short-term mortality (OR 1.01, 95% CI 0.55-1.84; p = 0.98) between both
devices were similar. MANTA device has a similar efficacy and safety
profile compared to Perclose device.<br/>Copyright &#xa9; The Author(s)
2024.

<26>
Accession Number
2029083961
Title
Plasma hyperosmolality during cardiopulmonary bypass is a risk factor for
postoperative acute kidney injury: Results from double blind randomised
controlled trial.
Source
Perfusion (United Kingdom). 40(2) (pp 466-474), 2025. Date of Publication:
01 Mar 2025.
Author
Svenmarker S.; Claesson Lingehall H.; Malmqvist G.; Appelblad M.
Institution
(Svenmarker, Malmqvist) Department of Public Health and Clinical Medicine,
Umea University, Umea, Sweden
(Claesson Lingehall) Department of Nursing, Umea University, Umea, Sweden
(Appelblad) Department of Public Health and Clinical Medicine, Heart
Centre, Umea University, Umea, Sweden
Publisher
SAGE Publications Ltd
Abstract
Introduction: The study objective was to investigate whether a Ringer's
acetate based priming solution with addition of Mannitol and sodium
concentrate increases the risk of cardiac surgery associated kidney injury
(CSA-AKI). <br/>Method(s): This is a double blind, prospective randomized
controlled trial from a single tertiary teaching hospital in Sweden
including patients aged >=65 years (n = 195) admitted for routine cardiac
surgery with cardiopulmonary bypass. Patients in the study group received
Ringer's acetate 1000 mL + 400 mL Mannitol (60 g) + sodium chloride 40 mL
(160 mmol) and heparin 2 mL (10 000 IU) 966 mOsmol (n = 98), while
patients in the control group received Ringer's acetate 1400 mL + heparin
2 mL (10 000 IU), 388 mOsmol (n = 97) as pump prime. Acute kidney injury
was analysed based on the Kidney Disease Improving Outcomes (KDIGO 1-3)
definition. <br/>Result(s): The overall incidence of CSA-AKI (KDIGO stage
1) was 2.6% on day 1 in the ICU and 5.6% on day 3, postoperatively. The
serum creatinine level did not show any postoperative intergroup
differences, when compared to baseline preoperative values. Six patients
in the Ringer and five patients in the Mannitol group developed CSA-AKI
(KDIGO 1-3), all with glomerular filtration rates <60 mL/min/1.73
m². These patients showed significantly higher plasma
osmolality levels compared to preoperative values. Hyperosmolality
together with patient age and the duration of the surgery were independent
risk factors for postoperative acute kidney injury (KDIGO 1-3).
<br/>Conclusion(s): The use of a hyperosmolar prime solution did not
increase the incidence of postoperative CSA-AKI in this study, while high
plasma osmolality alone increased the associated risk by 30%. The data
suggests further examination of plasma hyperosmolality as a relative risk
factor of CSA-AKI.<br/>Copyright &#xa9; The Author(s) 2024.

<27>
Accession Number
2033038619
Title
Advances in understanding the effects of cardiopulmonary bypass on gut
microbiota during cardiac surgery.
Source
International Journal of Artificial Organs. 48(2) (pp 51-63), 2025. Date
of Publication: 01 Feb 2025.
Author
Zhang Y.; Luo W.; Zhao M.; Li Y.; Wu X.
Institution
(Zhang, Luo, Li, Wu) Department of Cardiac surgery, The Second Hospital &
Clinical Medical School, Lanzhou University, Lanzhou, China
(Zhao) Department of Cardiology, First Hospital of Lanzhou University,
Lanzhou University, Lanzhou, China
Publisher
SAGE Publications Ltd
Abstract
Cardiopulmonary bypass (CPB) is an indispensable technique in cardiac
surgery; however, its impact on gut microbiota and metabolites remains
insufficiently studied. CPB may disrupt the intestinal mucosal barrier,
altering the composition and function of gut microbiota, thereby
triggering local immune responses and systemic inflammation, which may
lead to postoperative complications. This narrative review examines
relevant literature from PubMed, Web of Science, Google Scholar, and CNKI
databases over the past decade. Keywords such as "gut microbiota,"
"cardiopulmonary bypass," "cardiac surgery," and "postoperative
complications" were employed, with Boolean operators used to refine the
search results. The review examines changes in gut microbiota before and
after CPB, their role in postoperative complications, and potential
strategies for modulation to improve outcomes.<br/>Copyright &#xa9; The
Author(s) 2025.

<28>
Accession Number
2037965012
Title
Effect of intraoperative intravenous remimazolam on the postoperative
quality of recovery after noncardiac surgery: A meta-analysis of
randomized controlled trials.
Source
PLoS ONE. 20(3 MARCH) (no pagination), 2025. Article Number: e0319044.
Date of Publication: 01 Mar 2025.
Author
Liu H.; Zhou M.; Chen X.; Esmaeili E.; Sun M.; Wu Z.
Institution
(Liu, Chen, Esmaeili, Sun, Wu) Department of Anesthesiology, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
(Liu, Chen, Esmaeili, Sun, Wu) Institute of Anesthesia and Critical Care
Medicine, Union Hospital, Tongji Medical College, Huazhong University of
Science and Technology, Wuhan, China
(Liu, Chen, Esmaeili, Sun, Wu) Key Laboratory of Anesthesiology and
Resuscitation, Huazhong University of Science and Technology, Ministry of
Education, China
(Zhou) Operation room, Xinzhou district people's hospital, Wuhan, China
Publisher
Public Library of Science
Abstract
Objectives The postoperative quality of recovery holds significant
economic and prognostic implications. Numerous studies have investigated
the postoperative quality of recovery following surgery. However, the
impact of intraoperative intravenous remimazolam on postoperative recovery
has yielded conflicting results. Methods In this qualitative review of
randomized controlled clinical trials assessing the use of intraoperative
remimazolam, we present the effects of intravenous remimazolam on
postoperative recovery quality in noncardiac surgery patients. We
conducted a comprehensive search of PubMed, MEDLINE, Web of Science and
Cochrane Library for randomized controlled trials published up to
September 23, 2024, without any language restrictions, to investigate the
impact of intraoperative intravenous remimazolam on the quality of
postoperative recovery following noncardiac surgery. The primary outcome
measure was the quality of postoperative recovery assessed using global
QoR-40 scores or QoR-15 scores. Secondary outcomes included five
dimensions of quality of postoperative recovery: physical comfort,
emotional state, physical independence, psychological support, and pain.
As well as time to extubation, VAS score, PACU stay, and days in hospital.
We analyzed the pooled data using a random-effects model. Results This
meta-analysis included 18 studies published between 2022 and 2024
involving 1720 patients. The quality of postoperative recovery was
assessed using the QoR-15 or QoR-40 questionnaires. The pooled results
showed no significant difference in QoR scores between the two groups on
the first postoperative day (SMD = 0.12; 95% CI -0.13-0.36; I²
= 78%; p = 0.35). Furthermore, differences in QoR dimensions, PACU
duration, extubation time, and length of hospital stay were not observed.
Conclusion Our analysis showed that the quality of recovery after general
anaesthesia in the remimazolam group was similar to that of conventional
sedation. Therefore, remimazolam may be used as a potential anaesthetic
agent as an alternative to conventional sedation for non-cardiac surgical
anaesthesia.<br/>Copyright &#xa9; 2025 Liu et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<29>
Accession Number
2030110122
Title
Conventional versus minimally invasive extra-corporeal circulation in
patients undergoing cardiac surgery: A randomized controlled trial
(COMICS).
Source
Perfusion (United Kingdom). 40(3) (pp 730-741), 2025. Date of Publication:
01 Apr 2025.
Author
Angelini G.D.; Reeves B.C.; Culliford L.A.; Maishman R.; Rogers C.A.;
Anastasiadis K.; Antonitsis P.; Argiriadou H.; Carrel T.; Keller D.;
Liebold A.; Ashkaniani F.; El-Essawi A.; Breitenbach I.; Lloyd C.; Bennett
M.; Cale A.; Gunaydin S.; Gunertem E.; Oueida F.; Yassin I.M.; Serrick C.;
Murkin J.M.; Rao V.; Moscarelli M.; Condello I.; Punjabi P.; Rajakaruna
C.; Deliopoulos A.; Bone D.; Lansdown W.; Moorjani N.; Dennis S.
Institution
(Angelini, Reeves, Culliford, Maishman, Rogers) Bristol Medical School,
University of Bristol, Bristol, United Kingdom
(Anastasiadis, Antonitsis, Argiriadou) Aristotle University of
Thessaloniki School of Medicine, Thessaloniki, Greece
(Carrel, Keller) University Hospital Bern, Bern, Switzerland
(Liebold, Ashkaniani) Universitatsklinikum Ulm, Ulm, Germany
(El-Essawi) Universitatsmedizin Gottingen, Gottingen, Germany
(Breitenbach) Klinikum Braunschweig, Braunschweig, Germany
(Lloyd, Bennett) University Hospitals Plymouth NHS Trust, Plymouth, United
Kingdom
(Cale) Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
(Gunaydin, Gunertem) Numune Training and Research Hospital in Ankara,
Ankara, Turkey
(Oueida, Yassin) Saud Al-Babtain Cardiac Centre, Dammam, Saudi Arabia
(Serrick, Rao) University Health Network, Toronto, ON, Canada
(Murkin) University of Western Ontario, London, ON, Canada
(Moscarelli, Condello) Anthea Hospital Bari, Italy
(Punjabi) Imperial College Healthcare, London, United Kingdom
(Rajakaruna, Bone, Lansdown) University Hospitals Bristol NHS Foundation
Trust, Bristol, United Kingdom
(Deliopoulos) AHEPA University Hospital, Thessaloniki, Greece
(Moorjani, Dennis) Royal Papworth Hospital, Cambridge, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Introduction: The trial hypothesized that minimally invasive
extra-corporeal circulation (MiECC) reduces the risk of serious adverse
events (SAEs) after cardiac surgery operations requiring extra-corporeal
circulation without circulatory arrest. <br/>Method(s): This is a
multicentre, international randomized controlled trial across fourteen
cardiac surgery centres including patients aged >=18 and <85 years
undergoing elective or urgent isolated coronary artery bypass grafting
(CABG), isolated aortic valve replacement (AVR) surgery, or CABG + AVR
surgery. Participants were randomized to MiECC or conventional
extra-corporeal circulation (CECC), stratified by centre and operation.
The primary outcome was a composite of 12 post-operative SAEs up to 30
days after surgery, the risk of which MiECC was hypothesized to reduce.
Secondary outcomes comprised: other SAEs; all-cause mortality; transfusion
of blood products; time to discharge from intensive care and hospital;
health-related quality-of-life. Analyses were performed on a modified
intention-to-treat basis. <br/>Result(s): The trial terminated early due
to the COVID-19 pandemic; 1071 participants (896 isolated CABG, 97
isolated AVR, 69 CABG + AVR) with median age 66 years and median EuroSCORE
II 1.24 were randomized (535 to MiECC, 536 to CECC). Twenty-six
participants withdrew after randomization, 22 before and four after
intervention. Fifty of 517 (9.7%) randomized to MiECC and 69/522 (13.2%)
randomized to CECC group experienced the primary outcome (risk ratio =
0.732, 95% confidence interval (95% CI) = 0.556 to 0.962, p = 0.025). The
risk of any SAE not contributing to the primary outcome was similarly
reduced (risk ratio = 0.791, 95% CI 0.530 to 1.179, p = 0.250).
<br/>Conclusion(s): MiECC reduces the relative risk of primary outcome
events by about 25%. The risk of other SAEs was similarly reduced. Because
the trial terminated early without achieving the target sample size, these
potential benefits of MiECC are uncertain.<br/>Copyright &#xa9; The
Author(s) 2024.

<30>
Accession Number
2037515516
Title
Effect of Enhanced Recovery After Surgery (ERAS) Programs on Perioperative
Outcomes in Patients Undergoing Cardiac Surgery: A Systematic Review and
Meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(5) (pp 1325-1334),
2025. Date of Publication: 01 May 2025.
Author
Diz-Ferreira E.; Diaz-Vidal P.; Fernandez-Vazquez U.; Gil-Casado C.;
Luna-Rojas P.; Diz J.C.
Institution
(Diz-Ferreira) Well-Move Research Group, University of Vigo, School of
Medicine, University of Santiago de Compostela, Spain
(Diaz-Vidal, Fernandez-Vazquez, Gil-Casado, Luna-Rojas) School of
Medicine, University of Santiago de Compostela, Spain
(Diz) Department of Anesthesia and Postoperative Critical Care, Hospital
Alvaro Cunqueiro, Vigo, Department of Functional Biology and Health
Sciences, Well-Move Research Group, University of Vigo, Spain
Publisher
W.B. Saunders
Abstract
Background: Enhanced recovery after surgery (ERAS) programs emerged as a
strategy to reduce perioperative morbidity; however, there is currently
limited evidence of their clinical efficacy. The objective of this study
was to assess the impact of ERAS programs in cardiac surgery on hospital
length of stay, mortality, atrial fibrillation, and quality of life.
<br/>Method(s): A systematic review and meta-analysis were conducted in
accordance with the Preferred Reporting Items for Systematic reviews and
Meta-Analyses statement, encompassing studies on ERAS programs in adult
patients undergoing elective cardiac surgery. The effect size and 95%
confidence interval (CI) were estimated with a random-effects model. The
protocol was preregistered on Open Science Framework. <br/>Result(s):
Eighteen studies (published between 2016 and 2023) comprising 4,469
patients were included in the analysis, of which only one was a randomized
controlled trial. The implementation of ERAS was associated with a
reduction in hospital stay of 1.24 days (95% CI: -1.67, -0.82, p < 0.001,
I² = 83%). No differences were observed between the groups in
mortality (odds ratio: 0.65, 95% CI: 0.28, 1.48, p = 0.3, I² =
0%), nor in the incidence of atrial fibrillation (odds ratio: 0.77, 95%
CI: 0.57, 1.03, p = 0.08, I² = 17%). A meta-analysis of quality
of life was not feasible due to a lack of sufficient data.
<br/>Conclusion(s): Although ERAS programs were associated with a
reduction in hospital stay and no differences in mortality or atrial
fibrillation, the quality of the evidence was very low. To recommend the
implementation of ERAS programs in cardiac surgery, it is necessary to
have randomized studies providing evidence of its efficacy, and studies
including quality of life and other patient-centered recovery criteria
outcomes.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<31>
Accession Number
2037394744
Title
How Would We Prevent Our Own Acute Kidney Injury After Cardiac Surgery?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(5) (pp 1123-1134),
2025. Date of Publication: 01 May 2025.
Author
Pruna A.; Monaco F.; Asiller O.O.; Delrio S.; Yavorovskiy A.; Bellomo R.;
Landoni G.
Institution
(Pruna, Monaco, Delrio, Landoni) Department of Anesthesia and Intensive
Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
(Asiller) Department of Anesthesia and Intensive Care, Ankara University
Faculty of Medicine, Ankara, Turkey
(Yavorovskiy) I.M. Sechenov First Moscow State Medical University of the
Russian Ministry of Health, Moscow, Russian Federation
(Bellomo) Department of Critical Care, The University of Melbourne,
Melbourne, Australia
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Monash University, Melbourne, Australia
(Bellomo) Data Analytics Research and Evaluation Centre, Austin Hospital,
Melbourne, Australia
(Bellomo) Department of Intensive Care, Austin Hospital, Melbourne,
Australia
(Bellomo) Department of Intensive Care, Royal Melbourne Hospital,
Melbourne, Australia
(Landoni) School of Medicine, Vita-Salute San Raffaele University, Milan,
Italy
Publisher
W.B. Saunders
Abstract
Acute Kidney Injury (AKI) is a common complication after cardiac surgery
affecting up to 40% leading to increased morbidity and mortality. To date,
there is no specific treatment for AKI, thus, clinical research efforts
are focused on preventive measures. The only pharmacological preventive
intervention that has demonstrated a beneficial effect on AKI in a
high-quality, double-blind, randomized controlled trial is a short
perioperative infusion of a balanced mixture of amino acid solution. Amino
acid infusion reduced the incidence of AKI by recruiting renal functional
reserve and, therefore, increasing the glomerular filtration rate. The
beneficial effect of amino acids was further confirmed for severe AKI and
applied to patients with chronic kidney disease. Among non-pharmacological
interventions, international guidelines on AKI suggest the implementation
of a bundle of good clinical practice measures to reduce the incidence of
perioperative AKI or to improve renal function whenever AKI occurs. The
Kidney Disease Improving Global Outcomes (KDIGO) bundle includes the
discontinuation of nephrotoxic agents, volume status and perfusion
pressure assessment, renal functional hemodynamic monitoring, serum
creatine, and urine output monitoring, and the avoidance of hyperglycemia
and radiocontrast procedures. However, pooled data from a meta-analysis
did not find a significant reduction in AKI. The aim of this review is to
delineate the most appropriate evidence-based approach to prevent AKI in
cardiac surgery patients.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<32>
Accession Number
2032920306
Title
Human leukocyte antigen alloimmunization in a randomized trial of
amustaline/glutathione pathogen-reduced red cells in complex cardiac
surgery patients.
Source
Transfusion. 65(3) (pp 459-465), 2025. Date of Publication: 01 Mar 2025.
Author
Norris P.J.; Stone M.; Di Germanio C.; Balasko B.; Kaidarova Z.; Friend
H.; Varrone J.; Corash L.; Mufti N.; Benjamin R.J.
Institution
(Norris, Stone, Di Germanio, Balasko, Kaidarova) Vitalant Research
Institute, San Francisco, CA, United States
(Norris, Stone, Di Germanio) Department of Laboratory Medicine, University
of California, San Francisco, San Francisco, CA, United States
(Norris) Department of Medicine, University of California, San Francisco,
San Francisco, CA, United States
(Friend, Varrone, Corash, Mufti, Benjamin) Cerus Corporation, Concord, CA,
United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Although alloimmunization risk of pathogen-reduced (PR)
platelets has been studied, the risk has not been reported with PR red
blood cells (RBCs). Study Design and Methods: In a Phase III, randomized,
controlled trial (Red Cell Pathogen Inactivation), cardiac or
thoracic-aorta surgery patients were randomized to transfusion with
amustaline/glutathione PR versus conventional RBCs. Pre-transfusion and
Day 28 samples were evaluated for Human leukocyte antigen (HLA) Class I
and Class II antibodies at low, medium, and high cutoff values.
<br/>Result(s): The HLA alloimmunization analysis included 114
participants (53% female) in the PR and 113 (51% female) in the
conventional RBC arms. In a modified intention-to-treat analysis, 13.7% (N
= 29) and 7.2% (N = 15) developed new high-level HLA Class I or Class II
antibodies, respectively; however, there was no signal that PR-RBCs
affected the rate of HLA Class I (odds ratio (OR) 1.3 [95% confidence
interval (CI) 0.62-2.9]) or Class II antibody formation (OR 0.99 [95% CI
0.35-2.8]). Female transfusion recipients had higher risk of developing
new high-level HLA Class I antibodies (OR 12.0 [95% CI 3.5-40.9]) and
Class II antibodies (OR 5.0 [95% CI 1.4-17]). The mean number of RBC (5.5
vs. 3.6 units, p = 0.018) and platelet (1.8 vs. 1.1 units, p = 0.043)
transfusions was higher in subjects with new high-level HLA Class II
antibodies. <br/>Discussion(s): Receipt of amustaline/glutathione PR-RBC
units did not affect HLA alloimmunization risk. Female sex and number of
RBC and platelet transfusions were risk factors for the development of new
high-level HLA Class I and Class II antibodies.<br/>Copyright &#xa9; 2025
AABB.

<33>
Accession Number
646785935
Title
Red blood cell transfusion management for people undergoing cardiac
surgery for congenital heart disease.
Source
Cochrane Database of Systematic Reviews. 2025(3) (no pagination), 2025.
Article Number: CD009752. Date of Publication: 19 Mar 2025.
Author
Wilkinson K.L.; Kimber C.; Allana A.; Doree C.; Champaneria R.; Brunskill
S.J.; Murphy M.F.
Institution
(Wilkinson) Department of Paediatric and Adult Cardiothoracic Anaesthesia,
Southampton University NHS Hospital, Southampton, United Kingdom
(Kimber, Doree, Champaneria, Brunskill) Systematic Review Initiative, NHS
Blood and Transplant, Oxford, United Kingdom
(Allana) Department of Anaesthetics, University Hospital Southampton NHS
Trust, Southampton, United Kingdom
(Murphy) NHS Blood & Transplant, Oxford University Hospitals NHS
Foundation Trust; University of Oxford, Oxford, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Background: Congenital heart disease is the most common neonatal
congenital condition. Surgery is often necessary. Patients with congenital
heart disease are potentially exposed to red cell transfusion
preoperatively, intraoperatively and postoperatively when admitted for
cardiac surgery. There are a number of risks associated with red cell
transfusion that may increase morbidity and mortality. <br/>Objective(s):
To evaluate the association of red blood cell transfusion management with
mortality and morbidity in people with congenital heart disease who are
undergoing cardiac surgery. <br/>Search Method(s): We searched multiple
bibliographic databases and trials registries, including the Cochrane
Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase
(Ovid), CINAHL (EBSCOhost), Transfusion Evidence Library,
ClinicalTrials.gov and the World Health Organization (WHO) ICTRP. The most
recent search was on 2 January 2024, with no limitation by language of
publication. <br/>Selection Criteria: We included randomised controlled
trials (RCTs) comparing red blood cell transfusion interventions in
patients undergoing cardiac surgery for congenital heart disease.
Participants of any age (neonates, paediatrics and adults) and with any
type of congenital heart disease (cyanotic or acyanotic) were eligible for
inclusion. No comorbidities were excluded. <br/>Data Collection and
Analysis: Two of five (AA, CK, KW, SB, SF) review authors independently
extracted data and assessed the risk of bias in the trials. We contacted
study authors for additional information. Two review authors (CK, KW) used
GRADE methodology to assess evidence certainty for critical outcomes and
comparisons. <br/>Main Result(s): We identified 19 relevant trials. The
trials had 1606 participants, all of whom were neonates or children. No
trials were conducted in the preoperative period or with adults. The
trials compared different types of red blood cell transfusions. No trial
compared red blood cell transfusion versus no red blood cell transfusion.
None of the trials was at low risk of bias overall. Eight trials had a
high risk of bias in at least one domain, most commonly, blinding of
participants and personnel. For our critical outcomes, we judged the
certainty of the evidence based on GRADE criteria to be low or very low.
Five trials (497 participants) compared a restrictive versus a liberal
transfusion-trigger. It is very uncertain whether a restrictive
transfusion-trigger has an effect on all-cause mortality in the short-term
(0 to 30 days post-surgery) (risk ratio (RR) 1.12, 95% confidence interval
(CI) 0.42 to 3.00; 3 RCTs, 347 participants; very low certainty evidence)
or long term (31 days to two years post-surgery) (RR 0.33, 95% CI 0.01 to
7.87; 1 RCT, 60 participants; very low certainty evidence). The evidence
is also very uncertain on the incidence of severe adverse cardiac events
(RR 1.00, 95% CI 0.73 to 1.37; 2 RCTs, 232 participants) and infection (RR
0.81, 95% CI 0.47 to 1.39; 2 RCTs, 232 participants) (both very low
certainty evidence). A restrictive transfusion-trigger may have little to
no effect on the duration of mechanical ventilation (mean difference (MD)
-1.65, 95% CI -3.51 to 0.2; 2 RCTs, 168 participants; low-certainty
evidence) or of ICU stay (MD 0.15, 95% CI -0.72 to 1.01; 3 RCTs, 228
participants, low-certainty evidence). Five trials (231 participants)
compared washed red blood cells in CPB prime versus unwashed red blood
cells in CPB prime. Washing red blood cells in CPB prime may have little
to no effect on all-cause mortality in the short term (0 to 30 days
post-surgery) (RR 0.25, 95% CI 0.03 to 2.18; 2 RCTs, 144 participants) or
long term (31 days to 2 years post-surgery) (RR 0.50, 95% CI 0.05 to 5.38;
1 RCT, 128 participants) (both low-certainty evidence). The evidence is
very uncertain about the effect of washed CPB prime on severe cardiac
adverse events (RR 0.88, 95% CI 0.47 to 1.64), infection (RR 1.00, 95% CI
0.50 to 1.99) and duration of ICU stay (MD -0.3, 95% CI -4.32 to 3.72) (1
RCT, 128 participants; very low certainty evidence). Two trials (76
participants) compared crystalloid (bloodless) CPB prime versus
red-blood-cell-containing CPB prime. It is very uncertain whether
bloodless prime has an effect on the duration of mechanical ventilation
(median 8.0 hours, interquartile range (IQR) 6.8 to 9.0 hours versus
median 7.0 hours, IQR 6.0 to 8.0 hours; 1 RCT, 40 participants) or
duration of ICU stay (median 23.0 hours, IQR 21.8 to 41.5 hours versus
median 23.5 hours, IQR 21.0 to 29.0 hours; 1 RCT, 40 participants) (both
very low certainty evidence). Two trials (160 participants) compared
ultrafiltration of CPB prime versus no ultrafiltration. It is very
uncertain whether ultrafiltration of CPB prime has an effect on all-cause
mortality in the short term (0 to 30 days post-surgery) (RR not estimable;
1 RCT, 50 participants; very low certainty evidence). Ultrafiltration may
reduce the duration of mechanical ventilation (MD -16.00, 95% CI -25.00 to
-7.00) and the duration of ICU stay (MD -0.6, 95% CI -0.84 to -0.36) (1
RCT, 50 participants; low-certainty evidence). One trial (59 participants)
compared retrograde autologous CPB prime versus standard CPB prime. It is
very uncertain whether retrograde autologous CPB prime has an effect on
the duration of mechanical ventilation (MD 0.02, 95% CI -0.03 to 0.07) or
duration of ICU stay (MD 0, 95% CI -0.01 to 0.01) (1 RCT, 59 participants;
very low certainty evidence). One trial (178 participants) compared
'fresh' (not near expiry date) versus 'old' (near expiry date) red blood
cell transfusion but did not report on our outcomes. Authors' conclusions:
No randomised controlled trial compared red blood cell transfusion against
no red blood cell transfusion in people with congential heart disease
undergoing cardiac surgery. There are only small, heterogeneous trials in
children that compare different forms of red blood cell transfusion, and
there are no trials at all in adults. There is therefore insufficient
evidence to accurately assess the association of red blood cell
transfusion with the morbidity and mortality of patients with congenital
heart disease undergoing cardiac surgery. It is possible that trial
outcomes are affected by the presence or absence of cyanosis, so this
should be considered in future trial design. Further adequately powered,
high-quality trials in both children and adults are
required.<br/>Copyright &#xa9; 2025 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<34>
Accession Number
2037662112
Title
TEG 6s-Guided Algorithm for Optimizing Patient Blood Management in
Cardiovascular Surgery: Systematic Literature Review and Expert Opinion.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(5) (pp 1162-1172),
2025. Date of Publication: 01 May 2025.
Author
Maxey-Jones C.; Seelhammer T.G.; Arabia F.A.; Cho B.; Cardonell B.; Smith
D.; Leo V.; Dias J.; Shore-Lesserson L.; Hartmann J.
Institution
(Maxey-Jones) CNY Medical Services, PLLC, Baldwinsville, NY, United States
(Seelhammer) Mayo Clinic, Rochester, MN, United States
(Arabia) Banner Health, Phoenix, AZ, United States
(Cho) Johns Hopkins University, Baltimore, MD, United States
(Cardonell) University of Missouri Columbia, Columbia, MO, United States
(Smith) Spectrum Healthcare Partners, Portland, ME, United States
(Leo, Dias, Hartmann) Haemonetics Corporation, Boston, MA, United States
(Shore-Lesserson) Northwell, New Hyde Park, NY, Anesthesiology, North
Shore University Hospital, Manhasset, NY, United States
Publisher
W.B. Saunders
Abstract
Objectives: To propose a comprehensive TEG 6s-based intraoperative and/or
immediately postoperative treatment algorithm for bleeding patients
undergoing cardiac surgery. To achieve this, TEG-based treatment
algorithms in cardiac surgery were evaluated through a literature review
and structured expert opinion. <br/>Design(s): Systematic literature
review. <br/>Setting(s): Cardiac surgery. <br/>Participant(s): Adult
patients undergoing cardiac surgery with intraoperative and/or immediately
postoperative bleeding. <br/>Intervention(s): TEG-guided transfusion
algorithm. <br/>Measurements and Main Results: A literature search was
conducted for original studies reporting TEG-based treatment algorithms in
cardiac surgery settings. Of 304 identified manuscripts, fourteen met all
inclusion criteria, with two further articles identified through authors'
suggestions. There is limited evidence describing the use of TEG 6s assays
in cardiac surgery with only one study reporting a dedicated algorithm
using the TEG 6s device at a non-US center. Two additional studies
assessed TEG 6s assays. The remaining manuscripts reported algorithms
based on the TEG 5000 device. Following the author's review of the
available data, and feedback from expert opinion, a simple transfusion
algorithm was proposed as an initial framework for developing a TEG
6s-based protocol with consideration for the 2021 Society of Thoracic
Surgery/Society of Cardiovascular Anesthesiologists/American Society of
Extracorporeal Technology/Society for the Advancement of Patient Blood
Management Patient Blood Management Guidelines. <br/>Conclusion(s): A new
algorithm for cardiac surgery based on TEG 6s assays has been proposed
based on the available evidence and expert opinion for research alignment
and clinical validation.<br/>Copyright &#xa9; 2025 The Author(s)

<35>
Accession Number
2033951823
Title
Clinical Outcomes of PCI in Hospitals With or Without Surgical Backup: A
Meta-analysis.
Source
Angiology. (no pagination), 2025. Date of Publication: 2025.
Author
Haddad T.A.; Toubasi A.A.; Fahmawi A.; Zaid A.
Institution
(Haddad, Toubasi, Zaid) Faculty of Medicine, University of Jordan, Amman,
Jordan
(Fahmawi) Faculty of Medicine, Jordan University of Science and
Technology, Irbid, Jordan
Publisher
SAGE Publications Inc.
Abstract
Percutaneous coronary interventions (PCIs) have seen a steady rise. Recent
guidelines have established that PCIs conducted at non-surgical on-site
(NSOS) facilities have low complication rates and outcomes comparable to
surgical on-site (SOS) centers. However, differing perspectives in the
growing literature continue to sustain controversy. A thorough literature
review was performed across four databases, including PubMed, Cochrane
Library, Scopus, and Web of Science, to identify studies comparing
outcomes between hospitals. The primary endpoints were: 30-day mortality,
myocardial infarction (MI), cerebral vascular accident (CVA), emergency
coronary artery bypass surgery (eCABG), rePCI, and target vessel
revascularization (TVR). The final search yielded 22 studies, including a
total of 2,181,897 patients. The majority of patients (71.9%) underwent
PCI in SOS hospitals. There was a significant association of increased
eCABG (OR = 1.99; 95% CI: 1.08-3.67) and rePCI (OR = 1.62; 95% CI:
1.37-1.91) rates in SOS hospitals. However, 30-day mortality (OR = 0.91;
95% CI: 0.53-1.54), MI (OR = 1.08; 95% CI: 0.91-1.28), CVA (OR = 1.13; 95%
CI: 0.69-1.86), and TVR (OR = 1.06; 95% CI: 0.92-1.21) showed no
significant difference between hospitals. Subgroup analyses among clinical
trials and ST-segment elevation myocardial infarction (STEMI) patients
found no significant associations. Conclusively, this meta-analysis
provides updated insight into the impact of SOS on PCI outcomes, having no
difference except for eCABG and rePCI rates.<br/>Copyright &#xa9; The
Author(s) 2025.

<36>
Accession Number
2037693685
Title
Push down the membranous septum to reduce pacemaker need: A simple
deployment technique in sutureless aortic valve replacement.
Source
JTCVS Techniques. 30 (pp 48-51), 2025. Date of Publication: 01 Apr 2025.
Author
Nakayama T.; Nakamura Y.; Higuma Y.; Higashino A.; Inoue N.
Institution
(Nakayama, Nakamura, Higuma, Higashino) Department of Cardiovascular
Surgery, Chiba-Nishi General Hospital, Matsudo, Japan
(Inoue) Department of Cardiovascular Surgery, Center Hospital of the
National Center for Global Health and Medicine, Shinjuku, Japan
Publisher
Elsevier Inc.

<37>
Accession Number
2029693781
Title
Improved tricuspid regurgitation after transcatheter aortic valve
replacement is associated with better survival: Systematic review and
meta-analysis with reconstructed time-to-event data.
Source
Perfusion (United Kingdom). 40(3) (pp 621-630), 2025. Date of Publication:
01 Apr 2025.
Author
Naito N.; Takagi H.
Institution
(Naito, Takagi) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Publisher
SAGE Publications Ltd
Abstract
Background: This meta-analysis compared survival outcomes among patients
experiencing improvement in untreated significant tricuspid regurgitation
(TR) following transcatheter aortic valve replacement (TAVR) for severe
aortic stenosis, in contrast to those without improvement. <br/>Method(s):
MEDLINE and EMBASE were searched through January 2024. Pooled hazard
ratios (HR) with 95% confidence intervals (CI) were computed. Employing
network meta-analysis, a comparison involving four post-procedural TR
categories (improved, no improvement, worsened, and no change) was
executed. Subsequently, these categories were amalgamated into two groups
(less TR after TAVR and same or greater TR after TAVR), and a standard
meta-analysis was conducted. Kaplan-Meier curves depicting long-term
all-cause mortality were reconstructed utilizing individual patient data
derived from the studies. <br/>Result(s): A systematic review identified
seven non-randomized studies encapsulating 698 patients. Network
meta-analysis revealed that improved TR after TAVR correlated with
significantly lower long-term all-cause mortality compared to the
remaining cohorts. Similarly, pooled all-cause mortality of standard
meta-analysis demonstrated significant reduction in patients whose TR was
sub-baseline than those exhibiting same or greater TR after TAVR (HR [95%
CI] = 0.43 [0.32-0.58], p <.01). The hazard ratio, derived from
reconstructed time-to-event data, showed a lower long-term all-cause
mortality in patients with less TR after TAVR relative to the other cohort
(HR [95% CI] = 0.46 [0.32-0.67], p <.01). <br/>Conclusion(s): This
meta-analysis revealed that improved TR after TAVR correlates with
superior long-term survival. The benefits of simultaneous or staged
intervention on the tricuspid valve in individuals undergoing TAVR warrant
validation in future investigations.<br/>Copyright &#xa9; The Author(s)
2024.

<38>
Accession Number
2037427144
Title
Characterization of ischemic etiology in heart failure with reduced
ejection fraction randomized clinical trials: A systematic review and
meta-analysis.
Source
European Journal of Internal Medicine. 134 (pp 51-58), 2025. Date of
Publication: 01 Apr 2025.
Author
Canepa M.; Anastasia G.; Ameri P.; Vergallo R.; O'Connor C.M.; Sinagra G.;
Porto I.
Institution
(Canepa, Anastasia, Ameri, Vergallo, Porto) Cardiovascular Unit,
Department of Internal Medicine, University of Genova, Italy
(Canepa, Ameri, Vergallo, Porto) Cardiovascular Unit, IRCCS Ospedale
Policlinico San Martino, Genoa, Italy
(O'Connor) Inova Heart and Vascular Institute, Falls Church, VA, United
States
(O'Connor) Division of Cardiology, Duke University Medical Center, Durham,
NC, United States
(Sinagra) Cardiovascular Department, Azienda Sanitaria Universitaria
Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
Publisher
Elsevier B.V.
Abstract
Aims: We investigated how ischemic etiology has been assigned in heart
failure with a reduced ejection fraction (HFrEF) randomized controlled
trials (RCTs). <br/>Methods and Results: We performed a systematic review
and meta-analysis of definitions, rates of ischemic etiology and of each
ischemic definition component: i) coronary artery disease (CAD), ii)
myocardial infarction (MI), iii) coronary revascularization, and iv)
prior/current angina. A total of 145 HFrEF RCTs were selected, of which
133 (91.7 %) enrolling both ischemic and non-ischemic patients (629
patients/study on average, median age 64.8 years and ejection fraction
28.2 %). The majority of these RCTs (84.2 %) lacked of clear ischemic
etiology definition. Rate of ischemic etiology was 57.8 % (122 RCTs,
169,855 patients), of CAD 53.8 % (25 RCTs, 18,756 patients), of prior MI
46.7 % (57 RCTs, 80,582 patients), of prior revascularization 39.9 % (32
RCTs, 30,730 patients), and of prior/current angina 25.5 % (22 RCTs,
25,572 patients). In studies presenting both variables, prior MI showed
the strongest correlations with assigned ischemic etiology (beta = 0.84, p
< 0.0001, 49 RCTs), followed by prior/current angina (beta = 0.84, p <
0.0001, 20 RCTs), prior revascularization (beta = 0.30, p = 0.006, 28
RCTs), whereas CAD had no significant correlation (beta = 0.29, p = 0.162,
from 17 RCTs). Rate of prior MI decreased over time (1986-2007: 51.4 +/-
11.6 %; 2008-2016: 48.2 +/- 8.8 %; 2017-2023: 41.4 +/- 16.6 %; p = 0.057),
whereas the one of prior revascularization increased (28.3 +/- 11.2 %;
40.7 +/- 19.6 %; 49.3 +/- 19.4 %; p = 0.048). <br/>Conclusion(s): An
accurate definition of ischemic etiology is mostly lacking in HFrEF RCTs,
and primarily assigned based on investigators clinical judgment, sometimes
in the presence of a prior MI, although the rate of this component showed
a decline over time.<br/>Copyright &#xa9; 2025 The Authors

<39>
Accession Number
2037901514
Title
Ovarian cancer and isolated cardiophrenic lymph nodes metastases: a
systematic review.
Source
Journal of the Turkish-German Gynecological Association. 26(1) (pp 49-54),
2025. Date of Publication: 01 Mar 2025.
Author
Psomiadou V.; Fotiou A.; Iavazzo C.
Institution
(Psomiadou, Iavazzo) Metaxa Memorial Cancer Hospital, Piraeus, Greece
(Fotiou) Department of Obstetrics and Gynecology, Attikon Hospital,
National and Kapodistrian University, Athens Medical School, Athens,
Greece
Publisher
Turkish-German Gynecological Association
Abstract
Currently, there is limited information available on the best course of
action for advanced epithelial ovarian cancer (OC) with isolated
extra-peritoneal disease in the cardiophrenic lymph nodes. Recently, there
have been numerous reports of successful surgical removal of metastatic
cardiophrenic lymph nodes in patients with OC, mostly during primary or
interval cytoreduction procedures. However, the optimal management of
isolated, extra-peritoneal cardiophrenic lymph node metastasis (ICLNM)
remains unclear, since this clinical scenario is rather uncommon in OC and
chemotherapy is so far the indicated treatment for patients with from
advanced stage disease. We searched the English-language literature for
cases of OC with ICLNM or recurrence, evaluating the feasibility and
safety of surgical excision. From 2009 to 2022 only 11 cases were
reported. In seven the tumor was of serous histology. ICLN was detected in
five cases with primary disease and in the remaining six it was recurrence
of OC. The primary disease was treated in 10/11 patients with primary
cytoreduction while the other received systemic chemotherapy. The ICLNM
was removed in all the patients, in 10 via video-assisted thoracic surgery
and in one via transdiaphragmatic incision. Median follow-up was 10
months.<br/>Copyright&#xa9; 2025 The Author.

<40>
Accession Number
2034000613
Title
Common Risk Factors for Atrial Fibrillation After Transcatheter Aortic
Valve Implantation: A Systematic Review from 2009 to 2024.
Source
Journal of Cardiovascular Development and Disease. 12(3) (no pagination),
2025. Article Number: 90. Date of Publication: 01 Mar 2025.
Author
Montenegro-Palacios J.F.; Vidal-Canas S.; Murillo-Benitez N.E.;
Quintana-Ospina J.; Cardona-Murillo C.A.; Liscano Y.
Institution
(Montenegro-Palacios, Vidal-Canas, Murillo-Benitez, Quintana-Ospina,
Cardona-Murillo, Liscano) Specialization in Internal Medicine, Department
of Health, Universidad Santiago de Cali, Cali, Colombia
(Montenegro-Palacios, Murillo-Benitez, Quintana-Ospina, Cardona-Murillo)
Genetics, Physiology, and Metabolism Research Group (GEFIME), Universidad
Santiago de Cali, Ciencias de la Salud, Cali, Colombia
(Vidal-Canas, Liscano) Grupo de Investigacion en Salud Integral (GISI),
Departamento Facultad de Salud, Universidad Santiago de Cali, Cali,
Colombia
(Murillo-Benitez) Department of Research and Education, Clinica de
Occidente S.A., Cali, Colombia
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Transcatheter Aortic Valve Implantation (TAVI) is an effective treatment
for severe aortic stenosis in high-risk patients; however, atrial
fibrillation (AF) is a common complication associated with the procedure.
New-Onset Atrial Fibrillation (NOAF) after TAVI is linked to increased
mortality and additional complications. This study aimed to evaluate the
incidence of NOAF following TAVI and identify risk factors associated with
mortality and the development of thromboembolic events. A systematic
review of 18 studies was conducted using databases such as MEDLINE/PubMed,
EMBASE, Web of Science, Scopus, Cochrane Library, Google Scholar, Wiley
Online Library, SciELO, and Redalyc. No language restrictions were
applied, and the search covered studies from 2009 to 2024. The follow-up
period ranged from 48 h to 730 days, with a mean of 180 days. Early
monitoring and management of AF are essential in patients undergoing TAVI.
The incidence of NOAF ranged up to 29.04%, meaning about 29 out of every
100 patients were affected. AF rates varied between 7.2% and 37%, with an
average of around 20. Standardizing anticoagulation strategies is
important to reduce complications. Randomized studies are needed to
evaluate the relationship between AF and post-TAVI mortality and to
determine whether AF is a marker of higher risk or an independent factor
in these patients.<br/>Copyright &#xa9; 2025 by the authors.

<41>
Accession Number
2037618856
Title
Intraoperative Oxygenation and Microcirculatory Changes Following Off-pump
Coronary Artery Bypass Grafting: An Exploratory Secondary Analysis of a
Randomized Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(5) (pp 1188-1196),
2025. Date of Publication: 01 May 2025.
Author
Nam K.; Chung J.; Ju J.-W.; Cho Y.J.; Jeon Y.
Institution
(Nam, Chung, Ju, Cho, Jeon) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul National University
College of Medicine, Seoul, South Korea
Publisher
W.B. Saunders
Abstract
Objectives: The effect of perioperative hyperoxia on microcirculation
after cardiac surgery remains inconclusive. We evaluated the relationship
between intraoperative fractional inspired oxygen and microcirculation
after off-pump coronary artery bypass grafting (OPCAB). <br/>Design(s):
Exploratory secondary analysis of a multicenter cluster-randomized trial.
<br/>Setting(s): Three teaching hospitals. <br/>Participant(s): Adult
patients who underwent OPCAB. <br/>Intervention(s): Seven postoperative
microcirculatory parameters, including De Backer scores and the proportion
of perfused vessels via sublingual microscopy (from all and small
vessels), and thenar muscle tissue oxygenation, occlusion slope, and
recovery slope via the vascular occlusion test, were compared between
patients receiving 30% and 80% oxygen intraoperatively. Generalized
estimating equations were used to account for intracluster correlation.
<br/>Measurements and Main Results: The analysis included 52 and 51
patients from the 30% and 80% oxygen groups, respectively, for sublingual
microscopy and 59 and 53 patients for the vascular occlusion test.
Although all microcirculatory parameters were similar between groups, the
80% oxygen group had higher De Backer scores for all vessels (mean, 9.8
+/- 2.9 mm^-1 vs. 8.7 +/- 2.0 mm^-1; p = 0.011) and
small vessels (4.0 +/- 1.8 mm^-1 vs. 3.4 +/- 1.1
mm^-1; p = 0.024) than the 30% oxygen group at the end of
surgery. The 80% oxygen group also exhibited greater thenar muscle tissue
oxygenation immediately before vascular occlusion (78.4% +/- 10.5 vs.
74.0% +/- 9.3; p = 0.031) and a higher recovery score (4.1%.s^-1
+/- 1.7 vs. 3.2%.s^-1 +/- 1.4; p = 0.001). <br/>Conclusion(s):
Patients receiving 80% oxygen during OPCAB had significantly better
postoperative microcirculatory profiles than those receiving 30% oxygen.
These findings highlight the potential for optimizing perioperative
oxygenation to improve or mitigate microcirculatory impairment, thereby
reducing postoperative complications.<br/>Copyright &#xa9; 2025 Elsevier
Inc.

<42>
Accession Number
2038089304
Title
Outcomes of transcatheter vs surgical aortic valve replacement in
pre-existing chronic liver disease patients: A meta-analysis of
observational studies.
Source
IJC Heart and Vasculature. 58 (no pagination), 2025. Article Number:
101651. Date of Publication: 01 Jun 2025.
Author
Ali A.; Ali M.A.; Khattak A.I.; Khattak F.; Afridi A.; Azeem T.; Shabbar
Banatwala U.S.; Alam U.; Khan A.; Jalal U.; Moeez A.; Khan M.W.Z.; Collins
P.; Ahmed R.
Institution
(Ali, Ali, Khattak, Afridi, Azeem, Alam, Moeez, Khan) Khyber Medical
College, Peshawar, Pakistan
(Khattak) Bacha Khan Medical College, Pakistan
(Shabbar Banatwala) Dow University of Health Sciences, Pakistan
(Khan) Dow International Medical College, Pakistan
(Jalal) Allama Iqbal Medical College, Pakistan
(Collins, Ahmed) National Heart and Lung Institute, Imperial College
London, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Aortic valve stenosis in patients with chronic liver diseases,
particularly liver cirrhosis and End-Stage Liver Disease, poses
significant management challenges due to the interplay between
cardiovascular and hepatic dysfunction. This systematic review and
meta-analysis compared the safety and efficacy of Transcatheter Aortic
Valve Replacement (TAVR) and Surgical Aortic Valve Replacement in this
high-risk population. An extensive search of PubMed, Embase, and Web of
Science (inception to January 5, 2025) identified 11 retrospective studies
comprising 19,097 patients. Risk ratios for dichotomous outcomes and mean
differences (MD) for continuous outcomes, each with 95% confidence
intervals, were calculated using random-effects models. The analysis
revealed that TAVR significantly reduced hospital mortality (RR 0.36, 95 %
CI: 0.30-0.42; I² = 7.6 %), acute kidney injury (RR 0.51, 95 %
CI: 0.33-0.78; I² = 57.2 %), bleeding (RR 0.33, 95 % CI:
0.28-0.39; I² = 0.0 %), stroke (RR 0.35, 95 % CI: 0.23-0.51;
I² = 6.1 %), and blood transfusion (RR 0.48, 95 % CI:
0.40-0.57; I² = 7.6 %). TAVR was also associated with shorter
hospital stays (MD -6.77 days, 95 % CI: -9.17 to -4.38; I² =
97.5 %). No significant differences were observed in vascular
complications requiring surgery or hospital charges and post-operative
infections. These findings suggest TAVR offers significant advantages over
SAVR in reducing complications such as mortality, acute kidney injury, and
bleeding in patients with liver disease. However, further randomized
trials are necessary to confirm long-term outcomes and establish optimal
treatment strategies for this high-risk population.<br/>Copyright &#xa9;
2025 The Author(s)

<43>
Accession Number
2033678986
Title
Dexmedetomidine for Prevention of Postoperative Delirium in Patients
Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis of
Randomized Controlled Trials.
Source
Current Anesthesiology Reports. 15(1) (no pagination), 2025. Article
Number: 37. Date of Publication: 01 Dec 2025.
Author
Barbosa L.M.; Queiroz I.; Tavares A.H.; Mesquita C.F.D.; Katz J.N.
Institution
(Barbosa) Medicine Department, Federal University of Minas Gerais, Belo
Horizonte, Brazil
(Queiroz) Medicine Department, Catholic University of Pernambuco, Recife,
Brazil
(Tavares) Medicine Department, University of Pernambuco, Recife, Brazil
(Mesquita) Medicine Department, Federal University of Pernambuco, Recife,
Brazil
(Katz) Department of Medicine, NYU Grossman School of Medicine, New York,
United States
(Katz) Cardiology Department, Bellevue Hospital, New York, United States
(Queiroz) Alfredo Balena, 190, Minas Gerais, Belo Horizonte, Brazil
Publisher
Springer
Abstract
Background: Postoperative delirium is a prevalent complication following
cardiac surgery. In recent studies, dexmedetomidine has been proposed as a
potential alternative to mitigate this condition. This meta-analysis aimed
to evaluate the efficacy and safety of dexmedetomidine for preventing
postoperative delirium in cardiac surgery. <br/>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
surgery. We pooled risk ratios (RR) for binary outcomes with 95%
confidence intervals (CI) with a random-effects model. We used R version
4.4.1 for statistical analyses. The Grading of Recommendations,
Assessment, Development, and Evaluations (GRADE) approach evaluated the
quality of evidence. <br/>Result(s): Our meta-analysis included 15 RCTs
comprising 3675 patients, of whom 1842 (50.1%) 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: 0.51 to 0.89; p = 0.01). There
were no significant differences in hypotension (RR 1.42; 95% CI: 0.90 to
2.26; p = 0.13), mortality (RR 0.78; 95% CI: 0.44 to 1.36; p = 0.37), or
acute kidney injury (RR 0.96; 95% CI: 0.61 to 1.51; p = 0.87) between
groups. However, Trial sequential analysis showed insufficient power to
discard type 1 error for our results. <br/>Conclusion(s): Dexmedetomidine
significantly reduced the incidence of postoperative delirium in cardiac
surgery patients. Larger RCTs are warranted to validate these results.
<br/>Level of Evidence: MD.<br/>Copyright &#xa9; The Author(s), under
exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature 2025.

<44>
Accession Number
2033963078
Title
Clinical Outcomes and Prognostic Implications of TAVR in Patients With
Active Cancer: A Meta-Analysis.
Source
Clinical Cardiology. 48(3) (no pagination), 2025. Article Number: e70121.
Date of Publication: 01 Mar 2025.
Author
Saberian P.; Contreras R.; Gurram A.; Nasrollahizadeh A.; Keetha N.R.;
Nguyen A.L.; Nayak S.S.; Keivanlou M.-H.; Hashemi M.; Amini-Salehi E.;
Ameen D.
Institution
(Saberian, Hashemi) Cardiovascular Research Center, Hormozgan University
of Medical Sciences, Bandar Abbas, Iran, Islamic Republic of
(Contreras, Nayak, Ameen) Department of Internal Medicine, Yale New Heaven
Health Bridgeport Hospital 267 Grant St, Bridgeport, CT, United States
(Gurram) Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Nasrollahizadeh) Tehran Heart Center, Cardiovascular Diseases Research
Institute, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Keetha) Ohio Kidney and Hypertension Center 7255, Middleburg Hts, OH,
United States
(Nguyen) Division of Hematology/Oncology, Department of Internal Medicine,
UC San Diego Health Moores Cancer Center, San Diego, CA, United States
(Keivanlou, Amini-Salehi) School of Medicine, Guilan University of Medical
Sciences, Rasht, Iran, Islamic Republic of
Publisher
John Wiley and Sons Inc
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an
alternative to surgical aortic valve replacement (SAVR) for high-risk
patients with severe aortic stenosis (AS). However, the clinical outcomes
and prognostic implications of TAVR in patients with active cancer remain
uncertain. This meta-analysis evaluates procedural success, complications,
and survival outcomes of TAVR in patients with and without active cancer.
<br/>Method(s): A comprehensive literature search was conducted across
PubMed, Scopus, and Web of Science databases. Statistical analysis was
performed using a random-effects model. Statistical analyses were
conducted using STATA version 18.0. <br/>Result(s): The results of the
meta-analysis showed no significant difference in in-hospital mortality
between cancer and non-cancer patients (OR = 1.17; 95% CI: 0.83, 1.65; p =
0.27). Similarly, 30-day mortality did not differ between the two groups
(OR = 0.93; 95% CI: 0.72, 1.19; p = 0.49). However, 1-year mortality was
significantly higher in cancer patients (OR = 1.93; 95% CI: 1.45, 2.56; p
< 0.01). Two-year mortality was also higher in cancer patients (OR = 2.65;
95% CI: 1.79, 3.93; p < 0.01). No significant differences were observed in
major bleeding, acute kidney injury, stroke, or permanent pacemaker
implantation between the groups. <br/>Conclusion(s): While TAVR offers
comparable in-hospital and short-term survival outcomes for cancer and
non-cancer patients, long-term mortality is significantly higher in those
with active cancer. These findings suggest that TAVR is a viable option
for cancer patients with severe AS but requires careful long-term
prognostic considerations. Further studies are needed to optimize
management strategies for this complex population.<br/>Copyright &#xa9;
2025 The Author(s). Clinical Cardiology published by Wiley Periodicals
LLC.

<45>
Accession Number
2038062341
Title
Impact of anesthetic technique on troponin I levels in pediatric cardiac
surgery: a randomized clinical trial.
Source
Brazilian Journal of Anesthesiology (English Edition). 75(3) (no
pagination), 2025. Article Number: 844603. Date of Publication: 01 May
2025.
Author
Barelli J.V.G.; Araujo D.D.; Zeferino S.P.; Dantas G.M.; Galas F.B.
Institution
(Barelli, Araujo, Zeferino, Dantas) Faculdade de Medicina da Universidade
de Sao Paulo, SP, Sao Paulo, Brazil
(Galas) Faculdade de Medicina da Universidade de Sao Paulo, Departamento
de Anestesia, SP, Sao Paulo, Brazil
Publisher
Elsevier Editora Ltda
Abstract
Background: This study aimed to evaluate the effects of the inhalational
anesthetic sevoflurane on postoperative myocardial injury and renal
function in children under 2 years old with congenital heart disease
(RACHS 1, 2, and 3) undergoing cardiac surgery with extracorporeal
circulation. <br/>Method(s): A randomized clinical trial was conducted
with 66 patients divided into two groups: one receiving sevoflurane and
the other Total Intravenous Anesthesia (TIVA). The primary outcome was the
serum troponin I levels within the first 48 hours postoperatively.
Secondary outcomes included urine output and serum urea levels.
<br/>Result(s): The median troponin I levels at 48 hours were 10.5 ng.mL-1
(IQR: 8.2-12.7) in the sevoflurane group and 11.0 ng.mL^-1 (IQR:
8.7-13.0) in the TIVA group (p = 0.336). The sevoflurane group showed
higher urine output on the second postoperative day (median: 800 mL [IQR:
420-913] vs. 541 mL [IQR: 312-718], p = 0.034) and lower serum urea levels
(median: 24 mg.dL^-1 [IQR: 16-35] vs. 36 mg.dL^-1
[IQR: 23-49], p = 0.030). <br/>Conclusion(s): While sevoflurane did not
significantly impact myocardial injury markers, it demonstrated potential
renal protective effects in this patient population. Further research is
necessary to confirm these findings across different pediatric age groups
and surgical contexts.<br/>Copyright &#xa9; 2025 Sociedade Brasileira de
Anestesiologia

<46>
Accession Number
2033928252
Title
Antithrombotic strategy following valve-in-valve transcatheter aortic
valve replacement. A German Statutory Health Claims data analysis.
Source
Clinical Research in Cardiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Heyne S.; Hohmann C.; Macherey-Meyer S.; Meertens M.M.; Kuhn E.; Marschall
U.; Wienemann H.; Mauri V.; Adam M.; Baldus S.; Lee S.
Institution
(Heyne, Hohmann, Macherey-Meyer, Meertens, Wienemann, Mauri, Adam, Baldus,
Lee) Clinic III for Internal Medicine, Faculty of Medicine, University
Hospital Cologne, University of Cologne, Kerpener Str. 62, Cologne,
Germany
(Kuhn) Department of Cardiac Surgery, Faculty of Medicine, University
Hospital Cologne, University of Cologne, Cologne, Germany
(Marschall) BARMER, Wuppertal, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aims: Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR)
procedures are increasingly used. Specific recommendations on
antithrombotic strategies following ViV-TAVR are lacking. We aimed to
assess the efficacy of different antithrombotic strategies following
ViV-TAVR. <br/>Methods and Results: We performed a retrospective analysis
of German Statutory Health Claims data following ViV-TAVR stratified by
antithrombotic strategies according to prescription within 90 days.
Antithrombotic regimens included antiplatelet therapy (APT), direct oral
anticoagulants (DOACs) or vitamin K antagonists (VKAs). The composite
endpoint was all-cause mortality, stroke and/or systemic embolism (SSE)
and mechanical complication of heart valve prosthesis at 12 months. Cox
proportional hazard regression models were used to compare outcomes. In
total, 908 patients between 2005 and 2022 were identified. Of these, 286
received DOACs, 99 received VKAs, 351 received APT exclusively and 172 had
no prescription. The incidence of the composite endpoint was 20.8% in the
APT group, 20.3% in the DOAC group and 25.3% in the VKA group which was
not statistically significantly different. The rate of SSE in the
acetylsalicylic acid (ASA) mono group was higher compared to the dual
antiplatelet therapy (DAPT) group (27.3% vs. 12.4%, univariable HR 0.42,
95% CI [0.19, 0.95], p = 0.03). <br/>Conclusion(s): In this analysis of
German Health Claims data, DOACs seemed to be a safe alternative to VKAs
and APT. ASA monotherapy was associated with higher rates of SSE compared
to DAPT. Given the high risk of bias of this retrospective analysis and
the growing use of valve-in-valve procedures, randomized controlled trials
are needed to confirm these findings.<br/>Copyright &#xa9; The Author(s)
2025.

<47>
Accession Number
2036017338
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. 14(6) (no pagination), 2025.
Article Number: e034932. Date of Publication: 18 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
(Shuvy) Jesselson Integrated Heart Centre, Shaare Zedek Medical Center and
Faculty of Medicine, Hebrew University, Jerusalem, Israel
Publisher
American Heart Association Inc.
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%). <br/>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.<br/>Copyright
&#xa9; 2025 The Author(s). Published on behalf of the American Heart
Association, Inc., by Wiley.

<48>
[Use Link to view the full text]
Accession Number
2037898286
Title
Prophylactic efficacy of oral gabapentin on postoperative shivering: A
meta-analysis of randomized controlled trials.
Source
Medicine (United States). 104(10) (pp e41421), 2025. Date of Publication:
07 Mar 2025.
Author
Liang X.; Chen M.; Hong A.; Gu Z.; Jiang J.; Chen Y.; Zhu M.; Tian W.
Institution
(Liang, Gu, Zhu) Department of Anesthesiology, Jiangnan University Medical
Center, Wuxi No.2 People's Hospital, Affiliated Wuxi Clinical College of
Nantong University, Wuxi, China
(Liang, Hong, Tian) Department of Anesthesiology, Affiliated Hospital of
Nanjing University of Chinese Medicine, Jiangsu Province Hospital of
Chinese Medicine, Nanjing, China
(Chen) Department of Orthopedic, Jiangnan University Medical Center,
Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
(Jiang) Jiangnan University Medical Center, Affiliated Wuxi Clinical
College of Nantong University, Wuxi, China
(Chen) Department of Cardiology, Yixing People's Hospital, Yixing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative shivering may lead to severe side effects during
postoperative care, particularly in patients with impaired cardiopulmonary
function. The efficacy of oral gabapentin as a preventive strategy for
postoperative shivering has not been quantitatively analyzed. In this
meta-analysis, we aimed to evaluate the effectiveness of gabapentin as a
drug for treating postoperative shivering. <br/>Method(s): A review of the
Cochrane Library, PubMed, and Embase was conducted by 2 researchers for
randomized controlled trials (RCTs). In this meta-analysis, Review Manager
was used to analyze these RCTs on oral gabapentin for postoperative
shivering. <br/>Result(s): Six trials with 544 patients were included in
our meta-analysis. Prophylactic oral gabapentin reduced postoperative
shivering compared with placebo (pooled risk ratio [RR]: 0.38, 95%
confidence interval [CI]: 0.25-0.57). The anti-shivering effect could be
achieved after both general anesthesia (pooled RR of 3 trails: 0.28, 95%
CI: 0.14-0.56) and orthopedic surgery (pooled RR of 4 trails: 0.38, 95%
CI: 0.24-0.58). Meanwhile, gabapentin also could decrease postoperative
vomiting (POV; pooled RR 0.35, 95% CI 0.16-0.77). <br/>Conclusion(s): Our
current meta-analysis shows that compared with placebo, oral gabapentin
can reduce the incidence of postoperative shivering. This result also
provides new evidence to strengthen the clinical application value of
gabapentin in the conventional treatment of POV.<br/>Copyright &#xa9; 2025
the Author(s).

<49>
Accession Number
2038070070
Title
The effects of sodium-glucose transporter 2 inhibition on cardiac
surgery-associated acute kidney injury: An open-label randomized pilot
study.
Source
Journal of Clinical Anesthesia. 103 (no pagination), 2025. Article Number:
111811. Date of Publication: 01 Apr 2025.
Author
Snel L.I.P.; Oosterom-Eijmael M.J.P.; Rampanelli E.; Lankadeva Y.R.;
Plummer M.P.; Preckel B.; Hermanides J.; van Raalte D.H.; Hulst A.H.
Institution
(Snel, Oosterom-Eijmael, Preckel, Hermanides, Hulst) Department of
Anesthesiology, Amsterdam University Medical Center, Amsterdam,
Netherlands
(Snel, Oosterom-Eijmael, van Raalte) Department of Endocrinology,
Amsterdam University Medical Center, Amsterdam, Netherlands
(Snel, Oosterom-Eijmael, Rampanelli, Hulst) Amsterdam Cardiovascular
Sciences Research Institute, Amsterdam, Netherlands
(Snel, Oosterom-Eijmael, Preckel, Hermanides) Amsterdam Public Health
Research Institute, Quality of Care, Amsterdam, Netherlands
(Rampanelli, van Raalte) Department of Experimental Vascular Medicine,
Amsterdam University Medical Center, Amsterdam, Netherlands
(Rampanelli, Hulst) Amsterdam Gastroenterology Endocrinology Metabolism
Research Institute, Amsterdam, Netherlands
(Lankadeva) Preclinical Critical Care Unit, Florey Institute of
Neuroscience and Mental Health, The University of Melbourne, Melbourne,
VIC, Australia
(Lankadeva, Plummer, Hulst) Department of Critical Care, Melbourne Medical
School, The University of Melbourne, Melbourne, VIC, Australia
(Plummer) Intensive Care Unit Research, Royal Adelaide Hospital, Adelaide,
SA, Australia
Publisher
Elsevier Inc.
Abstract
Background: Sodium-glucose transporter-2 (SGLT2) inhibitors reduced the
incidence of acute kidney injury in large cardiovascular outcome trials in
patients with chronic heart and kidney failure. Acute kidney injury is a
common complication following cardiac surgery. We hypothesized that
perioperative SGLT2 inhibition could reduce kidney injury after cardiac
surgery, measured with the biomarker neutrophil gelatinase-associated
(NGAL). <br/>Method(s): In this open-label phase IV, randomized,
parallel-group, pilot study, adult patients undergoing elective cardiac
surgery with cardiopulmonary bypass were randomized to receive either an
SGLT2 inhibitor, empagliflozin (10 mg; oral) once daily, from three days
before surgery until postoperative day two, or standard-of-care. The
primary outcome was the between-group difference of serum NGAL on the
second postoperative day. Moreover, other biomarkers for acute kidney
injury were measured, including serum kidney injury molecule-1 (KIM-1),
hypoxia-inducible factor-1 alpha (HIF-1alpha), and urine NGAL/Creatinine
and KIM-1/Creatinine ratios. Additional outcomes included acute kidney
injury incidence within the first seven days following cardiac surgery
according to Kidney Disease: Improving Global Outcomes criteria and
metabolic parameters, including ketone body concentrations and glycemic
control. <br/>Result(s): Between March 2022 and April 2023, 55 patients
were included (sex: 73 % male, age: 66 +/- 10 years, BMI: 28 +/- 4
kg/m², empagliflozin n = 25, control n = 30) in the
intention-to-treat analysis. There were no significant between-group
differences in serum and urine NGAL or KIM-1. However, empagliflozin
significantly reduced the incidence of acute kidney injury (20 % vs 66.7
%; absolute difference 46.7 %, 95 % CI, -69.7 - -23.6; P < .001). A
significant increase in serum HIF-1alpha after surgery was solely observed
in the control group. We observed no between-group differences in the
incidence of (euglycemic) ketoacidosis or hypoglycemic events.
<br/>Conclusion(s): In this pilot study, perioperative SGLT2 inhibition
was not associated with lower NGAL levels. We observed that SGLT2
inhibition reduced the incidence of acute kidney injury in this small
study population. As the results of this pilot study are
hypotheses-generating, further validation is needed in a large-scale,
double-blind, placebo-controlled, randomized trial, which is currently
ongoing.<br/>Copyright &#xa9; 2024

<50>
Accession Number
2035974625
Title
The Effect of Intraoperative Dexmedetomidine on Postoperative Delirium
Sedation Agitation Score in cardiac surgery.
Source
Anesthesiology and Pain Medicine. 15(2) (no pagination), 2025. Article
Number: e156544. Date of Publication: 30 Apr 2025.
Author
Ghanbarpour M.H.; Dabbagh A.; Jahangirifard A.; Shafigh N.; Fani M.; Fani
K.
Institution
(Ghanbarpour) Department of Anesthesiology, School of Medicine, Zanjan
University of Medical Sciences, Zanjan, Iran, Islamic Republic of
(Dabbagh) Department of Anesthesiology, Anesthesiology Research Center,
School of Medicine, Shahid Beheshti University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Jahangirifard) Lung Transplantation Research Center, National Research
Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Shafigh) Department of Anesthesiology and Critical Care Medicine, School
of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Fani) School of Medicine, Shahid Beheshti University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Fani) Department of Anesthesiology, School of Medicine, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Brieflands
Abstract
Background: Postoperative delirium is a significant problem that
deteriorates the cognitive state of patients after cardiac surgery, which
can be a short-or long-term complication. <br/>Objective(s): This study
was conducted to evaluate the efficacy of dexmedetomidine, commenced
simultaneously with anesthesia induction and continued throughout the
surgical operation, on postoperative delirium after cardiac surgery with
cardiopulmonary bypass. <br/>Method(s): This randomized, double-blind,
case-control trial was conducted on sixty-one patients undergoing cardiac
surgery. The patients were randomly divided into dexmedetomidine (case)
and normal saline (control) groups. The primary outcome was the incidence
of delirium, as screened by the Confusion Assessment Method for the ICU
(CAM-ICU). <br/>Result(s): There was no distinction in CAM-ICU outcomes
between the two groups at 6 and 24 hours postoperatively. However, the
difference in non-positive CAM-ICU results was statistically significant
at 24 hours for +1 and-1 Richmond Agitation-Sedation Scale scores.
<br/>Conclusion(s): Starting dexmedetomidine before cardiopulmonary bypass
did not significantly affect the delirium rate based on CAM-ICU
assessments. Further research examining larger groups is necessary to
clarify the efficacy of perioperative dexmedetomidine on postoperative
delirium.<br/>Copyright &#xa9; 2025, Ghanbarpour et al.

<51>
Accession Number
2032956166
Title
Early and Late Outcomes of Transcatheter Aortic Valve Replacement in
Patients With Prior Chest Radiation: A Systematic Review and
Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. 105(5) (pp 1012-1023),
2025. Date of Publication: 01 Apr 2025.
Author
Tzoumas A.; Kyriakoulis I.; Ntoumaziou A.; Sagris M.; Kampaktsis P.N.
Institution
(Tzoumas) Division of Cardiovascular Health and Disease, University of
Cincinnati Medical Center, Cincinnati, OH, United States
(Kyriakoulis) Faculty of Medicine, School of Health Sciences, University
of Thessaly, Larissa, Greece
(Ntoumaziou) Cincinnati Children's Hospital, Cincinnati, OH, United States
(Sagris) School of Medicine, "Hippokration" General Hospital, National and
Kapodistrian University of Athens, Athens, Greece
(Kampaktsis) Hackensack University Medical Center, Hackensack, NJ, United
States
(Kampaktsis) Aristotle University of Thessaloniki, Thessaloniki, Greece
Publisher
John Wiley and Sons Inc
Abstract
Background: Patients with prior history of chest or mediastinal radiation
are deemed high risk for surgical AVR. Transcatheter aortic valve
replacement (TAVR) has emerged as a promising alternative for these
patients, however, this patient population was underrepresented in prior
TAVR trials. <br/>Aim(s): To compare the outcomes of TAVR in patients with
versus without a history of prior chest or mediastinal radiation.
<br/>Method(s): This study was performed according to the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Systematic search of electronic databases was conducted up to September
2023. We compared early and late mortality as well as complications. A
meta-analysis was conducted with the use of a random effects model. The
I-square statistic was used to assess heterogeneity. <br/>Result(s): Seven
studies comprising 6358 patients were included in this meta-analysis.
Patients undergoing TAVR in the radiation group had a higher risk for
heart failure exacerbation (OR: 2.06; 95% CI: 1.18-3.59) and aortic valve
reintervention (OR: 5.68; 95% CI: 1.83-17.67) in the early postoperative
period compared to the nonradiation group. Analysis revealed similar
short-term (in-hospital or 30-day) all-cause-mortality (OR: 1.63; 95% CI:
0.89-2.98) between the two groups. Other perioperative complications
including myocardial infarction (MI), stroke, pacemaker insertion
requirement, major bleeding as well as access-related complications were
not significantly different between the two groups. TAVR in the radiation
group was not associated with increased all-cause mortality compared to
the nonradiation group (OR: 1.40; 95% CI: 0.93-2.11) after a mean
follow-up of 17.6 months. Other endpoints including MI, stroke, need for
pacemaker insertion, heart failure readmission rate, and need for aortic
valve reintervention were similar in the mid-term follow-up between the
two groups. <br/>Conclusion(s): TAVR in patients with a history of prior
chest or mediastinal radiation was associated with similar short-term and
mid-term mortality compared to patients without radiation. The history of
chest or mediastinal radiation was associated with more frequent heart
failure hospitalizations and aortic valve reintervention in the
postoperative period. No difference was found in mid-term complications.
Future studies are warranted to validate our findings.<br/>Copyright
&#xa9; 2025 Wiley Periodicals LLC.

<52>
Accession Number
2032698291
Title
Comparison of remimazolam and sevoflurane for general anesthesia during
transcatheter aortic valve implantation: a randomized trial.
Source
Canadian Journal of Anesthesia. 72(3) (pp 397-408), 2025. Article Number:
e013080. Date of Publication: 01 Mar 2025.
Author
Harimochi S.; Godai K.; Nakahara M.; Matsunaga A.
Institution
(Harimochi, Nakahara, Matsunaga) Department of Anesthesiology and Critical
Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima
University, Kagoshima, Japan
(Godai, Matsunaga) Operating Room, Kagoshima University Hospital,
Kagoshima, Japan
(Godai) Department of Anesthesiology and Critical Care Medicine, Graduate
School of Medical and Dental Sciences, Kagoshima University, 8-35-1
Sakuragaoka, Kagoshima, Japan
Publisher
Springer
Abstract
Purpose: Safe perioperative management of patients undergoing
transcatheter aortic valve implantation (TAVI) is crucial. Remimazolam is
a newly developed short-acting benzodiazepine. We hypothesized that
combining remimazolam and flumazenil would reduce emergence time compared
with sevoflurane in patients undergoing general anesthesia for TAVI.
<br/>Method(s): We conducted a prospective, randomized, parallel-design,
open-label, single-centre clinical trial between June 2022 and August 2023
at Kagoshima University Hospital. We allocated patients randomly to either
the remimazolam/flumazenil group or the sevoflurane group. Patients in the
remimazolam group received iv remimazolam whereas patients in the
sevoflurane group received sevoflurane for general anesthesia maintenance.
Patients in both groups received a remifentanil infusion throughout the
TAVI procedure (0.2 mug.kg^-1.min^-1iv). Remimazolam
and sevoflurane were adjusted to maintain a Bispectral IndexTM
(Covidien/Medtronic, Minneapolis, MN, USA) of 40-60. In the remimazolam
group, flumazenil (0.2 mg iv) was administered immediately after
remimazolam discontinuation. The primary outcome was time to extubation.
Secondary outcomes included intraoperative variables (hemodynamic
variables and vasopressor dose), rate of intra- and postoperative
complications, and recovery of muscle strength. <br/>Result(s): Overall,
60 patients were enrolled, and data from 56 were included. The median
[interquartile range] time to extubation was significantly shorter in the
remimazolam group than in the sevoflurane group (6.5 [5.1-8.1] min vs 14.2
[10.9-15.9] min; difference in medians, -6.9 min; 95% confidence interval,
-8.7 to -5.0; P < 0.001). Statistically significant differences were
observed in the perfusion index (P = 0.03) and regional cerebral oxygen
saturation (P = 0.03) between the groups. No significant differences
between the two groups were seen in other secondary outcomes.
<br/>Conclusion(s): Compared with sevoflurane, a combination of
remimazolam and flumazenil significantly reduced the time to extubation in
patients undergoing general anesthesia for TAVI. Therefore, remimazolam
may be a suitable choice for general anesthesia in patients undergoing
TAVI. Study registration: UMIN.ac.jp (UMIN000047892); first posted 30 May
2022.<br/>Copyright &#xa9; The Author(s) 2024.

<53>
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. 39(5) (pp 1180-1187),
2025. Date of Publication: 01 May 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. <br/>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). <br/>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.
<br/>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. <br/>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. <br/>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.
<br/>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.<br/>Copyright &#xa9; 2025
Elsevier Inc.

<54>
Accession Number
2037346925
Title
Current evidence and indications for left atrial appendage closure.
Source
Journal of Cardiology. 85(4) (pp 268-274), 2025. Date of Publication: 01
Apr 2025.
Author
Shinohara M.; Saji M.; Koike H.; Ohara H.; Enomoto Y.; Nakanishi R.;
Fujino T.; Ikeda T.
Institution
(Shinohara) Helmsley Electrophysiology Center, Department of Cardiology,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Shinohara, Saji, Koike, Ohara, Nakanishi, Fujino, Ikeda) Division of
Cardiovascular Medicine, Department of Internal Medicine, Toho University
Faculty of Medicine, Tokyo, Japan
(Enomoto) Division of Cardiovascular Medicine, Toho University Ohashi
Medical Center, Tokyo, Japan
(Enomoto) Division of Cardiology, National Center for Global Health and
Medicine Hospital, Tokyo, Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide and its
prevalence increases with age. The main and most severe complication of AF
is ischemic stroke, yet an estimated 50 % of eligible patients cannot
tolerate or are contraindicated to receive oral anticoagulation (OAC). In
patients with AF, the left atrial appendage (LAA) is the main source of
thrombus formation. Percutaneous LAA closure (LAAC) has emerged over the
past two decades as a valuable alternative to OAC for reducing the risk of
strokes and systemic embolisms in patients with AF who cannot tolerate
long-term OAC. With newer generation devices such as the Watchman (Boston
Scientific, Natick, MA, USA) and Amulet (Abbott, Abbott Park, IL, USA)
gaining approval from the US Food and Drug Administration in recent years,
the safety and efficacy of LAAC in specific populations intolerant to OAC
have increased and more patients are being treated. This systematic review
provides the indications for LAAC and the evidence for evaluating the use
of the currently available device therapies. We also examine the current
unsolved problems with patient selection and postprocedural antithrombotic
regimens.<br/>Copyright &#xa9; 2025 Elsevier Ltd

<55>
Accession Number
2034059623
Title
Incidence of stroke in patients with atrial fibrillation undergoing
surgical treatment: a meta-analysis.
Source
BMC Cardiovascular Disorders. 25(1) (no pagination), 2025. Article Number:
233. Date of Publication: 01 Dec 2025.
Author
Lin D.; Cheng Y.; Yu S.; Liu X.; Yan C.; Cheng W.
Institution
(Lin, Cheng, Yu, Liu, Yan, Cheng) Department of Cardiac Surgery, Southwest
Hospital, Third Military Medical University (Army Medical University),
Chongqing, China
Publisher
BioMed Central Ltd
Abstract
Introduction: Atrial fibrillation (AF) is self-limiting condition, but it
may also increase the risk of stroke and death. The association between AF
and surgery with stroke was assessed both subjectively and statistically
using systematic review and meta-analysis. <br/>Method(s): For data
collection, a thorough search was made in PubMed, EMBASE, Science Direct,
Google Scholar, and Cochrane Library using searching keywords
"postoperative ischemic stroke, atrial fibrillation, stroke, cardiac
surgery, brain ischemia, and heart surgery". Direct and indirect
comparisons were made using random-effect network meta-analysis.
<br/>Result(s): 16-studies were identified comprising of 132,208 patient,
64% male, median age > 63 years and follow-up > 1.5 years. Pooling the
results from the random-effects model showed odds ratios associated with
the risk of stroke of surgical processes (CABG) in patients with AF. The
odds ratio OR = 1.1 (0.65-1.54, P < 0.001) and heterogeneity (I2 = 17%, P
= 0.13) exposing higher risk of the stroke. Odds ratio (HR 1.5, 0.9-1.71)
without heterogeneity showed greater risk of stroke after heart valve
surgery in patients with AF. Study 8 didn't show any risk of the stroke
after left atrial appendage (LAA) clipping intervention, but the outcomes
were biased. A pooled analysis showed odd ratio OR, 2 (1.7-2.1, P <
0.0001), without heterogeneity indicating higher stroke risk in general
cardiac surgery. The patients undergone cardiac surgery from three studies
with pooled analysis study-5 OR 2 (1.7-2.1, P > 0.001), study-6 OR 1.8
(1.7-1.9, P > 0.001), and study-14 OR 7.8 (6.2-8.1, P > 0.0001).
<br/>Conclusion(s): The study clearly defines stroke outcomes when they
are quantified, however, further research is required.<br/>Copyright
&#xa9; The Author(s) 2025.

<56>
Accession Number
2034046958
Title
Comparison of ezetimibe and atorvastatin versus atorvastatin alone on
short-term major adverse cardiac events after percutaneous coronary
intervention, a double-blind placebo-controlled randomized clinical trial.
Source
Trials. 26(1) (no pagination), 2025. Article Number: 108. Date of
Publication: 01 Dec 2025.
Author
Farshidi H.; Bijani B.; Sobhani S.A.; Dastsouz F.; Abbaszadeh S.
Institution
(Farshidi, Bijani, Dastsouz, Abbaszadeh) Cardiovascular Research Center,
Hormozgan University of Medical Sciences, Bandar Abbas, Iran, Islamic
Republic of
(Farshidi) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Sobhani) Department of Pathology, School of Medicine, Hormozgan
University of Medical Sciences, Bandar Abbas, Iran, Islamic Republic of
Publisher
BioMed Central Ltd
Abstract
Background: Major cardiovascular events (MACE) after percutaneous coronary
intervention (PCI) are among the most common causes of death in patients.
Lipid-lowering strategies seem to affect these events. Reaching the best
regimen for controlling lipid abnormalities is important. This study aimed
to compare the effect of ezetimibe and atorvastatin versus atorvastatin
alone in short-term major cardiovascular events in patients after PCI in
Bandar Abbas in 2018. <br/>Method(s): This double-blinded randomized
controlled trial was done in Bandar Abbas in 2018 on 224 patients.
Patients were randomly divided into two groups either to receive ezetimibe
and atorvastatin (group A) or atorvastatin alone (group B). Patients were
followed for 1 month for major cardiovascular events and drug side
effects. Data was analyzed using SPSS software. <br/>Result(s): Patients
in the two groups had similar baseline characteristics. The mean
low-density lipoproteins (LDL) level was 69.83 +/- 28.8 in group A and
82.45 +/- 29.9 in group B (P = 0.014). At the end of the study,
high-sensitivity C-reactive protein (hs-CRP) values were notably lower in
group A (P value = 0.005). Three (2.7%) patients in group A and 1 patient
(0.9%) in group B had a myocardial infarction (P value = 0.313). Also, 11
patients (9.8%) in group A and 13 patients (11.6%) in group B had unstable
angina (P value = 0.666). No patients had death, cerebrovascular event, or
stent thrombosis in the two groups. <br/>Conclusion(s): Although adding
ezetimibe to atorvastatin can decrease LDL and hs-CRP levels in short-term
follow-up; it is not effective in lowering short-term major cardiovascular
events in patients after PCI. Studies with longer-term follow-up are
recommended. Trial registration: IRCT, IRCT20171028037047N1. Registered on
22 June 2018, https://irct.behdasht.gov.ir/trial/28808.<br/>Copyright
&#xa9; The Author(s) 2025.

<57>
Accession Number
2036004964
Title
Comparative Analysis of Ultrasound-Guided Pain Management Approaches for
Sternotomy in Cardiac Surgeries-Transversus Thoracic Muscle Plane Block vs
Pecto-Intercostal Fascial Block.
Source
Ochsner Journal. 25(1) (pp 11-16), 2025. Date of Publication: 01 Mar 2025.
Author
Vanjare H.; Deshmukh C.P.; Barasker S.K.; Kassim A.M.; Arya B.
Institution
(Vanjare, Barasker, Arya) Department of Anaesthesia, Sri Aurobindo Medical
College & PG Institute, Madhya Pradesh, Indore, India
(Deshmukh) Department of Community Medicine, Sri Aurobindo Medical College
& PG Institute, Madhya Pradesh, Indore, India
(Kassim) Department of Anaesthesia, Jawaharlal Institute of Postgraduate
Medical Education and Research, Pondicherry,, Tamil Nadu, India
Publisher
Ochsner Clinic
Abstract
Background: Pain management after sternotomy in cardiac surgery is vital
for recovery. Opioids are commonly used, but they carry risk. Central
neuraxial techniques and nerve blocks are options for a multimodality
approach. Fascial plane blocks such as the transversus thoracic muscle
plane block (TTMPB) and the pecto-intercostal fascial block (PIFB) are a
relatively new way to relieve pain, and their popularity has increased
with the use of ultrasound for precise anatomic visualization. Because the
effectiveness of both blocks is similar, we conducted this study to
compare the pain management of the TTMPB and the PIFB after sternotomy in
cardiac surgery. <br/>Method(s): This randomized double-blind study
included 118 patients who underwent cardiac surgery. In the TTMPB group
(n=59), 20 mL of 0.2% ropivacaine was injected bilaterally using
ultrasound assistance in the transversus thoracic plane. In the PIFB group
(n=59), 20 mL of 0.2% ropivacaine was injected in the pecto-intercostal
plane. Study outcomes were opioid consumption in the first 24 hours and
pain scores at 0, 3, 6, 12, and 24 hours postoperatively. <br/>Result(s):
Patient characteristics in the 2 groups were similar. Opioid consumption
was similar in both groups (P=0.672), and we found no difference in pain
scores between the 2 groups at any of the time intervals.
<br/>Conclusion(s): The TTMPB and the PIFB were similarly effective in
treating acute poststernotomy pain in our patient
population.<br/>Copyright &#xa9; 2025 by the author(s).

<58>
[Use Link to view the full text]
Accession Number
2037648457
Title
Early PCSK9 Inhibitor Therapy Following Percutaneous Coronary Intervention
(PERFECT): A Pilot Randomized Controlled Trial.
Source
Cardiology Discovery. 5(1) (pp 62-68), 2025. Date of Publication: 01 Mar
2025.
Author
Xia J.; Xiao Z.; Wu L.; Yu H.; Pang Y.; Hu S.; Hou L.
Institution
(Xia, Wu) Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong
University School of Medicine, Shanghai, China
(Xiao) Department of Radiology, Tongren Hospital, Shanghai Jiao Tong
University School of Medicine, Shanghai, China
(Yu, Pang, Hou) Department of Cardiology, Songjiang Hospital Affiliated to
Shanghai Jiao Tong University School of Medicine, Shanghai, China
(Hu) Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser
Hospital), Qingdao, Shandong, China
Publisher
Wolters Kluwer Health
Abstract
Objective: This study aimed to assess the impact of proprotein convertase
subtilisin/kexin type 9 (PCSK9) inhibitor treatment immediately after
percutaneous coronary intervention (PCI) on the myocardial salvage index
(MSI) in patients with anterior ST-segment elevation myocardial infarction
(STEMI) 5-10 d after the procedure. <br/>Method(s): The early PCSK9
inhibitor thERapy Following pErcutaneous Coronary in Tervention (PERFECT)
trial is a prospective randomized controlled trial. From January 2021 to
December 2023, 32 patients with anterior STEMI from Tongren Hospital,
Shanghai Jiao Tong University School of Medicine, Songjiang Hospital
Affiliated to Shanghai Jiao Tong University School of Medicine, and
Shanghai Tenth Peoplea's Hospital were enrolled in the PERFECT trial.
Patients were randomly assigned in a 1:1 ratio to the PCSK9 inhibitor
group (n = 16) or the control group (n = 16), and their baseline data were
collected. Patients in the PCSK9 inhibitor group (ie, alirocumab group)
received a subcutaneous injection of PCSK9 inhibitor (alirocumab, 75 mg)
immediately after PCI based on conventional treatment. In the control
group, patients received only conventional treatment. The primary endpoint
was the MSI measured by cardiovascular magnetic resonance 5-10 d after
PCI. The secondary endpoints included the left ventricular ejection
fraction measured by cardiovascular magnetic resonance 5-10 d after PCI
and the time to peak of creatine kinase isoenzyme-MB and high-sensitivity
cardiac troponin T. Safety endpoints included any clinical adverse events
that occurred during the 6-month follow-up period. <br/>Result(s):
Baseline data during admission showed no intergroup significance. No
significant difference in MSI (55.54% +/- 14.80% vs. 44.72% +/- 15.42%, P
= 0.056) and left ventricular ejection fraction (51.24% +/- 8.91% vs.
44.99% +/- 8.84%, P = 0.060) was observed. Additional, there was no
significant difference in the time to peak of creatine kinase isoenzyme-MB
((12.97 +/- 5.67) h vs. (14.31 +/- 7.04) h, P = 0.557) and
high-sensitivity cardiac troponin T ((21.03 +/- 12.46) h vs. (21.44 +/-
9.99) h, P = 0.920) between the 2 groups. During the 6-month follow-up
period, only 1 patient in the PCSK9 inhibitor group developed cerebral
hemorrhage 6 months after PCI. <br/>Conclusion(s): Early treatment with
alirocumab did not exhibit a significant increase in MSI at 5-10 d in
patients with anterior STEMI. Larger trials are necessary to evaluate the
impact of early administration of PCSK9 inhibitors after myocardial
infarction.<br/>Copyright &#xa9; 2025 The Chinese Medical Association,
published by Wolters Kluwer Health, Inc.

<59>
Accession Number
2037167260
Title
Pharmacological preventions and treatments for pericardial complications
after open heart surgeries.
Source
Heart. 111(8) (pp 353-361), 2025. Date of Publication: 01 Apr 2025.
Author
Malektojari A.; Tahmasebipour R.; Fadaeihosein M.; Ghazizadeh S.; Ardali
F.; Haghighat B.; Keshavarz F.; Azari Y.Y.; Javdan F.; Shahsavari E.; Ersi
M.H.; Abbaszadeh S.; Al-Jafar R.; Dehghan A.; Pitre T.
Institution
(Malektojari, Ghazizadeh, Ardali, Shahsavari) Evidence Based Medicine
Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran,
Islamic Republic of
(Malektojari, Tahmasebipour, Ghazizadeh, Azari, Abbaszadeh) Cardiovascular
Research Center, Hormozgan University of Medical Sciences, Bandar Abbas,
Iran, Islamic Republic of
(Tahmasebipour, Fadaeihosein, Haghighat, Keshavarz, Azari, Javdan, Ersi)
Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar
Abbas, Iran, Islamic Republic of
(Al-Jafar, Dehghan) Department of Epidemiology and Biostatistics, School
of Public Health, Imperial College London, London, United Kingdom
(Al-Jafar) Data Services Sector, Lean Business Services, Riyadh, Saudi
Arabia
(Dehghan) MRC-PHE Centre for Environment and Health, School of Public
Health, Imperial College London, London, United Kingdom
(Pitre) Division of Respirology, Department of Medicine, University of
Toronto, Toronto, ON, Canada
Publisher
BMJ Publishing Group
Abstract
Background Pericardial complications following cardiac surgery are common
and debilitating, significantly impacting patients' survival. We performed
this network meta-analysis to identify the most effective and safest
preventions and treatments for pericardial complications following cardiac
surgery. Methods We systematically searched PubMed/MEDLINE, EMBASE and
Cochrane CENTRAL from inception to 22 January 2024. Pairs of reviewers
screened eligible studies. They included randomised controlled trials that
enrolled adults undergoing major cardiac surgeries and reported
postpericardiotomy syndrome, pericardial effusion and pericarditis as
primary or secondary outcomes. We summarised the effects of interventions
using relative risks and corresponding 95% CIs. We performed a frequentist
random-effects network meta-analysis using the restricted maximum
likelihood estimator. Results We included 39 trials that enrolled a total
of 6419 participants. Our network meta-analysis demonstrates colchicine
reduces the risk of postpericardiotomy syndrome (RR 0.53, 95% CI 0.38 to
0.73). Beta-blockers probably prevent atrial fibrillation with a large
magnitude of effect (RR 0.4, 95% CI 0.20 to 0.81) and may prevent
postoperative pericarditis (RR 0.66, 95% CI 0.45 to 0.97) compared with
control. Fish oil (RR 0.28, 95% CI 0.09 to 0.90), non-steroidal
anti-inflammatory drugs (RR 0.37, 95% CI 0.23 to 0.59) and colchicine (RR
0.37, 95% CI 0.23 to 0.59) may reduce the risk of postoperative atrial
fibrillation. We found no evidence of a difference in the risk of pleural
effusion, all-cause mortality, serious adverse events or postoperative ICU
stay. Conclusions The results of our study highly recommend colchicine use
to reduce the risk of the postpericardiotomy syndrome and beta-blocker use
to reduce postoperative atrial fibrillation. Additionally, our study
suggests that further research is needed to investigate other
interventions and to evaluate newly proposed interventions in large,
high-quality trials, as the current evidence for some interventions is
relatively weak.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2025.

<60>
Accession Number
2031074431
Title
Impact of Dexmedetomidine Dosing and Timing on Acute Kidney Injury and
Renal Outcomes After Cardiac Surgery: A Meta-Analytic Approach.
Source
Annals of Pharmacotherapy. 59(4) (pp 319-329), 2025. Date of Publication:
01 Apr 2025.
Author
Li H.; Wang L.; Shi C.; Zhou B.; Yao L.
Institution
(Li, Wang, Shi, Zhou, Yao) Department of Anesthesiology, Peking University
International Hospital, Beijing, China
Publisher
SAGE Publications Inc.
Abstract
Background: Acute kidney injury (AKI) is a common and serious complication
following cardiac surgery. Dexmedetomidine, a highly selective
alpha2-adrenergic agonist, has shown potential renoprotective effects, but
previous studies have yielded conflicting results. <br/>Objective(s): This
meta-analysis aimed to evaluate the efficacy and safety of dexmedetomidine
in preventing AKI and reducing postoperative serum creatinine levels in
adult patients undergoing cardiac surgery. <br/>Method(s): We
comprehensively searched 5 databases for randomized controlled trials
comparing dexmedetomidine with control groups in adult cardiac surgery
patients. The main outcomes were the incidence of AKI and change in
postoperative serum creatinine levels. Meta-analyses were conducted using
RevMan 5.4 models, and subgroup analyses were performed based on
dexmedetomidine dosing and timing of administration. Continuous outcomes
were combined and analyzed using either mean difference (M.D.), while
dichotomous outcomes were analyzed using risk ratio (RR) with 95%
confidence intervals (CI). <br/>Result(s): Our study included a total of
14 trials involving 2744 patients. Dexmedetomidine administration
significantly reduced the incidence of AKI compared to control groups (RR
= 0.54, 95% CI: 0.41-0.70, P < 0.00001). Postoperative serum creatinine
levels were also lower with dexmedetomidine (MD = -0.14 mg/dL, 95% CI:
-0.28 to -0.001, P =0.04). Subgroup analyses revealed that higher initial
doses (>0.5 mug/kg) and administration during intraoperative and
postoperative periods were associated with more pronounced renoprotective
effects. Dexmedetomidine did not significantly affect mortality but
reduced the duration of the length of hospital stay and mechanical
ventilation. <br/>Conclusions and Relevance: This meta-analysis
demonstrates that dexmedetomidine administration, particularly at higher
doses and during both intraoperative and postoperative periods, reduces
the risk of AKI in adults undergoing cardiac surgery. These findings
support the use of dexmedetomidine as a preventive strategy to enhance
renal outcomes in this population.<br/>Copyright &#xa9; The Author(s)
2024.

<61>
Accession Number
2036002708
Title
Mini-Sternotomy vs. Right Anterior Mini-Thoracotomy for Surgical Aortic
Valve Replacement - A Systematic Review and Meta-Analysis.
Source
Brazilian Journal of Cardiovascular Surgery. 40(3) (no pagination), 2025.
Article Number: e20240211. Date of Publication: 2025.
Author
Starvridis D.; Rad A.A.; Montanhesi P.K.; Kirov H.; Wacker M.; Tasoudis
P.; Mukharyamov M.; Treml R.E.; Wippermann J.; Doenst T.; Sultan I.; Sa
M.P.; Caldonazo T.
Institution
(Starvridis, Wacker, Wippermann) Department of Cardiothoracic Surgery,
University Clinic Magdeburg, Magdeburg, Germany
(Rad) Medical Sciences Division, University of Oxford, Oxford, United
Kingdom
(Montanhesi) Hospital Israelita Albert Einstein, Sao Paulo, Sao Paulo,
Brazil
(Kirov, Mukharyamov, Doenst, Caldonazo) Department of Cardiothoracic
Surgery, Jena University Hospital, Jena, Germany
(Tasoudis) Division of Cardiothoracic Surgery, University of North
Carolina, Chapel Hill, NC, United States
(Treml) Department of Anesthesiology and Intensive Care Medicine,
Friedrich Schiller University Jena, Jena, Germany
(Sultan, Sa) Department of Cardiothoracic Surgery, University of
Pittsburgh, Pittsburgh, PA, United States
(Sultan, Sa) UPMC Heart and Vascular Institute, University of Pittsburgh
Medical Center, Pittsburgh, PA, United States
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: Minimally invasive techniques for aortic valve replacement
have become increasingly popular. The most common minimally invasive
approaches are mini-sternotomy and right anterior mini-thoracotomy. We
aimed to review the literature and compare clinical outcomes for these two
approaches. <br/>Method(s): Three databases were assessed. The primary
endpoint was perioperative mortality. The secondary endpoints were
reoperation for bleeding, stroke, operation duration, intensive care unit
length of stay, cardiopulmonary bypass time, cross-clamping time, hospital
length of stay, paravalvular leak, renal complications, conversion to full
sternotomy, permanent pacemaker implantation, and wound infection. Random
effects models were performed. <br/>Result(s): Ten studies were included
in the meta-analysis (30,524 patients). There was no difference in
perioperative mortality between groups (odds ratio: 0.83; 95% confidence
interval 0.57-1.21; P=0.33). In comparison with mini-sternotomy, right
anterior mini-thoracotomy showed higher rates of reoperation for bleeding
(odds ratio: 0.69; 95% confidence interval 0.50-0.97; P=0.03), lower rates
of stroke (odds ratio: 1.27; 95% confidence interval 1.01-1.60; P=0.04),
and longer operation duration (standard mean difference:-0.58; 95%
confidence interval-1.01 to-0.14; P=0.01). Other secondary endpoints were
not statistically significant. <br/>Conclusion(s): The results suggest
that both techniques present similar perioperative mortality rates for
aortic valve replacement. However, right anterior mini-thoracoto-my is
associated with higher rates of reoperation for bleeding, lower rates of
stroke, and longer operation duration time.<br/>Copyright &#xa9; 2025,
Sociedade Brasileira de Cirurgia Cardiovascular. All rights reserved.

<62>
Accession Number
2033725662
Title
Comparative outcomes video-assisted thoracic surgery versus open thoracic
surgery in pulmonary echinococcosis: a systematic review and
meta-analysis.
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2025.
Article Number: n71. Date of Publication: 2025.
Author
Salvador I.C.M.C.; da Nobrega Oliveira R.E.N.; de Almeida Silva I.; Torres
L.A.F.; Camarotti M.T.; Passos F.S.; Mariani A.W.
Institution
(Salvador, de Almeida Silva) University Anhembi Morumbi, Street Francisca
Julia, 563, North Zone, SP, Sao Paulo, Brazil
(da Nobrega Oliveira) Department of Thoracic Surgery, Barretos Cancer
Hospital, Barretos, Brazil
(Torres) Hospital Universitario Onofre Lopes, RN, Natal, Brazil
(Camarotti) Pernambuco's Health College, PE, Recife, Brazil
(Passos) Department of Thoracic Surgery, INCAR Hospital, Santo Antonio de
Jesus, Brazil
(Mariani) Faculty of Medicine, Heart Institute, Hospital das Clinicas,
University of Sao Paulo (HCFMUSP), SP, Sao Paulo, Brazil
Publisher
Springer
Abstract
Aim: This meta-analysis aimed to evaluate and compare the outcomes of
video-assisted thoracic surgery (VATS) and open thoracic surgery (OT) in
the management of pulmonary echinococcosis. <br/>Method(s): We conducted a
comprehensive search of PubMed, Embase, and Cochrane databases for studies
comparing VATS and OT. Odds ratios (ORs) for binary outcomes and mean
differences (MDs) for continuous variables were calculated with 95%
confidence intervals (CIs) using the DerSimonian and Laird random-effects
model. Heterogeneity was assessed using I² statistics.
<br/>Result(s): Seven studies involving 2292 patients were included. VATS
demonstrated significant advantages over OT, with reductions in
intraoperative blood loss (MD - 81.65 mL, 95% CI - 129.90 to - 33.40),
duration of thoracic drainage (MD - 2.29 days, 95% CI - 3.61 to - 0.98),
operative time (MD - 45.73 min, 95% CI - 68.41 to - 23.05), narcotic use
(MD -3.98 days, 95% CI - 6.21 to - 1.75), length of hospital stay (MD -
3.66 days, 95% CI - 5.66 to - 1.67), postoperative drainage volume (MD -
124.77 mL, 95% CI - 206.27 to - 43.27), and visual analogic score pain at
24 h after surgery (MD - 2.05 points, 95% CI - 2.40 to - 1.70). However,
VATS was associated with a higher incidence of atelectasis (OR 3.27, 95%
CI 1.03-10.35). No significant differences were observed in other
complications, such as bronchopulmonary fistula, surgical wound infection,
prolonged air leak, or failure of lung expansion. <br/>Conclusion(s): VATS
was associated with perioperative benefits, including reduced recovery
times and resource utilization. Nonetheless, the higher risk of
atelectasis suggests OT may remain favorable in complex cases requiring
broader surgical access. Tailoring the surgical approach to the patient's
needs remains crucial. Trial registry: International Prospective Register
of Systematic Reviews; N: CRD42025630187; URL:
https://www.crd.york.ac.uk/prospero/.<br/>Copyright &#xa9; The Author(s),
under exclusive licence to The Japanese Association for Thoracic Surgery
2025.

<63>
Accession Number
2033728323
Title
Hemodynamic Effects of Altering Tidal Volume During Positive Pressure
Ventilation in the Fontan Circulation: A Randomized Crossover Trial.
Source
Paediatric Anaesthesia. (no pagination), 2025. Date of Publication: 2025.
Author
Navaratnam M.; Schmidt A.R.; Kaplinski M.; De Souza E.; Beattie M.J.; Rowe
E.V.; Punn R.; Ramamoorthy C.
Institution
(Navaratnam, Rowe, Ramamoorthy) Department of Anesthesiology,
Perioperative and Pain Medicine, Stanford Children's Hospital, Stanford
University Medical Center, Palo Alto, CA, United States
(Schmidt) Department of Pediatric Anesthesiology, University Children's
Hospital Zurich-Eleonore Foundation, Zurich, Switzerland
(Kaplinski, Beattie, Punn) Department of Pediatric Cardiology, Stanford
Children's Hospital, Stanford University Medical Center, Palo Alto, CA,
United States
(De Souza) Department of Anesthesiology, Perioperative and Pain Medicine,
Stanford University School of Medicine, Stanford, CA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Primary determinants of pulmonary blood flow in the Fontan
circulation are low transpulmonary gradient and pulmonary vascular
resistance (PVR). Changes in intrathoracic pressure during intermittent
positive pressure ventilation can influence the transpulmonary gradient,
PVR, pulmonary blood flow, and cardiac output. The aim of this study was
to evaluate the effect of low (5 mL/kg) versus high (10 mL/kg) tidal
volume (V<inf>T</inf>) ventilation on Fontan circulation hemodynamics.
<br/>Method(s): Postoperative patients with a Fontan circulation were
enrolled in this single-center, randomized crossover trial. Patients,
randomized to group 1 or 2, underwent a ventilation study sequence
(baseline ventilation [7 mL/kg], then high V<inf>T</inf> [10 mL/kg] or low
V<inf>T</inf> [5 mL/kg], then washout ventilation [7 mL/kg], followed by
low [5 mL/kg] or high V<inf>T</inf> [10 mL/kg]) in the operating room at
the end of the cardiac surgical procedure. Respiratory, hemodynamic, and
transesophageal (TEE) measurements were recorded after 5 min in each
ventilation condition. The primary aim of this study was to evaluate the
effect of low V<inf>T</inf> ventilation (5 mL/kg) versus high
V<inf>T</inf> ventilation (10 mL/kg) on transpulmonary gradient (Fontan
pressure minus left atrial pressure). The secondary aim was to compare TEE
measurements of pulmonary blood flow, stroke volume, and Fontan flow
between low and high V<inf>T</inf> ventilation. We also compared standard
hemodynamic and ventilation parameters for all ventilation conditions.
Analysis was of paired data, calculating the between-treatment difference
within participants across ventilation conditions. <br/>Result(s): Eleven
patients were included in the final data analysis with a median [IQR] age
of 5 [4, 11] years and weight of 16.3 [13.8, 31.6] kg. The mean (+/-SD)
peak inspiratory pressure during low and high V<inf>T</inf> ventilation
was 15.3 (+/-2.9) cmH<inf>2</inf>O and 22.2 (+/-3.7) cmH<inf>2</inf>O,
respectively (difference -6.9, 95% CI -7.8, -5.9, p < 0.001). The mean
airway pressure during low and high V<inf>T</inf> ventilation was 7.3 +/-
0.8 and 8.7 +/- 0.9 (difference -1.5, 95% CI -2.1, -0.8, p = 0.001) with a
mean inspiratory time of 0.62 (+/-0.22) s and 1.21 (+/-0.55) s (difference
-0.59, 95% CI -0.84, -0.34, p < 0.001), respectively. During low
V<inf>T</inf> ventilation, the mean Fontan pressure was 13.3 (+/-1.8) mmHg
compared to 12.3 (+/-2.5) mmHg for high V<inf>T</inf> ventilation
(difference 0.8, 95% CI -0.5, 2.1, p = 0.18). The mean transpulmonary
gradient was 7.0 +/- 1.3 mmHg compared to 6.8 +/- 1.2 mmHg during low and
high V<inf>T</inf> ventilation, respectively (difference 0.2, 95% CI -0.2,
0.6, p = 0.21). We found no significant differences between low and high
V<inf>T</inf> ventilation in TEE measures of pulmonary blood flow, stroke
volume, and Fontan flow. <br/>Conclusion(s): This randomized, crossover
pilot trial of Fontan patients showed that a low V<inf>T</inf> ventilation
(5 mL/kg) resulted in significantly lower peak and mean airway pressure
compared with a high V<inf>T</inf> ventilation (10 mL/kg). However, there
were no significant changes in transpulmonary gradient, mean Fontan
pressure, or TEE parameters of stroke volume, pulmonary blood flow, or
Fontan flow. Clinical Trials Registration Number: NCT04633343. Principal
Investigator: Manchula Navaratnam. Date of Registration: November 11,
2020. Clinical Trials Registration Registry URL:
https://clinicaltrials.gov/study/NCT04633343?term=Fontan%20ventilation&ran
k=3. Prior Presentations: Congenital Cardiac Anesthesia Society Annual
Meeting Top Oral Abstract Presentation. Presenter: Alexander R Schmidt,
March 30th, 2023.<br/>Copyright &#xa9; 2025 John Wiley & Sons Ltd.

<64>
Accession Number
2037940938
Title
Optimal timing for percutaneous coronary intervention in patients
undergoing transcatheter aortic valve replacement: A network
meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2025. Date of
Publication: 2025.
Author
Carvalho P.E.P.; Nascimento B.R.; Gewehr D.M.; Rivera A.; Clemente M.;
Braga M.A.P.; Pansani L.N.; Almeidinha L.; Felix N.; Veiga T.M.A.;
Barbanti M.; Lemos P.A.; Marino M.A.; Taramasso M.; Garot P.
Institution
(Carvalho) Center for Coronary Artery Disease, Minneapolis Heart
Institute, Minneapolis, United States
(Gewehr) Department of Internal Medicine, Federal University of Minas
Gerais, Belo Horizonte, Brazil
(Rivera) Interventional Cardiology Department, Hospital Madre Teresa, Belo
Horizonte, Brazil
(Clemente) Curitiba Heart Institute, Curitiba, Brazil
(Braga) Department of Medicine, Nove de Julho University, Sao Bernardo do
Campo, Brazil
(Pansani) Department of Medicine, Petropolis School of Medicine,
Petropolis, Brazil
(Almeidinha) Department of Medicine, Federal University of Rio de Janeiro,
Rio de Janeiro, Brazil
(Nascimento) Department of Cardiovascular Surgery, Faculty of Medicine of
Sao Jose do Rio Preto, Sao Jose do Rio Preto, Brazil
(Nascimento, Marino) Department of Internal Medicine, Rochester General
Hospital, Rochester, United States
(Felix) Department of Medicine, Federal University of Campina Grande,
Campina Grande, Brazil
(Veiga) Department of Medicine, Federal University of Minas Gerais, Belo
Horizonte, Brazil
(Barbanti) Universita degli Studi di Enna "Kore", Enna, Italy
(Barbanti) Ospedale Umberto I, ASP 4 di Enna, Enna, Italy
(Lemos) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Lemos) Heart Institute - InCor, University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Taramasso) Cardiovascular Surgical Department, University Hospital of
Zurich, Zurich, Switzerland
(Garot) Institut Cardiovasculaire Paris Sud (ICPS), Hopital Jacques
Cartier, Ramsay-Sante, Massy, France
Publisher
Elsevier Inc.
Abstract
Background: The optimal timing for percutaneous coronary intervention
(PCI) in patients undergoing transcatheter aortic valve replacement (TAVR)
is uncertain. <br/>Objective(s): To compare different PCI timings in
patients with CAD undergoing TAVR. <br/>Method(s): MEDLINE, Embase, and
Cochrane were systematically searched for studies comparing different
timings of PCI in patients with aortic stenosis and coronary artery
disease (CAD) undergoing TAVR. PCI in a staged procedure to TAVR and PCI
concomitantly to TAVR were compared with TAVR alone without PCI. A
frequentist random-effects network meta-analysis calculates the odds ratio
(OR) with a 95 % confidence interval (CI). Treatments were ranked using
P-score analysis. <br/>Result(s): Two randomized controlled trials and 24
observational studies comprising 10,901 patients with aortic stenosis and
CAD were included. Compared with PCI and concomitant TAVR, staged PCI was
associated with lower rates of stroke (OR 0.54; 95 % CI 0.37-0.78),
myocardial infarction (OR 0.54; 95 % CI 0.31-0.91), and all-cause
mortality at 30 days (OR 0.62; 95 % CI 0.41-0.95). In addition, a subgroup
analysis showed that staged PCI performed after TAVR is associated with
the lowest rates of all-cause mortality of all strategies. In P-score
analysis, staged PCI presented the highest likelihood of preventing stroke
and myocardial infarction. <br/>Conclusion(s): In patients with aortic
stenosis and CAD undergoing TAVR, staged PCI is associated with lower
rates of stroke, myocardial infarction, and short-term mortality compared
with other timings.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<65>
Accession Number
2038167176
Title
Can amino acid interventions prevent acute kidney injury in cardiac
surgery? A meta-analysis and systematic review.
Source
Nephrology Dialysis Transplantation. 40(4) (pp 823-826), 2025. Date of
Publication: 01 Apr 2025.
Author
Tinica G.; Brinza C.; Popa C.; Covic A.; Voroneanu L.; Kanbay M.; Burlacu
A.
Institution
(Covic, Tinica, Brinza, Popa, Covic, Voroneanu, Burlacu) Department of
Medicine, Faculty of Medicine, University of Medicine and Pharmacy
"Grigore T. Popa", Iasi, Romania
(Covic, Covic, Voroneanu) Department of Nephrology, Nephrology Clinic,
Dialysis, and Renal Transplant Center - "C.I. Parhon" University Hospital,
Iasi, Romania
(Tinica, Burlacu) Department of Cardiology, Institute of Cardiovascular
Diseases "Prof. Dr George I.M. Georgescu", Iasi, Romania
(Kanbay) Department of Internal Medicine, Division of Nephrology, Koc
University School of Medicine, Istanbul, Turkey
(Kanbay) Department of Medicine, Koc University School of Medicine,
Istanbul, Turkey
Publisher
Oxford University Press

<66>
Accession Number
2038208169
Title
Prevalence of postoperative neurocognitive disorders in older non-cardiac
surgical patients: A systematic review and meta-analysis.
Source
Journal of Clinical Anesthesia. 103 (no pagination), 2025. Article Number:
111830. Date of Publication: 01 Apr 2025.
Author
Huang W.W.Y.; Fan S.; Li W.-Y.; Thangavelu V.; Saripella A.; Englesakis
M.; Yan E.; Chung F.
Institution
(Huang) School of Medicine, University of Limerick, Limerick, Ireland
(Fan) Schulich School of Medicine and Dentistry, Western University,
London, ON, Canada
(Li, Saripella, Yan, Chung) Department of Anesthesia and Pain Management,
Toronto Western Hospital, University Health Network, University of
Toronto, ON, Canada
(Thangavelu, Yan, Chung) Institute of Medical Science, Temerty Faculty of
Medicine, University of Toronto, ON, Canada
(Englesakis) Library & Information Services, University Health Network,
Toronto, ON, Canada
Publisher
Elsevier Inc.
Abstract
Study objective: The growing number of older persons undergoing surgery
are at a higher risk of neurocognitive disorder due to multimorbidity and
age-related changes. Previous reviews estimated postoperative
neurocognitive disorder or cognitive dysfunction (POCD) prevalence without
accounting for the sample size or study quality. The prevalence of POCD in
this population requires further investigation. This systematic review and
meta-analysis applies systematic weighting to estimate the pooled
prevalence of POCD in older non-cardiac surgical patients. <br/>Design(s):
Systematic review and meta-analysis. <br/>Setting(s): MEDLINE, MEDLINE
ePub, Embase, Cochrane Central Register of Controlled Trials and Cochrane
Database of Systematic Reviews for relevant articles. <br/>Patient(s):
Non-cardiac surgical patients aged >=60 years old. <br/>Intervention(s):
Perioperative cognitive assessments. Measurement: The primary outcome was
the prevalence of POCD. <br/>Main Result(s): Thirty-nine studies (n =
12,921) were included with mean age of 70.0 +/- 8.9 years and 44.3 %
women. The overall prevalence of POCD was 23 % (95 % CI: 20 %, 27 %) at
day 7, 16 % (95 % CI: 7 %, 25 %) at 1 month, 10 % (95 % CI: 8 %, 13 %) at
3 months and 3 % (95 % CI: 2 %, 4 %) at 1 year. Our meta-regression showed
a higher prevalence of POCD in abdominal surgeries at day 7 (beta = 0.13,
95 % CI: 0.03-0.22, P = 0.01) and 3 months (beta = 0.49, 95 % CI:
0.40-0.58, P < 0.001), versus orthopedic surgeries. <br/>Conclusion(s):
The overall prevalence of POCD in older non-cardiac surgical populations
was 23 %, 16 %, 10 %, and 3 % at day 7, 1 month, 3 months, and 1 year,
respectively. Abdominal surgery had a higher prevalence of POCD than
orthopedic surgery. The substantial risk of POCD calls for cognitive
screening, risk mitigation and interventions to improve surgical outcomes.
Through routine preoperative cognitive screening and addressing modifiable
risk factors, the incidence and impact of POCD can be markedly reduced,
enhancing patient outcomes and recovery.<br/>Copyright &#xa9; 2025

<67>
Accession Number
2038208829
Title
Investigating the effects of applying low acoustic frequencies on the pain
from venous and arterial blood sampling: A clinical trial study.
Source
Advances in Integrative Medicine. (no pagination), 2025. Article Number:
100480. Date of Publication: 2025.
Author
Mohammadi S.; Ezzati E.; Mahooti R.; Kavyannejad F.; Paran M.S.;
Kavyannejad R.
Institution
(Mohammadi) Department of Anesthesiology, School of Medicine, Kermanshah
University of Medical Sciences, Kermanshah, Iran, Islamic Republic of
(Ezzati) Department of Anesthesiology, School of Paramedical, Kermanshah
University of Medical Sciences, Kermanshah, Iran, Islamic Republic of
(Mahooti) Emam Khomaini Hospital, Kermanshah University of Medical
Sciences, Kermanshah, Iran, Islamic Republic of
(Kavyannejad, Paran) Al-Zahra Hospital, Kermanshah University of Medical
Sciences, Kermanshah, Iran, Islamic Republic of
(Kavyannejad) Department of Physiology, School of Medicine, Kermanshah
University of Medical Sciences, Kermanshah, Iran, Islamic Republic of
Publisher
Elsevier Australia
Abstract
Background: The pain of the blood sampling process is an unpleasant and
common experience in the treatment process. Stimulation the thalamus
structure and corticothalamic pathways with at specific frequencies could
play a role in modulating pain perception. The aim of this study was to
investigate the use low acoustic frequencies in reducing pain during
arterial and venous blood sampling. <br/>Material(s) and Method(s): In a
triple-blinded clinical trial study, 300 patients in each process were
randomly divided into control and intervention groups. Patients in the
intervention groups received sound frequencies of 10-200 Hz with an
intensity of 50 dB during the procedures. Pain intensity, heart rate
changes, number of attempts for successful sampling, and time required for
each procedure were measured. Data were analyzed using Prism 10 software.
<br/>Result(s): Pain levels were significantly lower in the intervention
groups with increasing sound frequencies in both procedures (P < 0.05).
The duration of blood sampling procedures was significantly shorter with
increasing sound frequency (P < 0.05), but no difference was observed in
the frequency of sampling attempts (P > 0.05). By increasing the sound
frequency, the intensity of tachycardia significantly decreased following
the blood sampling process (P < 0.05), especially at higher frequencies.
<br/>Conclusion(s): Applying low sound frequencies effectively could
reduce acute pain and its consequences resulting from an invasive process.
Sound frequencies appear to play a role in modulating pain pathways in the
central nervous system. Implications for Clinical Practice: The study
findings suggest that sound frequency ranges as a non-pharmacological
analgesia intervention can be used to reduce pain and discomfort following
a variety of blood sampling procedures, which performed by
nurses.<br/>Copyright &#xa9; 2025 Elsevier Ltd

<68>
Accession Number
2034129767
Title
Effects of high-flow oxygen therapy on oxygenation in dogs undergoing
diagnostic bronchoscopy.
Source
Frontiers in Veterinary Science. 12 (no pagination), 2025. Article Number:
1545427. Date of Publication: 2025.
Author
Ortlieb J.; Bender H.; Schneider M.; Tacke S.; Hassdenteufel E.
Institution
(Ortlieb, Bender, Schneider, Tacke, Hassdenteufel) Department of
Veterinary Clinical Sciences, Small Animal Clinic,
Justus-Liebig-University Giessen, Giessen, Germany
Publisher
Frontiers Media SA
Abstract
Introduction: Hypoxemia is a common complication during bronchoscopy and
bronchoalveolar lavage (BAL). High-Flow Oxygen Therapy (HFOT) has been
used to improve oxygenation and prevent periods of hypoxemia in people
undergoing bronchoscopy. <br/>Objective(s): The main objective of this
study was to evaluate the effect of HFOT on oxygenation in dogs undergoing
diagnostic bronchoscopy compared to a traditional oxygen supplementation
method (TOT). A secondary objective was to assess potential HFOT-related
complications. <br/>Method(s): Prospective randomized clinical trial. Dogs
presented for diagnostic bronchoscopy were randomly assigned to receive
either HFOT or TOT using nasal cannulas during the bronchoscopic
procedure. Oxygenation was monitored through PaO<inf>2</inf> measurements
taken at seven time points: baseline (t0), after preoxygenation (t1),
post-induction (t2), pre- and post-BAL sampling (t3 and t4), at the end of
the procedure (t5), and 1 h after bronchoscopy (t6). Pre- and
post-procedure thoracic radiographs were assessed for air leak syndrome or
aerophagia. <br/>Result(s): 20 privately owned dogs presented for
diagnostic bronchoscopy were included in the study (HFOT group: n = 10,
TOT group: n = 10). Baseline characteristics and physiological parameters
did not differ significantly between groups. Five dogs in each group
showed hypoxemia (PaO<inf>2</inf> < 80 mmHg) at baseline with 1/5 in each
group having PaO<inf>2</inf> < 60 mmHg. HFOT improved oxygenation
throughout the procedure, with a significant increase in PaO<inf>2</inf>
observed after preoxygenation (P = 0.001) and at the end of the procedure
(P = 0.013). Additionally, only 1/10 dogs in the HFOT group experienced
hypoxemia during bronchoscopy compared to 5/10 dogs in the TOT group, and
patients in the HFOT achieved numerically higher PaO<inf>2</inf> values
across all time points during the procedure (t1-t5). No serious adverse
events related to HFOT were observed, although aerophagia occurred in both
groups without necessitating intervention. <br/>Conclusion(s): HFOT can
improve oxygenation and prevent episodes of hypoxemia in dogs undergoing
bronchoscopy compared to traditional oxygen supplementation
methods.<br/>Copyright &#xa9; 2025 Ortlieb, Bender, Schneider, Tacke and
Hassdenteufel.

<69>
Accession Number
2035949465
Title
Ovarian cancer and isolated cardiophrenic lymph nodes metastases: a
systematic review.
Source
Journal of the Turkish German Gynecology Association. 26(1) (pp 49-54),
2025. Date of Publication: 01 Mar 2025.
Author
Psomiadou V.; Fotiou A.; Iavazzo C.
Institution
(Psomiadou, Iavazzo) Metaxa Memorial Cancer Hospital, Piraeus, Greece
(Fotiou) Department of Obstetrics and Gynecology, National and
Kapodistrian University of Athens Medical School, Attikon Hospital,
Athens, Greece
Publisher
Galenos Publishing House
Abstract
Currently, there is limited information available on the best course of
action for advanced epithelial ovarian cancer (OC) with isolated
extra-peritoneal disease in the cardiophrenic lymph nodes. Recently, there
have been numerous reports of successful surgical removal of metastatic
cardiophrenic lymph nodes in patients with OC, mostly during primary or
interval cytoreduction procedures. However, the optimal management of
isolated, extra-peritoneal cardiophrenic lymph node metastasis (ICLNM)
remains unclear, since this clinical scenario is rather uncommon in OC and
chemotherapy is so far the indicated treatment for patients with from
advanced stage disease. We searched the English-language literature for
cases of OC with ICLNM or recurrence, evaluating the feasibility and
safety of surgical excision. From 2009 to 2022 only 11 cases were
reported. In seven the tumor was of serous histology. ICLN was detected in
five cases with primary disease and in the remaining six it was recurrence
of OC. The primary disease was treated in 10/11 patients with primary
cytoreduction while the other received systemic chemotherapy. The ICLNM
was removed in all the patients, in 10 via video-assisted thoracic surgery
and in one via transdiaphragmatic incision. Median follow-up was 10
months.<br/>Copyright &#xa9; 2025 The Author.

<70>
Accession Number
2034076538
Title
Hemoadsorption use in adult cardiac surgery for infective endocarditis: A
comprehensive meta-analysis.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2025. Date of
Publication: 2025.
Author
Dutta P.; Ganduboina R.; Muderrisoglu C.; Obulareddy A.C.R.; Palagati K.;
Areddy V.R.; Reddy G.A.; Sainathan S.
Institution
(Dutta, Muderrisoglu) Department of Surgery, University of Illinois,
Chicago, IL, United States
(Ganduboina) Department of Surgery, NRI Institute of Medical Sciences,
Visakhapatnam, India
(Obulareddy) Division of Surgery, SVS Medical College, Mahbubnagar, India
(Palagati) Division of Surgery, Government Medical College, Anantapur,
India
(Areddy) Division of Surgery, Sri Venkateswara Medical College, Tirupati,
India
(Reddy) Division of Internal Medicine, New York Medical College at St
Mary's General Hospital and St Claire's Health, New York, NY, United
States
(Sainathan) Division of Cardiothoracic Surgery, University of Miami,
Miami, FL, United States
Publisher
SAGE Publications Inc.
Abstract
Introduction: Infective endocarditis (IE) is a severe infection of the
endocardium, primarily affecting the heart valves, exhibiting high
morbidity and mortality rates. Cardiac surgery for IE with cardiopulmonary
bypass (CPB) can further exacerbate the inflammatory response and cytokine
production from IE. The current meta-analysis evaluates the use of
CytoSorb hemoadsorption in IE patients undergoing cardiac
surgery to determine its efficacy in reducing inflammatory mediators and
improving clinical outcomes. <br/>Method(s): PubMed, Cochrane, Google
Scholar, Clinical Trials, and Google Scholar were searched for articles
until July 2024. After performing a risk of bias and quality assessment,
data on operative times, mortality, and morbidity were extracted for
meta-analysis. Statistical Software R (version 4.4.0) was used to
calculate odds ratio (OR) and standardized mean differences using a
random-effect model with a 95% confidence interval (CI) and p-value less
than 0.05. <br/>Result(s): Eight studies, encompassing 1076 patients, were
included in the analysis. These comprised three randomized controlled
trials and five nonrandomized studies. The majority of these studies
exhibited some concerns regarding bias. Hemoadsorption group showed lower
discharge mortality (OR: 0.58, 95% CI: 0.33-1.00, p = 0.05) compared to
controls, but no significant disparity is observed in other outcomes.
In-hospital outcomes also showed higher heterogeneity, with an I2 value
greater than 50%. <br/>Conclusion(s): CytoSorb use in patients undergoing
cardiac surgery with CPB used for IE has no impact on operative mortality
and morbidity but has a beneficial effect on discharge
mortality.<br/>Copyright &#xa9; The Author(s) 2025.

<71>
Accession Number
646969996
Title
Outcomes of Incentive Spirometry for Patients Undergoing Coronary Artery
Bypass Surgery: A Randomised Controlled Trial.
Source
International journal of nursing practice. 31(2) (pp e70011), 2025. Date
of Publication: 01 Apr 2025.
Author
Gokce E.; Alptekin D.; Gezer D.; Akpolat R.; Sisman H.; Kayhanli G.;
Arslan S.
Institution
(Gokce) Department of Medical Services and Techniques, Toros University
Health Services Vocational School, Mersin, Turkey
(Alptekin) Department of Medical Services and Techniques, Cukurova
University Abdi Sutcu Health Services Vocational School, Adana, Turkey
(Gezer) Department of Nursing Surgery, Tarsus University Faculty of Health
Sciences, Mersin, Turkey
(Akpolat) Department of Nursing Surgery, Cyprus International University,
Nicosia, Cyprus
(Sisman) Department of Nursing Surgery, Selcuk University Aksehir Kadir
Yallagoz Health School, Konya, Turkey
(Kayhanli) Division of Cardiology, Cukurova University Medical Hospital,
Adana, Turkey
(Arslan) Department of Nursing Surgery, Cukurova University Faculty of
Health Sciences, Adana, Turkey
Abstract
BACKGROUND: Incentive spirometry is used in addition to care, especially
in reducing pulmonary complications after surgery. Complications in the
cardiovascular and pulmonary systems can basically be determined by blood
values and vital signs, which are important objective data of
haemodynamics. AIM: This study aimed to test the hypothesis that the use
of incentive spirometry in conjunction with postoperative pulmonary
rehabilitation care has a notable impact on arterial blood gas, oxygen
saturation (SpO2) and vital signs. <br/>METHOD(S): This randomised,
controlled trial used repeated-measures design. It was conducted between
2021 and 2022, and data from 58 patients who underwent coronary artery
bypass graft surgery at the cardiovascular surgery clinic of a university
hospital were analysed. All patients received pulmonary rehabilitation,
and incentive spirometry was added for the experimental group.
<br/>RESULT(S): In the experimental group, on post-op day 3, the arterial
partial pressure of oxygen (PaO2) (p = 0.01), arterial oxygen saturation
(SaO2) (p = 0.002) and oxygen saturation (SpO2) (p < 0.001) values were
statistically significantly higher. Additionally, on post-op day 3 the
experimental group had significantly lower systolic blood pressure (p =
0.03), diastolic blood pressure (p = 0.004) and respiratory rate (p <
0.001). <br/>CONCLUSION(S): Incentive spirometry after coronary artery
bypass graft surgery improves oxygen levels and vital signs.<br/>Copyright
&#xa9; 2025 The Author(s). International Journal of Nursing Practice
published by John Wiley & Sons Australia, Ltd.

<72>
Accession Number
2034097496
Title
Home-Based Rehabilitation After Transcatheter Aortic Valve Replacement
(REHAB-TAVR): A Pilot Randomized Controlled Trial.
Source
Journal of the American Geriatrics Society. (no pagination), 2025. Date
of Publication: 2025.
Author
Shi S.M.; Rapley F.-A.; Margulis H.; Laham R.J.; Guibone K.; Percy E.;
Kaneko T.; Wang K.-Y.; Kim D.H.
Institution
(Shi, Wang, Kim) Frailty Research Center, Hinda and Arthur Marcus
Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
(Shi, Wang, Kim) Division of Gerontology, Department of Medicine, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Shi, Laham, Wang, Kim) Harvard Medical School, Boston, MA, United States
(Rapley) Clinical Research Center, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Margulis) Rehabilitation Services, Hebrew SeniorLife, Boston, MA, United
States
(Laham, Guibone) Division of Cardiology, Department of Medicine, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Percy) Division of Cardiac Surgery, Department of Surgery, University of
British Columbia, Vancouver, Canada
(Kaneko) Department of Surgery, Washington University School of Medicine,
St. Louis, MO, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: The benefit of early cardiac rehabilitation after
transcatheter aortic valve replacement (TAVR) is not well established.
This pilot study evaluated the feasibility and short-term effects of a
home-based exercise program, with or without cognitive-behavioral
intervention (CBI). <br/>Method(s): We randomized 51 patients (mean age,
83.9 years; 19 women) to a home-based exercise program with CBI (Group A;
n = 18) or without CBI (Group B; n = 15), or telephone-based education
control (Group C; n = 18). The exercise program focusing on balance,
flexibility, strength, and endurance began within 7 days post-discharge
and was delivered once weekly by a physical therapist for 8 weeks. CBI
included discussions on exercise benefits and barriers, goal setting,
detailed exercise planning, and a weekly cash adherence incentive. The
primary outcome was a disability score (range: 0-22; higher scores
indicate greater disability) at 8 weeks. Secondary outcomes included the
Short Physical Performance Battery (SPPB) (range: 0-12; higher scores
indicate better function), self-efficacy, and outcome expectation scores.
Feasibility outcomes included adherence and drop-out rates.
<br/>Result(s): Fifteen participants (83.3%) in Group A, 10 (58.8%) in
Group B, and 10 (52.6%) in Group C completed >= 5 of the eight assigned
weekly sessions (p = 0.196). Two participants in each group were lost to
follow-up. At 8 weeks, the home-based exercise groups (Group A and B
combined) demonstrated lower disability scores (mean [SE]: 2.6 [0.3] vs.
4.5 [0.5]; p = 0.042) and higher SPPB scores (9.5 [0.6] vs. 6.5 [0.8]; p =
0.003) compared with the education group (Group C). Group A had lower
disability scores than Group B (2.1 [0.4] vs. 3.4 [0.5]; p = 0.047), with
no differences in self-efficacy and outcome expectation scores.
<br/>Conclusion(s): An early, home-based, multi-domain exercise program
appears feasible and may prevent disability and improve physical function
in older adults after TAVR. Adding CBI, including a modest cash incentive,
showed trends toward improved adherence and reduced disability. Trial
Registration: NCT02805309.<br/>Copyright &#xa9; 2025 The American
Geriatrics Society.

<73>
Accession Number
2034057968
Title
Vascular Complications and Bleeding After Transfemoral TAVR With Surgical
Versus Percutaneous Approach: A Contemporary Prospective Study.
Source
Journal of Interventional Cardiology. 2024(1) (no pagination), 2024.
Article Number: 8355054. Date of Publication: 2024.
Author
Dardaillon A.A.; Akodad M.; Huet F.; Meunier P.A.; Gandet T.; Macia J.-C.;
Schmutz L.; Targosz F.; Roubille F.; Steinecker M.; Lattuca B.; Robert P.;
Berdeu J.-M.; Cayla G.; Leclercq F.
Institution
(Dardaillon, Akodad, Huet, Meunier, Macia, Roubille, Steinecker, Berdeu,
Leclercq) Department of Cardiology, University Hospital of Montpellier,
Montpellier, France
(Akodad, Roubille) PhyMedExp INSERM U1046, University Hospital of
Montpellier, Montpellier, France
(Gandet) Department of Cardiovascular Surgery, University Hospital of
Montpellier, Montpellier, France
(Schmutz, Lattuca, Robert, Cayla) Department of Cardiology, University
Hospital of Nimes, Nimes, France
(Targosz) Department of Cardiology, Perpignan Hospital, Perpignan, France
Publisher
John Wiley and Sons Inc
Abstract
Background: Percutaneous (PC) access has become the first-line strategy
for transfemoral (TF) transcatheter aortic valve replacement (TAVR), but
surgical cutdown (SC) may be required in selected and usually challenging
cases. We aimed to compare the efficacy and safety of SC versus
echo-guided PC approach in TF TAVR. <br/>Method(s): Between November 2019
and December 2020, all patients undergoing TF TAVR were included in a
prospective study. The choice of PC or SC strategy was left at operators'
discretion, according to predictable access site difficulties. The primary
endpoint included all vascular complications (VCs) and all bleeding at
1-month follow-up according to Valve Academic Research Consortium-2
criteria. <br/>Result(s): Among 225 patients, 166 (73.8%) and 59 (26.2%)
underwent PC or SC approach, respectively. Median age was 82 years,
EuroSCORE 2 was higher (p = 0.02), and peripheral arterial disease (p <
0.001) was more common in the SC group. Femoral access was successful in
100% in the SC group vs 97.6% in the PC group (p = 0.2). The primary
endpoint was reached in 32 patients (14.2%), 5 (8.4%) in the SC group and
27 (16.2%) in the PC group (p = 0.1) with low incidence of major VC in
both groups (1.7% vs 3% in the SC and PC groups respectively, p = 0.6).
<br/>Conclusion(s): Despite a higher risk profile of patients in the SC
group, SC and PC approaches appear safe and effective in TF TAVR, with a
high success rate. SC may be considered when vascular access is
anticipated as complex, but this strategy might be confirmed in a
randomized study. Trial Registration: ClinicalTrials.gov identifier:
NCT03865043.<br/>Copyright &#xa9; 2024 Annick Astie Dardaillon et al.

<74>
Accession Number
646960412
Title
Transesophageal Echo Associated Gastrointestinal Injuries: A Pooled Rate
of Injuries.
Source
American Journal of Gastroenterology. Conference: American College of
Gastroenterology Annual Meeting, ACG 2023. Vancouver, BC Canada. 118(10
Supplement) (pp S529-S530), 2023. Date of Publication: 01 Oct 2023.
Author
Gangwani M.K.; Hayat U.; Awan R.U.; Aziz A.; Dahiya D.S.; Aziz M.;
Lee-Smith W.M.; Amantul-Raheem H.; Nawras Y.; Kamal F.; Inamdar S.
Institution
(Gangwani, Aziz, Lee-Smith, Nawras) University of Toledo, Toledo, OH,
United States
(Hayat) Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, United
States
(Awan) Ochsner Rush Medical Center, Meridian, MS, United States
(Aziz) University of Augusta, Augusta, GA, United States
(Dahiya) University of Kansas, School of Medicine, Kansas City, KS, United
States
(Amantul-Raheem) Deccan College of Medical Sciences, Toledo, OH, United
States
(Kamal) Thomas Jefferson Health, Philadephia, PA, United States
(Inamdar) University of Arkansas, Toledo, OH, United States
Publisher
Wolters Kluwer Health
Abstract
IntroductionTransesophageal echocardiography (TEE) is a growing modality
that plays a significant role in guiding clinical decision-making.
However, upper gastrointestinal (GI) injuries are frequently observed as
complications of TEE. The objective of this study is to systematically
review the incidence rates and different types of GI injuries associated
with TEE. <br/>Method(s): A comprehensive literature search was performed
across multiple databases, including MEDLINE, EMBASE, Cochrane Central
Register of Controlled Trials, Web of Science Core Collection, and the
Global Index Medicus. The search utilized specific keywords related to
"TEE" and "GI injuries". Pooled rates were calculated for overall
injuries, GI complications, lacerations, and perforations, with
corresponding 95% confidence intervals (CI). Additionally, a subgroup
analysis was conducted using odds ratios (OR) to compare bleeding rates
between the variceal and non-variceal groups. <br/>Result(s): A total of
1,151 articles were evaluated, and 26 studies with 55,319 patients were
included in the analysis. The overall rate of adverse events was found to
be 0.51% with a 95% confidence interval (CI) of 0.3% to 0.7%. Among all
adverse events, bleeding was the most commonly reported, followed by
dysphagia and lacerations (refer to Table 1 for details). The highest
rates of adverse events were observed in liver transplant patients at
1.35%, followed by critically ill patients in the intensive care unit
(ICU) and in-hospital settings at 1.1%. Adverse events during
intraoperative TEE were noted at a rate of 0.7%, while patients undergoing
cardiac procedures experienced adverse events at a rate of 0.67%. The
pooled complication rate for bleeding was calculated to be 0.17% with a
95% CI of 0.1% to 0.3%. The rate of odynophagia/dysphagia was estimated to
be 0.27% with a 95% CI of -0.1% to 0.5%, and lacerations had a rate of
0.12% with a 95% CI of -0.1% to 0.5%. A subgroup analysis comparing
variceal and non-variceal cohorts across three studies revealed no
significant difference in bleeding rates (Figure 1). <br/>Conclusion(s):
Our review documented the complications associated with TEE and their
correlation with different patient subgroups. Our study demonstrates
benefits of TEE outweigh the minimal risks involved in at-risk patients
including those with varices. Further studies are needed to validate our
findings and provide valuable insights for future clinical
decision-making.

<75>
Accession Number
646965617
Title
Pancreaticopleural Fistula: An Uncommon Complication of Chronic
Pancreatitis.
Source
American Journal of Gastroenterology. Conference: American College of
Gastroenterology Annual Meeting, ACG 2023. Vancouver, BC Canada. 118(10
Supplement) (pp S1543), 2023. Date of Publication: 01 Oct 2023.
Author
Moon G.; Nasir A.B.; Khan M.T.; Ajayi T.; Rumman A.
Institution
(Moon, Nasir, Khan, Ajayi, Rumman) University of Oklahoma Health Sciences
Center, Oklahoma City, OK, United States
Publisher
Wolters Kluwer Health
Abstract
Introduction: Pancreaticopleural fistulas (PPFs) are usually seen in
middle-aged men with chronic alcoholism, occurring in 0.4% of cases of
pancreatitis. It occurs when pancreatic secretions digest fascial planes
via a pseudocyst which communicates with the pleural cavity or via a tract
between the posterior pancreatic duct and the pleura. Although there is no
defined cutoff value, only PPFs will demonstrate pleural fluid amylase
levels >50,000U/L. This case is unique as the patient's presentation was
atypical for PPFs. Case Description/Methods: A 43-year-old female with
chronic pancreatitis, alcohol abuse, and tobacco abuse presents for SOB,
recurrent abdominal pain and 30 lb weight loss in the past year. She was
discharged a week prior to presentation after a month-long admission for
acute on chronic pancreatitis. A CT abdomen/pelvis with contrast showed
small volume ascites, bilateral pleural effusions (greatest on left),
coarse calcifications throughout the pancreatic parenchyma, a lobulated
fluid collection in pancreatic body which extended superiorly into the
left hemithorax around the distal esophagus through the esophageal hiatus
with largest component measuring 2.3 x 4.4cm, in close proximity to the
pancreatic duct (Figure 1). Labs were significant for serum procalcitonin
0.04ng/mL, lipase 104U/L, hematocrit 27.7%, CRP 45.1mg/L. Based on the
Atlanta Classification, the fluid collection in the pancreatic body was
concerning for a pseudocyst with developing PPFs. Thoracic surgery
declined surgery. GI offered ERP however patient declined the procedure.
She was discharged home in a stable condition with close GI follow-up.
<br/>Discussion(s): In a systematic review, MRCP was the most sensitive
diagnostic modality for detecting PPF (80%), then ERCP (78%) and then CT
(47%) (1). As with chronic pancreatic sequelae, PPF patients can be
managed conservatively, endoscopically, or surgically. Management should
be modified based on each patient's pancreatic ductal defect. Large-scale
studies examining PPF intervention success rates would be beneficial. Our
patient's presentation was atypical for PPF as patients present more
commonly with pulmonary rather than abdominal symptoms, the opposite of
her presentation. So it is imperative to keep a high index of suspicion
for the possibility of a PPF.

<76>
Accession Number
646965947
Title
Recurrent atherosclerotic cardiovascular disease events preventable with
guideline recommended lipid-lowering treatment following myocardial
infarction.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2374), 2022.
Date of Publication: 01 Oct 2022.
Author
Sakhuja S.; Bittner V.A.; Brown T.M.; Farkouh M.E.; Levitan E.B.; Rosenson
R.; Safford M.M.; Muntner P.; Chen L.; Sun R.; Noshad S.; Dhalwani N.;
Woodward M.; Colantonio L.D.
Institution
(Sakhuja, Levitan, Muntner, Chen, Sun, Colantonio) University of Alabama
Birmingham, School of Public Health, Birmingham, United States
(Bittner, Brown) University of Alabama Birmingham, Department of Medicine,
Division of Cardiovascular Disease, Birmingham, United States
(Farkouh) University of Toronto, Toronto, Canada
(Rosenson) Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New
York, United States
(Safford) Weill Cornell Medicine, New York, United States
(Noshad, Dhalwani) Amgen Inc., Thousand Oaks, United States
(Woodward) Imperial College London, The George Institute for Global
Health, London, United Kingdom
Publisher
Oxford University Press
Abstract
Background: The 2018 American Heart Association/American College of
Cardiology (AHA/ACC) cholesterol guideline provides recommendations for
lipid-lowering therapy (LLT) including statins, ezetimibe and proprotein
convertase subtilisin/kexin type 9 inhibitor (PCSK9i) to prevent recurrent
atherosclerotic cardiovascular disease (ASCVD) events in adults with
established ASCVD. Many adults with ASCVD who are recommended to take
statins, ezetimibe and/or PCSK9i do not receive these medications.
<br/>Purpose(s): To estimate the number of recurrent ASCVD events
potentially prevented by population-wide use of guideline recommended LLT
following a myocardial infarction (MI). <br/>Method(s): We simulated the
population-wide impact of receipt of 2018 AHA/ACC cholesterol guideline
recommended LLT over 3 and 5 years among US adults with government health
insurance through Medicare or commercial health insurance following
hospital discharge for MI. We used data from patients with an MI
hospitalization in 2018-2019 to estimate the percentage receiving
guideline recommended LLT defined by having the medications available to
take in the 30 days after their discharge date. We used data from patients
with an MI hospitalization in 2013-2016 to estimate the 3 and 5-year
cumulative incidence of recurrent ASCVD events (i.e., MI, coronary
revascularization or ischemic stroke). The reduction in AS-CVD events
associated with guideline recommended LLT was estimated from a
meta-analysis by the Cholesterol-Lowering Treatment Trialists
Collaboration. We conducted a sensitivity analysis estimating the number
and percentage of ASCVD events prevented if LLT recommendations from the
2019 European Society of Cardiology/European Atherosclerosis Society
(ESC/EAS) cholesterol guideline were followed. We repeated all analyses
with recurrent coronary heart disease (i.e., MI or coronary
revasculariza-tion) and ischemic stroke events as separate outcomes.
<br/>Result(s): Among 279,395 adults with an MI hospitalization in
2018-2019 (mean age 75 years, 54% men, mean low-density lipoprotein
cholesterol 92 mg/dL), 27% were receiving guideline recommended LLT. With
current lipid-lowering medication use, we estimated that 70,698 (95% CI:
70,311- 71,077) and 89,255 (95% CI: 88,841-89,730) ASCVD events would
occur in 3 and 5 years, respectively, after MI hospital discharge (Table,
top panel). If all patients were to receive 2018 AHA/ACC guideline
recommended LLT, the number of ASCVD events was estimated to be reduced by
21.6%, representing 15,264 (95% CI: 14,451-16,679) events prevented over 3
years and 19,271 (95% CI: 18,245-21,055) events prevented over 5 years. A
higher number of recurrent ASCVD events were estimated to be averted
following the LLT recommendations of the 2019 ESC/EAS cholesterol
guideline (Table, bottom panel). <br/>Conclusion(s): Population-wide
implementation of guideline recommended LLT in adults with an MI
hospitalization could prevent a substantial number of recurrent ASCVD
events. (Table presented).

<77>
Accession Number
646957642
Title
Left atrial appendage occlusion versus standard of care in patients with
atrial fibrillation and a prior thrombo-embolic event despite oral
anticoagulant therapy: a propensity score matched comparison.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 632), 2022. Date
of Publication: 01 Oct 2022.
Author
Maarse M.; Seiffge D.; Fierro N.; Tondo C.; Pracon R.; De Backer O.;
Nielsen-Kudsk J.; Estevez-Loureiro R.; Benito-Gonzalez T.; Nombela-Franco
L.; Arzamendi D.; Alla V.; Swaans M.; Werring D.; Boersma L.
Institution
(Maarse, Swaans, Boersma) St Antonius Hospital, Nieuwegein, Netherlands
(Seiffge) Bern University Hospital, Inselspital, Bern, Switzerland
(Fierro) San Raffaele Hospital, Milan, Italy
(Tondo) Centro Cardiologico Monzino, Milan, Italy
(Pracon) National Institute of Cardiology, Warsaw, Poland
(De Backer) Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Nielsen-Kudsk) Aarhus University Hospital, Aarhus, Denmark
(Estevez-Loureiro) University Hospital Complex of Vigo, Vigo, Spain
(Benito-Gonzalez) Leon Hospital (University Assistance Complex of Leon),
Leon, Spain
(Nombela-Franco) Hospital Clinico San Carlos, Madrid, Spain
(Arzamendi) Centro Medico Teknon, Barcelona, Spain
(Alla) Creighton University Medical Centre, Omaha, United States
(Werring) University College London, London, United Kingdom
Publisher
Oxford University Press
Abstract
Introduction: Patients with atrial fibrillation (AF) that suffer from
ischemic stroke despite oral anticoagulant (OAC) therapy have a very high
risk of recurrent stroke and better prevention strategies are needed. Left
atrial appendage occlusion (LAAO) is a promising secondary prevention
strategy that may provide mechanical protection in patients that suffer
from thrombo-embolic events under OAC. However, evidence showing
effectiveness of LAAO in this population is scarce and the current
international guidelines only consider LAAO in patients with a
contra-indication for OAC. <br/>Purpose(s): To compare percutaneous LAAO
to standard-of-care including continuing/switching anticoagulation therapy
for secondary stroke prevention in patients with AF and a prior
thrombo-embolic event and/or LAA thrombus under OAC therapy.
<br/>Method(s): The STR-OAC LAAO cohort is an international collaboration
combining a selection of patients from multiple LAAO registries (22
participating centers). Patients that underwent percutaneous LAAO because
of a thrombo-embolic event and/or LAA thrombus on OAC were included.
Propensity score matching (optimal matching method, 1:1 ratio) with a
previously published multi-center dataset of patients continuing/switching
anticoagulation treatment after a thrombo-embolic event was performed to
adjust for imbalances in age, sex, hypertension, diabetes mellitus and
CHA2DS2-VASc score. The primary outcome was ischemic stroke. Time-to-event
analysis was performed with Kaplan-Meier curves and Coxproportional-hazard
regression analyses. <br/>Result(s): A total of 404 patients underwent
LAAO between 2010-2021 and were included in the STR-OAC LAAO cohort. Mean
age was 72+/-9 years; 44% was female and mean CHA2DS2-VASc and HAS-BLED
score were 4.8+/-1.7 and 2.5+/-1.4, respectively. Most patients received a
Watchman or Amplatzer device (53% and 43%). Oral anticoagulation was
discontinued after LAAO at discharge or after confirmation of adequate LAA
closure at 1-3 months follow-up in 44% or 20%, respectively. The remaining
35% of patients continued OAC after LAAO as an adjunctive strategy. All
LAAO patients were propensity-score matched and included in the primary
outcome analysis. Baseline characteristics were well balanced after
matching (Table 1). During follow up including 1406 patient-years (LAAO
1007; control 399) a total of 61 patients experienced an ischemic stroke:
2.2% per patient-year in LAAO group versus 9.8% per patient-year in the
control group. LAAO was associated with a significantly lower risk of
ischemic stroke (HR 0.33, 95% CI [0.19-0.59], p<0.001) compared to
standard-of-care (Figure 1). <br/>Conclusion(s): In this propensity-score
matched study, LAAO was associated with a lower risk of ischemic stroke
compared to standard-of-care in patients with a thrombo-embolic event
and/or LAA thrombus despite OAC treatment. Randomized controlled trial
data may further confirm the effectiveness of LAAO in this very high-risk
population. (Table presented). (Figure presented).

<78>
Accession Number
646958089
Title
Specific characteristics of STEMI in COVID-19 patients and their practical
implications: a systematic review.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1424), 2022.
Date of Publication: 01 Oct 2022.
Author
Gitto M.; Novelli L.; Cozzi O.; Reimers B.; Condorelli G.; Stefanini G.G.
Institution
(Gitto, Novelli, Cozzi, Reimers, Condorelli, Stefanini) Humanitas Research
Hospital, Milan, Italy
Publisher
Oxford University Press
Abstract
Introduction: STEMI is one of the cardiac emergencies whose management has
been mostly challenged by the COVID-19 pandemic. Patients presenting with
the "lethal combo" of STEMI and concomitant SARS-CoV- 2 infection have
faced dramatic issues related to need for self-isolation, systemic
inflammation with multi-organ disease, and difficulties to obtain timely
diagnosis and treatment. <br/>Method(s):We performed a systematic search
of three electronic databases from February 1st 2020 to January 31st 2022.
We included all studies reporting crude rates of in-hospital outcomes of
STEMI patients with concomitant COVID-19. <br/>Result(s): A total of 9
observational studies were identified, mainly conducted during the first
wave of the pandemic. STEMI patients with COVID -19 were more likely
Afro-American and displayed higher rates of hypertension and diabetes with
lower smoking prevalence. Associated comorbidities, including coronary
artery disease, prior stroke and chronic kidney disease were also more
common in those with SARS-CoV-2 infection. At coronary angiography, a
higher thrombus burden in COVID-19 positive STEMI patients was
highlighted, with up to 10-fold higher rates of stent thrombosis and
greater need for glycoprotein IIb/IIa inhibitors and aspiration
thrombectomy; this was not always associated with prolonged times from
symptom onset to hospital admission and door-to-balloon. COVID-19 positive
STEMI patients were less likely to receive coronary angiography and
primary PCI, and more likely to be treated with fibrinolytics only. At the
same time, patients with Covid-19 were more prone to present MINOCA.
In-hospital mortality ranged from 15% to 40%, with consistent variability
across different studies and subjects who tested positive for SARS-CoV- 2
did also present higher rates of cardiogenic shock, cardiac arrest,
prolonged ICU stay, mechanical ventilation, major bleeding, and stroke.
<br/>Conclusion(s): The coexistence of STEMI and COVID-19 was associated
with increased in-hospital mortality and poor short-term prognosis. This
was not entirely attributable to logistic issues determining delayed
coronary revascularization, since patients' specific clinical and
angiographic characteristics, including higher burden of cardiovascular
risk factors and greater coronary thrombogenicity might have substantially
contributed to this trend. (Table presented).

<79>
Accession Number
646957089
Title
Impact of diabetes and glucose-lowering therapy on post-operative atrial
fibrillation after cardiac surgery: secondary analysis of the SEARCH-AF
CardioLink-1 randomized clinical trial.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 508), 2022. Date
of Publication: 01 Oct 2022.
Author
Pandey A.; Hibino M.; Ha A.; Quan A.; Verma A.; Bisleri A.; Mazer C.D.;
Verma S.
Institution
(Pandey, Hibino, Quan, Bisleri, Mazer, Verma) St. Michael's Hospital,
Toronto, Canada
(Ha) UHN - University of Toronto, Toronto, Canada
(Verma) Southlake Regional Health Centre, Newmarket, Canada
Publisher
Oxford University Press
Abstract
Background: Diabetes mellitus is an important risk factor for atrial
fibrillation (AF) and is associated with an increased risk of
complications for patients with AF. The impact of diabetes on
post-operative AF after cardiac surgery is not well-defined.
<br/>Purpose(s): We sought to characterize the effect of diabetes,
insulin, and oral hypoglycemic agents on the incidence of post-operative
atrial fibrillation (POAF) after cardiac surgery. Accordingly, we
conducted a secondary analysis of the Post-Surgical Enhanced Monitoring
for Cardiac Arrhythmias and Atrial Fibrillation (SEARCH-AF) CardioLink-1
randomized trial. <br/>Method(s): In the SEARCH-AF trial, 336 patients
with risk factors for stroke (CHA2DS2-VASc score >=2) and no history of
preoperative AF were randomized to usual care or continuous cardiac rhythm
monitoring for 30 days after discharge from cardiac surgery with a
wearable, patched-based device. The primary outcome was occurrence of
cumulative atrial fibrillation/flutter (AF/AFL) lasting for >=6 minutes
detected by continuous monitoring or AF/AFL documented by a 12-lead
electrocardiogram within 30 days of randomization. We assessed the
association between diabetes and occurrence of post-operative AF. In
addition, we examined the association between POAF and glucose-lowering
therapy among patients with diabetes. <br/>Result(s): Among the 176 (52%)
patients with diabetes in the study cohort, 80 (45%) patients were treated
with at least 1 oral hypoglycemic agent and 44 (25%) patients were treated
with insulin. The incidence of POAF occurring within 30 days after
discharge from surgery was similar between patients with or without
diabetes (cumulative incidence: 10.8% vs. 10.0%, log-rank p=0.77). Among
patients with diabetes, the incidence of POAF was highest in those who
were not treated with glucose-lowering therapy (17.3%) when compared with
those treated with oral hypoglycemic agents (10.0%) or insulin (4.5%)
(log-rank ptrend=0.045 among the 3 groups). In an exploratory analysis, we
observed a trend suggesting a lower incidence of POAF among cardiac
surgical patients who were treated with SGLT-2 inhibitors (log-rank
ptrend=0.084). <br/>Conclusion(s): The incidence of POAF occurring after
discharge from cardiac surgery is equally high among patients with or
without diabetes. Our results suggest a potential association between
specific glucose-lowering therapies and risk of POAF after cardiac
surgery, meriting further investigations. (Figure presented).

<80>
Accession Number
646960145
Title
Lipoprotein(a) and the effect of alirocumab on coronary and non-coronary
revascularization following acute coronary syndrome.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1386), 2022.
Date of Publication: 01 Oct 2022.
Author
Steg P.; Szarek M.; Valgimigli M.; Islam S.; Zeiher A.M.; Bhatt D.L.;
Bittner V.A.; Diaz R.; Goodman S.G.; Harrington R.A.; Jukema J.W.; Pordy
R.; Scemama M.; White H.D.; Schwartz G.G.
Institution
(Steg) Hospital Bichat-Claude Bernard, Paris, France
(Szarek) State University of New York Downstate Medical Center, New York,
United States
(Valgimigli) Cardiocentro Ticino Institute, Lugano, Switzerland
(Islam) NYU Long Island School of Medicine, Division of Health Services
Research, Mineola, United States
(Zeiher) Goethe University Hospital, Frankfurt, Germany
(Bhatt) Brigham and Women's Hospital, Boston, United States
(Bittner) University of Alabama Birmingham, Birmingham, United States
(Diaz) Estudios Cardiologicos Latinoamerica (ECLA), Rosario, Argentina
(Goodman) St. Michael's Hospital, Toronto, Canada
(Harrington) School of Medicine, Stanford, United States
(Jukema) Leiden University Medical Center, Leiden, Netherlands
(Pordy) Regeneron Pharmaceuticals, Inc., Tarrytown, United States
(Scemama) Sanofi, Paris, France
(White) Auckland City Hospital, Auckland, New Zealand
(Schwartz) University of Colorado, Aurora, United States
Publisher
Oxford University Press
Abstract
Background: Many patients require arterial revascularization after an
index ACS. Lipoprotein(a) is thought to play a pathogenic role in
atherothrombosis. In the ODYSSEY OUTCOMES trial, the PCSK9 inhibitor
alirocumab reduced major adverse cardiovascular events after ACS, with
greater reduction among those with higher lipoprotein(a).
<br/>Objective(s): We determined whether the risk of first coronary or any
(coronary, peripheral artery or carotid) revascularization after ACS was
modified by the level of lipoprotein(a) and treatment with alirocumab or
placebo. <br/>Method(s): The ODYSSEY OUTCOMES trial (NCT01663402) compared
alirocumab with placebo in 18,924 patients with ACS and elevated
atherogenic lipoproteins despite optimized statin treatment. Treatment
effects were summarized by competing-risks proportional hazard models.
<br/>Result(s): A total of 1559 (8.2%) patients had coronary, 204 (1.1%)
peripheral artery, and 40 (0.2%) carotid revascularization after
randomization. Alirocumab reduced first coronary revascularization (9.6%
vs. 11.3% at 4 years; hazard ratio [HR] 0.88, 95% confidence interval [CI]
0.80-0.97; p=0.01) and any first revascularization (10.8% vs. 13.0%; HR
0.85, 95% CI 0.78-0.94; p=0.001). Baseline lipoprotein(a) quartile was
directly associated with risk of coronary or any revascularization in the
placebo arm (ptrend <0.0001) and inversely related to treatment HRs
(ptrend <0.001). The greatest benefits of alirocumab on coronary or any
revascularization were observed in patients with baseline lipoprotein(a)
in the top quartile (>=59.6 mg/dL) (figures). <br/>Conclusion(s):
Alirocumab reduced revascularization after ACS. The risk of
revascularization and reduction in that risk with alirocumab were greatest
in patients with elevated lipoprotein(a) at baseline. (Figure presented).

<81>
Accession Number
646961264
Title
Meta-analysis on the comparison of direct oral anticoagulants versus
vitamin K antagonists after transcatheter aortic valve implantation in
patients with pre-existing atrial fibrillation.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2100), 2022.
Date of Publication: 01 Oct 2022.
Author
Mateo Q.; Tiongco R.; Bernardo J.
Institution
(Mateo, Tiongco, Bernardo) Saint Lukes Medical Center Global City, Taguig,
Philippines
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve replacement is a treatment option
for symptomatic patients with severe aortic stenosis who are candidates
for a bioprosthesis across the entire spectrum of risk. TAVR carries a
risk for thrombotic and bleeding events, underscoring the importance of
defin-ing the optimal adjuvant antithrombotic regimen. Antithrombotic
consider-ation is complicated by the fact that many patients undergoing
TAVR are generally elderly with multiple comorbidities, including
conditions that may require long-term oral anticoagulation such as atrial
fibrillation. The optimal antithrombotic regimen for patients with AF
undergoing TAVR is currently unknown. The objective of this meta-analysis
is to add knowledge to ex-isting data involving the use of direct oral
anticoagulant in patients with pre-existing atrial fibrillation undergoing
TAVI and to explore the safety and efficacy of DOACs compared with VKA in
this population Methods: A systematic search for randomized controlled
trials which compare direct oral anticoagulant and vitamin K antagonist
was done using PubMed, Cochrane, MEDLINE and Clinicaltrials.gov. Studies
which were done in the last five years (January 2016-October 2021) and
those that involved human subjects were included in the study. Search
terms include "Direct Oral Anticoagulant", "Vitamin K Antagonist", "TAVR",
"atrial fibrilla-tion", "DOAC" AND "TAVI" OR "VKA" AND "TAVI" AND "atrial
fibrillation" AND "randomized controlled trial". <br/>Result(s): Five
retrospective observational studies and two RCTs (3,998) were included in
this meta-analysis comparing direct oral anticoagulant vs vitamin K
antagonist in patients with known atrial fibrillation post TAVI.
Dabigatran, Rivaroxaban, Apixaban, and Edoxaban were used in these
dif-ferent studies. Among patients with concomitant indication of oral
anticoag-ulant like atrial fibrillation, there is no significant
difference between direct oral anticoagulant and vitamin K antagonist in
terms of outcomes on all-cause mortality, major and/or life threatening
bleeding and stroke as shown in these values, (OR 1.05, 95% CI: 0.89-1.25,
P=0.57, I²=39%), (OR=1.04, 95% CI: 0.85-1.27, P=0.70,
I²=45%) and (OR=1.10, 95% CI: 0.80-1.51, p=0.56,
I²=0%), respectively. When only the two RCTs are compared,
still there is no significant difference on the outcomes mentioned above
between direct oral anticoagulant and vitamin K antagonist based on these
values (OR=1.07, 95% CI: 0.85-1.36, P=0.57, I²=0%), (OR=1.15,
95% CI: 0.59-2.24, P=0.68, I²=66%) and (OR=0.99, 95% CI:
0.65-1.49, p=0.95, I²=39%), respectively. <br/>Conclusion(s):
Use of direct oral anticoagulant was non inferior with vitamin K
antagonist in terms of outcomes on all-cause mortality, major and/or life
threatening bleeding and stroke. Direct oral anticoagulant is easier to
use with its known safety profile, hence, it is a plausible alternative to
warfarin in this population in patients with known atrial fibrillation
post TAVR.

<82>
Accession Number
646956592
Title
The long-term cardiac events after coronary bifurcation stenting with
second-generation drug-eluting stents in elderly patients are comparable
to those of younger patients.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1256), 2022.
Date of Publication: 01 Oct 2022.
Author
Kim J.H.; Franchin L.; Hong S.J.; Cha J.J.; Lim S.; Joo H.J.; Park J.H.;
Yu C.W.; Ahn T.H.; Lim D.S.; Dascenzo F.
Institution
(Kim, Hong, Cha, Lim, Joo, Park, Yu, Ahn, Lim) Korea University Anam
Hospital, Seoul, South Korea
(Franchin, Dascenzo) University of Turin, Turin, Italy
Publisher
Oxford University Press
Abstract
Background: Elderly patients undergoing percutaneous coronary intervention
(PCI) generally have a high risk of adverse clinical outcomes. We
investigated the long-term clinical impact of PCI on coronary bifurcation
disease in elderly patients in Korea and Italy. <br/>Method(s): From the
BIFURCAT (comBined Insights from the Unified RAIN and COBIS bifurcAtion
regisTries) data, we evaluated 5,537 patients who underwent PCI for
coronary bifurcation disease. The primary outcome was major adverse
cardiac events (MACEs), defined as the composite of target vessel
myocardial infarction, target lesion revascularisation, and stent
thrombosis. Kaplan-Meier estimates and Cox proportional hazard models were
used to compare elderly patients (aged >=75 years) and younger patients
(aged <75 years). <br/>Result(s): A total of 1,415 patients (26%) were
aged >=75 years. Elderly patients were more frequently female, had higher
rates of hypertension and chronic kidney disease (CKD), and presented more
frequently with left main (LM) disease. After a median follow-up of 2.1
years, MACEs were comparable between elderly and younger patients. In
multivariable analysis, old age was not an independent predictor of MACEs
(p=0.977). In elderly patients, CKD and LM disease were independent
predictors of MACEs, whereas in younger patients, hypertension, diabetes,
CKD, reduced left ventricular ejection fraction, LM disease, and two-stent
strategy usage were independent predictors. <br/>Conclusion(s): Elderly
patients who underwent coronary bifurcation PCI with second-generation
drug-eluting stents demonstrated similar clinical outcomes to those of
younger patients. Both CKD and LM disease were independent predictors of
MACEs, regardless of age after coronary bifurcation PCI. (Figure
presented).

<83>
Accession Number
646960750
Title
Cost-effectiveness of statin therapy in categories of patients in the UK.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2841), 2022.
Date of Publication: 01 Oct 2022.
Author
Mihaylova B.; Wu R.; Williams C.; Zhou J.; Schlackow I.; Emberson J.;
Reith C.; Keech A.; Robson J.; Wilkinson K.; Armitage J.; Collins R.; Gray
A.; Simes J.; Baigent C.
Institution
(Mihaylova, Williams, Zhou, Emberson, Reith, Armitage, Collins, Gray,
Baigent) University of Oxford, Nuffield Department of Population Health,
Oxford, United Kingdom
(Wu, Robson) Queen Mary University of London, Wolfson Institute of
Population Health, London, United Kingdom
(Schlackow) University of Oxford, Oxford, United Kingdom
(Keech, Simes) University of Sydney, NHMRC Clinical Trials Centre, Sydney,
Australia
(Wilkinson) Public Representative, Oxford, United Kingdom
Publisher
Oxford University Press
Abstract
Background: Cardiovascular disease (CVD) mortality has declined steadily
over the last few decades across Europe and North America.
<br/>Purpose(s): To provide contemporary estimates of long-term
effectiveness and cost-effectiveness of statin therapy in different
categories of patients in UK. <br/>Method(s): The CTT-UKB micro-simulation
model, developed using the Cholesterol Treatment Trialists' Collaboration
data (CTT: 118,000 participants; 5 years follow-up), and calibrated in the
UK Biobank cohort (UKB: 502,000 participants; 9 years follow-up). The
model integrates parametric risk equations for incident myocardial
infarction, stroke, coronary revascularization, diabetes, cancer and
vascular and nonvascular death, and projects annually these endpoints and
survival using patient characteristics at entry. UKB data and linked
primary and hospital care data informed healthcare costs in the model
(2020 UK); 2021 UK NHS Drug Tariff informed statin costs (atorvastatin
40mg at 1.22 and 80mg at 1.68 per 28 tablets); and Health Survey for
England data informed health-related quality of life in the model.
Previous CTT meta-analysis, atorvastatin doseresponse randomized trials,
and further meta-analyses of statin trials and cohort studies informed
effects of 40mg/80mg atorvastatin therapy daily on rates of incident
myocardial infarction, stroke, coronary revascularization, vascular death,
diabetes, myopathy and rhabdomyolysis. The model was used to project gains
in quality-adjusted life years (QALYs) and additional cost per QALY with
lifetime use of atorvastatin 40mg or 80mg daily in categories of UKB
participants by sex, age at statin initiation (40-49; 50-59 and 60-70
years), and 10-year CVD risk (QRISK3 risk (%): <5; 5-10, 10-15, 15-20,
>=20). Further scenarios explored effects of 5-year delay of statin
initiation in people under 45 years of age or stopping statin therapy at
80 years of age. <br/>Result(s): Across men and women in categories by age
and CVD risk, lifetime use of atorvastatin 40mg daily was associated with
increases in survival by 0.44-1.69 years (0.28-1.02 QALYs), and
atorvastatin 80mg daily with increases in survival of 0.45-1.87 years
(0.32-1.13 QALYs; Figure 1) with gains larger among participants at higher
CVD risk. Both atorvastatin 40mg and 80mg doses were in the range of
cost-effective treatments with incremental cost per QALY gained with
atorvastatin 40mg daily versus no statin therapy below 7200/QALY and with
atorvastatin 80mg vs 40mg daily below 16000/QALY (Figure 2) across all
patient categories studied. Compared to lifetime statin therapy, stopping
therapy at 80 years of age substantially reduced benefits and was not
cost-effective in any patient category studied. Similarly, compared to
immediate initiation, 5-year delay of statin therapy in 40-45 years old
patients was not a cost-effective. <br/>Conclusion(s): In the UK, statin
therapy remains highly cost-effective across men and women 40-70 years
old, including those at 10-year CVD risk <5%. (Figure presented).

<84>
Accession Number
646957499
Title
Clinical factors affecting survival in patients with D-transposition of
the great arteries after atrial switch repair: a meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 680), 2022. Date
of Publication: 01 Oct 2022.
Author
Nartowicz S.; Jakielska E.; Cieplucha A.; Ratajczak P.; Grajek S.N.;
Lesiak M.; Trojnarska O.
Institution
(Nartowicz, Jakielska) Poznan University of Medical Sciences, Poznan,
Poland
(Cieplucha, Grajek, Lesiak, Trojnarska) Poznan University of Medical
Sciences, 1st Department of Cardiology, Poznan, Poland
(Ratajczak) Poznan University of Medical Sciences, Department of
Pharmacoeconomics and Social Pharmacy, Poznan, Poland
Publisher
Oxford University Press
Abstract
Background: Atrial switch repair (AtrSR) was the initial method of
operation in patients with D-transposition of the great arteries (D-TGA)
constituting the right ventricle as a systemic one. Currently, it has been
replaced with arterial switch operation (ASO), but the cohort of adults
after AtrSR is still large and requires strict cardiological management of
late complications. For this reason, we aimed to evaluate potential
long-term mortality risk factors in patients with D-TGA after AtrSR
(either Mustard or Senning procedure) Method: We searched MEDLINE database
for suitable trials. We included 22 retrospective and prospective cohort
studies of patients with D-TGA with at least 5 years mean/median follow-up
time after Mustard or Senning procedure, with an end-point of non-sudden
cardiac death (n-SCD) and sudden cardiac death (SCD) after at least 30
days after surgery. <br/>Result(s): A total of 2912 patients were
enrolled, of which 351 met the combined endpoint of n-SCD/SCD. The
long-term mortality risk factors were: NYHA>II/heart failure
hospitalization (OR=7.25; p=0.0001), tricuspid valve regurgitation
(OR=4.64; p=0.0005), Mustard procedure (OR=2.15; p=0.0008), complex D-TGA
(OR=2.41; p=0.005), right ventricle dysfunction (OR=1.94; p=0.05).
Supraventricular arrhythmia (SVT; OR=2.07; p=0.09) and pacemaker
implantation (OR=2.37; p=0.29) did not affect long-term survival in this
group of patients. In an additional analysis, SVT showed a statistically
significant impact on SCD (OR=2.74; p=0.005) but not on n-SCD (OR=1.5;
p=0.57). <br/>Conclusion(s): This meta-analysis identified that at least
moderate tricuspid valve regurgitation, NYHA class > II/heart failure
hospitalization, right ventricle dysfunction, complex D-TGA and Mustard
procedure as risk factors of long-term mortality in patients after AtrSR.
(Figure presented).

<85>
Accession Number
646959542
Title
Total arterial revascularization is associated with long-term survival
benefit in coronary artery bypass grafting: systematic review with
meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2139), 2022.
Date of Publication: 01 Oct 2022.
Author
Ren J.; Royse A.; Tian D.; Royse C.; Boggett S.; Bellomo R.; Gaudino M.;
Fremes S.
Institution
(Ren, Royse, Royse, Boggett, Bellomo) University of Melbourne, Melbourne,
Australia
(Tian) University of Sydney, Sydney, Australia
(Gaudino) Weill Cornell Medicine, New York, United States
(Fremes) Sunnybrook Health Sciences Centre, Toronto, Canada
Publisher
Oxford University Press
Abstract
Importance: Total arterial revascularization (TAR), the complete
avoid-ance of saphenous vein grafting (SVG) in coronary artery bypass
grafting (CABG), is advocated based on the superior conduit durability and
resis-tance against atherosclerosis. However, the low adoption rate of TAR
indi-cates a high level of controversy. <br/>Objective(s): To compare
long-term survival between TAR and conventional CABG involving SVG. Data
sources: A comprehensive literature search was conducted through digital
databases including MEDLINE, Embase, and Cochrane Central Register of
Controlled Trials from the inception to May 2021. Study selection: The
inclusion criteria were randomized clinical trials, or propensity-score
balanced or multivariable-adjusted observational studies with a sample
size of at least 100 patients in each arm, isolated CABG, comparing TAR
(SVG=0) vs. non-TAR (SVG>=1), and inclusion of all-cause mortality. Data
extraction and synthesis: Two reviewers performed independent ex-traction
following Preferred Reporting Items for Systematic Reviews and
Meta-analyses (PRISMA) guidelines. Pooled hazard ratios (HR) and 95%
confidence intervals (CI) were estimated with random-effect and
fixed-effect models using generic inverse variance weighting. Individual
patient time-to-event data were reconstructed to create an overall
Kaplan-Meier survival function for matched studies. Sensitivity analyses
were performed according to the risk of bias, matching status, and source
of HR. <br/>Main Outcomes and Measures: The primary endpoint was all-cause
mor-tality. <br/>Result(s): A total of 23 studies (100,314 patients), all
with a retrospective observational design, were identified. The weighted
mean follow-up time was 8.8 years post-operatively. Total arterial
revascularization was associated with greater freedom from all-cause
mortality than non-TAR (HR, 0.77, 95% CI, 0.71 to 0.84, p<0.001). There
was evidence of low heterogeneity (I²=45%) across studies. Low
publication bias was observed. Leave-one-out influence analysis and
sensitivity analyses produced consistent results. Cochrane Collaboration
signaling domains showed no critical risk of bias. Conclusions and
relevance: This meta-analysis found superior late survival associated with
total arterial revascularization. Further randomized clinical trials are
needed.

<86>
Accession Number
646960037
Title
Revascularization strategies versus optimal medical therapy in chronic
coronary syndrome: a systematic review and network meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2143), 2022.
Date of Publication: 01 Oct 2022.
Author
Galli M.; Benenati S.; Zito A.; Capodanno D.; Biondi-Zoccai G.; Ortega-Paz
L.; D'Amario D.; Porto I.; Burzotta F.; Trani C.; De Caterina R.; Escaned
J.; Gaudino M.; Angiolillo D.J.; Crea F.
Institution
(Galli, Burzotta, Trani, Crea) Catholic University of the Sacred Heart,
Rome, Italy
(Benenati, Porto) Ospedale Policlinico San Martino IRCCS, Genoa, Italy
(Zito, D'Amario) IRCCS Foundation Agostino Gemelli University Hospital,
Rome, Italy
(Capodanno) AOU Policlinico - Vittorio Emanuele, Catania, Italy
(Biondi-Zoccai) Sapienza University of Rome, Rome, Italy
(Ortega-Paz, Angiolillo) University of Florida College of Medicine,
Jacksonville, United States
(De Caterina) University of Pisa, Pisa, Italy
(Escaned) Hospital Clinico San Carlos, Madrid, Spain
(Gaudino) Weill Cornell Medicine, New York, United States
Publisher
Oxford University Press
Abstract
Background: Whether revascularization reduces ischemic events and
im-proves prognosis in patients with chronic coronary artery syndrome
(CCS) without left main (LM) disease or reduced left ventricle ejection
fraction (LVEF) remains a topic of debate. Nevertheless, the impact of
revascular-ization on outcomes in patients with CCS may be influenced by
the revas-cularization strategy adopted. <br/>Purpose(s): We aimed at
evaluating the comparative effects of different revascularization
strategies in patients with CCS. <br/>Method(s): A total of 18 randomized
controlled trials including angiography-guided percutaneous coronary
intervention (PCI), physiology-guided PCI and coronary artery bypass graft
(CABG), were included. Effect estimates included direct comparisons for
all treatments and direct and indirect ev-idence were in agreement for all
included outcomes, fulfilling the consis-tency assumption. Incidence rate
ratios (IRR) and associated 95% confi-dence intervals (CIs) were used to
adjust outcomes according to follow-up durations. Medical therapy was used
as reference strategy. <br/>Result(s): Compared with medical therapy, at a
mean follow-up of 5.1 years, all revascularization strategies were
associated with a reduction of the primary endpoint, as defined in each
trial, the extent of which was modest with angiography-guided PCI (IRR
0.86, 95% CI 0.75-0.99) and greater with physiology-guided PCI (IRR 0.60,
95% CI 0.47-0.77) and CABG (IRR 0.58, 95% CI 0.48-0.70). Moreover,
angiography-guided PCI was associated with increased primary endpoint
compared to physiology-guided PCI (IRR 1.43, 95% CI 1.14-1.79) and CABG
(IRR 1.49, 95% CI 1.27-1.74). CABG was the only strategy associated with
reduced myocardial infarc-tion (IRR 0.68, 95% CI 0.52-0.90),
cardiovascular death (IRR 0.76, 95% CI 0.64-0.89), and all-cause death
(IRR 0.87, 95% CI 0.77-0.99), but in-creased stroke (IRR 1.69, 95% CI
1.04-2.76). Results were consistent at secondary analysis exploring the
impact on outcomes of baseline charac-teristics, such as 3-vessel disease,
diabetes mellitus, year of publication or stents used. <br/>Conclusion(s):
In CCS patients without LM disease or reduced LVEF, physiology-guided PCI
and CABG were associated with better outcomes than angiography-guided PCI.
Compared with medical therapy, CABG was the only revascularization
strategy associated with a reduction of myocar-dial infarction and death
rates, at the cost of higher risk of stroke. (Figure presented).

<87>
Accession Number
646958183
Title
Activation of mitochondrial telomerase reverses relative lymphopenia post
myocardial infarction: results from the randomised, double-blinded TACTIC
phase IIa pilot trial.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1225), 2022.
Date of Publication: 01 Oct 2022.
Author
Spyridopoulos I.; Bawamia B.; Spray L.; Wangsaputra V.; Stellos K.;
Bennaceur K.; Kharatikoopaei E.; Ogundimu E.; Gale C.P.; Keavney B.; Maier
R.; Hancock H.; Richardson G.; Austin D.
Institution
(Spyridopoulos, Bawamia, Spray, Wangsaputra, Bennaceur, Maier, Hancock,
Richardson) Newcastle University, Newcastle-Upon-Tyne, United Kingdom
(Stellos) European Center for Angioscience, Mannheim, Germany
(Kharatikoopaei, Ogundimu) Durham University, Durham, United Kingdom
(Gale) Leeds Teaching Hospitals, Leeds, United Kingdom
(Keavney) University of Manchester, Manchester, United Kingdom
(Austin) James Cook University Hospital, Middlesbrough, United Kingdom
Publisher
Oxford University Press
Abstract
Background: Immune ageing is a phenomenon which includes lymphopenia,
expansion of pro-inflammatory T-lymphocyte subsets and telomere
shortening. While lymphopenia predicts mortality after myocardial
infarction (MI), MI itself leads to both an increase in terminally
differentiated memory CD8+ T-lymphocytes (CD8+ TEMRAs) and a decrease in
telomere length. Activation of telomerase has been shown to ameliorate
lymphopenia, and improve heart function after MI in mouse models. TA-65 is
an oral telomerase activator, which may ameliorate immune ageing and
improve outcome after MI. <br/>Method(s): This double-blinded, randomized
placebo-controlled pilot study evaluated the use of TA-65 in 90 MI
patients over 65 years, the average onset age for immune ageing. Patients
were randomised to either TA-65 (16 mg daily, n=45) or placebo (n=45) for
12 months. The majority of patients underwent percutaneous coronary
intervention (87%) or coronary artery bypass surgery (2%) as treatment for
their index MI. The pre-defined primary endpoint was the proportion of
CD8+ TEMRA T-lymphocytes at 12 months, a marker of immune ageing. A linear
mixed effects model was used for the analysis. <br/>Result(s): The
proportion of CD8+ TEMRAs after 12 months did not differ between the 2
treatment groups, although only increased significantly in the placebo
group (+2.2%, 95% CI: 0.14-4.24). TA-65 was well tolerated, with total
adverse events lower in the treatment group (TA-65 vs. placebo group:
n=130 vs. n=185). We observed at 12 months a 62% reduction in mean
high-sensitivity CRP (hsCRP: TA-65 vs. placebo group: 1.1+/-0.9 vs.
2.9+/-6.4 mg/L) and a 15%-increase in mean peripheral blood lymphocytes in
TA-65 after 12 months. In the whole sample, among those who were treated
with TA-65 compared to Placebo, after 12 months peripheral blood
lymphocytes increased (+285 cells/mul, 95% CI: 117-452). The latter was
due to significant increases in the TA-65 group from baseline to 12 months
across all major lymphocyte populations: CD3+ (+15%), CD4+ (+14%),CD8+
T-lymphocytes (+19%), B-lymphocytes (+17%) and natural killer cells
(+12%), while no changes occurred in major lymphocyte populations in the
placebo group over the course of the study. <br/>Conclusion(s): In this
randomised clinical trial, we found that while CD8+ TEMRAs were not
significantly altered after 12 months, the telomerase activator TA-65
significantly increased all major lymphocyte subsets and substantially
reduced hsCRP at 12 months in patients with MI. These findings suggest
TA-65 holds great promise in potentially reducing inflammation while
improving an age-related decline in major lymphocyte populations, thereby
enhancing immunity. A larger, multicentre, powered phase IIb efficacy
trial to examine the potential effect of TA-65 in prognosis and heart
function after MI is therefore warranted.

<88>
Accession Number
646962952
Title
To compare efficacy and safety of direct oral anticoagulants in patients
with concurrent atrial fibrillation and bioprosthetic heart valve repair
or replacement: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1630), 2022.
Date of Publication: 01 Oct 2022.
Author
Kaur A.; Dhaliwal A.; Khandait H.; Konje S.; Bhatia K.; Sohal S.; Turagam
M.; Gwon Y.; Mamas M.; Dominguez A.; Bhatt D.; Velagapudi P.
Institution
(Kaur, Konje, Bhatia, Dominguez) Icahn School of Medicine at Mount Sinai
Morningside West, New York City, United States
(Dhaliwal) New York Hand Surgery, New York, United States
(Khandait) Trinitas Regional Medical Center, Elizabeth, NJ, United States
(Sohal) Newark Beth Israel Medical Center, Newark, United States
(Turagam) Mount Sinai Hospital, New York, United States
(Gwon, Velagapudi) University of Nebraska Medical Center, Omaha, United
States
(Mamas) Keele University, Keele, United Kingdom
(Bhatt) Brigham and Women's Hospital, Harvard Medical School, Boston,
United States
Publisher
Oxford University Press
Abstract
Background: Use of direct oral anticoagulants (DOACs) is contraindicated
in patients with mechanical valves. However data on their use in patients
with atrial fibrillation (AF) and bioprosthetic valves (BV) is still
limited. <br/>Purpose(s): To assess the safety and efficacy of DOACs
versus Vitamin K antagonist (VKA) in patients with AF after BV repair or
replacement. <br/>Method(s): We performed a comprehensive review of
electronic databases (PubMed, Embase, Scopus, Cochrane) using MeSH terms
and keywords for DOACs, AF and BVs from inception through December 2021.
Randomized clinical trials (RCT) or observational studies that reported
clinical outcomes comparing DOACs versus VKA in patients with AF and BVs
were eligible for inclusion. Ten articles were reviewed for full text.
Primary outcome was a composite of all cause stroke or systemic embolic
event. Secondary outcomes included major bleeding and all-cause mortality.
Subgroup analysis stratified by study design was performed. Pooled risk
ratio (RR) and 95% confidence interval (CI) were calculated using Mantel-
Haenszel method with DerSimonian-Laird estimator for tau2 for random
effects model. Interstudy heterogeneity was assessed using the Higgins I 2
value. All statistical analysis was performed using RevMan 5.4.1 software.
<br/>Result(s): Ten studies (5 RCTs, 5 observational studies) with a total
of 5,333 patients (DOACs n=2434; VKA n=2899) were included. Aortic, mitral
and mixed BV repair or replacement were 74.2%, 25.6% and 0.02%
respectively. The mean age was 72.6+/-11.9 years. The mean follow-up was
15.7+/-12.9 months. Type of DOACs included apixaban (n=553, 22.7%),
rivaroxaban (n=893, 36.7%), dabigatran (n=151, 6.2%) and edoxaban (n=837,
34.4%). There was no significant difference in primary outcome of stroke
or systemic embolic event (RR: 0.79; CI: 0.56-1.11; p>0.05;
I²=12%) or secondary outcomes of major bleeding (RR: 0.84; CI:
0.64-1.11; p>0.05; I²=45%), and all-cause mortality (RR: 0.84;
CI: 0.64-1.11; p>0.05; I²=29%) between DOACs compared with VKA.
<br/>Conclusion(s): In patients with AF and BV, DOACs are non-inferior to
VKA for risk of stroke or systemic embolism, major bleeding, and all-cause
mortality. Thus, DOACs can serve as a viable alternative to VKAs which
have a narrow therapeutic index, multiple drug interactions, and require
frequent monitoring. (Figure presented).

<89>
Accession Number
646958869
Title
Peri-procedural, 30-day and 1 year-outcomes in chronic dialysis patients
undergoing transcatheter aortic valve implantation.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2082), 2022.
Date of Publication: 01 Oct 2022.
Author
Albuquerque F.; Lima R.; Campante Teles R.; Gomes D.; Lopes P.; Felix
Oliveira A.; Goncalves M.; Brito J.; Raposo L.; Leal S.; Mesquita Gabriel
H.; De Araujo Goncalves P.; De Sousa Almeida M.; Mendes M.
Institution
(Albuquerque, Lima, Campante Teles, Gomes, Lopes, Felix Oliveira,
Goncalves, Brito, Raposo, Leal, Mesquita Gabriel, De Araujo Goncalves, De
Sousa Almeida, Mendes) Hospital Santa Cruz, Carnaxide, Portugal
Publisher
Oxford University Press
Abstract
Background: Patients on chronic dialysis (CD) due to end-stage renal
disease (ESRD) with symptomatic severe aortic stenosis eligible for
tran-scatheter aortic valve implantation (TAVI) were excluded from
randomized clinical trials. Our study aimed to investigate the outcomes of
patients with chronic dialysis who underwent TAVI. <br/>Method(s): Single
center analysis on prospectively collected data of all con-secutive
patients who underwent TAVI between January 2011 and Decem-ber 2020
according to baseline renal function: chronic dialysis group (CD) and
control group (CTRL). Procedural, 30-day and 1-year outcomes were
assessed. Outcomes were defined in accordance with the VARC-3 criteria.
<br/>Result(s): A total of 875 patients underwent TAVI during the study
period, of whom 22 (2.5%) were on chronic dialysis. Patients on CD were
younger (median age 80 years, [IQR 73-84] vs 84 years, [IQR 80-87];
p<0.001), more likely to be men [365/863 (42.8%) vs 18/22 (81.8%);
p<0.001] and more likely to have peripheral vascular disease [41/853
(4.8%) vs 7/22 (31.8%); p=0.031] and lower body mass index (median 24.1
kg/m², [IQR 21.5-26.5] vs 26.3 kg/m², [IQR
23.7-29.3]). Short-term major or life-threatening bleeding were
significantly higher in CD patients (odds ratio [95% confidential
interval]: 3.67 [1.50-8.96], p 0.005). In contrast, no differences were
found regarding rates of vascular complications requiring inter-vention
(OR [95% CI]: 1.35 [0.31-5.90], p=0.662), permanent pacemaker implantation
(OR [95% CI]: 0.87 [0.25-2.98], p=1.000) or stroke (OR [95% CI]: 1.51
[0.20-11.64], p=0.504). Importantly, dialysis patients had significantly
higher rates of in-hospital, 30-day and 1-year mortality rates (13.6 vs
2.1%, p<0.001; 18.9% vs 2.9, p<0.001 and 26.4% vs 10.7%, p<0.001,
respectively). On multivariate analysis, after adjusting for age, gender,
rel-evant co-morbidities, and procedure-related complications, CD remained
independently associated with mortality at 1-year. Survival curves during
follow up are presented in Figure 1. <br/>Conclusion(s): Chronic dialysis
patients submitted to TAVI had significantly higher rates of short-term
life threatening and/or major bleeding, short-term and long-term
mortality. Careful selection of patients who would benefit from TAVI among
patients with ERDS requiring dialysis is necessary to prevent high rates
of postprocedural complications and improve outcomes of this high-risk
population. (Figure presented).

<90>
Accession Number
646957165
Title
Changes in the treatment strategy following intracoronary pressure wire in
a contemporaneous real-life cohort of patients with intermediate coronary
stenosis. Results from a nationwide registry.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1214), 2022.
Date of Publication: 01 Oct 2022.
Author
Rodriguez Leor O.; Toledano B.; Lopez Palop R.; Rivero F.; Brugaletta S.;
Linares J.A.; Puigfel M.; Sadaba M.; Vaquerizo B.; Rondan J.; Gomez I.;
Saez R.; Planas A.; Lozano F.; Perez De Prado A.
Institution
(Rodriguez Leor, Toledano) Hospital Universitari Germans Trias i Pujol,
Barcelona, Spain
(Lopez Palop) Virgen de la Arrixaca University Clinical Hospital, Murcia,
Spain
(Rivero) La Princesa University Hospital, Madrid, Spain
(Brugaletta) Hospital Clinic de Barcelona, Barcelona, Spain
(Linares) Clinical University Hospital Lozano Blesa, Zaragoza, Spain
(Puigfel) University Hospital de Girona Dr. Josep Trueta, Girona, Spain
(Sadaba) Galdakao-Usansolo Hospital, Galdakao, Spain
(Vaquerizo) Hospital del Mar, Barcelona, Spain
(Rondan) University Hospital of Cabuenes, Gijon, Spain
(Gomez) University Hospital 12 de Octubre, Madrid, Spain
(Saez) Basurto University Hospital, Bilbao, Spain
(Planas) General University Hospital of Castellon, Castellon de la Plana,
Spain
(Lozano) University General Hospital Ciudad Real, Ciudad Real, Spain
(Perez De Prado) Hospital of Leon, Leon, Spain
Publisher
Oxford University Press
Abstract
Background: Intracoronary pressure wire is useful to guide
revascularization in patients with coronary artery disease. <br/>Aim(s):
To evaluate changes in diagnosis (coronary artery disease extent),
treatment strategy and clinical results after intracoronary pressure wire
study in real-life patients with intermediate coronary artery stenosis.
<br/>Method(s): Observational, prospective and multicenter registry of
patients in whom pressure wire was performed. The extent of coronary
artery disease and the treatment strategy based on clinical and
angiographic criteria were recorded before and after intracoronary
pressure wire guidance. 12-month incidence of MACE (cardiovascular death,
non-fatal myocardial infarction or new revascularization of the target
lesion) was assessed. <br/>Result(s): 1414 patients with 1781 lesions were
included. Complications related to the procedure were reported in 42
patients (3.0%). The extent of coronary artery disease changed in 771
patients (54.5%). Figure 1 shows extent of coronary artery disease based
on coronary angiographic analysis and following intracoronary pressure
wire study. Figure 2A shows the extent of coronary artery disease based on
coronary angiographic analysis and its reclassification following
intracoronary pressure wire study. Figure 2B shows the extent of coronary
artery disease following pressure wire study and its classification when
only considering the coronary angiographic analysis. Figure 2 shows change
in treatment strategy following intracoronary pressure wire study. There
was a change in treatment strategy in 779 patients (55.1%) (18.0% if
medical treatment; 68.8% if PCI; 58.9% if surgery (p<0.001 for PCI vs
medical treatment; p=0.041 for PCI vs CABG; p<0.001 for medical treatment
vs CABG). In patients with PCI as the initial strategy, the change in
strategy was associated with a lower rate of MACE (4.6% vs 8.2%, p=0.034).
<br/>Conclusion(s): The use of intracoronary pressure wire was safe and
led to the reclassification of the extent of coronary disease and change
in the treatment strategy in more than half of the cases, especially in
patients with PCI as initial treatment. (Figure presented).

<91>
Accession Number
646964357
Title
Concomitant tricuspid repair in mitral regurgitation surgery: a systematic
review and meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1592), 2022.
Date of Publication: 01 Oct 2022.
Author
Costa G.; Cardoso J.; Donato H.; Goncalves L.; Teixeira R.
Institution
(Costa) Centro Hospitalar de Coimbra, Coimbra, Portugal
(Cardoso) Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia,
Portugal
(Donato, Teixeira) Centro Hospitalar Universitario de Coimbra, Coimbra,
Portugal
(Goncalves) Coimbra Institute for Clinical and Biomedical Research,
Coimbra, Portugal
Publisher
Oxford University Press
Abstract
Background: Tricuspid Regurgitation (TR) is common in patients with severe
mitral disease. However, the evidence is insufficient to inform a decision
about whether to perform prophylactic tricuspid-valve repair during
mitral-valve surgery in patients who have moderate TR or less-thanmoderate
regurgitation. <br/>Purpose(s): To compare the outcomes of concomitant
tricuspid repair in mitral valve surgery versus no concomitant tricuspid
repair in less-thansevere TR patients. <br/>Method(s): We systematically
searched PubMed, Embase and Cochrane databases, in December 2021, for
interventional studies comparing concomitant tricuspid repair in mitral
valve surgery versus no tricuspid intervention. Random-effects
meta-analysis was performed. <br/>Result(s): Four randomised trials were
included, providing a total of 651 patients (323 in prophylactic tricuspid
intervention group and 328 patients in conservative group). Our
meta-analysis showed a similar all-cause mortality for concomitant
prophylactic tricuspid repair compared with no tricuspid intervention
(pooled OR, 0.54; 95% CI [0.25, 1.15], P=0.11; I²=0%).
Additionally, there is a similar New York Heart Association (NYHA) III-IV
classes in both groups, despite a lower trend in the tricuspid
intervention group (pooled OR, 0.63; 95% CI [0.38, 1.06], P=0.08;
I²=0%) (Figure 3). However, there was a significant lower
progression of TR (pooled OR, 0.06; 95% CI [0.02, 0.24], P<0.01;
I²=0%) and moderate-severe TR (pooled OR, 0.23; 95% CI [0.11,
0.46], P<0.01; I²=27%). <br/>Conclusion(s): Our pooled analysis
suggests that a tricuspid-valve repair at the time of mitral-valve surgery
in patients with moderate or less-thanmoderate TR does not impact
perioperative or postoperative all-cause mortality, despite reducing TR
severity and progression of TR following intervention. (Figure presented).

<92>
Accession Number
646962852
Title
Early aortic valve replacement improves exercise capacity in truly
asymptomatic patients with severe aortic stenosis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1629), 2022.
Date of Publication: 01 Oct 2022.
Author
Banovic M.; Boskovic N.; Bojanic M.; Nedeljkovic I.; Jovanovic M.; Penicka
M.; Bartunek J.
Institution
(Banovic, Boskovic, Bojanic, Nedeljkovic, Jovanovic) Clinical Center of
Serbia, Belgrade, Serbia
(Penicka, Bartunek) Olv Hospital Aalst, Aalst, Belgium
Publisher
Oxford University Press
Abstract
VBackground: Exercise capacity is a strong predictor of morbidity and
mortality overall. In severe aortic stenosis (AS) ustained pressure
overload during watchful waiting is associated with LV structural and
functional deterioration and impaired clinical outcome both pre- and post
aortic valve replacement (AVR). The effect of early surgical aortic valve
replacement (SAVR) in asymptomatic patients with severe AS and normal left
ventricular function on exercise capacity in unknown. <br/>Aim(s):We
investigated whether the early surgical AVR in truly asymptomatic patients
with severe aortic stenosis and normal LVEF improves the exercise
capacity. <br/>Method(s): This is a sub-analysis or the AVATAR trial
(NCT02436655), which is international prospective randomized controlled
trial that evaluated the safety and efficacy of early SAVR in the
treatment of asymptomatic patients with severe AS, according to common
criteria (valve area <=1 cm² with aortic jet velocity >4 m/s or
a mean transaortic gradient >=40 mm Hg), and with normal left ventricular
function. Patients underwent cardiopulmonary exercise testing (supine
bicycle, ramp protocol, 15 W/min) at the baseline and 12 months following
the randomization. Patients who had positive exercise testing at baseline
visit were excluded. We compared the value of workload (in WATs), VO2 max,
VO2 AT, VE/VCO2 and PETCO2 slope at the inclusion and at 12 months.
<br/>Result(s): Total of 157 patients (mean age, 67 years; 57% men) were
randomly allocated to early surgery (n=78) or conservative treatment
(n=79). Mean LVEF and Vmax in early surgery and conservative treatment
group were 70% and 4.5m/s and 69% and 4.5m/s, respectively. After 12
months in patients with conservative treatment there was a slight decrease
in the values of workload, VO2 max, VO2 AT, VE/VCO2 and PETCO2 slope, but
without statistical significance. However operated patients showed a
significant increase in workload (115.4+/-38.4 watts at 12 months vs
104.8+/-42.2 at inclusion, p=0.038) and VO2 max (19.7+/-6.8 at 12 months
vs 16.2+/-5.4 at the inclusion, p=0.048), while there was slight increase
in the values of VO2 AT, VEVCO2 and PETCO2 but without statistical
significance. <br/>Conclusion(s): Early SAVR improve the functional
capacity in asymptomatic patients with severe aortic stenosis and normal
left ventricular ejection fraction.

<93>
Accession Number
646964961
Title
Ten years survival benefit of CABG or PCI based on individual prediction.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2043), 2022.
Date of Publication: 01 Oct 2022.
Author
Serruys P.W.; Gao C.; Ninomiya K.; Hara H.; Garg S.; Onuma Y.; Kappetein
A.P.; Mohr F.W.; Mack M.
Institution
(Serruys, Gao, Ninomiya, Hara, Onuma) National University of Ireland,
Galway, Ireland
(Garg) Royal Blackburn Hospital, Blackburn, United Kingdom
(Kappetein) Erasmus University Medical Centre, Rotterdam, Netherlands
(Mohr) Heart Center of Leipzig, Leipzig, Germany
(Mack) Baylor Scott and White The Heart Hospital, Plano, United States
Publisher
Oxford University Press
Abstract
Background: To compare the observed and individual predicted mortalities
according to the SYNTAX score II 2020 (SSII-2020) in the all-comers SYNTAX
population, and retrospectively assess the appropriateness of
revascularization with percutaneous coronary intervention (PCI) and
coronary artery bypass grafting (CABG) in patients with three vessel
disease (3VD) and/or left main disease (LMCAD). <br/>Method(s): Internal
and external validation of the SSII-2020 to predict 10-year all-cause
death was performed in the respective randomized and registry SYNTAX
populations. Differences in individual predicted mortalities following
CABG or PCI were ranked and displayed with the observed mortalities. The
proportions of screened patients deriving a survival benefit from CABG or
PCI were determined retrospectively. <br/>Result(s): A total of 2602
participants (astreated population) were included in the randomized and
registry cohorts. In the randomized cohort, all-cause mortality at 10
years, as an average treatment effect, was 23.8% (199/865) with CABG and
28.6% (249/901) with PCI, with a differential survival benefit of 4.6%
(95% CI: 0.58% to 8.7%, log-rank p value=0.023). In the CABG and PCI
registries, mortalities were 27.8% (167/644) and 55.4% (99/192),
respectively. Calibration and discrimination of the SSII-2020 was helpful
in CABG and PCI patients in the randomized and registry cohorts. In the
PCI registry, the SSII-2020 underestimated mortality since specific
comorbidi-ties that entail high mortality are not included in the formula
(C-index: 0.72, intercept: 0.38, slope: 0.66), whilst in the CABG
registry, it predicted mor-tality with a helpful calibration and
discrimination (C-index: 0.70, intercept: 0.00, slope: 0.76). The
proportions of patients with a predicted survival benefit following CABG
and PCI were respectively 78.3% (1383/1766) and 21.7% (383/1766) in the
randomized cohort, and 82.4% (2143/2602) and 17.7% (459/2602) in the whole
SYNTAX trial population. <br/>Conclusion(s): In the randomized and
registry cohort of this all-comers pop-ulation with 3VD and/or LMCAD,
there was reasonable agreement between the individual predicted and
observed mortalities after CABG or PCI, such that the predicted 10-year
survival benefit might be helpful in determining the appropriateness of
each modality of revascularization. (Figure presented).

<94>
Accession Number
646964312
Title
Outcomes comparison between robotic and conventional mitral valve surgery:
a systematic review and meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2164), 2022.
Date of Publication: 01 Oct 2022.
Author
Pratita J.; Ardaya R.; Pritazahra A.; Rahman F.H.F.
Institution
(Pratita) Fakultas Kedokteran Universitas Indonesia (FKUI), Division of
Cardiothoracic and Vascular Surgery, Department of Surgery, Central
Jakarta, Indonesia
(Ardaya) University College London, School of Surgical and Interventional
Sciences, London, United Kingdom
(Pritazahra) University College London, Institute of Cardiovascular
Science, London, United Kingdom
(Rahman) MMC Hospital, South Jakarta, Indonesia
Publisher
Oxford University Press
Abstract
Background: Robotic-assisted cardiac surgery has emerged as a popular
minimal invasive cardiac surgery approach, as it provides several
advan-tages compared to conventional and other minimally invasive
approaches. Mitral valve surgeries, including repair and replacement, are
currently the most common cardiac surgeries performed with a robotic
approach. How-ever, there are concerns that surgeon's learning curve and
prolonged op-eration time associated with this approach could compromise
the surgical outcomes, hence the low acceptance of the technique in the
clinical setting. In addition, despite various studies comparing robotic
and conventional mi-tral surgery, it remains unclear whether the former
would give comparable, if not better, outcomes. <br/>Purpose(s): This
study aims to compare the outcomes of robotic and con-ventional sternotomy
mitral valve surgeries. <br/>Method(s): A comprehensive literature search
was performed through Pubmed, CENTRAL, and ScienceDirect for studies
comparing robotic and sternotomy approach for mitral valve repair and
replacement. Studies were screened with our eligibility criteria, and
their quality was examined using the Newcastle-Ottawa scale. The primary
outcome analysed in this study was the perioperative mortality.
<br/>Result(s): Twelve studies involving 4300 patients (2223 experienced
robotic surgery) were included. Pooled analysis showed that patients who
under-went robotic surgery had a significant decrease in perioperative
mortal-ity compared to those who underwent sternotomy surgery (RR 0.33,
95% CI 0.18, 0.60, p=0.0003, I²=0%). Moreover, ICU length of
stay was also shorter in the robotic group (MD -13.67, 95% CI -20.04,
-7.29, p<0.0001, I²=93%). Re-operation risk due to bleeding was
not significantly different between both groups (RR 1.13, 95% CI 0.79,
1.62, p=0.51, I²=0%). Eg-ger's test result showed no evidence
of small-study effects (p=0.83), and the funnel plot appeared symmetrical,
meaning there was no publication bias. <br/>Conclusion(s): Results from
our meta-analysis refute the current concerns limiting the acceptance of
robotic approach in mitral valve surgeries, show-ing significantly lower
perioperative mortality and ICU length of stay, as well as a comparable
re-operation risk due to bleeding with the conventional ap-proach. (Figure
presented).

<95>
Accession Number
646962736
Title
Early intervention versus conservative management of asymptomatic severe
aortic stenosis: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1628), 2022.
Date of Publication: 01 Oct 2022.
Author
Costa G.; Cardoso J.; Goncalves L.; Teixeira R.
Institution
(Costa) Centro Hospitalar de Coimbra, Coimbra, Portugal
(Cardoso) Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia,
Portugal
(Goncalves) Coimbra Institute for Clinical and Biomedical Research,
Coimbra, Portugal
(Teixeira) Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
Publisher
Oxford University Press
Abstract
Background: Aortic stenosis (AS) is the most common valvular disease in
developed countries. However, the specific timing of intervention for
asymptomatic patients with severe AS remains controversial.
<br/>Purpose(s): To compare the outcomes of early aortic valve replacement
(AVR) versus watchful waiting (WW) in asymptomatic patients with AS.
<br/>Method(s): We systematically searched PubMed, Embase and Cochrane
databases, in December 2021, for both interventional or observational
studies comparing early AVR with WW in the treatment of asymptomatic
severe AS. Random-effects meta-analysis was performed. <br/>Result(s):
Thirteen studies were included in which two were randomised clinical
trials. A total of 4,679 patients were included, providing a 1,268 pooled
death events (327 in early AVR and 941 in WW). Our meta-analysis showed a
significantly lower all-cause mortality for the early-AVR compared with WW
group, although with a moderate amount of heterogeneity between studies in
the magnitude of the effect (pooled odds ratio [OR], 0.41; 95% confidence
interval [CI] 0.34, 0.50, P<0.01; I²=60%). An early surgery
strategy displayed a significantly lower cardiovascular mortality (pooled
OR, 0.33; 95% CI [0.19, 0.56], P<0.01; I 2=64%) and heart failure
hospitalisations (pooled OR 0.19; 95% CI [0.10, 0.39], P<0.01,
I²=7%). However, both groups had similar rates of stroke
(pooled OR 1.30; 95% CI [0.73, 2.29], P=0.36, I²=0%) and
myocardial infarction (pooled OR 0.49; 95% CI [0.19, 1.27], P=0.14,
I²=0%). <br/>Conclusion(s): Our pooled data suggest that an
early-AVR strategy is preferable for asymptomatic patients with severe AS.
(Figure presented).

<96>
Accession Number
646964097
Title
Valvular surgery is associated with an increased risk of post-operative
atrial fibrillation: secondary analysis of the SEARCH-AF CardioLink-1
randomized trial.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2163), 2022.
Date of Publication: 01 Oct 2022.
Author
Hibino M.; Verma S.; Pandey A.; Quan A.; Verma A.; Bisleri G.; Mazer C.D.;
Ha A.
Institution
(Hibino, Verma, Pandey, Quan, Bisleri, Mazer) St. Michael's Hospital,
Toronto, Canada
(Verma) Southlake Regional Health Centre, Newmarket, Canada
(Ha) UHN - University of Toronto, Toronto, Canada
Publisher
Oxford University Press
Abstract
Background: Patients undergoing valve surgery have a higher risk of
de-veloping post-operative atrial fibrillation (POAF) relative to those
under-going isolated coronary artery bypass grafting (CABG). Whether this
risk extends beyond hospital discharge is unknown. <br/>Purpose(s): We
examined the association between surgery type (isolated CABG vs. valve
repair/replacement) on the incidence of post-operative atrial fibrillation
(POAF) by conducting a secondary analysis of the Post-Surgical Enhanced
Monitoring for Cardiac Arrhythmias and Atrial Fibrilla-tion (SEARCH-AF)
CardioLink-1 randomized trial. <br/>Method(s): In the SEARCH-AF trial, 336
patients with risk factors for stroke (CHA2DS2-VASc score >=2) and no
history of preoperative AF were ran-domized to usual care or continuous
cardiac rhythm monitoring for 30 days after discharge from cardiac surgery
with a wearable, patched-based de-vice. The primary outcome was occurrence
of cumulative atrial fibrilla-tion/flutter (AF/AFL) lasting for >=6
minutes detected by continuous mon-itoring or AF/AFL documented by a
12-lead ECG within 30 days of ran-domization. We compared the risk of POAF
between patients who under-went CABG vs. valve repair/replacement.
Patients who experienced post-operative AF during hospitalization were
excluded from this analysis. <br/>Result(s): The overall cohort consisted
of 255, 39, and 42 patients who un-derwent isolated CABG, isolated valve
replacement/repair, and CABG + valve repair/replacement, respectively.
Baseline characteristics were similar among the groups except for younger
age (p=0.0014), higher preva-lence of preoperative myocardial infarction
(p=0.002) and lower ejection fraction (p=0.025) in the isolated CABG
group. Eighteen patients experi-enced post-operative AF during
hospitalization. Patients who underwent CABG + valve surgery or isolated
valve surgery were more likely to ex-perience post-operative AF compared
with those who underwent isolated CABG (Log-Rank ptrend=0.0096). Among
patients who were randomized to continuous cardiac rhythm monitoring, the
probability of post-operative AF among patients who underwent isolated
CABG, valve surgery, and CABG + valve surgery was 15.8%, 29.4%, and 35.0%,
respectively (Log-Rank ptrend=0.017). After multivariable adjustment, the
risk of developing post-operative AF within 30 days after discharge
remained higher among patients who underwent valve surgery compared with
those who under-went isolated CABG (hazard ratio (HR) 2.22, 95% CI
1.01-4.87. Patients who underwent CABG + repair/replacement had the
highest risk of ex-periencing post-operative AF when compared to patients
who underwent isolated CABG (HR 2.78, 95% CI 1.12-6.86).
<br/>Conclusion(s): Patients undergoing valve repair or bioprosthetic
valve re-placement have a substantial risk of post-operative AF within 30
days after discharge from surgery. An aggressive cardiac rhythm monitoring
strategy during this vulnerable period should be considered for this
high-risk patient population. (Figure presented).

<97>
Accession Number
646961640
Title
Outcomes of heart transplantation in adults and pediatrics congenital
heart disease: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2153), 2022.
Date of Publication: 01 Oct 2022.
Author
Mendel B.M.; Holiyono H.I.H.; Angellia P.A.; Prakoso R.P.; Siagian S.N.S.
Institution
(Mendel, Prakoso, Siagian) National Cardiovascular Center Harapan Kita,
Jakarta, Indonesia
(Holiyono, Angellia) University of Indonesia Hospital, Depok, Indonesia
Publisher
Oxford University Press
Abstract
Background: Heart transplantation (HTx) has progressed from an
experimental therapy option to a well-established therapeutic option for
congenital heart disease (CHD) patients in end-stage heart failure, thus
we can expect a large number of people with CHD to be evaluated for HTx in
the next decades. <br/>Objective(s): To create a systematic review and
meta-analysis regarding short-term and long-term outcomes of HTx in
end-stage adults and pe-diatrics CHD patients. <br/>Method(s): Four online
databases were screened from the date of incep-tion to January 2022, where
the acquired studies were assessed using the PRISMA statement. The
inclusion criteria were cohort studies that evalu-ated outcomes of heart
transplantation in end-stage congenital heart dis-ease patients. The
mortality of adults and pediatrics population were ana-lyzed using
random-effect model, showed as summary statistics of overall risk ratio
(RR) with 95% confidence interval (CI). Quality appraisal was conducted
using the STROBE statement. <br/>Result(s): Ten studies met the inclusion
criteria and were eligible to be an-alyzed. The pediatric population had
stronger 1-year mortality risk [Std. Mean difference 0.62, 95% CI, 0.12 to
3.07; P<0.00001] and 5-year mortal-ity risk [Std. Mean difference 0.82,
95% CI, 0.37 to 1.84; P<0.00001], while adult population were found to
have higher overall post-transplantation mortality risk [Std. mean
difference 1.17, 95% CI 0.66 to 2.08; P<0.00001]. <br/>Conclusion(s):
Adults CHD patients experienced higher mortality rate follow-ing heart
transplantation, with improved long-term survival in comparison to
pediatrics CHD recipients. However, further study should be conducted with
standardized subjects as there is moderate quality of evidence and higher
heterogeneity during our meta-analysis. (Figure presented).

<98>
Accession Number
646959124
Title
Prognostic value of left ventricular global longitudinal strain in
patients with severe aortic stenosis for transcatheter aortic valve
implantation-related morbidity and mortality: a meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2085), 2022.
Date of Publication: 01 Oct 2022.
Author
Stens N.A.; Van Iersel O.; Rooijakkers M.J.P.; Van Wely M.H.; Nijveldt R.;
Bakker E.A.; Van Royen N.; Thijssen D.H.J.
Institution
(Stens, Van Iersel, Rooijakkers, Van Wely, Nijveldt, Bakker, Van Royen,
Thijssen) Radboud University Medical Centre, Nijmegen, Netherlands
Publisher
Oxford University Press
Abstract
Aims: Current methods, including left ventricular ejection fraction
(LVEF), demonstrate limited prognostic value for post-Transcatheter Aortic
Valve Implantation (TAVI) outcomes. Studies elaborating on LV global
longitudinal strain (GLS) showed promising results, but are often
underpowered. <br/>Purpose(s): This meta-analysis aims to evaluate the
prognostic value of pre-procedural global longitudinal strain (GLS) for
post-TAVI mortality and mor-bidity. <br/>Method(s): A systematic search
was conducted in PubMed, Embase and Web of Science from 2001 to 2021. All
studies that comprised patients with severe aortic stenosis who underwent
TAVI and investigated the as-sociation between preprocedural
speckle-tracking-derived GLS and clini-cal outcomes, were included. An
inversely-weighted random effects meta-analysis was adopted to investigate
the association between preprocedural GLS vs primary (i.e. all-cause
mortality) and secondary (i.e. major cardiovascular events [MACE])
post-TAVI outcomes. <br/>Result(s): Of the 1,057 identified records, 12
were eligible, all of which had a low-to-moderate risk of bias
(Newcastle-Ottawa scale). On average, the 2,068 unique patients
demonstrated preserved ejection fraction but im-paired longitudinal
function (mean LVEF 52.2+/-4.4%, GLS -13.5+/-1.6%). Patients with a lower
GLS had a higher all-cause mortality (pooled hazard ratio (HR) 1.99 [95%
confidence interval (CI): 1.59, 2.50]) and MACE (1.26 [95% CI: 1.08,
1.46]) risk compared to patients with higher GLS. In addition, each 1%
decrease of GLS was associated with an increased postprocedu-ral mortality
(HR 1.06 [95% CI: 1.03, 1.08]) and MACE risk (pooled HR 1.08 [95% CI:
1.01, 1.15]). <br/>Conclusion(s): Preprocedural GLS was significantly
associated with post-TAVI mortality and morbidity. This suggests a
potential clinically important role of pre-TAVI evaluation of GLS for risk
stratification of patients with se-vere aortic stenosis. (Figure
presented).

<99>
Accession Number
646962889
Title
Factors associated with outcome five years after infectious endocarditis -
the POET trial.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1675), 2022.
Date of Publication: 01 Oct 2022.
Author
Pries-Heje M.
Institution
(Pries-Heje) Rigshospitalet - Copenhagen University Hospital, Copenhagen,
Denmark
Publisher
Oxford University Press
Abstract
Introduction: In stabilized patients with left-sided infectious
endocarditis (IE) a shift to oral antibiotic treatment was non-inferior
compared to conventional intravenous antibiotic treatment as assessed six
months after randomization (1). After 5 years the primary outcome was
superior in the orally treated group (2). Factors associated with primary
outcome in the POET trial have not previously been reported.
<br/>Purpose(s): To identify factors associated with the occurrence of the
primary outcome in the POET trial (Partial Oral Antibiotic Endocarditis
Treatment) after 5-years of follow-up. <br/>Method(s): The POET trial was
a Danish national randomized clinical trial with inclusion from 2011-2017.
Patients were randomized 1:1 to shift to partial oral versus continued
intravenous antibiotic treatment after fulfilling stabilization criteria.
Patients were followed from randomization until July 2020. The primary
outcome was a composite outcome including the occurrence of 1) all-cause
mortality, 2) non-intended heart valve surgery, 3) embolization or 4)
relapse of positive blood culture with the primary IE causing bacteria.
Associations between baseline characteristics and IEspecific factors and
the occurrence of the primary outcome were examined using univariate
cox-regression analysis and a multivariate model was constructed using
backwards elimination at p>0.05. The proportional hazard assumption was
assessed with Schoenfeld residuals. <br/>Result(s): A total of 400
patients with left-sided endocarditis were randomized. After a median
follow-up of 5.4 years (IQR 4.0-6.9), one or more of the components of the
primary outcome had occurred in 156 patients (Table 1) (mean age 71.5
years (SD 10.0), 119 males (76.3%)). Patients who reached a primary
outcome were older, more comorbid, more often had an existing prosthetic
valve at time of IE admission, had IE localized to the aortic valve, had
vegetations >9 mm or valvular incompetence at time of admission. In
multivariable regression analysis older age (HR 1.03; 95% CI 1.02-1.05,
p<0.001), diabetes (HR 1.56; 95% CI 1.06-2.30, p=0.025), renal failure (HR
2.13; 95% CI 1.40-3.24, p<0.001), and prosthetic aortic valve (HR 1.52;
95% CI 1.08-2.14, p=0.016) were associated with a risk of reaching a
primary outcome, while heart valve surgery during primary admission for
endocarditis (HR 0.41; 95% CI 0.27-0.62, p<0.001) and shift to oral
antibiotic treatment (HR 0.69; 95% CI 0.50-0.95, p=0.022) were associated
with a lower risk (Table 2). <br/>Conclusion(s): In the POET-trial older
age, diabetes, renal failure and prosthetic aortic valve at baseline were
independently associated with a higher risk of reaching a primary outcome,
while heart valve surgery and shift to oral antibiotic treatment were
associated with a lower risk. These findings may inform future guidelines
for treatment of endocarditis. (Table presented).

<100>
Accession Number
646959028
Title
Clinical impact of peri-device leaks following percutaneous left atrial
appendage occlusion: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2135), 2022.
Date of Publication: 01 Oct 2022.
Author
Samaras A.; Papazoglou A.; Balomenakis C.; Bekiaridou A.; Moysidis D.;
Patsiou V.; Orfanidis A.; Feidakis A.; Giannakoulas G.; Tzikas A.
Institution
(Samaras, Papazoglou, Balomenakis, Bekiaridou, Moysidis, Patsiou,
Orfanidis, Feidakis, Giannakoulas, Tzikas) Ahepa University Hospital, 1st
Cardiology Department, Thessaloniki, Greece
Publisher
Oxford University Press
Abstract
Background: Peri-device leaks (PDL) are quite common after left-atrial
appendage occlusion (LAAO) given the complex anatomy of LAA and
sur-rounding structures. However, there is uncertainty regarding the
prognostic implications of PDL. <br/>Material(s) and Method(s): Literature
search was conducted in MEDLINE (PubMed), EMBASE, Scopus by ELSEVIER and
Cochrane Central Reg-ister of Controlled Trials (CENTRAL) databases until
12 October 2021. A random-effects meta-analysis was performed to assess
the effect of PDL presence on thromboembolism, all-cause mortality and
major bleeding oc-currence. Sensitivity analyses accounted for: i. the
combined AF ablation performance, ii. the anticoagulation strategy
followed after LAAO, iii. mean PDL size, and iv. mean female percentage.
<br/>Result(s): Of 699 articles initially retrieved, 46 were deemed
eligible for this analysis (9,184 AF patients undergoing LAAO out of whom
1,446 had PDL). PDL presence was significantly associated with elevated
odds of thromboembolism (FIgure 1) [pooled odds ratio (pOR) 3.05, 95%
confidence interval (CI) 1.94-4.81; I²=37%]; yet PDL was not
significantly linked with mortality (pOR=0.86, 95% CI: 0.25-2.95;
I²=69%) and major bleeding rates (0.95, 95% CI: 0.27-3.35;
I²=72%). AF-ablation did not signifi-cantly interact with the
prognostic impact of PDL when performed in con-junction with LAAO (p for
subgroup= 0.17). Antiplatelet discharge medi-cation affected the
prognostic value of PDL (p for subgroup <0.01 and =0.04, respectively).
The prognostic significance of mean PDL size [peri-procedural or at 1-3
months or D(mean size)/D(time of follow-up)] on the risk of
thromboembolism did not yield any significant association (p values
>0.05). Meta-regression analysis of the mean female percentage
demon-strated a non-significant trend towards a positive linear
correlation between female percentage and risk of thromboembolism (p=0.10)
(FIgure 2). <br/>Conclusion(s): This is the first meta-analysis on the
prognostic impact of PDL after LAAO. The findings highlighted a
significant association between PDL and thromboembolic events, warranting
careful post-LAAO de-vice surveillance. (Figure presented).

<101>
Accession Number
646964444
Title
Early aortic valve replacement in asymptomatic severe aortic stenosis with
preserved ejection fraction.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1593), 2022.
Date of Publication: 01 Oct 2022.
Author
Costa G.; Cardoso J.; Goncalves L.; Teixeira R.
Institution
(Costa) Centro Hospitalar de Coimbra, Coimbra, Portugal
(Cardoso) Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia,
Portugal
(Goncalves) Coimbra Institute for Clinical and Biomedical Research,
Coimbra, Portugal
(Teixeira) Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
Publisher
Oxford University Press
Abstract
Background: Aortic stenosis (AS) is the most common valvular disease in
developed countries. Specific timing of intervention for asymptomatic
patients with severe aortic stenosis and preserved ejection fraction
remains controversial. <br/>Purpose(s): To compare the outcomes of early
aortic valve replacement (AVR) versus watchful waiting (WW) in
asymptomatic AS patients with preserved ejection. <br/>Method(s): We
systematically searched PubMed, Embase and Cochrane databases, in November
2021, for both interventional or observational studies comparing early-AVR
with WW in the treatment of asymptomatic severeAS with preserved ejection
fraction criteria. Random-effects metaanalysis was performed.
<br/>Result(s): Eight studies were included in which two were randomized
clinical trials. A total of 2672 patients were included, providing a 642
pooled death events (327 in early-AVR and 941 in watchful waiting). In our
metaanalysis, early-AVR revealed a significant lower all-cause mortality
(pooled OR, 0.39; 95% CI [0.30, 0.51], P<0.01; I²=47%).
Additionally, the early- AVR group presented a lower rate of
cardiovascular mortality (pooled OR, 0.33; 95% CI [0.19, 0.56], P<0.01;
I²=64%). Both strategies had similar rate of stroke (pooled OR,
1.30; 95% CI [0.39, 4.27], P=0.67; I²=0%) and myocardial
infarction (pooled OR, 0.49; 95% CI [0.14, 1.78], P=0.28;
I²=0%). Heart Failure hospitalizations presented a lower trend
early-AVR group (pooled OR, 0.22; 95% CI [0.05, 1.08], P=0.36;
I²=36%). <br/>Conclusion(s): Our pooled data suggests that
early-AVR strategy is preferable for asymptomatic severe AS patients with
preserved ejection fraction. (Figure presented).

<102>
Accession Number
646960770
Title
The music therapy effectiveness in hypertensive patients with acute
myocardial infarction after previous coronary artery bypass surgery;
18-year experience of the MUSIC study.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2197), 2022.
Date of Publication: 01 Oct 2022.
Author
Mitrovic P.; Paladin A.; Radovanovic M.; Radovanovic N.; Rajic D.; Matic
G.; Jozic T.; Dizdarevic I.; Jankovic J.; Radovanovic M.N.
Institution
(Mitrovic, Radovanovic, Radovanovic) Clinical Center of Serbia, School of
Medicine, University of Belgrade, Department of Emergency Cardiology,
Cardiology Clinic, Belgrade, Serbia
(Paladin) Serbian National Broadcasting Agency, Belgrade, Serbia
(Rajic, Matic, Jozic, Dizdarevic, Jankovic, Radovanovic) Clinical Center
of Serbia, Department of Emergency Cardiology, Cardiology Clinic,
Belgrade, Serbia
Publisher
Oxford University Press
Abstract
Patients who have clinical evidence of hypertension (HT) after coronary
artery bypass surgery (CABS) have a poor prognosis in expression of acute
myocardial infarction (AMI), as one of the MACE. Unrelieved anxiety can
produce an increase in sympathetic nervous system activity leading to an
increase in cardiac workload. The purpose of this study was to evaluate
the effectiveness of music therapy on prognosis of patients with HT and
AMI, after CABS. <br/>Method(s): 314 patients (males 78.4%, mean age
59.8+/-1.2 yrs) with AMI after previous CABS have been selected from the
patients consecutively submitted from January 2003 to January 2019. HT was
registered in 166 (53.0%) pts with AMI after previous CABS. All patients
with HT were randomized and divided in 2 groups: Study group of 83
patients treated with music therapy and Control group of 83 patients with
no music therapy. Each patient in study group underwent two sessions of
medical therapy (12 minutes) in a day. Both groups were similar in
baselines, post-AMI characteristics and post-AMI medical therapy. The
plasma cytokine and catecholamine were measured in both groups.
<br/>Result(s): In the Study group, heart rate was significantly decreased
by music therapy (p=0.0196). In the Control group, there were no
significant changes in heart rate. Among cytokines (p=0.0160), plasma
interleukin-6 (IL-6) (p=0.0179) in the Study group was significantly lower
than those in the Control group, as well as plasma adrenaline (p=0.0162)
and noradrenalin (p=0.0218) levels. <br/>Conclusion(s): This study
provides support for the use of musical therapy in patients with HT and
AMI after previous CABS. The positive effects of music therapy, in these
patients, are probably because of enhanced of parasympathetic activities
and reduction of plasma cytokine and catecholamine levels.

<103>
Accession Number
646956425
Title
Outcomes following acute myocardial injury and type 2 myocardial
infarction in patients with and without coronary artery disease.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1149), 2022.
Date of Publication: 01 Oct 2022.
Author
Taggart C.; Gard A.; Bularga A.; Wereski R.; Kimenai D.; Chapman A.R.;
Lindahl B.; Mills N.L.; Eggers K.
Institution
(Taggart, Bularga, Wereski, Kimenai, Chapman, Mills) University of
Edinburgh, Edinburgh, United Kingdom
(Gard, Lindahl, Eggers) Uppsala University, Uppsala, Sweden
Publisher
Oxford University Press
Abstract
Background: Acute myocardial injury and type 2 myocardial infarction
typically occur in the setting of a concurrent illness. Differentiating
acute myocardial injury from type 2 myocardial infarction is challenging
as it relies on the assessment of myocardial ischaemia. Indeed, some have
questioned whether this distinction is important, as patients with both
conditions are at increased risk of future cardiovascular events. Whether
this risk is similar and the role of identifying those with coronary
artery disease is uncertain. <br/>Purpose(s): To determine whether future
risk of cardiovascular events and death differs in patients with type 2
myocardial infarction and acute myocardial injury according to the
presence or absence of prior coronary artery disease. <br/>Method(s): We
conducted a secondary analysis of a multi-centre randomised controlled
trial of 48,282 consecutive patients with suspected acute coronary
syndrome. Patients with an adjudicated index diagnosis of acute myocardial
injury and type 2 myocardial infarction were stratified according to
whether they were known previously to have coronary artery disease defined
as prior coronary revascularisation, myocardial infarction, or angina.
Cardiovascular death or myocardial infarction adjusted for the competing
risk of non-cardiovascular death and all-cause death at one year was
compared. <br/>Result(s): In 9,115 patients with elevated cardiac troponin
concentrations, 1,676 (18%) and 1,121 (12%) had acute myocardial injury
and type 2 myocardial infarction, respectively. Patients with either
condition known to have coronary artery disease were older (mean [standard
deviation] age 78 [11] versus 73 [16] years) and more likely to be female
(55% versus 45%) than those with no prior history. Coronary artery disease
was previously identified in 40% (454/1,121) and 30% (509/1,167) of those
with type 2 myocardial infarction and acute myocardial injury,
respectively. Cardiovascular death or myocardial infarction at one year
was more common in patients known to have coronary artery disease than
those without for both acute myocardial injury (23% [115/509]) versus 14%
[158/1,167]; P<0.001) and type 2 myocardial infarction (20% [91/454]
versus 10% [69/667]; logrank P<0.001) (Figure 1). Similarly all-cause
death at one year was higher in patients with known coronary artery
disease for both acute myocardial injury (31% [357/1,167] versus 18%
[123/667]; P<0.001) and type 2 myocardial infarction (40% [115/509] versus
30% [135/454]; P<0.001) (Figure 2). <br/>Conclusion(s): Coronary artery
disease is recognised in around one third of patients with acute
myocardial injury and type 2 myocardial infarction and is associated with
higher rates of cardiovascular events and all-cause death. Risk doubled in
those with coronary artery disease and was similar whether the index
diagnosis was myocardial injury or infarction, suggesting that coronary
investigation and secondary prevention may have a role in both conditions.
(Figure presented).

<104>
Accession Number
646956393
Title
PARADISE-MI - event rates and treatment effect of sacubitril/valsartan v
ramipril by the presence or absence of transient pulmonary congestion
and/or LVEF less or greater than 40.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1449), 2022.
Date of Publication: 01 Oct 2022.
Author
Petrie M.; Solomon S.; Claggett B.L.; Jering K.; Steg G.; Granger C.;
Lewis E.; Kober L.; Mann D.; Rouleau J.L.; McMurray J.J.; Maggioni A.;
Braunwald E.; Pfeffer M.A.
Institution
(Petrie, McMurray) University of Glasgow, Glasgow, United Kingdom
(Solomon, Claggett, Jering, Braunwald, Pfeffer) Brigham and Women's
Hospital, Harvard Medical School, Boston, United States
(Steg) Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT
French Alliance for Cardiovascular T, Paris, France
(Granger) Duke University, Durham, United States
(Lewis) School of Medicine, Stanford, United States
(Kober) Rigshospitalet - Copenhagen University Hospital, Copenhagen,
Denmark
(Mann) Washington University School of Medicine, St Louis, United States
(Rouleau) Montreal Heart Institute, Montreal, Canada
(Maggioni) ANMCO Research Center, Florence, Italy
Publisher
Oxford University Press
Abstract
Background/Introduction: Sacubitril/valsartan was compared to ramipril in
patients with acute myocardial infarction in the PARADISE-MI trial. In the
whole trial population sacubitril/valsartan did not reduce the composite
primary outcome of CV death or incident heart failure compared to
ramipril. Whether or not event rates and/or treatment effects vary in
patients with different baseline characteristics is unknown.
<br/>Purpose(s): To investigate a) event rates b) the treatment effect of
sacubitril/valsartan compared to ramipril and c) safety by the presence or
absence of transient pulmonary congestion and/or left ventricular ejection
fraction (LVEF) <=40%. <br/>Method(s): PARADISE-MI was a double-blind,
randomised clinical trial that compared sacubitril/valsartan to ramipril
in 5661 patients with an acute myocardial infarction with either LVEF
<=40% and/or transient pulmonary congestion. 3 groups were investigated:
1) LVEF <=40% with pulmonary congestion (n=2012) and 2) LVEF <=40% without
pulmonary congestion (n=2596) and 3) LVEF not <=40% with pulmonary
congestion (n=1044). <br/>Result(s): Patients with pulmonary congestion
(with and without LVEF <=40%) were more likely to have had a prior MI,
prior CABG or PCI, had more atrial fibrillation and were more often
treated with mineralocorticoid receptor antagonists and diuretics than
patients with no pulmonary congestion and LVEF <=40%. Patients with LVEF
<=40% and pulmonary congestion had more than twice the rate of the primary
composite outcome compared to those with LVEF <=40% without pulmonary
congestion: 10.2 (95% CI 9.2-11.3) vs. 4.8 (4.3-5.5) events per 100
patient-years, respectively). Patients with pulmonary congestion and LVEF
not <=40% had an intermediate event rate (6.6, 5.5-7.9, events per 100
patient-years). A similar pattern of event rates was seen for the
components of the primary outcome and for all secondary outcomes whether
Clinical Events Committee or investigator-reported events were analysed.
The treatment effect of sacubitril/valsartan versus ramipril did not vary
between the 3 congestion/LVEF subgroups. The safety of
sacubitril/valsartan compared to ramipril did not vary between
congestion/LVEF subgroups. <br/>Conclusion(s): Patients with pulmonary
congestion with or without LVEF <=40% had higher rates of primary and all
secondary outcomes than those without pulmonary congestion and LVEF <=40%.
The treatment effect, and safety, of sacubitril/valsartan compared to
ramipril was consistent in patients with or without pulmonary congestion
and with or without LVEF <=40%. (Figure presented).

<105>
Accession Number
646958910
Title
Efficacy of controlvit as a complementary strategy in reducing
hospitalizations in patients with heart failure. Randomized clinical
trial.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2820), 2022.
Date of Publication: 01 Oct 2022.
Author
Achury D.M.; Garcia A.G.; Marino A.M.; Bohorquez W.B.; Gonzalez R.G.
Institution
(Achury, Gonzalez) Javeriana University, Bogota, Colombia
(Garcia, Marino, Bohorquez) San Ignacio Hospital, Bogota, Colombia
Publisher
Oxford University Press
Abstract
Introduction: In patients with heart failure, the main cause of hospital
admissions is due to episodes of decompensation, which are associated with
an increase in the costs and resources needed for care; they have a
negative impact on the quality of life and prognosis of the disease.
Therefore, it is necessary to design, evaluate and implement alternatives
to achieve efficient follow-up and monitoring, improving adherence to
treatment and helping identify decompensation episodes that facilitate
their early treatment, so new hospital admissions can be avoided. For this
reason, the use of information and communication technologies (apps) is
emerging as an excellent strategy for the possibility of improving
coverage, real-time monitoring and timeliness of care.
ControlVit is an electronic application that allows permanent,
real-time monitoring of biomedical measurements for early detection of
complications. <br/>Objective(s): To determine the efficacy of
ControlVit as a complementary strategy in reducing hospital
admissions in patients in a heart failure program. Methodology: A
randomized, placebo-controlled, open-label clinical trial was conducted,
(n=140), included patients with heart failure under controlled clinical
follow-up in a structured heart failure program, into NYHA FC II-IV,
capable of handling smartphones and with permanent internet connectivity.
All patients were provided with educational elements, a scale and a blood
pressure monitor to enter clinical data and a symptom questionnaire
necessary for follow-up. The patients were randomized to 2 groups:
intervention: use of ControlVit vs. placebo, with a 6-month
follow-up. The primary outcome was the difference in readmissions for
heart failure between the 2 groups. Patients on the waiting list for heart
transplantation or use of ventricular assist devices were excluded. All
participants signed informed consent and the protocol was approved by the
institutional ethics committee. <br/>Result(s): A total of 140 patients
were included in the study (intervention = 71, placebo = 69), with an
average age of 66 years, 71% were men, the main etiology of heart failure
was ischemic (60%), the main comorbidities were arterial hypertension
(44%), dyslipidemia (42%), hypothyroidism (38%), chronic kidney disease
(38%), and diabetes mellitus (27%). During follow-up, there were 6 deaths
(3 in each group) and 17 readmissions (3 in the intervention group and 14
in the control group). After adjustment for comorbidities, HR 0.72 CI95
(0.52; 0.92), p=0.0325 was found. <br/>Conclusion(s): In patients with
heart failure, ControlVit is a useful and complementary tool
for follow-up, which reduces hospital admissions due to episodes of
decompensation.

<106>
Accession Number
646959729
Title
Comparison of the safety and efficacy of antithrombotic regimens following
TAVR in patients without having an indication for chronic oral
anticoagulation.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2090), 2022.
Date of Publication: 01 Oct 2022.
Author
Guedeney P.; Roule V.; Mesnier J.; Chapelle C.; Portal J.J.; Laporte S.;
Ollier E.; Zeitouni M.; Kerneis M.; Barthelemy O.; Sorrentino S.; Silvain
J.; Vicaut E.; Montalescot G.; Collet J.P.
Institution
(Guedeney, Zeitouni, Kerneis, Barthelemy, Silvain, Montalescot, Collet)
Hospital Pitie-Salpetriere, Paris, France
(Roule) University Hospital of Caen, Department of Cardiology, Caen,
France
(Mesnier) Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT
French Alliance for Cardiovascular T, Paris, France
(Chapelle, Laporte, Ollier) University Hospital of Saint-Etienne, Unite de
Recherche Clinique Innovation et Pharmacologie, Saint-Etienne, France
(Portal, Vicaut) Lariboisiere APHP Site of Saint Louis University
Hospital, Unite de Recherche Clinique, Paris, France
(Sorrentino) Magna Graecia University of Catanzaro, Catanzaro, Italy
Publisher
Oxford University Press
Abstract
Aims: To compare the safety and efficacy of antithrombotic regimens
following transcatheter aortic valve replacement (TAVR) in patients
without having an indication for chronic oral anticoagulation <br/>Methods
and Results: We conducted a Prospero-registered systematic review and
network meta-analysis of randomized controlled trials evaluat-ing
post-TAVR antithrombotic regimens up to March 2021. We estimated the
relative risk and 95% confidence intervals using a fixed effect model in a
frequentist pairwise and network metanalytic approach. We included 6
studies comprising of 3,777 patients with a mean weighted follow-up of
13.3 months. Single antiplatelet therapy (SAPT) was associated with a
sig-nificant reduction of life-threatening, disabling, or major bleeding
compared to dual antiplatelet therapy (DAPT) (Risk Ratio [RR] 0.44, 95%
confidence interval [CI]: 0.28-0.69), apixaban (RR: 0.47, 95% CI
0.26-0.84) and lowdose rivaroxaban + 3-month SAPT (RR: 0.30, 95% CI:
0.16-0.57). Risk of all-cause death was significantly reduced with DAPT
compared to low-dose rivaroxaban + 3-month SAPT (RR: 0.60, 95% CI:
0.41-0.88) and a consis-tent reduction was observed with SAPT and DAPT
compared to apixaban (RR: 0.60, 95% CI: 0.31-1.16 and RR: 0.58, 95% CI:
0.32-1.04, respec-tively). There were no differences between the various
regimens with re-spect to myocardial infarction and stroke. Apixaban
significantly reduced the risk of pulmonary embolism, valve thrombosis and
grade 3 or 4 re-duced leaflet motion. <br/>Conclusion(s): Following TAVR
in patients without an indication for chronic oral anticoagulant, SAPT was
associated with the lowest risk of bleeding compared to DAPT and direct
oral anticoagulant-based regimens without significant ischemic offset.
(Table presented) (Figure presented).

<107>
Accession Number
646962015
Title
Diuretic use before and after transcatheter aortic valve implantation: a
nationwide study.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1620), 2022.
Date of Publication: 01 Oct 2022.
Author
Begun X.; Butt J.H.; Kristensen S.L.; Weeke P.E.; Backer O.D.; Schou M.;
Kober L.; Fosboel E.L.
Institution
(Begun, Butt, Kristensen, Weeke, Backer, Schou, Kober, Fosboel)
Rigshospitalet - Copenhagen University Hospital, Department of Cardiology,
The Heart Center, Copenhagen, Denmark
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is the new
standard of care in patients of older age with symptomatic severe aortic
stenosis, and these patients often depend upon diuretics for symptom
relief. Randomized clinical trials suggest that approximately one third of
patients undergoing TAVI do not achieve symptom relief. Furthermore, some
patients have more symptoms after intervention, but "real-life" data are
lacking. <br/>Purpose(s): We examined use of diuretic therapy before and
one year after TAVI in order to identify the proportion of patients who
had intensification of diuretic treatment after intervention as a proxy
for more symptoms. We also examined baseline factors associated with an
intensification event. <br/>Method(s): Using Danish nationwide registries,
we identified all Danish citizens who underwent TAVI from January 1, 2008
to December 31, 2019 and were alive one year after the intervention.
Diuretic use pre-TAVI and 1- year post-TAVI (based on prescription
fillings) was divided into the following groups: 1) no use; 2) low
diuretic use: 1-40 mg of furosemide (or equivalent bumetanide); 3)
intermediate diuretic use: 41-120 mg of furosemide; and 4) high diuretic
use: >120 mg furosemide. Diuretic intensification was defined as a change
from one pre-TAVI diuretic group to a higher post-TAVI diuretic group.
Factors associated with intensified diuretic treatment was examined with
logistic regression. In this analysis of intensification, only patients
who could potentially have an intensification event were included (i.e.,
no diuretic use, low diuretic use, or intermediate diuretic use groups).
<br/>Result(s): A total of 3,978 patients (median age 81 [interquartile
range 77-85]; 54% men) undergoing TAVI were identified. Pre-TAVI, 1,279
(32%) had no diuretic use, 1,818 (46%) had low diuretic use and 881 (22%)
had intermediate diuretic use. Overall, patients with pre-TAVI
intermediate diuretic use had a greater burden of cardiovascular and
non-cardiovascular comorbidities (higher prevalence of heart failure,
atrial fibrillation, chronic kidney disease and diabetes) compared with
those with no or low diuretic use. The distribution of age and sex was
similar between diuretic groups. One year post-TAVI, 1,406 (35.3%) had no
diuretic use, 1,635 (41.1%) had low diuretic use, 654 (16.4%) had
intermediate diuretic use and 283 (7.1%) had high diuretic use (Figure 1).
Overall, 1,077 (27%) patients had intensification of diuretic treatment
one year after undergoing TAVI. Ischemic heart disease and chronic renal
failure were associated with an intensification event (odds ratio 1.23
[95% CI 1.05-1.23] and 1.46 [95% CI 1.10-1.94], respectively).
<br/>Conclusion(s): Among patients undergoing TAVI not treated with
high-dose diuretics at time of intervention, approximately 1 out of 4
patients had intensification of diuretic treatment one year after
intervention. Ischemic heart disease and chronic renal failure were
associated with intensification. (Figure presented).

<108>
Accession Number
646958924
Title
Proprotein convertase subtilisin/kexin type 9 (PCSK9), platelet activation
and interaction with the vascular endothelium: the impact of PCSK9
inhibition with evolocumab in acute coronary syndrome.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1281), 2022.
Date of Publication: 01 Oct 2022.
Author
Ziogos E.; Chelko S.P.; Walsh E.; Engel M.; Gerstenblith G.; Halushka
M.K.; Leucker T.M.
Institution
(Ziogos, Gerstenblith, Leucker) The Johns Hopkins University School of
Medicine, Department of Medicine, Baltimore, United States
(Chelko, Engel) Florida State University College of Medicine, Department
of Biomedical Sciences, Tallahassee, United States
(Walsh, Halushka) The Johns Hopkins University School of Medicine,
Department of Pathology, Baltimore, United States
Publisher
Oxford University Press
Abstract
Background/Introduction: Platelet activation and endothelial dysfunction
may contribute to adverse outcomes in patients with acute myocardial
infarction. Pre-clinical studies indicate PCSK9 enhances platelet
activation. <br/>Purpose(s): Our goals were (1) to examine the role of
PCSK9 as a potential mediator of platelet activation in patients with
acute coronary syndrome (ACS) and (2) to perform immunohistochemical
studies of left internal mammary artery (LIMA) specimens to examine
interactions among PCSK9, platelets, and endothelial cells in specimens
obtained during coronary bypass surgery. <br/>Method(s): Participants from
the Evolocumab in Acute Coronary Syndrome trials (EVACS; NCT03515304,
NCT04082442), with a NSTEMI and a troponin-I of >5 ng/ml or a STEMI were
randomized to placebo or to 420 mg SC of evolocumab, a monoclonal
anti-PCSK9 antibody, within 24 hours of hospitalization. We performed
serial ex vivo analysis of PF4, a marker of platelet activation, in serum
samples obtained at baseline (prior to study drug administration) and at
day 30. PF4 values were normalized to total platelet count. All of the
participants were on guideline-directed therapies for ACS. Additionally,
LIMA samples from patients undergoing coronary bypass surgery were
immunostained with PCSK9, the endothelial cell transmembrane glycoprotein
CD31 (platelet endothelial cell adhesion molecule- 1) and the platelet
surface marker CD61 (integrin beta-3). Outcome data were summarized using
medians and interquartile ranges. <br/>Result(s): Forty-six participants
were randomized in a 1:1 fashion to placebo or to evolocumab. Mean (+/-SD)
age of the cohort was 60+/-13 years, 48% were women and 22% were African
American. Baseline PF4 levels (expressed as ng/1k platelets) were similar
between the two groups (placebo: 9.3 [4-12] vs evolocumab 8.0 [4-12],
p=0.8). In the placebo group, there was a significant increase in PF4 at
30 days to 13.1 [11-14], p<0.01 (baseline vs 30 days). In contrast, there
was no significant change from baseline in the evolocumab group at 30 days
(10.7 [6-13]), which was significantly lower than the placebo group
(p=0.04). Furthermore, immunostaining of LIMA specimens obtained from
patients during coronary artery bypass surgery revealed colocalization of
PCSK9, CD31, and CD61 on the vascular endothelial cell surface (see
Figure). <br/>Conclusion(s): PCSK9 inhibition with evolocumab decreases
platelet activation in ACS patients on dual anti-platelet therapy. PCSK9
is associated with platelets and endothelial cells at the vascular
endothelium. PCSK9 is a potential mediator of the interaction between
platelets and vascular endothelial cells in patients with coronary artery
disease. (Figure presented).

<109>
Accession Number
646962413
Title
Long-term impact of persistent vegetations at 6 month followup after
treatment of infective endocarditis: a substudy of the Partial Oral vs
Intravenous Antibiotic Treatment of Endocarditis (POET) tria.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1670), 2022.
Date of Publication: 01 Oct 2022.
Author
Hjulmand J.; Pries-Heje M.; Try Lenz I.; Carter-Storch R.; Gill S.; Bruun
N.E.; Povlsen J.A.; Christiansen U.; Helweg-Larsen J.; Fosboel E.; Toender
N.; Moser C.; Iversen K.; Ihlemann N.; Bundgaard H.
Institution
(Hjulmand, Pries-Heje, Try Lenz, Helweg-Larsen, Fosboel, Moser, Bundgaard)
Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
(Carter-Storch, Gill, Ihlemann) Odense University Hospital, Odense,
Denmark
(Bruun) Roskilde University Hospital, Roskilde, Denmark
(Povlsen) Aarhus University Hospital, Aarhus, Denmark
(Christiansen) Aalborg University Hospital, Aalborg, Denmark
(Toender) Nordsjaellands Hospital, Hilleroed, Denmark
(Iversen) Herlev Hospital, Herlev, Denmark
Publisher
Oxford University Press
Abstract
Background: Our knowledge of changes in vegetation size throughout the
course of infective endocarditis (IE) and the impact of persistent
vegetations on mortality or embolization after completed antibiotic
treatment is sparse. No study has previously investigated the prevalence
or clinical impact of persistent vegetations on transthoracic
echocardiography (TTE) at 6-months follow-up after ended IE treatment.
<br/>Purpose(s): To investigate the association between persistent
vegetations at the 6-months TTE after treatment for IE and long-term
prognosis as assessed in the POET trial. <br/>Method(s): The POET trial
was a nationwide, multicenter RCT, randomizing 400 patients to either
partial oral or intravenous (IV) antibiotic treatment of left-sided IE,
after initial stabilization of infection using conventional IV therapy. A
persistent vegetation was defined as a vegetation seen on 6-months
follow-up TTE (4-7 months) after ended antibiotic treatment for IE. In the
POET trial, primary outcome was defined as 1) all-cause mortality, 2)
unplanned cardiac surgery, 3) embolic events or 4) relapse of bacteremia,
in the 5-year follow-up period. Patients without TTE due to death or lack
of available TTE were excluded. <br/>Result(s): Out of 400 patients, 20
were excluded due to death during 6- months follow-up, and 201 were
excluded due to unavailable TTE, leaving 179 TTEs for analysis. At
6-months follow-up, a persistent vegetation was seen in 30 patients
(16.7%, 21 males (70%), mean age 69.6 years (SD 7.7)) (Table 1). Seventeen
patients (56.7%) had a persistent vegetation on the aortic valve and 13
patients (43.3%) on the mitral valve. More patients without a persistent
vegetation had undergone initial surgical treatment of IE than those with
a vegetation (57.7 vs 23.3%, p=0.001). In all surgically treated patients
with persistent vegetation at 6-months follow-up, the vegetation was found
on another valve than the operated valve. The composite primary outcome
from 6-months follow-up and until 5-year follow-up occurred in 8 patients
(26.7%) with a persistent vegetation, compared to 38 patients (25.5%)
(p=1.00) without. (Table 2) In patients randomized for peroral treatment,
no significant difference in prevalence of persistent vegetation was found
(15 patients (50%) with persistent vegetations vs. 74 patients (49.7%)
without, p=1.00). <br/>Conclusion(s): The occurrence of persistent
vegetations at 6 months followup was 16.7%. There was no association
between persistent vegetations at 6-months follow-up and the occurrence of
the primary outcome after 5 years follow-up, suggesting that the risk
associated with residual vegetations after end of antibiotic treatment is
negligible after 6-months. (Table presented).

<110>
Accession Number
646957619
Title
Lower recurrence rates of atrial fibrillation in early compared to late
ablation - a Danish nationwide study.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 531), 2022. Date
of Publication: 01 Oct 2022.
Author
Toennesen J.; Pallisgaard J.L.P.; Rasmussen P.V.R.; Ruwald M.R.; Zoerner
C.Z.; Gislason G.G.; Hansen M.L.H.
Institution
(Toennesen, Pallisgaard, Rasmussen, Ruwald, Zoerner, Gislason, Hansen)
Gentofte University Hospital, Gentofte, Denmark
Publisher
Oxford University Press
Abstract
Introduction: Guidelines recommend antiarrhythmic drugs (AAD) before
ablation for atrial fibrillation (AF). However, recently published
randomized clinical trials have demonstrated that ablation is more
effective in maintaining sinus rhythm compared to AAD as first line
therapy. Therefore, data pertaining the impact of early ablation on AF
recurrence in large, unselected cohorts is highly warranted.
<br/>Purpose(s): To examine clinically relevant AF recurrence after
ablation by time from AF diagnosis to ablation. <br/>Method(s): Using
Danish nationwide registries, all Danish patients above 18 years who
underwent first-time AF ablation from January1st 2010 to December31st 2018
were identified and included at the date of ablation. The patients were
categorized by time from diagnosis with AF to ablation. Recurrent AF was
defined using a composite endpoint comprising claimed prescriptions of
AAD, hospital admissions due to AF, re-ablation, or electrical
cardioversions. The cumulative incidence of recurrent AF by time from
diagnosis to ablation at 1-year follow-up after a blanking period of 90
days, was estimated using the Aalen-Johansen estimator, taking death as a
competing risk into account. The relative rates of recurrent AF by time
from diagnosis to ablation were examined using Cox models adjusted for
sex, age, procedure-year, heart failure, ischemic heart disease, chronic
obstructive pulmonary disease, chronic kidney disease, hypertension, and
diabetes. <br/>Result(s): The study cohort consisted of 8,098 patients.
Median age [IQR] increased from 60 [52 to 66] in the early ablation group
(AF ablation within 1 year after diagnosis) to 64 [57 to 70] in the late
ablation group (ablation at least 3 years after diagnosis). The number of
patients with a CHA2DS2- VASc score of 2 or more increased from 44% in the
early ablation group to 51% in the late ablation group. Use of amiodarone
remained stable, while use of Class IC anti-arrhythmic medication
increased by time from diagnosis to ablation. Figure 1 shows the 1-year
cumulative incidence of recurrent AF, hazard ratios (HR), and 95%
confidence intervals (95% CI) stratified by time from diagnosis to
ablation in years and depict that the risk of recurrent AF increased
incrementally and significantly by time from diagnosis to ablation
compared to the early ablation group. Figure 2 shows the 1-year cumulative
incidence of recurrent AF, hazard ratios (HR), and 95% confidence
intervals (CI 95%) stratified by time from diagnosis to ablation in months
and depict that very early ablation (within 6 months) is associated with
less recurrent AF. <br/>Conclusion(s): In this large nationwide study
examining recurrent AF post ablation, recurrence rates of AF increased
incrementally according to time from AF diagnosis to AF ablation. Early
ablation could potentially provide substantial benefits and improve
outcomes after ablation, indicating ablation as first-line therapy might
be more ideal. (Figure presented).

<111>
Accession Number
646962911
Title
Coronary perforation incidence and temporal trends (COPIT): systematic
review and meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2064), 2022.
Date of Publication: 01 Oct 2022.
Author
Mikhail P.; Howden N.; Monjur M.; Said C.; Jeyaprakash P.; Bland A.;
Collison D.; McCartney P.; Adamson C.; Morrow A.; Carrick D.; McEntegart
M.; Ford T.
Institution
(Mikhail, Howden, Said, Bland, Ford) Gosford Hospital, Gosford, Australia
(Monjur) St George Hospital, Sydney, Australia
(Jeyaprakash) Nepean Hospital, Sydney, Australia
(Collison) Golden Jubilee National Hospital, Glasgow, United Kingdom
(McCartney, Adamson, Morrow) University of Glasgow, Glasgow, United
Kingdom
(Carrick) Hairmyres Hospital, East Kilbride, United Kingdom
(McEntegart) Columbia University, New York, United States
Publisher
Oxford University Press
Abstract
Background: Despite advancements in Percutaneous Coronary Interven-tion
(PCI) technology and techniques, iatrogenic coronary artery perfora-tion
(CAP) remains a dreaded potential complication within the cardiac
catheterisation laboratory. Data detailing the incidence of coronary
perfora-tion during PCI has previously been obtained from relatively small
datasets. A swell of large data published in recent times provides
invaluable information regarding PCI related CAP. <br/>Purpose(s): COPIT
is a systematic review and meta-analysis targeted at de-tailing the
incidence, outcomes, etiology and treatment modalities of PCI related CAP
including evaluation of temporal trends since the inception of PCI to
contemporary practice. Additionally, COPIT provides hypothesis generating
data regarding predictors of CAP during PCI. <br/>Method(s): A prospective
systematic review and meta-analysis using MEDLINE and EMBASE via the OVID
interface (PROSPERO ID: CRD42020207881) was performed according to the
PRISMA guidelines. Identified relevant studies were used in a
pre-specified sensitivity analysis to detail incidence, outcomes,
etiology, treatment modalities and risk fac-tors of PCI complicated by
CAP. Studies limited to PCI in high risk popula-tions only such as CTO-PCI
or rotational atherectomy only were excluded. <br/>Result(s): 67 studies
met eligibility criteria detailing 5,568,191 PCIs over a 38-year period
(1982-2020). The pooled incidence of CAP was 0.39% (95% CI: 0.34-0.45%)
with no change in incidence over that time. Approx-imately 1 in 5
perforations led to cardiac tamponade (21.1%). Ellis 3 perfo-rations are
increasing in frequency and account for 43% of all perforations. Mortality
due to perforation occurs in 7.5% of all CAP (95% CI 6.7% - 8.4%) but has
declined over the studied period. Meta-regression suggested that female
gender, hypertension, chronic kidney disease and previous coronary bypass
grafting were all associated with higher incidence of CAP. Coronary
perforation was most frequently caused by distal wire exit (37%) followed
by balloon dilation catheters (28%). Covered stents were used to treat 25%
of perforations, with emergency cardiac surgery needed in 17%.
<br/>Conclusion(s): Coronary perforations occurs in approximately 1 in 250
all-comer PCI procedures. A tendency towards increase in coronary
perfo-rations is likely reflective of contemporary trends towards high
pressure post-dilatation with 1:1 vessel sizing as well as an ageing
population with increasingly complex, calcific coronary disease. However,
reduction in CAP related mortality suggests earlier recognition and
effective treatment with transcatheter techniques. (Figure presented).

<112>
Accession Number
646959066
Title
Tricuspid regurgitation: frequency, management and outcome among patients
with severe left-sided valvular heart disease in Europe. Insights from the
ESC-EORP valvular heart disease II survey.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1530), 2022.
Date of Publication: 01 Oct 2022.
Author
Dreyfus J.; Komar M.; Attias D.; De Bonnis M.; Ruschitzka F.; Popescu
B.A.; Laroche C.; Tribouilloy C.; Prokophiev A.B.; Mizariene V.; Bax J.J.;
Maggioni A.P.; Vahanian A.; Iung B.
Institution
(Dreyfus, Attias) Centre Cardiologique du Nord (CCN), Saint Denis, France
(Komar) Jagiellonian University, Krakow, Poland
(De Bonnis) IRCCS San Raffaele Hospital, Milan, Italy
(Ruschitzka) University Hospital Zurich, Zurich, Switzerland
(Popescu) Emergency Institute for Cardiovascular Diseases, Bucarest,
Romania
(Laroche, Maggioni) European Society of Cardiology, Sophia-Antipolis,
France
(Tribouilloy) University Hospital of Amiens, Amiens, France
(Prokophiev) National Medical Research Center, Novosibirsk, Russian
Federation
(Mizariene) Hospital of Lithuanian University of Health Sciences, Kaunas,
Lithuania
(Bax) Leiden University Medical Center, Leiden, Netherlands
(Vahanian) University Paris Diderot, Paris, France
(Iung) AP-HP-Bichat Hospital-Cardiology Department, Paris, France
Publisher
Oxford University Press
Abstract
Background: Tricuspid regurgitation (TR) is frequent among patients with
severe left-sided valvular heart disease (LS-VHD). <br/>Objective(s): This
study sought to assess TR frequency, management and outcome in this
population. <br/>Method(s): Among 6883 patients with severe LS-VHD or
previous valvular intervention in the EURObservational Research Programme
prospective VHD II survey, we analyzed frequency and grade of TR according
to LSVHD, and 6-month survival according to TR grade. Among 2081 patients
who underwent an intervention for severe LS-VHD, we analyzed frequency and
outcome of concomitant TV intervention, and concordance between Class I
indications for concomitant TV surgery (patients with severe TR) and
real-practice decision-making. <br/>Result(s): Moderate to severe TR was
very frequent among patients with severe mitral VHD (>=30%), especially in
patients with secondary mitral regurgitation (46%), and rare among
patients with aortic VHD (<5%). Higher TR grade was associated with a
poorer 6-month survival (P<0.001). Rates of concomitant tricuspid valve
(TV) intervention at the time of left-sided heart valve surgery were high
at the time of mitral valve surgery (more than 40%). Concomitant TV
intervention at the time of left-sided heart valve surgery (LS-HVS) was
not associated with an increase in-hospital mortality (P=0.93).
Concordance between Class I indications for concomitant TV surgery at the
time of LS-HVS according to guidelines and real-practice decision-making
was very good (88% overall). <br/>Conclusion(s): TR was frequent in
patients with mitral VHD and was associated with a poorer outcome as TR
grade increased. Compliance to guidelines for Class I indications for
concomitant TV surgery at the time of LSHVS was very good. With the trend
toward more transcatheter treatment for left-sided VHD, there is a
critical need for safe and efficient tricuspid valve transcatheter
treatment for patients with concomitant TR.

<113>
Accession Number
646959806
Title
The impact of statin on post-operative atrial fibrillation after discharge
from cardiac surgery: secondary analysis of the SEARCH-AF CardioLink-1
randomized trial.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2342), 2022.
Date of Publication: 01 Oct 2022.
Author
Hibibo M.; Verma S.; Pandey A.; Quan A.; Verma A.; Bisleri G.; Ha A.;
Mazer C.D.
Institution
(Hibibo, Verma, Pandey, Quan, Bisleri, Mazer) St. Michael's Hospital,
Toronto, Canada
(Verma) Southlake Regional Health Centre, Newmarket, Canada
(Ha) UHN - University of Toronto, Toronto, Canada
Publisher
Oxford University Press
Abstract
Background: There is conflicting evidence regarding the use of statins to
reduce the risk of post-operative atrial fibrillation (POAF) in patients
undergoing cardiac surgery. <br/>Purpose(s): We sought to determine the
effects of statin use on the burden of new-onset post-discharge POAF in
the Post-Surgical Enhanced Monitoring for Cardiac Arrhythmias and Atrial
Fibrillation (SEARCH-AF) CardioLink-1 randomized controlled trial.
<br/>Method(s): In the SEARCH-AF trial, 336 patients with risk factors for
stroke (CHA2DS2-VASc score >=2) and no history of preoperative AF were
randomized to usual care or continuous cardiac rhythm monitoring for 30
days after discharge from cardiac surgery with a wearable, patched-based
device. The primary endpoint was the occurrence of cumulative atrial
fibrillation/flutter (AF/AFL) lasting for >=6 minutes detected by
continuous monitoring or AF/AFL documented by a 12-lead electrocardiogram
within 30 days of randomization. Using time-to-event analysis and Cox
regression, we evaluated the association between the risk of
post-operative AF in relation to statin use and dosing intensity (low,
moderate, high) at the time of discharge. We excluded patients who
experienced post-operative AF during hospitalization in this analysis.
<br/>Result(s): In the overall cohort (n=336), 260 (77.4%) patients were
treated with statins at the time of hospital discharge. There were 18
(5.4%) patients who experienced post-operative AF during hospitalization.
Patients prescribed with statins were more likely to be male (p=0.018),
had lower CHA2DS2-VASc scores (p=0.011), and were more likely to undergo
isolated coronary artery bypass grafting (CABG) (p=0.083). Baseline
characteristics were otherwise similar between the 2 groups. Patients
treated with statins at discharge had a 2-fold lower rate of
post-operative AF than those who were not treated with statins in the
overall cohort (17.6% vs. 8.2%, Log-Rank p=0.017) and among those who were
randomized to continuous cardiac rhythm monitoring (31.6% vs. 16.0%,
Log-Rank p=0.027) (Figure). After adjusting for surgery type (CABG vs.
valve surgery) and the CHA2DS2-VASc score, statin use at discharge was
associated with a lower risk of post-operative AF within 30 days after
surgery (hazard ratio 0.48, 95% CI 0.24-0.97). Furthermore, increasing
intensity of statin therapy was associated with lower risk of POAF
(ptrend=0.0012) (Figure 1) <br/>Conclusion(s): Among cardiac surgery
patients with risk factors for stroke and no history of pre-operative AF,
the use of statins was associated with a reduction in post-operative AF
risk within 30 days of discharge. The routine use of high-intensity statin
to prevent post-operative AF after cardiac surgery deserves further study.
(Figure presented).

<114>
Accession Number
646965932
Title
Infective endocarditis of mitral valve, valve replacement or repair?- a
meta-analysis of 10,965 patients.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2122), 2022.
Date of Publication: 01 Oct 2022.
Author
Fathy M.H.; Elnagar M.A.; Elbadawi M.A.; Awad A.K.
Institution
(Fathy, Elnagar, Elbadawi, Awad) Ain Shams University Hospital, Cairo,
Egypt
Publisher
Oxford University Press
Abstract
Background: Being characterized by high mortality and recurrence rates,
native mitral valve infective endocarditis (IE) constitutes a burden on
both patients and surgeons from its poor prognosis and debatable
interventions. Mitral valve repair (MVRr) and mitral valve replacement
(MVRp) are two main surgical methods. Nevertheless, which of them carries
an outweigh benefit over the other is still controversial. Thus, in our
meta-analysis we aimed to further investigate the efficacy of each
technique on both short term and long-term outcomes. <br/>Method(s): Our
search strategy was applied on several databases including the PubMed,
Scopus, Web of science, and Cochrane literature databases to compare MVP
and MVR, with data extracted for baseline characteristics, mortality,
survival, recurrent endocarditis, and valve reoperation. Risk and hazard
ratio (RR and HR) and 95% confidence interval (CI) were pooled and
analyzed using RevMan 5.0. <br/>Result(s): A total of 22 relevant
publications with a total population of 10,965 patients, with 3,557
patients having undergone MVRr and 7,408 patients having undergone MVRp,
respectively, were analyzed. Patients who underwent MVP may benefit from a
lower risk of early mortality (RR 0.44; 95% CI, 0.38-0.51; p<0.00001;
I²=0%), a higher long-term survival rate (HR 0.56; 95% CI,
0.36-0.76; p<0.001; I²=0%), and a lower risk of recurrence (RR
0.66; 95% CI, 0.40-0.93; p=0.05; I²=0%). Although the risk of
reoper-ation was observed lower for MVRr, it was not statistically
significant (RR, 0.86; 95% CI, 0.36-1.36; p=0.76; I²=37%).
<br/>Conclusion(s): Our results suggests that MVRr showed superiority in
the terms of in hospital mortality and long-term survival. Furthermore, it
has lower risk of recurrence and valve reoperation. Therefore, MVRr is an
ap-propriate as a primary treatment choice and should be considered
when-ever possible in most IE patients. <br/>Conclusion(s): Our results
suggests that MVRr showed superiority in the terms of in hospital
mortality and long-term survival. Furthermore, it has lower risk of
recurrence and valve reoperation. Therefore, MVRr is an ap-propriate as a
primary treatment choice and should be considered when-ever possible in
most IE patients. (Figure presented).

<115>
Accession Number
646958615
Title
Measurement error in echocardiographic assessment of aortic stenosis: an
epidemiological consideration of research methodology and clinical
practice.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2863), 2022.
Date of Publication: 01 Oct 2022.
Author
Velders B.J.J.; Groenwold R.H.H.; Kappetein A.P.; Braun J.; Klautz R.J.M.;
Vriesendorp M.D.
Institution
(Velders, Braun, Klautz, Vriesendorp) Leiden University Medical Center,
Cardiothoracic Surgery, Leiden, Netherlands
(Groenwold) Leiden University Medical Center, Leiden, Netherlands
(Kappetein) Medtronic, Coronary and Structural Heart, Maastricht,
Netherlands
Publisher
Oxford University Press
Abstract
Background/Introduction: Current international guidelines on treatment of
valvular heart disease contain recommendations for aortic valve
replacement based exclusively on abnormal echocardiographic parameters in
asymptomatic patients with aortic stenosis (AS). To prevent
misclassification and subsequent mistreatment of patients, these
recommendations require accurate and unbiased measurements of hemodynamic
parameters. <br/>Purpose(s): To illustrate consideration and impact of
measurement error in echocardiographic assessment of aortic stenosis in
both the research and clinical setting. <br/>Method(s): First, a
systematic review was performed to investigate the recognition of and
correction for measurement error in clinical studies on the prognostic
value of peak aortic jet velocity (Vmax), mean pressure gradient (MPG),
and effective orifice area (EOA). Second, all potential erroneous sources
in the calculation of those primary parameters were listed stratified to
random or systematic measurement error, and subsequently their magnitude
was quantified. Third, the impact of various types of measurement error on
current thresholds for intervention was graphically illustrated in
different clinical scenarios. <br/>Result(s): The presence of measurement
error was acknowledged in 44% of the 36 included studies, while none
utilized methods to correct for it. Interobserver variability ranged
between 0.9-8.3% for Vmax and MPG but was substantially higher for EOA
(range 7.7-12.7%) implying lower reliability (Figure 1). Furthermore, the
invalid assumption of a circular left ventricular outflow tract area
resulted in a median underestimation in EOA of 22.5% compared to
3D-transesophageal echocardiography (3D-TEE), computed tomography (CT),
and cardiovascular magnetic resonance (CMR) planimetry. Figure 2
illustrates the impact of this discrepancy on the classification of AS
using one-sided t-tests to determine the areas under the curve; the
proportion of patients with non-severe AS in a hypothetical cohort (based
on values from the PARTNER 3 trial [1[) increased by 42%. Conclusion(s):
Measurement error is underrecognized in studies of echocardiographic
assessment of aortic stenosis. This review demonstrates that random and
systematic measurement errors affect echocardiographic assessment, leading
to potential misdiagnosis and subsequent mistreatment. Clinicians and
scientists should be aware of the implications of measurement errors to
enhance rightful clinical decision-making and assure research validity.
(Figure presented).

<116>
Accession Number
646957949
Title
Systolic blood pressure time in range and long-term clinical outcomes in
patients with ischaemic cardiomyopathy.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 838), 2022. Date
of Publication: 01 Oct 2022.
Author
Zhou Z.; Fu G.; Jian B.; Liang M.; Chen G.; Wu Z.
Institution
(Zhou, Fu, Jian, Liang, Chen, Wu) First Affiliated Hospital of Sun Yat-sen
University, Department of Cardiac Surgery, Guangzhou, China
Publisher
Oxford University Press
Abstract
Background: The relationship between systolic blood pressure (SBP) control
and long-term clinical outcomes in patients with ischaemic cardiomyopathy
remains unclear. It has been previously reported that either too high or
too low SBP may lead to a poorer prognosis. But current SBP control
metrics may not take into account the possible effects of fluctuating SBP
overtime on patients. <br/>Purpose(s): This study aimed to estimate the
association between time in range (TIR) of SBP and long-term clinical
outcomes in patients with ischaemic cardiomyopathy. <br/>Method(s): This
study was a post-hoc analysis of The Surgical Treatment of Ischaemic Heart
Failure (STICH) trial, a randomized controlled trial with two hypotheses
that enrolled participants with coronary artery disease and left
ventricular ejection fraction <=35%. The SBP target range of the TIR was
defined as 110 to 130 mmHg and the SBP TIR was calculated by linear
interpolation method. Patients were equally divided into four groups by
quartiles of TIR. Multivariable-adjusted Cox proportional hazards
regression models were constructed to compare the effects of different
levels of TIR on a 10-year prognosis. The primary outcome was all-cause
mortality. Subgroup analyses were performed according to whether patients
were assigned to coronary artery bypass grafting (CABG) or medical therapy
(MED), and in populations with different baseline SBP. <br/>Result(s): A
total of 1194 eligible patients were included according to the purpose of
our study. Compared with patients in the quartile 4 group (TIR
77.87-100%), the fully adjusted hazard ratios (aHRs) and 95% confidence
intervals (CIs) of all-cause mortality were 1.32 (0.98-1.78) for quartile
3 group (TIR 54.81-77.63%), 1.40 (1.03-1.90) for quartile 2 group (TIR
32.59-54.67%), and 1.53 (1.14-2.04) for quartile 1 group (TIR 0-32.56%) (P
for trend = 0.005). When evaluated TIR as a continuous variable, per 1-SD
decrement (29.28%) in TIR significantly increased the incidence of
all-cause mortality [1.15 (1.04-1.26)]. Similarly, the decrement in TIR
significantly elevated the risk of cardiovascular (CV) mortality and the
risk of all-cause mortality plus CV rehospitalization. Consistent results
were also observed in subgroup analyses of either CABG or MED, or
different baseline SBP, indicating the robustness of our findings.
<br/>Conclusion(s): This study suggested that in patients with ischaemic
cardiomyopathy, a higher SBP TIR was significantly associated with a
decreased risk of all-cause mortality, CV mortality and the composite of
allcause mortality plus CV rehospitalization, regardless of whether the
patient received CABG or MED, and the level of baseline SBP. Our findings
support that TIR might be a substitutable metric of SBP control for
long-term clinical outcomes in patients with ischaemic cardiomyopathy.
(Figure presented).

<117>
Accession Number
646964730
Title
Ventricular arrhythmias and sudden cardiac death caused by mitral valve
prolapse: should we operate and when?.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1647), 2022.
Date of Publication: 01 Oct 2022.
Author
Cameron J.; Sutherland N.; Han H.C.; Raman J.; Lim H.
Institution
(Cameron, Han) Austin Hospital, Melbourne, Australia
(Sutherland) Northern Health, Melbourne, Australia
(Raman, Lim) University of Melbourne, Melbourne, Australia
Publisher
Oxford University Press
Abstract
Background: Several autopsy and observational studies have investigated
the link between mitral valve prolapse (MVP) and sudden cardiac death
(SCD) due to the well accepted yet rare occurrence of complex ventricular
arrhythmia (VA) in this cohort. Few studies however have investigated
whether arrhythmia burden and more importantly SCD are reduced following
surgical correction of MVP. <br/>Purpose(s): To investigate the impact of
mitral valve surgery (MVS) (replacement or repair) on VA and SCD in
patients with MVP. <br/>Method(s): A systematic review of the current
literature was conducted using an electronic search of the PubMed database
in October 2021. Studies were included if subjects had undergone mitral
valve (MV) repair or replacement with documented rates of arrythmias/SCD
pre- and postintervention. Small patient numbers in individual reports
precluded formal meta-analysis and results were reported on a per study
basis. <br/>Result(s): 19 identified studies (10 cohort studies, nine case
studies) comprised 1322 patients with a pooled mean age of 63.4 years and
38.9% were female. 748 of the 1322 patients underwent MVS: 263 MV repair,
18 MV replacement (one with leaflet and papillary muscle excision), two MV
repair with Maze procedure, 177 percutaneous transcatheter MV repair, 45
annuloplasty with or without valve repair, and in 243 cases the surgical
method was not specified. Of the 10 included cohort studies, seven of the
eight which investigated rates of VA post MVS concluded there was a
significant reduction, while one reported the predisposition to arrythmia
persisted after relieving the abnormal mechanical effects of non-ischaemic
MR (75% due to MVP). One study reported a reduction in SCD post MVS. Each
of the nine included case studies showed a reduction in VA post MVS. One
study showed mitral annular disjunction (MAD) was independently associated
with a higher risk of arrhythmic events, this link persisting with time
dependent MVS although reduced compared to medical management.
<br/>Conclusion(s): The underlying mechanisms for VA and SCD associated
with MVP are not completely understood, and guidelines for the surgical
correction of MVP based on arrhythmic and SCD risk are lacking. This
systematic review illustrates a possible reduction in VA following MVS.
Further identification of patients at risk of SCD, and potential use of
risk stratification algorithms, would allow for consideration of earlier
management and appropriate use of implantable cardioverter-defibrillators
(ICD) placement/MVS with an expected survival benefit.

<118>
Accession Number
646964107
Title
Meta-analysis comparing outcomes in patients undergoing transcatheter
aortic valve implantation with versus without percutaneous coronary
intervention.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1590), 2022.
Date of Publication: 01 Oct 2022.
Author
Costa G.; Marinho V.; Costa M.; Goncalves L.; Teixeira R.
Institution
(Costa, Teixeira) Centro Hospitalar de Coimbra, Coimbra, Portugal
(Marinho, Costa, Goncalves) Centro Hospitalar Universitario de Coimbra,
Coimbra, Portugal
Publisher
Oxford University Press
Abstract
Background: Patients having transcatheter aortic valve implantation (TAVI)
routinely undergo coronary angiography before the procedure to define the
coronary anatomy and to evaluate the extend of coronary artery disease
(CAD). Whether percutaneous coronary intervention (PCI) prior/concomitant
with TAVI confers any additional clinical benefit in patients with CAD
remains unclear. <br/>Purpose(s): To compare the outcomes of PCI prior to
TAVI in patients with significant coronary artery disease and severe
aortic stenosis. <br/>Method(s): We systematically searched PubMed, Embase
and Cochrane databases, in November 2021, for both retrospective and
prospective studies comparing TAVI with PCI versus TAVI alone.
Random-effects metaanalysis was performed. <br/>Result(s): Eleven studies
were included in which one was a randomized clinical trial. A total of
2530 patients were included, providing a 145 pooled death events (64 in
TAVI with PCI and 81 in TAVI only). In terms of 30-day clinical outcomes,
our pooled analysis revealed a similar all-cause mortality (pooled OR,
1.24; 95% CI [0.80, 1.93], P=0.34; I²=27% - Figure),
cardiovascular mortality (pooled OR, 1.44; 95% CI [0.56, 3.75], P=0.45;
I²=57%) and stroke (pooled OR, 1.07; 95% CI [0.53, 2.13],
P=0.86; I²=0%). However, our analysis revealed a higher rate of
myocardial infarction (pooled OR, 4.28; 95% CI [1.56, 11.69], P<0.01;
I²=0%) and major bleeding events (pooled OR, 1.40; 95% CI
[1.02, 1.93], P=0.04; I²=0%) in the TAVI with PCI group. A
1-year clinical outcomes analysis revealed a trend for lower allcause
mortality in TAVI only group (pooled OR, 1.37; 95% CI [0.98, 1.91],
P=0.06; I²=0%), similar cardiovascular death rate (pooled OR,
1.15; 95% CI [0.70, 1.89], P=0.59; I²=6%) and major bleeding
events (pooled OR, 1.62; 95% CI [0.95, 2.76], P=0.07; I²=0%).
<br/>Conclusion(s): Our pooled data suggests that PCI with TAVI in
patients with severe aortic stenosis and concomitant CAD grants no
additional clinical advantage. (Figure presented).

<119>
Accession Number
646956519
Title
Clinical profile and in-hospital outcome of patients supported by
intra-aortic balloon pump in the clinical setting of cardiogenic shock
according to aetiology.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1101), 2022.
Date of Publication: 01 Oct 2022.
Author
Garofalo M.; Corsini A.; Potena L.; Schinzari M.; Nardi E.; Barberini F.;
Gargiulo C.; Malaguti M.; Sabatino M.; Semprini F.; Galie N.; Nanni S.
Institution
(Garofalo, Schinzari, Nardi, Gargiulo, Galie) Policlinico IRCCS
Sant'Orsola-Malpighi - Alma Mater Studiorum Universita di Bologna,
Dipartimento Cardio-Toraco-Vascolare - Medicina Specialistica, Diagnostica
e Sperimentale, Bologna, Italy
(Corsini, Potena, Barberini, Sabatino, Semprini, Nanni) Policlinico IRCCS
Sant'Orsola-Malpighi, Dipartimento Cardio-Toraco-Vascolare, Bologna, Italy
(Malaguti) Alma Mater Studiorum Universita di Bologna, Dipartimento di
Medicina Specialistica, Diagnostica e Sperimentale, Bologna, Italy
Publisher
Oxford University Press
Abstract
Background: Despite controversial evidence, intra-aortic balloon pump
(IABP) is still the most used temporary mechanical support in cardiogenic
shock (CS), as a bridge to recovery or to more advanced mechanical support
and/or heart transplantation [1]. Indeed, the available evidence, which is
mainly restricted to the context of acute coronary syndromes (ACS) and is
limited by the variability of CS definitions, shows no benefit in terms of
mortality [2]. Randomized controlled trials on IABP in the setting of non-
ACS CS are still missing. As a result, European guidelines do not
recommend the routine use of IABP, which may be considered in refractory
CS [3]. <br/>Purpose(s): The aim of our study was to analyse the use of
IABP in the context of CS, providing insights into its indications,
outcomes, and complications in relation to the aetiology (ACS vs non-ACS)
of CS. <br/>Method(s):We retrospectively enrolled all consecutive adult
patients receiving IABP for refractory CS at our tertiary referral
Hospital between 2009 and 2018, and analysed data focusing on in-hospital
outcomes, including death, recovery, heart transplantation, and escalation
to more advanced mechanical support such as venoarterial extracorporeal
membrane oxygenation (VA-ECMO) or left ventricular assist device (LVAD),
and on IABPrelated complications. <br/>Result(s): 403 patients received
IABP, 75.2% (n=303) for ACS CS and 24.8% (n=100) for non-ACS CS. With
respect to ACS patients, non-ACS patients were younger (age 59+/-18.3 vs
73.1+/-12.6 years old, p<0.001), had a lower left ventricular ejection
fraction (LVEF) [25% (IR 18-35%) vs 38% (IR 25-45%), p<0.001], were
supported by IABP for longer time [6 (IR 2-18) vs 2 (IR 1-4) days,
p<0.001], required more use of inotropes/vasoconstrictors [80.0% (n=80) vs
33.8% (n=102), p<0.001], and needed more often escalation to VA-ECMO
[23.0% (n=23) vs 1.3% (n=4), p<0.001]. Non-ACS patients showed higher
in-hospital mortality than ACS patients [46.0% (n=46) vs 33.9% (n=103),
p=0.042]. Non-ACS patients were more frequently bridged to heart
transplantation [20.0% (n=20) vs 0.3% (n=1), p<0.001] or LVAD [4.0% (n=4)
vs 0.6% (n=2), p=0.055] than ACS patients; mortality after
transplantation/LVAD did not significantly differ between the two groups
[12.5% (n=3/24) vs 66.7% (n=2/3), p>0.05]. The incidence of IABP-related
overall and major complications (including ischemic stroke, major
bleeding, and peripheral or visceral ischemia) was not different with
respect to the non-ACS vs ACS aetiology [major complications: 8.0% (n=8)
vs 5.0% (n=15), p>0.05]. <br/>Conclusion(s): In our experience, in the
clinical setting of CS treated with IABP, non-ACS patients show a worse
clinical profile and prognosis than ACS patients, and more often require
escalation to more advanced mechanical support and/or heart
transplantation, while the incidence of IABP-related complications appears
similar independently of the aetiology. (Figure presented).

<120>
Accession Number
646964601
Title
Revascularization of significant coronary artery disease in patients
undergoing transcatheter aortic valve implantation: a systematic review
and meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1597), 2022.
Date of Publication: 01 Oct 2022.
Author
Aarts H.; Van Hemert N.D.; Meijs T.A.; Van Nieuwkerk A.C.; Voskuil M.;
Delewi R.
Institution
(Aarts, Van Hemert, Meijs, Voskuil) University Medical Center Utrecht,
Utrecht, Netherlands
(Van Nieuwkerk, Delewi) Amsterdam University Medical Center, Amsterdam,
Netherlands
Publisher
Oxford University Press
Abstract
Background: The prevalence of coronary artery disease (CAD) in patients
with severe aortic valve stenosis undergoing transcatheter aortic valve
implantation (TAVI) is high. However, the importance of a percutaneous
coronary intervention (PCI) prior to TAVI has been matter of debate.
Importantly, patients undergoing TAVI are characterized by high age often
accompanied by highly calcified coronary arteries, increasing the risk of
severe periprocedural complications. Moreover, patients with a severe
aortic valve stenosis are limited in their ability to compensate for these
lifethreatening complications. Together with the necessity of dual
antiplatelet therapy after PCI, this may explain a possible negative
effect of PCI in this patient population. However, there is still
insufficient evidence regarding the importance of PCI in patients
undergoing TAVI. <br/>Purpose(s): The aim of this systematic review and
meta-analysis was to assess the need for PCI in patients with significant
CAD undergoing TAVI. <br/>Method(s): A systematic search was conducted to
identify studies comparing optimal medical treatment only versus PCI in
patients with significant CAD undergoing TAVI. Endpoints were all-cause
mortality, cardiac death, stroke, myocardial infarction, and major
bleeding which were assessed at 30 days, one year, and beyond one year
following TAVI. <br/>Result(s): A total of 14 studies was included in this
meta-analysis, including 3838 patients of which 1806 patients (47.1%)
underwent PCI before TAVI. All-cause mortality was not significantly
different between optimal medical treatment only and PCI at 30 days (OR:
1.27; 95% CI, 0.91-1.77; p=0.17; I²=0%), at one year (OR: 0.91;
95% CI, 0.64-1.29; p=0.59; I²=45%), and beyond one year (OR
0.68; 95% CI, 0.42-1.08; p=0.10; I²=49%). Cardiac death and
myocardial infarction was similar across the groups at 30 days (OR cardiac
death: 1.94; 95% CI, 0.36-10.56; p=0.45; I²=28%; OR myocardial
infarction: 0.50; 95% CI, 0.13-1.91; p=0.31; I²=0%), and at one
year (OR cardiac death: 0.77; 95% CI, 0.19-3.13; p=0.72;
I²=84%; OR myocardial infarction: 0.74; 95% CI, 0.21-2.66;
p=0.64; I²=18%). Stroke did not significantly differ between
PCI and optimal medical treatment groups at 30 days (OR: 0.77; 95% CI,
0.31-1.92; p=0.57; I²=0%). However, patients that underwent
TAVI without preceding PCI had significantly lower risk of major bleeding
at 30 days (OR: 0.66; 95% CI, 0.46-0.94; p=0.022; I²=0%).
<br/>Conclusion(s): This systematic review and meta-analysis showed no
significant differences in clinical outcomes between patients with and
without PCI prior to TAVI at both short- and long-term follow-up, apart
from a higher risk of major bleeding within 30 days in patients undergoing
PCI before TAVI.

<121>
Accession Number
646957386
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
with stenting for multivessel coronary artery disease without left main
coronary disease:reconstructed individual patient data.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1416), 2022.
Date of Publication: 01 Oct 2022.
Author
Chew N.W.S.; Ng C.H.; Xiao J.L.; Chan K.H.; Loh P.H.; Low A.; Lee C.H.;
Tan H.C.; Chan M.Y.
Institution
(Chew, Chan, Loh, Low, Lee, Tan, Chan) National University Heart Centre,
Singapore, Singapore
(Ng, Xiao) National University of Singapore, Singapore, Singapore
Publisher
Oxford University Press
Abstract
Background and aims: Data are emerging on 10-year mortality comparing
coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI) with stenting for multivessel disease (MVD) without
left main (LM) involvement. We conducted an updated two-stage metaanalysis
using reconstructed individual patient data to compare long-term mortality
between CABG and PCI for patients with MVD without significant LM coronary
disease. <br/>Method(s): Medline and Embase databases were searched for
articles comparing CABG with PCI for MVD. A two-stage meta-analysis was
conducted using reconstructed patient level survival data for all-cause
mortality with subgroups by SYNTAX score. The shared-frailty and
stratified Cox models were fitted to compare survival endpoints.
<br/>Result(s): We screened 1496 studies and included six randomized
controlled trials with 7181 patients. PCI was associated with greater
10-year all-cause mortality risk (HR: 1.282, CI: 1.118-1.469, p<0.001)
compared with CABG. In patients with low SYNTAX score, 10-year all-cause
mortality after PCI was comparable to CABG (HR: 1.102, 0.822-1.479,
p=0.516). However, in patients with moderate to high SYNTAX score, 10-year
allcause mortality was significantly higher after PCI compared with CABG
(HR: 1.444, 1.122-1.858, p<0.001; HR: 1.856, 1.380-2.497, p<0.001
respectively). <br/>Conclusion(s): This updated reconstructed individual
patient-data metaanalysis revealed a sustained lower cumulative all-cause
mortality of CABG over PCI for multivessel disease without LM involvement.
(Figure presented) (Table presented).

<122>
Accession Number
646957652
Title
Fractional flow reserve versus angiography guided revascularization for
patients with multivessel coronary artery disease: a systematic review and
meta-analysis of randomized controlled trials.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1368), 2022.
Date of Publication: 01 Oct 2022.
Author
Goel S.; Slomovich S.; Edris S.; Park W.J.; Agarwal C.; Hooda A.;
Krishnamoorthy P.M.; Gidwani U.; Sharma S.; Kini A.
Institution
(Goel, Hooda, Krishnamoorthy, Gidwani, Sharma, Kini) Icahn School of
Medicine at Mount Sinai, New York, United States
(Slomovich, Edris) South Nassau Communities Hospital, Oceanside, United
States
(Park) South Nassau Communities Hospital, Oceanside, United States
(Agarwal) Maimonides Medical Center, Brooklyn, United States
Publisher
Oxford University Press
Abstract
Background: Recently published randomized controlled trials (RCT) have
questioned the utility of Fraction Flow Reserve (FFR) to guide
revascularization in patients with multivessel coronary artery disease
(CAD) as compared to Angiography Purpose: This current analysis aimed to
compare the clinical outcomes associated with FFR guided versus standard
angiography-guided revascularization for patients with multivessel CAD
using a large number of randomized patients with stable CAD and acute
coronary syndrome (ACS) Methods: We conducted an electronic database
search of all published data for RCT that compared FFR versus Angiography
for patients with multivessel CAD and reported on subsequent mortality,
cardiac death, myocardial infarction, revascularization, and other
outcomes of interest. Event rates were compared using a forest plot of
odds ratios using a fixed-effects model assuming interstudy heterogeneity.
<br/>Result(s): Eleven RCT (n=6052; FFR = 3043, Angiography = 3027) were
included in the final analysis. Mean follow-up period was 1.7 years. In
our analysis, FFR guided revascularization as compared to angiography
guided revascularization alone was not associated with any significant
reduction in overall mortality (OR = 1.10, 95% CI = 0.83-1.47, P=0.47,
I2=0), cardiac mortality (OR = 0.95, 95% CI = 0.63-1.45, P=0.42, I2=0),
all revascularization (OR = 0.96, 95% CI = 0.80-1.14, P=0.17, I2=31%) or
myocardial infarction (OR = 0.99, 95% CI = 0.79-1.23, P=0.33, I2=12%).
There was also no difference between two groups in terms of major adverse
cardiac or cerebrovascular event [MACCE] (OR = 1.13, 95% CI = 0.90-1.42,
P=0.39, I2=5%), major adverse cardiac event [MACE] (OR = 0.86, 95% CI =
0.70-1.07, P=0.55, I2=0), stroke/TIA (OR = 1.61, 95% CI = 0.92-2.82,
P=0.36, I2=8%) or target lesion revascularization [TLR] (OR = 0.86, 95% CI
= 0.44-1.67, P=0.71, I2=0). Furthermore, sensitivity analysis was
conducted to include only studies with ACS patients and studies which used
CABG only for revascularization. However, there was no difference between
the two groups for any of the above outcomes <br/>Conclusion(s): There is
no difference in clinical outcomes in patients undergoing FFR-guided
versus angiography guided revascularization for multivessel CAD. (Figure
presented).

<123>
Accession Number
646957987
Title
Prognostic value of left and right ventricular strain in heart failure
with reduced and preserved ejection fraction: a meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 75), 2022. Date
of Publication: 01 Oct 2022.
Author
Pastore M.C.; Fusini L.; Mandoli G.E.; Carrucola C.; Vigna M.; Muratori
M.; Pepi M.; Cavigli L.; D'ascenzi F.; Focardi M.; Valente S.; Mondillo
S.; Pontone G.; Patti G.; Cameli M.
Institution
(Pastore, Mandoli, Carrucola, Vigna, Cavigli, D'ascenzi, Focardi, Valente,
Mondillo, Pontone) University of Siena, Siena, Italy
(Fusini, Muratori, Pepi) IRCCS Monzino Cardiology Center, Milan, Italy
(Patti, Cameli) University of Eastern Piedmont, Novara, Italy
Publisher
Oxford University Press
Abstract
Background: The association of speckle tracking echocardiography measures
of left ventricular (LV) and right ventricular (RV) strain with clinical
outcome in heart failure with reduced and preserved ejection fraction
(HFrEF and HFpEF) has been extensively investigated. In fact, while the
contribute of LV ejection fraction (LVEF) for prognosis is controversial,
myocardial strain has proven to be a strong and independent prognostic
predictor in many HF studies. <br/>Purpose(s): The aim of this
meta-analysis was to assess the prognostic value of LV global longitudinal
strain (GLS) and free wall RV longitudinal strain (fwRVLS) by
2-dimensional speckle tracking echocardiography in patients with HFrEF, HF
with mildly-reduced ejection fraction (HFmrEF) and HFpEF. <br/>Method(s):
A systematic literature search of medical databases including Pubmed,
Scopus, Ovid Online, EMBASE, Web of Science, Cochrane Central Register of
Controlled Trials, Scopus was performed using PRISMA principles. All
relevant studies in English language reporting the predictive value of LV
GLS and/or fwRVLS for mortality and/or cardiovascular events in HFrEF,
HFmrEF and HFpEF, with follow up >6 months, were identified. Case
reports/series and abstract congresses were excluded (Fig. 1). All-cause
mortality and a composite endpoint of cardiovascular death,
rehospitalization for HF, cardiac transplantation, ventricular assist
device implantation were analyzed. Hazard ratios (HR) were extracted from
univariate and multivariate random-effects models reporting on the
association of LV GLS and fwRVLS and outcome and described as pooled
estimates with 95% confidence intervals (CI). <br/>Result(s): Fifty
studies (n=18276 patients) satisfied the inclusion criteria (35 studies in
chronic HF, 15 studies in acute HF). Most studies (n=36) included patients
with HFrEF, while 14 studies included patients with HFmrEF (n=3) and with
HFpEF (n=11); thus HFmrEF and HFpEF were grouped together for the
analysis. Overall, 48 studies included LV GLS (median value = -9% [from
-17% to -11%], 17 studies included fwRVLS (median value = -18% [from -24%
to -14%]). Over a median follow up of 32 [from 7 to 67] months follow up,
5618 (31%) had a cardiovascular event or died. LV GLS and fwRVLS were
independently associated with all-cause mortality and the composite
outcome, regardless of LVEF (Fig. 2), both in HFrEF (HR 1.26; 95% CI
[1.15; 1.37]; p<0.01 for LV GLS and HR 1.06; 95% CI [1.03; 1.09]; p<0.01
for fwRVLS) and in HFpEF (HR 1.07; 95% CI [1.03; 1.12]; p<0.01 for LV GLS
and HR 1.08; 95% CI [0.96; 1.21]; p<0.01 for fwRVLS). <br/>Conclusion(s):
These meta-analysis data demonstrate that LV and RV strain are associated
with mortality and cardiovascular events in patients with HF, HFmrEF and
HFpEF and may provide important additive prognostic information. These
findings emphasize the potential usefulness of LV GLS and fwRVLS in
clinical practice to improve the risk stratification and management of
patients with HF regardless of LVEF. (Figure presented).

<124>
Accession Number
646962632
Title
Determinants of myocardial injury following transcatheter aortic valve
implantation: a pre-specified substudy from the POPular TAVI trial.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2106), 2022.
Date of Publication: 01 Oct 2022.
Author
Van Ginkel D.J.; Brouwer J.; Nijenhuis V.J.; Delewi R.; Swaans M.J.;
Timmers L.; Rensing B.J.W.M.; Baan J.; Ten Berg J.M.
Institution
(Van Ginkel, Brouwer, Nijenhuis, Swaans, Timmers, Rensing, Ten Berg) St
Antonius Hospital, Nieuwegein, Netherlands
(Delewi, Baan) Amsterdam UMC - Location Academic Medical Center,
Amsterdam, Netherlands
Publisher
Oxford University Press
Abstract
Background: Myocardial injury is frequently observed in patients
under-going transcatheter aortic valve implantation (TAVI) and has been
linked to worse prognosis [1,2]. Yet, knowledge concerning the underlying
mecha-nisms and preventive strategies is scarce. <br/>Purpose(s): To
identify clinical determinants and the effect of periprocedural
antithrombotic strategies on markers of myocardial injury after TAVI.
<br/>Method(s): The POPular TAVI trial was a prospective, open label,
multicen-tre randomized controlled trial, investigating the addition of
clopidogrel to aspirin (cohort A) or oral anticoagulation (OAC) (cohort B)
in patients un-dergoing TAVI [3] Patients randomised to clopidogrel
received a 300mg loading dose before TAVI, followed by a 75mg maintenance
dose once daily. In patients using OAC, this was continued during TAVI
with an international normalized ratio aimed at 2.0. All OAC patients used
a vitamin-K antagonist. Blood samples were taken at baseline, 6, 24, 48,
and 72 hours following TAVI to determine myocardial injury using Creatine
Kinase-MB (CK-MB) and high-sensitive cardiac troponin T (hs-cTnT)
according to the VARC-2 criteria. Also, baseline and procedural variables
were collected in detail. A linear mixed effects model was used for
pair-wise analysis of the changes in enzyme levels at different time
points between groups. Regres-sion analysis was performed using the
logistic regression model. Statistical analyses were performed using R
(version 3.4.1). <br/>Result(s): In total, 131 patients undergoing
transfemoral TAVI were included at two study sites, of whom 63 (48%)
received clopidogrel and 68 (52%) did not. Almost half of the patients
(45%) were on OAC. The rise in CK-MB (mean peak 23.4+/-13.3 U/l) and
hs-cTnT (mean peak of 0.23+/-0.33 ug/) was maximal at 6 and 24 hours,
respectively. The CK-MB and hs-cTnT levels did not differ between the
clopidogrel and no clopidogrel group at any time point (figure 1).
Myocardial injury occurred in 18 (30.1%) patients receiving OAC versus 39
(54.2%) patients not receiving OAC (p=0.007). The course of hs-cTnT
reached higher levels in patients with chronic kidney disease (p<0.001)
and in patients with a preserved left ventricular ejection fraction (LVEF)
(p=0.008). Also, the use of a controlled mechanical expanding pros-thesis
was associated with a higher rise of hs-cTnT (p=0.007). (Figure 2) In
multivariable analysis, predictors of a maximal increase in hs-cTnT were a
preserved LVEF (OR 1.15, 95% CI 1.02-1.30) and chronic kidney dis-ease (OR
1.13, 95% CI 1.01-1.28). Other procedural factors, like balloon dilation
and rapid ventricular pacing, were not associated with myocardial injury.
<br/>Conclusion(s): The addition of clopidogrel to aspirin or OAC during
TAVI was not associated with a reduction in myocardial injury. Instead,
OAC therapy, as compared to aspirin, was associated with a reduction in
rise and fall of hs-cTnT. Also, patients with a preserved LVEF or chronic
kidney disease observed higher levels of hs-cTnT. (Figure presented).

<125>
Accession Number
646965871
Title
Transcatheter mitral-valve repair for functional mitral regurgitation data
from the real-life in comparison with landmark randomized trials.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2121), 2022.
Date of Publication: 01 Oct 2022.
Author
Kaddoura R.; Al-Badriyeh D.B.; Abushanab D.A.; Al-Hijji M.A.
Institution
(Kaddoura, Abushanab, Al-Hijji) Hamad Medical Corporation Heart Hospital,
Doha, Qatar
(Al-Badriyeh) Qatar University, Doha, Qatar
Publisher
Oxford University Press
Abstract
Background: Publication of COAPT and MITRA-FR trials on the use of
transcatheter mitral-valve repair (TMVR) for functional mitral
regurgitation (MR) in 2018, has raised many questions due to their
divergent results despite having similar objectives. <br/>Purpose(s): To
investigate the characteristics and outcomes of patients from real-life
data who underwent TMVR for functional MR, in comparison with the two
landmark trials. <br/>Method(s): A meta-analysis was performed according
to Cochrane Hand-book for Systematic Reviews and the Preferred Reporting
Items for Sys-tematic Reviews and Meta-analyses statement. A comprehensive
system-atic literature search was conducted to identify observational
studies that enrolled patients with functional MR, published in 2020 and
2021. No further restrictions were implemented. Independent reviewers
performed study selection, data extraction, risk-of-bias and
quality-of-evidence as-sessments. Variables of interest were related to
patient demographics, medications, echocardiogram parameters, and
outcomes. Patient variables from observational studies were compared with
those reported in random-ized trials, using a random-effects model for
each variable. Mean difference (MD) and odds ratio (OR), with 95%
confidence intervals (95% CI), were used to compare continuous and
categorical data, respectively. Variables that were not reported in both
COAPT and MITRA-FR trials were not pre-sented. R software was used for
non-comparative pooling of variables, and RevMan software was used for
comparative meta-analysis. <br/>Result(s): Thirty-two studies, enrolling
9497 patients, were included. Pa-tients were found to be older in
real-life than in landmark trials ([MD -2.73; 95% CI: -4.06, -1.40] for
COAPT; [MD -4.33; 95% CI: -5.94, -2.72] for MITRA-FR), while more males
were recruited in MITRA-FR trial (OR 1.71; 95% CI: 1.15-2.52). Moreover,
patients in MITRA-FR trial were less likely to have atrial fibrillation or
renal insufficiency. Patients from real-life were more likely to be more
symptomatic (i.e., New York Heart Associa-tion (NYHA) class III/IV) and
less likely to have implanted cardiac devices than those in randomized
trials. MITRA-FR trial patients had better compli-ance with
guideline-directed therapies for heart failure with reduced ejec-tion
fraction. Ejection fraction ranged from 31.3% to 33.9% between three study
arms. More patients in randomized trials presented with moderate-to-severe
MR (grade 3+), whereas severe MR (grade 4+) was more common among patients
from real-life. Procedure success, defined as MR grade <=2+, was more
frequent in randomized trials, with better symptoms' relief in COAPT trial
(NYHA class I/II). There was no difference in number of devices implanted
between real-life and landmark trials data. [Tables 1 and 2]
<br/>Conclusion(s): Real-life data on TMVR in functional MR, as presented
by low-quality and heterogenous observational studies, showed substantial
differences from the results of the main randomized trials. (Table
presented).

<126>
Accession Number
646959228
Title
Perioperative rosuvastatin therapy increases creatine kinase and the risk
of acute kidney injury in patients undergoing cardiac surgery.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2675), 2022.
Date of Publication: 01 Oct 2022.
Author
Wijesurendra R.; Sardell R.; Hill M.; Jayaram R.; Samuel N.; Staplin N.;
Emberson J.; Collins R.; Zheng Z.; Haynes R.; Casadei B.
Institution
(Wijesurendra, Sardell, Hill, Samuel, Staplin, Emberson, Collins, Haynes)
University of Oxford, Nuffield Department of Population Health, Oxford,
United Kingdom
(Jayaram, Casadei) University of Oxford, Division of Cardiovascular
Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
(Zheng) Fuwai Hospital, Beijing, China
Publisher
Oxford University Press
Abstract
Introduction: In patients undergoing cardiac surgery, perioperative statin
therapy does not prevent atrial fibrillation or myocardial injury, but
results in increased creatinine levels after surgery. Here we investigated
the incidence of acute kidney injury (AKI) in 1922 patients scheduled for
elective cardiac surgery who were randomized to perioperative rosuvastatin
(20 mg once daily) or placebo in the Statin Therapy In Cardiac Surgery
(STICS) trial. <br/>Method(s): AKI post-surgery was defined according to
international guidelines using plasma creatinine. Biomarkers related to
kidney function, muscle injury and inflammation were investigated,
including cystatin C, total creatine kinase (CK), troponin I, growth
differentiation factor 15 (GDF-15), interleukin-6 (IL-6), procalcitonin,
and placental growth factor (PGF). <br/>Result(s): At 48 hours
post-surgery, AKI was significantly more common in patients allocated to
rosuvastatin compared to placebo when defined by creatinine (24.7% vs
19.3%; OR 1.37 [95% CI 1.10-1.70]; p=0.005; Figure 1A) or by cystatin C
(9.2% vs 5.1%; OR 1.86 [95% CI 1.29-2.67]; p<0.001; Figure 1B). Elevations
in CK to >10x and >40x baseline level were also more frequent in
rosuvastatin-allocated patients compared to placebo (30.9% vs 26.5%,
p=0.02, and 2.1% vs 0.7%, p=0.02, respectively; Figure 1C). Post-operative
concentrations of troponin I, GDF-15, IL-6, pro-calcitonin, and PGF were
similar between the groups (Table 1). <br/>Conclusion(s): Perioperative
rosuvastatin initiation increased the absolute risk of AKI after cardiac
surgery by 4-5%. Rosuvastatin also led to greater elevations in
post-operative creatine kinase, but did not affect other biomarkers of
tissue injury, inflammation, and myocardial injury. Further research is
needed to delineate the underlying mechanism of AKI with pe-rioperative
rosuvastatin. (Figure presented) (Table presented).

<127>
Accession Number
646963196
Title
Comparing direct oral anticoagulants versus vitamin K antagonist in
patients with atrial fibrillation after transcatheter aortic valve
replacement: an updated meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1631), 2022.
Date of Publication: 01 Oct 2022.
Author
Dhaliwal A.; Kaur A.; Konje S.; Bhatia K.; Sohal S.; Rawal H.; Turagam M.;
Gwon Y.; Mamas M.; Dominguez A.; Bhatt D.; Velagapudi P.
Institution
(Dhaliwal) New York Hand Surgery, New York, United States
(Kaur, Konje, Bhatia, Dominguez) Mount Sinai St Luke's and Mount Sinai
West Hospital, New York, United States
(Sohal) Newark Beth Israel Medical Center, Newark, United States
(Rawal) Insight Hospital and Medical Center, Chicago, United States
(Turagam) Mount Sinai Hospital, New York, United States
(Gwon, Velagapudi) University of Nebraska Medical Center, Omaha, United
States
(Mamas) Keele University, Keele, United Kingdom
(Bhatt) Brigham and Women's Hospital, Harvard Medical School, Boston,
United States
Publisher
Oxford University Press
Abstract
Background: Oral anticoagulation therapy is indicated for patients
undergoing transcatheter aortic valve replacement (TAVR) with concomitant
or new onset atrial fibrillation (AF). However the data on optimal
anticoagulation regimen in this population remains unclear.
<br/>Purpose(s): To compare efficacy and safety outcomes of direct oral
anticoagulants (DOACs) versus Vitamin K antagonists (VKA) in patients with
AF post TAVR. <br/>Method(s): We searched electronic databases (PubMed,
Embase, Scopus, Cochrane) from inception to February28th, 2022 using MeSH
terms and keywords for DOACs, AF or TAVR. Primary outcome of interest was
allcause stroke or systemic embolic event. Secondary safety outcomes were
major bleeding and all-cause mortality. Pooled risk ratio (RR) and 95%
confidence interval (CI) were calculated using a random-effects model.
Interstudy heterogeneity was assessed using the Higgins I 2 value. All
statistical analysis were performed using RevMan 5.4.1 software.
<br/>Result(s): We identified five eligible studies (1RCT, 4
observational) including 3694 patients (DOAC n=1581, VKA n=2113). The mean
age was 81.4+/-0.9 years. The mean follow-up was 12.4+/-14.3 months. Type
of DOACs included apixaban (n=394, 24.9%), rivaroxaban (n=354, 22.4%),
dabigatran (n=119, 7.5%) and edoxaban (n=714, 45.2%).There was no
significant difference in primary outcome of stroke or systemic embolic
event (RR: 0.93; CI: 0.65-1.33; p>0.05; I²=5%), or in secondary
outcomes of major bleeding (RR: 1.02; CI: 0.78-1.34; p>0.05;
I²=44%) and all-cause mortality (RR: 0.87; CI: 0.59-1.27;
p>0.05; I²=56%) between DOACs and VKA groups.
<br/>Conclusion(s): This meta-analysis shows anticoagulation therapy with
DOACs has similar safety and efficacy outcomes compared to VKA in patients
with AF undergoing TAVR. (Figure presented).

<128>
Accession Number
646959371
Title
Dual versus single antiplatelet therapy after transcatheter aortic valve
replacement: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 2087), 2022.
Date of Publication: 01 Oct 2022.
Author
Eikelboom R.; Qiu Y.; Kim K.; Whitlock R.; Belley-Cote E.
Institution
(Eikelboom, Qiu, Kim) McMaster University, Hamilton, Canada
(Whitlock, Belley-Cote) Population Health Research Institute, Hamilton,
Canada
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is the
inter-vention of choice for patients with severe symptomatic aortic
stenosis who have high or intermediate surgical risk. TAVR valves are at
risk of thrombo-sis and serious sequelae including stroke, peripheral
embolism, and valve dysfunction requiring intervention. The optimal method
of antithrombotic therapy to reduce risk of thrombosis with an acceptable
increase in risk of bleeding is uncertain. <br/>Objective(s): This
systematic review and meta-analysis assesses the ef-fects of dual
antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT) on
mortality, thrombosis and bleeding in patients undergoing TAVR.
<br/>Method(s): We systematically searched EMBASE, MEDLINE and CENTRAL
from January 1, 2002 until February 9, 2021 for randomized tri-als
comparing DAPT to SAPT after TAVR. Two reviewers independently screened
titles and abstracts, and then the full text of potentially relevant
articles in duplicate. Data abstraction and risk of bias was also
performed in duplicate. Risk ratios and 95% confidence intervals were
pooled using the Mantel-Haenzel method and random effects modelling. We
assessed the certainty of the evidence for each outcome using the Grading
of Rec-ommendations, Assessments, Development and Evaluation (GRADE)
ap-proach. <br/>Result(s): We included 4 randomized controlled trials of
1086 patients. Risk of bias was low or somewhat concerning for all
studies. We found no differ-ence in mortality (risk ratio (RR) 1.02, 95%
confidence interval (CI), 0.63 to 1.63) or stroke (RR 1.03, 95% CI
0.57-1.84), but a significant increase in major bleeding (RR 2.04, 95% CI,
1.31-3.19), with DAPT compared to SAPT. There were too few events to
conduct meta-analysis for clinical valve thrombosis, subclinical valve
thrombosis, transvalvular gradients on echo-cardiography, or aortic valve
reintervention. The certainty of the evidence was low or very low due to
risk of bias, inconsistency, and imprecision. <br/>Conclusion(s): There is
very low certainty evidence that DAPT has little to no effect compared to
SAPT on mortality and stroke. There is low certainty evidence that DAPT
likely causes more major bleeding than SAPT.

<129>
Accession Number
646957300
Title
Reconstructed meta-analysis of percutaneous coronary intervention versus
coronary artery bypass grafting for left main disease.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1415), 2022.
Date of Publication: 01 Oct 2022.
Author
Chew N.W.S.; Ng C.H.; Kong G.; Tan D.; Lim W.H.; Kofidis T.; Yip J.; Loh
P.H.; Chan K.H.; Low A.; Lee C.H.; Yeo T.C.; Tan H.C.; Chan M.Y.
Institution
(Chew, Kofidis, Yip, Loh, Chan, Low, Lee, Yeo, Tan, Chan) National
University Heart Centre, Singapore, Singapore
(Ng, Kong, Tan, Lim) National University of Singapore, Singapore,
Singapore
Publisher
Oxford University Press
Abstract
Background: Randomized controlled trials (RCTs) comparing percutaneous
coronary intervention (PCI) with drug-eluting stents and coronary artery
bypass grafting (CABG) for patients with left main coronary artery disease
(LMCAD) have reported conflicting results. <br/>Objective(s): We performed
a systematic review from inception to 23 May 2021 and one-stage
reconstructed individual-patient data meta-analysis (IPDMA) that included
10-year mortality outcomes. <br/>Method(s): The primary outcome was
10-year all-cause mortality. Secondary outcomes included myocardial
infarction (MI), stroke and unplanned revascularization at 5 years. We did
IPDMA using published Kaplan-Meier curves to provide individual data
points in coordinates and numbers at risk were used to increase the
calibration accuracy of the reconstructed data. Shared frailty model or,
when proportionality assumptions were not met, a restricted mean survival
time model were fitted to compare outcomes between treatment groups.
<br/>Result(s): Of 583 articles retrieved, 5 RCTs were included. A total
of 4595 patients from these 5 RCTs were randomly assigned to PCI (N=2297)
or CABG (N=2298). The cumulative 10-year all-cause mortality after PCI and
CABG was 12.0% versus 10.6% respectively (HR 1.093, 95% CI: 0.925-1.292;
p=0.296). PCI conferred similar time-to-MI (RMST ratio 1.006, 95% CI:
0.992-1.021, p=0.391) and stroke (RMST ratio 1.005, 95% CI: 0.998-1.013,
p=0.133) at 5 years. Unplanned revascularization was more frequent
following PCI compared with CABG (HR 1.807, 95% CI: 1.524-2.144, p<0.001)
at 5 years. <br/>Conclusion(s): This meta-analysis using reconstructed
participant-level time-to-event data showed no statistically significant
difference in cumulative 10-year all-cause mortality between PCI versus
CABG in the treatment of LMCAD. (Figure presented).

<130>
Accession Number
646956409
Title
Midodrine in treatment of post coronary revascularization vasoplagia;
pilot, open label, assessor blinded randomized clinical trial.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 1098), 2022.
Date of Publication: 01 Oct 2022.
Author
Sheikhy A.; Ziaoddini M.; Navid H.; Ahmadi-Tafti H.; Hosseini K.
Institution
(Sheikhy, Ziaoddini, Navid, Ahmadi-Tafti, Hosseini) Tehran Heart Center,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Oxford University Press
Abstract
Purpose: Post cardiac surgery hypotension and inotrope dependence are
among major causes of prolonged intensive care unit (ICU) stay. Besides
routine managements, catecholamine inotrope-vasopressors are the
traditional treatment. However, there is an increasing interest to
catecholaminesparing agents, such as Midodrine, oral alfa1 agonist, in
patients with vasoplegia. Up to now there are no randomized study with
midodrine on post cardiac surgery patients. <br/>Material(s) and
Method(s): In this pilot, open label, assessor blind, randomized clinical
trial from June 2020 to December 2021, 65 patients with refractory (more
than 24 hours inotropes) hypotension after coronary revascularization were
included. Patients were randomly assigned to receive Midodrine add-on
therapy (10 mg stat and 5 mg po every 12 hours) or placebo addon routine
treatment. The primary outcome was liberation time from IV
inotrope-support. Secondary outcomes were ICU admission time and total
vasopressor dosage after randomization. <br/>Result(s): 32 patients
enrolled in Midodrine group, with a mean age of 60.72, and 33 patients
received placebo with mean age of 63.27. Median liberation time from
inotrope was 27 hours in Midodrine group and 49 hours in placebo group
(p=0.022). ICU admission time for Midodrine and placebo groups were 115
and 121 hours, respectively (p=0.990). Total vasopressor dosage after
randomization were similar in two studied groups, 4352 mug in Midodrine
group and 5637 mug in placebo group (p=0.405). No adverse event was
observed in Midodrine group. <br/>Conclusion(s): Midodrine add-on inotrope
therapy was a safe medication with appropriate compliance in ICU admitted
patients after cardiac surgery, which seems to decrease the inotrope
dependent time. (Figure presented).

<131>
Accession Number
646957627
Title
The prognostic significance of the echocardiographic evaluation of left
ventricular myocardial deformation indices at peak cardiopulmonary
exercise in patients with severe dilated cardiomyopathy.
Source
European Heart Journal. Conference: 43rd European Society of Cardiology
Congress, ESC 2022. Barcelona Spain. 43(Supplement 2) (pp 932), 2022. Date
of Publication: 01 Oct 2022.
Author
Triantafyllidi H.; Birmpa D.; Fambri A.; Benas D.; Ikonomidis I.;
Iliodromitis E.K.
Institution
(Triantafyllidi, Birmpa, Fambri, Benas, Ikonomidis, Iliodromitis) Attikon
University Hospital, 2nd Department of Cardiology, Athens, Greece
Publisher
Oxford University Press
Abstract
Background: Cardiopulmonary exercise testing (CPET) integrally estimates
exercise capacity (peak VO2) and cardiovascular (CV) prognosis (VE/VCO2
slope) in patients with dilated cardiomyopathy (DCM). Myocardial
deformation indices (MDI), measured by speckle tracking imaging (STI),
allow reliable measurements of left ventricular (LV) function. Little is
known about the exercise-induced changes of the multidimensional
mechanical properties of the heart and their impact in patient's survival.
We aimed to investigate the predictive role regarding 3-year survival of
LV MDI (at rest and peak exercise) as well as the main CPET parameters
(peak VO2, VE/VCO2 slope) in DCM patients with reduced ejection fraction
(EF) using as primary combined end-point the heart transplantation and all
cause death. <br/>Patients and Methods: We evaluated LV function using STI
at rest and at peak exercise during the same CPET session in 53 DCM
patients (54+/-12 years, 76% males, ejection fraction 33+/-9%).We measured
global longitudinal strain (GLS), longitudinal strain rate at systole
(LSRS) and diastole (LSRD) at baseline and at peak CPET along with CPET
parameters. After a period of 38+/-15 months, all DCM patients were
evaluated by a telephone interview. <br/>Result(s): From the whole
population, totally 7 patients (13%) reached the primary end-point (Group
A) as 2 patients were submitted to heart transplantation and 5 patients
died (60+/-13 years, 86% males, EF = 28+/-9%) while 46 patients remained
alive at 3-year follow-up (Group B, 53+/-12 years, 74% males, EF =
33+/-9%). We found that Group A patients had similar age, sex and EF but
reduced peak VO2 (p=0.04) and increased VE/VCO2 slope (p=0.004), impaired
GLS at baseline and peak exercise (p=0.02 and p=0.04, respectively) as
well as LSRS at peak exercise (p=0.05) compared to Group B patients.
<br/>Conclusion(s): The evaluation of GLS (rest and peak exercise) and
LSRS (peak exercise) as systolic indices of LV myocardial deformation adds
valuable information regarding CV prognosis in patients with severe
idiopathic DCM. A combined baseline work-up protocol consisted of MDI
evaluation at rest and exercise plus the CPET indices may characterize the
true severity of heart failure in a DCM population. (Figure presented).

<132>
Accession Number
2038186249
Title
Coronary Artery Bypass Grafting With Mitral Annuloplasty or Replacement
for Ischemic Mitral Regurgitation in Medicare Beneficiaries.
Source
Annals of Thoracic Surgery. (no pagination), 2025. Date of Publication:
2025.
Author
George T.J.; Squiers J.J.; DiMaio J.M.; Banwait J.K.; Grayburn P.A.; Mack
M.J.; Schaffer J.M.
Institution
(George, Squiers, DiMaio, Mack, Schaffer) Department Cardiothoracic
Surgery, Baylor Scott & White The Heart Hospital, Plano, Texas, United
States
(DiMaio, Banwait, Grayburn, Mack) Baylor Scott & White Research Institute,
Plano, Texas, United States
Publisher
Elsevier Inc.
Abstract
Background: Retrospective studies of patients with ischemic mitral
regurgitation (iMR) undergoing coronary artery bypass grafting (CABG) with
concomitant mitral valve surgery frequently report improved survival with
mitral valve repair/annuloplasty (MVr) over replacement (MVR). However,
the only randomized controlled trial found no survival difference.
<br/>Method(s): Medicare claims data were queried to identify
beneficiaries with iMR undergoing CABG/MVr or CABG/MVR. Kaplan-Meier
estimates of survival after CABG/MVr and CABG/MVR were generated, and
20-year restricted mean survival times (RMSTs) were compared. Then,
surgeons were stratified by their rate of CABG/MVr into groups with a
demonstrated preference for MVr (PA) or MVR (PR). Outcomes were reanalyzed
by surgeon preference. Overlap propensity score weighting was used for
risk adjustment in all analyses. <br/>Result(s): Among 10,471
beneficiaries with iMR, 6457 (61.7%) underwent CABG/MVr and 4014 (38.3%)
underwent CABG/MVR. Risk-adjusted RMSTs were 6.02 years (95% CI, 5.77-6.26
years) after CABG/MVr and 5.57 years (95% CI, 5.33-5.81 years) after
CABG/MVR (difference, 5.4 months; 95% CI, 1.2-9.4 months; P = .01). Among
1118 surgeons, 223 were PA surgeons (performed 2191 operations; 89.5% MVr
rate) and 235 were PR surgeons (performed 1930 operations; 23.0% MVr
rate). Risk-adjusted RMSTs were 5.76 years (95% CI, 5.36-6.15 years) vs
5.77 years (95% CI, 5.40-6.14 years) among beneficiaries undergoing
surgery by PA surgeons and PR surgeons, respectively (difference, 0.1
years; 95% CI, -6.6 to 6.6 months, P = .964). <br/>Conclusion(s): In
Medicare beneficiaries with iMR undergoing CABG/mitral valve surgery,
CABG/MVr was associated with improved survival, even after risk adjustment
for measured confounders. This may be due to unmeasured confounding
variables affecting the decision to perform MVr or MVR, such as valvular
pathology and/or severity of regurgitation. After endeavoring to account
for unmeasured confounders using surgeon preference as an instrumental
variable, surgeons who preferred CABG/MVr or CABG/MVR achieved similar
long-term survival for their patients.<br/>Copyright &#xa9; 2025 The
Society of Thoracic Surgeons

<133>
Accession Number
2038177480
Title
SAPIEN 3 versus Myval transcatheter heart valves for transcatheter aortic
valve implantation (COMPARE-TAVI 1): a multicentre, randomised,
non-inferiority trial.
Source
The Lancet. (no pagination), 2025. Date of Publication: 2025.
Author
Terkelsen C.J.; Freeman P.; Dahl J.S.; Thim T.; Norgaard B.L.; Mogensen
N.S.B.; Tang M.; Eftekhari A.; Povlsen J.A.; Poulsen S.H.; Pedersen L.;
Hjort J.; Ellert J.; Christiansen E.H.; Sorensen H.T.; Nissen H.
Institution
(Terkelsen, Thim, Norgaard, Povlsen, Poulsen, Christiansen) Department of
Cardiology, Aarhus University Hospital, Aarhus, Denmark
(Hjort) Department of Clinical Medicine, Aarhus University Hospital,
Aarhus, Denmark
(Tang) Department of Cardiothoracic and Vascular Surgery, Aarhus
University Hospital, Aarhus, Denmark
(Freeman, Eftekhari) Department of Cardiology, Aalborg University
Hospital, Aalborg, Denmark
(Dahl, Mogensen, Ellert, Nissen) Department of Cardiology, Odense
University Hospital, Odense, Denmark
(Pedersen, Sorensen) Department of Clinical Epidemiology, Aarhus
University Hospital and Aarhus University, Aarhus, Denmark
Publisher
Elsevier B.V.
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a
guideline-directed treatment for severe aortic stenosis and degenerated
aortic bioprostheses. When new transcatheter heart valve (THV) platforms
for TAVI are launched, they should be compared with best-in-practice
contemporary THVs for their short-term and long-term performance. The
COMPARE-TAVI 1 trial was designed to provide a head-to-head comparison of
the SAPIEN 3 or SAPIEN 3 Ultra THVs and the Myval or Myval Octacor THVs.
<br/>Method(s): This multicentre, all-comers, randomised, non-inferiority
trial was done at three university hospitals in Denmark. Eligible patients
were aged 18 years or older, scheduled for transfemoral TAVI, and eligible
for treatment with SAPIEN 3 THVs or Myval THVs. Patients were randomly
assigned (1:1) to treatment with SAPIEN 3 (29 mm diameter) or SAPIEN 3
Ultra (20 mm, 23 mm, or 26 mm diameter) THVs or Myval or Myval Octacor
THVs (20-32 mm diameter). The TAVI procedure was performed according to
local practice and under local anaesthesia unless leaflet laceration was
performed. The primary endpoint was a composite of death, stroke, moderate
or severe aortic regurgitation, or moderate or severe haemodynamic THV
deterioration at 1 year according to Third Valve Academic Research
Consortium criteria. All patients assigned to THV treatment were included
in the intention-to-treat analysis, and all patients who were treated as
randomly assigned were included in the per-protocol analysis. With an
expected event rate of 13%, the prespecified non-inferiority margin was
5.3%. This trial is registered with ClinicalTrials.gov, NCT04443023, and
is closed to accrual. <br/>Finding(s): Between June 15, 2020, and Nov 3,
2023, 1031 patients were enrolled. Enrolment was paused twice because of
patent-related legal proceedings. Of 1031 patients, 517 patients were
randomly assigned to SAPIEN 3 THVs and 514 to Myval THVs. The median
patient age was 81.6 years (IQR 77.6-85.0), and 415 (40%) of 1031 patients
were female and 616 (60%) were male. The primary endpoint occurred in 67
(13%) of 517 patients randomly assigned to SAPIEN 3 THVs versus 71 (14%)
of 514 patients randomly assigned to Myval THVs (risk difference -0.9%
[one-sided upper 95% CI 4.4%]; p<inf>non-inferiority</inf>=0.019).
<br/>Interpretation(s): Myval THVs were non-inferior to SAPIEN 3 THVs in
terms of a 1-year composite endpoint of death, stroke, moderate or severe
aortic regurgitation, or moderate or severe haemodynamic THV
deterioration. <br/>Funding(s): Meril Life Sciences, Vingmed Denmark, the
Danish Heart Foundation, and the Central Denmark Region.<br/>Copyright
&#xa9; 2025 Elsevier Ltd

<134>
Accession Number
2038148992
Title
Autotransfusion in obstetrics: a narrative review.
Source
Annals of Blood. 10 (no pagination), 2025. Article Number: 3. Date of
Publication: 30 Mar 2025.
Author
Pfalzgraf H.; Chamby A.; Gilchrist K.; Sheth S.; Waters J.; Phillips J.
Institution
(Pfalzgraf, Chamby, Gilchrist, Sheth, Waters, Phillips) Department of
Obstetrics and Gynecology, George Washington University Hospital,
Washington, DC, United States
Publisher
AME Publishing Company
Abstract
Background and Objective: Autotransfusion is the collection and
re-infusion of a patient's own blood. The technology has now been
available for many decades and is used frequently in surgical procedures
with anticipated large volume blood loss, such as cardiothoracic and
trauma surgery cases. Due to concern for blood contamination, as well as
lack of provider comfort and access to the technology, autotransfusion is
underutilized in obstetrics, despite postpartum hemorrhage (PPH) being a
leading cause of maternal mortality. The objective of this narrative
review is to contextualize the use of cell salvage in obstetrics and
highlight opportunities for further clinical research. <br/>Method(s):
Peer reviewed literature with key words obstetrics, autotransfusion, cell
salvage, PPH published in English in PubMed and Google Scholar from
1987-2024 was reviewed. Key Content and Findings: This review synthesizes
current practices and protocols in obstetrics, examines available
literature surrounding safety and efficacy, and outlines other
considerations for autotransfusion use in obstetrics where it has been
historically underutilized. <br/>Conclusion(s): Our literature review of
existing data suggests that, when appropriately processed, autotransfusion
is a feasible, safe, and efficacious alternative to allogeneic blood
transfusion for patients at high risk for excessive blood loss during
childbirth. We highlight opportunities for future research and emphasize
the critical need for practice standardization to improve widespread
use.<br/>Copyright &#xa9; AME Publishing Company.

<135>
Accession Number
646951123
Title
Rationale and Design of the CREATE Trial: A Multicenter, Randomized
Comparison of Continuation or Cessation of Single Antithrombotic Therapy
at 1Year After Transcatheter Aortic Valve Replacement.
Source
Journal of the American Heart Association. (pp e039350), 2025. Date of
Publication: 21 Mar 2025.
Author
Liu R.; Li Y.; Zhang L.; Lu Z.; Fu Z.; Modine T.; Jilahawi H.; Pocock S.;
Wu Y.; Song G.
Institution
(Liu, Li, Lu, Fu, Song) Interventional Center of Valvular Heart Disease
Beijing Anzhen Hospital, Capital Medical University Beijing China, China
(Zhang, Wu) Cardiovascular Disease Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking
Union Medical College Beijing China, China
(Modine) Department of Cardiology and Cardio-Vascular Surgery Hopital
Cardiologique de Haut-Leveque, Bordeaux University Hospital Bordeaux
France, France
(Jilahawi) Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles
CA USA
(Pocock) London School of Hygiene and Tropical Medicine London United
Kingdom, United Kingdom
Abstract
BACKGROUND: Current guidelines and expert consensus recommend lifelong
single antiplatelet therapy for patients undergoing transcatheter aortic
valve replacement who have no indication for anticoagulation or dual
antiplatelet therapy. However, there is no direct evidence from randomized
controlled trials supporting this practice. Furthermore, the optimal
duration of antiplatelet therapy in this population has not been
adequately investigated. METHODS AND RESULTS: CREATE (A Multicenter
Randomized Controlled Study to Evaluate Cessation of Antithrombotic
Therapy at 1 Year in TAVR Patients-The CREATE Study) is a prospective,
multicenter, open-label, randomized controlled trial for patients who have
undergone successful transcatheter aortic valve replacement and have no
indication for long-term oral anticoagulation or antiplatelet therapy.
Eligible patients are free from major bleeding and ischemic events for 1
year postprocedure before being randomized 1:1 to single antiplatelet
therapy (control group) or no antiplatelet therapy (experimental group).
The primary efficacy end point is the incidence of bleeding events,
defined by the VARC-3 (Valve Academic Research Consortium-3) criteria, at
1-year postrandomization. The primary safety end point is a composite of
cardiac death, myocardial infarction, and ischemic stroke at 1 year. The
trial is powered for both superiority in efficiency and noninferiority in
safety. Accordingly, a total of 3380 patients will be enrolled.
<br/>CONCLUSION(S): The CREATE trial aims to assess if stopping
antiplatelet therapy at 1-year after transcatheter aortic valve
replacement reduces bleeding risk without increasing ischemic events in
patients not requiring chronic antithrombotic therapy. REGISTRATION: URL:
https://www.chictr.org.cn; Unique identifier: ChiCTR2400087454.

<136>
Accession Number
2038192560
Title
Inhaled vs. intravenous vasodilators in perioperative pulmonary
hypertension during chest surgery using cardiopulmonary bypass: A
systematic review and meta-analysis.
Source
Pulmonary Pharmacology and Therapeutics. 89 (no pagination), 2025. Article
Number: 102357. Date of Publication: 01 Jun 2025.
Author
Ogura Y.; Imai E.; Taito S.; Tsuji T.; Kamimura Y.; Tsuge T.; Amano K.
Institution
(Ogura, Imai, Taito, Tsuji, Kamimura, Tsuge) Scientific Research WorkS
Peer Support Group (SRWS-PSG), Osaka, Japan
(Ogura, Amano) Department of Education and Training, Mitsui Memorial
Hospital, Kanda-Izumi-cho-1, Chiyoda-ku, Tokyo, Japan
(Imai) Division of Anesthesia, Mitsui Memorial Hospital,
Kanda-Izumi-cho-1, Chiyoda-ku, Tokyo, Japan
(Taito) Division of Rehabilitation, Department of Clinical Practice and
Support, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku,
Hiroshima, Japan
(Tsuji) Department of Anesthesiology, Okazaki City Hospital, 1-3 Goshoai,
Kouryuji-cho, Aichi, Okazaki, Japan
(Tsuji, Kamimura) Department of Anesthesiology and Intensive Care
Medicine, Nagoya City University Graduate School of Medical Sciences, 1
Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
(Tsuge) Department of Rehabilitation, Kurashiki Medical Center, 250
Bakuro, Okayama, Kurashiki, Japan
(Tsuge) Department of Epidemiology, of Medicine, Dentistry and
Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Okayama,
Japan
Publisher
Academic Press

<137>
Accession Number
2038142307
Title
How safe is it to discharge home patients with a chest tube in place? A
narrative review of the literature.
Source
European Journal of Cardio-thoracic Surgery. 67 (pp i41-i46), 2025. Date
of Publication: 01 Mar 2025.
Author
Minervini F.; Bertoglio P.; Brunelli A.; Shargall Y.
Institution
(Minervini) Division of Thoracic Surgery, Cantonal Hospital of Lucerne,
Lucerne, Switzerland
(Bertoglio) Division of Thoracic Surgery, IRCSS Azienda
Ospedaliero-Universitaria, Bologna, Italy
(Brunelli) Department of Thoracic Surgery, St James's University Hospital,
Leeds, United Kingdom
(Shargall) Division of Thoracic Surgery, Department of Surgery, Faculty of
Health Sciences, McMaster University, St Joseph's Healthcare Hamilton,
Hamilton, Canada
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: In a time of particular focus on healthcare costs and quality
metrics, combined with widespread embracing of the Early Recovery After
Surgery approach, an outpatient setting for the management of prolonged
air leak or excessive fluid drainage appears to be an acceptable option.
The aim of this review is to evaluate the safety, efficacy and financial
benefit of discharging home patients with chest tube after lung surgery or
following chest drain insertion due to a pneumothorax. <br/>METHOD(S): We
reviewed the current literature analysing all available full-text papers
published in English (PubMed, Cochrane and EMBASE databases). Data were
reported as descriptive narrative. <br/>RESULT(S): Our findings show that
discharging home patients with chest tube in situ has not only a positive
impact on length of stay but it also seems to be cost-effective. In our
literature review, contrasting results have emerged regarding readmission
rates and development of complications, especially empyema.
<br/>CONCLUSION(S): Thus, outpatients management of patients discharged
with a chest drain is feasible and cost-effective. A standardization of
follow-up with dedicated ambulatory setting might improve patients' safety
and increase this practice amongst thoracic surgery
institutions.<br/>Copyright &#xa9; The Author(s) 2025. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<138>
Accession Number
2038142371
Title
Posterior left pericardiotomy: what is the advantage in cardiac surgery?.
Source
European Journal of Cardio-thoracic Surgery. 67 (pp i18-i26), 2025. Date
of Publication: 01 Mar 2025.
Author
Di Franco A.; Sandner S.; Soletti G.J.; Mack C.A.; Redfors B.; Gaudino M.
Institution
(Di Franco, Soletti, Mack, Gaudino) Department of Cardiothoracic Surgery,
Weill Cornell Medicine, New York, NY, United States
(Sandner) Department of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
(Redfors) Department of Molecular and Clinical Medicine, Institute of
Medicine, Gothenburg University, Gothenburg, Sweden
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Redfors) Department of Population Health Sciences, Weill Cornell
Medicine, New York, NY, United States
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Postoperative atrial fibrillation (POAF) is the most common
complication following cardiac surgery and is associated with prolonged
in-hospital stay and increased costs, morbidity (including stroke and
heart failure) and mortality. Posterior pericardiotomy (PP) is a surgical
intervention aimed at draining the pericardium into the left pleural
cavity to reduce POAF occurrence. This review summarizes the current
evidence on the use of PP and highlights future perspectives for clinical
research. <br/>METHOD(S): The present work is a narrative review, a
systematic literature search was therefore not performed. After collegial
discussion, the most relevant papers as per the authors' opinion were
selected and formed the basis of the present review. <br/>RESULT(S):
Several studies support the hypothesis that PP decreases the incidence of
POAF, pericardial effusion and cardiac tamponade after cardiac surgery.
Although an increased incidence of pleural effusion has been reported
after PP, this finding does not translate into increased pulmonary
complications. Whether the systematic use of PP during cardiac surgery
improves long-term outcomes is unclear. <br/>CONCLUSION(S): PP is a simple
and safe technique that holds the potential to positively impact cardiac
surgical patients' postoperative course. The results of upcoming,
multicentre trials will help shed definitive light on this
topic.<br/>Copyright &#xa9; The Author(s) 2025. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<139>
Accession Number
646951710
Title
Letter: The effect of virtual reality on postoperative anxiety and pain in
patients following cardiac surgery: a randomized controlled trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2025.
Date of Publication: 21 Mar 2025.
Author
Xie H.; Gao F.; Zheng X.
Institution
(Xie, Gao, Zheng) Department of Anesthesiology, Fuzhou University
Affiliated Provincial Hospital, Fuzhou, China
(Xie, Gao, Zheng) Department of Anesthesiology, Shengli Clinical Medical
College of Fujian Medical University, Fuzhou, China

<140>
Accession Number
2038162948
Title
Impact of pre-procedural red cell distribution width on one-year all-cause
mortality following transcatheter aortic valve replacement: A systematic
review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2025. Date of
Publication: 2025.
Author
Pingili A.; Kodali L.S.M.; Vadiyala M.R.; Koskina L.; Patel B.A.; Sanku
K.; Desai R.; Kondapaneni M.
Institution
(Pingili) Department of Internal Medicine, MedStar Health, Baltimore, MD,
United States
(Kodali) Department of Public Health & Health Sciences, University of
Michigan - Flint, Flint, MI, United States
(Vadiyala) Department of Internal Medicine, Maimonides Medical Center,
Brooklyn, NY, United States
(Koskina) Department of Internal Medicine, MedStar Health Union Memorial
Hospital, Baltimore, MD, United States
(Patel) Department of Internal Medicine, Trinity Health Oakland Hospital,
Pontiac, MI, United States
(Sanku) Department of Cardiology, Mount Sinai Medical Center, Miami Beach,
FL, United States
(Desai) Independent Outcomes Researcher, Atlanta, GA, United States
(Kondapaneni) Department of Heart & Vascular Center, MetroHealth,
Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Background: Red cell distribution width (RDW) has emerged as a novel
biomarker associated with adverse outcomes in patients with cardiovascular
disease (CVD). We aimed to determine the prognostic significance of
pre-procedural RDW levels on one-year all-cause mortality (ACM) following
transcatheter aortic valve replacement (TAVR) by conducting a systematic
review and meta-analysis due to limited evidence on the impact of RDW
levels in TAVR patients. <br/>Method(s): We systematically reviewed
articles on pre-procedural RDW and one-year ACM post-TAVR until February
2024 using PubMed and Google Scholar. Binary random effects model was used
for pooled adjusted odds ratio (aOR), with 95 % confidence intervals (CI)
and I2 statistics for heterogeneity. <br/>Result(s): A total of 7 studies
with 3273 patients aged between 70-90 years and 45 % males were analyzed.
High pre-procedural RDW was an independent predictor of one-year ACM (aOR
1.60, 95%CI 1.13-2.27, p < 0.01). This association is even more prominent
when aged > 80 years vs. <80 years (aOR 1.64, 95 % CI 1.17-2.31, p < 0.01
vs. aOR 1.46, 95 % CI 0.49-4.32, p < 0.01). Leave-one-out sensitivity
analysis validated the robustness of our meta-analysis.
<br/>Conclusion(s): Our study indicated that elevated baseline RDW is an
independent predictor of one-year ACM post-TAVR. Further studies are
needed to validate the importance of RDW as a marker of post-TAVR
outcomes.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<141>
Accession Number
646951636
Title
Cerebral Embolic Protection Devices in Transcatheter Aortic Valve
Implantation: Meta-Analysis With Trial Sequential Analysis.
Source
Journal of the American Heart Association. (pp e038869), 2025. Date of
Publication: 21 Mar 2025.
Author
Warraich N.; Sa M.P.; Jacquemyn X.; Kuno T.; Serna-Gallegos D.; Sultan I.
Institution
(Warraich, Serna-Gallegos, Sultan) Division of Cardiac Surgery, Department
of Cardiothoracic Surgery University of Pittsburgh Pittsburgh PA USA
(Warraich, Serna-Gallegos, Sultan) UPMC Heart and Vascular Institute,
University of Pittsburgh Medical Center Pittsburgh PA USA
(Sa) Division of Cardiac Surgery Massachusetts General Hospital, Harvard
Medical School Boston MA USA
(Jacquemyn) KU Leuven Leuven Belgium
(Kuno) Division of Cardiology, Massachusetts General Hospital Harvard
Medical School Boston MA USA
Abstract
BACKGROUND: We aimed to reevaluate randomized controlled trial data on
outcomes of cerebral embolic protection device use during transcatheter
aortic valve implantation. A conventional meta-analysis followed by trial
sequential analysis was conducted to evaluate the strength of the current
evidence. METHODS AND RESULTS: Databases were searched for randomized
controlled trials. Primary outcomes included all stroke, disabling stroke,
and all-cause mortality. Conventional study-level meta-analysis was
performed using random-effects modeling. Trial sequential analysis was
conducted to generate adjusted significance boundaries, futility
boundaries, and the required information size considering a type I error
of 5% and a power of 90%. Seven trials were included with a total of 4031
patients, of whom 2171 were treated with a device and 1860 were not.
Conventional meta-analysis showed no significant difference in all stroke
(relative risk [RR], 0.85 [95% CI, 0.61-1.18]; P=0.339) and disabling
stroke (RR, 0.59 [95% CI, 0.30-1.13]; P=0.113) with device use. The trial
sequential analysis determined an absence of evidence for all stroke
(required information size of 71 650 [5.6%]) and disabling stroke
(required information size of 337 256 [1.2%]). Conventional meta-analysis
determined no significant difference in all-cause mortality (RR, 1.03 [95%
CI, 0.49-2.17]; P=0.928) with device use. The trial sequential analysis
determined that the futility boundary was reached (required information
size of 5772 [69.3%]). <br/>CONCLUSION(S): There are insufficient
randomized controlled trial data on cerebral embolic protection device use
to provide conclusive meta-analytic findings for stroke outcomes.

<142>
Accession Number
2038142379
Title
How soon should we remove a chest drain following anatomic lung
resection?.
Source
European Journal of Cardio-thoracic Surgery. 67 (pp i27-i30), 2025. Date
of Publication: 01 Mar 2025.
Author
Abdul Khader A.; Lim E.
Institution
(Abdul Khader, Lim) Department of Thoracic Surgery, Royal Brompton and
Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust,
London, United Kingdom
(Lim) Academic Division of Thoracic Surgery, Imperial College, The Royal
Brompton Hospital, London, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Chest drain duration has a key influence on recovery
post-thoracic surgery. There is no universally accepted protocol
determining the timing of chest drain removal. We aim to review and
discuss the factors that determine how soon chest drains can be removed
following anatomic lung resection. <br/>METHOD(S): Fluid output and air
leak are the main determinants of chest drain removal. We reviewed the
literature to determine which cut offs have been proposed and the use of
protocol for decision-making in chest drain removal. <br/>RESULT(S): Use
of air leak alone as the determinant for chest drain removal optimizes
chest drain management, and studies that have utilized this protocol can
achieve drain removal on the 1st postoperative day in most cases. Moving
forward, surgery without routine chest drains can help move towards day
case thoracic surgery, even for anatomic lung resection.
<br/>CONCLUSION(S): Utilizing digital drainage with a strict air leak
protocol helps to minimize drain duration post lung resection. The future
landscape of chest drain management should focus on the usage of chest
drains on an as required basis for air leak, even for anatomic lung
resection.<br/>Copyright &#xa9; The Author(s) 2025. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<143>
Accession Number
2038206545
Title
Ten-year clinical outcomes after left main coronary artery stenting with
new-generation or early-generation DES.
Source
Revista Espanola de Cardiologia. (no pagination), 2025. Date of
Publication: 2025.
Author
Wiebe J.; Kuna C.; Ibrahim T.; Kufner S.; Hintz I.; Justenhoven P.;
Kessler T.; Schunkert H.; Valgimigli M.; Richardt G.; Bresha J.; Laugwitz
K.-L.; Kastrati A.; Cassese S.
Institution
(Wiebe, Kuna, Kufner, Hintz, Justenhoven, Kessler, Schunkert, Kastrati,
Cassese) Department of Cardiology, Deutsches Herzzentrum Munchen,
Technische Universitat, Munich, Germany
(Wiebe, Kessler, Schunkert, Laugwitz, Kastrati) DZHK (German Centre for
Cardiovascular Research), Partner Site Munich Heart Alliance, Munich,
Germany
(Ibrahim, Bresha, Laugwitz) 1. med. Klinik, Klinikum rechts der Isar,
Technische Universitat, Munich, Germany
(Valgimigli) Division of Cardiology, Cardiocentro Ticino Institute, Ente
Ospedaliero Cantonale, Lugano, Switzerland
(Richardt) Department of Cardiology, Klinik Bad Oldesloe, Bad Oldesloe,
Germany
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction and objectives: Long-term data after stenting of the left
main coronary artery (LMCA) are scarce, especially regarding
new-generation drug-eluting stents (DES). This analysis aimed to describe
the 10-year clinical outcomes of patients who underwent percutaneous
coronary intervention with different DES generations for LMCA disease.
<br/>Method(s): Individual patient data from the randomized controlled
ISAR-LEFT MAIN and ISAR-LEFT MAIN 2 trials were pooled and 10-year
clinical follow-up was obtained. The Kaplan-Meier method was used to
calculate event rates. The main endpoints of interest for this analysis
were all-cause mortality, myocardial infarction, target lesion
revascularization and definite stent thrombosis. <br/>Result(s): A total
of 1257 patients were included in this analysis, of which 650 patients
were treated with new-generation DES and 607 with early-generation DES. At
10 years, the mortality rate was more than 40% in both groups. After
statistical adjustment, 10-year mortality was significantly reduced in
patients treated with new-generation DES compared with those treated with
early-generation DES (HR<inf>adj</inf>, 0.78; 95%CI, 0.62-0.97). After 10
years, the risk of myocardial infarction (HR<inf>adj</inf>, 0.43; 95%CI,
0.23-0.80), target lesion revascularization (HR<inf>adj</inf>, 0.66;
95%CI, 0.49-0.89), and definite stent thrombosis (HR<inf>adj</inf>, 0.13,
95%CI, 0.04-0.49) was significantly reduced by new-generation DES compared
with early-generation DES. <br/>Conclusion(s): Patients undergoing
percutaneous coronary intervention for LMCA disease have high 10-year
mortality regardless of DES generation. The use of new-generation DES in
patients with LMCA disease is associated with improved long-term clinical
outcomes compared with early-generation DES.<br/>Copyright &#xa9; 2025
Sociedad Espanola de Cardiologia

<144>
Accession Number
2038142380
Title
Retained blood syndrome after cardiac surgery.
Source
European Journal of Cardio-thoracic Surgery. 67 (pp i3-i8), 2025. Date of
Publication: 01 Mar 2025.
Author
Niemann B.; Grieshaber P.
Institution
(Niemann) Department of Adult and Pediatric Cardiovascular Surgery,
Giessen University Hospital, Giessen, Germany
(Grieshaber) Division of Congenital Cardiac Surgery, Department of Cardiac
Surgery, Heidelberg University Hospital, Heidelberg, Germany
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Retained blood syndrome (RBS) is defined as the postoperative
retention of blood within the thoracic cavity. In addition to the
mechanical impacts on cardiac and pulmonary function, RBS triggers
inflammatory processes. It is associated with increased morbidity
following cardiac surgery. The goal of this non-systematic review was to
summarize the current understanding of the pathophysiology, consequences
and both prophylactic and therapeutic measures related to RBS.
<br/>METHOD(S): The subjects to be covered were defined in advance. A
literature search was conducted in PubMed and Google Scholar using
relevant search terms and MeSH terms. <br/>CONCLUSION(S): RBS is a
significant complication following cardiac surgical procedures. It is
associated with a poorer prognosis due to mechanical suppression of
haemodynamics and the amplification of inflammatory processes. Therefore,
preventing pericardial and pleural effusions should be a priority in
cardiac surgical care. If RBS occurs, aggressive anti-inflammatory therapy
should be initiated to prevent the development of long-term
complications.<br/>Copyright &#xa9; The Author(s) 2025. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.

<145>
Accession Number
2038152877
Title
Prophylactic use of intravascular balloon occlusion in elective general
non-cardiac surgery. Systematic review and meta-analysis of the
literature.
Source
Cardiovascular and Metabolic Science. 36(1) (pp 35-50), 2025. Date of
Publication: 01 Jan 2025.
Author
Caicedo-Moncada B.L.; Beltran-Torres F.A.; Mendez-Ordonez E.M.
Institution
(Caicedo-Moncada, Beltran-Torres) Division of Postgraduate and advanced
training, Faculty of Medicine, El Bosque University, Bogota, Colombia
Publisher
Asociacion Nacional de Cardiologos de Mexico
Abstract
Introduction: the use of endovascular occlusion balloon in elective
non-cardiac surgery has emerged as an effective strategy to prevent
intraoperative bleeding, a significant complication that can impact both
surgical outcomes and patient recovery. This device, which selectively
occludes large blood vessels, allows for precise control of blood flow,
thereby minimizing the risk of hemorrhage and improving visibility in
critical surgical areas. <br/>Material(s) and Method(s): a search was
performed across three major databases (PubMed, Ovid, and Embase), in
addition to Google Scholar as a source of gray literature and the National
Institute of Health (NIH) as a national database, covering the period from
2014 to 2024. <br/>Result(s): this systematic review included 17 articles;
two showed a moderate risk of bias, while the others demonstrated good
quality and low risk of bias. A total of 3,379 patients were analyzed,
95.3% women. The primary indication for the use of endovascular occlusion
balloons was surgical procedures related to abnormal placentation in 67.5%
of cases, with an average blood loss of 1,256 mL (SD: 699.9). The
application of the balloon resulted in a significant reduction in blood
loss of 856 mL (OR -3.43; 95% CI -6.22 to -0.63), with no significant
differences observed in age, gender, or surgical duration.
<br/>Conclusion(s): the use of intravascular balloon occlusion in elective
non-cardiac general surgical procedures with a high risk of hemorrhage
demonstrates effectiveness in reducing intraoperative blood loss. The most
frequently observed complications include transient arterial thrombosis
and localized issues at the puncture site. While various clinical
scenarios for its application have been described, the strongest evidence
supports its use in obstetric procedures, particularly those related to
abnormal placentation.<br/>Copyright &#xa9; 2025 Asociacion Nacional de
Cardiologos de Mexico. All rights reserved.

<146>
Accession Number
2038161427
Title
Risk, rate or rhythm control for new onset supraventricular arrhythmia
during septic shock: Protocol for the CAFS multicentre, parallel-group,
open-label trial.
Source
BMJ Open. 15(4) (no pagination), 2025. Article Number: e090404. Date of
Publication: 01 Apr 2025.
Author
Labbe V.; Desnos C.; Preau S.; Doyen D.; Contou D.; Bagate F.; Souweine
B.; Pey V.; Bertrand P.-M.; Muller G.; Boissier F.; Asfar P.; Bonnet N.;
Joffre J.; Sy O.; Dres M.; Annoni F.; Monnet X.; Carreira S.; Vivier E.;
Serck N.; Wiart A.; Voicu S.; Heming N.; Le Breton C.; Chevrel G.;
Chemouni F.; Piagnerelli M.; Haentjens L.; Fartoukh M.; Taccone F.; Durand
D.; Monthieux G.; Berard L.; Rousseau A.; Mekontso Dessap A.
Institution
(Labbe, Annoni, Taccone, Durand) Department of Intensive Care, Universite
Libre de Bruxelles, Hopital Universitaire de Bruxelles, Brussels,
Anderlecht, Belgium
(Labbe, Bagate, Monnet, Fartoukh, Mekontso Dessap) Institut Mondor de
Recherche Biomedicale, Groupe de Recherche Clinique CARMAS, Cardiovascular
and Respiratory Manifestations of Acute Lung Injury and Sepsis, Universite
Paris-Est Creteil Val de Marne, Ile-de-France, Creteil, France
(Desnos, Fartoukh) Service de Medecine Intensive Reanimation, Centre
Hospitalier Universitaire Tenon, Sorbonne Universite, Assistance Publique
- Hopitaux de Paris, Ile-de-France, Paris, France
(Preau) Service de Medecine Intensive Reanimation, Centre Hospitalier
Universitaire Lille, Hauts-de-France, Lille, France
(Preau) Unite 1167, Institut Pasteur de Lille, Institut National de la
Sante et de la Recherche Medicale, Lille University, Lille, France
(Doyen) Medecine Intensive Reanimation, Centre Hospitalier Universitaire
Nice, Provence-Alpes-Cote-d'Azur, Nice, France
(Doyen) Laboratoire de PhysioMedecine Moleculaire LP2M, CNRS-UNS, UMR
7370, Equipe Pathophysiologie du Transport Ionique, Universite Cote
d'Azur, Provence-Alpes-Cote d'Azur, Nice, France
(Contou) Service de Reanimation Polyvalente, Centre Hospitalier Victor
Dupouy, Argenteuil, France
(Bagate, Mekontso Dessap) Service de Medecine Intensive Reanimation,
Hopitaux Universitaires Henri Mondor, Universite Paris Est Creteil,
Assistance Publique - Hopitaux de Paris, Ile-de-France, Creteil, France
(Souweine) Service de Medecine Intensive Reanimation, Centre Hospitalier
Universitaire Clermont-Ferrand, Clermont-Ferrand, France
(Pey) Service de Reanimation Polyvalente Rangueil, Hopital de Rangueil,
Occitanie, Toulouse, France
(Bertrand) Intensive Care Unit, Centre Hospitalier de Cannes, Cannes,
France
(Muller) Medecine Intensive Reanimation, Centre Hospitalier Universitaire
Orleans, Centre-Val de Loire, Orleans, France
(Muller) MR INSERM, 1327 ISCHEMIA, Universite de Tours, Centre-Val de
Loire, Tours, France
(Muller) Clin. Research in Intensive Care and Sepsis-Trial Group for
Global Evaluation and Research in Sepsis, French Clinical Research
Infrastructure Network (F-CRIN) Research Network, Orleans, France
(Boissier) Medical Intensive Care Unit, Centre Hospitalier Universitaire
de Poitiers, Nouvelle-Acquitaine, Poitiers, France
(Boissier) Centre d'Investigation Clinique 1402, Investigations of Sleep
Acute Lung Injury, & Ventilation Group, Institut National de la Sante et
de la Recherche Medicale, Universite de Poitiers, Nouvelle-Aquitaine,
Poitiers, France
(Asfar) Departement de Medecine Intensive-Reanimation, Centre Hospitalier
Universitaire Angers, Pays de la Loire, Angers, France
(Bonnet) Service de Reanimation Medico-Chirurgicale, Centre Hospitalier
Universitaire Avicenne, Universite Sorbonne Paris Nord, Assistance
Publique - Hopitaux de Paris, Ile-de-France, Bobigny, France
(Joffre) Service de Medecine Intensive Reanimation, Centre Hospitalier
Universitaire Saint Antoine, Sorbonne Universite, Assistance Publique -
Hopitaux de Paris, Ile-de-France, Paris, France
(Sy) Service de Medecine Intensive Reanimation, Centre Hospitalier Melun,
Melun, France
(Dres) Service de Medecine Intensive Reanimation, Centre Hospitalier
Universitaire Pitie-Salpetriere, Sorbonne Universite, Assistance Publique
- Hopitaux de Paris, Paris, France
(Monnet) Service de Medecine Intensive Reanimation, Hopital de Bicetre,
DMU 4 CORREVE, Assistance Publique - Hopitaux de Paris, Ile-de-France, Le
Kremlin-Bicetre, France
(Monnet) Inserm UMR S_999, FHU SEPSIS, Universite Paris-Saclay,
Ile-de-France, Gif-sur-Yvette, France
(Carreira) Service d'Anesthesie-Reanimation Polyvalente, Hopital Saint
Camille, Bry-sur-Marne, France
(Vivier) Service de Reanimation Polyvalente, Centre Hospitalier Saint
Joseph Saint Luc, Auvergne-Rhone-Alpes, Lyon, France
(Serck) Service des Soins Intensifs, Clinique Saint-Pierre Ottignies,
Ottignies, Belgium
(Wiart) Service des Soins Intensifs, Centre Hospitalier de Wallonie
Picarde (CHwapi), Tournai, Belgium
(Voicu) Service de Reanimation Medicale et Toxicologique, Centre
Hospitalier Universitaire Lariboisiere, Universite Paris Cite, Assistance
Publique - Hopitaux de Paris, Ile-de-France, Paris, France
(Heming) Service de Medecine Intensive Reanimation, Centre Hospitalier
Universitaire Raymond Poincare, Universite Versailles Saint
Quentin-Universite Paris Saclay, Assistance Publique - Hopitaux de Paris,
Ile-de-France, Garches, France
(Heming) Laboratoire d'Infection et Inflammation, Unite 1173, Faculte de
Medecine Simone Veil, Institut National de la Sante et de la Recherche
Medicale, Universite Versaillles Saint Quentin, University Paris Saclay,
Ile-de-France, Garches, France
(Le Breton) Service de Medecine Intensive Reanimation, Centre Hospitalier
Universitaire Louis Mourier, DMU ESPRIT, Universite Paris Cite, Assistance
Publique - Hopitaux de Paris, Ile-de-France, Colombes, France
(Chevrel) Service de Reanimation, Centre Hospitalier Sud Francilien,
Ile-de-France, Corbeil-Essonnes, France
(Chemouni) Service de Medecine Intensive Reanimation, Centre Hospitalier
Marne-La-Vallee, Ile-de-France, Jossigny, France
(Piagnerelli) Service des Soins Intensifs, Centre Hospitalier
Universitaire Charleroi, Wallonie, Charleroi, Belgium
(Haentjens) Service des Soins Intensifs, Centre Hospitalier Universitaire
Ambroise Pare, Wallonie, Mons, Belgium
(Monthieux, Berard, Rousseau) Department of Clinical Pharmacology and
Clinical Research Platform Paris-East (URCEST CRC-CRB), Centre Hospitaleir
Universitaire Saint-Antoine, Assistance Publique - Hopitaux de Paris,
Ile-de-France, Paris, France
(Mekontso Dessap) Institut Mondor de Recherche Biomedicale, Institut
National de la Sante et de la Recherche Medicale, Universite Paris-Est
Creteil Val de Marne, Ile-de-France, Creteil, France
Publisher
BMJ Publishing Group
Abstract
Introduction New-onset supraventricular arrhythmia (NOSVA) is the most
common arrhythmia in patients with septic shock and is associated with
haemodynamic alterations and increased mortality rates. With no data
available from randomised trials, clinical practice for patient management
varies widely. In this setting, rate control or rhythm control could be
beneficial in limiting the duration of shock and preventing evolution to
multiorgan dysfunction. Methods and analysis The Control Atrial
Fibrillation in Septic shock (CAFS) study is a binational (French and
Belgium), multicentre, parallel-group, open-label, randomised controlled
superiority trial to compare the efficacy and safety of three management
strategies in patients with NOSVA during septic shock. The expected
duration of patient enrolment is 42 months, starting from November 2021.
Patients will be randomised to receive either risk control (magnesium and
control of risk factors for NOSVA), rate control (risk control and low
dose of amiodarone) or rhythm control (risk control and cardioversion
using high dose of amiodarone with external electrical shock if NOSVA
persists) for 7 days. Patients with a history of SVA, NOSVA lasting more
than 48 hours, recent cardiac surgery or a contraindication to amiodarone
will not be included. We plan to recruit 240 patients. Patients will be
randomised on a 1:1:1 basis and stratified by centre. The primary endpoint
is a hierarchical criterion at day 28 including all-cause mortality and
the duration of septic shock defined as time from randomisation to
successful weaning of vasopressors. Secondary outcomes include: individual
components of the primary endpoint; arterial lactate clearance at day 3;
efficacy at controlling cardiac rhythm at day 7; proportion of patients
free from organ dysfunction at day 7; ventricular arrhythmia, conduction
disorders, thrombotic events, major bleeding events and acute hepatitis
related to amiodarone at day 28; intensive care unit and hospital lengths
of stay at day 28. Ethics and dissemination The study has been approved by
the French (Comite Sud-Ouest et Outre-Mer II, France, registration number
2019-A02624-53) and Belgian (Comite ethique de l'hopital Erasme, Belgium,
registration number CCB B4062023000179) ethics committees. Patients will
be included after obtaining signed informed consent. The results will be
submitted for publication in peer-reviewed journals. Trial registration
number NCT04844801.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights
and permissions. Published by BMJ Group.

<147>
Accession Number
2038174047
Title
Outcomes After CABG Compared With FFR-Guided PCI in Patients Presenting
With Acute Coronary Syndrome.
Source
JACC: Cardiovascular Interventions. 18(7) (pp 838-848), 2025. Date of
Publication: 14 Apr 2025.
Author
Takahashi K.; Otsuki H.; Zimmermann F.M.; Ding V.Y.; Piroth Z.; Oldroyd
K.G.; Wendler O.; Reardon M.J.; Desai M.; Woo Y.J.; Yeung A.C.; De Bruyne
B.; Pijls N.H.J.; Fearon W.F.
Institution
(Takahashi, Otsuki, Yeung, Fearon) Stanford University School of Medicine
and Stanford Cardiovascular Institute, Stanford University, CA, United
States
(Zimmermann) St. Antonius Hospital, Nieuwegein, Netherlands
(Zimmermann, Pijls) Catharina Hospital, Eindhoven, Netherlands
(Ding, Desai) Quantitative Sciences Unit, Stanford University, Stanford,
CA, United States
(Piroth) Gottsegen National Cardiovascular Center, Hungary
(Oldroyd) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Wendler) Cleveland Clinic London, London, United Kingdom
(Reardon) Houston Methodist Debakey Heart & Vascular Center, Houston, TX,
United States
(Woo) Department of Cardiothoracic Surgery, Division of Cardiovascular
Medicine and Stanford Cardiovascular Institute, Stanford University, CA,
United States
(De Bruyne) Cardiovascular Center Aalst, Belgium
(Fearon) VA Palo Alto Medical Systems, Palo Alto, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: There are limited data comparing coronary artery bypass
grafting (CABG) with percutaneous coronary intervention (PCI) in patients
presenting with non-ST-segment elevation acute coronary syndrome
(NSTE-ACS). <br/>Objective(s): The aim of this study was to evaluate
differences in outcomes in patients presenting with or without NSTE-ACS
after CABG compared with fractional flow reserve (FFR)-guided PCI using
current generation drug-eluting stents. <br/>Method(s): The FAME 3 trial
(Fractional flow reserve versus Angiography for Multivessel Evaluation;
NCT02100722) was an investigator-initiated, randomized controlled trial to
attest noninferiority of FFR-guided PCI using the current-generation
drug-eluting stents to CABG with respect to the primary endpoint, defined
as a composite of death, myocardial infarction (MI), stroke, or repeat
revascularization at 1 year, in 1,500 patients with 3-vessel coronary
artery disease. The prespecified key secondary endpoint was a composite of
death, MI, or stroke at 3 years. <br/>Result(s): Of 1,500 patients
enrolled, 587 (39.2%) presented with NSTE-ACS. Patients were followed up
for a median of 1,080 days (Q1-Q3: 1,080-1,080 days). At 3 years, the risk
of the composite of death, MI, or stroke was similar between patients
presenting with NSTE-ACS and with chronic coronary syndrome (CCS) (11.8%
vs 10.0%; adjusted HR [aHR]: 1.20; 95% CI: 0.81-1.77; P = 0.37). Patients
presenting with NSTE-ACS had a similar risk of death, MI, or stroke at 3
years after CABG as compared with PCI (aHR: 0.98; 95% CI: 0.60-1.60; P =
0.94), whereas patients presenting with CCS had a significantly reduced
risk after CABG compared with PCI (aHR: 0.58; 95% CI: 0.38-0.90; P = 0.02;
P<inf>interaction</inf> = 0.11), which was driven by a lower risk of MI
(aHR: 0.32; 95% CI: 0.15-0.64; P = 0.002; P<inf>interaction</inf> = 0.01).
<br/>Conclusion(s): The risk of death, MI, or stroke at 3 years was
similar after CABG compared with FFR-guided PCI in patients presenting
with NSTE-ACS, but reduced by CABG in patients presenting with CCS.
(Fractional flow reserve versus Angiography for Multivessel Evaluation
[FAME 3]; NCT02100722)<br/>Copyright &#xa9; 2025

<148>
Accession Number
2038133250
Title
Cardiac Surgery 2024 Reviewed.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2025. Date of
Publication: 2025.
Author
Kirov H.; Caldonazo T.; Mukharyamov M.; Toshmatov S.; Fleckenstein P.;
Kyashif T.; Siemeni T.; Doenst T.
Institution
(Kirov, Caldonazo, Mukharyamov, Toshmatov, Fleckenstein, Kyashif, Siemeni,
Doenst) Department of Cardiothoracic Surgery,
Friedrich-Schiller-University of Jena, University Hospital Jena, Jena,
Germany
Publisher
Georg Thieme Verlag
Abstract
For the 11th consecutive time, we systematically reviewed the
cardio-surgical literature for the past year (2024), using the PRISMA
approach for a results-oriented summary. In 2024, the discussion on the
value of randomized and registry evidence increased, triggered by
consistent findings in the field of coronary artery disease (CAD) and
discrepant results in structural heart disease. The literature in 2024
again confirmed the excellent long-term outcomes of CABG compared with PCI
in different scenarios, generating further validation for the CABG
advantage reported in randomized studies. This has been reflected in the
new guidelines for chronic CAD in 2024. Two studies indicate novel
perspectives for CABG, showing that cardiac shockwave therapy in CABG
improves myocardial function in ischemic hearts and that CABG guided by
computed tomography is safe and feasible. For aortic stenosis, an early
advantage for transcatheter (TAVI) compared with surgical (SAVR) treatment
has found more support; however, long-term TAVI results keep being
challenged, this year by new FDA and registry data in favor of SAVR. For
failed aortic valves, redo-SAVR showed superior results compared with
valve-in-valve TAVI. In the mitral field, studies showed short-term
noninferiority for transcatheter treatment compared with surgery for
secondary mitral regurgitation (MR), and significant long-term survival
benefit in registries with surgery for primary MR. Finally, surgery was
associated with better survival compared with medical therapy for acute
type A aortic intramural hematoma. This article summarizes publications
perceived as important by us. It cannot be complete nor free of individual
interpretation but provides up-to-date information for patient-specific
decision-making.<br/>Copyright &#xa9; 2025. Thieme.All rights reserved.

<149>
Accession Number
2038177617
Title
Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve
Replacement in Patients at Lower Surgical Risk: Meta-analysis of
Randomized Trials.
Source
Canadian Journal of Cardiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Lerman T.T.; Greenberg N.; Kheifets M.; Talmor-Barkan Y.; Codner P.; Perl
L.; Witberg G.; Orvin K.; Eisen A.; Grinberg T.; Skalsky K.; Shapira Y.;
Belkin D.; Jorgensen T.H.; Horsted Thyregod H.G.; De Backer O.; Fishman
B.; Kornowski R.; Levi A.
Institution
(Lerman, Kheifets, Talmor-Barkan, Codner, Perl, Witberg, Orvin, Eisen,
Grinberg, Skalsky, Shapira, Kornowski, Levi) Department of Cardiology,
Rabin Medical Center, Petah Tikva, Israel
(Lerman, Greenberg, Kheifets, Talmor-Barkan, Codner, Perl, Witberg, Orvin,
Eisen, Grinberg, Skalsky, Shapira, Belkin, Fishman, Kornowski, Levi)
Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv,
Israel
(Greenberg) Department of Internal Medicine F-Recanati, Beilinson
Hospital, Rabin Medical Center, Petah Tikva, Israel
(Jorgensen, De Backer) Department of Cardiology, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Horsted Thyregod) Department of Cardiothoracic Surgery, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Fishman) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
Publisher
Elsevier Inc.
Abstract
Background: The use of transcatheter aortic valve implantation (TAVI) for
severe aortic stenosis is expanding to patients across the entire spectrum
of surgical risk. We performed a meta-analysis and compared TAVI with
surgical aortic valve replacement (SAVR) in trials that enrolled
lower-risk patients. <br/>Method(s): We conducted a meta-analysis of
randomized controlled trials and compared safety and efficacy outcomes
between TAVI and SAVR among lower-risk patients (mean and/or median
Society of Thoracic Surgeons [STS] score < 4). Point-estimate
meta-analysis and reconstructed individual patient data survival analysis
were conducted. Primary outcomes included all-cause mortality, stroke, and
a composite of all-cause mortality or disabling stroke (PROSPERO,
CRD42024541837). <br/>Result(s): The analysis included 6 randomized
controlled trials, totaling 2668 TAVI and 2573 SAVR patients, with a mean
follow-up time of 3.02 years. TAVI was associated with lower risk of
all-cause mortality (risk ratio, 0.68; 95% confidence interval, 0.52-0.88)
and a composite of all-cause mortality or disabling stroke (risk ratio,
0.69; 95% confidence interval, 0.55-0.86) without a significant difference
in stroke up to 2 years. Longer-term point-estimate analysis showed no
difference. In reconstructed individual patient data, TAVI was associated
with a lower risk of all-cause mortality, driven by an early advantage.
Restricted mean survival time differences for primary outcomes were < 2.5
months and <= 1 month for all-cause mortality. TAVI was associated with a
lower risk of bleeding, kidney injury, and atrial fibrillation, but a
higher risk of pacemaker implantation and moderate to severe aortic
regurgitation. <br/>Conclusion(s): In patients at lower surgical risk,
TAVI was associated with improved short-term mortality. More data from
long-term studies are needed.<br/>Copyright &#xa9; 2025 Canadian
Cardiovascular Society

<150>
Accession Number
2034105863
Title
Application of high-dose tranexamic acid in the perioperative period: a
narrative review.
Source
Frontiers in Pharmacology. 16 (no pagination), 2025. Article Number:
1552511. Date of Publication: 2025.
Author
Duan Y.; Wan X.; Ma Y.; Zhu W.; Yin Y.; Huang Q.; Yang Y.
Institution
(Duan, Wan, Ma, Zhu, Yin, Huang, Yang) Department of Critical Care
Medicine, The Second Affiliated Hospital, Kunming Medical University,
Kunming, China
Publisher
Frontiers Media SA
Abstract
Objective: To investigate the efficacy and safety of high-dose tranexamic
acid in different types of surgeries and provide a reference for clinical
practice. <br/>Method(s): We systematically searched PubMed, Cochrane
Library, Science, Embase, and CNKI databases, from their inception to
January 2025, to include representative literature related to high-dose
tranexamic acid in the perioperative period for a thematic synthesis. The
analysis focused on clinical evidence related to obstetric, cardiac,
urologic, orthopedic, and spinal surgeries. <br/>Result(s): High-dose
tranexamic acid markedly reduces blood loss and transfusion requirements
in most types of surgery; however, the optimal dose varies by surgery
type. Available studies have shown a favorable safety profile; however,
some areas (e.g., cardiac surgery) still require careful monitoring for
seizures and risk of thrombotic events. <br/>Conclusion(s): The clinical
benefit of high-dose tranexamic acid should be assessed based on surgical
characteristics and patient individualization. More multicenter studies
are needed to clarify the dose-effect relationship and long-term
safety.<br/>Copyright &#xa9; 2025 Duan, Wan, Ma, Zhu, Yin, Huang and Yang.

<151>
Accession Number
2034068518
Title
Challenges in Ventilation in Patients Undergoing Non-Cardiac Thoracic
Surgery.
Source
Current Anesthesiology Reports. 15(1) (no pagination), 2025. Article
Number: 40. Date of Publication: 01 Dec 2025.
Author
Senturk E.; Canbaz M.; Senturk M.
Institution
(Senturk) Department of Anesthesiology, Acibadem Atasehir Hospital, Turgut
Ozal Street. No:11, Istanbul, Atasehir, Turkey
(Canbaz) Medical Faculty of Istanbul, Istanbul University, Millet Cad
Capa, Istanbul, Fatih, Turkey
(Senturk) Department of Anesthesiology and Reanimation, School of Medicine
Icerenkoy, Acibadem University, Kayisdagi Street No:32, Istanbul,
Atasehir, Turkey
Publisher
Springer
Abstract
Purpose of review: This review summarizes the recent literature on
hypoxemia and acute lung injury in one-lung ventilation, shedding light on
the mechanisms and prevention strategies for these critical complications.
It also aims to provide comprehensive guidance for research on acute lung
injury, presenting the latest findings to support advancements in this
field. Recent findings: In one-lung ventilation (OLV) techniques highlight
significant advancements in patient outcomes and lung protection
strategies. Conventional ventilation, characterized by standard tidal
volumes, has been largely overshadowed by protective lung ventilation
(PLV) and the open lung approach (OLA) due to the latter methods' superior
efficacy in minimizing ventilator-induced lung injury (VILI). PLV utilizes
lower tidal volumes and higher positive end-expiratory pressure (PEEP) to
reduce alveolar overdistension and collapse, which has been shown to
decrease postoperative pulmonary complications. The OLA further enhances
lung protection by incorporating recruitment maneuvers and individualized
PEEP settings to maintain alveolar stability throughout the procedure.
Recent studies suggest that combining PLV and OLA techniques not only
improves oxygenation but also attenuates inflammatory responses, leading
to better overall clinical outcomes. However, further randomized
controlled trials are necessary to solidify these findings and optimize
OLV protocols. <br/>Summary: Protective lung ventilation and the open lung
approach in one-lung ventilation (OLV) provide better clinical outcomes by
reducing ventilator-induced lung injury.<br/>Copyright &#xa9; The
Author(s), under exclusive licence to Springer Science+Business Media,
LLC, part of Springer Nature 2025.

<152>
Accession Number
2038162929
Title
Fractional Flow Reserve Versus Angiography-Guided Revascularisation in
Patients With Severe Aortic Stenosis: A Systematic Review.
Source
Heart Lung and Circulation. (no pagination), 2025. Date of Publication:
2025.
Author
Mridha N.; Zaka A.; Raffel C.; Murdoch D.; Walters D.
Institution
(Mridha, Raffel, Murdoch, Walters) The Prince Charles Hospital, Brisbane,
QLD, Australia
(Mridha, Raffel, Murdoch, Walters) The University of Queensland, School of
Medicine, Brisbane, QLD, Australia
(Mridha, Zaka) Griffith University, School of Medicine, Gold Coast, QLD,
Australia
(Zaka) Bond University, School of Medicine, Gold Coast, QLD, Australia
(Raffel) Queensland University of Technology, Brisbane, QLD, Australia
Publisher
Elsevier Ltd
Abstract
Background: Aortic stenosis (AS) and coronary artery disease usually
coexist in older adults. Although fractional flow reserve (FFR) is the
gold standard for demonstrating functionally significant coronary artery
stenoses, its efficacy in patients with severe AS awaiting transcatheter
aortic valve implantation is unclear. This systematic review assesses the
clinical outcomes between FFR- and angiography-guided coronary
revascularisation in patients with severe AS. <br/>Method(s): This review
conformed to the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines. PubMed, Ovid MEDLINE, Web of Science,
and Cochrane databases were searched until 12 March 2024. Eligible studies
included randomised controlled trials or observational studies including
patients with severe AS with concurrent coronary disease comparing FFR-
with angiography-guided percutaneous coronary intervention. Primary
outcomes were all-cause mortality and myocardial infarction. Secondary
outcomes were composite major adverse cardiovascular events.
<br/>Result(s): Five retrospective cohort studies were identified,
including 1,927 patients. The average follow-up was 34.7 months.
FFR-guided cohorts exhibited higher incidence rates for all-cause
mortality (17.4% vs 15.6%), myocardial infarction (4.4% vs 3.3%), and
major adverse cardiovascular events (21.8% vs 18.5%) than the
angiography-guided cohorts. A total of 32.8% the angiography-guided cohort
and 33.1% from the FFR-guided cohort underwent percutaneous coronary
intervention. Due to insufficient power and inconsistency of the available
data (including heterogenous patient selection criteria, differences in
procedural protocols, anatomical distribution of stented lesions,
non-uniform reporting of measured outcomes), a meta-analysis for the
primary and secondary outcomes was not conducted. The methodological
quality of the included studies was found to be of fair quality according
to the Newcastle-Ottawa checklist. <br/>Conclusion(s): Despite the
recognised usefulness of FFR in the assessment of coronary artery disease,
its clinical efficacy in patients with severe AS undergoing transcatheter
aortic valve implantation remains uncertain amidst inconclusive
observational data. Large-scale randomised controlled trials are
required.<br/>Copyright &#xa9; 2024 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<153>
Accession Number
646930441
Title
Comparative Outcomes of Mitral Valve Repair versus Replacement in
Infective Endocarditis: A 16-Year Meta-Analysis of Time-to-Event Data from
Over 4000 Patients.
Source
The American journal of cardiology. (no pagination), 2025. Date of
Publication: 17 Mar 2025.
Author
Comentale G.; Ahmadi-Hadad A.; Moldon H.J.; Carbone A.; Manzo R.; Macchio
C.C.; Damiano A.; Bossone E.; Esposito G.; Pilato E.
Institution
(Comentale, Ahmadi-Hadad, Moldon, Macchio, Damiano, Pilato) Division of
Cardiac Surgery, Department of Advanced Biomedical Sciences, University of
Naples "Federico II", Italy
(Carbone) Division of Cardiology, University of Campania "Luigi
Vanvitelli", Italy
(Manzo, Bossone, Esposito) Division of Cardiology, Department of Advanced
Biomedical Sciences, University of Naples "Federico II", Italy
Abstract
Mitral valve (MV) repair for infective endocarditis (IE) has proven to be
a good and safe option, but current trends favor replacement; the
available data, in addition, don't allow to reach a general consensus on
the preferred first-line approach. The present metanalysis, aimed to
compare short- and long-term outcomes between MV repair (MVRep) and MV
replacement (MVR) in patients with IE. A search of PubMed was conducted on
3thAugust 2024, yielding 120 results. (PROSPERO CRD: CRD42023490612). Four
additional suitable studies were identified and added from Embase and
Medline (via Ovid). Statistical analyses were performed using RStudio,
SPSS, and RevMan. Pseudoindividual patient data were extracted from
Kaplan-Meier curves by converting the graphical plots into raw data
coordinates through WebPlotDigitizer. A total of 21 studies were eligible
for inclusion. The 16-year reconstructed analysis revealed that patients
undergoing MVRep have higher survival compared to the MVR group (HR: 1.41,
95% Cl: 1.30-1.53, p<0.001). Moreover, IE recurrence was significantly
lower in MVRep (95% CI, RR:0.46, 12=41%, P=0.03). Reoperation rates,
however, were similar between MVRep and MVR (95% CI, RR:0.78, 12=0%,
P=0.27). In-hospital mortality was similar between the groups (95% CI,
RR:0.40, 12=34%, P=0.07). In conclusion, MV repair should be favored over
replacement in IE when there is no evidence of local extension of the
infections and if valve leaflets have not degenerated. This approach is
associated with improved overall survival and a reduced risk of IE
recurrence, making it particularly advantageous for younger
patients.<br/>Copyright &#xa9; 2025 The Authors. Published by Elsevier
Inc. All rights reserved.

<154>
Accession Number
2034096315
Title
Effect of one-lung ventilation in children undergoing lateral thoracotomy
cardiac surgery with cardiopulmonary bypass on postoperative atelectasis
and postoperative pulmonary complications.
Source
BMC Pediatrics. 25(1) (no pagination), 2025. Article Number: 268. Date of
Publication: 01 Dec 2025.
Author
Chen H.; Liu T.; Dong W.; Sun Y.
Institution
(Chen, Liu, Sun) Department of Anesthesiology, Shanghai Children'S Medical
Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang
Road, Pudong, Shanghai, China
(Dong) Department of Cardio-Thoracic Surgery, Shanghai Children'S Medical
Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Publisher
BioMed Central Ltd
Abstract
Background: Right lateral thoracotomy is increasingly used because of its
cosmetic benefits, shorter hospital stays, rapid return to full activity,
and ease of reoperation in pediatric patients with uncomplicated
congenital heart disease. Currently, one-lung ventilation (OLV) is used in
these children to facilitate surgical exposure. We aimed to assess the
effect of OLV on postoperative outcomes. <br/>Method(s): Children aged 6
months to 6 years undergoing right lateral thoracotomy cardiac surgery
with cardiopulmonary bypass (CPB) were randomized into an OLV group or a
control group. For the OLV group, the tidal volume was 5 ml/kg with 6
cmH2O positive end-expiratory pressure from the incision until the end of
CPB, whereas patients in the control group received two-lung ventilation,
except during vena cava occlusion. Lung ultrasonography was performed
twice in the supine position for each patient: first, 3 min after
intubation before surgery (T<inf>1</inf>), and second, 3 min after lung
recruitment maneuvers at the end of surgery (T<inf>2</inf>). The primary
outcome was the incidence of postoperative pulmonary complications within
72 h of surgery and significant atelectasis (defined by a consolidation
score of >= 2 in any region) at T<inf>2</inf>. <br/>Result(s): Overall,
54/96 (56.3%) children developed postoperative pulmonary complications
after lateral thoracotomy cardiac surgery with CPB. The incidence of
postoperative pulmonary complications was 52.1% (25/48) and 60.4% (29/48)
in the OLV and control groups, respectively (odds ratio: 0.712; 95%
confidence interval: 0.317-1.600; p =.411). At the end of surgery, the
incidence of significant atelectasis was 37.5% in the OLV group compared
to 64.6% in the control group (odds ratio: 0.329; 95% confidence interval:
0.143-0.756; p =.008). The consolidation score of the left lung (dependent
lung) in the OLV group was significantly lower than that in the control
group (p =.007); there was no significant difference in the right lung's
postoperative consolidation score between the two groups (p =.051).
<br/>Conclusion(s): There was no significant difference in the incidence
of postoperative pulmonary complications within 72 h of surgery between
the two groups. However, children who underwent right lateral thoracotomy
cardiac surgery with CPB in the OLV group showed a low incidence of
atelectasis at the end of surgery. Trial registration: ChiCTR,
ChiCTR2100048720. Registered on July 13, 2021,
www.chictr.org.cn.<br/>Copyright &#xa9; The Author(s) 2025.

<155>
Accession Number
646919643
Title
Hypoxemia in trauma patients receiving two different oxygen strategies: a
TRAUMOX2 substudy.
Source
Scandinavian journal of trauma, resuscitation and emergency medicine.
33(1) (pp 47), 2025. Date of Publication: 18 Mar 2025.
Author
Rosenkrantz O.; Arleth T.; Creutzburg A.; Petersen L.B.; Baekgaard J.;
Zwisler S.; Mikkelsen S.; Klimek M.; Rasmussen L.S.; Steinmetz J.
Institution
(Rosenkrantz, Arleth, Creutzburg, Baekgaard, Steinmetz) Department of
Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University
Hospital, Rigshospitalet, Copenhagen, Denmark
(Rosenkrantz) Department of Clinical Epidemiology, Aarhus University
Hospital and Aarhus University, Aarhus, Denmark
(Petersen, Zwisler, Mikkelsen) Prehospital Research Unit, Department of
Regional Health Research, University of Southern Denmark, Odense, Denmark
(Petersen, Zwisler) Department of Anaesthesiology and Intensive Care,
Odense University Hospital, Odense, Denmark
(Klimek) Department of Anaesthesiology, Erasmus University Medical Centre
Rotterdam, Rotterdam, Netherlands
(Rasmussen) Danish Ministry of Defence Personnel Agency, Copenhagen,
Denmark
(Steinmetz) Aarhus, Denmark
Abstract
BACKGROUND: The randomized controlled trial, TRAUMOX2, compared early
restrictive vs. liberal oxygen strategies for trauma patients. The
objective of this substudy was to quantify the occurrence and duration of
hypoxemic episodes during the trial's eight-hour intervention.
<br/>METHOD(S): This observational substudy analyzed a subset of patients
at two trial sites in Denmark. Continuous pulse oximetry recorded arterial
oxygen saturation (SpO2) during the intervention. The primary outcome was
the proportion of patients who had episodes of hypoxemia with SpO2 < 90%
for at least five minutes. Additionally, the study assessed differences in
the occurrence and duration of hypoxemia between the restrictive and
liberal oxygen groups. <br/>RESULT(S): This substudy included 82 patients.
After secondary exclusion, 60 patients (median age, 49 years
[interquartile range 33-61] and 75% male) were analyzed. Three out of 60
patients (5%) had at least one episode of SpO2 < 90% for at least five
minutes (95% confidence interval 1-14%); Two patients in the restrictive
oxygen group and one in the liberal oxygen group. Two episodes occurred
during initial resuscitation, and one episode occurred in the intensive
care unit following a procedure related to thoracic injuries.
<br/>CONCLUSION(S): In this substudy of 60 patients from the TRAUMOX2
trial, hypoxemia (SpO2 < 90% for at least five minutes) was observed in 5%
of patients, with no difference between the restrictive and liberal oxygen
groups. These findings suggest that, among trauma patients not already
requiring continuous monitoring, such episodes of hypoxemia are relatively
rare early post-trauma.<br/>Copyright &#xa9; 2025. The Author(s).

<156>
Accession Number
2038118068
Title
Comparing erector spinae plane (ESP) and thoracic paravertebral (TPV)
block analgesic effect after elective video-assisted thoracic surgery: a
randomized, multiple-blinded, non-inferiority trial.
Source
Journal of Thoracic Disease. 17(3) (pp 1531-1540), 2025. Date of
Publication: 31 Mar 2025.
Author
Dossi R.; Patella M.; Barozzi B.; Dellaferrera G.; Tessitore A.;
Gimigliano I.; Cafarotti S.; Saporito A.
Institution
(Dossi, Barozzi, Gimigliano, Saporito) Department of Anaesthesia, San
Giovanni Hospital, Bellinzona, Switzerland
(Patella, Dellaferrera, Tessitore, Cafarotti) Department of Thoracic
Surgery, San Giovanni Hospital, Bellinzona, Switzerland
(Cafarotti, Saporito) Faculty of Biomedical Sciences, University of Lugano
(USI), Lugano, Switzerland
Publisher
AME Publishing Company
Abstract
Background: Video-assisted thoracic surgery (VATS) is the gold standard
for minimally invasive lung resections. Postoperative pain from VATS can
hinder breathing and increase complications. Thoracic epidural analgesia
(TEA) is effective but invasive. Less invasive options like thoracic
paravertebral (TPV) block and erector spinae plane (ESP) block are being
explored. This study compares ESP and TPV in a randomized, non-inferiority
trial, focusing on opioid consumption post-VATS. <br/>Method(s): This
single-center, randomized, multiple-blinded, controlled, non-inferiority
trial included 50 patients undergoing VATS at the Regional Hospital of
Bellinzona and Valli (ORBV). Patients were randomized to receive either an
ESP block with local anesthetic and a TPV block with saline (Anest ESP) or
an ESP block with saline and a TPV block with local anesthetic (Sham ESP).
The primary outcome was the cumulative dose of rescue opioids at 24 and 48
hours postoperatively. <br/>Result(s): Data from 47 patients were
analyzed. There was no statistically significant difference in opioid
consumption between the Anest ESP and Sham ESP groups at 24 hours (P=0.09)
and 48 hours (P=0.12). In a sub-analysis by type of surgery, the NRS
values were higher, as postulated, in major surgery. Cardiopulmonary
complications and procedural times were low and comparable between groups.
<br/>Conclusion(s): The study did not demonstrate the non-inferiority of
the ESP block compared to the TPV block for postoperative analgesia
following VATS. However, both blocks provided effective pain relief with
no significant differences in outcomes. The findings suggest that both ESP
and TPV blocks are viable alternatives to TEA.<br/>Copyright &#xa9; AME
Publishing Company.

<157>
Accession Number
2034096032
Title
Comparison between single bolus dose administration and continuous
infusion of remimazolam for general anesthesia induction in non-cardiac
surgery: a single-center prospective randomized controlled trial.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 150. Date
of Publication: 01 Dec 2025.
Author
Ikeda T.; Miyoshi H.; Kido K.; Sumii A.; Otsuki S.; Kato T.; Nakamura R.;
Narasaki S.; Tsutsumi Y.M.
Institution
(Ikeda, Miyoshi, Kido, Sumii, Otsuki, Kato, Nakamura, Narasaki, Tsutsumi)
Department of Anesthesiology and Critical Care, Hiroshima University,
Hiroshima, Japan
(Miyoshi) Department of Anesthesiology and Critical Care Institution,
Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan
Publisher
BioMed Central Ltd
Abstract
Background: Remimazolam is a short-acting benzodiazepine anesthetic
recommended for continuous infusion during anesthesia induction. However,
the safety and efficacy of single bolus dose administration remain under
investigation. This study compared continuous infusion with single bolus
dose administration and assessed the safety of a single bolus dose
administration. <br/>Method(s): The participants were randomly assigned
into three groups based on the method of remimazolam administration the
day before surgery: (1) continuous infusion group (continuous infusion at
12 mg/kg/h), (2) single bolus dose administration of 0.1 group (single
administration of 0.1 mg/kg), or (3) single bolus dose administration of
0.2 group (single administration of 0.2 mg/kg). The time between drug
administration and loss of consciousness was determined, and hemodynamic
monitoring was performed. <br/>Result(s): 67 patients (continuous infusion
group (n = 22), single bolus dose administration of 0.1 group (n = 22),
and single bolus dose administration of 0.2 group (n = 23)) were included
in the study. The different times to loss of consciousness were 88.2 +/-
16.2 s, 59.5 +/- 31.5 s, and 42.6 +/- 11.4 s in the continuous infusion
group, single bolus dose administration of 0.1 group, and single bolus
dose administration of 0.2 group, respectively. No significant differences
were observed in the incidence of adverse events between the groups. The
results are presented as mean +/- standard deviation (SD).
<br/>Conclusion(s): Single-dose remimazolam is a safe method for
anesthesia induction, resulting in shorter time to loss of consciousness
compared with continuous infusion, while maintaining a similar incidence
of adverse events. Trial registration: jRCTs061230049, registered on
17/08/2023.<br/>Copyright &#xa9; The Author(s) 2025.

<158>
Accession Number
2033528954
Title
Impact of SGLT2 Inhibitors on Renal Function in Type 2 Diabetic Patients
with Coronary Artery Disease Undergoing Percutaneous Intervention: A
Systematic Review and Meta-Analysis.
Source
Current Diabetes Reviews. 21(9) (no pagination), 2025. Article Number:
e030724231535. Date of Publication: 2025.
Author
Basutkar R.S.; Cutinha R.M.; Sathish V.; Shahil A.; C.K N.S.
Institution
(Basutkar, Cutinha, Sathish, Shahil, C.K) Department of Pharmacy Practice,
Nitte (Deemed to be University), NGSM Institute of Pharmaceutical
Sciences, NGSMIPS, Karnataka, Mangalore, India
Publisher
Bentham Science Publishers
Abstract
Background: Contrast agents directly cause kidney toxicity in patients who
are candidates for percutaneous intervention having cardiovascular disease
with type 2 diabetes. <br/>Aim(s): This meta-analysis aims to assess the
effects of SGLT2i on renal function in individuals undergoing percutaneous
intervention. <br/>Method(s): The databases used for the search included
Google Scholar, PubMed, Cochrane Central Registry of Controlled Trials,
and Scopus. We considered randomized controlled and observational studies
published from January, 2013, to August, 2023. Eligibility to include the
studies was assessed independently. The Cochrane modified data extraction
form and Joanna Briggs Institute were used to extract the data. The
quality of the studies was evaluated using the Cochrane risk of bias tool
and the Newcastle-Ottawa scale. The GradePro software was used to measure
the certainty of the evidence. <br/>Result(s): The pooled estimate showed
a substantial reduction in serum creatinine levels at 48 and 72 hours
post-PCI who received SGLT2i (MD -9.57; 95% CI -18.36, -0.78; p-value 0.03
and MD -14.40; 95% CI -28.57, -0.22; p-value 0.05). There was a decrease
in the occurrence of the CI-AKI among SGT2i users (RR: 0.46; 95% CI: 0.32,
0.67; p value< 0.0001). No substantial difference was observed in the
number of patients requiring hemodialysis; however, a lower proportion of
patients among SGLT2i users required hemodialysis (RR: 0.88; 95% CI: 0.19,
4.07; p-value = 0.87). <br/>Conclusion(s): The use of SGLT2i confers
substantial beneficial effects on kidney function and reduces the
occurrence of contrast-induced acute kidney injury among diabetes patients
undergoing PCI procedures with cardiovascular disease.<br/>Copyright
&#xa9; 2025 Bentham Science Publishers.

<159>
Accession Number
2034072902
Title
The Composite Number Needed to Treat for Semaglutide in Populations with
Overweight or Obesity and Established Cardiovascular Disease Without
Diabetes.
Source
Advances in Therapy. (no pagination), 2025. Article Number: 102782. Date
of Publication: 2025.
Author
Lubker C.; Bhavsar J.; Duque do Vale R.; Emerson S.S.; Nortoft E.; Plutzky
J.; Roberts G.; Tarp J.M.; Lincoff A.M.
Institution
(Lubker, Duque do Vale, Nortoft, Tarp) Novo Nordisk A/S, Soborg, Denmark
(Bhavsar) Novo Nordisk Inc., Plainsboro, NJ, United States
(Emerson) Department of Biostatistics, University of Washington, Seattle,
WA, United States
(Plutzky) Cardiovascular Division, Brigham and Women's Hospital, Harvard
Medical School, Boston, United States
(Roberts) Health Economics and Outcomes Research Ltd, Cardiff, United
Kingdom
(Lincoff) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland Clinic Lerner College of Medicine of Case Western Reserve
University, Cleveland, OH, United States
Publisher
Adis
Abstract
Introduction: Number needed to treat (NNT), an outcome measure derived
from the estimated risk results of clinical trials, is widely used to
demonstrate value to stakeholders by identifying how many patients require
treatment to avoid one event of interest. However, NNTs calculated for
primary trial endpoints may underestimate a treatment's value by not
considering other outcomes. In this secondary analysis of data from the
SELECT cardiovascular (CV) outcomes trial, we aimed to determine the NNT
for semaglutide for major adverse cardiovascular events (MACE), in
addition to NNTs when other clinically and payer-relevant outcomes are
included. <br/>Method(s): This study is a secondary analysis of data from
the randomized, double-blind SELECT trial (ClinicalTrials.gov NCT03574597)
of once-weekly subcutaneous administration of semaglutide compared with
placebo in 17,604 patients with overweight or obesity and with established
cardiovascular disease (CVD) (39.8 months mean follow-up). The outcomes
were NNT<inf>3P-MACE</inf> (based upon the trial's composite primary
endpoint of death from cardiovascular causes, non-fatal myocardial
infarction, non-fatal stroke), NNT<inf>EXTENDED</inf> (inclusive of
NNT<inf>3P-MACE</inf>, hospitalization for any cause, coronary
revascularization, and non-CV death), and NNT<inf>CKM</inf> (inclusive of
NNT<inf>EXTENDED</inf>, glycated hemoglobin level [HbA<inf>1c</inf>] >=
6.5%, and a 5-point nephropathy composite). <br/>Result(s): The relative
risk reductions observed for the events comprising the NNTs were 20%
(NNT<inf>3P-MACE</inf>), 20% (NNT<inf>EXTENDED</inf>), and 41%
(NNT<inf>CKM</inf>). At 1 and 4 years post initiation of semaglutide,
NNT<inf>3P-MACE</inf> was 125 and 58, NNT<inf>EXTENDED</inf> was 49 and
25, and NNT<inf>CKM</inf> was 20 and 11, respectively. <br/>Conclusion(s):
When clinically and payer-relevant outcomes from the SELECT trial are
included in calculations of NNT, semaglutide was associated with greater
risk reductions and lower estimates of NNT than for the primary endpoint
alone. Our findings suggest that including the broader effects of
semaglutide beyond the primary trial endpoint recognizes additional value
to stakeholders.<br/>Copyright &#xa9; The Author(s) 2025.

<160>
Accession Number
2038144114
Title
Outcomes after fractional flow reserve-guided percutaneous coronary
intervention versus coronary artery bypass grafting (FAME 3): 5-year
follow-up of a multicentre, open-label, randomised trial.
Source
The Lancet. (no pagination), 2025. Date of Publication: 2025.
Author
Fearon W.F.; Zimmermann F.M.; Ding V.Y.; Takahashi K.; Piroth Z.; van
Straten A.H.M.; Szekely L.; Davidavicius G.; Kalinauskas G.; Mansour S.;
Kharbanda R.; Ostlund-Papadogeorgos N.; Aminian A.; Oldroyd K.G.; Al-Attar
N.; Jagic N.; Dambrink J.-H.E.; Kala P.; Angeras O.; MacCarthy P.; Wendler
O.; Casselman F.; Witt N.; Mavromatis K.; Miner S.E.S.; Sarma J.; Engstrom
T.; Christiansen E.H.; Tonino P.A.L.; Reardon M.J.; Otsuki H.; Kobayashi
Y.; Hlatky M.A.; Mahaffey K.W.; Desai M.; Woo Y.J.; Yeung A.C.; Pijls
N.H.J.; De Bruyne B.
Institution
(Hlatky) Department of Health Policy, Stanford University, Stanford, CA,
United States
(Fearon, Takahashi, Otsuki, Hlatky, Yeung) Department of Medicine,
Stanford University, Stanford, CA, United States
(Woo) Department of Cardiothoracic Surgery, Stanford University, Stanford,
CA, United States
(Fearon, Yeung) Stanford Cardiovascular Institute, Stanford University,
Stanford, CA, United States
(Fearon) VA Palo Alto Health Care System, Palo Alto, CA, United States
(Zimmermann) St Antonius Hospital, Nieuwegein, Netherlands
(Zimmermann, van Straten, Tonino, Pijls) Catharina Hospital, Eindhoven,
Netherlands
(Ding, Desai) Quantitative Sciences Unit, Stanford University, Stanford,
CA, United States
(Piroth, Szekely) Gottsegen National Cardiovascular Center, Budapest,
Hungary
(Davidavicius, Kalinauskas) Clinic of Cardiac and Vascular Diseases,
Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
(Davidavicius, Kalinauskas) Vilnius University Hospital Santaros Klinikos,
Vilnius, Lithuania
(Mansour) Centre Hospitalier de l'Universite de Montreal, Montreal, QC,
Canada
(Kharbanda) Oxford University Hospital NHS Trust, Oxford, United Kingdom
(Ostlund-Papadogeorgos) Danderyd University Hospital and Karolinska
Institutet, Solna, Sweden
(Aminian) Centre Hospitalier Universitaire de Charleroi, Charleroi,
Belgium
(Oldroyd, Al-Attar) Golden Jubilee National Hospital, Glasgow, United
Kingdom
(Jagic) Clinical Hospital Centre Zemun, University of Belgrade, Belgrade,
Serbia
(Dambrink) Isala Hospital, Zwolle, Netherlands
(Kala) Medical Faculty of Masaryk University, Brno, Czechia
(Kala) University Hospital Brno, Brno, Czechia
(Angeras) Sahlgrenska University Hospital, Gothenburg, Sweden
(MacCarthy) Kings College Hospital, London, United Kingdom
(Wendler) Cleveland Clinic London, London, United Kingdom
(Casselman, De Bruyne) Cardiovascular Center Aalst, Aalst, Belgium
(Witt) Sodersjukhuset Hospital, Stockholm, Sweden
(Witt) Karolinska Institutet, Solna, Sweden
(Mavromatis) Atlanta VA Healthcare System, Decatur, GA, United States
(Mavromatis) Emory University School of Medicine, Atlanta, GA, United
States
(Miner) Southlake Regional Health Centre, Newmarket, ON, Canada
(Sarma) Wythenshawe Hospital, Manchester, United Kingdom
(Engstrom) Rigshospitalet, Copenhagen, Denmark
(Christiansen) Aarhus University Hospital, Aarhus, Denmark
(Reardon) Houston Methodist Hospital, Houston, TX, United States
(Kobayashi) NY Presbyterian Brooklyn Methodist Hospital, New York, NY,
United States
(Kobayashi) Weill Cornell Medical College, New York, NY, United States
(Mahaffey) Stanford Center for Clinical Research, Department of Medicine,
Stanford University, Stanford, CA, United States
(De Bruyne) Lausanne University Centre Hospital, Lausanne, Switzerland
Publisher
Elsevier B.V.
Abstract
Background: Long-term outcomes following percutaneous coronary
intervention (PCI) or coronary artery bypass grafting (CABG) might be
changing because of improved techniques and better medical therapy. This
final prespecified analysis of the Fractional Flow Reserve (FFR) versus
Angiography for Multivessel Evaluation (FAME) 3 trial aimed to reassess
their comparative effectiveness at 5 years. <br/>Method(s): FAME 3 was a
multicentre, randomised trial comparing FFR-guided PCI using
current-generation zotarolimus-eluting stents versus CABG in patients with
three-vessel coronary artery disease not involving the left main coronary
artery. 48 hospitals in Europe, USA and Canada, Australia, and Asia
participated in the trial. Patients (aged >=21 years with no cardiogenic
shock, no recent ST segment elevation myocardial infarction, no severe
left ventricular dysfunction, and no previous CABG) were randomly assigned
to either PCI or CABG using a web-based system. At 1 year, FFR-guided PCI
did not meet the prespecified threshold for non-inferiority for the
outcome of death, stroke, myocardial infarction, or repeat
revascularisation versus CABG. The primary endpoint for this
intention-to-treat analysis was the 5-year incidence of the prespecified
composite outcome of death, stroke, or myocardial infarction. The trial
was registered at ClinicalTrials.gov, NCT02100722, and is completed; this
is the final report. <br/>Finding(s): Between Aug 25, 2014 and Nov 28,
2019, 757 of 1500 participants were assigned to PCI and 743 to CABG.
5-year follow-up was achieved in 724 (96%) patients assigned to PCI and
696 (94%) assigned to CABG. At 5 years, there was no significant
difference in the composite of death, stroke, or myocardial infarction
between the two groups, with 119 (16%) events in the PCI group and 101
(14%) in the CABG group (hazard ratio 1.16 [95% CI 0.89-1.52]; p=0.27).
There were no differences in the rates of death (53 [7%] vs 51 [7%]; 0.99
[0.67-1.46]) or stroke (14 [2%] vs 21 [3%], 0.65 [0.33-1.28]), but
myocardial infarction was higher in the PCI group than in the CABG group
(60 [8%] vs 38 [5%], 1.57 [1.04-2.36]), as was repeat revascularisation
(112 [16%] vs 55 [8%], 2.02 [1.46-2.79]). <br/>Interpretation(s): At the
5-year follow-up, there was no significant difference in a composite
outcome of death, stroke, or myocardial infarction after FFR-guided PCI
versus CABG, although myocardial infarction and repeat revascularisation
were higher with PCI. These results provide contemporary evidence to allow
improved shared decision making between physicians and patients.
<br/>Funding(s): Medtronic and Abbott Vascular.<br/>Copyright &#xa9; 2025
Elsevier Ltd